Patient Education
Assess Patient Needs
An important first step in optimizing patient education is to adequately assess each patient's needs. Take into account patients' level of knowledge about their headaches. Also, be aware of their attitudes, beliefs, and cultural background and how these elements might affect the treatment process. Be sensitive to environmental and social factors, which can also play a role in determining patients' receptivity to treatment.
Discuss Diagnosis
Primary headaches are far more common than secondary headaches. However, patients often fear a serious underlying cause of their headaches, making it critical to reassure your patients and yourself as to the diagnosis. At times, testing is necessary to establish a diagnosis or rule out underlying disease. If you order tests, be sure to explain them thoroughly, as well as the rationale for ordering them (i.e., ruling out secondary headache causes).
Once the history and physical exam are complete, it is important to share your diagnosis with the patient. Again, patients may have initiated the consultations on the basis of numerous preexisting notions of what is causing their headaches. Take the time to explain their headache type. Once patients understand that their headaches are not caused by a more serious secondary condition, they often wish to learn as much about their headaches as possible.
For most patients, it may be helpful to discuss specific risk factors or headache triggers that may precipitate or exacerbate headache symptoms (see table below). In addition to helping patients understand the factors that put their nervous system at risk for migraine, this discussion provides an opportunity to modify or change some of these risk factors and avoid future headaches.
Table: Factors that May Influence Onset or Severity of Migraine Symptoms
| Physical |
Dietary |
- Menses, ovulation, or pregnancy
- Birth control/hormone replacement (progesterone) therapy
- Illness
- Intense or strenuous activity/exercise
- Sleeping too much/too little/jet lag
- Fasting/missing meals
- Bright or flickering lights
- Excessive or repetitive noises
- Odors/fragrances/tobacco smoke
- Weather/seasonal changes
- High altitudes
- Medications
- Stress/stress letdown
|
- Sour cream
- Ripened cheeses (cheddar, Stilton, Brie, Camembert)
- Sausage, bologna, salami, pepperoni, summer sausage, hot dogs
- Pizza
- Chicken liver, pate
- Herring (pickled or dried)
- Any pickled, fermented, or marinated food
- Monosodium glutamate (MSG) (soy sauce, meat tenderizers, seasoned salt)
- Freshly baked yeast products, sourdough bread
- Chocolate
- Nuts or nut butters
- Broad beans, lima beans, fava beans, snow peas
- Onions
- Figs, raisins, papayas, avocados, red plums
- Citrus foods
- Bananas
- Caffeinated beverages (tea, coffee, cola, etc.)
- Alcoholic beverages (wine, beer, whiskey, etc.)
- Aspartame/phenylalanine-containing foods or beverages
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Discuss Treatments
Once patients have a better understanding of their headache type, it is important to include them in the treatment decision process. In many cases, it is beneficial to explain that even though there is no "cure" for headache, with proper treatment headaches can be effectively managed. Be sure to spend adequate time discussing all the possible treatment options and any potential side effects. Be specific when explaining proper medication use, including correct dosing, when to treat, the frequency of medication usage, and how and when to use rescue medications if appropriate. Educate patients about nonpharmacologic treatments, including behavior modification, a healthy diet, and exercise. Set realistic treatment expectations, and encourage patients to take responsibility for their treatment. Allow for a question and answer period before ending the visit.
With appropriate education, providers and patients can establish a partnership that will improve compliance and greatly increase the likelihood of a successful treatment outcome. Early investment in education pays big dividends over years of headache management.
Optimize Your Practice
Appointing a coordinator for all patient education activities is an important step toward tailoring patient education for your practice. Depending on the practice, allied health professionals or even nonmedical office staff should play an important role on the patient education team. Proper training may be necessary to ensure that the staff is adequately prepared to handle patients effectively.
Choose the Right Tools
Educational handouts, such as brochures or fact sheets, can be quite helpful (refer to table 2.2 of the original guideline document). Creating your own educational materials, while giving you complete control over content, can be both time-consuming and costly. Pharmaceutical manufacturers can often supply your practice with educational resources, although you should be sure that the content is clinically sound and not overly promotional. Clinicians can also refer patients to headache-focused patient organizations such as the National Headache Foundation (www.headaches.org, 888-643-5552) and the American Council for Headache Education (www.achenet.org, 856-423-0258).
Make Your Office Patient-Education-Friendly
Once you have chosen your educational materials, make sure they are accessible to your patients. Potential locations include the office entryway, reception area, bathrooms, and exam rooms. In some cases, it may be ideal to create a "Patient Library" in a spare room or closet, to store all patient education materials. Also, consider making your educational charts patient-friendly by using checklists or diagrams.
Maximize Your Time
Finding the time to properly educate your patients may be a challenge. The table below provides some quick tips to help you maximize your time and effectively communicate all the information your patient needs.
| Timesaving Teaching Tips |
- Keep focused on the goals of patient and family education
- Partner with the patient to establish learning objectives
- Assess knowledge and ability before you teach
- Never "assume"
- Focus on teaching behaviors and skills
- Actively involve the patient
- Take advantage of teachable moments
- Individualize your teaching
- Help the learner believe
- Evaluate learning
- Share your teaching with the rest of the healthcare team
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