Recently, Neura Health’s medical director Dr. Thomas Berk sat down with Shoshana Lipson from Migraine Meanderings for an open mic Q&A session. This insightful conversation aimed to tackle some of the most common myths and misconceptions about migraine that continue to pervade our understanding of this debilitating condition. Here we delve deeper into their discussion, summarizing the key points and explanations.

‍

The origin of bizarre migraine remedies

‍

Shoshana Lipson:

Some bizarre home remedies for migraine attacks include putting a potato or onion on your head. Do these ancient remedies have any basis in fact?

‍

Dr. Thomas Berk:

These remedies likely stem from times when people were desperate and unsure how to deal with migraine. Historical practices like placing a potato or onion on the head to "suck away the migraine" or even poking a hole in the skull to release pressure (trepanation) highlight the extreme measures that people resorted to. These rituals originated when medical understanding was rudimentary at best, and such myths persisted due to the lack of effective treatments.

‍

Although laughable today, these remedies underscore a critical issue — people with migraine often reach for any possible solution when they are determined to find relief. It also points to a time when migraine attacks were not well-understood and were shrouded in superstition and folklore.

‍

Widespread misinformation and its ramifications

‍

Shoshana Lipson:

How prevalent is misinformation about migraine, and does it have real ramifications?

‍

Dr. Thomas Berk:

Misinformation is rampant. It exists because many people, including some healthcare providers, have limited knowledge about migraine. They sometimes reduce migraine to issues like blood flow or inflammation and suggest treatments that have no scientific evidence backing them. This misinformation can lead to ineffective treatment plans and even exacerbate the condition.

‍

People might follow advice or treatments from unverified sources, leading to postponement of effective treatment. Moreover, this misinformation can also lead to a loss of trust in medical professionals, further hindering the path to proper care.

‍

The gap in medical education

‍

Shoshana Lipson:

Why is there so much misinformation among medical professionals?

‍

Dr. Thomas Berk:

The education on migraine and headache disorders in medical schools is woefully inadequate. At NYU, one of the top medical schools, there is only a single hour of headache education. This lack of comprehensive training results in doctors who lack the critical knowledge required to effectively diagnose and treat migraine.

‍

When patients consult doctors who are not adequately trained in migraine management, they may receive outdated or insufficient advice. The myth that visiting a neurologist guarantees comprehensive migraine care is debunked by the reality of limited training in this specialized area.

‍

Misconceptions about drug-seeking behavior

‍

Shoshana Lipson:

One harmful myth is that people with chronic migraine are often seen as drug addicts. Why does this perception persist?

‍

Dr. Thomas Berk:

This myth persists because patients with chronic migraine can often appear desperate for relief. Physicians who lack empathy or understanding may misconstrue this desperation as drug-seeking behavior. This misconception can prevent patients from receiving the pain management they desperately need.

‍

Labeling patients as drug seekers can have devastating consequences, such as under-treatment of pain and increased frustration and hopelessness among patients. This stigma needs to be addressed to ensure that patients receive compassionate and comprehensive care.

‍

Migraine is an invisible disease

‍

Shoshana Lipson:

Why do you think there's a lack of empathy for people with migraine since they don't appear visibly ill?

‍

Dr. Thomas Berk:

Migraine is an invisible disease. Unlike a broken arm or a person on crutches, people with migraine don't have visible signs of their condition. Consequently, they often don't receive the same level of empathy. Even someone experiencing a migraine might be met with indifference because their pain isn't outwardly apparent.

‍

Misconceptions about migraine attacks and auras

‍

Shoshana Lipson:

People often think that if someone doesn't have an aura before a headache, it isn't a migraine. Is this true?

‍

Dr. Thomas Berk:

Most people with migraine don't experience aura — only about 25-30%. Migraine can occur with or without an aura, and both are valid forms of the condition. This myth persists because auras are dramatic and easily identifiable, but they are not requisite for a migraine diagnosis.

‍

Understanding that migraine attacks can present in various forms ensures that more individuals receive accurate diagnoses and appropriate treatments. Awareness campaigns should emphasize the diverse manifestations of migraine to dismantle this long-standing myth.

‍

The intricacies of vestibular migraine

‍

Shoshana Lipson:

How do you differentiate vestibular migraine from other dizziness-inducing conditions?

‍

Dr. Thomas Berk:

Vestibular migraine, a subtype involving vestibular symptoms like vertigo, can be challenging to diagnose. Detailed patient histories and sometimes specialized testing are necessary. Vestibular migraine must be distinguished from conditions like vestibular neuritis or benign paroxysmal positional vertigo (BPPV), which may require different treatments.

‍

Accurate diagnosis is crucial for effective treatment. Because vestibular symptoms can be associated with various conditions, thorough examinations and patient histories help pinpoint the true cause, ensuring that patients receive the most effective interventions.

‍

Switching CGRP inhibitors: A viable option

‍

Shoshana Lipson:

Is it true that if one CGRP inhibitor doesn't work, none of the others will?

‍

Dr. Thomas Berk:

Switching CGRP medications can be beneficial. They work differently despite targeting the same pathway. Even if one doesn't work, another might. Studies have shown that switching between different CGRP inhibitors can yield positive results for patients who didn't respond to the initial medication.

‍

Patients should be encouraged to explore all available options under the guidance of their healthcare provider.

‍

Comprehensive treatment plans are essential

‍

Shoshana Lipson:

Can a single acute medication effectively manage all migraine attacks?

‍

Dr. Thomas Berk:

Effective treatment often requires multiple medications or alternative treatments, depending on the type and severity of the migraine. A well-rounded plan can include first-line, second-line, and even third-line treatments, accommodating various scenarios.

A comprehensive treatment plan might encompass a range of acute and preventive strategies, tailored to the individual’s unique needs. Such a plan allows patients to manage different types of attacks effectively and reduces the risk of medication overuse or adaptation.

‍

The need for empathy and specialized care

‍

Shoshana Lipson:

Are all doctors equipped to treat migraine effectively?

‍

Dr. Thomas Berk:

The education on migraine among general physicians is often insufficient. It makes a considerable difference when a patient is treated by a specialist who is well-versed in the complexities of migraine. Empathy, proper training, and understanding of up-to-date treatment modalities are crucial for effective care.

‍

Patients should seek out healthcare providers who specialize in headache medicine for the most accurate diagnosis and effective treatment plans. This might involve consulting headache specialists or neurologists with extensive experience in managing migraine.

‍

Most concerning misinformation

‍

Shoshana Lipson:

What is the most concerning misinformation about migraine that you see or hear?

‍

Dr. Thomas Berk:

The most dangerous myth is that migraine (attacks) are the patient's fault. This misinformation can lead to poorly managed treatment and exacerbate the patient's challenges. Blaming patients for their condition can erode their mental health and willingness to seek help.

‍

Exciting developments in migraine treatment

‍

Shoshana Lipson:

What developments in migraine treatment are you most excited about?

‍

Dr. Thomas Berk:

I’m excited about advancements in genetic research, which may explain why migraine present differently among individuals. New treatments focusing on inflammatory molecules, like PACAP, show great promise and could be more effective for some patients than current CGRP inhibitors.

Final thoughts

‍

Migraine disease is complex and deeply misunderstood. Seeking proper treatment from knowledgeable and empathetic healthcare providers is crucial. As research continues, there’s hope for more effective treatments and a better understanding of this debilitating condition.

‍

If you live with migraine, please consult a headache specialist and consider a comprehensive treatment plan tailored to your unique needs. And most importantly, never lose hope. Promising new treatments and better educational resources for healthcare providers are on the horizon.

‍

Watch the full video of the conversation here:

Neura Health offers a specialized, compassionate and patient-first approach to migraine care. Sign up for Neura Health membership and book a video visit to get started on your treatment journey.

‍