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Expert Perspectives on the Interdisciplinary Management of Migraine - Episode 1

Migraine Overview and Evaluation

A migraine specialist, Dr Kita Williams, provides an overview of migraine and her approach to evaluating patients with headache.

Kita Williams, MD: The challenges of the migraine diagnosis that I see in evaluating my patients is letting people know that it’s OK that you’re experiencing a migraine and that because of the stigma associated with migraine, individuals often feel as if they should just shake it off. They often try to minimize what they’re experiencing because of how society sees it. Let’s face it, a migraine is not something we can quantitate. It’s not something you can get an MRI and see. It’s something that a person must tell you—that they’re not feeling well—and because of that, it’s subjective. People often feel that they’re a burden, and because of that, they don’t want to take time to take care of themselves or take the time that’s necessary to take off from work. I tell patients and family members, and even other clinicians, that when there is a chronic condition that we know about—most people know about diabetes or hypertension—those are chronic diseases that we care about and treat. Migraine is also a chronic disease. It’s deserving of the care and treatment that these other diseases get, and I explain that.

This is how I segue into letting patients know that, if they had high blood pressure, I wouldn’t say to take a high blood pressure medicine if you think your blood pressure is high. No, we’d seek to prevent the blood pressure from going high. That’s when we can discuss how we must seek to prevent migraines from occurring and have a responsive reaction as opposed to an impulsive reaction to caring for the migraine.

When evaluating a patient with headache, we see if they’re having migraines. I ask questions such as, “Do you have pain on 1 side of your head, like a unilateral presentation for your pain? Is it pulsating in quality? How is the pain, moderate or severe?” Other things that people with migraines have is that they avoid physical activity. They’re avoiding work or climbing stairs, or anything that could exacerbate their pain, and I ask about that. I ask questions about any nausea or vomiting associated with their head pain and about any light or sound sensitivity. These are the criteria that we look for a migraine diagnosis, and this is established by the International Headache Society. Basically, patients must have at least 5 headache attacks that last between 4 and 72 hours untreated or unsuccessfully treated. This headache must have at least 2 of those characteristics that I just named, and if the patient says yes to at least 2, then we’re likely looking at a migraine.

Transcript Edited for Clarity