Key Questions
- What is a ditan?
- Is a ditan used for prevention or acute migraine treatment?
- How will ditans be administered?
- How do ditans differ from triptans?
- What is a gepant?
- Is a gepant used for prevention or acute migraine treatment?
- How are these treatments different from existing medications?
- Will they require a prescription?
- How expensive are they likely to be?
- Who is ideally suited to try these new drugs?
- What side effects do ditans and gepants cause?
- When will these new medications be available?
Interview Notes
Find more about Uwe Reuter, MD, PhD, MBA and his work here:
Key Questions
- Isn’t Botox mainly a beauty treatment?
- What exactly is Botox made of and is it dangerous?
- Are people who are using Botox for chronic migraine also getting cosmetic benefits?
- How strong is the evidence supporting Botox?
- How much does Botox cost?
- How common are unwanted side effects of Botox?
- Should I be concerned about the possibility of “frozen forehead?”
- Is Botox treatment painful?
- If I’m scheduled for a Botox treatment and I am having a severe migraine attack, should I still receive a treatment or wait until after my attack has passed?
- If you begin showing improvement after receiving Botox, how long should you continue receiving additional treatments?
- If I don’t see positive effects after the initial round of Botox, should I discontinue use?
- Can Botox lead to depression or anxiety?
- How do you know if your doctor is properly trained in giving Botox injections?
Interview Notes
Find more about Andrew Blumenfeld, MD and his work here:
Key Questions
- What non-invasive neuromodulation devices have been approved by the FDA for the treatment of migraine?
- Are neuromodulation devices safe?
- Does insurance cover neuromodulation devices?
- Do you need a prescription for neuromodulation devices, and if so, does it have to be from a headache specialist or can it be from a primary care provider?
- Do these devices hurt when you use them?
- Can they be used for both acute and preventive treatment of migraine?
- How do I know if I’m a good candidate for a neuromodulation device?
- Can any of these devices be used for cluster headache?
- Are there any side effects from using these devices?
- Are there any new devices due to be released soon?
Interview Notes
Find more about Amaal Starling, MD and his work here:
Key Questions
- Of the four injectable forms of CGRP antagonists, how are they similar and how are they different?
- How soon should someone who tries CGRP antagonists expect to see results, and if someone tries one and it fails, should they try another type of anti-CGRP treatment?
- How much do the CGRP antagonists cost?
- How can the average person with migraine afford them?
- For those people who respond to CGRP antagonists, what kind of response should they expect?
- How many people do not get the desired response from the anti-CGRP treatments?
- Based on what we see happening in those super responders to the anti-CGRP treatments, is it possible that a migraine cure could be developed?
- Do anti-CGRP treatments reduce other symptoms such as neck pain, allodynia, fatigue, brain fog, nausea, etc.?
- How do CGRP antagonists address the different types of migraine diagnoses, such as chronic, episodic, hemiplegic, and vestibular migraine, as well as cluster headache and new daily persistent headache?
- Why is there often a reluctance on the part of physicians to using supplements like magnesium, feverfew, and butterbur to treat and/or prevent migraine?
- If somebody is going to consider supplements such as butterbur, feverfew, or magnesium as a therapy, is there any guidance on the types of these herbs or supplements to look for?
Interview Notes
Find more about Pierangelo Geppetti, MD and his work here:
Key Questions
- Can significant improvement be made with nonmedical approaches to treatment?
- How necessary is exercise?
- Do those with migraine tend to exercise more or less than the general population?
- And how does this change with increasing migraine frequency?
- How effective is exercise in reducing migraine severity and frequency?
- What physiological benefits does exercise offer to how we sleep, our brain, our stress levels, and our mood?
- What is exercise?
- How would you define it?
- Is all exercise equal?
- What types are best suited or safest for those with migraine?
- How much exercise do you need to do to see results? Based on your research how much exercise is optimal for patients?
- Can exercise still be effective for someone who suffers from chronic migraine with a high frequency of attacks?
- How can exercise as a trigger be managed?
- Do you have any guidance for those who find that sexual activity triggers a migraine attack?
- Who is the ideal migraine patient that would benefit from exercise?
Interview Notes
Find more about Mattias Linde, MD, PhD and his work here:
Key Questions
- What relationship is there between our posture and migraine?
- Is neck pain or discomfort a trigger or a symptom of migraine?
- Is there such a thing as postural headache?
- What is a healthy head and upper body posture?
- How does tension-type headache compare to cervicogenic headache?
- What is massage therapy and how effective is it?
- What is orthopedic massage?
- What is a hypertonic muscle?
- Is walking considered an active therapy that can address muscle stiffness?
- What is postural correction?
- What risks are involved in seeing an osteopath or a chiropractor?
- Where can people find active alternatives to help address neck issues?
Interview Notes
Find more about Mark Braschinsky, MD and his work here:
Key Questions
- How important are food triggers with migraine?
- Are we really getting enough nutrition from our diet?
- What is a ketogenic diet?
- What is ketosis?
- Do carbohydrates contribute to inflammation in the body?
- Is there any evidence that low-carbohydrate diets are helpful for migraine?
- Are ketogenic or low-carbohydrate diets safe?
- How is sugar intake related to migraine?
- What are some ways of dealing with nausea?
- Is there a recommended diet for migraine?
- What are some good strategies for staying on a healthy diet?
- What are some important nutrients for people with migraine?
Interview Notes
Find more about Angel Morent, NP and his work here:
Key Questions
- What are the differences between acute therapies and preventive therapies for migraine?
- How does a physician decide where to start with a patient if it’s determined that they do need some kind of preventive?
- Why are medications developed for other conditions, such as hypertension and epilepsy, helpful in migraine prevention?
- What are some of the neuromodulation devices available and how can they help with migraine prevention?
- How effective has Botox proven to be as a migraine preventive?
- How do the anti-CGRP treatments compare to the other “off label” preventive treatments that have been around longer, such as Botox, topiramate, and propranolol?
- Can a combination of pharmaceuticals, neuromodulation devices, and alternative or natural treatments be synergistic in migraine treatment?
- How effective are supplements such as magnesium, riboflavin, butterbur, and feverfew in migraine prevention?
- Is it recommended or even possible to combine two preventive pharmaceuticals, such as Botox and CGRP treatments?
- How long does a patient need to be on a particular preventive treatment therapy or approach before they can determine if it’s working?
- What are the guidelines for preventive therapies based on migraine frequency i.e. for patients with high frequency versus low frequency per month?
Interview Notes
Find more about Anna Andreou, PhD and her work here:
Key Questions
- How many women have hormonal migraine?
- What is the relationship between hormonal migraine and other types of migraine?
- Why is hormonal migraine often missed?
- What are three different types of diagnoses related to hormone and migraine?
- How important is the exact diagnosis for treatment?
- Is it possible to effectively manage menstrual migraine?
- Is there a standard treatment for menstrual migraine or should it be customized to each individual?
- Who is the best person to see for a hormonally-related migraine condition?
- Why is record-keeping so important to treatment when a woman suspects hormonal migraine?
- Which hormones are involved in hormonal migraine and how does their involvement impact treatment?
- How can NSAIDs be used in symptomatic treatment and prevention of menstrual migraine?
- What role can contraceptives play in treatment of hormonal migraine?
- What is a common strategy some doctors will use for hormonal migraine?
- Are hormone level measurements helpful in treating menstrual migraine?
- Why do hormones cause a migraine in some women and not others?
- Is there anything wrong with the hormone levels of women with hormonal migraine?
- What is the connection between migraine and other conditions such as endometriosis, polycystic ovary syndrome, or hypothyroidism?
- How does someone’s general health affect their migraine condition?
- What are the safety considerations related to stopping periods as a treatment for menstrual migraine?
- What is the optimal contraceptive method/option for someone with hormonal migraine?
- What is the difference between pre-menstrual prevention and regular migraine prevention?
- What type of migraines are more severe, refractory to treatment and longer lasting than others?
- What options do women with migraine with aura have for treatment?
- Can women with migraine with aura safely take the contraceptive pill?
- Are there natural alternatives that can be used to treat hormonal migraine?
- What other advice would you give to your patients?
Interview Notes
Find more about Anne MacGregor, MD and her work here:
Key Questions
- How common is neck pain in people with migraine?
- Which comes first: neck pain or the migraine attack?
- Is neck pain a cause of migraine, a symptom of migraine, or both?
- What is occipital neuralgia and its relationship with migraine?
- What is the relationship of cervicogenic headache with migraine?
- Can someone have migraine with neck pain and without head pain?
- What role can head and neck injuries play in migraine?
- What precautions should people be aware of with treatments such as chiropractic manipulations?
- What approaches may be helpful in addressing neck pain symptoms?
- What role can exercise play in treating neck pain?
- What does emerging research suggest about the role of C1 nerve root characteristics in migraine?
- When might neck pain be a sign of something serious other than migraine?
Interview Notes
Find more about Andrew Charles, MD and his work here:
Key Questions
- What’s the difference between a side effect and an adverse event to a medication?
- How common are side effects and adverse events?
- Why are migraine patients at higher risk of medication-related adverse events?
- What are typical side effects for common migraine medications, such as topiramate, propranolol, valproate, antidepressants, and triptans?
- What is serotonin syndrome and how do you know if you have it?
- What are the most common supplements migraine patients take, and what are their potential side effects?
- When should a migraine patient report symptoms of a possible adverse event?
- What should you do if you’re taking a brand new drug and you think you may be experiencing an adverse event?
- What is pharmacogenetics and why is it important for migraine patients?
Interview Notes
Find more about Shivang Joshi, MD, RPh and his work here:
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:
