Migraine Management Essential #2 — Partnering with The Right Doctor

The Right Doctor:

 

To manage our Migraines as well as possible, we need to partner with a doctor who understands Migraine disease and how to treat it. One would think that finding such a doctor would be an easy matter, especially given that Migraine affects 18 percent of women and six to eight percent of men, but that's not the case.

 

Many people see multiple doctors before receiving an accurate diagnosis, then continue to have problems receiving appropriate treatment. A World Health Organization (WHO) report stated that:

 

"Lack of knowledge among health-care providers is the principal clinical barrier to effective headache management. This problem begins in medical schools where there is limited teaching on the subject, a consequence of the low priority accorded to it."

 

The report also revealed that, worldwide, formal undergraduate medical training included just four hours about headache and Migraine; specialist training included 10 hours.

 

Another issue is that we tend to assume that neurologists are Migraine and headache specialists, an assumption which isn't necessarily accurate. Neurologists aren't necessarily Migraine specialists, and Migraine specialists aren't necessarily neurologists. There are, however Migraine and headache specialists whose practices focus on patients with Migraine and other headache disorders. Since "headache medicine" is their chosen field, these doctors tend to keep up with publications in their field and attend continuing medical education meetings on a regular basis. For information and links to help find a Migraine and headache specialist, see Doctors and Treating Migraine.

 

Partnering with Our Doctors:

 

Once we've found a doctor to work with, we need to establish and maintain a good partnership. Let's be very honest here. If we go to our doctor expecting him or her to write a prescription that's going to take care of everything without our having to do anything, we're going to fail. It's that simple. No matter how hard our doctors work, no matter how good our treatment regimen is, there are things we must do to manage this disease:

 

  • We need to identify and manage our Migraine triggers. Once we identify them, we may find that some are avoidable. We may find that we can avoid at least some of our Migraines by avoiding certain foods a beverages, watching our sleep schedule, staying well hydrated, etc. Preventive therapies can definitely help, but doing something such as indulging in a food we know is a trigger, then being upset that we get a Migraine is akin to touching a live electrical wire, then being upset that we got shocked.
  • We need to stick to our treatment regimens. If we have concerns about treatments prescribed by our doctors, the time to address those concerns is when the prescription is written, before we leave the doctor's office. If we don't want to take certain medications, it's up to us to tell our doctors and ask what our other options are. If there's something we think we want to try, we need to speak up and ask our doctors about it.
  • We need to discuss treatment plans with our doctors. Our Migraines can vary from one to the next, so we need to have plans in place because we can't call our doctors every time we have a Migraine. We should have abortive and rescue treatments available to us. Rescue treatments are those we use when our first-line abortive treatments fail. If we have three or more Migraines a month, or if our Migraines are especially severe or debilitation,we should also have preventive treatments. We should plan with our doctors:
  • What to do or take first when we have a Migraine, and at what point.
  • Rescue - What to do if our first-line treatment fails.
  • What to do if our rescue treatment fails.
  • What constitutes an emergency and what we should do. Do we call our doctors? Do we go to the ER?
  • We must be honest and thorough in talking with our doctors. They need to know about everything we take, including over-the-counter medications and supplements. They need to know about all medications that other doctors may have prescribed for us. We must be honest with them about our medical history, our symptoms, and every thing they ask.
  • We need to talk with our doctors about how we can best help ourselves. Migraine management isn't all about medications and treatments. It's also about lifestyle modifications and taking care of ourselves. Many of us can't handle some of the lifestyle changes that "normal" people can - such as daily exercise - but there are often modified versions we can handle. Sometimes a change as simple as going to bed and getting up at the same time every day can make an enormous difference. We need to watch our overall health as well because our bodies are less susceptible to our Migraine triggers when we're in good health.

 

In return, it's reasonable to expect our doctors to:

 

  • Outline our options, and make decisions WITH us rather than FOR us.
  • Answer our questions and discuss topics of concern to us.
  • Develop a full treatment plan with and for us including preventive, abortive, and rescue treatments, as well as plans for when and how to get assistance when our abortive and rescue treatments fail or if a Migraine is unusually severe or frightening.
  • Consult with and / or send reports to our other doctors. Our care must be coordinated so that there are no conflicts between treatments prescribed by our doctors.

 

Patient-doctor partnerships are relationships built from mutual respect. When both patient and doctor work together toward the common goal of better Migraine management, outcomes are better. If your doctor doesn't want to work in this way, find a new doctor. Yes, we need to respect our doctors, but in essence, patients are consumers of health care services. Don't settle for less that what you need and deserve.

 

 

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Sources:

 

World Health Organization, Lifting the Burden. "Atlas of Headache Disorders and Resources in the World 2011." Geneva. World Health Organization. May, 2011.

 

 

Reviewed by David B. Watson, MD.

 

© Teri Robert, 2016. All rights reserved.
last updated September 5, 2016.

 

 

All content © Teri Robert, 2004 - Present, unless otherwise noted.  All rights reserved.


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