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Discussing Migraine With Your Patients: A Common Sense Guide for Clinicians

Book Review

This is a book that opens up possibilities for people with headache and those who care for them. Dawn A. Marcus, MD, and Duren Michael Ready, MD, provide a welcome addition to the essential titles for helping primary care and headache specialists provide the best care for those with common and complex headache disorders.  

Drs. Marcus and Ready are both well-regarded headache experts. Dr. Marcus worked as a neurologist at the University of Pittsburgh and has authored more than 20 books,
including some of the most practical guides in headache management. Dr. Ready is a family physician and the director of the Headache Clinic at Baylor Scott & White Health in Temple, Texas, as well as a fellow of the American Headache Society. I have met Dr. Ready many times at pain and family practice meetings and was introduced to Dr. Marcus’s work through Dr. Ready.

In 2012, I had the great fortune of being introduced to Dr. Marcus at the American Academy of Pain Management (now the Academy of Integrative Pain Management) meeting. Dr. Ready was presenting an advanced course on headache titled “What to Try When Nothing’s Working,” and Dr. Marcus was presenting a poster on the healing benefit of pets for those in pain—another area where she was an expert.  

Their friendship ran deep, as did their encyclopedic knowledge of most topics when they spoke. When Dr. Marcus talked about the pets in her clinic and how they helped those in the most severe pain, you could tell this was a clinician with a compassionate soul aiming to find the best ways to help those entrusted to her care.  

The premise of this book is on par with this noble aim. Unfortunately, Dr. Marcus passed away unexpectedly in 2013, as poignantly discussed by Dr. Ready in the preface. This left the book uncompleted, but, as Dr. Ready notes, with an urgent need to fulfill Dr. Marcus’s wish to get this information out to practitioners. In short, they succeeded in creating one of the most well-compiled and practical to implement books on headache management.

The book is reminiscent of the impactful lectures I have heard given by Dr. Ready.  In these lectures, which typically last between 2 and 4 hours, Dr. Ready presents a plethora of information regarding diagnosis, treatment, and improving quality of life for patients. He often stays afterward and provides copies of his lectures, as well as resources, handouts, and tools, including videos of how to perform the reviewed procedures. The attendees are very grateful to walk away with this practical “toolkit.”  

When I read the book and noted the inclusion of step-by-step video instructions for office-based procedures, it felt as these lectures were being polished off, formatted, and presented in an easy-to-read format for incorporation into practice. 

The practical chapters provide information on key areas:

  • How to initiate discussion of headaches to optimize diagnosis and evaluation
  • The genetics of headache
  • Central sensitization in headache and common comorbidities
  • The role of medication and advanced techniques, including injection therapy and complementary therapies, that can be helpful in refractory headache disorders
  • Creating and optimizing the migraine team
  • How to optimally use a headache diary
  • The role of behavioral therapy, including helping patients accept their headaches
  • Knowing how to manage stress

The true gift of this book lies in the practical sections that discuss how to respond to your patients when, for example, they state: “I do not have time to practice stress management” or “Exercise will make my headache worse.” The practical tools that can be used with patients in these scenarios include:

  • Adapting a role model
  • The 6 D’s of pain coping
  • Top 10 tips for headache prevention 
  • Deep relaxation—when you are deeply relaxed, you can handle difficult situations with greater ease 

In the end, this book masterfully provides the tools that clinicians have been scrambling to collect. More importantly, this book discusses the importance of discussion! While clinicians try to do the necessary tasks in less and less time, and often feel more detached and overwhelmed by the experience, this book takes a step back to say: “We have your back.”  

It provides tools to save time while emphasizing a return to the all-important clinician-patient partnership and helps patients rise to the challenges that headache often presents.  As Dr. Marcus notes in the preface: “This material is designed to help engage the patient as an active treatment partner and ensure patients and their doctors are on the same page for treatment plans and expectations.”  I know that Dr. Marcus is smiling down on this book.  Additionally, Dr. Ready should be commended for helping to shepherd this important collection to those on the front line of compassionately improving the lives of those with headache.  

Last updated on: August 21, 2017
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