Real Medicine, Studying Medicine

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.

HEADACHE.Infographic704

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.

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6 thoughts on “Weekly Whine: Headaches”

  1. Great post! I am a migraine sufferer as well. I have tried every single triptan (well, except for Imitrex) and thankfully they all do the trick for me. I hate how dopey they make me feel but there is nothing but bliss when it kicks in and the pain is gone. Thankfully (knocking on wood) I don’t get them frequent enough to warrant daily prophylaxis.

    As a family physician, and migraine sufferer, I make it my business to try to be as up-to-speed on the latest treatments as possible.

    1. Thanks! I’ve only tried Rizatriptan and it doesn’t even make me feel dopey! I’ll try another one soon as my new medical aid kicks in in the New Year. I hope more family physicians will follow your lead.

  2. Gladly I’ve never had a headache so severe that I felt the need to consult a GP, but my sister suffers from regular migraines and none of the doctors she has seen have been able to help her. I’m quite sure she would agree with your assessment.

  3. I’ve not read up on the lit, but how much do you think environmental factors like stress or work conditions and lighting or fresh air impact the frequency or severity of migraines? And maybe that’s partially why the drugs can’t touch them? (P.s. I love hyperboleandahalf!)

    1. Oh, it definitely has a big impact. That’s part of the reason why migraines are such difficult research topics – it’s hard to control all the variables. I know for example that shortly before and after a big exam I get a lot of migraines, and especially resistant to NSAIDs. Flickering lights also bring about migraines for me, and at the change of seasons when the variation in light intensity is most noticeable.
      It’s a lot more complicated obviously.
      (Hyperboleandahalf is awesome :))

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