Migraine Patient Guide to a Successful Doctor Appointmentby Teri Robert Patient Advocate
Visiting a doctor for migraine or other headache disorders is never easy, especially a new doctor. We all know that, and we sometimes dread the experience. I'm often asked what should be taken to the first visit with a new doc and what questions we should ask at that first visit.
This guide is meant to help make those first visits and follow-up visits easier. Let’s make appointments something we look forward to as a tool for better headache and migraine management.
Please give this statement some thought as you prepare for appointments:
“Optimal healthcare can be achieved only when patients are educated about their health, and patients and physicians work together as treatment partners in an atmosphere of mutual respect.”
What to Take with You:* Records from previous doctors. Some doctors and their staffs are reluctant to give records directly to the patient. You should know, however, that you have a legal right to your records, and they cannot legally refuse to give you a copy. Under HIPAA, once you give them a written request for your records, they must provide you with a cop within 30 days. They are within their rights to charge you what it costs them to make a copy, but they must give you a copy if you request it. (See Your Rights to Your Medical Records.)
Your migraine and diary. I know, keeping a diary can be a real nuisance, but even when we can't see patterns, the information can prove very valuable to your doctor in diagnosis and in setting a treatment regimen. A migraine and headache diary can be done in a number of ways. You can use a small notebook, a printed form, or a document on your computer. If you choose the document on the computer, you can make notes during your episodes, then transfer them to the computer later. If you'd like to print or download our diary, you can find a free diary workbook in Your Migraine and Headache Diary .
Medical history information - both yours and your family's. We now know there's a genetic component to migraine, so this is important, especially if you haven't yet been diagnosed. Keep in mind that there may be people in your family who called their migraines "sick headaches" or thought they were sinus headaches .
Your list of symptoms, comments, and questions. No matter how "together" we usually are, it's virtually impossible to remember everything once we get to the doctor's office. A very effective way of doing this is to type the list on your computer, leaving space between the questions to take notes. Then print two copies to take with you - one for your doctor, and one for yourself.
Confidence and self respect. Absolutely, good doctors deserve our respect. Just don't forget that we deserve respect too. Headache disorders tend to make us a bit more emotional and a bit less confident. We begin to doubt ourselves. Don't fall into that trap. Just have your information and questions ready. Give and expect respect, and don't settle for less.
A friend or family member. Even with your list, it's possible to forget something you want to bring up during your appointment. It's also terribly difficult to remember everything our doctors say during an appointment. Having someone with us helps with both of these issues.
Hope. Dr. Peter Goadsby put it best when I asked how we can be better treatment partners with our doctors. He said, "Please bring hope... we will provide expertise, and together we will make progress."
What to Ask Your Doctor:
It's probably important to note for this section that I've had some great experiences with doctors and some pretty rotten experiences as well. There were times when I stayed with less than great doctors, but those times are over. I have now "fired" a few doctors too. Don't get me wrong. I respect doctors, but I expect them to both deserve my respect and to return it. So, the first few questions in this section are about how the doctor works with his/her patients and what you want and can expect from the doctor. Not everyone will be comfortable with these questions, so you can, of course, just not use them. They are here because they are questions I always want answered before I decide if I am even going to begin treatment with a particular doctor.
Questions About the Doctor and His/Her Practice:
I'll suggest the phrasing here, but you'll want to phrase these questions in a way that's natural for you, of course.
I want to be active in my healthcare. How do you feel about the team approach where the patient is an active member of their own health care team?
Because I want to understand, not because I question your judgment, I tend to ask quite few questions. Will this bother you?
Will you be the doctor I see every time I have an appointment here? (for group practices)
What's the procedure if I need assistance outside of office hours?
Questions About Migraines / Headaches and Treatment:
What is the diagnosis full diagnosis for your migraines or headaches? (migraine without aura, migraine with aura, sporadic or familial hemiplegic migraine, cluster headaches, tension-type headache, etc.) Keep in mind that a diagnosis of "migraine" is incomplete. You need to know which form(s) of migraine.
If you don't understand what happens in your body during these episodes, and want to know, ask the doctor to explain it.
Are there lifestyle changes you can make to help prevent these migraines or headaches?
If you don't know your migraine triggers, ask your doctor for help identifying them.
If you are diagnosed with migraine, are the episodes frequent enough to consider preventive medications?
Regarding medications being prescribed:
What type of drug is this, and how does it work?
If prescribing more than one drug, what should be taken when, and in what order?
What are the possible side effects? Will they go away? At what point should you call you about any side effects?
What is this drug's potential to cause medication overuse headache (MOH)? If you have already used it as many consecutive days as it can safely be used without risking MOH, what can you take instead?
If nausea is a problem, and the doctor does not offer to prescribe an antinausea drug, it would be a good idea to ask for one. (Reglan, Phenergan, Compazine)
If there has been a significant change in your migraine or headache patterns, and your doctor is not ordering an imaging study (CT scan or MRI), ask about it.
Does the doctor suggest any supplements? If so, which ones and in what dosage?
What about complementary therapies such as aromatherapy, acupuncture, massage, biofeedback?
There are many other questions you may want to ask that will pertain to your individual situation, but this is a beginning. You may want to copy and paste these into your word processing program. That way you can add extra spaces between them and make notes while you're in the doctor's office.
All of this is a lot to take in. Don't let it overwhelm you. You can bookmark this page so you can come back to it, or you can print it so you have it to refer to. To make things a bit easier for you, I've created a free downloadable workbook that has pages for basic medical history, current medical history, and listing medications you're tried in the past for migraine and / or headache. I use these forms myself to save time and ensure that I don't forget things. My doctors love them and are fine when I write "see additional page" on parts of their forms. Download the free Doctor's Appointment Workbook.