Treatment decisions under migraine headache influence

by Diana E. Lee

At an appointment with my local neurologist I showed up feeling bone tired and mentally drained.

Next thing I knew I was going back on a medication I had deliberately chosen to stop taking just because a doctor told me I should be taking something.

When the doctor finally came into my exam room he looked over the list of medications I was taking and declared that Lyrica alone is insufficient as a migraine preventative because it only works on the nerves and doesn’t stop the brain from triggering migraines. He said he wanted me to go back on Depakote, even though I reminded him I’d been on it twice before with no results.

It was as though he wasn’t even listening to me. Of course I need an effective preventative, no argument there. But I’ve been on everything under the sun with no results. Depakote ER has not worked for me at all, ever. Not in 2004, not earlier this year. Wishing for a different result will not create one. Sadly, I’m pretty sure he suggested this course of action because he has no idea what to do with me and isn’t willing to admit it.

“Here, take this,” he said, handing me a prescription slip. “I want to see you back in three months.” No registration of my concerns; no plan for titrating up. Just an order to come back in three months.

“But wait, I’m not sure I want to go back on that. What’s the point?” I’m thinking as he exits through the doorway. He disappeared around the corner, no doubt heading for his next patient since he is chronically behind schedule, while I stood there feeling like I’d been run over by a steamroller.

Why did I let this happen? Unfortunately the perfect storm of factors conspired to keep me from insisting he listen to my concerns.

* Lack of energy/stamina/fortitude to stick to my decision because I was feeling so beaten down by constant pain.

* Lack of sleep the night before.

* Intimidation. This doctor has a gift for making it clear he doesn’t really listen to you.

* I don’t want to displease doctors, who I view as authority figures.

* The belief I need to keep up this relationship in case I need an IV in a pinch to break a migraine.

* How in the world can you be an assertive patient in a ten minute appointment? That time frame is completely inadequate.

In consultation with my other neurologist I decided my instincts were right that I didn’t need a third trial of this medication. My other neurologist also reinforced my belief that it makes no sense to give me that medication at a low dose with no plan for increasing the dose until three months have passed, if at all.

It felt good to have someone listen to my concerns and give his perspective without ramming it down my throat.

Diana E. Lee is a chronic migraine patient who blogs at Somebody Heal Me.

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  • David Allen, MD

    Sounds like you did the right thing. The other physician likely couldn’t think of a better answer and didn’t have the time to review other options. He should have said “I’m not sure what to do, let me send you to someone who I think will give you better options”. More physicians should do that.

    I assume you’ve tried amitriptyline or another tricyclic, beta-blockers, Topamax, verapamil, oral supplements (B2, CoQ10, Magnesium oxide). Sleep patterns, other sources of pain in the head or neck, and even Botox should be considered as well.

  • anonymous

    I’m glad that you followed up with your other neurologist.

    Once many physicians are really comfortable with a medication, and have gotten good results for the most part, this seems to happen.

    Also, is your neurologist that recommended the Depakote (again!) a Migraine Specialist? It may be that this person is not as versed in Migraine treatment, and don’t have all of the newest information.

    To make things more complicated, sometimes, referrals from the original doctor to their colleagues and notes on the new patient do not even closely resemble the patient’s self- reported data, and notes that they have made over the years.

    There are some patients that suspect that their current physician doesn’t listen to what they’re really saying- and in 10 minutes- there’s no shot of getting through to them.

    This may be true, and this article should remind us all of one thing:

    We all have to take time to stop and listen to each other-

    A good patient/doctor relationship needs to have to an aspect of give and take. I applaud Ms. Lee for her article, and hope that this will open up an honest conversation here.

  • jeisea

    Suggest you google Vitamin B2 prevents migraine. I’ve had migraine for over 40 years and specialist suggested research on Riboflaavin for prevention. He also said to keep dark grape juice in small containers in freezer. He recommended sipping small amounts if I had breakthrough migraine. Dark grape juice is riboflavin or B2. It eases nausea and symptoms. I take less than the amount suggested in research and it does prevent migraine for me. If I forget or run out I get migraine withing 48 hours. I still may get breakthrough migraine but less severe.

    It might be worth discussing with your medical specialist.

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