Gregory J. Esper, MD:
The first thing that I would say
is that migraine is the most
common type of headache.
Migraines will, if they're
really bad,
stop people functioning
in their tracks.
Most general practitioners are
familiar with migraine
and its treatments.
I think that the problem
for a patient
comes when
the general practitioner has
done what they can
for the migraine,
but the migraines are
severe in intensity
and greater in frequency
than the practitioner is
comfortable with.
If I had 30 seconds to examine
a patient with headache,
I'm going to focus on the eyes.
I want to look
at their visual fields
to make sure
that their visual fields are
full.
Now, if I had more than 30
seconds to examine a patient,
I'm going to do other aspects
of the neurological exam.
But if I'm pretty sure it's
a migraine, what I'm going to do
is I'm going to have
a discussion with the patient,
and I'm going to go through all
of those historical factors
that I elicited.
Do you drink red wine?
Are you eating aged cheeses?
Are you sensitive to peanuts?
Are you getting enough sleep?
What's your stress level like?
And I'm going to address
the non-pharmacologic,
the non-medicinal things first.
There are home
and herbal remedies that a lot
of patients take, and they never
come to the attention
of doctors.
If you're a patient
and you feel like your headaches
are out of control,
that's when you need to see
a doctor.
If you feel like you're taking
too much medication,
that's when you need to see
a doctor.
If you can't function at work,
that's when you need to see
a doctor.
If you're missing days at work,
go see a doctor.
