Taking care of the person with migraine for health care providers
(If you are a patient, you can show this to your health care provider!)
Creating a positive relationship and working alliance with your patient is an important step to getting the information you need to care for people with migraines. Remember this is team work!
Here are some tips:
Be clear and honest with your patient.
Use a language that is clear, not medical jargon. Take the time necessary for explanations. Be honest about potential side effects and expected effectiveness of treatments. If there is medical uncertainty, if you don’t have a precise diagnosis, be honest about it.
Consider different options.
There are many options to improve the migraine situation, including lifestyle changes, medications, injections etc. Each patient has their priorities and concerns. Be open to alternative options. Empower your patient as much as possible.
Set Realistic Expectations.
There are a few lucky people who will be super-responders to any treatment, but most people will have a partial response. Explain clearly to the patient what migraine is and what can be expected in the long term.
Be on Time.
Life in a busy clinic is not always simple and delays occur. If you are late for the next appointment, acknowledge it and apologize. If you are often late, revisit the flow of your clinic and find ways to be more time effective.
Write a plan for the patient.
Write down the recommendations you made (investigations, referral, behavioral aspects, acute and preventive approaches). Quite often migraine appointments are busy and there is a significant load of information for the patient. Use handouts to help the patient to understand your recommendations.
Review the headache diaries carefully.
Train your patients to use diaries, it will save time in the long term. If your patient has filled a headache diary, it’s respectful to take the time to review it. If the patient has not filled a diary, be patient and remind her/him that such a tool makes the medical decisions and monitoring much easier.
Review medications and keep track of past trials.
Double check what they are currently taking. People with migraine use many different medications. They may have tried dozens in the past. Consider having a central place in the chart where past trials are recorded so remaining options are clear and the next step easier to determine.
Be clear about access to your clinic.
Depending on your clinic’s resources, set clear expectations for phone call returns, represcriptions, urgent visits etc. Make a rescue plan with the patient and explain when going to the ED may be warranted.
Remember that your patient may be facing a lot of suffering.
If things are not going well, if there are side effects, if treatments do not work, it may be frustrating. Your patient may be discouraged and angry. Offer support, display empathy. If your patient’s behavior is threatening or abusive, speak up and address the issue respectfully and safely. Consider a patient contract in difficult situations.