Two Vital Migraine Related Issues That Doctors Often Don't Mention
Whether we're going to the doctor for migraines, cluster headaches, another headache disorder, or something else entirely, our appointments are generally vastly different from appointments in the "old days." There aren't enough doctors of any kind, particularly specialists, so appointments are shorter, and far less time is spent on any type of patient education.
When it comes to migraines, there are two issues often not mentioned by doctors that I find especially disturbing:
- Migraine trigger identification and management.
- Medication overuse headache (MOH) and how to avoid it.
Migraines don't just happen; they're triggered. Sometimes, those triggers are avoidable, IF we know about them. It's absolutely incredulous to me that so many doctors, including some migraine and headache specialists, never mention triggers to their migraine patients. A good example of this is my own migraine history. I've had migraines since I was six-years-old, BUT I never knew about triggers until I was 46-years-old. It wasn't until my migraines were daily and ravaging my life that I learned about triggers while doing my own online research. Soon after that, I saw a migraine specialist for the first time, and he did discuss triggers. When all was sorted out about my triggers, I was extremely frustrated because some of my triggers are avoidable, but since I hadn't know about them, I'd had countless migraines over the previous 40 years that might well have been avoided.
If your doctor has never discussed triggers with you, it's beyond time that he or she did. Please bring it up at your next appointment. In the meantime, here's some information for you about migraine triggers:
- 10 Common Triggers of Migraines - Infographic
- Common Migraine Triggers
- Migraine and Headache "Betters" - Trigger Management
- The best way to investigate food triggers is by doing an elimination diet. Here's an article on that topic. At the end of the article, you'll find a free downloadable workbook. Managing Migraine - Migraine Food Triggers
- Since keeping a good migraine diary is key to identifying triggers, here's a link to an article that includes a free downloadable diary workbook: Your Migraine and Headache Diary
MOH and How to Avoid It:
First, I understand how many of us detest the term medication overuse headache. It seems to blame the patient. I don't have any control over the naming of different types of migraines and headaches, so I just remind myself that it does say overuse, not misuse or abuse, and the people who do the naming were being literal in this case. So, let's put this aside, and have a useful conversation.
I'm truly stumped about why so many doctors don't warn us about MOH, especially when they prescribe medications that can cause it if we take them too frequently. Once again, my own history echoes that of other migraineurs. During the first 40 years that I was treated on and off for migraines, not a single doctor ever warned me to limit how frequently I used the medications they prescribed and over-the-counter medications. Not one. Again, I learned it on my own via the Internet, and my first migraine and headache specialist talked to me about it. It amazes and dismays me how many migraineurs ask what MOH is because no doctor has ever mentioned it to them.
I follow conference information and medical journals carefully to keep track of any new information about medication overuse headache. Here are two solid links for you:
- Medication Overuse Headache - When the Remedy Backfires includes comprehensive information on which medications and combinations of medications can cause MOH.
- How Can I Avoid Overusing Migraine and Headache Medications?
I asked migraine and headache specialist and HealthCentral contributor Dr. David Watson for his thoughts on this topic. He replied:
"Too often physicians and patients can rely too heavily on the active treatment - prescribing or taking medication. This is natural as it seems like are doing something. Unfortunately, too often this is done in the absence of the less active but at least as important education regarding self-care. We forget what not to do, like not exposing ourselves to certain triggers or not 'overusing' acute medications. Effective migraine treatment incorporates the 'do this' with the 'don't do this' as equals."
When I think about this situation with doctors often not telling us about these two vitally important issues, my first reaction is to think, "If they're not going to tell us these things, they shouldn't be treating people with migraine disease." When I think a bit more, I become more rational about it and realize it's not that black and white. Should they tell us? Absolutely, but the reality in today's medical practices is that appointments are often, because there are so many patients to be seen, too short. In reality, our doctors aren't responsible for our health; we are. When we're informed, proactive treatment partners with our doctors, everything goes better. To put this all in perspective, I recommend that you read Migraine and Headache "Betters" - Better Treatment Partners. Dr. Rob Cowan, Dr. Peter Goadsby, Dr. William Young, and Dr. David Watson all shared tips for patients and doctors working as treatment partners for this article.
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Reviewed by David Watson, MD.
© Teri Robert, 2015. • Last updated January 20, 2015.