The patient-physician relationship in the approach to therapeutic management

Recent epidemiological investigations have demonstrated that migraine, and more generally primary headaches, are underdiagnosed and poorly treated. To tackle and resolve this problem, in addition to identifying efficient screening means and reliable disability measurement tools, it is crucial to improve communication between physicians and patients. In particular, physicians should be willing and have time to establish a relationship of active and mutual cooperation with their patients and should do so through a number of inescapable steps: listening to patients, understanding their needs, identifying with their condition, giving them explanations and information, reassuring their concerns, advising them on what should be done, making sure that they have correctly understood what they have been told, finding out whether they want to be involved in decision-making and choosing a treatment. Patients must be in a position to freely express their opinions, with no hurry and without fear. Indeed, the time spent with patients, as Graham pointed out as early as 40 years ago, is the most important ingredient of migraine therapy. Proper measures should be taken to overcome the two major obstacles that stand in the way of a good patient-physician relationship: a physician's lack of adequate skills and the organisational absurdities of the health system.