1. Schedule an Appointment Specifically for Headache Evaluation
   A separate physician appointment should be scheduled for and dedicated to the evaluation of headache, and headache only. When headache is discussed during an office visit for other medical concerns or after an ob-gyn exam, there may not be enough time or attention to properly assess the headache.
   
   
2. Be Prepared to Provide the Necessary Information
   The physician needs to know specific and detailed information about the headaches in order to determine the proper diagnosis and treatment plan. Women can be prepared for the interview by:
   1. Symptoms: Track your migraine symptoms and be prepared to provide information about the pain location, character, and associated symptoms (e.g., nausea, vomiting, light sensitivity)
   2. Patterns and characteristics: Follow the onset and history of your headache symptoms over time. This will help determine any patterns or triggers, such as menstruation, travel, allergies or stress.
   3. Medications: Record all medications (both prescription and over-the-counter) that you are taking and recall past treatments and their outcome that you take or have taken for headache. Also record other possible triggers that may impact headache such as caffeine, vitamins, or dietary supplements.
   4. History: Learn about any possible family history of headache. Migraine often runs in families and this will help confirm a diagnosis.
   5. Illnesses: Provide the necessary information about other medical conditions that may influence your headaches—such as depression, sleep irregularities or eating disorders.
   
   
3. Talk to your Doctor  
   To ensure that women are able to communicate effectively with their physician during the appointment, they should arrive early and bring notes, questions, headache calendar, medical records or other information. If possible, arrange child care so that you can devote full attention to the visit. Most patients feel more comfortable talking to their physician when they are wearing their street clothes. If the nurse suggests that you change into the examination gown, it is reasonable to request that you sit first with the physician to discuss headaches. It is important that you be in a comfortable environment so they interact with the physician without distractions. All women need to be sure they understand exactly what the diagnostic and treatment plans are and how the treatment plan will be evaluated over time. Don’t hesitate to make a list of questions and items you want to talk to your doctor about. The list of questions or concerns will help you be prepared learn more about your headaches and how to treat them.
   
   
4. Provide Reliable Feedback
   The physician will be relying on the headache patient to provide feedback about the effectiveness of treatment. It is crucial to discuss the impact headache has on one's life. We know that physicians are much more likely to respond with more appropriate and aggressive treatment if patients describe the impact their headaches are having on their life. "Doctor, my headaches prevent me from working three days each month" goes further than just describing pain intensity and location. Often treatment plans have to be modified over time, and reliable information is needed. Carefully follow all treatment recommendations, and report progress back to the physician as requested. The physician (and the headache sufferer) should be interested in tracking success of treatment over time.
   
   
5. Know What to Expect
   Headache patients need to make sure they share their treatment goals with the physician. Remember, headache is a chronic medical condition that can rarely be cured. The goal is to manage headaches, and allow the headache sufferer to function more normally. Treatment expectations need to be realistic- migraine is not a curable disorder, rather one that can be managed with a treatment plan (like diabetes, high blood pressure, and heart disease). Patients need to be educated about headaches. There is a great deal that women can do to ensure that they receive the best possible medical care.

Migraine and Pregnancy

What Should I Do Before I Become Pregnant?

Will my Migraines Change During my Pregnancy?

Will Having Migraines When I’m Pregnant Hurt the Baby?

What Teatments are Safe When I’m Pregnant?

• Relaxation techniques  Relaxation techniques reduce levels of pain-provoking brain chemicals. Biofeedback is a type of relaxation technique that is effective for three in four pregnant women.

• Stress management  Learn to prevent the release of stress chemicals and muscle tension when exposed to daily stresses. Managing stress is effective for two in three women.

• Cognitive restructuring  Learn to tell yourself positive thoughts about your headaches. Tell yourself, “I have techniques to help reduce my headache,” instead of “Oh no – I’m getting a headache! The day is ruined.”

• Distraction  Take your mind off of the pain by going for a walk, listening to soothing music or doing neck stretches.

• Acetaminophen
• Intranasal lidocaine
• Opioid painkillers (when used infrequently)
• Some nausea medications, such as metoclopramide and ondansetron
• Topical peppermint oil

• Vitamin B6
• Ginger
• Metoclopramide (Reglan)
• Ondansetron (Zofran)

Can I Plan to Breastfeed?

• Gives your baby needed hormones and immune factors
• Provides essential fats to promote good brain development
• Promotes bonding between baby and mom
• Reduces mom’s risk for breast and ovarian cancer
• Delays return of headaches during the first month after delivery

• Acetaminophen
• Ibuprofen
• Sumatriptan (Imitrex)
• Opioid painkillers (when used infrequently)
• Ondansetron (Zofran) for nausea