Archives: Summit Talks

Racial Inequities In Migraine Treatment

Key Questions
  • What is different about the experience that people of color have in seeking health care?
  • What are some historical or systemic factors that play into people of color receiving suboptimal health care? 
  • Along with race, what other factors might play into a patient receiving less than adequate health care?
  • What are the cultural factors that affect how we talk about pain and whether we seek professional help?
  • How much does the ethnicity of physicians matter in the care received by people of color?
  • Is migraine equally prevalent in all races?
  • Why are people of color often underrepresented in clinical trials?
  • How can we improve migraine care for people of color?
  • What role do health care practitioners have in combating racial inequities?
Interview Notes

Overcoming Monthly Menstrual Migraine

Key Questions
  • How is menstrual migraine different from migraine in general?
  • What is the connection between a woman’s menstrual cycle and migraine?
  • How does migraine change throughout a woman’s lifespan?
  • What treatments and/or lifestyle modifications are recommended for hormonal and menstrual migraine?
  • Is testing of hormone levels helpful in migraine management?
  • Does migraine become less severe with age?
  • How does treatment change during perimenopause and menopause?
  • Is it best to consult a gynecologist or a headache specialist for hormonal and menstrual migraine?
  • Are there any nonmedical options for treating hormonal and menstrual migraine?
  • Can hormonal or menstrual migraine mask any other conditions?
Interview Notes

Understanding Vestibular Migraine

Key Questions
  • What is vestibular migraine?
  • To what extent can the symptoms of vestibular migraine cause disability?
  • Are vestibular symptoms more likely to happen at a certain stage of an attack?
  • Is headache always a feature of vestibular migraine?
  • What is the difference between vestibular migraine, and migraine with dizziness or vertigo as part of the attack?
  • Are there any triggers specific to vestibular migraine attacks?
  • What is the difference between vestibular migraine and other conditions that cause vestibular symptoms, like Meniere’s disease, BBPV, or PPPD?
  • What is the relationship of tinnitus to vestibular migraine?
  • Why is the diagnosis of vestibular migraine so complicated?
  • How much does having an accurate diagnosis of vestibular migraine matter?
  • Can vestibular migraine symptoms get worse over time if untreated?
  • How can people who suspect they have vestibular migraine find help?
  • How can vestibular migraine be treated?
  • Are there any exercises specific to treating vestibular migraine?
  • Are there any options in neuroplasticity training for vestibular migraine?
  • Is there any evidence that meditation can be helpful for vestibular migraine?
  • What does the future hold for those living with vestibular migraine?
Interview Notes

When Migraine Starts or Stays in Your Neck

Key Questions
  • How prevalent is neck pain for those with migraine?
  • What is the trigeminal cervical complex?
  • What is the difference between primary and secondary headache?
  • How do we know if neck pain is a symptom of a migraine attack or if it’s triggering the attack?
  • What are trigger point injections?
  • What is cervicogenic headache?
  • What is occipital neuralgia?
  • How can we distinguish between occipital neuralgia and migraine with neck pain?
  • Can Botox help relieve neck pain with migraine?
  • How do we determine whether neck pain is a symptom of a migraine attack or caused by a structural or neurological issue apart from migraine?
  • What types of imaging studies are done for neck pain?
  • What are the treatments for neck pain that may be triggering a migraine attack?
  • What is radiofrequency ablation (neurotomy)?
  • How does posture affect the neck and migraine?
  • Is it better to use heat or ice for neck pain?
  • Which nonmedical interventions are helpful for neck pain with migraine?
Interview Notes

Understanding Treatment Failure and Options

Key Questions
  • How can we differentiate between difficult-to-treat migraine, resistant migraine, and refractory migraine?
  • How common is refractory migraine?
  • What are the preventive drug classes that are considered when evaluating if someone has resistant or refractory migraine?
  • What constitutes a preventive or acute drug failure?
  • When should someone with refractory migraine go to the hospital?
  • What is the difference between refractory migraine and status migraine?
  • Why would someone have a migraine every single day?
  • Why is the long-lasting chronic migraine so difficult to treat?
  • What are the preventive and acute treatment options for someone with difficult-to-treat or refractory migraine?
  •  Why are nonpharmacological treatments not used more often to treat migraine?
Interview Notes

Juggling Multiple Conditions With Migraine

Key Questions
  • Why is it important to notify the doctor who’s treating your migraine of all of your other health problems?
  • How common are comorbid conditions in people with migraine?
  • What are the most common comorbid conditions in people with migraine?
  • Are there some conditions that have a relatively low incidence of occurrence but a high correlation with migraine?
  • Is endometriosis more common in women with migraine than in women without migraine?
  • How do researchers determine whether migraine is causing a symptom, such as insomnia, or if it is triggering migraine attacks?
  • How does a physician determine if a patient’s comorbidities are correlated with migraine or caused by migraine?
  • Is migraine sometimes related to a history of trauma or PTSD?
  • Is there a link between migraine and concussion?
  • Is Raynaud’s syndrome a comorbid condition, or are cold hands and feet just a symptom of migraine?
  • Is depression a cause or an effect of migraine?
  • Can migraine medication cause depression?
  • Is there a causal link between migraine and anxiety?
  • How do you determine if GI problems are a symptom of migraine or a side effect of medication?
  • How common is constipation as a side effect with the CGRP medications?
  • Does chronic pain increase migraine comorbidities?
  • What is the link between migraine and stroke/cardiovascular issues?
  • Are there any treatment synergies for migraine and its comorbidities?
  • Are there any treatments that are contraindicated for people with certain comorbidities?
  • What acute migraine medications are recommended for people with heart issues?
Interview Notes

Managing Migraine With Little to No Insurance

Key Questions
  • What is meant by “underserved populations,” and who are some underserved populations when it comes to migraine care?
  • Why is migraine disease more prevalent in the U.S. among people with lower income, people over 65 years old, people insured by Medicaid, and people without health insurance?
  • What are some of the challenges faced by underserved populations needing care for migraine disease?
  • How can underserved communities get better access to migraine care?
  • What are some strategies for addressing financial barriers to migraine care?
  • Why are there so few headache specialists in the U.S.?
  • How can we advocate for more resources for migraine research?
Interview Notes

Autoimmune Disease and Migraine: What’s the Link?

Key Questions
  • What is autoimmune disease?
  • What are some of the most common autoimmune diseases?
  • Why are autoimmune diseases more common in women than in men?
  • What is Lyme disease, and is it an autoimmune disease?
  • What sort of specialist and credentials should you seek when deciding on a doctor to treat Lyme disease?
  • Is an autoimmune disease disorder a trigger or a comorbidity in someone with migraine?
  • What is the association between with autoimmune disease and migraine?
  • How well do researchers understand the link between autoimmune disorders and migraine?
  • What role does inflammation play in migraine and in autoimmune disorders?
  • How can we treat or manage inflammation?
  • Does a compromised immune system put someone at greater risk for migraine?
  • How do you treat and manage both migraine and autoimmune disease together?
  • Can multiple biological treatments for different diseases be used at the same time on a patient, such as a CGRP medication for migraine and a different biologic for an autoimmune disorder?
  • Can lifestyle changes — sleep, diet, exercise — be effective forms of treatment for migraine and autoimmune diseases?
  • Why is sleep important for reducing inflammation and for good health in general?
  • Why is exercise important for good health, including for migraine management?
  • Are there practical ways to boost your immune system against autoimmune disorders and COVID-19?
Interview Notes

Sex Headaches: Serious or Just Awkward?

Key Questions
  • What causes headache during sexual activity?
  • How common is sex headache?
  • Can sexual activity provide relief from a migraine attack?
  • Should you seek emergency care if you experience a sudden-onset headache during sexual activity?
  • Does a headache associated with sexual activity happen every time a person has sex?
  • What are the symptoms of sex headache?
  • How are sex headaches treated?
  • Who is most likely to be affected by sex headache?
  • Can anyone experience sex headache regardless of migraine diagnosis?
  • How does sex headache affect cluster headache?
  • Can medication affect libido?
  • What are some recommendations for those struggling with side effects of decreased libido?
Interview Notes

Shortening Attacks With Early Migraine Intervention

Key Questions
  • How effective is early intervention in trying to stop or mitigate a migraine attack while it is still in the mild stage?
  • How can we identify the best time to treat an attack in the early stages?
  • How do we know if some of the symptoms we’re having can be considered premonitory symptoms?
  • Do premonitory symptoms vary from person to person, or even attack to attack?
  • What is the migraine aura, and how can we recognize when it’s happening?
  • Can migraine aura change over the course of someone’s lifetime?
  • Does aura need to be present in order for a diagnosis of migraine?
  • What is the earliest point in a migraine attack when an acute medication should be used?
  • How do you decide whether to use abortive medications to treat an attack early, especially when you’re prescribed a limited amount of medication, and when some of your attacks can be milder than others?
  • Is it still possible to intervene early in an attack when you wake with morning migraine?
  • Can nonmedicinal approaches to treating migraine — such as meditation, breathwork, exercise, hydration, or using ice packs — be effective treatments early in an attack?
Interview Notes

Difficult Diagnoses: Rare Headache Types

Key Questions
  • What is new daily persistent headache?
  • What is the difference between new daily persistent headache and chronic migraine?
  • Is new daily persistent headache a primary or a secondary headache?
  • What is hypnic headache, or sleep headache?
  • Are there any triggers for hypnic headache?
  • What is cluster headache, and how is it treated?
  • What is hemicrania continua?
  • How can hemicrania continua be differentiated from cluster headache or new daily persistent headache?
  • Does hemicrania continua have a cure?
  • What is hemiplegic migraine?
  • How can hemiplegic migraine be differentiated from stroke?
  • Is there a known genetic cause for hemiplegic migraine?
  • What is thunderclap headache?
  • Why aren’t there many clinical trials of medications for the rare headache types?
  • What is migraine with brain stem aura?
  • What is primary cough headache?
Interview Notes

Finding Work That Works Despite Migraine

Key Questions
  • What are some of the challenges of managing a career with frequent and disabling migraine?
  • What type of work might be best suited for someone living with frequent or chronic migraine?
  • When is it appropriate to ask for job accommodations at work?
  • If fragrance is a trigger for someone with migraine, what’s the best way to go about handling a situation in which a coworker wears a lot of perfume?
  • What guidance would you give to someone with migraine who is considering starting their own business?
  • Should you tell your employer or a prospective employer that you have migraine disease?
  • What if you disclose that you have migraine and then face repercussions from your employer?
  • If an issue arises at work that an employee suspects is discrimination because of their disablity, what resources are available to help?
  • Are there accommodations you can ask for when working from home?
  • How should the question “Do you have a disability?” be answered on job applications?
  • What are some things that can be done to raise awareness of migraine in the workplace?
Interview Notes