You are going to see a headache specialist, and may have waited a long time for the appointment! While all practices differ a little bit, there are some common features that you should expect:

 

History: You will be asked to describe your headaches in detail. For example, describe an episode (if the headaches are episodic) from beginning to end, including warning signs; the location, character and severity of the pain; sensitivity to light, sound or odors; effect of movement or physical activity on the pain.  Are there any other symptoms with the headache? Have you noticed any triggers (food, beverages, environmental, stress)? How do your headaches affect your life, even when you are not having one? You may have more than one type of headache – be ready to explain each type. 

 

Although parents and other relatives can help, it is best if the patient tells their own story – no one else really knows exactly what is happening in your head!. A very young child may not be able to relate all of the details but can often provide the major features or draw pictures. Adults will need to decide in advance who they want in the exam room with them; this is a consideration if there are very sensitive issues you need to discuss privately.

 

Family history:  Does anyone else in your family have headaches? If so, whom?  What type of headaches do/did they have? If they found a successful treatment, what was it?

 

Medications: Make a list of everything you are taking, even herbals and over-the-counter medications. For “as needed” medications, indicate how much you are really using (per day, per week, or per month). 

 

If you have taken medications for headache in the past, it would be helpful to bring a list of the medications you used, and indicate whether or not they were effective, and side effects experienced. If you do not have a list, the dispensing pharmacy can provide one.

 

Headache Disability: How do your headaches impact various aspects of your life – work, school, family, social, legal? You may be asked to fill out a questionnaire about this (see Headache Calendar, below).

 

Headache Calendar: If you keep a headache calendar, bring it with you. Otherwise, try to keep a calendar or diary prior to your visit.

 

Diagnostic Tests and Old Records: Bring imaging studies (films or CDs) and ask that relevant old records be sent to the office prior to your appointment.

 

Forms: Most headache specialists have various forms for you to fill out, incorporating the information above and other details to help you get individualized care. The forms may take 30-60 minutes to complete and may require some research on your part - take the time to review them and fill them out in advance.

 

Other:  Read the information provided in advance with regard to cancellation policies, prescription refill policies, insurance authorizations, and other office procedures.

 

Every office is a bit different. You will probably be seen and interviewed by more than one provider, such as a nurse, nurse practitioner/physician assistant, medical student, resident or fellow. You may also be evaluated by a physical therapist or psychologist. There is a very large overlap between certain conditions and headaches, including depression, anxiety, post-traumatic stress disorder, abuse, obstructive sleep apnea, and other various medical conditions. You may expect that these topics will be addressed in some fashion, either during the interview process, using questionnaires, or with consultations by specialists in the area. The goal is to make sure that your evaluation addresses all of the factors that might be contributing to your headaches and develop a treatment plan which has the best chance of succeeding.

 

Most of the appointment will be spent in conversation. You may expect to have your vital signs taken and a neurological examination, and examination of the head and neck.

 

Do not wear perfume, cologne or other scented products to your appointment. Scents often trigger headaches, and there are office personnel as well as other patients who may be affected.

 

Good communication and follow-up are important to make sure that you are making good progress. Be sure to follow through with the discharge instructions, contact the office if there are problems and keep your follow-up appointments.

 

Deborah I. Friedman, MD, MPH