Selected Podcast
An Update on Migraine Headache
Katherine Carroll MD discusses headaches and migraines. She shares some of the challenges associated with treating headache and migraine patients, how Northwestern Medicine is treating headaches differently and why comprehensive care for headaches at a center like The Urgent Headache Infusion Clinic at Northwestern Memorial Hospital is so important.
Featured Speaker:
Learn more about Katherine Carroll, MD
Katherine Carroll, MD
Dr. Carroll's practice involves general neurology. She has a particular interest in headache, seizure disorders, neuromuscular disorders, electromyography (EMG), and women's health.Learn more about Katherine Carroll, MD
Transcription:
Melanie Cole: Welcome. This is Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole, and today we're discussing headaches and migraines. Joining me is Dr. Katherine Carroll. She's the Chief of Comprehensive Neurology and an Assistant Professor of Neurology at Northwestern Medicine. Dr. Carroll, it's a pleasure to have you join us today. Let's start with differentiating a headache versus a migraine.
Dr. Katherine Carroll: A migraine is a type of headache. Migraine is typically a more severe headache and when we define a headache as a migraine, we're looking for certain features. Typically it is more likely to be a one sided headache that has pounding or throbbing characteristics, at least moderate. Most often severe pain is associated with the migraine headache and it limits the ability of the patient to function. The headache is so severe and alters the activities they want to do for that day or they need to take a rest on account of having the headache. Other features that go along with the migraine that are not seen with other headache types, are light or sound sensitivity and nausea or vomiting.
Host: Well then tell us about some of the challenges associated with treating headaches and migraine patients as you've seen it. What are some of the barriers and challenges?
Dr. Carroll: So the challenges are that, you know, one size doesn't fit all. Each patient's headaches are unique and their experience of the headaches is unique. So it's often a challenge to find a treatment approach or a combination of treatment approaches which the patient is comfortable with and which offer them relief.
Host: Tell us about the new Urgent Headache Infusion Clinic at Northwestern Memorial Hospital. What are your goals for the clinic Doctor?
Dr. Carroll: We're very excited about our Acute Headache Infusion Clinic, which launched in September of 2018. This is a place where patients can come who are already established patients with a neurologist at Northwestern and when they're experiencing a very severe prolonged migraine, they can contact us and they can be treated for that migraine within our own clinic. In the clinic, we offer a variety of IV medications deemed and ordered by the patient’s neurologists that are aimed to give them migraine headache relief. The goals of the clinic were to avoid these patients having to go to the emergency room where oftentimes there's a very long waits and high costs associated with that. Also, this allowed the patient to be cared for by their own neurologist.
Host: Well then let's talk about some of the treatments that you're discussing here. And first, why do some treatments fail for headache patients?
Dr. Carroll: Treatments sometimes fail because some patients just don't respond to treatments as other patients do. As I said before, it's not one size fits all. And what one medication might work great for one person doesn't work for the other person. You always got to pay attention to side effect profile of medication, the other medications a patient is on. Frankly, also have to be patient about what medications they're comfortable with trying and what they have some concerns about trying to make sure you have a shared goal in treating their migraines
Host: Well, as long as you brought up medications and as we're going to talk about some common triggers for headaches and migraines, how can over-medication actually contribute to those headaches? And when you're looking at that profile, what are you looking for?
Dr. Carroll: So definitely when you see a patient who's having frequent headaches, you need to ask them what they are taking for the headaches and how much of it they are taking because there always is in that situation a concern that they could be overusing headache rescue medications and that actually can contribute to increased frequency headaches and more refractory headaches in general.
Host: Well then Dr. Carroll, as long as we're talking about medication, what are some of the newer classes of medications available for migraine patients? How have they changed the game for you?
Dr. Carroll: Yes, it's a very exciting time for those of us who treat patients with migraines. There is a whole new class of medications, the CGRP inhibitors which are designed to prevent migraines. These are all given currently as once a month injections and they have, they were designed specifically to prevent migraines. There also is now available is CGRP inhibitor rescue medication, so this is a rescue medication a person can take at the onset of the migraine which inhibits CGRP and giving them hopefully the chance for good migraine relief. There are certainly multiple triptan options available depending upon the agent, they're available in the oral, nasal spray injectable form as well as another new agent, which is different than a triptan, and it's called ditan. So it's really, you know, honest to say that there's so many more options available now that just weren't available in the past, over two years ago.
Host: Well, and as you're telling us about new options, speak about some of those other options for prevention, including different classes of medications or Botox, you know, tell us about some of those other options that might be available.
Dr. Carroll: Other options for preventions include blood pressure medications like beta blockers or calcium channel blockers. Some of the anti-depressant medications can be used for depression as can some of this antiseizure medications. Botox is indicated for chronic migraine prevention. So this is a patient who's having 15 or more headache days per month, then Botox is an FDA approved indication for that patient.
Host: Then how were you treating headaches differently and why is comprehensive care for these patients that suffer so greatly from migraines and headaches so important?
Dr. Carroll: Yeah, it is very important and certainly we're talking a lot about medications, which is typically a very important part of their care, but you also have to look at the whole person, how the migraines are affecting their quality of life, how they are affecting them on a personal and psychological level. Some patients are very open and interested to alternative options for their headaches, including massage, acupuncture, biofeedback, physical therapy, and I think it's important to discuss those potential options with them as well.
Host: Well, it certainly is. And is there any new research being done in the area? What does the future hold? What's exciting in your field right now?
Dr. Carroll: I think exciting is this explosion of all these new medications, new medications that have been developed to not only prevent migraines but also to treat migraines. As we spoke about before, this is a very diverse patient population and it's so nice to have so many options available to offer these patients the chance for migraine relief.
Host: As we wrap up, Dr. Carroll, tell referring physicians what you'd like them to know about the New Urgent Headache Infusion Clinic at Northwestern Memorial Hospital and when you feel it's important that they do refer.
Dr. Carroll: I think they should refer their patients to see one of us as a neurologist if they have a patient who is frequently going to the emergency room for their headaches or they have a patient who's frequently calling them with severe or prolonged migraine headaches, then I would encourage them to refer their patient to the headache clinic so they can have established care with the neurologist. So the next time they have that severe prolonged migraine, they don't have to go to the emergency room. They don't have to suffer and they can be treated in our Acute Headache Infusion Clinic.
Host: What a great topic and great information. Dr. Carroll, thank you so much for coming on and telling us about the clinic. And that concludes this episode of Better Edge, a Northwestern Medicine Podcast for physicians. To refer your patient or for more information, please visit our website at nm.org to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine Podcasts. I'm Melanie Cole.
Melanie Cole: Welcome. This is Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole, and today we're discussing headaches and migraines. Joining me is Dr. Katherine Carroll. She's the Chief of Comprehensive Neurology and an Assistant Professor of Neurology at Northwestern Medicine. Dr. Carroll, it's a pleasure to have you join us today. Let's start with differentiating a headache versus a migraine.
Dr. Katherine Carroll: A migraine is a type of headache. Migraine is typically a more severe headache and when we define a headache as a migraine, we're looking for certain features. Typically it is more likely to be a one sided headache that has pounding or throbbing characteristics, at least moderate. Most often severe pain is associated with the migraine headache and it limits the ability of the patient to function. The headache is so severe and alters the activities they want to do for that day or they need to take a rest on account of having the headache. Other features that go along with the migraine that are not seen with other headache types, are light or sound sensitivity and nausea or vomiting.
Host: Well then tell us about some of the challenges associated with treating headaches and migraine patients as you've seen it. What are some of the barriers and challenges?
Dr. Carroll: So the challenges are that, you know, one size doesn't fit all. Each patient's headaches are unique and their experience of the headaches is unique. So it's often a challenge to find a treatment approach or a combination of treatment approaches which the patient is comfortable with and which offer them relief.
Host: Tell us about the new Urgent Headache Infusion Clinic at Northwestern Memorial Hospital. What are your goals for the clinic Doctor?
Dr. Carroll: We're very excited about our Acute Headache Infusion Clinic, which launched in September of 2018. This is a place where patients can come who are already established patients with a neurologist at Northwestern and when they're experiencing a very severe prolonged migraine, they can contact us and they can be treated for that migraine within our own clinic. In the clinic, we offer a variety of IV medications deemed and ordered by the patient’s neurologists that are aimed to give them migraine headache relief. The goals of the clinic were to avoid these patients having to go to the emergency room where oftentimes there's a very long waits and high costs associated with that. Also, this allowed the patient to be cared for by their own neurologist.
Host: Well then let's talk about some of the treatments that you're discussing here. And first, why do some treatments fail for headache patients?
Dr. Carroll: Treatments sometimes fail because some patients just don't respond to treatments as other patients do. As I said before, it's not one size fits all. And what one medication might work great for one person doesn't work for the other person. You always got to pay attention to side effect profile of medication, the other medications a patient is on. Frankly, also have to be patient about what medications they're comfortable with trying and what they have some concerns about trying to make sure you have a shared goal in treating their migraines
Host: Well, as long as you brought up medications and as we're going to talk about some common triggers for headaches and migraines, how can over-medication actually contribute to those headaches? And when you're looking at that profile, what are you looking for?
Dr. Carroll: So definitely when you see a patient who's having frequent headaches, you need to ask them what they are taking for the headaches and how much of it they are taking because there always is in that situation a concern that they could be overusing headache rescue medications and that actually can contribute to increased frequency headaches and more refractory headaches in general.
Host: Well then Dr. Carroll, as long as we're talking about medication, what are some of the newer classes of medications available for migraine patients? How have they changed the game for you?
Dr. Carroll: Yes, it's a very exciting time for those of us who treat patients with migraines. There is a whole new class of medications, the CGRP inhibitors which are designed to prevent migraines. These are all given currently as once a month injections and they have, they were designed specifically to prevent migraines. There also is now available is CGRP inhibitor rescue medication, so this is a rescue medication a person can take at the onset of the migraine which inhibits CGRP and giving them hopefully the chance for good migraine relief. There are certainly multiple triptan options available depending upon the agent, they're available in the oral, nasal spray injectable form as well as another new agent, which is different than a triptan, and it's called ditan. So it's really, you know, honest to say that there's so many more options available now that just weren't available in the past, over two years ago.
Host: Well, and as you're telling us about new options, speak about some of those other options for prevention, including different classes of medications or Botox, you know, tell us about some of those other options that might be available.
Dr. Carroll: Other options for preventions include blood pressure medications like beta blockers or calcium channel blockers. Some of the anti-depressant medications can be used for depression as can some of this antiseizure medications. Botox is indicated for chronic migraine prevention. So this is a patient who's having 15 or more headache days per month, then Botox is an FDA approved indication for that patient.
Host: Then how were you treating headaches differently and why is comprehensive care for these patients that suffer so greatly from migraines and headaches so important?
Dr. Carroll: Yeah, it is very important and certainly we're talking a lot about medications, which is typically a very important part of their care, but you also have to look at the whole person, how the migraines are affecting their quality of life, how they are affecting them on a personal and psychological level. Some patients are very open and interested to alternative options for their headaches, including massage, acupuncture, biofeedback, physical therapy, and I think it's important to discuss those potential options with them as well.
Host: Well, it certainly is. And is there any new research being done in the area? What does the future hold? What's exciting in your field right now?
Dr. Carroll: I think exciting is this explosion of all these new medications, new medications that have been developed to not only prevent migraines but also to treat migraines. As we spoke about before, this is a very diverse patient population and it's so nice to have so many options available to offer these patients the chance for migraine relief.
Host: As we wrap up, Dr. Carroll, tell referring physicians what you'd like them to know about the New Urgent Headache Infusion Clinic at Northwestern Memorial Hospital and when you feel it's important that they do refer.
Dr. Carroll: I think they should refer their patients to see one of us as a neurologist if they have a patient who is frequently going to the emergency room for their headaches or they have a patient who's frequently calling them with severe or prolonged migraine headaches, then I would encourage them to refer their patient to the headache clinic so they can have established care with the neurologist. So the next time they have that severe prolonged migraine, they don't have to go to the emergency room. They don't have to suffer and they can be treated in our Acute Headache Infusion Clinic.
Host: What a great topic and great information. Dr. Carroll, thank you so much for coming on and telling us about the clinic. And that concludes this episode of Better Edge, a Northwestern Medicine Podcast for physicians. To refer your patient or for more information, please visit our website at nm.org to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine Podcasts. I'm Melanie Cole.