A brilliant writer on how we take care of people with difficult-to-treat migraines
Atul Gawande is a surgeon at the Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School. He is also a very talented writer who has written four books and has been writing for the New Yorker since 1998. I had the privilege of meeting him and found him to be very humble and low-key, despite him being a surgeon, MacArthur “genius” award recipient, famous writer, etc. His last book, Being Mortal should be read by everyone who is dealing with elderly parents, grandparents, or friends.
His last article in the New Yorker, The Heroism of Incremental Care describes how headache specialists approach patients with severe and persistent migraine headaches. Fortunately, these are a minority of our patients, but require our unflagging attention and care. Some tell me that they’ve tried “everything” and ask, “please do not abandon me”. My response is to reassure the person that I will never stop trying to help and also that I’ve never seen anyone who has tried everything – we always find medications, supplements, devices, procedures, and other treatments that the patient has not yet tried.
Just like with the man in Gawande’s story, some patients improve very slowly and over a long period of time, so patience and perseverance are essential. I must admit that we cannot be sure if it is our treatment or just the passage of time that leads to improvement. However, it may not matter since our support helps avoid a sense of helplessness and hopelessness that can lead to depression and a decline in the ability to function.
Thank you for this post. As a chronic migraine patient, more than once I have asked a headache doctor to please not “abandon” me as we search for a treatment together, only to be passed off to an assistant or someone else as soon as the first-line treatments failed to work. The importance of finding a physician who exhibits compassion and persistence cannot be overstated, especially when dealing with chronic migraine. This is often just as important as the efficacy of the care itself.
Unfortunately, methysergide has been off the market in the US for several years. This is why we sometimes use methergine instead, however, it is much less effective than methysergide for the prevention of migraine and cluster headaches.
Dr Mauskop, do you recommend methergine or methysergide to chronic migraine patients who are not responding to other treatments?