"Frustration" is the most common feeling I sense when I meet patients in my headache clinic for the first time. They are often frustrated by their headaches, by the lack of understanding of their condition by their circle (whether family, friends, or work) and, most importantly, by the actions (or lack of actions) of prior physicians.... and I get it.
I have very rarely, if ever, bad mouthed the care of prior physicians. After all, my opinions about their care are just that; opinions. They are not medical facts. However, again and again I have seen patients receiving suboptimal care due to prevailing misconceptions in medical community, not only among general practitioners, but more likely among neurologists. I like to call these "migraine myths", and I am set to share with you some of them; hopefully this can make you feel that a doctor "gets it":
Myth #1
You should start treating migraines "conservatively", by Magnesium and Vitamin B2 (Riboflavin)
If only I had a penny (or a dollar to account for the ridiculous inflation we are seeing) for everytime I had a person with near daily migraines, or even less-frequent-yet-debilitating headaches, who was only treated by magnesium and vitamin B2, because they are "natural".
Please do not get me wrong, I have nothing against "natural" treatments, or even against magnesium and riboflavin. They do have some efficacy in treating migraines. However, one should understand the role they play in its management; the landmark study that showed riboflavin efficacy was done on patients with very mild headaches. Their average attack was less than 4 headaches per month. Even then, it required 4 months of treatment to show statistically significant reduction in the number of attacks, and there was no change in the use of rescue medications.
The role of mangesium is even more controversial, after one study was milked hard (statisitically speaking), it showed the most mild benefit of one day reduction; after 12 weeks of treatment; compared to placebo, while the second study showed no benefit at all.
The bottom line: Magnesium and Riboflavin are "meh"... at best. It is ok to take them if you have few headaches a month, but if your migraines are serious enough that you are seeing a neurologist, they better skip those already, in my opinion.
References:
1) Schoenen, Jean, Jean Jacquy, and M. Lenaerts. "Effectiveness of high‐dose riboflavin in migraine prophylaxis A randomized controlled trial." Neurology 50.2 (1998): 466-470.
2) Peikert, A., C. Wilimzig, and R. Köhne-Volland. "Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study." Cephalalgia 16.4 (1996): 257-263.
3) Pfaffenrath, V., et al. "Magnesium in the prophylaxis of migraine‐a double‐blind, placebo‐controlled study." Cephalalgia 16.6 (1996): 436-440.
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