The Role of the Patient in Maximizing Efficacy of Drug Therapy in Migraine

There is abundant evidence for the incapacity and reduction in quality of life experienced by individuals with migraine and also for a somewhat unsympathetic attitude from the 80% or so of the population who do not experience recurrent incapacitating headaches. The burden of migraine is reviewed and it is noted that despite the manifest difficulties faced by those with the disease, there appears to be a reluctance to consult physicians about the problem and a disinclination of many physicians to take recurrent headaches seriously. The role of the patient is therefore to conduct a personal evaluation as to the effects of the headache; to learn about what is known of the causes, triggers and management options in migraine; and to feel empowered enough to consult a primary care physician and, if necessary, a neurologist when the debilitating effect of the syndrome is recognized. It is appropriate to teach individuals with migraine about the more characteristic features of the condition, so that they will embrace the diagnosis and be content to forego fruitless investigations. They should also be aware of the frequent concurrence of other headache types, of the dangers of over-frequent medication, of the necessity of following a drug regimen (as well as dietary and other lifestyle changes) and of the value of prophylactic medications. Patients should also be proactive in educating the rest of the public, in order to create an understanding environment for those developing this condition in the future. With regard to the treatments that can be employed, patients should become educated about the indications for prophylaxis, the nature of the agents available and their potential unwanted effects and about the delay before any response is seen in many cases. It is useful for those with migraine to go to one of the websites where the impact of their disorder can be pointed out to them by means of tests such as the Headache Impact Test or the Migraine Disability Assessment Scale. Differentiation of oncoming severe from milder headaches is valuable if the patient learns the signs that indicate one or the other type; again, patients must know something of the nature of the various agents available, including their benefits and their limitations. They should also be keenly aware of the causes and characteristics of medication-induced headaches, and of the other unwanted effects of frequent ingestion of analgesics. While the new and effective medications for migraine have provided huge relief from this disorder worldwide, there is much more to migraine therapy than drugs, and it is especially in the non-pharmacological field that patients themselves must assume responsibility for the management of their disorder. Education is thus the key to effective migraine care.