The pattern matters more than the episode

People arrive able to describe the pain in detail and rarely able to describe the pattern. Yet the pattern is what treatment is planned from: how often attacks come, how long they last, what time of day they start, which side they sit on, what happens in the hours before one arrives, and what reliably sets one off.

Keeping a simple record for two or three weeks before your appointment is one of the most useful things you can do. Date, start time, duration, what you had eaten, how you had slept, and what you took for it. Patterns that are invisible from inside an attack become obvious on paper.

What the first appointment looks at

Dr Pravin takes the history of the headaches themselves and then looks wider: sleep, neck and shoulder tension, jaw clenching, screen hours, meal timing, and the stretches of the week when attacks cluster. Neck tension in particular runs alongside a great many recurring headaches and is frequently what treatment starts with.

Bring anything you already have — previous diagnoses, scans, and the medicines you take both preventively and during an attack.

How treatment runs

Sessions are planned as a course rather than taken one at a time, and they are spaced against your own pattern rather than a fixed calendar. Where attacks cluster around a particular part of the week or the cycle, sessions are timed accordingly.

Treatment is directed at the frequency and the intensity of the attacks, and at the neck and shoulder tension and the disturbed sleep that so often travel with them. Progress is reviewed at each session against the record you have been keeping, which is the other reason it is worth keeping.

  • Two to three weeks of a simple headache record before you start
  • Sessions timed against your own pattern
  • Neck, shoulder and sleep treated alongside the headaches
  • Progress reviewed against the record at each visit

Alongside your existing medicine

Treatment here is planned around the medication you already take, both preventive and acute. Bring your prescriptions to the first appointment and keep taking them as your doctor has set out.