Essential Information for Helping Migraine Patients
The following information is crucial for a migraine treatment specialist. The first two questions are the most significant because they immediately reveal how challenging the situation is and what kind of issues the patient is dealing with. This information also provides an initial understanding of how long an intensive migraine self-care program should be maintained and how many clinic treatments might be necessary (if the patient is a clinic client).
Whether it's a migraine self-care coaching session via video call or a clinic visit, I always perform visual observations as well. During an in-person meeting, I gather a lot of information from the moment I escort the patient from the waiting room to the consultation room. I pay attention to the following aspects:
? Eyes: The eyes of someone who has experienced a lot of pain and discomfort are like a mirror; they reveal the current situation.
? Face: The face reveals a lot about a person's overall health in many ways.
? Gait and movement: These provide a lot of information and speed up the actual examination process.
I follow a set of questions, which is an important tool before proceeding to the examination phase and the subsequent stage, where I share the results of the examination. I conduct a physical examination using palpation, which is an extremely precise and quick method for assessing the condition of the nervous system (neuro) and the musculoskeletal areas. The palpation examination confirms the observations I have made before the patient starts describing their condition. I always ask the following questions first, in this order:
? What type of migraine do you have, or do you experience multiple types? (It is not uncommon for one person to have both migraines with and without aura)
? Describe your usual migraine attack
? When were you diagnosed with migraines?
? Briefly describe the development of your migraines. What were they like in the beginning, and how have they changed over time?
? The previously mentioned details about the frequency of migraine attacks and how long the condition has persisted.
? Are you on medication, and if so, what kind? ? What medications and other treatments are you currently undergoing?
? Do you have any other diagnosed illnesses? If so, what is their current status?
? Have you experienced any physical traumas (e.g., herniated disc, disc rupture, vertebral fracture)? Have you ever been in a car accident?
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? Do your mother, father, grandparents, or siblings suffer from migraines? (This is an interesting piece of information, as migraines are highly hereditary)
? Do your migraine attacks follow a specific schedule, or can they occur at any time of day? ? Do you feel that you sleep well? How many hours of sleep do you get per night? Do you feel rested after sleeping? ? Are you stressed? (Generally, migraine sufferers are more or less stressed due to the constant migraine attacks)
? How much and in what ways does your migraine limit your life? ? Have you ever received self-care instructions for migraines? (Not physical therapy or exercise instructions, but specific guidance and a program for implementing self-care)
? Do you experience a band-like headache, and if so, how often? (Typical of tension headaches)
? Do you experience tingling, numbness, weakness, or fatigue in your fingers or hands, especially when your arms are raised?
? Do you have symptoms like tinnitus (ringing in the ears)? (This can include itching, buzzing, clicking, or similar symptoms in the ear and may even include ear pain)
? Do you experience dizziness and/or nausea?
? Do you have diarrhea, constipation, or both?
We always discuss challenges related to work hours, and I provide guidance on how to manage self-care during the workday and while traveling. We also discuss how to take breaks at work and generally how to pace your work. Quite often, issues related to vision come up, which are due to extensive use of near vision, such as working at a computer.
These are the kinds of information I gather from a migraine patient. There are other aspects as well, which are covered later with each individual.
The Noble Art of Listening
In the early days, I used to let the patient freely "unload" their story. There were two reasons for this. I was, and still am, often the first person for many migraine sufferers who takes the time to listen to them calmly and understands their problems. Questions like "How can I help you?" and, for those returning for a follow-up appointment, "How have you been? How are you feeling?" have been essential in my work. After working with people suffering from migraines and musculoskeletal pain for over 29 years, I can say that it is still striking how many people reveal that no one else has ever bothered to ask them such questions, or at least it happens far too rarely. Countless times, I have found myself in a situation where the patient bursts into tears simply out of relief that someone is willing to listen to them without constantly interrupting. As I write this, I recall a person in a leadership position at a large company who came to see me. When I greeted them in the waiting room, they smiled cheerfully at me. When we reached the consultation room, and I asked, "How are you?" they broke down in tears. Their story once again highlighted how lonely a person in a leadership position can be at the worst of times: immense pressure, responsibility for a large number of employees, and no one to listen to their concerns. Unfortunately, many people are left far too alone with their problems, which is why it is absolutely essential for a migraine treatment specialist to listen carefully to the patient. My mantra, "Observe, internalize, examine, guide, instruct, help," serves as an important guiding principle for me.
Treating migraines, just like self-care for migraines, fortunately, isn't rocket science. Ultimately, you can achieve excellent results with well-executed basic work. There are a significant number of nuances in this work that vary between individuals and sometimes even within the same person. "Surprises" and sudden changes that come from external sources are, for a hands-on person like me, interesting "puzzles" to solve.
If you want to learn more about treating and self-caring for migraines, as well as about migraines in general, subscribe to this newsletter by pressing the "Subscribe" button.