Patient Vignette
“I am 39 years old, the mother of three children, and I work as an administrator at a school in South Carolina. For years I have had headaches that come and go, and when I was 22, I had a headache that I now think was probably my first severe migraine attack. I was in bed with the lights out. I have only had 6 or seven headaches that have been this bad since that time. But, the headaches I usually get just slow me down a bit. Usually, I get a little grumpy at work; I do not start on any big projects and I get quiet.
I take an over-the-counter medicine, which seems to work okay because in about 2 to 3 hours, the headache is almost gone. The sad part is that these headaches come about once a week, and it can take a little while for the medicine to work. I do not tell people at work that I have �another headache;� they probably just think I am a little moody because I am much less social when I have these headaches.”
S.T.
New medicines for migraine are available regularly, and it is difficult to know which of these medicines are right for you.
- Are newer medications better or safer?
- Should you stay on the one you have been using for many years?
- How do you and your physician decide which medicines are right for you?
Each medicine has a different profile, meaning it offers different benefits and risks of side effects. It is important that you and your doctor discuss which medicine will meet your needs. Sometimes, you may need to try one or two or even three different medications before finding the one that meets your needs. In order to avoid this trial and error approach, it is important that you and your doctor make time for a thorough headache visit so that you can discuss your needs regarding achieving a pain-free state, problems with recurrence, or reducing disability.
Because headache management may be complex, involving many different medications, it is very important that you work closely with your health care provider in creating and maintaining a good treatment plan that works for you. This treatment plan should change over time as your life changes. For example, pregnancy, new jobs, or onset of other illnesses may affect your headaches and their treatment. Therefore, it is important that you know how to establish and maintain a good partnership with your health care providers.
How Can You Improve Communications With Your Doctor?
Step 1: Make a scheduled appointment to discuss your headaches.
Family practice physicians, internists, neurologists, and gynecologists are all skilled in treating headache. However, some doctors treat more headache than others, and you may need to talk to your health care providers to see if they are the ones that should work with you on treating your headaches.
Unfortunately, many patients try to discuss their headaches with doctors during an office visit that has been scheduled for another reason. It is critical that you schedule an office visit specifically to discuss your headaches.
It takes approximately 30 minutes, and sometimes more, for a complete headache interview, review of different treatment options, and designing a treatment plan. If you try to add your headache work-up onto an office visit that is scheduled for another reason, you are unlikely to get the time and attention that your headaches deserve due to time constraints on your physician.
Step 2: What should you tell your doctor?
Once you have scheduled your office visit and the health care provider is ready to spend time with you reviewing your headache history, there are several key points to raise so they understand all the different aspects of your headache. Here are a few important points to discuss:
- Symptoms: Tell the doctor what other symptoms come with your headache, such as nausea or vomiting. This is important as it might help determine if you need a tablet, nasal spray, an orally disintegrating medication, or an injection.
- Timing: The doctor should know how fast your headaches develop. Some medications, such as injections, work very quickly.
- Other Illnesses: It is very important that the doctor know about other health concerns because the medications may help or make worse these coexisting conditions. Some health conditions that are common among migraine sufferers include depression, anxiety, hypertension, and asthma.
- Impact of Headaches: Discuss the impact headache has on your work, family, and home life. This is important as it will help the doctor better understand how severe your headaches are and how disabling attacks can be.
Step 3: Work with your doctor when designing a treatment plan.
When you go to your doctor, both of you want the treatment plan to work. There is no point in the physician giving you a medicine that you do not want to take. Therefore, one way to improve the chances that a treatment plan will work is to discuss issues that are important to you. There are almost 100 different headache medicines available, and finding the one that is right for you requires that the doctor know what you want. Surely, there are medicines that are right for you.
Below is a list of specific issues that may help you tell your doctor what is important to you in designing a treatment plan.
| Headache Treatment Preference | Importance Ranking (priority) | |||
| Rapid pain relief | __ high | __medium | __low | |
| Complete loss of head pain (pain-free) | __ high | __medium | __low | |
| No headache recurrence | __ high | __medium | __low | |
| No nausea | __ high | __medium | __low | |
| No drowsiness | __ high | __medium | __low | |
| Easy-to-take | __ high | __medium | __low | |
| No disability | __ high | __medium | __low | |
| Low risk of side effects | __ high | __medium | __low | |
| __ high | __medium | __low | ||
How do You and Your Doctor Decide Which Medicine Is Right for You?
Headache medications are available in several different kinds of delivery formulations. Sometimes patients can actually pick the delivery that is preferable for them. For example:
What are the different ways you can take headache medicines?
- Oral tablets
- Orally disintegrating tablets (dissolve in your mouth so you do not have to swallow with liquid)
- Nasal sprays
- Injections under the skin (subcutaneous, sc)
- Rectal suppositories
Reviewing these different options will help your physician come up with a recommendation on which medicine is right for you. Several headache medicines are available in different formulations so you may actually have a choice on which way you prefer to take your medication.
For example, some people do not like injections, others do not care for suppositories, and others may prefer a nasal spray. Only you can tell your doctor what you prefer, and this will help make sure you get a medication that you are willing to take.
For a listing of various headache medications see Understanding your medicines
Discuss other health and headache concerns with your doctor.
For migraine sufferers, there may be more than just the head pain that needs to be discussed. For example:
Associated symptoms
Sometimes the symptoms associated with headache (such as nausea, vomiting, and sensitivity to light and/or sound) are more disabling than the head pain itself. Transient neurological symptoms (migraine aura) also should be discussed.
Other health concerns
Sometimes patients have other illnesses that can contribute to headache severity or frequency, such as depression, anxiety, diabetes, high blood pressure, or even seizures. The doctor needs to assess all these other health concerns to see if any one of them is contributing to your headaches.
Environmental Triggers
Environmental factors (such as smells, pollution, noise, lighting, foods, and sleep patterns, among others) may trigger headaches in susceptible people.
Acute or Preventive
The medicines discussed in Understanding Your Medicines are all for occasional use and are known as “acute” (or “abortive”) treatments for headache, since they are used to stop (or “abort”) a headache attack in progress. If you find you have frequent, disabling headaches, you may be a candidate for “preventive” medicines that can reduce both the frequency of your headaches and can make any “breakthrough” headaches less severe and easier to treat.
Assessing your headache treatment needs:
- Are you using your medications more than 1-2 times a week on average?
- Do you have 3 or more severe, hard-to-treat attacks per month?
- Do you dislike the acute therapies you have tried?
- Do you have infrequent but very severe and disabling attacks?
- Do you have headaches that are predictable such as:
- Headaches that increase in frequency during stressful events such as travel, holidays, or tax season?
- Do you miss work, social events, or family activities because of headaches?
If you answered yes to any of these questions, you may benefit from a preventive therapy for your migraine.
Many physicians have a variety of different preventive therapies they use in their patients. Selecting one may be based on your health history, presence of other existing conditions, or the clinical experience of the physician.
Preventive Headache Therapies Proven Effective in Clinical Trials for Migraine (Other medications not listed may also be helpful.)
| Class of medication | Example of medication | |
| Antiepileptics (anticonvulsants) Antidepressants Beta-blockers Serotonergics |
Depakote� (divalproex sodium) Elavil� (amitriptyline) Inderal�, Blocadren�, (propranolol, timolol) Sansert� (methysergide) |
|
Achieving Success with Your Chosen Headache Medication
Step 1: Follow the agreed treatment plan.
During the office visit, you will need to agree with your physician that the treatment plan is right for you. If you to not agree that the medication is right for you, or if you have concerns about the medication, please make sure you tell your doctor so you can discuss the recommendations and what might be appropriate in exchange.
Step 2: Avoid under and overuse of medicines
. Because headaches come back, often on a regular basis, medicines should be taken as directed. If overused, many headache medications will cause an increase in headaches, even leading to a syndrome called chronic daily headache. Sometimes the headache medication along with other drugs such as caffeine, lead to a worsening in headache frequency and intensity. If you feel this is occurring, call your physician immediately, so you can break the cycle of headache rebound and chronic daily headache.
Step 3: Maintain your headache hygiene.
In order for headache medications to work and a treatment plan to be successful, you must assume responsibility for taking care of your own illness. This means engage in good “headache hygiene.” This often sounds easier than it is and requires you to be disciplined in several areas of your life. Help yourself succeed by giving your medications a good chance of working for you.
Remember…
- Take your medicines as recommended by your doctor (avoid overuse and underuse).
- Schedule office visits regularly and keep the appointments. This is a time when medications are adjusted according to your specific needs; doses may be changed or even new medications tried to avoid unwanted side effects (drowsiness, tingling, etc.).
- Take care of your personal lifestyle so you do not make your headaches worse. This includes engaging in regular sleep patterns, eating regular meals, avoiding triggers (red wine, too much caffeine), and getting regular exercise.
- Keep an accurate diary of your headaches. Note any hormonal changes (e.g., menstrual periods) or other factors that you think may have triggered or influenced your headaches.
- Call your health care provider if there is a change in your headache pattern, intensity or severity, or if you are unhappy with your current treatment plan.
This brochure is sponsored by an unrestricted educational grant from AstraZeneca Pharmaceuticals, Inc.