To do a needs assessment directed to neurologists attending a workshop on communication skills emphasizing relationships between physician and patient, assessment of disability and quality of life of migraine patients, and communication of therapies for migraine.

A structured questionnaire was sent to all participants related to the issues indicated in the objective. This was prepared by the faculty and the results were collated by the author and presented at the beginning of the workshop. This paper overviews the use and results of a needs assessment to highlight learning needs of the participants and to focus the issues, interest and interactions of neurologists in a workshop. The workshop focused primarily on communication skills and on the understanding of disability and quality of life issues in migraine patients.

In general the responses revealed that the attendees were neurologists in practice for more than 15 years, that over 50% had prior knowledge of communication skills and used them in various ways, and 74% were involved in teaching family physicians. Some knew and used disability and quality of life tools but up to one third of participants did not assess disability in their patients. Most wanted to learn more about communication skills and other objectives noted and 19% of respondents wanted to learn more about prophylactic antimigraine treatments and how to differentiate/contrast the triptans.

Using a needs assessment tool allowed organizers of an educational workshop to determine the current knowledge and perceived and unperceived needs of the participants with respect to communication skills, assessing disability and quality of life issues, and communication of treatments to migraine patients.

To examine the importance of good communication when informing the patient of the diagnosis of migraine; to review the essentials of successful communication between physician and patient on the aspect of diagnosis; to survey learning resources for physicians on communicating information to patients.

This paper is based on observations made by the author of the successful interactions of numerous international “headache experts” with their patients, on a review of the medical education literature pertaining to the teaching of communication skills, and on 30 years of not always successful communication with patients.

Communicating the diagnosis of migraine is an opportunity to educate and reassure the patient, to lay the foundation for rational treatment and to help establish the successful doctor-patient relationship which is essential for effective management. No matter how accurate the diagnosis, failure to communicate it effectively to the patient (and often to significant others) may impair interactions with the patient and compromise therapy. Effective communication of a diagnosis requires clarity, relevance to the patient, a positive attitude, and reinforcement through repetition, questioning and dialogue. In terms of using the diagnosis to lay a foundation for therapy, it is useful to explain the symptoms as transient physical dysfunction of normal tissues, to indicate that there are multiple mechanisms underlying the dysfunction of which only some may presently be susceptible to treatment and to stress the relevance of emotions as factors which may powerfully affect, for better or worse, the underlying disturbed physiology of migraine. Into this model can be “plugged” all the relevant therapies for migraine. This is the ideal, but every day experience in the headache consultant's office suggest that in both primary care and specialist practice, it is infrequently attained. There are scant resources other than example for physicians to learn communication of headache diagnosis specifically but there are numerous print and web resources available to physicians who wish to learn and/or teach the generic principles of effective communication, and these principles require little or no modification to be applied to the headache patient and the headache doctor.

Current recommendations for treating elevated blood pressure (BP) in the acute stroke are based largely on expert opinion and vary with regard to treatment thresholds and choice of antihypertensive agents. In this study we investigate the influence of these recommendations by comparing the management of hypertension in acute stroke at a tertiary care hospital with current guidelines.

Retrospective chart review of patients admitted with acute stroke at The Ottawa Hospital-General Campus over six consecutive months. The use of antihypertensive medications (type, dose, routes of administration, BP recordings) in the first seven days after admission was noted.

Transdermal nitroglycerin paste was the most commonly used antihypertensive agent. In contrast to the 15% reduction in BP over 24 hours recommended for lowering BP in hypertensive patients with ischemic stroke, nitroglycerin caused a >15% reduction of BPover the first 24 hours on 60% of the occasions used. Furthermore, despite concerns about sublingual nifedipine, this was the second most commonly prescribed agent. Surprisingly, the mean time to first BP measurement following initiation of antihypertensive therapy was 117 ± 43 minutes in ischemic stroke and 88 ± 89 minutes in hemorrhagic strokes.

The current guidelines for management of acute poststroke hypertension appear to have little influence on prescribing patterns, leading to considerable variations in practice. Such variations, likely due to uncertainty caused by lack of evidence from randomised controlled trials, are intolerable as patients maybe submitted to nonstandardised, potentially harmful care such as inappropriate choice of antihypertensives and inadequate BP monitoring as observed in this study.