Treatment of migraines leaves a lot to be desired and in part not because we do not have effective treatment, but because of a communication barrier.  Doctors appear not to want to hear what migraine patients have to say about their headaches, according to a remarkable study by a top headache researcher Richard Lipton and his colleagues.  Patients and doctors agreed to be videotaped during a visit and 60 such interactions were analyzed.  The analysis showed that doctors did not ask about the disability of headaches and tended to ask closed-end short questions.  Very often the information they did obtain was incorrect.  55% of doctor-patient pairs were misaligned regarding frequency of attacks; 51% on the degree of impairment. Of the 20 (33%) patients who were preventive medication candidates, 80% did not receive it and 50% of their visits lacked discussion of prevention.  The authors recommended that doctors assess impairment using open-ended questions in combination with what is called the ask-tell-ask technique.