What They Say

Healthcare Provider: Tell me about your headaches, Mrs. Jones.

Patient: Well, it all started when I was 3 years old. …

Healthcare Provider: Yes, yes, that’s fine. How frequent are your headaches? Do you have an aura?

Healthcare Provider: I see you brought your MRI scan. I’ll show it to you. See, this is the brain, and this is the skull. And see these little white spots? They’re high-signal intensity abnormalities on T2- weighted images that can occur with headache.

Patient: Oh.

Healthcare Provider: Migraine is caused by abnormal blood vessels in the brain. Serotonin imbalance within the brain causes the blood vessels to react abnormally and cause headache.

Patient: So will I need surgery? Is it serious? Is it fatal?

Healthcare Provider: You don’t have any serious problem and you don’t need surgery. Are you depressed?

Patient [with tears welling up in her eyes]: Not at all!

Healthcare Provider: For people with your particular condition, we often use antidepressants. And we’ll have you meet with the psychologist. They have good treatments for you. Biofeedback and relaxation are also effective migraine therapies.

Patient: How do I take these?

Healthcare Provider: Just take one pill before you go to bed and I’ll see you back in 4 weeks.

Patient: Okay. Before you go, I wanted to ask a few questions. Here’s a list I wrote down for you.

Healthcare Provider: Here’s a couple of pamphlets and we’ll answer any questions you may still have at your next visit.

What They Mean

A new headache patient—and I’m already 20 minutes behind!

I brought 10 years worth of charts for him to review and he never even looked at them!

Doesn’t she realize I’ve already read 10 years worth of records about her? Why did she bring all of these if she’s going to tell me every detail that’s in them anyway!

This is a normal MRI scan. There is no tumor or abnormal blood vessels. Often small white spots are seen in patients with chronic migraine, but they are not a sign of any disease or damage.

Does he think I have a brain tumor? Are those spots an infection?

Migraine is not serious. There is no reason to worry.

Abnormal blood vessels! My uncle died of a brain aneurysm — is that what I’ve got? What’s serotonin, and how did I get it?

She’s not even listening to me! She seems very anxious and high-strung. Could be a mood disorder — not unusual with chronic headache. Maybe that’s why she’s not focusing on what I’m telling her. Luckily some migraine medications treat both.

Not again! My husband doesn’t believe me, my boss thinks I’m a faker. I can’t even find a healthcare provider who’ll take my headaches seriously.

She’s in denial. Maybe this mood problem is more serious than I thought! Antidepressants are great headache preventive medications, so that would be a good choice.

He really does think I’m just crazy. I’ll try these pills and see if they help. I’m so desperate at this point I’d try anything!

She needs to take this every day for several weeks before it will work.

I wonder what the side effects are. I’ll take it a couple of times and see if it works.

She brought 4 pages of questions! I don’t have time to answer 4 pages worth of questions today…

Dawn A. Marcus, M.D.
Associate Professor
University of Pittsburgh School of Medicine
Neurologist, Coordinator of Headache Research
The Pain Evaluation and Treatment Institute
Pittsburgh, PA