Weekly Whine: Headaches

I am starting to get the idea more and more that too many healthcare workers (particularly doctors) know far too little about headaches.

Having suffered migraines for more than a decade, I started having this suspicion while still in school, but now that I have a smidgen of knowledge myself, the suspicion grows. 

The first time I needed stronger rescue therapy at university (IM Diclofenac, which either helps or has a placebo effect), the GP insisted on performing ophthalmoscopy on me. This despite the fact that I gave a clear history migraine with aura, had been officially diagnosed before, and had no neck stiffness of any sort. Now, I appreciate that the GP may have felt it necessary to rule out any other causes, but the clincher for me was when I struggled to keep my eyes open BECAUSE: PHOTOPHOBIA, and the doctor said, “Don’t be such a baby, it’s just a little light!”

EXCUSE ME. What part of “I have a migraine, with aura, and have severe photophobia therefore I am wearing these sunglasses indoors” is so hard to understand?

The other interesting part is that despite more than a decade of migraines, the only medication that has ever been prescribed for me was a variety of NSAIDs. This even during times where I would have up to six migraines in a month. The first time I received a triptan was this year, after a pretty scary post-dromal incident that had me thinking I was stroking out, and then I basically had to beg for the prescription.

Sadly, I am yet to find a Triptan that actually works for me.

A friend of mine has had a similar story with tension-type headaches for the past few years, to an extent that severely impedes his productivity. Similarly he was prescribed one NSAID after the other, none of them effective.

This year during ENT we had a session on therapy for tension headaches, and I learned that physiotherapy and amitriptyline are the treatment of choice for chronic TTH (the British Association for the Study of Headache confirms this). Only after this, his GP prescribed amitrip, which seems slowly but surely to start working.

I feel that given the frequency of headaches in general practice, knowing about the latest research and treatment protocols of headaches should be a given. No GP would dare not be up to date on the latest protocols in treatment for hypertension or diabetes. I realise that it is easier said than done, and that it is much easier for a student to be up to date because of our academic environment, but if a patient continues to have severe headaches… dammit, then open a book and research it. (Do a lot of medical schools not teach this? Am I being too harsh?)

This post inspired by MommyMed3’s post about headaches.