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Expert Perspectives on the Interdisciplinary Management of Migraine - Episode 13

Best Practices for Collaborative Migraine Care

Dr Williams discusses best practices for taking care of patients with migraine in a collaborative manner.

Kita Williams, MD: As it pertains to best practices for collaborating on patient care between providers, I believe this is the highest form of caring for patients, when we can come together and talk about our patient. I found that the best outcomes happen when I can get another provider on the phone and discuss the patient. Often, I’ve made a phone call when a patient is on a medicine that I wanted to increase or wanted to replace with another medicine that would essentially treat the same disease. We’ll discuss it, we’ll come to the table, and we’ll talk about why each of us is wanting the patient to have the medication that they’re taking.

If they’re a cardiologist, they’re looking at it from 1 perspective. As a neurologist I’m looking at it from the perspective of how this can help my patient with their migraines. Often what we’re agreeing on a medication that does both, and we’re aware of the adverse effects and how the medication could adversely affect the patient. We’re coming to the table and saying, of all the choices, this is going to be the best medicine for this patient, but I’m also going to watch for a drop in their heart rate, to see if the patient’s blood pressure drops because of this medication, in addition to watching if this patient’s headaches go away. We’re both looking, and there’s no better care that the patient can get when their doctors talk, when they come together and talk about the patient. That makes the patient feel secure. That makes us as clinicians know that we’re doing the best that we can for this patient. It’s great to collaborate.

One of the greatest hurdles to interdisciplinary management of migraines is that many patients are on many medicines for their comorbidities, and for those individuals it’s not easy to come to a decision that makes everybody happy. Often we must see what happens. We must split the difference. We have to say we’ll try this, but we’ll monitor this closely to make sure that nothing happens, that liver enzymes are not skyrocketing. And if that happens, then we’re going to have to pull back. There’s a time for coming back to the drawing board if we recognize that something has gone awry with that patient.

The good news is that with all the medicines we have available, the chances of us finding something that will work for that patient, that both physicians will agree on, is greater than ever. Even though there are some hurdles to collaboration, there are some great benefits. It’s always great to collaborate with colleagues about the care of the patient.

Transcript Edited for Clarity