You have an upcoming new appointment to see a neurologist or headache specialist. Whether you are going to be seen soon or sometime in the future, or whether you are already tapped in and have a follow-up visit coming up, why not get prepared? Below, I’m sharing with you the best ways to get the most out of your visit, a topic that I originally dove into for a 2017 U.S. News & World Reports article I wrote entitled: 5 Ways to Make the Most of Your Visit with a Headache Doctor.
TIP #1: Know your headache
“Tell me about your headaches?” This is one of the most anxiety-provoking questions asked during a visit. Where do you even begin? Here’s how to approach this question:
1. WHO: You will be the star of the visit, but who else has headaches in your family? I (we) want to know!
2. WHAT: What does your headache feel like? Is it throbbing, burning, pressure, or stabbing? Describe what you feel. No need to sugarcoat the details. Let it flow out.
3. WHERE: Where in your head is the pain? Does it start in one place then travel to another? Point it out.
4. WHEN: When does your headache occur? Does it wake you up at night? Does it come on at the end of the day? Is there a seasonal or specific daily or weekly pattern? What is the relation to the menstrual cycle?
5. WHY: Why do your headaches occur? Let me know whether you experience any triggers, such as certain foods, weather, stressors, sleep irregularities, physical activity, changes in your body positioning, or otherwise. If you do not notice any, don’t worry; time may reveal.
6. HOW: How does your headache come on? Does it appear suddenly, or does it start out mild and intensify slowly over time? How long does it last? How often does it occur?
Tip #2: Keep a diary
Let me explain the importance of a diary and then tell you how to do it easily.
In treating headaches, we specialists determine whether they are chronic or episodic. Chronic means that 15 or more headache days are occurring per month; episodic means there are less than 15 headache days per month. A chronic pattern warrants more intensive therapy. An episodic pattern in most cases can be treated as needed. The presence of a diary allows headache specialists to determine appropriate treatment, assess whether treatment is effective (decreasing headache severity and frequency by at least 50%), and whether a patient is transitioning to a chronic from an episodic pattern. These treatment decisions are very difficult to determine if no diary is available.
On average, most headache visits occur every three to four months. This means when you are at the doctor’s office explaining elements of tip #1, you will have to recall three-to-four months’ worth of episodes. I have full faith that you can, but can you accurately dig deep? I would not be able to.
How to easily keep a diary.
Why not keep a calendar and put an X on the days you have a headache? Gone will be the days where you must dig deep to remember. With this method, there are no approximations; your headache days will be concrete, making management decisions that much easier. It’s a win–win all around.
My suggestion of an X on the calendar day is just that. Your headache diary is what you make of it. You can even use numbers to indicate severity (1=mild, 2=moderate, 3=severe), or you could write what it felt like. Tech savvy? Download one of the many headache apps available that make record keeping a breeze. Go with whatever makes you comfortable. Of note: the headache episode is not only signified by pain. There can be other symptoms such as fatigue, brain fog, dizziness, etc. Tracking of these symptoms can all be part of the diary.
Tip #3: Your history is important
There are many factors that contribute to a headache diagnosis. While specialists rely heavily on the responses from tip #1, we also believe that your past medical history is important.
Make a list of your conditions, allergies, surgeries, current and past medications, and family history. You will also find that in this section we will ask about your daily life, smoking habits, alcohol, and recreational drug use. This helps us get to know you better and identify certain risk factors to your headache pattern.
Tip #4: Gather your records
Have you been treated by another doctor or headache specialist? Come with your records or know how to access them from other facilities (you can ask your previous doctor or contact the medical records department). You will likely need to sign a medical release form, which gives your headache specialist permission to receive those records. Also important, if you’ve had any brain imaging done, check with the radiology department to have them placed on a CD to bring to your first visit.
Tip #5: Come with Questions
“Doc, I have a stupid question.” The only stupid question is the one that isn’t asked. So, please don’t be shy! Questions let us know your level of understanding and lead to further knowledge about your condition. It also pushes your doctor, too. Yes, we also learn from you!
Keep these five tips in mind as you prepare for your first visit. Follow-up visits benefit greatly from this information, too. Let these tips be the building blocks to better understanding between you and your headache doctor, thereby leading to great therapeutic options and essentially, results.