Visiting any doctor for the first time can be intimidating. Every so often, I encounter patients who are in tune with their body and able to describe rather succinctly what they’re experiencing. However, being able to confidently describe ailments and answer questions about them is no easy task.
As a headache specialist at the Montefiore Headache Center in Bronx, New York, I’ve noticed patients often have difficulty describing their headaches in detail; some may not be sure their pain or symptoms are related to their headache episode, and others may think some symptoms are too ridiculous to mention, fearing judgment.
Because headache disorders are chronic conditions, the goal of seeing a headache specialist is not only to reach an appropriate diagnosis and a successful means of treatment, but also to provide the patient with the knowledge to deal with his or her diagnosis, thereby leading to coping skills and empowerment. The patient, often seen as a victim by outsiders, then becomes empowered and is able to take charge of his or her life.
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
After seeing this difficulty displayed in my office time and time again, I want to share five simple tips that allow patients to make the most of their first visit with a headache specialist. These tips are not meant to encourage self-diagnosis, but rather to promote body awareness and aid in managing headaches. The first visit is the time to take charge of your care, and here’s how to do it:
1. Know your headache.
“Tell me about your headaches.” This can be the most anxiety-provoking question during a visit. Most patients have a difficult time telling doctors what they’re feeling, simply because they don’t know where to begin. Here’s how to approach this question:
1. Who: Who has headaches in your family? Let us know.
2. What: What does your headache feel like? There’s no judgment with the answer to this question — we won’t think any symptom is foolish. Is it throbbing, burning, pressure or stabbing? Describe what you feel, and imagery is always welcome. It’s a powerful descriptor and takes the headache doctor on a journey of relatability.
3. Where: Where in your head is the pain? Where does it start and where does it travel? Feel free to point to areas in your head.
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 weekly pattern?
5. Why: Why do your headaches occur? Let us know whether or not you experience any triggers, such as certain foods, weather, barometric pressure, stress level, lack of sleep, changes physical activity, change in your body positioning or otherwise. If you don’t notice any, don’t worry; time may reveal.
6. How: How does your headache come on? Is it there all of a sudden, or does it start out mild and intensify slowly over time? How long does it last? How often does it occur?
2. Keep a diary.
It’s so difficult to consistently keep a record of headache episodes. I often hear, “So much happens … I just can’t … that’s going to be hard … you mean, while I have a headache?”
In treating headaches, we differentiate whether they’re chronic or episodic. Chronic indicates that 15 or more headache days are occurring in one month; episodic means there are less than 15 headache days in one month. A chronic pattern warrants more intensive therapy. An episodic pattern can be treated as needed. The presence of a diary allows headache specialists to determine appropriate treatment and assess whether treatment is effective (decreasing headache severity and frequency by 50 percent) and whether a patient is transitioning to chronic from an episodic pattern. These decisions are very difficult to determine if no diary is available.
On average, most headache visits occur every three months. That means when you’re at the doctor’s office, you’ll have to recall three months worth of episodes, which can be a harrowing task. Why not keep a calendar and put an X on the days you have a headache? Gone will be the days where you have to 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, 10=severe), or you could write what it felt like. Tech savvy? Download one of the many headache apps available that make recordkeeping a breeze. Go with whatever makes you comfortable.
[See: 9 Tips to Tame Work Stress.]
3. Your past history is important.
There are many factors that contribute to a headache diagnosis. While we rely heavily on how you explain your headaches, your past medical history is also important.
Make a list of your conditions, allergies, surgeries, current and past medications, and family history. You’ll also find that we ask you about your daily life and use of cigarettes, alcohol or recreational drugs. This helps us get to know you better and identify certain risk factors to your headache pattern.
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 read through those records. And 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.
[See: How to Be a Good Patient Wingman.]
5. Come with questions.
The only bad question is the one that’s not asked. So, please don’t be shy. Questions let us know your level of understanding and promote further knowledge growth about your condition. It also pushes your doctor. Yes, we learn from you, as well.
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.
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5 Ways to Make the Most of Your First Visit to the Headache Doctor originally appeared on usnews.com
