The Migraine Research Foundation has released updated lists of doctors certified in headache management, including a list of doctors who treat children. Anyone can hang a shingle saying they are a headache specialist, even without any special training. MRF’s lists only include doctors who have passed a certification exam verifying their knowledge of headache medicine. Check out this excellent resource if you’re looking for a specialist to treat your (or your child’s) migraine or headache disorder.
Do you ever feel like taking a triptan only delays the inevitable? After three days in a row in which I noticed major tooth sensitivity (my current reliable prodrome symptom) and taking naratriptan within 30 minutes of its onset, a migraine has walloped me upside the head (pun intended). The attack is as bad as they get these days (knock on wood) and I’m completely wiped out. While the pain is only a level 4, I feel like my bones are made of wet dishrags and my mind is as muddled as the mint in a masterful mojito.
As I understand the science, triptans do, in fact, abort migraine attacks and each subsequent attack is a separate entity. But as a chronic migraineur, it doesn’t seem like that’s happening. Instead, I wonder if I would have gotten this migraine attack out of the way if I’d not taken the naratriptan Tuesday (and Wednesday and Thursday). Forget the fact that the weather is changing today and that I haven’t slept well all week. And that The Doctors’ description of TheraSpecs was spot on and the TheraSpecs site had great traffic yesterday, thus relieving my anxiety and potentially triggering a “letdown migraine.” These don’t factor into my superstitions.
As I think myself in circles, I wonder how many headache specialists grasp the magnitude of the mental and emotional aspects of migraine. Even though they aren’t trained to help us deal with these components, they should be aware of how deeply migraine affects not only our physical state, but our mental and emotional well-being as well. If I ruled the world, every headache clinic would employ therapists who understand migraine’s reach and can equip migraineurs with a toolbox to manage the non-physical parts of migraine.
I write this from a mental fog, so please excuse me if this meandering post makes no sense. I think it contains at least one important nugget of information, but I won’t know for sure until I re-read it after this migraine passes.
Getting in to see a headache specialist can take months and the appointments are never long enough to ask all your questions. Could group medical appointments be a solution that allows patients to spend more time with their doctors as well as learn from other patients? The motivation behind shared medical appointments is to “ease physician shortages, and reduce patient and doctor dissatisfaction over constantly feeling rushed during appointments.” The idea is a little off-putting at first, but patients with a variety of medical conditions — and their doctors — are finding great benefit in such appointments (according to news articles, at least).
A group visit can have as many as a dozen patients and last for as long as two hours. Every patient is asked for his or her concerns and can ask questions and provide input to other patients. The doctor acts as a facilitator and answers questions, often covering more topics than they could in a shorter visit. A physical exam, if necessary, is still done in private. Studies indicate that patients treated in groups actually have better outcomes than those who see their doctors in traditional appointments.
These appointments sound like a hybrid doctor’s visit and support group with the added benefit of a trained medical professional who can correct misunderstandings. Unlike a support group, I doubt there’s much exploration of the emotional burden and quality of life issues associated with illness. It would, however, introduce patients to others with similar struggles in their geographic area, thus possibly promoting support groups that gather spontaneously. It might also bring home to doctors just how much an illness impacts their patients’ lives.
I wonder how it works for patients who are in different stages of their treatment. Would a migraineur who has tried dozens of preventives benefit from being in a group with someone who had only tried two, and vice versa? I’m not ready to give up my one-on-one time with my headache specialist just yet, but the idea of a group visit is fascinating.
Would you attend a group medical appointment, whether for migraine or another illness? If you already have, what did you think and would you do it again?
Have a question for a headache specialist? Robert Cowan, MD, director of the Stanford Headache Clinic and a lifelong migraineur, wants to answer them. Submit your questions by 5 p.m. Pacific time on Friday, March 8, by tweeting with the hashtag #AskSUMed or commenting on the Scope blog post: Ask Stanford Med: Director of Stanford Headache Clinic taking questions on headache disorders.
Stanford Medicine asks that you follow these ground rules when submitting a question:
- Stay on topic
- Be respectful to the person answering your questions
- Be respectful to one another in submitting questions
- Do not monopolize the conversation or post the same question repeatedly
- Kindly ignore disrespectful or off topic comments
- Know that Twitter handles and/or names may be used in the responses
The pain is too bad for me to write much, but I wanted to be sure you all saw this excellent story from The Daily Mail. The Doctor Says You’re Just Stressed. But Could it be More Sinister? addresses that doctors often dismiss migraine and other conditions as “just stress” and advise patients to relax. The best part? This quotation from Dr. Giles Elrington, a neurologist and director of the National Migraine Centre in England:
“If I had a pound for every patient I see who is told their headache is down to stress, I’d be a rich man. Saying headaches are just down to stress won’t do. While stress, or the let-down period after stress, can trigger migraine attacks, it occurs in only 10 per cent of cases.”
Did you catch that? Stress is a factor in only 10% of migraine attacks. I’m not sure how the influence of a particular trigger can be calculated, but I like the man’s conclusion.