Jun 18, 2021

TRANSCRIPT

Interviewer: Today, we're going to talk about how you can go into your primary care physician and talk to them about headaches, so you can finally get that relief.

Dr. Karly Pippitt is a primary care physician, but she's also a headache specialist at University of Utah Health, so she understands both the perspective of a primary care physician and a headache expert. So, hopefully, we'll be able to bring those perspectives together to find out how to talk, how to prepare, and other things like that. So the first question is, what kind of barriers do people run into when they're trying to talk to their doctor about headaches?

Dr. Pippitt: I think probably one of the biggest barriers, when talking to primary care, is time, right? I mean, if I go to my primary care doctor, I probably have four or five things that I want sort of checked off my list to get taken care of, and this is just one in a list of a number of things. And what I have learned is that what's really important is you need to make a visit that is dedicated to your headaches. This is a problem that deserves the appropriate amount of time. So you need to go into it with that perspective if your provider doesn't guide you to that already.

Interviewer: I've been fortunate. I know people that have had severe headaches. And when we talk about headaches, are we talking just about headaches in general, or are we talking about migraines? I mean, what type of headache is it generally that people seek help for?

Dr. Pippitt: So most people I would say probably seek care for migraines, but I think one thing I've been very impressed by is how much people don't talk about headaches. And in my role at the Headache Clinic, I'll sometimes ask people questions about their headaches and they'll say, "No one ever asked me that before."

Interviewer: Yeah.

Dr. Pippitt: And it doesn't seem like a particularly earth-shattering question that I've asked them. So I think that's a pretty important thing is that if your headaches, migraines or not, are impacting something in your life, right, like it's keeping you from work, it's keeping you from school, it's keeping you from anything like that, that means you should talk about it.

Interviewer: Yeah. If you kind of take an inventory and you're like, "Yeah, that is kind of an issue." Because we all get just kind of one-off headaches, a lot of people do. And that's not what we're necessarily talking about here, or is it?

Dr. Pippitt: I think it can be. I think if it's not a one-off as much anymore, but like, "Hey, wait a minute, I think that's kind of been every day. And yeah, maybe I can get done what I need to do, but maybe I can't quite focus as well, or maybe I'm a little more irritable at home with my partner, with my family, and I don't really like that." Those are things you should talk to someone about.

Interviewer: All right. So make that appointment with your primary care provider and just make it just about headaches if that's what you want to tackle with your primary care provider. Then what would you recommend that a patient do to start moving towards maybe managing them a little bit better?

Dr. Pippitt: Yeah. So when you go in for that appointment, be ready. So most people who have headaches have more than one type of headache. This is sometimes I think if you don't have headaches or don't have frequent headaches, you don't think about this very much, but go in ready to talk about that. Maybe I have this sort of low-level headache if I don't eat enough that day or if I go a little bit late on a meal or don't stay super well hydrated, but maybe I get a really bad headache if a storm comes in or if I haven't slept very well for a couple of nights in a row. So be ready with sort of all of those different types of headaches and especially coming in with a diary. So I've seen all sorts of different diaries. There are apps for your phone that you can use. You can write these down on a calendar or just on a notepad. But you want to keep track of the frequency. So how frequent are you having headaches? How bad are they? So did you have to go home from work, or were you able to keep doing what you wanted to do that day? How did you sleep the night before? How active had you been? And then what did you take, and did it help or not? These are all important things to just sort of get a bigger picture, because we all think we remember. "Oh, I think I had a couple of headaches last month." But sometimes when you write it down, it can be pretty striking how frequent you might be having headaches.

Interviewer: Yeah. So go in prepared. It's going to take a little time beforehand. How long would you recommend somebody do the diary before then they actually go and talk to their doctor?

Dr. Pippitt: I'd probably say somewhere around six to eight weeks. Some of it depends on how bad your headaches are. So I think if your headaches are really pretty debilitating and you're having to miss work, then you might not want to go for quite that long. But at least a good couple of weeks of volume of extra information so that then you and your provider can look at that together to determine what might be the next appropriate step.

Interviewer: Okay. And you had mentioned that there are some apps out there and they tend to ask the questions that are going to be the most useful in that appointment. Most of them are pretty good, or do you have a recommendation?

Dr. Pippitt: The one that I've used the most is called My Migraine Buddy. It seems to be the most user-friendly. It actually prints out some nice, pretty charts that talk about how frequent, how intense was the pain, and things like that. That's the one I've heard the best reviews from patients.

Interviewer: Yeah. And when a patient comes in with that information to you because, as you mentioned at the top, you're a primary care physician, but you have also taken extreme interest in headaches and have educated yourself to the extent that maybe the common primary care physician has not. Are you kind of struck by when they come in with that information? Does that truly make it easier for the regular primary care physician?

Dr. Pippitt: Oh, absolutely. I mean I think anytime you come to me as a primary care doc and have information about when your last labs were, about your family's medical history that's really detailed, I'm never going to be upset about that. That is like a gift when you walk in the door.

Interviewer: Okay. So the person brings that in, they bring you some great information, and then at that point, you would review it, and you would likely come up with a treatment plan. Are we at that point yet?

Dr. Pippitt: Yeah. Absolutely. And treatment, we usually break down into two big categories. So one is rescue or acute treatment. So if you're having such intense headaches or migraines and whatever you're trying over the counter isn't working, that's sort of step number one, one thing we could treat. And then I think the second aspect of that is prevention. So if you're having really terrible migraines every week, that lasts for two or three days, well, then we should do something to try to reduce that frequency. So talking to them about what the options are, what might make the most sense based on their particular set of circumstances.

Interviewer: So if I'm a person with a headache and I've gone to my primary care physician and I know maybe they've had like a day or two of training, right, and maybe they have educated themselves off and on throughout their practice, how often can a primary care physician that's kind of got that base level of headache knowledge really solve a problem?

Dr. Pippitt: I think we are well equipped to solve the problem. There are a lot of good migraine medicines that have been out there for a while. And I would say before you escalate to a specialty level of care, unless there's something unusual or concerning about your headache in particular, but you should be able to try at least a couple of rescue medications with your primary care provider and at least a couple of prevention medications. I think it's important to always keep in mind there is no magic cure for any of this. There is no snap of my fingers that is going to make this go away. So patience is really important. If you come in with a migraine a week for a year, it's going to take some time to get at that. So being patient and having reasonable expectations about the outcome, I think is important going in.

Interviewer: Yeah. That can be important. I know some people personally that they have headache issues and they've gone to their doctor and then they felt like they weren't able to solve it so then they just gave up. So I think kind of realizing that it sounds like it's a process, where maybe a few treatments might need to be tried would be useful. At what point then would you want to consider going to more of a specialized headache care center?

Dr. Pippitt: I think if you've tried a couple of things with your primary care and you're not making any headway, if you'll pardon the pun, I think that's the time to think about talking to someone else. It's an okay thing to ask your primary care provider. Just be forthright and say, "At what point do you usually refer patients to a specialist?" I think most of us have a level of comfort with different medical conditions, like I'm clearly going to take care of a lot of things in my primary care practice that are headaches that some of my partners will not, but they'll take care of some things that I would probably send to a specialist as well. So I think asking your provider when. I think it's important that you've tried something, though. I occasionally will see patients in our Headache Clinic who've never tried anything before. They've never tried a prescription rescue medicine. They've never tried a prescription preventive medication. And while that's particularly lovely for me in the Headache Clinic, I would say it's not a good use of a pretty limited resource, because we're there to really take care of patients who've tried quite a few things and are not making any progress.

Interviewer: So we talked about how to talk to your doctor, your primary care physician about headaches, make that diary. It sounds like have a little bit of patience with them as they work through a few treatment options. Are there some other keys to getting that correct diagnosis and treatment from a primary care provider?

Dr. Pippitt: I think you as the patient are the one who knows your history best. So I think we worry that maybe the right questions aren't being asked. So if there's some symptom or something you're experiencing that you don't know if my hand tingling, before I get a migraine, has anything to do with it, bring it up, pay attention to those things. Really ask the questions when you go in so that you're well informed about your own condition, because that helps your provider make the correct diagnosis.

For Patients