First Contact — Headache in Primary Care

Topic: Improving Headache Care for Underserved PopulationsHosts: Mia Minen, MD, MPH, FAHS & Angeliki Vgontzas, MDGuest: Elizabeth Loder, MD, MPH, FAHSDescription: Millions of people living with migraine and other headache disorders never make it into a specialist's waiting room, and that gap is far from random. In Season 2, Episode 2 of First Contact: Headache in Primary Care, Drs. Mia Minen and Angeliki Vgontzas speak with Dr. Elizabeth Loder about the systemic barriers that prevent underserved populations from accessing quality headache care. From geographic shortages and insurance hurdles to VIP referral pipelines and language barriers, Dr. Loder breaks down who gets left out and why, and offers practical, affordable strategies primary care providers can use right now. You'll also hear how e-consults, embedded specialty clinics, and professional society guidance are helping bridge the gap for special populations, including pregnant women, adolescents, and elderly patients.

Topic: Headache Medicine Advocacy: Lessons from Headache on the HillHosts: Mia Minen, MD, MPH, FAHS & Angeliki Vgontzas, MDGuests: Robert Shapiro, MD, PHD, FAHS & Annika Ehrlich, DNP, FNP-C, CNRN, AQHDescription: Advocacy is a powerful tool for improving care for people living with migraine and other headache disorders, and clinicians and patients can make an impact together. In Season 2, Episode 1 of First Contact: Headache in Primary Care, Drs. Mia Minen and Angeliki Vgontzas speak with Drs. Robert Shapiro and Annika Ehrlich about how headache advocacy has shaped policy, expanded access to treatments, and helped drive meaningful change through initiatives like Headache on the Hill and the Alliance for Headache Disorders Advocacy (AHDA). You’ll hear practical ways busy clinicians (and patients) can get involved, whether that’s joining advocacy events, writing to representatives, leveraging social media, or simply connecting patients with opportunities to use their voices.[00:58] Why advocacy matters in headache medicine and what’s at stake[01:38] Dr. Shapiro’s advocacy journey + the origin of Headache on the Hill[03:57] Dr. Ehrlich on joining headache care and leading AHDA[06:02] The goals of Headache on the Hill and where federal policy falls short[07:40] Advocacy wins: cluster headache oxygen coverage + VA Headache Centers of Excellence[09:15] Why patients’ voices are essential—and how clinicians and patients work together[11:11] How to participate (including virtual options) when time/travel are barriers[12:46] Other ways to get involved: letter writing, webinars, and social media[14:14] How advocacy can counter burnout and restore a sense of momentum[15:10] Advocacy as an antidote to despair and why progress is possibleLearn more about the American Headache Society’s First Contact - Headache in Primary Care program.Learn more about getting involved with advocacy.

Topic: Migraine and New Generation Medications Host: Mia Minen, MD, MPH, FAAN, FAHS [@MiaMinenMD] Guest(s): Claire Sandoe, MD, MSC, FRCPC, Headache Fellow [@ClaireSandoe] | Michael J. Marmura, MD Description: In recent years, many new medications have been developed and approved for the treatment of headache and migraine disorders. These evidence-based treatments, such as those that target calcitonin gene-related peptide (CGRP), often work better and are better tolerated than older medications which were not designed to treat headache and migraine. In this episode, we review each of these new agents to help primary care providers feel comfortable incorporating them into their treatment plan. How do newer medications differ from earlier medications for migraine and headache disorders? Do they offer patients a better quality of life? Are there any restrictions on who can prescribe these newer migraine medications? Hear the answers to these questions and others from Claire Sandoe, MD, MSC, FRCPC, a headache neurologist at Women’s College Hospital and Assistant Professor at the University of Toronto, and Michael J. Marmura, MD, Associate Professor of Neurology at Thomas Jefferson University with a specialization in headache disorders. [01:42] How do newer medications differ from earlier medications for migraine and headache disorders? [03:44] What does the data on new medications tell us about how they can help certain patient populations? [05:40] Do these newer medications offer patients a better quality of life? [07:31] How are medications specific to the 5-HT1F receptor, such as lasmiditan, opening up new avenues for treatment? [08:27] How do you counsel patients who are concerned about the side effects of new medications? [09:56] What’s next when it comes to the development of new migraine treatments? [11:48] How does the side effect profile of newer medications compare to that of common older medications? [15:06] Are there any restrictions on who can prescribe these newer migraine medications? Is there anything else health care providers need to know in terms of prescribing them? Learn more about the American Headache Society’s First Contact - Headache in Primary Care program at https://americanheadachesociety.org/primarycare/, check out our Preventive Migraine Treatment page for more on preventive treatment at https://americanheadachesociety.org/topic/preventive-treatment/ and follow us on Twitter (@ahsheadache).

Topic: Migraine and Emergency Medicine Host: Mia Minen, MD, MPH, FAAN, FAHS [@MiaMinenMD] Guest: Benjamin W. Friedman, MD, MS [@benjaminbwf] Description: When migraine or headache pain is at its peak and usual treatments aren’t effective, patients often turn to the emergency department for relief. In some cases, this may be the most appropriate choice—especially when headache red flags are present. However, limited access to care, treatments or education often causes patients to make unnecessary trips to the ED. What are some headache red flags that warrant referring to the ED? What treatments are administered to patients with migraine who come to the ED? What can be done to help patients avoid returning to the ED? We cover these questions and others with Benjamin W. Friedman, MD, MS, an emergency physician and clinical epidemiologist in the department of emergency medicine at the Albert Einstein College of Medicine. [02:02] What are some headache red flags that should prompt someone to visit the emergency department? [04:00] Are there specific circumstances or factors, such as with pregnant or older patients, that should prompt someone to go to the emergency department for headache? [05:37] What treatments are given to patients with migraine who come to the emergency department? Does the American Headache Society have guidelines for deciding which medications to use? [08:40] What should health care providers know about using metoclopramide and prochlorperazine to treat patients with migraine? [10:17] If patients in the emergency department don’t respond to the top evidence-based treatments, what other treatment methods can be offered to them? [13:34] Do opioids have a role in managing headache or migraine in the emergency department? [15:52] How can emergency clinicians improve their approach when it comes to migraine? [16:38] What can be done to help patients from returning to the emergency department? Learn more about the American Headache Society’s First Contact - Headache in Primary Care program at https://americanheadachesociety.org/primarycare/, check out our Acute Treatment for Migraine page for more on rescue medications at https://americanheadachesociety.org/topic/acute-treatment/ and follow us on Twitter (@ahsheadache).

Topic: Migraine and Dentistry/Orofacial Pain Host: Mia Minen, MD, MPH, FAAN, FAHS [@MiaMinenMD] Guest: Marcela Romero-Reyes, DDS, PhD Description: To visit the dentist or not to visit the dentist? This question is often debated by patients with migraine who experience orofacial pain, or facial pain involving the temporomandibular joint (TMJ), mouth, head or neck. Whether or not a patient has been diagnosed with migraine, it can be difficult to determine if orofacial pain needs attention from a dentist or orofacial pain specialist. This is why it’s important for primary care providers to learn about the connection between dental pain, orofacial pain and migraine. What type of doctor should someone with orofacial pain see? How do you distinguish orofacial pain from migraine? What is involved in the management of temporomandibular disorders (TMD) for patients who also have migraine? We dive into these questions and more with Marcela Romero-Reyes, DDS, PhD, a dentist, certified orofacial pain specialist and director of the Brotman Facial Pain Clinic at the University of Maryland School of Dentistry. [01:31] What is the difference between dental and orofacial pain, and what type of doctor should be seen for each?  [03:21] How do you distinguish orofacial pain from migraine? [06:28] What have studies shown about the relationship between “TMJ” and migraine? Is “TMJ” the correct term to use? [11:19] What is involved in the management of temporomandibular disorders (TMD) for patients who also have migraine? [14:36] How can migraine differ from mid-facial pain? Learn more about the American Headache Society’s First Contact - Headache in Primary Care program at https://americanheadachesociety.org/primarycare/ and follow us on Twitter (@ahsheadache).

Topic: Migraine and Optometry/Ophthalmology Host: Mia Minen, MD, MPH, FAAN, FAHS [@MiaMinenMD] Guest: Kathleen B. Digre, MD [@kathleen_digre] Description: Approximately 33% of patients with migraine experience fully reversible visual (most common), sensory, or other central nervous system symptoms—known as aura—prior to or during migraine attacks. These symptoms are commonly confused with other neurological disorders by patients and clinicians alike. Understanding the basics of migraine aura can help health care providers make accurate diagnoses and provide appropriate medical care. What is aura? When should someone seek medical attention when experiencing visual disturbances? What treatment options are available for patients with migraine aura? Get answers to all of these questions and more from Kathleen B. Digre, MD, Distinguished Professor of Neurology and Professor of Ophthalmology at the University of Utah. [02:32] Why is the term “ocular migraine” incorrect, and what should we use instead? [04:29] Where can you find definitions of the different types of headache disorders? [05:20] What is aura? What are its symptoms? [06:42] Does aura occur in one or both eyes? [07:07] What is retinal migraine? [09:26] What are common mistakes that patients and health care providers make when it comes to understanding migraine with aura? [11:28] When should someone experiencing visual disturbances seek medical attention? [13:28] What treatment options are available for patients with aura? Learn more about the American Headache Society’s First Contact - Headache in Primary Care program at https://americanheadachesociety.org/primarycare/, check out our Migraine with Aura page for more on the symptoms and treatment for migraine with aura at https://americanheadachesociety.org/topic/migraine-with-aura/ and follow us on Twitter (@ahsheadache).

Topic: Migraine and Psychology/Psychiatry Host: Mia Minen, MD, MPH, FAAN, FAHS [@MiaMinenMD] Guest: Noah L. Rosen, MD, FAHS [@NoheadachesNoah] Description: Both migraine and psychiatric disorders are common conditions that often go unrecognized, underserved and undertreated across the globe. The relationship between migraine and psychiatric disorders is complicated, and people dealing with both need informed care from a primary care provider who understands the nuances and connections between these conditions. Are there pharmacological treatments that may be considered to co-treat migraine and psychiatric comorbidities? What evidence is there for the efficacy of older drugs versus newer options for migraine and psychiatric disorders? We discuss these questions and more with Noah L. Rosen, MD, FAHS, Associate Professor of Neurology and Psychiatry at the Zucker School of Medicine at Northwell Health. [01:40] What is the connection between migraine and psychiatric disorders? [05:18] Are there behavioral therapies for migraine? How do you encourage patients to try them? [07:23] What is cognitive behavioral therapy? How can it help patients? [08:52] What are the options for raising awareness among health care providers about behavioral therapy and addressing the stigma patients often face? [10:15] Are there pharmacological treatments that exist for both migraine and psychiatric disorders? [14:25] What evidence is there for the efficacy of older drugs versus newer options for migraine? Learn more about the American Headache Society’s First Contact - Headache in Primary Care program at https://americanheadachesociety.org/primarycare/. Check out our Behavioral Treatment for Migraine page for more information on behavioral therapies at https://americanheadachesociety.org/topic/behavioral-treatment/ and follow us on Twitter (@ahsheadache).

About 60% to 70% of women with migraine experience attacks associated with hormonal changes. Hear Dr. Susan Hutchinson and Dr. Catherine Stika answer frequently asked questions about hormones and migraine, including hormonal treatment options and how to have these conversations with your migraine patients. The First Contact Headache in Primary Care podcast breaks down topics in headache medicine for primary care providers and other healthcare professionals who care for patients with headache disorders. The program’s goal is to provide educational resources to empower healthcare professionals and improve headache and migraine care for patients. Learn more on the Primary Care website.

Many women notice a reduction in migraine activity during pregnancy, especially in the second and third trimesters. But when should patients be concerned about headache during pregnancy? Learn from Dr. Susan Hutchinson and Dr. Catherine Stika about some headache red flags for pregnant patients, how to manage migraine after delivery and more. The First Contact Headache in Primary Care podcast breaks down topics in headache medicine for primary care providers and other healthcare professionals who care for patients with headache disorders. The program’s goal is to provide educational resources to empower healthcare professionals and improve headache and migraine care for patients. Learn more on the Primary Care website.

It’s important for healthcare providers to discuss pregnancy-safe treatment options with their migraine patients. From changes in medications to treatment at home, find out how to help women manage their migraine while pregnant in this podcast episode with Dr. Nina Riggins, Dr. Susan Hutchinson and Dr. Catherine Stika. The First Contact Headache in Primary Care podcast breaks down topics in headache medicine for primary care providers and other healthcare professionals who care for patients with headache disorders. The program's goal is to provide educational resources to empower healthcare professionals and improve headache and migraine care for patients. Learn more on the Primary Care website.