VIDEO
Headache Treatments : How to Control Migraines Naturally
What the specialist headache nurse needs to know and why?
The specialist nurse is there to assist and support you in your understanding of your symptoms, diagnosis, and treatment.
Your nurse is there to provide you with the information you need to make your choices and decisions, to allow you to get back in control of your headache symptoms, no matter how long it takes.
There are currently only a few such nurses in the United Kingdom, so these questions could be asked by your doctor or your practice nurse or even friends and family after you have seen the specialist.
Do you understand what the specialist has said to you?
The nurse wants to make sure that you do understand what the provisional diagnosis or options are. The nurse also wants to be sure that you understand the strategy that has been suggested or outlined. The nurse will want and need you to feel involved and engaged in the process in order to give you back control of your headache symptoms.
Do you understand the diagnosis?
The biggest hurdle in diagnosis is the concept of medication overuse headache. Many people find that the diagnosis of migraine, cluster headache and other similar headache types are much easier to come to terms with than the diagnosis of medication overuse headache.
Let’s talk about your meal patterns.
The nurse needs to understand how you eat during the day in order to offer you advice on what could be changed. Small changes can make big differences.
What sort of drinks do you have?
What you drink is as important as how much you drink. The nurse will spend some time going through the detail before making suggestions that might help you to raise your migraine threshold.
What sort of changes are you ready to make?
The process will mostly be about change. Small changes can be as powerful as, and produce a larger improvement than, the big changes. The changes will be about what drugs you take, what foods you eat, what drinks you drink, what hobbies you pursue. The steps will be small and manageable. The nurse will want you to decide what changes you feel you can make, when you feel you will be ready to make them and how you plan to make them.
What are you taking for your headache now?
The nurse will want to know what you are currently taking and how effective it is before suggesting ways of improving the result. The more effective your treatment, the fewer doses you will need. The fewer doses you need, the less likely you are to develop a medication overuse headache. These are the options that the specialist has suggested – what do you think?
The nurse will work through the suggestions and recommendations made by the specialist. The nurse will then discuss with you the option that you feel best meets your needs. The choice has to be yours, the decision must be yours: the nurse is there to act as a sounding board and to answer your queries to help you make that choice.
Which of these do you feel best suit you?
The nurse will explain to you the range of drug and drug combinations available to treat an attack. There will be variations between how quickly the drugs work, the side effects experienced, and the sustained pain-free effect achieved, and you will have to decide which you think will best meet your needs. This decision may well be modified by what you have tried already and what effect they had.
The choices and decisions are yours to make; the nurse’s role is to make you aware of what options are possible and how those options and combinations might work.
Do you want to take a preventative drug?
Not many people want to take a tablet every day without a guarantee that it will fix all their headaches. The nurse’s role is to explain why using a preventative drug might be a good idea for you. The nurse will then discuss the drugs available and review the suggestions made by the specialist and talk you through them. The choices and decisions are, as always, yours to make. The nurse will explain to you that you do not have to take a preventative drug forever. It is there to reduce the number of headache days you are getting at the moment. She is likely to monitor things in three-month time blocks and, once things are stable, think about stopping the drug after six, possibly twelve, months of regular use at an effective dose.
What do you expect from a preventative treatment?
You need to set realistic goals when it comes to considering treatment options. The nurse will explain that diet and lifestyle changes can dramatically reduce the total number of headache days you have. Once you have made these changes, you may need to consider preventative drugs to produce a further reduction. You will not become headache free with preventative drugs, but you should have many fewer headache days.
Different drugs work differently in different people and may work better for some types of headaches than for others. The ‘side effect profile’ will vary from drug to drug as well as from person to person. Choices are not always easy but the effects can be quite dramatic.
Would you like to speak to me again in a few days or weeks?
The nurse has a crucial role in supporting you through the process. Making changes and sticking to them is never easy, as life is busy and gets complicated. There are times when the changes just don’t seem to be working, or are going too slowly. Motivation can be hard to find and almost impossible to sustain, but the nurse can be there to give you the gentle nudge you need. These contacts are likely to be via the telephone rather than face to face.
When shall I see you again?
The nurse will arrange a face-to-face review at regular intervals that allow you to reflect on the options you have chosen. This may be at one, two, or three months, sometimes longer depending on how things are going. You can decide when that should be. These are the diary cards we would like you to keep. Diary cards are a useful way of discovering patterns or potential triggers as well as assessing your response to treatment. Diary cards vary, and therefore acquire different pockets of information. Centers often create their own diary cards whilst others use standard cards already available. You and the nurse need to decide exactly what information you are going to record and how accurately you plan to complete your diary. Diary cards are a tool to be used to support and assess the options you have chosen and to help in deciding what to try next.
The specialist has suggested that you have a medication overuse headache. Do you understand what that means?
The nurse will explain to you what medication overuse headache is and why you need to stop taking the painkillers you have been using. This is one of the hardest concepts to grasp and the nurse can support you during the ‘washout’, or withdrawal, phase.
You need to stop taking all the painkillers you are currently taking. Do you think you can do that?
Everyone feels differently when told that they have to stop the painkillers they are taking. A series of conscious and determined choices and decisions have to be made. The ‘cushions’ that are put in place to support the process are different for every single person the nurse sees. The nurse’s skill is in helping you find the ‘cushions’ that you need to succeed.
a. What steps do you think you need to take to be successful?
b. How do you think you can do it?
Do you want to take a preventative drug to support you during the washout?
Painkillers are not the only way of managing pain symptoms. There are several drugs or classes of drugs that can be used during and after your washout phase to help control the pain of your headache and that will reduce the need for you to take painkillers and contribute to successfully completing the washout.
The nurse will discuss with you the range of drugs available and talk through the doses and side effects as well as the effectiveness of these drugs. You will then need to decide which, if any, you feel you want to try.
When do you want to speak to me or see me again?
Making change is never easy, and having support is crucial to success in getting back in control, whatever the cause of your headache. A telephone call when things are getting tough might make all the difference to getting through the crisis. The nurse can make the difference between completing the washout successfully and not getting there, between treating your headache effectively and not getting the best effect.
The nurse can answer your questions, reassure you about side effects, and make suggestions about what to try next. The telephone can be as valuable as a face-to-face consultation. Time is often an issue and a telephone chat could be a quicker and easier option and just as effective, especially if diary cards can be faxed (or perhaps even emailed) through in advance of the telephone consultation.
