Overcoming Obstacles to Care

What is getting in the way of better headache and migraine treatment for you this year?

Last year The Journal of Headache and Pain published an interesting study about "Barriers to Care in Migraine" (study abstract). This was a particularly interesting study because it focused on those in six different countries who are most disabled by migraine. So not only were they looking at possible barriers, they were also comparing countries.

We'll get one thing out of the way first. Out of the countries studied, those in France and the USA have the most to be thankful for. Patients were most likely to overcome these common barriers in these countries.

That being said, migraine continues to be a huge problem no matter where you are (see Are We Failing in the Fight Against Migraine?).

The Barriers

The barriers in the study were these:

Was the patient currently consulting a health care professional for headache?
Did the patient have an accurate diagnosis?
Did the patient use minimally appropriate pharmacologic treatment?

Of the 8330 people significantly disabled by migraine, only 11.5% were overcoming all three barriers.

Now you may already see a problem with the study, but let's look at these three obstacles briefly.

A "Specialist"

For the study, patients didn't necessarily need a specialist, but they did need a doctor qualified in chronic headache medicine.

I agree that this is extremely important. Not that you need to be "currently" seeing a specialist, but a chronic headache condition of any kind is certainly worth the time and money to see a specialist in that area.

A Diagnosis

Once again, I wholeheartedly agree - a proper diagnosis is very important. Your condition may be treated very differently once you get beyond "I have a headache". The diagnoses in the study were pretty basic, but even then less than two thirds of patients even had a proper basic diagnosis of their headache condition.

A Prescription

Specifically, "the use of at least one recommended prescription acute treatment for migraine". Preventative medications were also included.

This varied somewhat from country to country, but it was based on current recommendations from the American Headache Society, depending somewhat on what was available country to country.

Certainly we should point out that what is "recommended" changes based on new information. But even so, the problem here is not so much what is included, but what is left out.

Admittedly harder to agree on and harder to measure, lifestyle recommendations are not included here. There are also excellent non-drug treatments available.

Today's Tips...

If you have not seen a headache specialist, do not have an accurate diagnosis, and have not even been offered a medication studied for your condition, there is a problem. Think of these as three "minimums" if you want to find good treatment.

But even when these three are present, our success rate is abysmal. Let's add some more minimums:

Do your own research, be your own advocate. This is not in the place of a specialist, but it it a crucial skill to learn alongside a doctor's visit.
Sleep - if you're not waking up refreshed, if there are other indications that you're not sleeping well, seek help.
Nutrition - you may not be encouraged to hear how many hours of training your doctor has had in nutrition. Once again, from experience in my own life and from the reports of others I can tell you that what you eat can be a powerful migraine fighter.
Exercise - or, if that word scares you, movement. Take a look at your movement throughout the day.
Non-drug treatments - these other treatments are not necessarily less powerful or even less well researched than drug treatments. We need to stop thinking of medication as our most powerful tool.

This was a useful study, but why not take a look at these 5 other things. What might you need to look at next? What might make this year a healthier one?

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