It can be difficult to manage migraine effectively within the constraints of a 10-minute consultation. Here, Dr Kernick suggests what you can do to get the most out of your appointment, as well as what to expect.

You should expect:

1) To be taken seriously.

Migraine can be an extremely disabling condition for many people. It has a significant impact physically, psychologically, socially and economically on not only those that have migraine but their families.

How to get the most out of your GP appointment: Explain briefly the impact of your problem on your day-to-day life and how it affects you.

2) To have a diagnosis.

It is usually reasonably straightforward to diagnose most migraine. Any severe headache which is associated with either nausea or made worse by light or other sensitivities such as sound, movement or touch is highly likely to be migraine. Sometimes diagnosis can be more difficult. For example, if you have aura without headache, or chronic migraine which can be accompanied by other headache types.

Your diagnosis may be:

i). Migraine with aura or without aura . An aura is a temporary neurological experience, often referred to as a ‘warning sign’ of an oncoming attack, which evolves over time. Visual auras, such as blind spots or seeing flashing lights, are the most common followed by pins and needles, but a wide range of other effects are possible.

and

ii). Episodic migraine (up to 14 headache days a month) or chronic migraine (15 or more headache days a month of which 8 days are migraine). As migraine becomes more chronic you may be more likely to experience other problems. The type of migraine can determine treatment pathways.

How to get the most out of your GP appointment: A diary can be helpful, noting the days you have headache and when they have features of migraine . Record any other symptoms you have, how severe your pain is and any medicines you have taken. If you have periods, keep a record of this too as it may help identify a potential relationship. There’s no need to provide your GP with lots of data – ideally, a simple summary is enough. Chronic migraine typically comes with other types of headaches – most commonly tension type headache and stabbing headache. Tell your GP how many types of headaches you get and if one is migraine they are most appropriately seen as all part of one spectrum.

3) To explore triggers.

Many people can identify specific triggers. However, if they are not obvious do not spend time searching for an elusive trigger – you may never find one. More important is to keep your environment as constant as possible. For example, regular hydration, food intake, routines, sleep patterns.

How to get the most out of your GP appointment: Tell them if you have identified any triggers or not.

4) To exclude medication overuse headache.

You can get medication overuse headache if you take painkillers or anti-inflammatory medication on more than 15 days of the month , or triptans on more than 10 days a month. You’re not alone if this affects you. Up to 7 in 10 people with chronic migraine get medication overuse headache. A diary can be helpful to identify this.

How to get the most out of your GP appointment: Tell your GP if you think you are taking medications on more days in the month than listed above.

5) To be offered treatment for the migraine attack.

Although aspirin and paracetamol can be a useful combination, you may be offered a migraine specific treatment from a family of drugs known as triptans. Your GP should assess whether a triptan taken by mouth, nasal spray or injection is the most appropriate. If one triptan doesn’t work, you should be prescribed another type of triptan as side effects or failure to respond does not necessarily mean others in the group will be similar. If triptans do not work then your GP may explore other treatment options, including rimegepant, one of a new class of drugs known as gepants.

How to get the most out of your GP appointment: Tell your GP what medication you have already tried, and if you have had any side effects.

6) For an anti-sickness medication to be considered.

Nausea and often vomiting are common migraine symptoms. This can stop other medicines from being absorbed as effectively, reducing how well they work. Metoclopramide and prochlorperazine are the most common anti-sickness medicines used.

How to get the most out of your GP appointment: Make sure your GP knows if you have nausea or vomiting associated with your migraine.

Check out part two of Dr. Kernick’s blog on how to get the most from your GP appointment, including when preventive medication might be considered and tips on useful migraine resources!