Your appointment with your Physician or Headache Neurologist

Communication: Making Sure You Have Success

  • Addie Peretz, MD, Robert Cowan, MD
    In this article, we will discuss how to make the most of your visit with your practitioner. We will help you prepare to see your doctor and understand the things you should know when you leave the doctor’s office.

Checklist Prior to Your Visit:

  • Write down what you want to talk about BEFORE you go into the office—come with a plan.
  • Keep a headache log as the bedrock of communication.
  • Bring in a list of the medications you have tried for pain and let the doctor know what worked and what did not work.
  • Arrive on time for your appointment to ensure that you have a full visit.

What You Should Know When You Leave Your Visit:

  • Have a Treatment Plan:
    • What to do WHEN you get a headache.
    • What to do to prevent headaches from happening.
    • Side effects to be aware of with any new medications.
    • Know the ground rules with your provider.
    • What is an emergency and what to do when there is one.
    • Whether to call or email to ask and get questions answered.
  • The Appointment

    Many patients feel like a deer in the headlights when they go in to see their healthcare provider. Often there is a lot going on and too little time. As a result, sometimes patients leave the doctor’s office more confused than when they came in. This article should help you avoid that lost feeling and help ensure that you get the most out of your appointment.

    Come to Your Appointment With a Plan

    Studies have shown that most doctors will frequently interrupt their patients. Sometimes, you have to be a bit firm to make yourself "heard." It is best if your appointment begins BEFORE you step foot in your provider’s office. Jot down notes about the issues you want to talk about.

    A headache log can be a good way to give your provider a sense of your headaches. In your headache log you should write down how often your headaches happen, how painful they are, how long your headaches last, and whether your rescue strategies are working. Some people also write down things that seem to trigger their headaches. There are many headache log apps available, including Headache Diary Lite, Headache Diary, iHeadache. If you prefer not to use an app you can always jot down when you have headaches in a calendar.

    In addition to a headache log, it is also helpful to write down a list of what you have tried in the past to make the headaches better. It is particularly helpful if you can tell your doctor what medications you have tried for headaches in the past. Telling your doctor what you liked and did not like about medications you have previously tried can better help them figure out a treatment plan that is right for you.

    Leave With a Written Treatment Plan

    Studies report that patients remember only a small part of what they are told during a visit with their provider. It is a good idea to write down information or ask for a written treatment plan. What should a treatment plan include?

    Every treatment plan will be different, but most should include:

    • What to do when a headache starts?
      • Should you take the medicine right away or wait and see how it goes?
    • It can be useful to score how bad the pain is on a scale of 1-10 (with 1 being minimal pain and 10 being unbearable pain). For instance, when my headache is a 6/10 (different people will have a different idea about what a "6" is, but you should know what yours is) then that’s when I take medication. You should discuss when to take medicine with your provider.
    • How long should it take for your medicine to work?
    • What should you do if your treatment is not helping? i.e. What is your rescue plan?
    • What else can you do to help decrease the pain besides taking medications?
      • Could a dark quiet area for when you have a headache or removing bad smells, flickering lights, or loud noises help manage your headaches?
    • If a trip to the Emergency Room or Urgent Care is part of your treatment plan, what medicines would be best (and what medicines should be avoided)? It is always good to have a plan from your provider when you go to the ER.
    • Know the Ground Rules

      Ask your provider what is the best way to communicate with him/her. Is the method the same for both routine questions and in an emergency? It is best to find out early in the relationship to avoid misunderstandings.

      1. What to do in an emergency Most healthcare providers have a system set up to help in emergencies. But sometimes providers and patients have different ideas about what is an emergency. Most would agree that a headache unlike any headache you have ever had in your life is an emergency worthy of a call to 911. This is very true for sudden onset, severe and more than momentary pain.
      2. What is not an emergency Most would agree that refills should be requested during office hours addressed with a phone call to the pharmacy or the office
      3. Ongoing Communication Have a clear sense of what to do when you need advice, and how best to communicate with your healthcare provider. Some providers are using e-mail for routine non-emergency questions and communications. This method may have a 24, 48, or 72 hour turn-around response time. Others prefer a phone call to the office and a call back.

      Conclusion

      Having an open and effective relationship with your healthcare provider is essential for good headache care. Like all relationships, it often comes down to good communication. Make sure that your provider knows what you want to get out of your visit. Make sure that you have a clear plan when you leave the office. These simple but important actions will help ensure that you get the most out of your relationship with your provider. 1

      Patient adherence and compliance

      reviewed by Dr. Christine Lay (Toronto, ON), Dr. Werner Becker, (retired) neuroscience professor, (Calgary, AB), Dr. Paul Cooper (London, ON)

      Dr. Dawn Buse, psychologist in headache treatment (New York) defines patient adherence and compliance as terms used to describe a patient's role in their medical care. Compliance specially refers to a patients' ability to follow instructions from their physician. Although it is the physician that provides medical advice and prescriptions, it is the patient who ultimately chooses if, when, and how to implement that advice. 2

      Adherence - Adherence is a preferable term in headache care because it refers to collaboration between the patient and the HCP. The patient plays a vital role in the success of his or her headache management. While an HCP may provide medical advice and prescriptions, it is the patient who ultimately chooses if, when, and how to implement that advice. 3

      Compliance - Compliance typically refers to patients following recommendations from their health care provider. Patients who are "non-compliant" are usually unable to comply due to the cost of treatment, side-effects or other reasons. It is important for patients to be open with their Health Care Provider (HCP) about the reasons for non-compliance so they can be addressed. 4

      A Very Brief Appointment With Your Physician or Specialist (So Come Prepared)

      Generally, a visit to a headache neurologist (specialist) is roughly 30 minutes in length, and in many cases even less time. Therefore, it is extremely important for the patient to come prepared, be on time, and to "write down" your questions for your physician - remembering to ask advice about applying "self care strategies" for when you are experiencing a headache, while at home.

      A published study by neurologist and researcher Dr. Richard Lipton shows that, in the United States, the average consultation time for migraine is just 11 minutes. 5

      Thinking faster than we speak

      Dr. Phil McGraw - psychologist

      The famous psychologist Dr. Phil McGraw claims that we "speak" at roughly 125 words per minute, while we "think" at around 1250 - 1400 words per minute. 6

      This means that when headache patients are responding to their physicians questions or concerning about their headache pattern - it is natural for the patient to be" thinking" at a much faster rate, than speaking when it comes to responding to questions the doctor will have. Many patients will experience jumbled thoughts in (what seems like) a very compressed time-frame. Add in some nervousness, anxiety, and a possible migraine, and it is no wonder why some patients can leave their appointment, saying silently to themselves," I forgot to mention this, or that".

      One method that some patients have used with some success is to write down the questions at home, beforehand, during a coffee when you are more relaxed. 7

      How to deal with sceptical doctors

      Dr. Stephen Silberstein and Dr. William Young

      There is nothing more frustrating than to visit a physician’s office for help, and to feel a sense of rejection from a sceptical doctor. On the one hand, you need to respect physicians very tight schedules - while on the other hand, you can ask yourself "was I clear in my characterization about my headaches, and associated symptoms? "

      You need to accept, and possibly alter anything that affects your treatment strategy. While keeping in mind that physicians are extremely busy, and may not have the time to answer all of your questions. This further cements the notion that prior preparation and education is so very important! 7

      In the following table, I have listed a few warning signs that you should be wary of - in terms of a sceptical doctor.

      Table 5 - Sceptical Doctor Warning Signs

      • if the physician maintains a confused, or puzzled look when you are explaining your symptoms
      • if the physician replies "you have to learn to live with it
      • your physician cuts your appointment short, and immediately suggests a pain medicine (keep in mind they have a schedule to keep)
      • you are honest and admit to ingesting excessive amounts of Over-the-Counter pain medicines - and your doctor does not recommend an alternative treatment 8

      Navigating Between Professionals and the Role of Testing

      There is nothing more frustrating than waiting months to see a physician, only to have them make a referral to another specialist. To you and me, this might appear as a tactic to "wash their hands of the problem". What your physician may not have the time to explain to you is that other specialists are often trained in "other" areas (eg. behavioural issues, neck problems, structural issues like aneurysms, blood clots), psychiatric disorders or sleep specialists, etc. So referrals are often in your best interest.

      When a test is ordered it is generally recommended to "rule-out" any structural abnormalities, like tumours, aneurisms, etc. There is no test available to confirm whether you have migraine, tension-type or cluster headache; these diagnoses are made on the basis of your symptoms and the results of your physical and neurological examination in the office. 9

      How to Find a Good Headache Doctor

      The two most successful methods toward finding a headache Neurologist are 1) receive a referral from a family physician, 2) to receive a referral from a headache charity - by phoning them, emailing them or by locating a physician from their website 3) if you suspect Chronic Migraine access the My Chronic Migraine website, then search for a specialist by province or postal code.

      Click here for a direct link

      When talking to another migraine sufferer, you can also inquire about a specialist's name -remembering that headaches are very individualistic and certain medicines might respond to your friends migraines; yet do absolutely nothing for your migraines. Patience and perseverance are needed so that a successful outcome can be attained. 10

      REFERENCES

      1. Peretz, A ,MD and Cowan, R, MD, Communication: Making sure you have success - 2018
      2. Patient Compliance, Adherence - interview - Dr. Christine Lay - updated by Dr. Werner Becker in 2018
      3. American Migraine Foundation, adherence definition, 2018
      4. Compliance definition: Dr. Paul Cooper, headache neurologist, London, Ontario, 2020
      5. Migraine Again, A very brief appointment - 2018
      6. Dr. Phillip McGraw, Thinking faster than we speak - 2018
      7. Silbertsein, S. and Young, WB - Migraine and Other Headaches, 2004 - How to deal with sceptical doctors
      8. Migraine and Other Headaches, 2004, Adapted - Sceptical doctor warning signs - Table
      9. Lucas, B - with medical edits Dr. Cooper, P. - Navigating between professionals and the role of testing, 2020
      10. MyChronicMigraine.ca - How to find a good headache doctor - 2019

Find-a-Headache-Doctor
Click a province on the map above
or the list below:
 
   British Columbia
Alberta

Saskatchewan
Manitoba
Ontario
Quebec 
New Brunswick 
   Nova Scotia 
Prince Edward Island 
Newfoundland / Labrador
Northwest Territories 
Nunavut 
Yukon Territories
       

The book Chronic Daily Headache features
an article reviewed by a Headache Neurologist
entitled "Why Some Headache Patients do
not Improve"!