How can you best prepare for an appointment with a new doctor or other migraine care provider?
Taking the time to prepare for a first appointment with a new provider is an important step in ensuring the best possible outcome for diagnosis and the beginning of your treatment. Several things a patient can do, and a provider’s mindset for history-taking can dramatically boost the productivity of the appointment.
“I'd bring things to the appointment. I'd bring a handwritten note, or a typewritten note, and I think that would be good. I certainly would bring a witness along with me to my headache attacks, a relative, a friend, somebody who knows me really well. Somebody that's willing to help correct the history if I say things that may not be typical of my attacks, or things that I observe. I've actually had patients do videos, which is rather interesting. It's probably more important in nonmigraine headache, like cluster headache, when they can actually show you an attack of water running down from your eye, or your nose, and nothing is more convincing than that kind of objective evidence, that's the diagnosis.
“In fact, some of the best diagnoses I've been able to make are patients that actually bring in videos from their iPhone, or smartphone, or whatever. Pictures help too. In migraine, people think there aren't any physical findings — well that's not true, there are actually a lot of physical findings, and I can get to that later. Bring in the history, bring in the story, and start with a typical attack. I think in the first instance you should probably spend 10 minutes or more, going over your headache, and the context it's in, and how you arrived at the doctor and were referred, but after that, the doctor, more likely, [will] move on to, ‘Tell me about an individual attack.’ Again, if you're 25 years old and you have one attack every two months, that's easy. If you're 39 years old and having headaches every day in a complex comorbid state, then the complexity of the diagnosis has to be split down into parts. This can be extremely difficult.”
Allan Purdy, MD
Professor of Neurology
Dalhousie University, Canada
Dr. Allan Purdy is a neurologist and a professor at Dalhousie University in Nova Scotia, Canada. Dr. Purdy is currently President of the American Headache Society. He has also served as president of the Canadian Headache Society and on the Board of Directors for the International Headache Society.
Dr. Purdy is regarded as one of the most gifted teachers in the field, developing educational programs for physicians around the world who care for patients with headache diseases. In addition to his research and education work, Dr. Purdy continues to see headache patients in his Canadian clinic on a part-time basis.