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Finding the Right Chronic Migraine Treatment

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How to Ensure Your Doctor Understands Your Migraine Severity

Medically Reviewed By William C. Lloyd III, MD, FACS
Female doctor talking with patient

If you’re suffering from frequent chronic migraine attacks, there’s no doubt you’re searching for relief. You know good communication with your doctor is an important step in getting there, but how can you be sure you’re effectively describing your migraine experience? Here are a few tips.

Find a doctor who specializes in treating chronic migraine.

You can start with your primary care doctor, but if your migraine headaches are severe or significantly impacting your daily routine, consider enlisting the help of a specialist. Neurologists treat disorders of the brain and nervous system. Some neurologists are also certified headache specialists, meaning they have expertise in treating and diagnosing migraine and headaches. A specialist is trained to differentiate between chronic migraine and other types of frequent headaches, rule out potential underlying causes of headaches, and address treatment concerns.

Keep a headache diary.

Before your doctor’s appointment, it’s wise to start a diary of when any migraine attacks occur. Ideally, you want to track both “regular” headaches and migraine attacks for at least 30 days, but the more data you can supply, the easier it is for your doctor to assess your patterns. Writing things down ensures you’re reporting accurately, so you don’t minimize or overestimate how often you are experiencing them. To meet the criteria for a chronic migraine diagnosis, you need to have headaches more than 15 days per month for the last three months, or headaches more than eight days per month for the last three months that have migraine symptoms. If you are rarely without pain, it’s important to say so even if you don’t know the exact number of migraines you’ve had in a month.

Describe your migraine symptoms.

In addition to frequency, your doctor will want to know about your migraine characteristics and history. Take some notes as your symptoms occur, so you can share them at your visit. To accurately communicate the severity of your chronic migraine, it’s important to convey the reality of how it affects your life. Emphasize to your doctor the level of disability caused by your migraine disease. Chronic migraine can impact your work, family life, social life, and more. List out examples of tasks migraine prevents you from accomplishing, and share all the ways you’ve adjusted your environment to accommodate migraine. Real-world insights like this can help illustrate the severity of your condition.

Additionally, make sure you can discuss all the details of your experiences, such as the following:

  • Migraine frequency (and changes in frequency): Episodic, or occasional, migraines can sometimes progress to chronic migraine.
  • Length of migraine attacks: Chronic migraine flares can last for several hours, but other types of headaches may be constant and persistent.
  • Known triggers: Tracking the environmental factors that often lead to migraine attacks can help your doctor understand the situation and help you avoid flares.
  • The location of your pain and symptoms: Migraines can occur on just one side of the head or both.
  • Descriptions of the pain: Migraines often cause moderate to severe pain that pulsates or throbs. Use adjectives and specific descriptions when talking to your doctor. If it feels like your head is exploding or is being squeezed by a vice, say that. If you’re in pain more days than not, be sure to mention that as well.
  • Any incidence of an aura: Some people have a migraine “aura,” which entails changes in vision, speech, or movement prior to migraine onset.
  • Other migraine symptoms you experience: Migraines often bring on nausea and/or vomiting. Sensitivity to light, sound, and smell is common. Pain may be made worse by physical activity.
  • Your treatment history: Treating chronic migraine often requires pain-relieving medication and preventative medication to be effective. Make sure your doctor knows what you’ve tried in the past, what has worked, and what hasn’t. It’s also helpful to relay medication frequency, as taking acute medicine too often can sometimes contribute to rebound headaches.
  • Family history: Chronic migraine, as well as other types of headaches, can run in families.

Since there is not one specific test to diagnose chronic migraine, your doctor will rely heavily on your reported headache history and symptoms. With a little effort on your part, you can feel confident you’re providing an accurate account of your experience, so you can get started on the road to relief.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Feb 26
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