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How to Talk to Your Practitioner About Your Headaches

 
 
How to Talk to Your Practitioner About Your Headaches
Phillip A. Bain, MD
 
Preparation for a headache evaluation ideally involves at least these activities:
1st: keeping a headache calendar, 2nd: thoroughly answering a number of general health and headache related questions 3rd: filling in a headache related disability survey such as MIDAS or HIT-6, 4th: asking family members about their headaches, 5th: doing background research on headache using resources listed herein or classes if locally available.
If you experience significant headaches that interfere with your work or family/leisure activities, don’t “go it alone.” Most recurring headaches may not be curable, but, with treatment, they can be controlled to reduce their frequency, severity, and impact on the sufferer’s life. You owe it to yourself to seek medical help.
 
To maximize your chances of getting better, there are many steps that you can take before, during, and after you meet with the medical practitioner.
 
Step 1: Finding a practitioner to manage your headaches
To start the process, schedule an office visit specifically to talk about your headache condition. Confirm that the provider evaluates and treats patients with headache. If he or she doesn’t, either seek the advice of a headache-interested practitioner in your area, ask your provider for a referral, or find an American Headache Society (AHS) member physician through the ACHE “Find a Physician” referral at /resources/physicians/.
 
Step 2: Preparing for your office visit
Realistically, you may have 15, or at most, 30 minutes to discuss your headache condition. This is especially true if you are seeing a primary care physician, so it’s important to be prepared. Preparing for each of these activities is detailed below
 
First, take time to organize the details of your headache history. Maintain a headache diary for at least one month, preferably more, to track the frequency of your headaches, their intensity, and whether or not they interfere with daily activities. Note if they are related to your menstrual period, if applicable, or if they fall into a specific pattern.
 
Second, prepare answers to the following questions:
  1. Timing:
    1. When did they start: the very first and any significant change?
    2. How often do they occur: any headache at all, any moderate or severe?
    3. How long do they last if untreated or treated ?
  2. Impact:
    1. Time from onset to peak pain/disability in minutes or hours?
    2. How disabling are they or what do they prevent you from doing?
  3. Warning signs:
    1. Do you have any signals that your headaches will occur soon, such as visual zigzag lines, dark spots in your vision, etc.?
  4. Associated Symptoms:
    1. Do you have nausea/vomiting, light/sound/odor sensitivity with your headaches?
  5. Family history:
    1. Do other members of your family get similar disabling headaches?
  6. Past non-drug efforts:
    1. Have you been treated by someone or done something yourself for headaches?
    2. What was done?
    3. What helped?
    4. What didn’t help?
  7. Medications:
    1. How often do you use an acute pain reliever per month for any purpose?
    2. What drugs do you use or have you used for headache (preventive and acute) and other conditions?
    3. What worked?
    4. What didn’t?
    5. What were the dosages used and how long did you take each?
  8. Previous tests:
    1. Have you ever had a brain CT or MRI?
    2. When was it done?
    3. What were the results?
Third, consider taking a headache disability quiz. You can find the Migraine Disability Assessment (MIDAS) test on the ACHE website at /tools/migraine. You can obtain the HIT-6 at http//www.headachetest.com. You will have to sign in at the HIT-6 site. This information, along with answers to the eight questions, will help give your practitioner a clearer idea of what type of headaches you suffer from and how much they affect your daily activities. When you make your appointment, ask the receptionist if they have a specific headache history form for you to complete before you arrive.
 
Fourth, headaches are usually genetic –that is, they can run in families. Find out if there is a history of headache in your family. Sometimes, family history will help clarify what types of headaches run in the family, when they started and what possible triggers may be related to your headaches.
 
Last, do some background reading on the ACHE website (simply follow links from the home page at ), or read one of the many helpful books on headache. Conquering Headache – An Illustrated Guide to Understanding Treatment & Control of Headache by Rapoport and Sheftell and Conquering Daily Headache by Rapoport, Sheftell, Tepper, and Blumenfeld can get you started.

Taking these steps is worthwhile also because the more you know about your headache condition, the better equipped you'll be to treat it effectively.

Depending on the diagnosis, the plan may involve preventive medications if your headaches are frequent and/or severe. For treatment of the acute headache, your provider will often prescribe a medication for nausea (e.g., metoclopramide), followed by a medication for the headache pain. He or she may also recommend a rescue or backup medication for the times when the first line agent isn’t completely effective. It is important that you understand what your medications are for and how to take them.
 
Based upon the initial evaluation, your practitioner should set up a follow-up appointment to assess how the program is working.  The timing of this session will depend on the nature of your condition. Continue to update your headache calendar, and record your progress with sleep, exercise, and any relaxation techniques used. Keep track of how effective the medications are, and note any side effects that you may have encountered. Also, record headache days and don’t forget to bring it to the visit.
 
Step 3: Prepare your plan in writing
Before you leave the office, it is helpful to have a check list to make sure you have all your questions answered and have all the information you need to help manage your headache condition. For example, during your office visit you may write down important information and compare it to this check list to make sure you have no unanswered questions.
  1. What is your specific headache diagnosis?
  2. What is the treatment plan including a list of specific medications and lifestyle changes?
  3. How often should these medications or treatments be taken (daily or weekly)?
  4. How do the medications work and what should be the expected outcome after taking them?
  5. When should you come back for the next office visit?
  6. What should you do if the medication is not working or you do not like the medications?
  7. What are some signs or symptoms that the medications are not helping.
  8. What level of success can I expect from the medications?
By working with your physician and developing an organized strategy to treat your headaches, you can significantly improve your headache pattern and decrease the impact headaches have on your family and work life. By being prepared for your headache-related office visits, you can make your time spent with your provider much more efficient and increase the chance of success. The time that you invest will reap rich rewards in your overall quality of life.
 
-Phillip A. Bain, MD, FACP, Dean Health System, Madison, WI
 
Updated May 2008 from Headache, the Newsletter of ACHE, Spring 2004,  Volume 15, Issue 1.
 
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