Mulling over Migraines with Photographer Bill Wadman

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katy Peters, and this is the Brain Life Podcast. As we know, migraines are a very common form of chronic headaches. They can affect our day-to-day function. And of course several of our podcast listeners may have migraine headaches, some of our patients. We know that there are newer medications and therapies are now available to combat and prevent migraines. And Daniel, in addition to these medications, I'm sure you're aware of lifestyle interventions that can lessen the chance of having a migraine.

Dr. Correa:
Definitely. It's something I would discuss with the soldiers that I would care for in the Army and managing their migraines so that it wouldn't interrupt because sometimes they have more limitations in the medication options that they have. And my wife, Marin, also struggles with migraines and often focuses on her sleep and hydration as key issues with her lifestyle strategies to manage her migraines.

Dr. Peters:
Yeah, I just was talking to a colleague that said that his wife has migraines and he actually was required to go to appointments with their neurologist so that they can both learn how to be a caregiver of a migraine patient because so much does deal with having proper sleep, proper hydration, and also proper diet.

Dr. Correa:
Yeah, I mean there's so many important aspects about our lives. It impacts our health and management of so many different conditions, and migraine is just a key example of that.

Dr. Peters:
So I had a great conversation with Bill Wadman. He is a new York-based portrait photographer. He actually shared with us his personal experience with migraine, along with all the lifestyle tips that he uses to prevent and alleviate migraine. What was awesome is he is a podcaster in his own right. And so it was just a great discussion. We had a lot of fun and hopefully he provided some great information to our listeners. Moreover, we actually will hear from his own neurologist and headache expert Dr. Susan Broner, a neurologist from Cornell University.
Hello Brain and Life listeners. This is Dr. Katy Peters and I'm delighted to have with us today, Bill Wadman. He's a new York-based portrait photographer with notable works that included 365 portraits, a photography tour de force that captured different portraits of a person daily over 365 days, but he extended this to even go to four years of daily portraits and also his moving artwork, Dancers in Motion. His work has been featured in Time, Businessweek and USA Today and the New York Times and numerous outlets worldwide. He also has podcasting chops as he's the co-host of his podcast On Taking Pictures. So I hope to learn some tips from him. So today he's sharing not only information on his fascinating career, but also on his journey with migraine headaches. Bill, welcome to the Brain and Life podcast.

Bill Wadman:
Thank you, Katy. I'm glad to be here.

Dr. Peters:
Wonderful. So before we discuss your journey with really having migraines and going through treating those, can you just tell us more about yourself and your photography and your artwork?

Bill Wadman:
Yeah, sure. I've been a professional photographer for the last 15 years. I shoot portraits, which means that I spend a lot of time with people while holding a camera. That's basically my job. I just have conversations with people and then wait until they're the way I want them to be. And I take pictures. I work for magazines, I work for corporations. I shoot CEOs and dancers and musicians and scientists and authors and members of Congress and all the way across the spectrum. For me, it's really about the conversations with the people. I just love people. I like having conversations like this, so I'm excited to be here. But that's the work I do professionally.
For my more artistic work, like you said, I've done a lot of stuff with dancers. I also make a lot of conceptual pictures that end up looking more like Norman Rockwell and Caravaggio than photographs, hopefully. That's my goal. So I do a lot of stuff all across the spectrum. But it's funny, I originally went to school for music, so I have a lot of artistic stuff floating around.

Dr. Peters:
That's fascinating. And do you have a favorite muse or somebody that you've done a picture of?

Bill Wadman:
The people that I really lose my mind when I photograph them, heroes. But my heroes are nerdy heroes. There's a guy named James Burke who was a BBC guy who used to do a show called Connections in the seventies. I don't know if you ever saw it. He wears a white leisure suit. Talked about how we went from the plow to the space shuttle over the course of 2000 years. I've met him once and I lost my mind. My mind blew up. Even though I've met much fancier people than him, it was like, oh my God, my whole childhood all in one place. So yeah, for me, everybody's interesting and everyone's just a person. That's the funny thing. You meet these people who have $200 million because they're some fancy pants, whatever, and it's like they're just a person who has to put on their shoes in the morning and come to work, and I find a way to connect with them. That's my job.

Dr. Peters:
That's great. And that's what we do as physicians is to find a way to connect with our patients and to hear their stories. And so I love that you're doing it through photography. And you also connect to people through your podcast. Do you mind just telling us about your podcast?

Bill Wadman:
Sure. I do a show called On Taking Pictures. We did for many years with my cohost Jeffrey Saddoris. We did about six and a half years of it. We took a little break. Now we're back again weekly. It's called On Taking Pictures. But really what we're talking about is what writer's block and overcoming depression and talking about what it means to be somebody who makes something in the world and how to get over the psychological ramifications of doing that for a living.

Dr. Peters:
I hope our listeners can check it out because I think everybody can suffer a little bit from maybe a writer's block or challenge with a creative streak. So one of the things you're here today to discuss with us, this is the Brain and Life podcast, we talk about sort of neurologic phenomenon or neurologic illness or challenges, and many of our listeners have had to deal with migraines. It's unfortunately a common headache disorder and it can even start in childhood. Could you sort of tell us about when your migraine started and how they started to manifest?

Bill Wadman:
Sure. I actually didn't have migraines until, I don't know, 19 or 20. I was in college when I started having them. I have one sibling, an older sister who also has migraines who got them around the same time. So she's three years older. So I was about three years behind her. So this would've been mid-nineties I guess it was, which is when compared to today, migraine relief was still in its infancy. It was get an ice pack, take some Excedrin, try to lay down and first steps of Triptans, I guess were coming out at the time. But yeah, it was in college and when I had them then, I've had them my whole life now as an adult, and it's funny, it's like I've lived with them for so long. I'm 48 now, so I've lived with them for 30 years or so. So I don't know, life without them entirely.
And that's kind of weird because people say, "Well, how do you do it?" It's like, well, I don't know anything different. This is just my reality is sometimes I have a crushing headache and you just have to get on with your day or find some way around it or take a break and take some drugs and do what you got to do. But things have improved somewhat. They're not quite as debilitating for me as they were back in the day. It was a little bit waiting for somebody to hit me over the head with a two by four. It's interesting just talking to you, it's just interesting to see how much it's changed in my life as much as it's been the same.

Dr. Peters:
It sounds like an evolution, especially with the new benefits and treatments. What treatments have you used to try to ease or prevent migraines?

Bill Wadman:
So I was on Imitrex old school before it went generic Imitrex, but for years I would take Sumatriptan, Sumatriptan, Sumatriptan, and a few years ago I remember saying to my wife, I said, "Let me go see if there's a migraine specialist." So I found Dr. Susan Broner in New York here at Weill Cornell, and I remember it took seven months to get an appointment 'cause these people are insanely busy. And I walked in and I had a 45-minute interview with a PA, and then I went in and had an hour long thing with Dr. Broner. I felt like I was getting interviewed for the Astronaut Corps or something. And they said, "Okay, well there's stuff we can do for you." And initially for insurance reasons, there's all these things that they want you to try. I don't like the idea of anything that changes me cognitively or makes me sleepy or has side effects that affect my life. I'd rather have the headaches. I've lived with those for 30 years. I'd rather have the headaches than have side effects from medications that I'm taking.
So I fought my way through all that and then I started doing Botox injections with her about two years ago, and I would say my pain scale was like a seven when I got headaches, it was pretty bad. Not excruciating, I am going to blow up the world in such pain, but it's debilitating. The Botox didn't make any changes to my frequency of headaches, but it did make a difference in the pain. My pain went down to a four, which after having Migraines for 30 years, it was like, oh my God, this is revelatory. I can actually still have a conversation while having a migraine. And to our point for the show here, it's like I could still work when I had a migraine.
There were a handful of times in my life before I tried new treatments where in the middle of a long day of shoots, I have a migraine come on. It's like, okay, well everyone's going out for lunch hour. I'm going to take a triptan and go lay down in the corner and hope that an hour later it kicks in enough that I can work the rest of the day. To not have to think about that or have to worry about that is amazing.
My second three months of Botox with the nerd tech not as good, and it was kind of a bad cycle and I said, you know what? It did something for me. Maybe I should try the injectables. And so just three weeks ago I injected the two shots of Emgality for the first time, which was interesting.

Dr. Peters:
How did it go?

Bill Wadman:
I was terrified by the pain though.

Dr. Peters:
Oh, no.

Bill Wadman:
Well, people talked about it like, |"Oh, it's so painful and this, that, and the other thing, and it's so scary and ah." I'm not a big fan of injections, so I kind of had put it off and kind of talked myself out of it and it really wasn't that bad.

Dr. Peters:
I love that your myth-busting about the pain of these injections.

Bill Wadman:
I mean, it's not nothing, but compared to if you had had a migraine right now and somebody says this is going to hurt for five seconds, but you won't have any migraine anymore, you would do it in a second. So why are you scared to do it when you don't have a headache? Does that make sense?

Dr. Peters:
It makes total sense, but it sounds like one of your big things that's sort of as a tip is you found a specialist, right?

Bill Wadman:
Yes.

Dr. Peters:
You went and found that migraine specialist and it sort of seemed to be a turning point in your journey that you got more tools for your toolbox. Are there any other tips? So I think that's one tip you'd give patients.

Bill Wadman:
I have the advantage of a really good insurance and I live in New York City, so I have access to some of the best doctors in the world. So for me, yeah, I guess the tip is to not be scared to try to find somebody new. If your current doctor doesn't seem like they understand what's going on with you, find a specialist.

Dr. Peters:
I think that's great advice for our listeners because it's really like how do you take that next step? How do you ask for a second consultation? I think those are all really important. Now beyond looking for a specialist, do you have any other tips for our listeners about alleviating or preventing migraines?

Bill Wadman:
Well, for me, exercise I think helps. I row on a rowing machine a fair amount, about five days a week I do about 45 minutes on a rower. So just that loosening up my shoulders for me. My migraines start in my neck on the right-hand side for me. If I sleep on my left-hand side, I wake up with a migraine. I almost always wake up with migraines. I don't get them in the middle of the day. If I don't have a headache in the morning, I'm not going to have one for the rest of the day, most likely. I almost always wake up at 4:00 AM to use the bathroom or something and that's when I have a migraine. And so sometimes I'll just take a triptan, then lay back down and by the time I wake up, it's gone.
Sometimes I'll sit there and I'll think, oh, it'll be gone. Don't worry about it. Don't worry about wasting a pill on this. Or you don't want to get a rebound from the triptan two days later or whatever it is. So just don't take one. And almost always, those are the ones that just get out of control and like a fire. It's got to nip it in the bud while you can. That's a big one for me is that if you have the meds and the meds work and don't have a lot of side effects, take it. You know what I mean, if you think you're having a headache, don't wait, because waiting, it can burn out of control. At least in my experience. The migraines sort of spin out in a bad way.

Dr. Peters:
Well, those are some great tips. Stay on top of your symptoms, I guess. Get some good exercise. What about sleep? You mentioned sort of position, but is it getting regular sleep? Does that help your migraines?

Bill Wadman:
Oh, I have no problem with regular sleep. I like sleep.

Dr. Peters:
Oh good. I like that.

Bill Wadman:
Only in the last few months have I ever had, I think it's just getting older where I've had a little insomnia in the middle of the night every once in a while, but that's rare. For me, sleeping, taking drugs and then laying down if I can. Sometimes I'll take drugs and then exercise, take a triptan and then get on the rower figuring maybe moving my circulatory system will get the drug around my system faster. It's like, well, let's burn some time.

Dr. Peters:
I like that. So in your line of work in particular, have you identified any triggers for your migraines?

Bill Wadman:
No. As I said, not specific to my work, but I definitely have triggers. Weather changes.

Dr. Peters:
Wow, okay.

Bill Wadman:
Low pressure especially. If there's a storm coming through or the barometric pressure drops, I'm almost guaranteed to have a headache. Sometimes there's a week of storms or whatever it is, and I just think, "Oh God, I hope there's not a week of storms 'cause this is going to be a nightmare." Travel can sometimes, which is equally barometric pressure I guess, if you're up in an airplane and coming back down. So something about that really triggers me off. Smells sometimes, especially perfumes. If I'm in a restaurant and somebody sits down behind me and it's a woman wearing a really strong perfume or something, it's like we got to go. If I walk by a Sephora, that's a nightmare. If I'm walking through an airport and you have to go through the duty free stuff, it's all... Sense, nightmare scenario. I run through them, I hold my breath and I run through them because I know it might trigger me.

Dr. Peters:
I can't imagine a mall. A mall during some stormy weather.

Bill Wadman:
Yep, a mall during stormy weather.

Dr. Peters:
Like the candle shop would just get you.

Bill Wadman:
Yeah, yeah. Although interestingly enough, so one of the things I do do is if I travel for work, a lot of times I'll put an extra day in there. So I might travel and shoot the same day. But if I'm going to travel, a lot of times I'll try to have a day between when I have to shoot and when I'm travel just to get my... It's both jet lag and get settled, my brain sometimes. I find that that's a better idea. I'm much less likely to have a headache after that. So yeah, it's interesting.

Dr. Peters:
Now in regards to your work, being a photographer, is there anything that's with your work that does alleviate your migraines, do you think being more active or being more engaged, does that help at all?

Bill Wadman:
Yeah, it's funny. I almost never have or at least notice a migraine while I am working. I think part of that is that I really love what I do and so I'm in deep conversation with somebody else usually. So yes, there are times that I have to work with a headache and I realize I have a headache, but while I'm working, it's such a mental and physical job in the sense that you're moving stuff around, you're carrying, you're moving lights, you're doing all this kind of stuff, but you're also worrying about all the technical stuff about numbers and aperture and shutter speed and flash power and all this nonsense while also trying to keep the conversation between you and the other person going. It's like you're juggling and it's like there's almost no room for a migraine. So there'll be times when I have a headache before and I have a headache after, but while I'm working I can sort of blow through it. It's very rarely debilitating, especially now with all the different stuff that I use.

Dr. Peters:
I think your insights and experience will and no doubt help our listeners and I'm going to hope we'll leave no room for migraines, no room for migraines. So.

Bill Wadman:
One of the doctors usually says to me, "How many days have you been clear this month?" And I remember at the beginning I was like, clear? I never don't have a headache. It may be a one, it may be a two, but it's very rarely nothing. And now there are days when I don't have a headache, which is kind of a real revelation. It's like the whole volume has been turned down. So the highest highs are now medium and the lowest lows have down below zero now. So treatment can help and it does work.

Dr. Peters:
Wonderful. Well, thank you for sharing your experience with us today and also insights into your photography and artwork. We have links to your portrait photography on our website and it can be viewed on your website, billwadman.com. And check out his podcast, On Taking Pictures.

Bill Wadman:
Great, thank you so much.

Dr. Peters:
Welcome and hello Brain and Life podcast audience. I'm honored to introduce our medical expert, Dr. Susan Broner, who will be discussing migraines. Now, migraines are more than just a headache. They're intense, they're throbbing pains that often accompanied by sensitivity to light or to sound, but we'll really delve into the details and really mull over migraines with Dr. Broner.
Dr. Broner is an assistant professor of clinical neurology at the Weill Cornell Medical College and Medical Director of the Weill Cornell Medicine Headache program. Dr. Broner is a board certified in neurology and in headache medicine and specializes in the diagnosis and treatment of headache disorders, including migraine and its variants and also clustered headaches and other chronic headaches and episodic headaches. Dr. Broner received her medical degree from Stony Brook School of Medicine. She completed her residency in neurology at Albert Einstein College of Medicine and went on to complete a fellowship in headache medicine at the Headache Institute of St. Luke's Roosevelt Hospital.
After serving as an attending neurologist and headache specialist at that facility, Dr. Broner founded the Manhattan Headache Center where she served as a medical director before joining Cornell. Dr. Broner's research priorities include migraine in women, acute and prevented approaches, integrative headache care and identifying and addressing the needs of underserved populations. She has authored and co-authored numerous articles in peer-reviewed journals and books and has lectured on headaches in both academic, corporate and community settings and serves as an expert to lay media outlets including TV, radio, internet, and we can also add podcasts now. Interested in underserved populations. She founded the Underserved Populations in Headache Medicine special interest groups for the American Headache Society and served as its Chair. She's a member of the WHO Lifting the Burden, the Global Campaign Against Headache, whose purpose is to improve healthcare delivery to people with headache globally. Thank you so much, Dr. Broner. We're so excited to talk to you with you today. Welcome.

Dr. Broner:
Thank you so much. I'm delighted to be here with you, Dr. Peters, to talk to you and your audience about migraines and headache disorders.

Dr. Peters:
Again, thank you for being our expert today. We're just going to start right off the bat. Tell us about migraines. What are migraines and how are they different from other headaches?

Dr. Broner:
Yeah, that is one of the most important questions for someone with a headache is what is it that I have? And in the same way that stomach ache is a symptom and not a diagnosis and many different things cause stomach ache, headache is just a symptom and many different types of diagnosis. So for example, there are 150 or more different diagnoses for headache and it's the features and the associated symptoms and the whole context which actually gives us the diagnosis and then it's the diagnosis that actually leads to treatment and help for people.
We categorize headache as being in three separate categories. We talk about primary headache disorders, we talk about secondary headache disorders, and then we talk about something called cranial neuropathies, which are irritations of nerve endings around the brain. When we talk about migraine, it's considered a primary headache disorder, meaning it's not caused by a brain tumor, it's not caused by another systemic problem that's going on in the brain, instead of it's its own genetic inherited neurological condition with specific symptoms. So migraine is a diagnosis. To answer your question in that light is diagnosis of recurrent headaches of which a person has to have at least five episodes with specific symptoms. Some people think if they don't have neurological symptoms, in other words, visual symptoms or something called an aura, which we can talk about in a little bit then it's not migraine, but most people with migraine, it's a head pain disorder with associated features.

Dr. Peters:
Well thank you so much for sharing all of that. And are there certain people, you mentioned sort of a genetic component. I've heard people say, "My mom had migraines, so I had migraines." Are there certain types of people that will end up developing migraine?

Dr. Broner:
Yeah, absolutely. So there is a genetic risk associated with migraine. There have been certain genes that have been identified that correlate to certain subtypes of migraine, certain hemiplegic migraine subtypes, those genes have been identified. But for what we call the common migraine or the migraine without aura, we don't have a single gene that is the cause of it. It's probably multiple genes that are responsible. But for most people with migraine there is a family history. However, sometimes that family history skips a generation or maybe their grandmother or grandfather didn't relate to them why they went into that dark room at certain times and then came back. They may not have shared that information. But in addition to identifying who might have it in your family to see if you might be a person that fits migraine diagnosis, there are certain variants that we see early in childhood that may be markers that you have a genetic predisposition even though you haven't identified a family person. And that includes things like sleepwalking in childhood, motion sickness in childhood or in adult years. Infant colic may be related to genetic predisposition to having migraine.

Dr. Peters:
Well, that is fascinating. Sleepwalking and infant colic, I never knew those things, so thank you for sharing. Now, are there risk factors for the development of migraines? Are there certain triggers that our audience should know about?

Dr. Broner:
Yeah, so we talk about two different aspects of this. So one is risk factors, that means what is my risk overall in developing migraine? And then the other aspect is what are triggers? What can I avoid or what can I do to prevent me from getting migraines? We think of migraine as a lifelong disorder that sort of peaks in the prime years of our life, which is one of the reasons why it's so disabling. It takes us out of action in the prime years of our life, generally improving as we age. But in that time period, there are certain factors that do increase your risk of having this genetic risk presenting itself as migraine. So women are more expected to have migraine than men. We think about 15% of the population having migraine, of which 20% are women and about 9% of men globally have migraine. So there is that genetic predisposition.
In terms of other factors that are involved in people's lives and whether or not they're getting migraines, it's very hard to predict but triggers, there are many different things that can increase a person's likelihood if they're getting migraine. And that sort of segues into talking about what are lifestyle habits and factors that people can focus on to minimize the risk of getting a migraine.

Dr. Peters:
That is so important for this podcast because we're all about brain health and brain wellness and so I can't wait to learn more about that. But before we go there, you sort of hinted to us about the migraine aura. Do you mind sort of elaborating a little bit more about what that phenomenology is?

Dr. Broner:
Migraine aura refers to what we call reversible neurological symptoms transient. So the most common one is a visual aura. In a visual aura, a person will be, for example, suddenly notice a small spot in their vision, which through which they can't see well. And then that spot will gradually enlarge and start to cover more of their visual field. And as it enlarges they might start to see zigzag lights, sparkly lights around that blind spot. It gradually builds over five minutes and then gradually fades resolving within five to 60 minutes of the onset of the aura.
It's caused by changes around the surface of the brain that create these sort of visual hallucinations if you will, and then pass through. And typically either as the aura ends, the headache starts or sometimes the headache starts at the onset of the aura. There's some other common aura types which include numbness around the arm and mouth and face and it can also include speech difficulty, people not speaking properly almost as if they have a stroke, as if they have an aphasia where the words are coming out jumbled or all wrong or backwards.
Some people with aura get weakness of one side of their body. What differentiates these from, for example, a stroke is that they're gradual and onset and that you've had multiple events of them and that they're in the confines of the description of what is typical of a migraine aura.
There's also some really interesting auras that are rarer that people can get. One is called Alice in Wonderland syndrome and it's thought that Lewis Carroll, who's the author of Alice in Wonderland had this aura and that in his descriptions of Alice, he was writing about them. In Alice in Wonderland, she has these episodes where she feels really, really tall and she gets all stretched out and then really, really small. That's what people with Alice in Wonderland aura can experience, these physical sensations of things looking very tiny or big or them feeling small or large. I haven't seen it a lot, but it certainly exists. So migraine is certainly a complex and interesting disorder that can affect so many aspects of our sensory system and our pain syndromes too.

Dr. Peters:
I've never seen a patient with Alice in Wonderland aura, but I'm sure that has to be almost a little overwhelming for the patient when they first have this. So what do you do to sort of educate those patients and how do they sort of come to you really in a diagnostic way? They're having headaches, maybe they're having some associated neurologic symptoms. Do you feel like you need to do certain testing first to before you give them a formal diagnosis of migraine with aura?

Dr. Broner:
Generally speaking, migraine is a diagnosis of exclusion, meaning, when we call it migraine, we're saying it's not from a brain tumor, it's not from a stroke, it's not epilepsy. It's this inherited condition with its own risk factors. So the diagnosis is made by several recurrent stereotyped attacks that are described very precisely over the years of how people experience that. When it falls out of the typical classification of what aura is like, then we may do investigative tests or if they're prolonged or it doesn't fit or if it's for the first time. But if people are having recurrent stereotyped episodes that fit the phenomenology of what migraine aura is like, then we can make that diagnosis without testing.

Dr. Peters:
Many of our listeners do have migraine and I know that they're probably listening today. Can you describe really the treatment journey for your patients with migraine and what they undergo?

Dr. Broner:
Because I'm in a tertiary center, usually when patients come to see me, they've probably seen a number of physicians already. Although I do have some patients who come to me for the first time. Whether they're coming to me for the first time or have seen other doctors, I always start with going over their symptoms, making the diagnosis. Even if they come to me with a diagnosis, I want to hear it fresh and know that what I think they have is the correct diagnosis. So that's the first aspect of that is if you have headaches, see your healthcare provider, talk about the symptoms, understand what it's you have, get the diagnosis and then you go to treatment paradigms.

Dr. Peters:
One of the challenges that I think our patients have, and I would love to know your opinion about this, is they often get that expert opinion from the headache specialist, but they can't get the medicines. They get told that they have to fail certain types of medicines before they go to the one that maybe that headache specialist really has a lot of experience with and knows can be tailored to that patient. Do you have any thoughts on that? I know this is a challenge that a lot of our patients face and a lot of our listeners.

Dr. Broner:
Access to the newest treatments can be challenging and there are many limits to that. In terms of what we provide for acute treatments, obviously by the time someone's getting to a specialist or a neurologist, they've tried over-the-counter medications and they're looking for something that's going to be more impactful for them. Within that are the first-line acute treatments like Triptan medications, Sumatriptan and Imitrex that have been on the market for decades now, those generally in the patients for whom those are safe, which include many people are generic and affordable. But when those aren't working, we need to look at the newer treatment options that are being offered, particularly the medications that work on CGRP, which is called Calcitonin-Gene-Related Peptide, which is our most recent breakthrough and our second migraine-specific treatment in 30 years. But it's exciting because we have this whole new pathway. So what are the barriers to that?
When they first came out a few years ago, many insurances weren't covering them at all. So the barriers are, one, you have to have insurance and many Americans don't have insurance. Two, your insurance has to cover it, and three, they put in barriers before which you will be allowed to get the medication. So you're absolutely right, they'll say you must need to have tried and failed two Triptans before you go to one of these CGRP blocking agents. And we have to work around that.
And part of that sort of echoes what we do in migraine anyway in migraine treatment anyway. I know it can be really frustrating for both patients and practitioners to take the time and move forward through the process, but we can't draw a person's blood and say, this is the drug that you are going to respond to. So we have to do these trials of medications anyway to find the right drug. So I say be patient, do the trials. If they don't work for you, if the ones that are on your formulary don't work for you, encourage your provider to get prior authorizations that are needed to get you those medications.
Now for people who don't have insurance and who are on either Medicare or Medicaid or have no insurance at all, that can be a really hard road to traverse. These companies do have methods within their infrastructure for people below a certain income to be able to obtain medication with the help of a provider prescribing it. So some corporations, some of the pharmaceutical manufacturers do have that back route to being able to get these medications.

Dr. Peters:
I agree with all of your recommendations and also what you do to help those patients that are having the challenges in getting their medicines. And in reading your bio, I was really excited about the Lifting the Burden, the global campaign against headaches. How are you doing that sort of on a global scale to give people access to these groundbreaking medications that are really targeting specifically the mechanism of migraine?

Dr. Broner:
So the World Health Organization has an arm called the Lifting the Burden campaign. They are headquartered in the UK in England, and over the years they have done remarkable work. They have allowed us to understand the true burden of migraine globally. It used to be thought as this maybe minor problem that people have, and through all of the data collection that they have done over the years, we now understand that migraine is the second most disabling condition globally in years lost to the disorder. And in women under 50, it's the number one disabling condition.
So what they have done over time is first, the first concept is you measure the burden and then you try to influence stakeholders in countries around the world to increase education to primary caregivers and neurologists, to get them educated about treatment options and give them more tools to manage headache and then also put in an infrastructure for treatment protocols that can be given around the globe.
So if you think about the United States, we have within our large population in the country, we have maybe 700 headache specialists. That's not enough to take care of the millions and millions of people suffering just from migraine alone. So we need primary care specialists, we need OB-GYN, all first-line headache practitioners really are encouraged and we love to have them participate in furthering the tools that they have already into understanding more about current treatment options and the most emerging current treatment options.
In terms of getting these expensive medications, when we're talking about the global burden, many people don't even have access or even access to a diagnosis and many people don't even have access to basic treatments that we take for granted here. They work on that level of trying to implement also infrastructures within certain countries to develop programs and partner with people on the ground who are interested in developing headache programs locally. I know that was a long-winded answer, but they cover a lot of territory.

Dr. Peters:
That is such an important initiative and it's pretty exciting to see what you're doing not just with your patients at Cornell, but sort of the world and what we can do to sort of really impact patient's health.
And another group that I think gets affected by migraine is really the caregivers of patients with migraine. I've often heard some of my friends that suffer from it, they couldn't go to their child's little league game because they had a migraine headache or they couldn't participate in certain types of activities that they were worried would be a trigger. Do you have any tips for our caregivers out there because we have a lot of caregiver listeners?

Dr. Broner:
Absolutely. Migraine does just as you said, does not just affect the person who's experiencing the migraine. It affects productivity, it affects the workplace. It's remarkable. And it affects everyone's lives who's affected by the migraine in one way or the other.
So I would say the number one thing that caregivers can do is to understand the disorder, familiarize yourself with what migraine is, what it's like to have migraine, what are the symptoms? And you can do that with great online sites such as the American Migraine Foundation has a large educational component to it. Learning about that, with that knowledge, you can then ask your partner, your mother, your brother, your father, your daughter, your sister, your coworker, how can I support you when I have these migraines? What can I do to help you succeed in getting control? Whether it's taking over what they need to do for a moment and helping them out, whether it's supporting their decision to get care. So many different ways down the line. Understanding is I think one of the biggest issues and certainly I think people with migraine feel invisible. They feel like people don't understand them, which they don't. And to have someone understand and their family understand makes a big difference in how they can heal.

Dr. Peters:
I'm so glad you're shedding the light and allowing us to understand migraine more. And at the very beginning of our discussion, we did talk about risk factors and triggers and for this podcast we're really a lot about brain health and what can we do for our bodies to keep our brains healthy. Are there any sort of tips in regards to body wellness that can help those migraine patients?

Dr. Broner:
Absolutely. So I think of the basic tenets of treating migraine are around lifestyle factors and that includes basics of hydration. How are you taking care of yourself? Aren't you drinking enough water? Are you taking breaks, enough breaks in the day where you're not just glued to a screen, where you're enriching your life in terms of moving around in the day? What are you eating? How are you eating? Are you eating healthfully? Eating healthfully and not skipping meals and avoiding junk food, so to say, has been shown to help people with migraine, minimizing caffeine to sort of eight ounces a day, not drinking excessive caffeine. And sleep, getting really good quality of sleep.
Stress reduction is also a really other important thing. I hesitate to say that because when I say that I want to just say to those of you who have migraine, it's not your fault you have migraine. Everybody has stress. Stress is a trigger for so many health conditions, including migraine. So people with migraine just don't need to deal with stress. Everybody has to deal with stress and it's part of our overall health strategy should be stress reduction and not specifically migraine related. So we don't want to pin that on us folks who have migraine.

Dr. Peters:
Well, I like that you're empowering not just the migraine patients to really have wellness to help manage their migraines, but you're empowering all of us, and I will say after this interview, I get to go see my trainer, so I'm going to remember that I'm empowering and preventing myself from having other symptoms and probably alleviate some stress.

Dr. Broner:
Exactly. Taking care of yourself is one of the basic things in life and will only serve to help your health.

Dr. Peters:
Well, Dr. Broner, this has been an absolutely wonderful experience. Thank you so much for sharing your insights and your expertise with us on migraine, and we also want to thank all of our Brain and Life podcast listeners, and I wish all brain wellness.

Dr. Broner:
Thank you so much for having me. It was a pleasure to speak with you and to contribute to what you do.

Dr. Correa:
Thank you again for joining us today on the Brain and Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain and Life magazine for free at brainandlife.org. Don't forget about Brain and Life en Espanol.

Dr. Peters:
Also, for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org and leave us a message at 612-928-6206.

Dr. Correa:
You can also find that information in our show notes and you can follow Katy and me and the Brain and Life magazine on many of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online @NeuroDrCorrea.

Dr. Peters:
And Dr. Katy Peters joining you from Durham North Carolina and online @KatyPetersMDPhD.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.

Dr. Correa:
Before you start the next episode, we would appreciate if you could give us five stars and leave a review. This helps others find the Brain and Life Podcast. See you next week.

Mulling over Migraines with Photographer Bill Wadman

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