Doctors, Treatment

What Do You Think of Your Doctor?

I need your input. I’m forever being asked what I know about particular headache specialists or clinics. I know the ones I’ve seen and that’s about it. You’re the expert on what you’ve experienced. Please share your opinion by commenting on the doctor who treats your headaches.

Fine print: You may identify the doctor or clinic by name, but be nice even if you didn’t think much of the doctor. You can point out what you disliked without trashing the person. Please keep in mind that people have differing opinions about particular doctors. I will delete inappropriate comments.

Doctors, News & Research, Society

Doctors Paid to Prescribe Generic Drugs

Health insurers have provided doctors with financial incentives to prescribe generic medications, according to an article in yesterday’s Wall Street Journal:

Health plans are drawing scrutiny for offering financial incentives to entice doctors to prescribe cheaper generic medicines, including paying doctors $100 each time they switch a patient from a brand-name drug.

Pharmaceutical companies have long gone to great lengths to try to get doctors to prescribe their brand-name pills. They spend billions of dollars, plying physicians with samples, educational lunches and speaker fees. But as the patents for a growing number of blockbuster medicines expire, some health insurers are trying to trump those perks with bonuses or higher reimbursements for writing more generic prescriptions.

The idea, health plans say, is to save everyone — patients, employers and insurers — money. And many doctors argue that it’s only right to reimburse them for spending time evaluating whether a cheaper generic alternative is better or as good for a patient.

Thanks to Dr. Christina Peterson of Migraine Survival for the heads up.

Chronic Migraine, Coping, Diet, Doctors, Treatment, Triggers

Kerrie’s 2007: A Year to Forget

There was a theme consistently underlying my 2007 posts: My migraines were BAD. The year started with five months of being woken up by a migraine nearly every night and ended with more than two months of horrendous all-the-time migraines. I felt more beaten down than I have in the last three years.

Before you get discouraged by the following review, know that I am more optimistic about treating my migraines than I have been since I got my occipital nerve stimulator in December 2003. (Read more on that following the treatment review.)

Acupuncture
I revisited acupuncture, but my superhero acupuncturist told me that more sessions would be a waste of time and money.

Naturopathy/Homeopathy
Shedding tears in the naturopath’s office the first time was enough to keep me from seeing her again. Against my hard fast rule that I not take anything I can’t identify (which I also broke with the acupuncturist), I took the homeopathic remedy, vitamin D and magnesium supplements she suggested. They did nothing.

Chiropractic
I gave the chiropractor two months, which she said was the maximum time to see results. I went five times one week, four the next, three for a couple weeks and so on. Turns out I hold my adjustments very well. Unfortunately my migraines didn’t changed and having my neck adjusted freaked me out. Once she stopped asking about my headaches, I knew she had given up.

Sleep Specialist
Many people with treatment-resistant headache disorders become much more treatable once they have sleep problems resolved. Although my sleep seemed fine, I saw a sleep specialist with a background in neurology. Sadly, my sleep is practically perfect. I sleep eight hours, wake up rested, nap when I need to without having it interfere with that night’s sleep.

New Headache Specialist
I saw a new Seattle-based headache specialist in May. We hit it off immediately. Too bad we focused on my blog, headache patients in general and clinical trials. I left enrolled in a clinical trial for Lyrica (which I quit) and with a potential advertiser for The Daily Headache, but without having discussed any of my questions or other treatment options.

Food Trigger Diets
Food triggers were my obsession, even though I’ve always thought them to hog the spotlight in headache treatment (only about 25% of people actually have food triggers).

Although wheat and dairy aren’t considered headache triggers in the general sense, they were my target for months. My no-dairy foray lasted six weeks — until I discovered that I’d dropped 12 pounds in that time. Testing wheat lasted three months, yet I had no ill-effects when I reintroduced it.

After a couple years of avoiding them, I’m almost positive that beans, nuts and legumes are triggers for me. But berries, squash, sunflower and soy oil, barley, pineapple, onions. . . are all questionable.

I declared that I was going on a drastic food trigger elimination diet. A couple weeks later came this post: Drastic Elimination Diet for Migraine Triggers: What Was I Thinking? You get the point.

Myofascial Release
Finally some good news. In August I started myofascial release and noticed results quickly. The changes aren’t dramatic, but each treatment usually gives me some relief. The effects have never lasted more than two days — and sometimes only a couple hours — but I’m not complaining.

Craniosacral Therapy
Two sessions weren’t enough to judge if craniosacral will be effective. I’ll definitely try again, but it just didn’t work out this time. The woman I saw was wonderful and spent an extra 30 minutes with me each visit. Unfortunately, driving to her practice takes 30 minutes. After spending 20 minutes lost on the way there and another hour on the way home, the negative associations were too strong for me to go back.

What Now?
When the last migraine spell lifted in mid-December I remembered how good I could feel. Thinking about what I love about my life was no longer a reminder of what I couldn’t have, but of how wonderful it truly is. I am happy and getting out of the house more. I even get to see friends!

This year’s list of treatments to try is as long as it was last year. Its like I’ve spent the last 10 years whittling down possibilities and arrived at the most promising therapies. Having had this faith shattered in the past, I am cautious. Nonetheless, I’m positive a brighter path is ahead.

Books & Products, Diet, Doctors, Treatment, Triggers

Why “Heal Your Headache” by David Buchholz Infuriates Me

I remember just how angry Heal Your Headache: The 1-2-3 Approach for Taking Charge of Your Pain makes me by the impassioned responses I get whenever I mention the book. I know David Buchholz’s treatment approach is effective for a lot of people. I am truly happy for them. Buchholz’s snarky attitude and shaky underlying evidence is the problem.

His conviction that that people who “fail” with his approach likely don’t follow it to the letter or are attention-seekers is offensive. And, oh yeah, he dismisses scientific research that he doesn’t agree with and blames other doctors for making themselves not believe in food triggers.

Perhaps Buchholz would label me as someone whose migraine and chronic daily headache result from a “hidden agenda.” Having a blog about it probably makes it look like my identity is so tied to migraine that I can’t possibly be “healed.” Sorry, folks, but I’d be thrilled to stop blogging because my migraines stopped sucking the life out of me.

Ignorance is his explanation for why most doctors don’t believe in a headache trigger diet:

The impression of most doctors that dietary modification doesn’t work to control headaches is based in part on misunderstanding and in part on misuse of the dietary approach. Doctors generally share their patients’ failure to recognize the important role of dietary triggers and are therefore unequipped to educate their patients appropriately.

Guess what happens? It’s yet another example of how low expectations preordain headache treatment failure (p. 72, non-contiguous paragraphs)

A few pages later, he explains why the scientific studies of food triggers aren’t true:

The failure of most of the few scientific studies that have looked at migraine dietary triggers to demonstrate a clear effect is a good example of the limitations on science in identifying truth that is otherwise obvious. Try telling a headache suffer who has had killer headaches after eating chocolate or drinking red wine that it’s all in his or her imagination. (p 77)

Can you say “false attribution”? How many people swear off a certain kind of alcohol after one horrendous night? Tequila itself isn’t the cause, but the person’s association of tequila with alcohol poisoning! The consistent lack of a clear effect in studies could be that there’s no effect. High school biology provides that lesson.

I even have food triggers, albeit none have been identified through an elimination diet, so I don’t disagree with him entirely. His poorly argued claims are unprofessional and condescending. Too bad many people overlook this because he is affiliated with a famous hospital. I know how desperation for relief drives can drive you to put faith in any treatment. While this one isn’t physically harmful, internalizing such criticism can be even more damaging.

See The Migraine Diet: Judith Warner & “Heal Your Headache” for context.

Doctors, News & Research, Patient Education, Resources, Society, Treatment

Is Your Doctor in Touch With Current Research?

Being an informed patient sometimes means feeling like you know more than your doctor does. Sometimes this isn’t just a feeling, but a fact.

In Why Doesn’t My Doctor Know This?, Dr. Kent Holtorf explains that “. . . [T]he overwhelming majority (all but a few percent) of physicians (endocrinologists, internists, family practitioners, rheumatologists, etc.) do not read medical journals. When asked, most doctors will claim that they routinely read medical journals, but this has been shown not to be the case.”

I don’t want to believe this statement, but with schedules crammed tight and overwhelming paperwork, it’s no surprise that some docs can’t keep up on all the research in their fields.

So the patient must step in. If you read about new study findings, look into more yourself. Many of the news articles will parrot each other, but dig around for the study abstract for more details. If the study is only of people with migraine with aura, and you don’t have auras, there’s no indication that you will benefit from the treatment in the article.

Don’t just bring in an article and ask, “What can you tell me about this?” Take concrete questions to your doctor. Does this treatment apply to you? Have other studies supported its findings? If your doc can’t answer your questions right away, ask that he or she get back to you.

If your doctor doesn’t act on the information, don’t assume that he or she is lazy or unwilling to work with you. One study does not prove a treatment is effective, future studies frequently contradict previously published research, or the approach may not be right for you.

However, if you feel like you are frequently stonewalled, being disrespected or not adequately treated, there’s always the option of shopping for another doctor.

[via We Are Advocates]