When patients come to their primary care physician with a headache, it’s not always diagnosed as the migraine it is, according to Cristina Wohlgehagen, MD, a neurologist at Texas Health Presbyterian Hospital in Dallas.
Here are 6 things Wohlgehagen would like primary care physicians to know and consider about patients with migraines:
1. There’s no harm in referring to a headache specialist
Wohlgehagen acknowledges that physicians are more pressed for time than ever before. Many of her migraine patients come to her after having suffered for years without finding the right treatment.
“I take the stance of, if you have a migraine, see a headache specialist. Why not start with the person who knows from the get go?”
2. Create a migraine questionnaire you can give patients
However, she realizes that many physicians will try to tackle the headache problem themselves, and so she recommends that physicians have a standard headache intake questionnaire that can be filled out if the patient reports chronic or severe headaches.
“A lot of the people coming to a doctor and saying, ‘I have headaches’ actually have migraines, which is easier to treat than the average person thinks,” she says.
The questionnaire can ask such questions as whether the headache is associated with light and sound sensitivity, whether nausea or food aversion accompanies it, as well as listing the frequency and severity of them. If the patient meets the criteria for migraine, then the physician can refer out to a specialist or attempt treatment.
3. Offer preventive medicines
Wohlgehagen finds that many of the patients who come to her were never offered migraine preventive medications by their physician, which she feels is a missed opportunity, especially for younger people. When offering medications, Wohlgehagen urges physicians to stick to those that are migraine-specific for symptomatic treatment and to counsel patients to treat early in the course of the migraine attack. It is okay to redose but limit use to 9 days per month. Consider offering preventive medications if a patient has more than 2 or 3 headaches a month. Antidepressants, antiepileptics, and antihypertensive medications can help with migraine prevention.