How Doctors Determine Migraine Treatment Plans

Stewart Tepper, MD, of the Geisel School of Medicine at Dartmouth, talks about how doctors determine migraine treatment plans

Migraine treatment varies from patient to patient. There is no universal method for managing the condition, which is why it’s important to team up with a medical professional like a headache specialist to determine a viable migraine treatment plan.

But what goes into these plans? Stewart Tepper, professor of neurology at the Geisel School of Medicine at Dartmouth, spoke with us about how professionals craft these strategies—and shared some tips for patients on how they can help.

What doctors consider

According to Tepper, a lot has to be established in order to create an effective treatment plan. “There are a number of considerations that we have to take into account right from the beginning,” he says. “Once you have all of that lined up, then the person receiving care and the provider can make a decision together.”

Tepper notes that some things to consider are migraine frequency and severity, as well as the level of disability they create for the patient. This will help to determine whether acute and/or preventive treatment is right for the patient. Tepper also points out that another factor to include when devising a migraine treatment plan is the presence of vascular disease, which can limit a patient’s options in terms of medication.

“All of that is done at the very first visit, when you, the patient—together with the provider—are trying to pick a reasonable and reliable way to terminate these attacks moving forward,” Tepper says.

What your doctor might ask you

The easiest way for a physician, neurologist or headache specialist to create a treatment plan is with you is to provide the professional with as much information as possible. They need to see the full picture, and to do that, they may ask you a number of questions.

Here are some questions, among others, you should expect your doctor to ask:

  • How quickly do your attacks peak?
  • How many of the attacks are morning migraines?
  • How many attacks are already full-blown by the time you’re seeking out a solution?
  • Are you nauseated? When and how bad is nausea?

The answers that patients provide to these and other questions will help create a starting point for providers as they determine the best way to move forward with treatment. Some strategies can be ruled out from the get-go, and others could possibly point to the most effective plans straight away.

How you can help

A lot of information is required when determining an individual patient’s treatment for migraine. Doctors will know what questions to ask, but the patient’s perspective is critical in getting the whole story. The patient has key first-hand experience with their headaches that can help better inform how to proceed with treatment.

Tepper says that a headache diary can be very useful in helping treatment efforts by organizing a patient’s symptoms and experiences.

“I always want to look at what people bring in,” he says. “From my standpoint, I don’t think there’s such a thing as too much information in a diary, but from your standpoint as a person with migraine, you may really just want the bare bones: frequency, severity, duration, drugs taken, and triggers if you know them. Menstrual cycles are also good things to record.”

While the entire process of building a treatment plan may seem like a lot to consider, working with a healthcare professional on personalized migraine treatment guidelines may help to alleviate some of the burden patients with migraine face—and even expose them to new preventive treatments. “In my professional career, there’s never been a more hopeful time for people with migraine,” Tepper says of new developments in the field.

The American Migraine Foundation prides itself on giving patients with migraine the means to get the help they need. To find a professional who may be able to create your treatment plan, visit our interactive Find a Doctor tool. For more information about migraine treatment, visit our Resource Library.