“Doc, I’ve got a migraine. Can you help me?”
In February of 2011, I published “Migraine, Its Not Just a Migraine.” In that article, I advised that patients “Don’t underestimate your headache. Don’t put off seeing your doctor. Please don’t learn to live with it or let it control your life. We have excellent treatments for all types of headaches. When you see your doctor, he will want to know the following things in order to help classify your headache and provide proper treatment options.”
Today’s article covers all those other types of headaches. Patients tend to refer to any bad headache as a “migraine.” A migraine is one specific type of headache. According to Wikipedia, the International Classification of Headaches delineates 13 headache groups divided into primary and secondary headaches. Today’s article will focus on headaches in the primary group: migraines, tension-type headaches, cluster headaches, and trigeminal automomic headaches. Headaches caused by cough, exertion and sexual activity, daily-persistent hypnic and thunderclap headaches also fall into this group.
“Doc, I’ve got a migraine” often leads to a wrong diagnosis. The patient’s self- diagnosis is often quoted in the nurse’s intake note as the patient’s chief complaint. When the busy doc enters the room, he is likely to review the nurse’s note and then begin taking his history.
“John, I see you’ve got a migraine. How long have you had the headache?”
“It started yesterday! My whole head hurts.”
At this point, an experienced doc who has time on his hands would take a full headache history and discover that the patient does not have a migraine. A busy doc who has patients waiting to be seen, patients waiting to be called, rounds to make at the hospital, and a family he would like to have dinner with might make the mistake of accepting the patient’s diagnosis, coding the visit as a migraine, and then treating the patient’s “migraine.”
Fortunately, the patient’s headache is likely to get better. Unfortunately, the patient now has a misdiagnosis of migraine which he will carry from doc to doc until someone finally diagnoses his headache appropriately.
Headaches are often complex. Many patients have several types of headaches lumped into one complaint. Proper diagnosis of a headache disorder requires a careful history, both taken by the doctor and given by the patient. Prior to going to your doctor, ask yourself the following questions:
- How severe are your headaches on a 1 to 10 scale?
- How frequent are your headaches?
- Do you have visual changes? Do lights or sounds bother you?
- Where in your head are your headaches?
- What is the quality of the pain? Piercing? Stabbing? Throbbing?
- Describe the onset. Does it build in intensity? Is it sudden and severe?
- What makes your headache worse?
- What makes it better?
- Are there associated changes in your ability to think, speak, feel or move parts of your body?
- What have you taken for your headache?
Share your answers, along with your thoughts, about your headaches with your doc but resist calling it a migraine headache. It may not be a migraine even if you have a long history of migraine headaches. In August of 2011, I published “Your Doctor, the CSI Tech.” Like a good CSI (Crime Scene Investigator), keep an open mind and investigate your headache carefully.
If you have headaches, keep a headache diary. Learn everything you can about your headache by collecting clues. Read about headaches on WebMD and other reliable sources. Once you have collected as much knowledge as you can, see your family doctor. Let your doctor verify the type of headache and discuss treatment options, both for rescue and control. Certain types of migraines may require consultation with a specialist and your family doc will help you find the right consultant.
The resource page at www.lzftc.com has lots of helpful links to reliable medical information. Be happy and live “Wellthy” by conquering your headaches.