Diagnosis and Treatment
Many patients want as much information as possible about their condition and their treatments. They often want to know how the drug works (this is often difficult to answer for conditions of the brain as we do not have a really good understanding of how the brain works), why the doctor has chosen that medication, what benefit is expected and what side-effects you should look out for. Of course, a lot of this information is customized to the consultation but it is difficult to remember all the questions you might want to ask and all the answers that you were given. Although there are many sources of information for patients, there are no suitable ones really focused on treatments available in Australia and the kinds of clinical problems that we face here. This information is to be used as a supplement to the consultation and could be read before or after a consultation.
I’m always happy to get feedback on this information and if you have any suggestions, please feel free to e-mail me at firstname.lastname@example.org.
I’m often surprised in a consultation to encounter a patient who has often had to wait quite a while for an appointment and when I ask them a simple question such as, “Tell me about your headaches.” I get a response such as “Well, I haven’t thought about it”. If you can’t describe to the doctor your condition, how is the doctor going to make a good assessment?
Typical information that the doctor would be interested in is the following:
- When did the headaches start?
- Please describe a typical attack, when they started, and have they changed?
- Please ensure that you know the names of all the treatments that you have been given and whether they helped and whether they cause side-effects. If you’re not sure, please talk to your referring doctor to make sure that the information has been included in the referral. Can you imagine how unhelpful it is to hear “I’ve had all kinds of tablets.” or “It was a white one”. This will just end up wasting time in which I will need to go back to the referring doctor and get that information.
- Slightly more difficult, please think about what you are trying to get out of the consultation and make sure the doctor understands that. Some patients are focused on finding out the cause. They will almost always be disappointed. Some want a permanent cure with no drugs. That is a great objective but they will often be disappointed too.
- Some things to think about ideas such as: would a 50% reduction in the frequency of your attacks be worthwhile from your point of view?
Diagnosis’ in headache is almost all by very careful analysis of history. It is a common concern to think that because of the severity of the pain you must have some severe disease inside your head. There are often concerns about tumors or other serious diseases. In fact, serious diseases causing headache as the first symptom are quite rare. In almost 20 years of assessing patients in a specialist headache clinic, I’ve only come across 3 patients where the headache was secondary to some other problem and in all of them the history and / or examination indicated that there was an underlying problem. It may be somewhat surprising but the patients about whom I will be more concerned about underlying disease are ones with headache of recent onset than those with a problem that has been there for 20 years. I would also be more concerned when headache came on for the first time in middle age or older person. Under such circumstances some investigation might be appropriate.
Standard blood tests are usually not helpful. Apart from history and examination, the only useful screening test is a brain scan and either a CT or MRI. Both can be used, although the latter is probably best in cluster headache. There is no need to have a scan at all in a patient with a typical history and especially who is responding to treatment. Sometimes, patients feel more comfortable having had a scan and even if it was some years ago there is no need to keep repeating it.
Headache is a very common symptom and most people will experience headache at sometime through their lives. However, not everybody gets headache that comes often enough and is bad enough to be a significant problem.
Click the links below to get information about each headache type.