Finding the Right Migraine Treatment

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How to Tell Your Doctor What Your Chronic Migraines Are Really Like

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Is it hard for you to describe your migraine pain? Does it feel like your doctor isn’t quite understanding the impact of chronic migraine on your life? It’s challenging for many people to find the words beyond “sharp” or “throbbing.” Your chronic migraine doctor needs more detail, though, to develop the best treatment plan for you. Learn how keeping a migraine diary and practicing your answers to migraine questions can help.

Describe Migraine: Capture Your Thoughts In a Headache Diary

You don’t have to describe your migraine spontaneously and perfectly at your next doctor’s appointment. Take that pressure off yourself. Instead, jot down notes about your migraine as it happens (or right after you recover) so you can share them with your doctor in advance. Information in your headache diary should include:

  • How often you have a migraine attack
  • How long each attack lasts
  • Descriptors–Did it feel like your head was in a vice? Did it feel like your head could explode?
  • Where you feel pain in your head—left side, right side, or both sides
  • Any other symptoms like aura (seeing bright lights or vision disturbances), nausea, or sensitivity to light, sound, or smell
  • What you try to ease your pain and how well it works
  • How much chronic migraine interferes with your activities
  • Suspected migraine triggers, which are different for anyone, although common ones include stress, caffeine, and menstrual periods in women

Convenient headache diary smartphone apps are available as well to make the process easier.

It can also be helpful to give your doctor specific examples of activities you aren’t able to do or enjoy due to your chronic migraine. What hobbies or household tasks have become difficult? What experiences do you need to avoid in order to stay away from triggers? How is migraine affecting your quality of life and wellbeing?

Practice Migraine Assessments

To better understand your migraine attacks, your doctor will likely give you one of two standard assessments that involve a series of questions. Some research has shown the Headache Impact Test (HIT-6) may be more effective at measuring migraine intensity, and the Migraine Disability Assessment Scale (MIDAS) may be more effective at measuring migraine frequency, so some doctors like to give both. Getting familiar with the tests can help you better describe your migraine to your doctor.

Headache Impact Test (HIT-6)

The HIT-6 is made up of these six questions:

  • When you have headaches, how often is the pain severe?
  • How often do headaches limit your ability to do usual daily activities including household chores, work, school, or social activities?
  • When you have a headache, how often do you wish you could lie down?
  • In the past four weeks, how often have you felt too tired to do work or daily activities because of your headaches?
  • In the past four weeks, how often have you felt fed up or irritated because of your headaches?
  • In the past four weeks, how often did headaches limit your ability to concentrate on work or daily activities?

You’ll answer these questions with a range from “never” to “always”.

Migraine Disability Assessment Scale (MIDAS)

The MIDAS is made of up these five questions:

  • On how many days in the last three months did you miss work or school because of your headaches?
  • How many days in the last three months was your productivity at work or school reduced by half or more because of your headaches?
  • On how many days in the last three months did you not do household work because of your headaches?
  • How many days in the last three months was your productivity in household work reduced by half or more because of your headaches?
  • On how many days in the last three months did you miss family, social or leisure activities because of your headaches?

You’ll answer all questions in number of days.

You’ll also be asked how many days you had a headache over the last three months and how painful they were on average on a scale of 1 to 10. It is important to share that you were in pain more days than you weren't even if you don’t have an exact count.

Talking About Migraine

You may have had trouble talking about migraine in the past, but now you have new tools. Use them to get more out of your next appointment with your migraine doctor.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Feb 26
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. The Migraine Disability Assessment Test. National Headache Foundation. https://headaches.org/wp-content/uploads/2018/02/MIDAS.pdf
  2. Migraine Headaches. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches
  3. Headache Diary. Stanford Health Care. https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/headache/diagnosis/headache-diary.html
  4. How to Talk to Your Practitioner About Your Headaches. American Headache Foundation. https://americanmigrainefoundation.org/resource-library/how-to-talk-to-your-practitioner-about-your-headaches/
  5. HIT-6 and MIDAS as measures of headache disability in a headache referral population. National Library of Medicine National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/19817883/
  6. Headache Management Tools: HIT. National Headache Foundation. https://headaches.org/2007/11/16/headache-management-tools-hit/