More Ways to be a Better Doctor

Doctor, are your patients staying away from you because of your “bedside manner”, or because of something that doesn’t happen in your conversation at all?

We want patients to get the best care possible, and so if good doctors are losing patients because of small things that can be improved – they should know about it.

An interesting little analysis of data was recently done by Zocdoc, a platform designed to help patients find good doctors and make appointments. After every appointment, patients are asked for a review. What do those reviews tell us?

This was one of those simple reviews of words and numbers, which admittedly can only tell us so much. However, there are some clues here that might help doctors improve their ratings.

First, which words are common in positive reviews? Here are some examples:More Ways to be a Better Doctor

  • Friendly – that’s the top one. Ok, pretty obvious.
  • Thorough – of course, we don’t want the doctor to rush us out with a prescription of 2 aspirin before she really took the time to understand our symptoms.
  • Questions – interesting. This might relate to the one above. Taking time to answer? Asking good questions?
  • Knowledgeable – Yes, that’s a biggie. How many hours did your doctor spend studying headache conditions? Certification helps here.
  • Appointment – Was it easy to get one?
  • Concerns – I can make a good guess here. Did the doctor actually listen to your concerns? There are many other related words down the list… caring, explained, answered, informative, attentive, listens

Of course, sometimes the negative reviews tell us more than the positive ones. So, let’s head over to that side. What did the bad reviews have to say?

  • Appointment – Yes, you saw this on the other list. Can you believe it, this was #1! Why? Were there mix-ups? Were appointments delayed? The research suggests that long wait-times, both before the appointment and in the waiting room were to blame. With a little organization, many of these complaints could have been avoided. Time to brainstorm in your office for some solutions!
  • Insurance – Again, easily making it in the top 2. Although the doctor only has so much control here, the office could make things go as smoothly as possible. Wouldn’t you like to be known as the doctor and team that does everything to help patients get coverage? That would be such a help.
  • Waiting/Waited – Already talked about this.
  • Questions – Another one high on both lists. Did the doctor not take the time to answer, or even listen? Rushed also made it high on the list.
  • Rude – That one should be obvious. But notice it’s a ways down the list!
  • Unprofessional – That can be improved, surely.

Another interesting thing to note about the negative reviews in particular. Words like “nurse” and “receptionist” were pretty significant. Meaning that the rest of the staff can make a huge difference. And, by the way, how does the doctor treat the staff? Just askin’.

I don’t want to see bad doctors thrown out of the business – I would like to see them become good doctors. But perhaps even more important, I don’t want good doctors to be avoided just because they don’t know how to talk to their staff, or because their receptionist made a mistake in scheduling, or because they haven’t found someone to help them administrate well. There are not enough good headache doctors as it is. Maybe a little feedback, positive and negative, can help make good doctors great.

To see the stats in more detail, check out What Really Motivates Positive and Negative Patient Reviews?. See also How to be a better Headache or Migraine Doctor


10 Headache and Migraine News Highlights from the past 3 Months (September 2017 edition)

It’s time to take a look at your favourite posts from the last three months! The most popular posts are first, but the posts in bold text had the most “likes” on Facebook.

The clear winners this month included a new study on glutamate levels – showing once again that migraine patients have biological differences even when they’re not having a migraine attack. And, a look at electromagnetic therapy.

  1. The Low Tyramine Diet for Migraine – Is it time to rethink it?
  2. Glutamate Levels Higher in People with Migraine
  3. New Drug-free Device for Migraine Tested
  4. Pulsed Shortwave (Electromagnetic) Therapy For Headache Pain
  5. Earplugs for Weather Migraine?
  6. More Positive Results from the CGRP Migraine Treatments
  7. Serotonin Syndrome: Are Triptan Users Really at Risk?
  8. In Search of a Simpler Botox Treatment
  9. Could Stress Levels Predict Migraine Attacks?
  10. After My Headache: Migraine Postdrome in Children

Migravent: Migraine Preventative (Supplement)

Recently I was reading an article which listed the remedies that 19 different people used to fight migraine. Although I wouldn’t recommend all the remedies listed, the article is worth it, just to see the animated gifs! (Check it out – 19 People Dish On The One Thing That Makes Them Feel Better When They Have A Migraine)

MigraventOne of the preventatives certainly deserves a little space here because it has helped a lot of people, and that is Migravent.

Migravent is one of many supplements taken to prevent migraine, although it is one of the more popular ones. It is designed to be taken with food, 2-3 times a day.

The ingredients are mostly well known for their migraine-fighting properties. Riboflavin (vitamin B2), magnesium (oxide and citrate), coenzyme Q10, and butterbur. It also contains piperine (BioPerine), an extract from black pepper, which helps with nutrient absorption (and may also be a mild antidepressant). Migravent is gluten free.

There has been a recent concern with butterbur products, but the company notes that the butterbur has been tested for safety by a 3rd party lab.

Although these ingredients are certainly available in individual supplements, researchers try to find special blends and delivery methods that will have maximum impact. Migravent is one of those products.

As you will see from the reviews on amazon, this product doesn’t help everyone. But the reviews are generally very positive.

As with most supplements like this, I would recommend that you check with your doctor, and keep a headache diary so you know if it’s helping. Usually 90 days is a minimum amount of time to see if something like this is really making a difference.

Have you tried Migravent? If so, leave a comment with your experiences.

Read more about Migravent here.


An Upcoming Documentary about Cluster: Clusterheads

It’s likely one of the most painful conditions known, and there’s no cure, and limited treatment. Cluster headache (CH), often nicknamed “suicide headache”, has tragically earned its moniker again and again.

Cluster sufferers, sometimes known as clusterheads, experience truly debilitating cycles of severe symptoms that can be life-destroying. And a new documentary now in production, created by two people who themselves suffer from cluster, is attempting to bring the reality of cluster to a wider audience.

Interview from Clusterheads

Cluster headache – like a knife in the head

Watch the new trailer below, and then see the links for more information on the documentary and cluster in general.


Serotonin Syndrome: Are Triptan Users Really at Risk?

Back in 2006, the FDA in the USA issued a warning about using triptan medications along with certain antidepressants because of the risk of serotonin syndrome. But how high is the risk? New studies suggest that the risk is extremely low, and that thousands have been mixing the medications with no problem.

What is the concern?

Serotonin syndrome can be serious, even fatal. It is caused by excessive accumulation of serotonin, and important neurotransmitter, in the body. Some medications and herbs have been associated with the problem, the idea being that they work to cause runaway levels.

This includes triptans, commonly used for migraine, and certain antidepressants – selective serotonin reuptake inhibitors (SSRIs) and selective serotonin/norepinephrine reuptake inhibitors (SNRIs).

There has been some suggestion that triptans alone could lead, in rare cases, to serotonin syndrome.

This is an important question, because many migraine patients also suffer from depression. And to be clear, for most migraine doctors, this was a “use with caution” warning, not a prohibition.

Re-evaluating the Research

Just because there is a “risk” doesn’t mean you should avoid something. Just because you have a “risk” of falling down the stairs, doesn’t mean you avoid stairs.

So here’s the question – just how high is the risk?

Researchers in Houston in the USA went back to check out the original research that the FDA had in 2006. They found that the evidence should not have been considered sufficient for the FDA warning. The evidence was “Class IV” – the lowest possible level. (See the abstract here: The FDA alert on serotonin syndrome)

Another study, presented at the 59th Annual Scientific Meeting of the American Headache Society, provided even more reason to question the warning. Over 14 years, about 19,000 patients who used both triptans and SSRI or SNRI antidepressants were evaluated – and between 4 and 7 patients developed serotonin syndrome. That’s about a 0.03% risk.

Of those patients, how serious was their condition, and do we even know for sure that it was caused by the medications? Serotonin syndrome, although it can be serious, usually is not fatal.

Of those patients, only two cases were related to triptan medications. And in one of the cases, the symptoms started before the patient took the triptan!

In the end, one of the researchers said simply,“Our data do not suggest a clinically meaningful risk of serotonin syndrome in patients coprescribed triptans with SSRI/SSNI antidepressants.”

Read more about this report: Triptans, Antidepressants, and Serotonin Syndrome: How Real Is the Risk?


From these studies, it seems that with regular use of triptans and antidepressants, the risk is almost nil. However, because of the seriousness of serotonin syndrome, patients should be aware and should report new symptoms to their doctor. It is also important to remember that there is concern about “street drugs”, taking more than is prescribed, and certain supplements such as St. John’s wort and ginseng. Your doctor needs to be aware of what other drugs and supplements you’re taking.

For more information on the drugs that have caused concern, see Serotonin Syndrome: Symptoms and causes.

via: Triptans (like Imitrex) mix well with antidepressants