General practice physicians and internists may refer you to a specialist for several reasons. If they suspect an underlying disease-based cause of your migraine symptoms or if you have abnormal findings on a neurological exam, they will typically refer you to a neurologist. If the migraine treatments they have prescribed for you are not working, or if your headaches are increasing in frequency without substantial relief, they may refer you to a neurologist, a headache medicine specialist, or a pain medicine physician.

You can also ask your doctor for a referral to a specialist if you feel that you aren't getting adequate or appropriate migraine care from your primary care doctor. Do keep in mind that migraine treatment is a process, and rarely does the first prescription or treatment plan a doctor develops work perfectly. It may take several changes in prescription, along with lifestyle changes, to achieve relief. However, if you feel your primary care doctor is not being responsive to your needs or just isn't knowledgeable about headache care, you have the right to request a specialist referral.

Some migraine specialists may be MDs who have special train-ing, substantial experience, and continuing medical education (CME) in headache medicine. They may also have a Certification of Added Qualification in Headache Management from the NBCHM. You can find a listing of doctors with this credential online at www.primarycarenet.org/nhf/nhf_intro.html.

A neurologist is frequently the first specialist a general practice physician will send a migraine patient to, especially if the patient has an abnormal neurological exam and requires neuroimaging studies such as MRI or CT scan.

A neurologist is a physician who specializes in diseases and disorders of the central nervous system — including the brain, spinal cord, nerves, and muscles. In addition to earning their MD or DO degree and completing a hospital internship, a neurologist has to have undertaken at least three years of specialty training in an accredited neurology residency program. After residency, the neurologist may then go on to earn board certification from the American Board of Psychiatry and Neurology (ABPN, for medical doctors) or the American Board of Osteopathic Neurologists and Psychiatrists (ABONP, for doctors of osteopathy).

Some neurologists may also have a board certification specific to headache medicine. The United Council of Neurologic Subspecialties (UCNS) certifies physicians in headache medicine, and the National Board of Certification in Headache Management (NBCHM) also offers a Certification of Added Qualification (CAQ) in Headache Management. Certification requires that physicians have substantial experience treating headache patients. Depending on the certification they are pursuing, they may also need to pass a rigorous exam, participate in conferences devoted to headache medicine, publish research related to headache in a peer-reviewed journal, and complete a certain number of continuing medical education courses each year.

After the neurologist confirms or establishes diagnosis, he or she will recommend a course of treatment. A neurologist is more likely to investigate preventative, or prophylactic, therapies for a migraine patient than to only prescribe acute pain-relief medications.