In Migrainism Part I we learnt that it is wrong to conjure up automatically the image of a menopausal spinster knitting mittens for her 12 cats when someone mentions the word migraine. It is wrong to assume that they (the migraineur, not the cats) are a dull, anti-social hypochondriac. I wish I was a hypochondriac (and yes I’ve been called one), as I’m pretty sure it would be a lot less painful.
So the biggest misconception I would like to dispel is that migraines are a psychological disorder. They’re not! You see a NEUROLOGIST when you have migraine, not a psychiatrist or a counselor. Migraines involve complex neural chemical and vascular changes, in the brain and - cue Elgar’s Cello Concerto played by Jacqueline du Pré to heighten emotional intensity - it actually upsets me that I still feel compelled to defend this point to friends. Why is it that if you have a headache, especially a migraine, people think you’re highly neurotic? Maybe I’m overly sensitive on this point but I am not depressed. Yes, stress can trigger migraines for some people. Yes, there are studies that suggest people with migraines are more prone to depression. Yes, I get blue now and then, I think I have reason to do so, but I do not have a depressive personality. Really I don’t. And this has actually been a blessing and a curse in relation to the treatment I have received.
In 2005 I saw a supposed pain specialist, not a migraine specialist, and he wrote TWO letters to the group of doctors I was consulting saying: “Miss Saxton always appears well dressed, polite, smiling and shows no anger at her condition. I find this surprising. I therefore suggest her condition is psychological”!!!! I’m sorry that my good manners and impeccable dress sense stopped you, Mr Pain Specialist, from diagnosing chronic migraine, damaged nerves and a spine fracture!!
So always remember to be rude and dress like a homeless person when going to the doctor! Anyway, I shall talk about this special doctor, who is a big offender of migrainism, in another blog.
With the above in mind you will now appreciate why I (nearly) made a trainee GP cry.
The Trainee GP
The other week, when I arrived at my local GP surgery the receptionist asked if I minded seeing a trainee GP before seeing my actual GP. Oh, I did not mind at all. It would only take 5 minutes, she said. The receptionist led me into the treatment room and immediately I saw my chance to educate this poor, sweaty, naïf trainee. In fact, I saw my chance to even the playing fields with all the patronizing doctors I had ever seen. I could get this one while he was young. He looked about 13 and had a limp handshake. I decided to take charge.
“Hello, do sit down” I kindly instructed trainee “Now do you have a pen and paper? You’re going to need to make notes”. He looked like Bambi caught on the M25 in rush hour. I can be quite scary and bossy when I decide to be.
“Um…um” he tried to stutter, “I think I’m meant to ask why you’re here today?”
“That’s not important young man. I’ll present you with my full case history in a moment but first I’m going to educate you about something called migraine – and if you really have what it takes to be a GP, it will be the most common neurological condition you will see. Now am I right in assuming you weren’t properly taught about migraines at medical school? Of course you weren’t! So let’s start with….” And off I went. And on I went. I stood up and strolled around the room doing my best impression of Professor Snape. At one point the receptionist knocked on the door to say the GP was ready, I shut the door in her face saying we hadn’t even got to second line treatment options. I knew time would be tight so I started talking double speed, I told poor trainee about Triptans, the pros and cons of Beta Blockers and when I noticed he was looking a bit peaky asked if he needed a glass of water. This then reminded me that dehydration was a key factor for migraine sufferers. Telling him I didn’t mean to be patronizing (which of course one always does) I suggested that at this early stage in his career it would probably be best if he simply referred patients with suspected migraines to the many specialist clinics I had just listed, as he could learn from the many excellent neurologists I had also just listed. It wasn’t his fault he was so young, he would learn over time, the important thing was…. And just as I was about to get started anew my actual GP appeared, looked rather annoyed, and said she’d been waiting for over 30 minutes. I, however, smiled proudly at my trainee, eager to see him show off his newfound knowledge. I felt confident I had done a great service to future migraneurs who would walk into his office in years to come. It did not, at that moment, occur to me that I had so freaked out the poor trainee he might decide a career in carpentry would be far less stressful than medicine. However, we moved to my actual GP’s office, she talked a little about the process of training a GP and, assuming I was now trainee’s unofficial tutor, I said I thought he showed great potential, great ability to listen and take notes, and would do well over time but could, perhaps, assert a little more confidence. She then turned to trainee and said “So, why is Victoria here today?”. Trainee looked at me, horror struck, the poor boy hadn’t gotten a chance to ask this vital question. But I was there for him.
“Oh, I just came in for a flu jab.”
Just in case you were wondering, my lecture/neurotic rant did not put trainee off the medical professional. A few weeks later I was walking past the GP surgery and I saw trainee and GP walking out, happily discussing something. I hid behind a tree.
The latest statistics from The World Health Organisation suggest medical students only receive four hours, total, of training in headaches. I’m going to investigate this further and report back. Maybe I could offer my services!