Phillip A. Bain, MD
Preparation for a headache evaluation ideally involves at least these activities:
- Keeping a headache calendar.
- Thoroughly answering a number of general health and headache related questions.
- Filling in a headache related disability survey such as MIDAS or HIT-6.
- Asking family members about their headaches.
- Doing background research on headache using resources considered to be reputable such as American Headache Society.
If you experience significant headaches that interfere with your work or family/leisure activities, don’t “go it alone.” Most recurring headaches may not be curable, but, with treatment, they can be controlled to reduce their frequency, severity, and impact on your life. You owe it to yourself to seek medical help.
To maximize your chances of getting better, there are many steps that you can take before, during, and after you meet with the medical practitioner.
Step 1: Find a practitioner to manage your headaches.
To start the process, schedule an office visit specifically to talk about your headache condition. Confirm that the provider evaluates and treats patients with headache. If he or she doesn’t, either seek the advice of a headache-interested practitioner in your area, ask your provider for a referral, or find an American Headache Society (AHS) member healthcare professional.
Step 2: Prepare for your office visit.
Realistically, you may have 15, at most 30 minutes to discuss your headache condition. This is especially true if you are seeing a primary care physician, so it’s important to be prepared. Preparing for each of these activities is detailed below.
First, take time to organize the details of your headache history. Maintain a headache diary for at least one month, preferably more, to track the frequency of your headaches, their intensity, and whether or not they interfere with daily activities. Note if they are related to your menstrual period, if applicable, or if they fall into a specific pattern. There are a number of good, free, headache diary apps for smartphones that can make tracking your headaches easier.
Second, prepare answers to the following questions:
- When did they start and has there been any recent significant change?
- How often do they occur? Include any headache at all as well as moderate or severe headaches.
- How long do they last if untreated?
- What is the time from onset to peak pain/disability (in minutes or hours)?
- How disabling are the headaches? E.g. what do they prevent you from doing?
3. Warning Signs
- Do you have any signals that your headaches will occur soon, such as visual zigzag lines, dark spots in your vision, etc?
4. Associated Symptoms
- Do you have nausea/vomiting, and/or light/sound/odor sensitivity with your headaches?
5. Family history
- Do other members of your family get similar disabling headaches?
6. Past non-drug efforts
- Have you been treated by someone or done something on your own to treat the headaches?
- What was done?
- What helped?
- What didn’t help?
- How often do you use an acute pain reliever per month for any purpose?
- What medications do you use or have you used for headache (preventive and acute) and other conditions?
- What worked?
- What didn’t?
- What were the dosages used and how long did you take each?
8. Previous tests
- Have you ever had a brain CT or MRI?
- When was it done?
- What were the results?
Third, consider taking a headache disability quiz. You can find the Migraine Disability Assessment (MIDAS) test here. You can obtain the HIT-6 at http//www.headachetest.com. You will have to sign in at the HIT-6 site. This information, along with answers to the eight questions, will help give your practitioner a clearer idea of what type of headaches you suffer from and how much they affect your daily activities.
When you make your appointment, ask the receptionist if they have a specific headache history form for you to complete before you arrive.
Fourth, headaches are usually genetic—that is, they can run in families. Find out if there is a history of headache in your family. Sometimes, family history will help clarify what types of headaches run in the family, when they started, and what possible triggers may be related to your headaches.
Last, do some background reading on the AMF website (simply follow links from the home page),or read one or more of the many helpful books on headache. The Women’s Migraine Toolkit, by Marcus and Bain, Conquering Headache—An Illustrated Guide to Understanding Treatment & Control of Headache by Rapoport and Sheftell and Conquering Daily Headache by Rapoport, Sheftell, Tepper, and Blumenfeld are a few that can provide you with important information about headaches.
Taking these steps is worthwhile also because the more you know about your headache condition, the better equipped you’ll be to treat it effectively.
Depending on the diagnosis, the plan may involve preventive medications if your headaches are frequent and/or severe.
For treatment of the acute headache, your provider will often prescribe a medication for nausea (e.g., metoclopramide), followed by a medication for the headache pain.
He or she may also recommend a rescue or backup medication for the times when the first line agent isn’t completely effective.
It is important that you understand what your medications are for and how to take them.
Based upon the initial evaluation, your practitioner should set up a follow-up appointment to assess how the program is working. The timing of this session will depend on the nature of your condition. Continue to update your headache calendar, and record your progress with sleep, exercise, and any relaxation techniques used. Keep track of how effective the medications are, and note any side effects that you may have encountered. Also, record headache days and don’t forget to bring it to the visit.
Step 3: Prepare your plan in writing
Before you leave the office, it is helpful to have a check list to make sure you have all your questions answered and have all the information you need to help manage your headache condition. For example, during your office visit you may write down important information and compare it to this check list to make sure you have no unanswered questions.
- What is your specific headache diagnosis?
- What is the treatment plan including a list of specific medications and lifestyle changes?
- How often should these medications or treatments be taken (daily or weekly)?
- How do the medications work and what should be the expected outcome after taking them?
- When should you come back for the next office visit?
- What should you do if the medication is not working or you do not like the medications?
- What are some signs or symptoms that the medications are not helping?
- What level of success can I expect from the medications?
By working with your physician and developing an organized strategy to treat your headaches, you can significantly improve your headache pattern and decrease the impact headaches have on your family and work life. By being prepared for your headache-related office visits, you can make your time spent with your provider much more efficient and increase the chance of success.
-Phillip A. Bain, MD, FACP, Dean Health System, Madison, WI