While you may prefer a different approach, this is how Brian D. Loftus MD, the developer of iHeadache and a headache specialist in Houston Texas, typically uses iHeadache in his practice.
Patients with Infrequent Headaches
Patients with infrequent headaches may only have a few severe headaches a month, so it is reasonable to ask them to fill out all parts of the headache diary.
If the patient's headaches do not warrant the need for a preventative therapy but they are having a significant number of hours they are disabled, then Dr. Loftus emphasizes the need to know as much as possible about time of their headache and treatments. Often times patients think they should only track the "bad headaches" so if patients with infrequent headaches have a lot of disability then asks them to begin entering every headache, even if it is mild. Many times the patient realizes they are having headaches much more often than they thought.
Patients with Chronic Headaches
To improve compliance with keeping their diary, Dr. Loftus finds it is best to ask patients who have chronic headaches to concentrate on entering acute medications taken for their headaches, the time they are completely and partially disabled, answering the real-time disability questions, and entering their worst or highest pain score of the day.
Notice that "symptoms" are not on the list of information Dr. Loftus want them to track. If the patient does not enter their symptoms then iHeadache cannot classify the headache type and will label it as an "Unclassified Headache". Dr. Loftus explains to his patients that it is fine for their headaches to show up as unclassified in their diary because they have been diagnosed as having chronic headaches - such as chronic migraine, new daily persistent headache or other types of chronic headache. He also tells the patient that he doesn't want them to be slowed down by entering symptoms for every headache because that can be time consuming and may decrease compliance with keeping their diary, therefore he is asking them to focus on entering only the key information above (text in bold above).
Young Patients With Frequent Headaches
In addition to the information he asks patients with chronic headaches to track, when Dr. Loftus sees younger patients who have frequent headaches, he emphasizes how important it is for them to use the preventative treatment section of iHeadache Online so they will have a history of the preventatives they have taken and failed. This will assist them as they move from physician to physician during their lives. He also explains the importance of entering the date they started the treatment and the dose. If the dose is increased or decreased he asks them to enter the date of the dose change in the stop date field along with a reason why the dose was changed. If the patient completely stops a preventative treatment then it is very important for them to enter the reason the treatment was discontinued.
Customizing iHeadache MD to Filter Headache Data
iHeadache tracks a lot of information about the patient's headache and you may not want or need to see all of it. With this in mind, we designed the headache dashboard and reports to be customizable. You can filter the data to show the information that you want to review. For example. Dr. Loftus has set up his dashboard to get a quick view of the patient’s headache counts, acute medication usage, disability, and triggers by month or 28 day periods depending on the frequency of the patient's visits. A quick glance at his dashboard enables Dr. Loftus to determine if:
- Acute therapies are working well
- The patient is potentially having medication overuse headaches
- Disability relating to their headaches is improving or getting worse
- The preventative medication needs adjustment or;
- The patient needs to begin a preventative therapy
If the patient is using preventative treatments, Dr. Loftus looks at the preventative section where he can quickly see a graphical representation of the preventatives and headache frequency. At this point, the treatment decisions are typically made and he goes to the Report tab to copy and paste data from the diary that he wants to include in his visit record.
Tracking Information When Not Having a Headache
iHeadache enables patients to mark an entry as "information only" so they can track information when they are not having a headache. Patients can use this function to track triggers both when they cause a headache and when they do not cause a headache. Patients can also setup custom symptoms. For example, if the patient is having vertigo but is unsure if it is related to their headaches, they can setup "vertigo" as a custom symptom. Then they can track when they have it with a headache and without a headache to determine if it is related to their headaches or a separate entity. If patient's are using this function then Dr. Loftus discusses the findings with the patient.
Improve Your Documentation
Insurance payers are wanting detailed documentation before they will approve procedures and medications. iHeadache MD makes it easy for you to generate data to justify costs.
Optimize Patient Care
iHeadache's report & dashboard make it easy for you to see which acute and preventative treatments are working and which aren't; so that you can individually customize the patient's treatment plan.
Reports from iHeadache give you a snapshot of the patient's disability, medication usage, treatment effectiveness and pain. This gives you more time to talk with the patient or see additional patients.