Long-term and successful migraine treatment is a lot more than just finding the right prescription and taking it as directed. You have to remain aware of your migraine triggers, and in some cases, you may have to make lifestyle changes to reach your treatment goals. You also need to keep track of this information so that when you do see your doctor, he can help you assess what's working and what isn't.

At the same time, your doctor should take the time to carefully consider the data you bring him (in the form of your headache diary) and to answer your questions and concerns. That doesn't mean he's expected to read a thirty-page document at each visit. Be as respectful of his time as he should be of yours. Highlight important information or send your diary in advance of your appointment for review. Talk to your doctor to find a process that works well for both of you.

Follow-up appointments should also be collaborative. Make sure you tell your doctor if your migraines start to increase in frequency or the severity or symptoms of your headaches starts to change. Track your medication use carefully. If you find yourself taking more medication with more headaches and less pain relief, you could be experiencing rebound or medication-overuse headache. And if a medication isn't working because it conflicts with certain lifestyle needs, then your doctor should work with you to find something more appropriate

Be forthcoming with any information that can impact your health and your migraine care. This includes recreational drug use, drinking, and sexual activity. Your doctor can't treat you effectively if he has an edited version of your lifestyle and/or things that may trigger a migraine attack. Most physicians have pretty much “seen it all,” and hiding information out of embarrassment or guilt can only hurt you. Remember, the doctor-patient relationship is one that is protected by confidentiality, so being open and honest is the best way to get on the path to better migraine management.

You can also help improve your patient care experience by doing some very basic things. Bring your headache diary to every appointment and show up on time and ready for your appointment. No one likes extended waits at the doctor's office, but patients often don't realize that when they are late for appointments, don't cancel or reschedule appointments, or show up at the doctor's office unprepared (e.g., no insurance card, forgotten lab appointments), they contribute to the overall problem.

Immediately phone your doctor if you experience any of the emergency symptoms described in “When to Seek Emergency Care” later in this chapter. Make sure that you tell the receptionist or answering service your specific problem so they can have a member of the clinical staff get on the line or return your call immediately. If it's after hours, leave a message with the answering service and then go to your nearest emergency care facility. Get a family member or friend to drive you (or call 911 if you are incapacitated).

You should also phone your physician if you're trying a new medication and it is absolutely not working for you (i.e., you experience little to no pain relief, your headaches increase in frequency). If your follow-up appointment is within the next day or two and you aren't in the midst of a migraine episode, it probably makes sense to have the discussion face-to-face. But if you have a wait of several weeks or longer, make the call.

The same goes for a new medication that is causing serious side effects, especially if your doctor didn't mention the side effect when he prescribed the drug. If a drug is causing a skin rash, breathing difficulties, or swelling, it's possible you are allergic to it. Discontinue the drug and phone your doctor immediately to report the problem. If breathing problems are severe, call 911 for emergency assistance. Most side effects are of a milder nature and may include stomach upset, sleepiness, and difficulty concentrating, depending on the drug you're taking. If these side effects are causing significant discomfort, then call your doctor. Frequently, side effects will decrease and even disappear over time, but they may warrant a change in prescription.