VIDEO
The Practice Nurse
My doctor has said that I can contact the practice nurse for advice. How can she help me with my headaches?
The practice nurse will be able to offer you advice and support through the diet and lifestyle changes that you need to consider. Change is always difficult and support can be hard to find. Nurses are skilled in supporting patients through this process, and raising your headache and migraine threshold is crucial in getting back in control. Some practice nurses have more knowledge about headaches than others. If they do have some experience with headache problems, they will be able to clarify some or all of the information given by your doctor. The role of a practice nurse rather than a specialist nurse is of a more general nature.
I have been given a triptan by the doctor for my migraine and he has suggested I see the practice nurse for review. What will the nurse do or want to know?
The nurse will want to know how well your treatment has worked, in order to be certain that you have found the best treatment for you. She will want to assess how the treatment has worked so that, if necessary, she can help you think about what else you might try.
The sorts of questions she will need to ask include:
• Did the triptan work quickly?
• Were there any side effects?
• If there were side effects, were they tolerable?
• Did the headache go away and stay away?
• Could you have taken your triptan any quicker?
• Would you like to try using a nasal spray instead of a tablet?
• Would you like to try a different triptan?
Should you try something such as ibuprofen (anti-inflammatory and painkiller) or domperidone (to help with sickness) with your triptan?
I’ll be working with the practice nurse to get my migraines under control. Can she prescribe anything for my migraine?
The best treatment for migraine is a triptan. The nurse will not be able to issue a prescription for a triptan but will be well placed to make suggestions or recommendations to the doctor.
The practice nurse has given me some diary cards to use but I don’t see how they can help. The main reason for using diary cards is to see just how many headache days you have, assess what symptoms you get with your headache, work out how long your headache lasts and see how effective your treatment is. It may seem like a chore filling in diary cards but it is a useful way of seeing what is happening to your headache symptoms over time. It can offer useful information or guidance on what options might be appropriate from both an acute and a preventative perspective.
My doctor has given me some diary cards to use and told me to see the nurse for review. What will happen during that review session?
The nurse will use the time to determine how many headache days you have had in each month, and see how well your treatment works. Recording the time of the attack as well as the range of symptoms you experience will help plan new treatment options and combinations of treatment. The aim is to be headache-free at two hours with no recurrence of symptoms in the next 24 hours.
The nurse will use your diary cards to monitor how many headache days you have and to see how these change over time if you are using preventative treatment. The goal is to try to reduce the total number of headache days by at least 50%.
My practice nurse has given me some diary cards to use but there does not seem to be much space to record what I eat and drink. Is it worth making my own cards as well? There are lots of different sorts of diary cards available.
Diary cards can be a useful tool but I am always reluctant to use them as food diaries. Headache is one of those situations with just too many variables to be able to offer you useful or even useable information. I feel that it is more helpful to focus on positive steps such as having regular meals and drinking lots of water rather than documenting everything you eat and drink.
For more information on food triggers, having seen my doctors, I’m now to see the practice nurse for ‘review’. How often should I aim to see the nurse?
There are two aspects to the review process. The first is about seeing how effective your acute treatment is, and the second is to assess your response to preventative treatment.
Acute treatments are assessed after three attacks have been treated. If the response is slow, incomplete or associated with too many side effects, alternative drugs or drug combinations can be suggested and then reviewed in due course. You will continue to go for review until you have found an acute treatment that suits you. The aim is to be headache-free in two hours, with no recurrence of symptoms within the next 24 hours.
Preventative drugs are usually assessed every three months.
The number of headache days you have had is counted, and a dose increase suggested if your response is deemed unsatisfactory and few or no side effects have been experienced. You will keep filling in your diary cards until there has been an improvement in the number of headache days you experience or you have reached the maximum dose of the drug or the side effects you experience prevent a further dose increase.
I am seeing the practice nurse for her to check on how I’m getting on with the treatment. Will she eventually send me back to the doctor?
The nurse will send you back to the doctor if and when she has run out of options to try. If you find an effective acute treatment, the doctor does not need to see you. If you find a preventative drug that dramatically reduces the number of migraine attacks you have, you will only need to see the doctor when it is time to stop taking them.
