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Illustration by Maya Chastain

Welcome to Ask the Migraine Expert, a column about managing life with migraine from Deena Kuruvilla, MD. Dr. Kuruvilla is a board certified neurologist and Director of the Westport Headache Institute in Fairfield County, Connecticut. Got a question for the migraine expert? Submit your question via this form.

Dear Migraine Expert,

I’m seeing a specialist soon. What should I expect and what should I have prepared?

Migraine Healthline community member

It can feel like you’ve won the lottery when you’ve made an appointment to see a headache or migraine specialist.

With just about 400 headache specialists across the United States for the 40 million Americans with migraine, finding one and scoring an appointment can be a big challenge.

Once you score one of these golden appointments, how do you make the most of the visit and ensure you have an action plan you’re comfortable with executing and all your concerns are addressed?

Identify your goals

It’s important to identify your personal goals for migraine management. Migraine is a disease just like asthma and diabetes, and it must be managed.

If your goal for the visit is to receive a diagnosis and get preliminary information about all the possible treatment options, let your physician know. If your goal is to confirm your diagnosis and start treatment as soon as possible, let them know this.

Highlighting your individual goals before your appointment so that you’re ready to share them with your physician is vital to openly communicating with your physician and setting realistic expectations.

Some common goals reported to me by patients include:

  • the exclusion of any dangerous causes for headaches
  • an overall reduction in monthly migraine days
  • an effective as-needed treatment, which provides pain freedom and freedom from bothersome symptoms such as nausea, vomiting, sensitivity to light and sound, and disability

Track your symptoms

In order to identify your personal goals, you can maintain a headache diary using your smartphone or a calendar. It’s helpful for your headache physician to have a realistic view of how many days each month you have no discomfort in the head or neck to obtain an accurate view of your monthly headache days.

You can also keep track of what you are using to treat the headaches, how many of the monthly headache days are disabling and causing interruptions to your daily life, and which associated symptoms you’ve experienced.

Associated symptoms include:

  • vision changes
  • numbness or tingling
  • weakness
  • speech changes
  • sensitivity to light and/or sound
  • nausea
  • vomiting
  • dizziness

Share your medical records

So that your physician’s office is prepared for your visit, ensure that all your previous medical records, neuroimaging, and lab studies have been received by your headache specialist’s office prior to your appointment.

In order to formulate an effective treatment plan, it is necessary to bring a list of all the past treatments you have tried, whether they were preventive, abortive, or integrative.

Share treatments you’ve tried

It’s often helpful to communicate with your headache physician about your personal goals for the visit. Share what your past experiences have been with treatments, medical professionals, and integrative medicine treatments such as acupuncture, chiropractic maneuvers, or meditation.

You should share what has worked and has not worked in the past and what side effects you have had with treatments. Understanding your past experiences can help your physician understand how to proceed with making recommendations that work for you.

Take notes

So much can be lost in translation during your initial visit with a headache physician due to the volume of information that’s exchanged in a limited time frame.

A study from Brown University showed that people forgot half of the information shared by healthcare professionals during their visit. The study went on to show that a quick reminder helped patients recall another 36 percent of the information. Even with prompting, 15 percent of the information was totally forgotten.

The researchers suggested that shared decision-making and open physician-patient communication can help to combat this issue.

Ask questions

Ask questions and bring up any concerns you have. There are so many times that patient questions have brought up more questions in my mind that really help to pinpoint the diagnosis and treatment plan.

At the end of your visit, ask your physician about the need for a follow-up visit and when the best time would be. Follow-up is especially necessary if a new treatment is started to monitor for side effects and measure the treatment efficacy.

Schedule specialist visits

Review the notes you have taken at the appointment and double check the plan.

In addition to ordering diagnostic studies or treatments, your doctor may have referred you to other specialists such as sleep medicine, psychiatry, or psychology. Make sure to schedule those appointments as soon as possible.

Research shows that multiple specialists such as a headache physician, psychology, psychiatry, and physical therapy, among others, work better as a team than any individual approach alone.

Monitor for treatment side effects

If a new treatment was started, monitor how you’re feeling and let your doctor know whether you’re experiencing any side effects.

Follow up with your insurance provider

Make sure to review and follow through on the plan that you and your doctor formulated together. For example, if a magnetic resonance imaging (MRI) study of the brain was ordered, confirm that you’re prepared to have this study done as advised by your physician.

The biggest barrier we run into with executing a plan is from insurance companies. Oftentimes, to get a neuroimaging study approved by insurance or to obtain prior authorization for medications, it can take several days to weeks.

It’s helpful to partner with your physician’s ancillary staff to make sure your insurance information is updated in their system and that your pharmacist is also communicating with your physician’s office.

The communication or lack of communication that occurs between insurance companies, pharmacies, and physician offices can be frustrating and confusing, but ultimately, we want you to be able to have your diagnostic studies and treatments in a timely manner.

Different migraine physicians may have different approaches to migraine diagnosis and treatment. If you ever have concerns or doubts about a physician’s approach, just ask!

Open communication is the key to a successful physician-patient partnership.

Deena Kuruvilla is a neurologist who’s passionate about all things headache. She has made it her life’s mission to treat, educate, and bring awareness to headache conditions such as migraine. She is the director of the Westport Headache Institute and has conducted research on medical devices, complementary and integrative medicine, and procedures for headache treatment. She has been featured in Prevention Magazine, Neurology Today, the Hartford Courant, and the Wall Street Journal. She lives in Fairfield, Connecticut, with her husband and two children and loves watching “The Masked Singer” with her family. Connect with her on Facebook or Instagram.