When Migraine Disables But Doesn’t Hurt

Key Questions
  • What are the two primary types of migraine?
  • Can migraine with aura occur without the head pain?
  • What types of head pain can occur with migraine?
  • Are patients with aura more at risk of stroke?
  • Should women with migraine with aura take estrogen-containing pills for contraception?
  • How can we tell the difference between migraine with aura and a stroke
  • How soon after an aura begins should the patient take their migraine medications?
  • What are some medications used to prevent migraine with aura?
  • What are some medications for patients with hemiplegic migraine or basilar-type migraine?
Interview Notes

Find more about Shazia Afridi, MD, PhD and her work here:

Understanding Balance, Vertigo and Dizziness

Key Questions
  • Why do some people with migraine experience dizziness or balance issues while others do not?
  • Is it true that you can have migraine without having headache?
  • How is vestibular migraine diagnosed?
  • Why are individuals with vestibular migraine often misdiagnosed?
  • What are some of the symptoms that people with vestibular migraine experience?
  • Do people with vestibular migraine have different triggers than people with migraine in general?
  • What treatments are available for vestibular migraine?
  • Is physical therapy or vestibular rehab an alternative treatment available for those with vestibular migraine?
  • Is diet something that should be considered when living with vestibular migraine?
Interview Notes

Find more about Michael Teixido, MD and his work here:

Diagnosing Pressure Headaches vs. CSF Leaks

Key Questions
  • Why is low-pressure headache misdiagnosed as chronic migraine?
  • What is postural headache?
  • What exactly is cerebral spinal fluid (CSF)?
  • What are high- and low-pressure headaches?
  • What are the risk factors for high- and low-pressure headaches?
  • What are the symptoms of high-pressure headache (pseudotumor cerebri or idiopathic intracranial hypertension)?
  • What is papilledema and how is it used to diagnose high-pressure headache?
  • What is a spinal tap?
  • How is high-pressure headache treated?
  • What is low-pressure headache (spontaneous intracranial hypotension, or SIH)?
  • What are the treatments for low pressure, or SIH?
Interview Notes

Find more about Deborah Friedman, MD, MPH, FAAN and her work here:

Alternative Treatments for Cluster Headache

Key Questions
  • What are the features or symptoms of cluster headache?
  • How can we tell the difference between cluster headache and migraine?
  • Why is it called “cluster” headache?
  • What is chronic cluster headache?
  • What are common triggers of cluster headache?
  • What are the best ways to treat cluster headache?
  • What are some alternative and less well known potential treatments for cluster headache?
  • What are “shadows” in cluster headache?
  • What commonly prescribed medications often do not work well for cluster headache?
  • Are there any devices that might be helpful for the treatment of cluster headache?
  • What kinds of cutting-edge research can we participate in, and how can we register for clinical trials?
  • What are TACs?
Interview Notes

Find more about Brian McGeeney, MD and his work here:

Clinical Errors that Undermine Migraine Care

Key Questions
  • How common are mistakes in medicine?
  • Why do errors occur?
  • How can patients and doctors avoid the problems inherent in overly industrialized medicine?
  • Where are treatment rates for people with migraine low?
  • What can we do to raise treatment rates?
  • How can patients receive the best possible care from their doctors?
  • What are the direct, indirect, and societal costs of migraine?
  • How much can we improve productivity just by helping people with migraine who come to work during an attack?
  • What is the most important thing for patients to give their doctors?
  • How does a patient know if they should find a new doctor?
Interview Notes

Find more about Zaza Katsarava, MD, PhD and his work here:

Tension Type Headache vs. Migraine

Key Questions
  • How do the diagnostic criteria for migraine differ from those of tension-type headache?
  • How are chronic migraine and chronic tension-type headache alike?
  • Can a headache start out as a tension-type headache and then transform into a migraine attack?
  • What triggers a tension-type headache?
  • Does stress play a role in a tension-type headache?
  • If you have both migraine and tension-type headaches, should you be treated with preventives for both?
  • What are the S.E.E.D.S. of success in headache management?
  • Do triptans work for tension-type headache?
  • What are some alternative therapies for tension-type headaches?
  • Are there natural supplements that can help with tension-type headaches?
Interview Notes

Find more about Larry Newman, MD and his work here:

S.E.E.D.S. acronym discussed in:

Scans and Tests: Do You Really Need One?

Key Questions
  • What kinds of tests are important for people with migraine to have?
  • Is there any danger in having repeated brain scans?
  • How important are patient history and physical examination in diagnosing migraine?
  • When would a person with migraine need a brain scan?
  • Do people with migraine need to worry about white-matter lesions?
  • If a person with migraine has aura symptoms, does that change the need for testing?
  • What types of tests should be administered for rare subtypes of migraine, like hemiplegic migraine or migraine with prolonged aura?
  • What does CFS (cerebral spinal fluid) pressure have to do with migraine?
  • How does an open PFO (patent foramen ovale) valve influence migraine?
  • Why would a person with migraine need an EEG?
  • What are persistent aura symptoms, and are there any tests needed when it is present?
Interview Notes

Find more about Dimos-Dimitrios Mitsikostas, MD, PhD and his work here:

Tests mentioned in the interview:

How to Interpret Migraine Research

Key Questions
  • What are the main types of research conducted in migraine research?
  • What are the definitions of common terms used in research studies such as “research protocol”, “study design”, “double-blind”, “relative and absolute risk”, “odds ratio”, and “confidence interval”, etc.?
  • What is peer review and why is it used so often in research?
  • What can we do to understand and interpret some of the peer-reviewed research studies that we might find on Google Scholar or PubMed?
  • Often in research studies on migraine, placebo can be as high as 30%. What does that mean?
  • What is research bias, and how is it overcome in order to achieve accurate research study results?
  • Why is it important to know the source of funding for a particular research study?
  • What is the structure of a typical research paper?
  • What are some red flags to watch out for when looking at a research paper that could indicate that it’s not a reliable study?
  • Why aren’t there more studies about non-medicinal methods of managing migraine, like exercise, diet, supplements, and essential oils?

Treating Each Phase of a Migraine Attack

Key Questions
  • What is a migraine attack?
  • What is cortical spreading depression, or CSD?
  • What are the known mechanisms behind a migraine attack?
  • Is migraine purely genetic?
  • What is epigenetics?
  • What can you expect from a treatment plan for migraine?
  • What are triptans used for? How many kinds and formats are there?
  • How do migraine patients respond to different triptans?
  • At what point should a migraine patient consider non-triptan forms of abortive medication or preventative drug treatments?
  • What new treatments for migraine are coming out soon?
Interview Notes

Find more about Antoinette Maassen van den Brink, PhD and her work here:

How to Get the Most from Your Doctor

Key Questions
  • How should patients prepare for their doctors’ appointments?
  • What kind of information should patients provide their doctors?
  • What should a patient expect from their doctor?
  • What do doctors expect from their patients?
  • What important differences exist between the initial appointment and follow-ups?
  • How can patients take control of their own health in between appointments?
  • Is a headache diary important?
  • What’s the difference between a good doctor-patient relationship and a bad one? What are some signs of each?
  • How can we foster a good relationship with our health care professional to get the best results?
Interview Notes

Find more about Patricia Pozo Rosich, MD, PhD and her work here:

Dodging False Promises and Treatment Claims

Key Questions
  • What does history teach us about the pursuit of migraine cures?
  • Why is it easy to fall victim to quackery and unscientific “cures”?
  • What is pseudoscience?
  • Why is it sometimes difficult to use the scientific method to study the efficacy of a treatment?
  • What is the placebo response and how significant is it?
  • How much trust should we place in social media treatment claims?
  • Is cannabis a proven effective treatment for migraine?
  • Is the ketogenic diet safe?
  • What is the best way to evaluate a new treatment?
  • How might the use of alternative treatments lead to the neglect of scientifically proven treatments?
  • What are some evidence-based alternative treatments?
  • Why are nerve blocks used in North America if there is limited evidence?
  • Why are some treatments listed in guidelines while others are not?
  • What are the problems with migraine surgeries?
Interview Notes

Find more about Elizabeth Leroux, MD, FRCPC and her work here:

Sleep, Insomnia and Energy

Key Questions
  • Can poor sleep make you more prone to dementia?
  • What does the brain do while we are sleeping?
  • If we miss out on sleep during the week, is it effective to “catch up” on the weekend?
  • Why is sleep especially important for someone who has migraine?
  • What is early-morning migraine?
  • What are some things we can do to improve our overall sleep habits?
  • What is ferritin and how does it impact our sleep?
  • Are there foods that can actually help you sleep better?
  • What is migraine recurrence?
  • Can a lack of sleep affect the effectiveness of our medications and treatments?