Treatment of migraines leaves a lot to be desired and in part not because we do not have effective treatment, but because of a communication barrier. Doctors appear not to want to hear what migraine patients have to say about their headaches, according to a remarkable study by a top headache researcher Richard Lipton and his colleagues. Patients and doctors agreed to be videotaped during a visit and 60 such interactions were analyzed. The analysis showed that doctors did not ask about the disability of headaches and tended to ask closed-end short questions. Very often the information they did obtain was incorrect. 55% of doctor-patient pairs were misaligned regarding frequency of attacks; 51% on the degree of impairment. Of the 20 (33%) patients who were preventive medication candidates, 80% did not receive it and 50% of their visits lacked discussion of prevention. The authors recommended that doctors assess impairment using open-ended questions in combination with what is called the ask-tell-ask technique.
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