Please Be Prepared: Our goal is helping the patient to have a better quality of life. The patient can greatly assist us in that goal if they are prepared.
Please bring your insurance card. Make sure if you need a referral, per your insurance, that you have that referral. If you arrive and you do not have your card or your referral, we can’t see you. That waste our time and yours. It also sets back our chance of helping you.
It is important if you have a list of medications that you are presently on. We try our best to get your prior chart notes before you come but sometimes they are either not sent, or they are sent and they do not have a medication list.
Try to find out what previous headache treatment trials you have had and which ones failed. We don’t want to try things that didn’t work.
Please, if it is within your power, be on time. We keep a full schedule. We try very hard to be exactly on time for our patients. If you arrive late, we may not be able to see you. We do this out of respect for our subsequent patients. We understand that traffic problems occur and can cause delays. We will do our best to accommodate you, but we must be fair to our next patient.
If you decide, for whatever reason, not to come, please let us know. We have patients waiting weeks to get in. A new patient is schedule for 90 minutes. When you don’t show up, it waste an appointment time that some desperate patient could have used. So, in fairness to our other patients, please do not simply no-show. To help discourage this behavior, we had to create a no-show fee.
Time: Because we are a headache-centered practice, we take the condition very seriously. The first visit routinely can take 90 minutes. If your condition is simple (which rarely is the case for our patients) it can be as short as an hour. If you have seen one of our providers before, it may also take a shorter time. On the other hand, if you have a severe problem with many complicating factors, if you have been seen by many neurologists and even headache clinics, it is possible that your first visit could take up to two hours.
Checking In: Health care is a very complicated “industry.” Because of that, we have many legal responsibilities with our patients. We must collect relevant data about you and your insurance. We must review our practice financial polices and HIPAA rules. Kaaren, our office manager, will also obtain your basic health history.
History: During the visit with the provider, we will start with a very detailed, and headache specific history. In headache work, the history is about 99% of the diagnoses so we will probably ask more detailed questions about the headaches than you have ever been asked before. This alone takes about thirty to forty-five minutes. It is very important that we not only understand the nature of your headaches clearly, but that we know what has worked and what has not worked.
Exam: We will next do a compete neurological exam, plus additional headache specific exams. In case exams make you nervous, I am happy to say that our exams almost always allows you to wear all your normal clothes.
Diagnoses: Next we will create our diagnoses and spend a great deal of time talking about the causes for the headaches and treatment options. We follow strictly the established guidelines of the International Headache Society criteria for diagnosing headaches.
Treatment: We will formulate the treatment plan.
In headache treatment, our focus is on trying to prevent the headache from even coming. There are four major ways to prevent headaches and we will discuss each of the following;
- Look for triggers and figuring out how to avoid them.
- Physical, hands on treatments such as acupuncture and massage. Some patients report benefit from chiropractic treatments. While we in evidence-based medicine don’t always agree with chiropractors when they talk about the causes of headaches, we agree with anyone who can help our patients get better.
- Dietary treatments. This means diets and specific nutritional supplements which are geared to prevent headaches.
- Prescription medications. There are two types of prescription medications. The preventative medications are aimed at correcting the underlying cause to the headaches, which in most cases are genetic errors within the brain. There also also abortive medications, which mimic the brain’s ability to turn off a headache. Lastly, and with limits, rescue medications are prescribed to stop the pain when none of the above are effective.
Education: We review carefully this treatment plan with the patient, using handouts and additional teaching tools. Sometimes we order tests such as MRIs or labs.
Follow Up: We schedule the patient back in timely manner to go over the plan and to make improvements. Usually the first follow up appointment is about three weeks after the first visit. This gives time to test the treatments.
Depending on the progress, the appointments are gradually spaced out, until the patient is completely satisfied with their progress. At that point, the patient is put on a yearly follow up or turned back over to their primary care provider. If we prescribe medications, then we must see a patient at least every year.
In conclusion, our ultimate goal with the patient is to increase their quality of life by addressing the true causes of their headaches, rather than covering them up.
J. Michael Jones, MPAS-C