How should I best prepare to discuss headaches with my doctor?
February 15, 2013 11:09 AM   Subscribe

I have been experiencing horrible headaches that I believe to be migraines. Any type of exercise (even mild) is the only potential trigger that I am able to identify. Exercise has been an important part of my life, but for the past few years I am not able to enjoy it as much because in the hours after I stop exercising headaches slowly creep in, and I am then sometimes in debilitating pain for 2-3 days.

I have a meeting with a new PCP next week, and I would like to be prepared to discuss these headaches in a way that provides her with as much information as possible and also leaves us with a plan of action for treatment. I have discussed this with doctors before, and I feel like we don't get very far and I don't get any sort of meaningful treatment or advice or things to look out for.

Here are the details that I am currently able to provide:

- The headaches are almost always associated with exercise, but there have been exceptions (like right now!).
- Another possible trigger may be bright sun.
- They are usually centered on the left side of my head, with pain going into the left side of my neck.
- They are throbbing.
- They make me sensitive to light.
- I am sometimes slightly nauseous.
- They usually only respond somewhat (if at all) to 1000mg of acetaminophen or 400mg of ibuprofen. Caffeine sometimes helps, sometimes makes it worse. 800mg of ibuprofen usually helps moderately, for a little while.
- Once they come on, they last all day, sometimes for 1-4 whole days.

I am in so much pain and I just want to be able to live a normal life, but these headaches are seriously crippling!

And, yes, I am drinking enough water.

What other details should I be prepared to discuss? Are there specific questions I can ask that will help me access more effective treatment? Are there specific types of treatment that I should be asking about? Are there specific tests I should be asking about?
posted by TurkishGolds to Health & Fitness (7 answers total) 4 users marked this as a favorite
Be sure to say things like "These headaches last for days and interfere with my normal daily activities. I have had to substantially curtail my life because of this pain. These headaches strongly negatively affect my quality of life."

Also, I have learned the importance of being able to give a complete history: When did these start? How often do they happen? What, if anything, triggers them? What makes them better? Was there another event that happened at the same time as the onset of this problem? Are there any other effects, no matter how weird, that you have noticed along with the headaches?

Lastly, if your PCP seems unresponsive or minimizing, be sure to advocate for yourself. My sister-in-law had persistent disabling headaches for months that her PCP kind of blew off, and they turned out to be caused a brain tumor. (NB: She is fine. It was a freak case. You probably do not have a brain tumor.) Be vigorous in pursuing care, because you have to live with the results.
posted by KathrynT at 11:35 AM on February 15, 2013 [3 favorites]

It will be helpful for your PCP if you have some sort of migraine diary. WebMD has a good example here(PDF warning).

One symptom question your provider may ask is if you have any auras or other visual symptoms during or prior to a headache. Family history may ask be asked, so it's worth asking your family about that ahead of time.

Actually now that I look at it the WebMD migraine center is surprisingly comprehensive, much better than the usual "you have cancer!" cliche. Main page is here and a list comparing medications is here. The layout is crappy but the info is good. Hope that helps! Migraines can be maddening to deal with.
posted by Wretch729 at 11:44 AM on February 15, 2013 [2 favorites]

I recently had my migraines re-evaluated in order to participate in a migraine drug study. I would tell the doctor you are concerned about the headaches and also that you are concerned they are migraines.

I think you have a pretty good list going on up there. Aside from what has alrwady been mentioned, here's what the study doc asked me about, in case it helps you:
-He asked about my experience with aura, though I don't typically have aura. For example if I have any blurred vision or flashing lights or anything.

-He looked into both of my eyes and up my nose.

-He asked me about my prodrome period, as that is sometimes the most annoying/longest part of the migraine for me.

-He asked about nausea/vomitting and sensitivity to light/sound.

-He asked me to describe my pain (i.e., I always get them in my left eye, feels like an ice pick in my eye).

-He asked if my pain was relieved by laying down/moving around, relieved by hot or cold compresses, etc.

This was at a pretty well regarded headache clinic. I would suggest that if you aren't happy with the answers your PCP has for you, to ask for a referral to a headache center or a neurologist.
posted by Katine at 11:47 AM on February 15, 2013

From a previous AskMe about what to ask your doctor at an appointment:
Mr. Know-It-Some's comment based on Jerome Groot's How Doctors Think:
[To] prompt the doctor to apply his or her knowledge and skills as effectively as possible...[Groot] suggests asking questions like:
-What else could it be?
-Is there anything that doesn't fit? and
-Is it possible I have more than one problem?
Also, yes, seconding the advice to be clear that the pain is interfering with your daily activities and your life in general. Lots of people (I do it too) tend to downplay the level of pain they feel because they don't want to seem like wimps, but the doctor needs to know just how much it is interfering with your life. And from your description, it is definitely interfering with your life!
posted by hurdy gurdy girl at 11:55 AM on February 15, 2013 [3 favorites]

There are some amazing new(ish) migraine drugs out there that can stop a migraine dead in its tracks. I'm not saying they're right for you by any means, but if you've never tried anything other than over-the-counter pain relief, you should be optimistic that there are several well-established medicines to try. They are not pain relievers, but work by reducing swelling in the blood vessels in your brain, among other things.
posted by Ausamor at 12:17 PM on February 15, 2013 [2 favorites]

I used to get horrible migraines (that magically went away when I developed Crohn's Disease, but that is neither here nor there) and there are great treatments to help them now (Imitrex, Relpax, Maxalt, for example).

Don't worry too much about trying to pinpoint exactly what causes them if it isn't making itself obvious. I was never able to figure out what triggered mine, but the aforementioned drugs worked wonders when nothing else ever touched the pain.
posted by stefnet at 1:31 PM on February 15, 2013

I would strongly suggest keeping a headache diary (I give these to almost every headache patient I see). You are clearly articulate enough to be able to describe your symptoms clearly and it is obviously the doctor's job to take a history. However, history taking is a skill (and a particular skill for taking headache histories) -if you have not had much luck with primary care previously it may be worth getting a neurology opinion. The thing that you will not be able to clearly express fully without a diary (because nobody can) is the precise frequency, severity, analgesic use, etc etc and this is very useful, both for determining extent of the problem and particularly for monitoring response to treatment. It may be worth thinking about your aura, if you have one, as people sometimes find this hard to describe.

You clearly have migraine from your description. Dependent on the frequency acute treatment may be sufficient, but you may need prophylaxis. You could take a prokinetic antiemetic (such as domperidone) with the ibuprofen (reduces nausea and improves analgesic absorption). Alternatively the doctor could try a triptan. Combinations of non-steroidals with triptans are even more effective as acute treatment. If the headaches are frequent (certainly if you are at a stage of taking analgesics more than 1-2 days a week) you should be on prophylaxis - taking analgesics more than 2 days a week tends to exacerbate and chronify migraine, and with frequent migraines it is obviously better to prevent the migraine than treat it once it has occurred. There are a lot of options for doing this, and the choice will be dependent on your particular case.

(fwiw I am a neurologist)
posted by inbetweener at 4:29 PM on February 15, 2013 [3 favorites]

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