If you have frequent headaches and you or your primary care doctor suspects that you have chronic migraine, you may be referred to a neurologist—a doctor who specializes in disorders of the brain and nervous system. Because a doctor will diagnose chronic migraine based on your symptoms and the pattern of your headaches, most of your initial appointment will consist of talking, as opposed to undergoing a detailed physical exam.
Of course, as in almost all office visits, someone will record your blood pressure and weight, and ask about any pain or discomfort you have. The following are a few other things you can expect when you go to the doctor, as well as some steps you can take to make the most of your appointment.
How to Prep for a Visit
You’ll be better able to help your doctor help you if you thoroughly plan for your visit. Juliette Preston, MD, director of the headache center at Oregon Health & Science University in Portland, suggests that you make the following lists and bring them to your appointment:
- All the medications you are currently taking
- Medications that help relieve your headaches
- Drugs you have tried that did not help your headaches
- All of the people in your family who you know have or had migraine; be sure to include the relationship of each to you.
- Things you want to know
Dr. Preston also suggests keeping a headache diary and bringing it to your appointment. It is very helpful for your doctor to know as much as possible about your symptoms—details such as when each episode started, how long it lasted, what you were doing just before it began, and what helped it, as well as what made it worse. Here are a few things to include:
- What you were doing in the days and hours before each episode began; make note of any foods
- you ate or activities you did prior to the attack.
- Any life stresses that increased in the days before each attack, if applicable
- Any symptoms you may have had in the hours before the pain began
In the Exam Room
“At first, we just chat a little, get to know each other,” Dr. Preston says of a typical visit with her. “I’ll want to know what brought you in, about the stresses in your life, what you eat, how well you sleep, how much exercise you get, and what your lifestyle is like.”
Before the visit, Dr. Preston—like many doctors—provides her patients with a questionnaire. If your doctor gives you something similar, fill it in as accurately and with as much detail as possible. This will save time at your appointment, allowing you and your doctor to discuss your information in greater depth and giving you both more time for follow-up questions.
Tests to Expect
Your doctor is unlikely to order many laboratory tests. “Any testing I do is to rule out other things,” says Robert Pearlman, MD, associate professor of neurology at University of Alabama at Birmingham Hospital. “Not often, but in certain cases, I might order brain scans—for example, if the patient never had headaches before and the headaches started suddenly, or if the headaches were accompanied by weakness. These tests would be performed to rule out various things that can cause headaches, like tumors or sinus problems.”
Scans your doctor might order would likely be CT (computed tomography) or MRI (magnetic resonance imaging). But don’t be concerned if your doctor sees no need for brain scans. The likelihood that your headaches are caused by a tumor is slim, and your doctor will know which symptoms indicate that a brain scan is necessary. “Most people who have brain tumors have headaches, but most people with headaches do not have brain tumors,” Dr. Preston explains. So try not to let yourself jump to thoughts of cancer.
Your doctor may order some blood tests in order to check for infection, and in rare cases, may want to examine some spinal fluid, taken by inserting a thin needle between two of the vertebrae in your lower back. This can be done as an outpatient. Like the brain scans, these tests are performed in order to rule out other possible but unlikely conditions that might be causing your symptoms.
Ask Your Doctor…
- What exactly do I have? Be sure that you under stand what your diagnosis is and what it means. “There are over 200 subtypes of headaches,” explains Dr. Preston, “and sometimes people leave their doctors’ offices without knowing their diagnosis or understanding what the diagnosis means.”
- What can I do to reduce the frequency of my headaches? Preventive drugs are designed to lower the number of attacks you have, so ask your doctor if any might be an option for you. Also, ask if there are any lifestyle changes that could help. Dr. Preston recommends avoiding your migraine triggers (alcohol and fermented foods are some common ones) and practicing stress-reduction techniques, such as mindfulness meditation.
- How often will I need to see you? Because migraine is an ongoing illness, you will probably need to see your doctor regularly, so ask how often you should expect to have appointments. Dr. Preston sees her patients every two months until they are stable; after that, they check in once a year to make sure things are still going well and to address any new issues that may have arisen.
- How do I explain migraine to my family and boss? Managing family life and a job is hard enough without needing to manage migraine as well. But it will be much easier if the people in your life understand your illness and what you are going through. Your doctor may be able to give you some tips on how best to explain to others what migraine is and how it affects you.