People who have migraines often don't talk to their doctors about their headaches, but it's an important conversation to have. Just starting the communication is the first step toward getting ahead of your migraines, and how you talk to your doctor about your migraines is as important as broaching the topic in the first place.
Here's what to say and how to say it.
Spell It Out
It's the details that make the difference, says Dr. Brian M. Grosberg, director of the Hartford HealthCare Headache Center in Hartford, Connecticut. There are many types of migraine headaches, all of which are treated differently. "I want to know about your attack profile," he says.
When you talk to your doctor, he or she may ask you these questions to get a better idea of how your migraines are triggered and how they affect you:
- Do your migraines come with nausea or vomiting?
- Does the pain build up gradually or come on suddenly?
- How long do your headaches typically last?
- How old were you when your migraines started?
- How often do your migraines occur?
- What's worse: the pain or the nausea?
- Does anyone else in your family get migraines?
- Do you experience aura or vision changes right before your headache?
- Do things that aren't normally uncomfortable (like wearing your hair in a ponytail or glasses on your nose) become uncomfortable during your migraine? (This is called allodynia.)
Write It Down
The best way to make sure you give your doctor all of the relevant information is to come prepared.
"Bring a headache diary with you that tracks your migraine history for a month," says Dr. Richard B. Lipton, director of the Montefiore Headache Center in New York City. This can be done with pen and paper or on your smartphone. Apps are available to make it even easier. Two examples of free apps: iHeadache, for Apple devices, and Migraine Buddy, with both Apple and Android versions.
Your diary should include any possible triggers, which differ from person to person. Some common triggers to consider include sleep loss, missed meals and stress. Others may include weather changes, bright lights, different odors, alcohol and certain foods, according to the American Migraine Foundation. Women should include details on their menstrual cycle and how, or whether, it aligns with migraine frequency or severity. Be as specific as possible in your logs because identifying a pattern will help your doctor understand your migraine headaches, Lipton says.
This information is important at the time of your initial diagnosis, but it's equally important throughout your treatment. Your headache diary can help your doctor get a handle on whether your current migraine treatment plan is working as well as it should be if you also log the medications you took, the dose and whether they worked. For example, "if you are using rescue medicine eight to 10 days of the month, you may need a preventive therapy," Lipton says.
Describe It Well
Migraines hurt, and your pain level should be noted in your migraine diary and during your conversation with your doctor, but how they affect your functioning may resonate more with your doctor, says Lipton.
"Instead of saying, ‘Oh, I had a migraine yesterday, and it was an agonizing—11 out of 10 on the pain scale,' say, ‘I had a headache yesterday and had to leave work early or couldn't take care of my baby,'" he says. This will give your doctor a much better idea of how migraines are affecting your life, Lipton says.
That information is important. More than 90 percent of people who get migraines say that the headaches interfere with education, career and social activities, the American Migraine Foundation says. A study published in the April 2016 issue of Mayo Clinic Proceedings found that about half of the participants with migraines had missed at least one family activity per month because of a migraine.
Honesty counts a lot when you are talking to your doctor about your migraines. Your headache doctor can't help you if you don't provide all of the relevant details. This includes your current therapies, including prescription, over-the-counter and natural remedies; any psychological history; and information on use of alcohol or illicit drugs, the National Headache Foundation emphasizes.
Some specific questions to ask your doctor include:
- What is my specific migraine diagnosis?
- What is the treatment plan?
- How often should these medications or treatments be taken?
- What are some possible side effects of migraine medicine?
- When will I know whether my treatment plan is working?
- When should I follow up with another appointment or call?
- Are there lifestyle habits I can change?
There's a lot of information to absorb, and it can be hard to take everything in during your doctor's appointment. It may help to take notes or bring a close friend or loved one with you to the visit.
The Bottom Line
Migraine is a chronic condition and it may change over time, so it's important to find a doctor who listens to you and takes your migraines seriously. You should never feel rushed or blown off during your appointments. Your doctor should follow through on coordination of treatment, give you feedback and educate you, the National Headache Foundation says.
"If your headaches are progressing in frequency or severity and you are worried, you should feel comfortable calling your doctor," Lipton says.
The bottom line is to be prepared, detailed and honest when talking to your doctor about migraines and not to be afraid to ask questions if something is not clear.