Migraine and Headache Treatment and Psychological Evaluations
Many of us have had the appalling experience of being told, even by doctors, that our Migraines or headaches are "all in our heads" or psychosomatic. Some people have even had the experience of their doctors referring them to a psychiatrist because the doctor has decided the Migraines or headaches are psychological in origin.
In many Migraine and headache specialty practices and clinics, a psychological exam is part of the initial visit. For those of us who have been told that our Migraines are "all in our heads," having to do this exam can make us feel apprehensive and wary. Certainly, this was my reaction when I was told that a psychological exam would be part of my first visit to the Jefferson Headache Center.
In fact, when I scheduled my appointment and was told that I'd see the psychiatrist before I saw my new Migraine specialist, I was ticked, and I told them so. I told them I had thought they'd be the last place in the world that I'd be told it was "all in my head" and that I didn't see why I had to see the psychiatrist before my specialist, Dr. Young.
Part of the psychological exam was a set of questions that was sent to me in advance with my registration packet. When I arrived at the clinic for that first appointment, they gave me another multi-page set of questions to complete for a psychological profile. I was not happy. Still, I wanted their help, so I obediently did my best to answer all the questions.
When I sat down in his office, Dr. Tramuta (the psychiatrist) said he'd been told that I wasn't happy about seeing him. He told me that he could understand that, but that he hoped I'd understand the purpose for seeing him. He explained that the purpose was two-fold:
- Since so many Migraineurs have comorbid major depressive disorder, he was for it, and if I did have it, see that it was being properly treated. If I were taking an antidepressant already or needed to be taking one, he'd make recommendations for Dr. Young to consider as he and I talked about my Migraine treatment.
- He also was to assess my coping skills for living with Migraine disease. If he felt I needed help with those coping skills, he'd see that I got it.
Well! That explanation put me more at ease and knocked the chip off my shoulder.
I was already being treated for major depressive disorder. Dr. Tramuta suggested other medication that could handle the depression as well as the medication I was taking and could help with Migraine prevention at the same time. After talking for a while and his reviewing some of the questions I'd answered, he said he felt my coping skills were amazingly good. That meant he wasn't going to request that I see him again, BUT he wanted me to remember that if I ever wanted to talk with him, I could, and that I should just ask the receptionist to schedule me to see him the same day I saw Dr. Young. He also addressed a concern that I had. My mother had severe bipolar disorder, and I'd always been terrified of inheriting it. He reassured me that if I were going to develop bipolar disorder, it probably would have surface by then, and I did know what to watch for so I could report any new symptoms to him.
Dr. Tramuta told me that the longer questionnaire I'd completed would be "scored," and he'd contact me if he felt he needed to talk with me again because of any of the answers, but he didn't think that would be the case.
When I saw Dr. Young that day, we discussed Dr. Tramuta's medication recommendation, and one of the changes he made to my treatment regimen was to change my antidepressant to one they thought might help with Migraine prevention as well as depression. It turned out that they were right, and I still take that medication.
What to expect:
- A psychological exam can be performed by a psychiatrist or psychologist.
- You will be screened for comorbid depression and other mental health disorders so you can be properly treated if you're diagnosed with any of them.
- You will discuss how you cope and live with Migraines and headaches. If you need help with coping skills, it will be made available.
- The purpose is not to tell us that our Migraines are psychological.
- You may or may not be asked to complete written evaluation questionnaires. It depends on how the psychiatrist or psychologist you see works.
- In some offices and clinics, if the psychological exam indicates that you need treatment or help with coping skills, getting that help may be a requirement of continuing with your Migraine specialist.
If your insurance plan covers mental health care, it should cover this psychological exam with the same rate of co-payment as medical care. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.
Fact Sheet. "The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)." United States Department of Labor, Employee Benefits Security Administration. January 20, 2010.
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© Teri Robert, 2014
Last updated January 22, 2014.