VIDEO
How To Get The Best From Your GP Or Family Doctor
You’re Doctor (Family Doctor – General Practitioner)
The pharmacist has recommended that I see my doctor about my migraines. How can she help me with them?
Your doctor can help but not all doctors’ have a particular interest in headache problems. She can listen to what you say, and will often be able to make a formal diagnosis as well as suggesting various treatment options. If your doctor does not feel able to help, she will be able to refer you to a specialist with an interest in headache.
If my doctor refers me to someone else, is it likely to be to a neurologist?
Yes, your doctor may refer you to a neurologist. If he does, you should ideally see a neurologist with an interest in headache problems. A specialist centre supported by specialist headache nurses would be even better. Your doctor will refer you if he has worries or concerns about your headache and associated symptoms or he is having difficulty controlling your headache.
My doctor says that she might refer me to a specialist about my headaches. Can she refer me to the specialist I want to see?
The answer to that question is not as straightforward as it should be. If there is a specialist service local to where you are, the referral is straightforward and the time it takes will simply reflect the local waiting time and capacity.
However, if there isn’t a specialist headache service already contracted to provide a service for your Primary Care Trust (PCT), the PCT may not agree to fund a referral out of your local area. If there is a local neurologist but the service offered is not a specialist one, again the PCT may choose not to fund the referral.
The challenge in the NHS is limited resources and how these are spent. There are no barriers if you can afford to go privately or your local health provider is able and willing to fund the referral as an NHS referral.
I feel that my doctor isn’t being very helpful. Although I’ve told him that the headache of my migraine starts in the night when I’m asleep, he just tells me to take painkillers when I feel the attack starting! What can I do, as it’s quite severe when I wake up?
In absolute terms your doctor is correct, as painkillers will not stop your migraine from starting if you take them at bedtime – before the attack starts. You need to wait until the warning symptoms begin or the headache begins for them to work. You need to think about possible reasons why the migraine starts in the night. Are you dehydrated?
Should you think about having a light snack before going to bed? Have you got over-stressed? The higher your migraine threshold is, the less likely and attack is to start.
There is no realistic way of knowing if your attack is going to start in the absence of any symptoms. If you take a tablet just in case a headache is going to happen, you could potentially take a painkiller every night – which will inevitably lead to a medication overuse headache. If, however, you have warning or premonitory symptoms before you go to bed, it makes sense to take a first-step treatment such as ibuprofen at the right dose.
I have been to see my doctor several times about my migraines but nothing I’ve tried seems to work. What can I do to find a better treatment?
There are a lot of options and everyone is different so you need to keep trying until you find a mix or combination that works. Your doctor will be able to offer you a variety of different drugs: anti-inflammatory, anti-emetics, and triptans. You can take these in many different combinations at the start of the attack and repeat the dose of anti-inflammatory through the next 24 hours. If you get a lot of nausea or vomiting, the anti-emetic can be repeated as well to improve the effectiveness of other treatments.
It is a question of trial and error. It would be great if you could find the right treatment first time but that rarely happens. Managing migraine is not just about taking tablets – it’s about lots of other things as well. Remember to eat and drink regularly, treat your attack early and give your treatment a chance to work.
How can I get my doctor to take my migraine seriously?
I get the feeling that she thinks I’m making a fuss about nothing. You can help your doctor by thinking about what you want to say before you go. Write it all down so that you don’t forget. If possible, make a double appointment to see your doctor. Having more time will take the pressure off both of you. You’ll be able to get your message across by making sure you have told your doctor everything you want her to know.
My doctor says that I have medication overuse headache and must stop taking the painkillers completely. I’m going to need some time off work to do this; will she be able to give me a sick note for it?
Your doctor will be able to give you a sick note if you feel that you need time off work to succeed. Your doctor, family, friends, and work colleagues will need to work together and support you so that you can successfully stop your painkillers.
Can I ask my doctor to give me a different triptan? I’ve been reading about the zolmitriptan nasal spray and, as I feel sick early on, think it might work better for me.
If you feel you want to try something different, certainly ask your doctor. Remember to explain why you want to try something else. A nasal spray may well be a good idea, especially as you get nausea early in your attack. There are two different nasal sprays available: one is zolmitriptan and the other is sumatriptan. If one does not work well for you, the other is certainly worth a try.
I want to try to find something that will stop my migraines happening at all. Can my doctor help me with that?
Your doctor can help by explaining what drugs are available. A preventative drug will reduce the total number of attacks or headache days that you have but will not stop them completely. All drugs have the potential to produce side effects; whatever choice you make will be a trade-off between how effective the drug is and the side effects. Some drugs work better than others, and some people respond well to some drugs and not others. So you will probably have to try different options before finding the right one for you.
