Headache Help (7 page)

ACCEPTANCE

If you’ve suffered from headaches for years, it may help to accept the fact that you have this condition, and that there is no magical cure but that headaches can be managed and treated. Acceptance (but not resignation) will help relieve anxiety. By accepting your condition, you will no longer think “What have I done wrong? Can I find a cure? Why can’t this just be cured?” Rather, your thoughts may be, “I have this condition; I need to keep informed, track my progress, and adjust my strategies. Don’t give up. Headaches can be managed.”

T
O TREAT YOUR HEADACHES, KEEP THIS MOTTO IN MIND
:

PATIENCE
   
PERSISTENCE
   
PERSEVERENCE

3

Being a Good Health Consumer

A
LTHOUGH
the self-help techniques in the previous chapter are useful, they may not be powerful enough to control many of your headaches. If you get chronic or severe headaches, it is wise to discuss with a doctor how to manage them and to get prescriptions for medications to treat and prevent the more severe ones.

How effectively a doctor can help you control your headaches, however, will depend a great deal on your relationship with the physician. If communication is poor, even an effective strategy will be doomed to fail. In headache treatment, finding the right combination of medications and figuring out the correct dosages takes time and mutual cooperation. Choosing the right doctor is essential. This chapter will help you:

• Prepare for a doctor’s visit.
  
• Determine what to look for in a doctor.
  
• Learn to be a good healthcare consumer.
  
• Learn how to best communicate your headache and associated problems.
  
• Learn how to help the doctor most effectively help you.
  

BRING YOUR HEADACHE CALENDAR TO YOUR APPOINTMENT

As we discussed in Chapter 2, having a calendar that charts a series of previous headaches will be extremely useful to the doctor in analyzing what triggers your headaches and determining the type of headaches you get. If you haven’t already done so, start a headache calendar as soon as you decide to see a doctor.

CHOOSING A DOCTOR

Ironically, many of us have learned to be good consumers of appliances or automobiles, investing much time, energy, and research comparing brands, energy uses, rebates, and so on, yet relatively few of us have learned to be good healthcare consumers.

For years, consumers took a passive role, subordinate and childlike, in their relationships with their doctor. The patient blindly accepted doctor’s orders without question. Yet in this age of healthcare reform, the doctor-patient relationship is becoming more balanced. Consumers need to take more responsibility to inform themselves about their condition and to track their own case and medical history. Also, as a medical consumer, you now have more rights than ever—the right to understand treatment and alternatives fully, to assess the potential benefits and risks of each alternative, and to get a second opinion.

Many physicians will treat headaches, yet not all are up-to-date about the latest techniques in headache management. To assess a doctor’s knowledge about treating headaches, you might:

• Ask a nurse in the practice what percent of the doctor’s clientele are headache patients.
  
• Ask several local physicians to recommend the best headache specialist in the area.
  
• Ask the doctor how effective the treatment should be in relieving the pain.
  
• Ask about the doctor’s strategy in treating your type of headache.
  
• Ask about the doctor’s availability after you leave the office if you have problems with a medication.
  

Here are some warning signs that should alert you to the need to see another practitioner. The doctor:

• Treats your headaches purely as a psychological problem.
  
• Minimizes the importance of your pain or expresses any doubts about your pain.
  
• Discourages you from bringing or presenting a prepared list of questions.
  
• Has inappropriately low expectations for satisfactory relief.
  
• Does not fully discuss with you possible risks and side effects of new medication.
  
• Does not create an open environment in which you feel free to ask questions and express your needs, anger, and fears.
  
• Prescribes pain medication, such as Demerol or codeine, without trying a medication that aims to treat the root of the headache mechanism, such as serotonin imbalances and blood vessel changes.
  
• Does not encourage you to call if you experience unpleasant side effects or ineffective relief, or to schedule a follow-up visit in several weeks.
  

Although going to your family doctor for headache treatment may be adequate and appropriate for you, going directly to a neurologist who specializes in headaches, particularly if you think you need a comprehensive approach to your headache treatment, may save you a lot of money, time, and irritation in the long run.

If you fear that your doctor is less than fully knowledgeable about headaches, consider asking for a referral to a neurologist or a headache expert. You might say that you believe the doctor to be an outstanding internist, but every internist can’t be expected to know the latest treatments for every condition. You might add that you’d like to take advantage of the recent strides in headache management, an emerging subspecialty, and state-of-the-art treatments that you understand are now available.

To ask for a second opinion, you might say, “I feel uncomfortable asking you this, but since this illness is so important to me, I need to obtain whatever information I can. I don’t doubt your opinion. It’s just that I need reassurance that this is the way to go. Do you have a colleague you might recommend for a consultation?”

Remember, you are the customer and need to be assertive about your own medical treatment. Free referrals can also be obtained through the headache associations listed in Appendix A.

HOW DOCTORS DO HEADACHE WORKUPS

When consulting with a doctor for headaches, be prepared to give a full medical history in as organized a way as possible. Chances are that the doctor will give you a form to fill out, similar to the “Headache Intake Assessment Form” at the end of this chapter. Note that this form includes the pain scale we’ve discussed earlier and potential headache triggers. Use your headache calendar to fill out such a form, or attach it to the form. Before you consult with the doctor, think about how you can best describe your pain. Consider the following:

• Is your pain one- or two-sided? Where about the head does it hurt (location of pain)?
  
• What’s the typical pattern (frequency and duration of pain)? What’s your headache history?.
  
• Is there a time of day or month when your headaches are more likely to occur?
  
• What are your suspected triggers? Does exercise, exertion, fatigue, a certain food, or alcohol bring on or aggravate the attack?
  
• Do you have an aura (visual warning), tingling, or sense of numbness before a headache?
  
• Does anything make your headache worse or provide relief?
  
• Does your headache pattern change with your menstrual periods? Did it change during pregnancy?
  
• What medications do you take for headache? How frequently? What helps? What doesn’t?
  
• What other medications do you take?
  
• What’s your family’s history insofar as headaches are concerned? (This question can be problematic, as many older people forget that they had headaches decades ago.)
  
• How do headaches affect your daily life? work? family? social life?
  
• What are your patterns concerning recreation? stress reduction? How do you experience stress (in your jaw, back, head, or elsewhere)?
  
• What are your past illnesses, allergies, experiences with different kinds of medications?
  

DESCRIBING PAIN

Be as specific as possible in describing the nature of the pain. One or more of the following may apply.

• piercing
  
• aching
  
• throbbing
  
• crushing
  
• boring
  
• burning
  
• pressing
  
• dull
  
• squeezing
  

Rate your pain severity as shown in Chapter 2, from 1 (very mild pain) to 10 (excruciating).

The doctor will listen to your heart, take your blood pressure, and test your nervous system through your reflexes, eye movements, and coordination. If you have a long history of migraine, tension, or cluster headache attacks that usually follow the same pattern, the doctor will be able to ascertain your problem and may not suggest a head scan, although such a test may be recommended for the legal protection of the doctor. A physician could be vulnerable, for example, if a chronic headache patient ever developed a brain tumor (which would be totally unrelated to these headaches) and the court challenged the decision not to obtain a test.

Nevertheless, in assessing your headaches, the doctor will need to eliminate the possibility of serious, though rare, physical problems as the root cause of the headaches, such as sinus disease, meningitis, glaucoma, brain tumor, bleeding in the brain, fluid on the brain, stroke, high blood pressure in the brain, and so on. The doctor may ask you seemingly strange cognitive questions, such as “Can you list the months of the year backward?” or other questions to test your memory, judgment, and ability to reason. These are not psychological evaluations; rather, they are used to evaluate whether any particular area of your brain is especially affected.

Although a full medical history and physical exam can eliminate many suspicions of more serious physical problems, the doctor may also prescribe one or more of the exams in the following list.

USEFUL TESTS FOR DIAGNOSING HEAD PAIN

• M
  AGNETIC RESONANCE IMAGING SCAN
  (MRI)
  A noninvasive procedure, the MRI allows the doctor to detect any serious causes of the migraines in the brain. While the MRI feels very claustrophobic and is expensive, it involves no radiation and is extremely sensitive in picking up any problems in the head.
  
• C
  OMPUTERIZED AXIAL TOMOGRAPHY
  (CAT
  SCAN
  )
  Also called a brain scan. This procedure can provide information on the sinuses and potential tumors or strokes. An injection of contrast dye into the arm may be necessary.
  
• S
  INUS X-RAY
  Although an MRI or CAT scan provides more detailed information, a sinus x-ray is much less expensive.
  
• S
  PINAL TAP
  Also called a lumbar puncture. This test is occasionally performed to assess certain nervous system conditions by evaluating the spinal fluid. It can cause a headache a few hours later. It is not necessary for most headache patients.
  
• E
  YE PRESSURE TEST
  Also called intraocular pressure testing. An ophthalmologist does this procedure to rule out glaucoma.
  
• B
  LOOD TESTS
  These tests can check for a variety of medical conditions, some of which may contribute to headaches, such as an abnormal thyroid.
  
• E
  LECTROENCEPHALOGRAM
  (EEG)
  This procedure records the electrical patterns in the brain, which can provide valuable clues to the brain’s functioning. This test is painless and safe and can be particularly helpful in assessing posttraumatic (concussion) headaches.
  

THE RESPONSIBLE PATIENT VERSUS THE “GOOD” PATIENT

You have a choice: you can be passive and just accept a doctor’s recommendations even if they prove ineffective; ignore the doctor’s advice and continue to suffer in silence; or discuss openly with the doctor your concerns, even though such a discussion may be uncomfortable, and ask for a change in treatment. Some people try to be “good” for fear that the doctor will otherwise view them as “difficult.” They try not to complain, ask too many questions, or admit that a medication didn’t work. Yet many treatment failures are beyond anyone’s control, and most doctors expect them in some patients.

Being a good patient doesn’t mean being an easy patient but a fully responsible adult working with the doctor as a partner and not undermining his or her recommendations. As a patient, you must work to understand the problems and complexities of your case, be knowledgeable about your condition and about the medication you are going to try, and understand the strategy that your doctor is using for your headache pattern.

Your doctor can be most effective when you either follow the recommendations or explain why you didn’t. Yet only half of pa tients actually comply with their doctors’ recommendations. Worse yet, some patients don’t even tell their doctors they didn’t comply. Little is gained if you go to your next appointment without having followed the strategy discussed at the previous meeting; all the time between the appointments is lost. Speak up or follow up by phone if you do not agree, do not understand, or have trouble following a recommendation. If you can’t follow the doctor’s recommendations, for whatever reason, call the office to make an alternate plan. Also, if you inconsistently or incorrectly take your medication, or take other headache-related medications at the same time without the doctor’s knowledge, you can hamper treatment. The doctor can’t know how to proceed properly if you didn’t use the first-choice treatment rationally and correctly. Only if you communicate well can the doctor explain the treatment, or modify it, depending on your reaction.