VIDEO
Headache Treatments : How to Stop Migraine Headaches
The Health Visitor
Health visitors just deal with mums and young kids so how can she help my migraines?
Health visitors do indeed provide support to mothers with young children. During this time in your life your migraine threshold will tend to be low and you will be vulnerable to migraine attacks. Your health visitor will be well placed to encourage you to think about potential triggers and to suggest changes and support strategies to help raise your threshold again.
My health visitor has been great helping me cope with my new baby. Do you think she could give me advice about my headaches?
Your health visitor is there to offer advice and provide support. She may suggest that you chat to your local pharmacist, see your practice nurse or visit your doctor. She is there to guide you in the right direction so that you can find the right solutions. Having a new baby is hard work and full of new stresses and experiences. If you need help, do ask for it – trying too hard on your own may increase the number of headaches you get.
The Community Midwife
One of the other mothers-to-be in my antenatal class has suggested that I ask the midwife for help with my migraines.
What sort of help can a midwife offer me?
Your midwife is there to monitor your pregnancy and respond to anything that happens that could affect you or your unborn child. Migraine with aura may occur for the first time in pregnancy, and your midwife may suggest that you go to see your doctor or recommend referral to a specialist if new or worrying symptoms develop.
Will the midwife be able to recommend a treatment for my migraine that is safe to use in pregnancy?
Your midwife will be aware of what you can take safely during pregnancy. She will also be able to discuss with you the relative risks involved in taking drugs during pregnancy and balancing these against the risks of not treating certain conditions or symptoms during pregnancy. It is a balance between pros and cons, of risk and benefit, and being active and well.
What will the midwife do if nothing works for my migraine?
Your midwife will suggest that you go to see your doctor if you continue to have problems with migraine while you are pregnant.
Your doctor may opt to refer you to a specialist if none of the acute treatments works or if you continue to have lots of headache days and need to think about prevention.
Who can offer specialist advice?
A new doctor at my health centre is listed as a GPwSI. What on earth is that?
AGeneral Practitioner with Special Interest, or GPwSI, is a doctor who has developed an interest and expertise in a particular area or specialty. For example, asthma or diabetes or heart problems . . . or headaches.
Who can help me?
The GPwSI at my health centre is supposed to have a special interest in headaches. How could he help me?
As a GPwSI who specialises in headaches, he can make a full and detailed assessment of your symptoms, undertake an examination, and decide what type of headache you have. It may be that your headache does not fit neatly in to a single diagnostic ‘box’ but fits partly into one of several boxes. If the diagnosis is straightforward, he will suggest a suitable treatment and management strategy. He will arrange to review you as appropriate.
If the diagnosis is less clear-cut or more complex, the GPwSI may refer you for investigation or send you to a neurologist for further assessment.
My doctor says that he needs to refer me to a neurologist. What is a neurologist?
A neurologist is a doctor who has undergone formal training in neurology – diseases of the nervous system. The consultant will lead a team of doctors with varying levels of experience, all training to become neurologists. They are generally based within secondary care – usually a hospital. Some neurologists have a wide range of interests and are generalists; others develop a sub-specialty interest, such as headache, multiple sclerosis, or Parkinson’s disease.
My doctor wants to refer me to a neurologist at our local hospital. Why should I see a neurologist?
Your doctor is just that, a generalist, not a specialist. A doctor will be able to recognize and diagnose most common headaches. If your doctor is not sure what is causing your headache or feels that there are some symptoms that don’t fit into the diagnostic ‘box’, he will want you to be seen by a specialist. A neurologist will be able to exclude any serious
or ‘sinister’ causes for your headaches, and will be best placed to support you if it is found that your headache symptoms are caused by some neurological condition.
Several of my friends get migraines, too. One of them is seeing a GPwSI and the other has been referred to a neurologist. Is a GPwSI better than a neurologist?
They both have a range of skills and expertise essential in managing and supporting the headache patient. A GPwSI with an interest in headache may be better placed to support a headache patient than a neurologist who is a generalist. A neurologist with an interest in headache is well placed to support headache patients with more a complex headache profile.
My doctor has told me to liaise with the specialist nurse about my headaches. What sort of nurse would that be?
Specialist nurse is a nurse who has detailed skills, knowledge, and expertise in a specific disease area. A nurse who specializes in headache is well placed to support the GPwSI, neurologist and patient from the point of diagnosis to discharge. Specialist nurses have a role in supporting people through complex decisions with regard to treatment and changes in diet and lifestyle.
How can a specialist headache nurse help me?
The specialist headache nurse will be able to support you when making choices about acute and preventative treatments. The nurse is also able to support you when stopping painkillers with a medication overuse headache – always a difficult and challenging time. She will encourage you to make changes in both diet and lifestyle to help your headache symptoms and support you while you are making those changes.
The neurologist at the hospital has said he is going to refer me to a specialist, but I thought he was a specialist. Where is he going to send me?
A neurologist is a specialist in diseases of the nervous system but headache problems can be difficult and complex. There are super-specialist centers, or tertiary centers, where the more complex and rare disorders – in your case, headaches – are diagnosed and managed.
Where can I find out about what specialist centers there are?
The best sources are probably the Migraine Trust and the Migraine Action Association. They both have websites and patient support lines where you can seek out services that are available both nationally and locally. The first step in tackling your headache is making the diagnosis.
The challenge is in trying to make the symptoms ‘fit the boxes’ as closely as possible – and, if they don’t fit, deciding which box comes closest. Every patient is different, and trying to understand your headache is never easy. Taking the history is about listening to your story, understanding your experience and distilling your answers in the hope that your headache fits into one of the ‘boxes’ from a diagnostic perspective.
