Talking To Your Headache Doctor
Good medical care begins with good communication

Accurate and open communication is the beginning of good medical care. This is especially true for headache patients, because a correct diagnosis depends almost entirely on information the patient gives the doctor. Unfortunately, both doctors and patients can fail to express their thoughts clearly and accurately. Doctors may not clearly explain their diagnosis and treatment recommendations. Patients may not clearly express their fears and concerns about their headaches. Patients may also be so anxious that they don’t hear or understand what their doctor is telling them. Doctors often complain that they simply don’t have enough time to deal with all of the questions many patients ask. Unfortunately, patients may react by thinking that their doctors are ignoring their needs and concerns.

Often, what doctors say is very different from what patients hear. For example, a doctor trying to reassure a patient that her headaches aren’t caused by a serious problem might say, “You don’t have any serious medical problems.” In response, the patient might think, “Oh no! Everybody thinks I’m faking my headaches. I can’t even find a doctor who takes me seriously.” Or, if the doctor explains that migraine is a condition caused by abnormal blood vessels in the brain, the patient might think, “Oh no! My uncle died of a burst blood vessel in the brain.”

There is even a difference between what patients want most from their doctors and what doctors think patients want from them. A study has shown that what patients want most from their doctors is a willingness to answer questions and a willingness to teach them about their treatment. On the other hand, doctors think that what matters most to their patients is headache expertise and understanding and compassion.

Both you and your doctor need to communicate clearly to effectively treat your headaches. Here are some simple steps you can take to improve your communication skills so your concerns are expressed and your needs are met.

1. Stay focused on the most important questions.

When you are first discussing headaches with your doctor, you will be asked many questions about symptoms, other illnesses, family history, and headache triggers. It takes a long time to answer these questions, but the information your doctor obtains is very important for reaching a correct diagnosis and recommending effective treatment. Don’t try to get all of your questions answered during the first visit. Decide what you need to know at this visit and what questions can be saved for a later visit.

2. Learn as much as you can about your headaches.

It’s important to understand your diagnosis. Ask your doctor directly, “What’s causing my headaches?” You should understand, though, that you may not get an answer during your first visit. Modern medicine is very good at figuring out what you don’t have. With headaches, it is often more difficult to figure out what you do have. Headaches are diagnosed by matching your headache description to typical headache patterns. When your headache pattern is not typical, this can be difficult. Your doctor may need to review old tests, order new tests, or confer with a colleague. Even if you don’t receive a specific headache diagnosis, this doesn’t necessarily mean that your headaches are caused by something serious or are not treatable. You can help by understanding as much as possible about headache types and what causes them. On the other hand, if you don’t describe your symptoms accurately, it might delay diagnosis. If, for example, you say your headaches come back several hours after treatment when you really have rebound headaches (which are caused by medication overuse), proper diagnosis and treatment might be delayed.

3. Share your concerns and reactions.

Don’t be afraid to rephrase what your doctor has told you to be certain you have understood it correctly. Doctors find it much easier to answer direct, specific questions like, “Do you mean to say I have a serious disease of the blood vessels?” Or, “I don’t think I’m depressed; I’m just very frustrated with these headaches, but my family doesn’t take me seriously.”

4. Learn as much as you can about your treatment plan.

Headache treatment can be complicated. Acute care medicines cannot be taken more than a few days per week, while preventive medicines must be used daily in order to work. Acute care medicines are taken to stop a headache that has already started, while preventive medicines are taken every day to prevent headaches from recurring. Some doctors will have their nurses explain medication instructions to you. Many patients find written instructions to be most helpful, so feel free to ask for them. Remember, you can also ask your pharmacist to answer any questions about your medication that weren’t answered in the doctor’s office.

5. Build an open and trusting relationship with your doctor.

Successful headache treatment depends upon an open relationship with your doctor. That relationship will be built over time. Your goal should be to have a few important questions answered during each visit, knowing that there will be future visits for addressing additional concerns.

Both doctor and patient need to learn how to convey clear messages to each other. As a patient, you can help your doctor respond more clearly by asking direct, specific questions and making certain that you understand the answers.

What you should expect from your doctor
Duckro PN, Richardson WD, and Marshall JE.
Taking control of your headaches. How to get the treatment you need.
New York: The Guilford Press, 1995

Best doctor I ever had said straight out he knew nothing about CH, so I should sit down and tell him all.

Bob's right, communication is vital, and it can't be a one-way street in either direction.