Preventive Migraine Treatment: How to Counsel Patients

Duren Michael Ready, MD, FAHS, discusses how to work with patients to achieve the best preventive treatment results

Duren Michael Ready, MD, FAHS, is the director of the Headache Clinic at Baylor Scott & White in Temple, Texas. Dr. Ready spoke during the 2018 Scottsdale Headache Symposium about how to counsel patients about their preventive migraine treatment. Watch the full interview here: 

Dr. Ready says that it’s important to educate patients about why they are taking a certain medication. They may, for example, feel hesitant to take an anti-hypertensive medication if they don’t have high blood pressure. Advising them that this is an off-label use can make all the difference, according to Dr. Ready. 

“Even if you give someone the most appropriate therapy in the world, you’re not going to get the response if they don’t buy-in,” he says. “They could actually be better but still think that they’re worse.”

One reason that this is so important is that there are going to be times when patients will want to stop taking a preventive migraine treatment. Dr. Ready says that discontinuation on the part of the patient is usually an adherence issue because patients often do what they think is best. If they’re tired of treatments that seem ineffective, they’re more likely to stop on their own. But Dr. Ready says that a medication is more effective if a patient understands what it’s going to do and believes in the treatment. If this is true, then so is the opposite: negative feelings inhibit medication response. 

“If they understand the purpose of it and how they can expect to benefit, they’re more likely to be adherent to the therapy,” Dr. Ready says.

It’s also important to tell patients about what pharmacists might say to them. Dr. Ready says highlighting possible red flags that could come up with the pharmacist will help with adherence because patients will know what to expect. Patients who plan on hearing these comments from their pharmacists will feel more at ease because their doctors have prepared them for these situations, Dr. Ready says.

How to Discontinue Preventive Migraine Treatment 

All that being said, there are still going to be instances when patients with migraine will want to discontinue a certain treatment. When weaning or discontinuing preventive treatments, Dr. Ready prefers to wait for 12 months of stability. If other reasons warrant quicker discontinuation, he tries to wait at least 9 months. This is because Dr. Ready believes the No. 1 risk for frequent headaches is, in fact, frequent headaches. 

“As the headaches get spaced out, then it’s harder for the brain to remember how to make a headache,” he says. “I like that pattern to be stable for at least 9 months before I back off on a medication.”

In the end, doctors need to explain every aspect of a medication in order to best treat the patient, according to Dr. Ready. Telling them why they’re taking it, how to take it and what to expect along every step of the way will ultimately help get the patient the best treatment possible.

This video is part of the American Headache Society’s video library. This collection is a valuable resource for health care providers treating or studying headache and face pain. This library provides information about patient care and developments in headache medicine in an easily digestible way. Check out our video offerings here.

Latest News