Migraine and Headache 'Betters' - Better Treatment Partners

Patient Expert

How many times have you wished that you and the doctor who treats your Migraines were making more progress? That he or she talked with you more? That he or she were a "better doctor" for your needs?

There are two sides to the equation when patients and doctors work together as treatment partners. An educated, "better" patient can bring out the very best in their doctors and vice versa.

For some tips on how we can be "better patients" and help our doctors be "better doctors," I went to the best source I could think of - some great Migraine and headache specialists. These are specialists who view their patients as true, equal partners when it comes to their Migraine and headache treatment.

Here are their tips:

From Dr. Rob Cowan, director of the headache center at Stanford:

  • For better patients, my favorites are patients who have their questions ready and have a clear sense of what they are hoping will happen during the appointment.
  • I like patients who bring their diary and a list of meds they take.
  • My more difficult patients are the ones who come ready to blame me for things other docs have done or who expect me to "cure" their headaches. The best patients see us as a team, collaborating to figure out ways to manage things.
  • In terms of better doctors, I guess it depends on what is meant. If by better, they mean a doctor who can be open-minded, , knowledgeable, creative, and compassionate, I am all on board. But often better means a doctor who has some secret pill that the last six doctors wouldn't give me, and as we both know, that is rarely an option.

From Dr. Peter Goadsby, UCSF:

  • Try and bring a summary of information not just pages and pages undigested.
  • A list of previous medicines, doses and how long taken as well as side effects; you may not have everything but more is better.
  • Diary- again summarized on some form of calendar is useful.
  • Be mentally prepared to go over some ground you already have with other doctors, we all like to get a clear history ourselves.
  • Be prepared for questions about your attacks you may not have thought of- they are not us being difficult- they are us being thorough and interested.
  • Its hard, you've suffered long, but if you could leave angst about how others have behaved behind, at least for a while, it will make the whole interaction more productive and pleasant for everyone.
  • Please bring hope... we will provide expertise, and together we will make progress.

Dr. Brian McGeeney, Boston Medical Center:

  • If you are doing well, feel free to let your doctor know about it. Physicians like to hear this, in addition to their many messages of patients in distress.
  • At a bare minimum, know all the regular medications you are taking at the time you see your physician- write them down if you need to. I am not just talking about headache meds, but anything you are taking.
  • If you have an agenda on meeting with your physician- tell them up front what you expect from the visit. Be sure to be clear what your main concerns are, and separate them from added extras.
  • Keeping a headache calendar and remember to bring it in. Must be easy to read and does not have to be information intensive.
  • Time and time again patients have legitimate particular concerns about medications-these need to be voiced by the patient- rather than letting the physician spend time digging up the unmentionable side effects you want to avoid- weight gain, hair loss, etc. Often patients do not communicate these medication concerns, whether founded or unfounded, to their provider and this only results in poor compliance and poor outcome.
  • Be respectful of the physicians time, by being succinct and to the point. If you feel ahead of time that you need and extended visit- tell the office staff/provider- they may be able to accommodate you at the end of the day or a time that allows greater flexibility.
  • Consider writing down questions or events/history but be brief, 1 page ideally. Physicians can be turned off by great volumes of material when that could easily be summarized.
  • More complicated patients could keep a running summary of treatment plans and responses.
  • If you encounter rude and disrespectful behavior from the office staff- let the provider and office manager know about it. Good managers and physicians like to get feedback.
  • If you have limited English ability or have difficulty expressing yourself, bring along someone. It is generally a good idea to have a separate pair of ears in the room. They can be a scribe for you, writing down points that you might forget.
  • Probably a good idea to keep your primary care physician updated on how you are doing with your specialist, independent of any feedback the specialist may give to your primary care. Sometimes it is not congruent!

Dr. David Watson, director of the headache center at West Virginia University:

  • Don't expect a single answer to "why" - this isn't appendicitis where the pathology and the treatment are clear cut.
  • Educate yourself with the internet, but be careful of what you read. Much of the internet is false, and it is very difficult to nuance information/
  • Know your current and past meds, doses, and effects! This is probably number one for me.
  • Give it time - at least for me, I'm much more concerned with the long term outcome of managing headaches and Migraines than the short term. Both are important, but too often patients focus so much on the short term, they lose sight of the long term. For example, refusal to tolerate any side effects long enough to see if the medication will work and the side effects will lessen, or refusal to change behaviors such as sleep hygiene or medication overuse because, "I tried that for 2 weeks before and nothing happened."
  • Now, this sounds like I'm complaining about patients, which I'm not. These are things that frustrate me for my patients when they get in their own way.

Dr. William Young, Jefferson Headache Center

  • Be forthcoming with your doctor, disclosing all treatments or medications you receive from other doctors. Not doing this is the worst mistake and can get you dismissed as a patient.
  • Answer questions yourself instead of allowing family members to answer for you.
  • Pulls out new facts or symptoms that you know or think is important at the beginning of your appointment. Waiting until the end of the appointment erases every decision made during the visit.

Summary and helpful tools:

With these informative tips and some work on our part, our appointments will be far more productive, and we'll be more effective treatment partners. We have some tools available that can help you follow some of the suggestions from our guest specialists:

Thank you to Dr.'s Cowan, Goadsby, McGeeney, Watson, and Young!

Live well,

PurpleRibbonTiny Teri1

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