Migraines, Patient Advocacy and Pelvic Pain: Three useful lessons from SURG 0131


I have an app that I made with the idea that it would empower people recovering from injury. It is a series of coaching tips to help boost a person's self efficacy, self esteem, motivation and internal locus of control. Here are two cards from the piece of mind deck:


It was during a headache lecture that I realised that I need to practice what I preach and become an expert on my own migraines. When presented with clinical cases our class found it very hard to diagnose each patient’s headache disorder. This is because headache and facial pain are divided into multiple categories and there are more than 300 individual headache disorders. There are no specific diagnostic tests and only 52% of patients are thought to be accurately diagnosed with only 12% receiving treatment. A headache diary is a critical pointer in diagnosis. Though this makes total sense I had not yet made any efforts towards tracking my headaches or migraines. I have only had two migraines with auras this year. But I am 45 and I know that there will be more. I also get headaches regularly - perhaps three or four a month.The first thing that I did after the lecture was download HeadApp. The next day I started reading about menstrual migraines and headaches and started to write a blog post about them.

I do wish that I had researched my headaches earlier. I think I fell into the default position of thinking that a doctor would know it all - despite what I tell my clients.


Since this lecture, I have taken a positive step towards being an expert in my own health condition. I am taking supplements and I have adjusted my lifestyle where I focus on sleep and meditating more in the week before my period. I’ve also discovered that some of my headaches can be prevented by having a mid morning snack to keep my blood sugar steady. I used to have a client who would cancel on me almost every month because of her menstrual migraines. Though I had encouraged her to seek medical assistance that was not the route she wanted to follow. I wish that I had encouraged her to track her migraines, to keep on top of her blood sugar and to supplement. I have emailed her my blog post in the hope that something from it resonates with her.


The lecture and the readings for the vaginal mesh scandal were very dispiriting. The message that I walked away with was that a lot of women needed to be hurt before someone would listen to them. The next day a client told me that she would have to cancel our session as she’d had an IUD implanted without any form of anaesthetic and she was still in pain. I have been meaning to write a blog post on patient advocacy for months now but these two events catalysed this process. I sent her a message with the above words from the Declaration of Montreal and suggested that she find a new gynaecologist. This course has given me much faith in the level of expertise of our medical professionals but has also left me a little disillusioned at the same time. I do encourage clients to seek a second opinion if something doesn’t feel right now.


During a session with another client (to help her back pain) she mentioned her vaginal atrophy. She assured me that nothing could be done for it. She has tried pessaries and oestrogen gel and they have not worked. She has resigned herself to not having sex for the rest of her life. When working through my course notes, I came across the (UCLH ) program “re-connect” which is centred around improving sexual relationships. I was able to forward her this information and recommend that she investigate the UCLH menopause clinic. I have also been able to gently reframe sex for her as a marathon, she won’t necessarily complete it tomorrow but with small steps she will get there. I have gently raised the subject of having sex with herself too. I haven’t spoken to clients about sex before but having some tools and a place to direct people to is very useful. Also, the way the material has been presented to me has reminded me that sex is just another biological process. I don’t need to feel invasive or rude for asking sensitively framed questions. This is especially true for women with lower back and pelvic pain as the two may be linked. This has been a nudge to add menopausal symptoms to my Detailed Medical History Questionnaire.


October was a busy month for me. It was a wake up to practice what I preach. It was a reminder to my clients to advocate for their rights; and I had my first conversation with a client about sex.



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