ENT Disorders

Migraine Disease

Migraine disease is often underestimated as a health condition when thought of only as a severe headache, characterized by light, smell and sound sensitivity and/or nausea. Migraine is an inherited disease that causes many different symptoms from one day to the next. In fact, it affects many parts of our body – the nervous, vascular and immune systems

Common Migraine Symptoms Of The Head

Migraine symptoms other than a headache.

Head & Neck pain





Common Comorbidities

When a person with migraine disease has another chronic health conditions, such as anxiety or insomnia, this is called a “co-morbidity”










Migraine Treatment

Since there are many problems with our nervous system that might make it quirky and hypersensitive, there is no single treatment that if effective, or “works”, for more than half the population.  The mainstay of treatment is to use medicines that help the brain work more normally.  Unfortunately, we do not know what is going to work for you.  Also, we don’t know if the medicine will cause a side effect. Your clinician will need to try one or more medicines before finding the best one for you. Please be patient. 

Our ENT doctors in RI know migraine disease causes many symptoms from one day to the next, affecting many parts of our body - the nervous, vascular and immune systems.

“Rescue” medicines

Caffeine, Ginger and other natural products



(metoclopramide, ondansetron, prochlorperazine, dimenhydrinate, trimethobenzamide)


(medicine specifically designed for migraine headaches)


Bbrogepant (Ubrelvy 50 or 100 mg tablet, its effect may last less than 24 hours)

Rimegepant (Nurtec ODT 75 mg dissolves in mouth, its effect may last up to 48 hours)


Lasmiditan (Reyvow 50,100 or 200 mg per day)


Barbiturates (sedative) - avoid

Opioids (narcotic) - avoid

“Preventive” medicines


Magnesium 400 mg daily

Riboflavin 400 mg daily

Coenzyme Q-10 300 mg daily

Melatonin 1-3 mg daily

Feverfew 100-300 mg daily

Butterbur 50-75 mg daily (check for purity)

5-HTP 400-600 mg daily



High blood pressure medicines

Anti-seizure medicines

(topiramate, valproic acid, lamotrigine, zonisamide)

CGRP blockers – Monoclonal Antibodies






OnabotulinumtoxinA (Botox and others)

Nerve blocks

Migraine Frequently Asked Questions

Have questions? We are here to help.

Why Do I need a referral if my insurance does not require it? What is the difference between a ‘clinical referral’ and an ‘insurance referral’?

An ‘insurance referral’ is a referral that is obtained by your PCP, directly through your insurance provider’s dedicated referrals portal. There is usually an associated referral number that is added to the claim that is submitted to your insurance with the claim for the services we provide. If your insurance requires a referral, we do not schedule an appointment until we have received this from your PCP. The reason for this is to protect the patient from receiving a large bill for services that normally would have been covered, if a referral had been obtained.


A ‘clinical referral’ is documentation from your referring provider, explaining the reason why they are referring you to our practice, and any past treatments, diagnostic testing, or other pertinent information that will assist our MD’s in treating you optimally.


As specialists, we have certain providers that require a ‘clinical referral’, prior to scheduling, to ensure that the referral is appropriate, and that necessary testing has been performed prior to seeing our physician. This is to ensure that a visit is not ‘wasted’ if the physician is not able to help you, or if necessary testing for optimal treatment has not been ordered and performed.

Why does it take so long to get an appointment? What is the turnaround time to get a new patient appointment?

Univoto’s specialists, and especially our sub-specialists, are very unique in their expertise, and this means that we are sometimes the sole resource for patients with complex head and neck disorders. This does mean that our schedules fill up quickly, and it may take up to three months to get a ‘New Patient’ appointment with one of our providers.


We can assure you that if you have an urgent need to be seen quickly, we have a process in place to get you in within 24 to 48 hours. Urgency is determined by a referral from a primary care physician, so if you feel your case is urgent, please reach out to your primary care physician as a first step.


We also are happy to offer appointments with our Physician’s Assistant, much more expediently. Please ask your patient coordinator if your diagnosis is one that our PA can treat, to decrease your wait time.

Does Univoto offer ‘emergency’ appointments, and what qualifies as an ‘emergency’?
Univoto DOES offer urgent appointments. However, urgency is determined by your primary care physician. We require clinical documentation of the urgent matter. Upon receipt of this documentation, we can usually get you in within 24 to 48 hours.

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