Managing your 10-minute appointment with your GP
Migraine can be difficult to diagnose and manage within the constraints of a 10-minute GP consultation. David Kernick, GP with a special interest in headache, Exeter Headache Clinic, gives his tips to help patients make the most of it.
Before your appointment, think about what you want to say
Jot down the key points you want to share. Also think about what you are hoping to get out of the consultation, e.g. a diagnosis, treatment, reassurance, all of these?
Help with the diagnosis
Tell your GP that you think you have migraine – evidence suggests that you are usually correct. The kinds of things that usually indicate migraine are episodes of pain with nausea, light or sound sensitivity, and if other people in your family get migraine.
Describe the impact
Try to explain to your doctor the impact of your migraine. It usually means that the treatment they give you is more appropriate. A simple diary summary may be helpful, but that doesn’t mean pages and pages of recordings. A simple statement is often best, e.g. “I have three attacks a month. I am unable to work for a day and have reduced capacity the following day. I’ve also been more anxious and feeling low as a result.”
Think about how many headache types you get
Often migraine comes with other types of headache and this can sometimes cause confusion. It’s a good idea to start by describing the pain that bothers you most. Other headaches are invariably part of the “migraine spectrum” but can also be due to what’s called “medication overuse headache”. One of the very cruel twists of having migraine is that if you take too much medication to ease the symptoms it can cause more headaches. The general rule is to not take more than 15 days of a painkiller a month or 10 days of a Triptan.
Describe the medications you have tried
It’s useful to know what you have tried and in particular how many painkillers you are taking to exclude medication overuse headache. Showing your doctor a written list may save time during your appointment.
Don’t waste too much time talking about triggers
The search for a magic trigger is usually elusive and if you have one or two they will usually be obvious. Your GP may not understand that more important is changes in your environment (e.g. hormones, stress changes, hydration, eating, sleep pattern, atmospheric change) and the need to keep things constant where this is possible. The migraine brain doesn’t like change.
Share any concerns you may have
It is normal to worry that there may be something serious causing migraine. Although this is extremely rare and most migraine will not need further investigation, it’s still very important for you to talk about any concerns.
Talk about any other problems
Often migraine does not come alone. Of particular importance is an associated increase in anxiety and depression and it is important your GP knows about this. They can treat this as well and you don’t need to put up with mental health issues just because you have migraine.
Tell your GP if you have plans to start a family
This will determine how your migraine is managed.
Have realistic expectations
There is no cure for migraine and the aim should be to enable you to have more control over your condition and live as well as possible. This may not all happen in one consultation. It is good practice to ensure your blood pressure has been checked recently and for your GP to look in the back of your eyes. You should expect to have a discussion about anti-sickness medication, a Triptan and migraine prevention if your migraine is affecting your daily life.
Direct your GP to accessible resources
If appropriate your GP may be amenable to a suggestion of further help. For example, the Exeter Headache Clinic, where I work, has a wide range of support material for GPs and patient information sheets across a wide range of topics.
Ask for a referral to a headache specialist
Your GP should be able to manage most migraine but if things are not working out then ask for an onward referral. The Migraine Trust has a list of clinics that have an interest in headache.
This is general advice. Everyone experiences migraine differently and medications work differently for different people. Before you stop or start any course of treatment, it’s very important that you seek the advice of your GP or specialist health professional. There is help and support on seeking medical advice here and you can contact our support services if you have questions about treatment and how to access it.