What is not helpful for your doctor to hear

You require and deserve a treatment plan for your headaches, but it cannot be emphasized enough that any treatment plan developed must be a product of you and your physician working together. While it is true that the treatment plan is intended primarily to reduce the frequency and severity of your headaches, inherent in the development of that plan is the implication that you will be self-empowered and so largely capable of managing your headaches independently.

Patients who are noncompliant with the treatment plan will be frustrated with the results. Not infrequently, patients will start a prophylactic medication for migraine, experience side effects, stop that medication without calling the prescribing physician and then eventually return for clinic follow-up complaining that their headaches have failed to improve. The lesson here is that if you want to improve, follow the treatment program; if the treatment prescribed is proving to be absolutely intolerable, call to request a switch to another medication or an earlier follow up appointment.

A final word: many severely afflicted headache patients often present for their initial appointments exclaiming that (1) "I've heard so many great things about you [directed to the physician]. I just know you're going to be the one to help me with my headaches"; and (immediately following this exclamation of faith), or (2) "I've tried everything. Nothing works" What such patients are telling us is that their "locus of control" has shifted from internal to external. In other words, the physician is now responsible for the patient's headaches. In addition, the second comment often indicates that the patient is destined to fail any therapeutic intervention attempted, whether because of inherent psychopathology, secondary gain (ie, the patient is deriving some type of positive reinforcement from being ill) or a simple case of the "give-ups" Surprisingly enough, not everyone who is chronically ill truly wants to get well. Happily, such patients are relatively few and are vastly outnumbered by individuals afflicted with headache who are both determined to improve and dedicated to doing their part in what it takes to achieve that improvement.