How to Approach Difficult Patients with Chronic Headache

One year ago, a 17-year-old female came to visit neurologist because she wanted to recover from chronic headache which she had been having. Her neurologist diagnosed chronic migraine. Even with adjustment on both medicine and dosage, the patient’s condition was not getting better. Her headache was so terrible that she had to drop out from school. Although the neurologist tried to find the root cause of the headache by means of MRI and MRA brain scans, her neurologist did not find anything abnormal. After doing some observations and looking for other factors related to the headache, the neurologist went to consult the case with a psychiatrist and found that the patient was having psychiatric problems, which could be matched with major depressive disorder and somatic symptom disorder. In addition, the patient’s family had been having a lot of conflicts, causing pressure upon the patient herself. The key strategies in continuously treating a patient are communication skills, in providing information, building a therapeutic relationship, and awareness of the patient’s mental state that was affecting her headaches. The goal of the collaboration between neurologist and the psychiatrist is the efforts into making the improvement of overall functions and quantity of her life. The patient’s outcome was better, both headache and depressive disorder. Nowadays, she starts planning to go back to school. Keywords: Chronic headache, migraine, major depressive disorder, somatic symptom disorder