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Getting the Right Migraine Treatment


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It can be a horrible experience, and we would all like to avoid them - but the truth is most of the general population have had some sort of headache, at some time in their lives.

But spare a thought for those who are worse off!

A significant part of the population experience severe, often incapacitating headache such as Migraine or Cluster Headache - or they have frequent headaches, such as “Chronic Daily Headache", that not only affect the quality of their lives but also their productivity.

If you're one of these people, you're not alone - and there are many ways to treat or manage these conditions, and finding the right treatment for you requires taking a logical approach.

In Medicine the logical, step-by-step approach that medical practitioners take to diagnose and treat symptoms is called a “Diagnostic Pathway".

It's very useful in many conditions, but none more so than in the management of headache because, as a headache sufferer, your involvement in the Diagnostic Pathway substantially affects your ability to receive the right treatment.

This is because diagnosis of headache is usually dependent solely on the verbal history you give to your doctor - and the clearer that is given, the better.

In making a headache diagnosis, one of the most important key features is the frequency of the headache. That is, how often in a period of time (say, in one month) the headache occurs.

On the basis of this, your treating doctor will begin by categorizing the headache into one of two categories - the first step towards developing an appropriate treatment.

These can include “Episodic" headaches - those occurring on less than 15 days of the month on average; and “Chronic" headaches - those occurring, on average, on more than half the days of the month.

From that point, your medical practitioner is more easily able to diagnose your headache.

The most common “Episodic" headaches are Migraine, Episodic Tension Headache, Cluster Headache.

"Chronic" headaches include Chronic Tension Type Headache, New Daily Persistent Headache, Transformed Migraine(or Chronic Migraine) and Hemicrania Continua.

This is why it's so valuable to keep a dairy of the number of headache attacks per month - because it's of such value for the medical practitioner when the patient comes for the initial consultation.

It's the beginning of a logical, step-by-step approach to not only making the correct diagnosis, but planning the correct treatment for the headache sufferer.

The first step in treating a headache patient is making a headache diagnosis. No headache is ‘just a headache’ and each headache type needs a specific management strategy.

One of the easiest ways to correctly define and diagnose headache is by frequency, this immediately putting it into either the Episodic or the Chronic category. From there on, the features of headache will define exactly what type of headache it is.

Unlike (say) a skin rash, the nature of a headache means it's often difficult to assess the symptoms without the patient's own verbal input into the diagnosis.

This is why your involvement, as a patient, is so important to headache diagnosis.

According to Dr Jacques Joubert, “No-one but the patient knows best how frequent his or her headaches are, and this is where the patient-held diary is so valuable. "

Dr Jacques Joubert (MbChB, MRCP, FRACP, MD) is a neurologist working in both clinical practice and medical research. He has had a long-standing interest in headache diagnosis in clinical practice as well as the effective management of headache.

Dr Joubert's approach is a unique melding of scientific rigor with a comprehensive view of the patient in their environment.

To read more of Dr Jacques Joubert's work, visit


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