How to Talk to Your Doctor
Trainers - Could you talk about how to work with your doctor, what would be helpful for people to know...

Dr. Bernstein - Well, I think the main thing that you need to try to remind people is to be really careful observers of their headaches. That is the starting point. They need to be very concise, about the headache in terms of how often, character of the pain, what sets it off and what makes it better. And if they really sit down and think about it, they can almost come up with their own diagnosis, certainly if they are that concise and good at observations their doctor can. You know if you ask somebody "What gives you a headache" and they sort of half jokingly say it's my kids and my job they are not quite joking. They have thought about it. They know. To make that observation is just a real important point. If they say their headache occurs very distinctly twice a month around their hormone changes, you know, mid cycle, premenstrual is an important point. That is a very good observation. They get nauseous and throw up and have to wear sunglasses for two days, boy it is pretty clear cut what this headache is. The talk about headache wrapping around their head and it is just squeezing their head, there is a pressure and a bomb going off inside their head all the time, that is a very good observation. It's really clear what that headache is. The headache that is there all day every day is important, if the headache is there once a month, that is clear. If the headache lasts for 30 seconds. You know people have 30 second headaches...they get these jabs and jolts. They get this electric shock shooting up one side of my head and it goes away and I get it a couple of times a week and I have had it for 6 months. It's good to tell people its not an aneurysm which is what someone else thinks they have. But, they have a pinched nerve. It is equivalent of banging their elbow. When they turn their head a certain way they get this electric shock. Okay that is very reassuring. Sometimes it gets lost in the translation when the patient describes it.

The other really important point is to be really honest about all the pills you are taking. I just can't emphasize that enough. That people forget about OTC analgesics. Advil doesn’t count, Excedrin doesn’t count. They don’t tell you about the herbs, they don't tell you about their vitamins. Some of those skin creams interestingly enough aggravate headaches. So, some of the acne creams the retinols and some of the cosmetics, A and D kinds of creams can cause headaches. If you are using a lot of skin creams, a lot of acne medicine, and think 'it's just skin cream it doesn't count,' it does matter. You have to be aware of anything that you put into your system. And then it goes back to their other habits. How many 6 packs of coke do you drink in a day? How much nutri-sweet do you consume in your diet? Do you skip lunch, do you skip dinner, do you skip breakfast? Do you eat one meal a day and fill it up with coffee in between? Those are all important points.

In making a diagnosis the physical is 2% and the history is 98%. History is the observations of the person's headache. How much the doctor can drag out of you in a short visit. But the most important thing in teaching your doctor about your headache means you have to be very precise in describing it. Don' t make your own diagnosis. Don't say 'My migraine is'... That may set the whole process going in the wrong direction. The reality is 'My headache is' and go from there. Basically those are the issues.

Trainers - Do you find that people are more forthcoming?

Dr. Bernstein - No, I have to drag it out of them.

Trainers - So they don't come in able to give you this information until you ask appropriate questions and point them in that direction. Do you think that is what they should look for in a neurologist or physician, somebody who will take that tact, do you think that is common... is that the patients responsibility?

Dr. Bernstein - It's their responsibility. Most headache care is not through a neurologist. Most headache care is through their primary care doctor, who don't have all the headache care background...well they know headache care generally but the reality is it is the person with the headache that needs to be the observer. Most adults are pretty good, if you really dig they come up with the answers. Teenagers are impossible. Teenagers go well 'sometimes this, sometimes that'. You get this incredible here, there everywhere response from teenagers. You have to really point it out like 'here is the calendar and here is what I want to know'. We are doing a study right now with Zomig and teenagers as there are no approved headache drugs for teenagers.

Some of them are wonderful. Some of them are real clear observers. But some have real trouble keeping track. YOu have to spend a lot of time pinning them done on frequency, intensity and does it interfere with their activities.

One of the key markers for us has been disability. That is when people start to take their headaches seriously is when it causes disability. If they are missing work, school, cancel plans...then they are willing to work with us. Until that happens they are much more likely to be kind of free-wheeling, just popping more pills, two more Excedrin here two more there, did you miss any work? nah, did you miss any of that, no, my stomach sure hurts. It's when they get their bleeding ulcer and have to stop their Excedrin and or they really start missing work. Then they are willing to work with us a whole lot more. In fact that is the screening question to see if they should be in a headache program or not. We tried a 10 question and a 5 question questionnaire. We finally settled on 'Do your headaches cause you any disability at home, work or school?' If the answer is yes then we have a marker to access whether our program is successful. Does your disability go down? We measure that. Then they have a marker to focus on.

Fortunately most people with headaches self-treat and they self-treat very successfully. Two Excedrin really does work. Ten doesn't. Self care is fine. Until it causes a disability. Then we get their attention. --