JC- Joe Coe
DNF – Danielle Newport Fancher
PM – Dr Peter McAllister

DNF – I just remember laying on the floor of the bathroom in the airport, which is just so gross, just lying there on the floor unable to sit up and being so sad and frustrated with my situation, and the pain was just so strong that I couldn’t move, and I was like this is really a challenge when you’re just laying on the floor of the airport bathroom.

JC – Lying under the bright lights of the airport bathroom, I couldn’t think of many worse places to have a migraine attack, but they can come on at any moment. Hi, I’m Joe Coe, the host of Talking Head Pain, where we confront pain head on. Migraine has been a part of my life for 20 years, so I understand the far reaching effects of migraine and that it doesn’t discriminate.
In this episode we are looking into how migraine affects a group of people that I fall into, millennials.

DNF – My name is Danielle Newport Fancher, I am 33, and I live in New York and work in media.

JC – We’re talking about migraines today, do you remember when you first experienced a migraine attack. How old were you?

DNF – Yes. I actually have a very vivid memory of my first migraine. So I got my first one when I was 16, and I was driving home from school and I remember leaving the parking lot and seeing a little spot in one of my weyes, which I now know is aura, but by the time I got to like a main intersection, the aura had taken over my full field of vision, and I was sitting in the intersection and I couldn’t see the road ahead of me, and I just stopped, so I sat in my car and I remember having so much anxiety that there were other people from my high school around me in cars also leaving the school, but I couldn’t move and I felt like I had completely created a traffic jam, so up until that point I had no awareness of migraine, and I had no awareness of aura, and it was a really scary thing from me to go through that and have no idea what was happening.

JC – The first one is pretty frightening, I understand that. What do your migraines look like now?

DNF – So I have intractable migraine, it basically means that even though I’ve had chronic migraine for well over a decade, I had a migraine one day and it never stopped, it started October 2nd 2013, it was like any other day, any other migraine that I had, the next morning I woke up with a migraine, same migraine was there a week later, and now we’re on 7 and half years later I have the same migraine. I know it sounds wild to think of someone being in constant pain for that long, but there are so many so many people just like me who are experiencing pain day in and day out, and I just feel like I’m not as sharp as I want to be.

JC – As a young woman, do you feel like people don’t take your pain seriously?

DNF – Yes. I have had many experiences of feeling like my pain isn’t taken seriously, but instead of being frustrated with that, which I have obviously experienced many times, I have made it my mission to share my experience more. I’ve almost taken on the responsibility of if people don’t get it, maybe I need to be more clear about how I talk about it and I think there are small micro ways to do that, like in conversations when somebody says something and i’m like, oh they don’t understand, it’s clarifying and talking about it, and explaining, burt i also feel like on a more macro level here being able to write my articles, and share my memoir and talk and be on podcasts, and just being able to share my perspective on a broader scale also communicates that this is real this tough and there’s so many of us. So I think if we are all joining in as a community doing these things and communicating whether it’s in very small ways or large ways, at least we know we did our best to change our dialogue around migraine.
So It’s like my whole mission to hopefully make somewhat of a dent on changing someone’s perspective on it.

JC – I love the active approach that Danielle takes with her migraine journey, she doesn’t see herself as a victim to migraine at all, but instead a tool to educate and connect with others. I wanted to dig into this further, why, as people living with migraine, are we not understood? Why do we need people from out community, like Danielle writing books and educating others through social media? I spoke to Neurologist, Dr Peter McAllister to understand this.

PM – I think a lot of patients with migraine, particularly those who have not seen a headache specialist, don’t think of it as a medical condition like you would diabetes or asthma or Crohn’s disease. migraine is a medical condition. migraine is according to the World Health Organisation, the second leading cause of functional disability, missing days of work and family life and social life of any other medical condition. They didn’t ask for migraine just like one doesn’t ask for asthma or diabetes.
And the second thing is, and most migraine patients know this, on some level, there is a stigma associated with migraine. A lot of folks don’t really think migraine is legitimate among medical conditions. And why is that? Well, because we all have some background, you know, little headaches and we discussed that. Also, the word headache in the English language is pejorative, like my boss gives me a headache or writing this paper gave me a migraine or something like that. So we have a condition that has negative connotations in the lay press anyway, I sometimes wish that migraine were renamed to something fancy like Central Nervous processing disorder or something like that, and got away from the negative connotations and negative stigma. Migraineurs, people who suffer from migraine are more likely to call in sick to work and say I have a cold rather than say they have a migraine, because when you pull a bunch of bosses, they don’t think that migraine is a legitimate reason to call in sick. So that’s something that I wish we had a better handle on and we can begin to make changes.

JC – Very interesting take, I think we’ve all come across someone, or even ourselves, who describes someone or something as a headache, but never fully considered the ramifications of that for the migraine community, and I know we’ve all called in sick and said it was anything but migraine at least once in our lives, I guess it’s for the fear of what our bosses might think, or our colleagues, which leads me to my next question for Danielle.

So how do you manage migraine and your career?

DNF – As I mentioned I work in media, in New York, and I do work a lot and I work very hard, but it’s a challenge, being in constant pain, and being ready to go to build presentations, to present to clients and to always be on in that way is a huge challenge.
I feel like my migraine pain comes in bouts, so some days if I am no in as much pain, I focus so much harder and get as much done as possible, if that means working all night, I’ll work all night, if on a Saturday I’m feeling ok, I’ll get my work done, but then it’s really to me figuring out how I can get everything done and be ready to go without pushing myself too hard to trigger another migraine, and if I’m in too much pain Im not going to get too much done. So it’s figuring out that balance between everything.

JC – And how open are you with your employer? How have you navigated talking about migraine with your employer?

DNF – If I look about to about ten years ago in my career, I didn’t tell anyone about my migraine, I was nervous to bring it up. I didn’t want to be seen as less capable, and so I kept it a secret for many years. Obviously now that I’ve done so much advocacy and written a memoir and many many articles about migraine, it’s kind of out there. But I’m pretty upfront about it with my colleagues, at this stage of my career, I’ve proven my value and that I can still maintain my workload and my job, so I think a part of it is that I do feel confident that I can have chronic pain and still build my career and do a good job. To me it’s just about transparency, if there’s a morning that I can’t work, I’ll email that I can’t do it. I’m just very honest about it with them, and I’m so lucky to have a team around me that supports me and is very understanding of it. But also, I work very hard and try to balance it all out.

JC – Definitely, I can relate to that as well. A little less serious, pro or con avocado toast?

DNF – Pro. Very millennial of course

JC – In millennial culture, a lot of it is about how we portray success, what we’re showing on instagram. Was it hard seeing peers achieving goals on a different timeline, how did you push yourself or justify that you’re on your own timeline.

DNF – It’s so hard to be in pain and feeling this sense like I’m falling behind and I think social media also paints a picture for anyone who might not be in pain that you might be falling behind of life stages and careers, because it paints such a beautiful picture of everyone’s life situation. So I think as a millennial, yeah it’s definitely tough, I know in my millennial circles, we feel very driven, a lot of pressure to be the best version of ourselves, whether that’s in our careers or in our lives, and that’s a lot of pressure to put on ourselves. And I really do find that when you’re in pain and you feel stunted in some way, whether it’s your career growth or being able to date, it’s tough. I think i’ve always really tried to keep as much going as I can, so I think there were phases where it was impossible to go on dates and keep the career going at the same level, and fulfill my whole social life while in pain I think there were different moments in time where I had to choose what’s the priority for that point in time, and I dont think thats just for migraine patients, I think that’s true for everyone. Being a millennial in this high pressure world it’s tough when you feel like migraine is getting in the way of your goals. If anything I really do feel like, despite being in constant pain for almost 8 years now, I have managed to keep almost everything going.

JC – It is hard to keep it all going, and thinking ‘is this going to be how I live for the rest of my life?’ Constantly managing migraine with everything else in my life, and although we might not have migraine totally under control, I find it reassuring knowing that there are innovative treatments specifically for migraine slowly making their way to shelves.

DNF – There have been so many years that I have taken medication for blood pressure, seizure medication, for all these different types of illness because results show that they help patients with migraine, and it was always such a funny thing for me, like where are all the migraine medications? Isn’t just such a fascinating thing that for all these years we were trying all these medications for other illnesses. But finally I really do feel like things are changing and we are starting to see more medication for people with migraine. I really think it is such a hopeful feeling, I feel like things have changed. Not only in having more options for us, but there’s more dialogue around migraine, we’re talking about it more, just getting more visibility on this illness and more funding just such an important thing, and I really do have this sense of hope for all of us that there are new things to try and we can hopefully have not only more awareness around our illness, but more relief.

JC – That sense of hope is really crucial for the migraine community, but I do think there are positives to migraine, so for you, what do you think your migraine superpower would be?

DNF – I truly believe that I can handle anything, that would be the migraine superpower that I have. It’s so funny that after all of this I think I can tackle anything. If I feel behind on things or If I do have a day where I can’t;t get things done because of my pain, somehow I will always be able to get it all done. There’s something about having the confidence that I can handle it, whatever it is. I’ve been able to get my career back on track, I feel really strongly about it, I’ve got an amazing relationship, I feel great about my social circles, like the friends who understand are the best, and I really think that it is possible, with time to keep everything going and reach all of those goals. Sometimes I need to take a bit of time and recalibrate a little bit and take breaks, or prioritise but I hope I can be an example that migraine isn’t completely holding us back.

JC – Someone needs to hear this, what tips or advice would you give to a millennial that’s living with migraine that might not have gotten to the point that you’re at.

DNF – It’s so hard to be in pain and feeling this sense like I’m falling behind and I think social media also paints a picture for anyone who might not be in pain that you might be falling behind of life stages and careers, because it paints such a beautiful picture of everyone’s life situation. So I think as a millennial, yeah it’s definitely tough, I know in my millennial circles, we feel very driven, a lot of pressure to be the best version of ourselves, whether that’s in our careers or in our lives, and that’s a lot of pressure to put on ourselves, and I really do find that when you’re in pain and you feel stunted in some way, whether it’s your career growth or being able to date, it’s tough. I think i’ve always really tried to keep as much going as I can, so I think there were phases where it was impossible to go on dates and keep the career going at the same level, and fulfill my whole social life while in pain I think there were different moments in time where I had to choose what’s the priority for that point in time, and I dont think thats just for migraine patients, I think that’s true for everyone. Being a millennial in this high pressure world it’s tough when you feel like migraine is getting in the way of your goals. If anything I really do feel like, despite being in constant pain for almost 8 years now, I have kept everything going.

JC – Danielle, I know how hard it is to live with migraine, the constant threat of an attack, thinking about how our careers might be impacted, I for one am grateful that there are new drugs and treatments that are coming to the market, some of the are already out on the market, I just hope that people like us don’t have to jump through fiery hoops to get it.

DNF – There have been so many years that I have taken medication for blood pressure, seizure medication, for all these different types of illness because results show that they help patients with migraine, and it was always such a funny thing for me, like where are all the migraine medications? Isn’t just such a fascinating thing that for all these years we were trying all these medications for other illnesses. But finally I really do feel like things are changing and we are starting to see more medication for people with migraine. I really think it is such a hopeful feeling, I feel like things have changed. Not only in having more options for us, but there’s more dialogue around migraine, we’re talking about it more, just getting more visibility on this illness and more funding just such an important thing, and I really do have this sense of hope for all of us that there are new things to try and we can hopefully have not only more awareness around our illness, but more relief.

JC – That sense of hope is really crucial for the migraine community, what do you think your migraine superpower would be?

DNF – I truly believe that I can handle anything, that would be the migraine superpower that I have. It’s so funny that after all of this I think I can tackle anything. If I feel behind on things or If I do have a day where I can’t;t get things done because of my pain, somehow I will always be able to get it all done. There’s something about having the confidence that I can handle it, whatever it is. I’ve been able to get my career back on track, I feel really strongly about it, I’ve got an amazing relationship, I feel great about my social circles, like the friends who understand are the best, and I really think that it is possible, with time to keep everything going and reach all of those goals. Sometimes I need to take a bit of time and recalibrate a little bit and take breaks, or prioritise but I hope I can be an example that migraine isn’t completely holding us back.

JC – Someone needs to hear this, what tips or advice would you give to a millennial that’s living with migraine that might not have gotten to the point that you’re at.

DNF – My number one piece of advice, and this has been throughout my migraine journey, is to connect with other people in pain, bottom line, this has been the one thing that has really really helped me. I think being in pain is so hard, and feeling like you’re the only one going through it, is much much harder. But knowing there are other people in your circles that get it, that you can call at any time, or get on social media and send them a message, like just knowing that someone’s out there who’s like I’m feeling it too. Today’s a hard pain day, like that is a game changer I feel like that alone has changed my whole journey and why I’ve started talking about it more, and why I’ve built this community, it’s just a game changer.

JC – It’s difficult opening up about migraine to friends and colleagues, especially when you’re a part of a generation that has been told that we’re whiners, complainers, or need participation trophies. However, Danielle has made it her mission to advocate and has helped countless people living with migraine to better understand the complexities of this disease.
You can find her work on Twitter and Instagram by following Migraine writer. Do you need some quick information about migraine, or have someone in your life that doesn’t real understand this disease? Our free patient audio guides offer valuable information and insights from leading experts that can help you become more informed.

JC: Joe Coe
JM: Joe McKay
PM: Dr. Peter McAllister

JC – Content warning, this episode contains sensitive content around suicide.

JM – I felt at one time I was afraid to go to sleep. I wasn’t getting more than two hours sleep in a row and that would probably be the time it Freddy Krueger was. So it was more or less. Like I was living in a Freddy Krueger movie. For those three weeks where you know, when I laid my head and on the bed at night, I knew about an hour and a half to two hours later, Freddy Krueger would be sitting on my chest and sticking his knife right right in my eye.

JC – That visual of Freddy sends chills up my spine. I’ve always been a fan of horror movies. I remember being a kid and begging my older cousin to let me watch and then having nightmares for weeks (and if we are being honest years),
There’s something about Freddy and the Nightmare of Elm Street franchise as a whole that really hits that mark when talking about head pain. Too many of us in head pain continue to live in our personal nightmares feeling trapped and helpless in our own bodies and heads.
Hi, I’m Joe Coe, the host of Talking Head Pain, where we confront pain head on. In this episode we talk with a man who rewrote his personal horror movie script.

JM – I’m Joe McKay. I’m 53 years old and I am an avid full time advocate now, retired, FDNY firefighter. Now I’m a full time advocate.

JC – So as you know, we’re talking about head pain. When did you first start getting headaches and head pain?

JM – It was about six months after, after 911. Myself and obviously, the whole Fire Department, a lot of first responders and volunteers working on a pile. I was working in the firehouse and about one in the morning, and I had all of a sudden felt like someone had stabbed me in the eye with an ice pick.
Scared me, scared me to death ended up in the emergency room. And a few hours later, they sent me home with the diagnosis of unspecified migraine. So that was that was the beginning of it all.

JC – That could be scary, too. What was going through your head aside from the pain after the hospital visit?

JM – Ah, just a lot of confusion, I had never experienced anything that painful before, and to walk away from the hospital without really without any answers was a little unnerving.

It wasn’t wasn’t till probably almost two months later that I got a proper diagnosis. And I’m lucky that I got better that early and I attribute that to being in the New York area where there’s a lot of, you know, a lot of neurologists that would more likely come across a patient with this condition with with cluster.

JC – As Joe said he is lucky because it often takes people a much longer time to get a proper diagnosis. Getting the right diagnosis is important because it can help make sure those living with headpain get on a the right treatment. Cluster headache is not something that many may have heard of. So I asked Neurologist Dr Peter McAllister to explain it for us.

PM – So cluster headache is another primary headache disorder but very, very different from migraine. Cluster headache has been labelled about the most horrible pain on the planet, beating kidney stones and burn pain and cancer pain etc. So it’s sometimes referred to as the suicide headache for a reason distraught patients in terrible pain or don’t have access to care and treatment have taken their lives, which is devastating. So cluster is a short acting headache. It’s got a very circadian patterns such that a patient may wake up in a cluster at 2:07am. Every night, with the idea that a hot poker is being rammed into their eye, the pain is excruciating. One major difference is that when a migraine sufferer has her really bad pain, what she’d like to do is lay down very gently and quietly not have everyone touch her. It’s just the opposite with cluster, they are so in pain, that they pace, they walk around, they’re agitated, leaving banging their head against the wall. The other discerning feature is the autonomic changes. So what happens in the cluster which is a 15 minute to a few hour Pain Syndrome, they often get a drooping of the eye, tearing of the eye, nasal congestion, redness of the eye these are we call the autonomic features that roll with it, cluster is always side locked, meaning it’s 100% either right side or left side. and even general neurologists will sometimes miss it. The treatment overlaps with migraine, but it can be very different to diagnosis sometimes takes three to five years after onset of symptoms.

JC – Dr McAllister didn’t hold back explaining the intense symptoms that cluster headache patients experience. I can imagine people like Joe, who live cluster headaches are constantly dealing with people just thinking it’s just a ‘bad headache.’ I wonder if that impacts men getting treatment?

Being a guy that sure you are that reminded me did you get does anyone bust your chops about like, having cluster headache or needing to take time for yourself or to do different treatments?

JM – Yes. Yeah. busting chops is is I was in New York City fireman and firehouse. Chop busting is, is an art form in the firehouse and if they’re not busting your chops, then usually there’s something wrong so but Yeah, I did.

I got the nickname oxygen boy, and some other there was a few others, holiday headache, they would say cuz I would always you know, the headaches would always seem to come around when a holiday was coming, but there was there’s always a holiday around. If you look at the calendar, that is you know, Arbour the day would be one is Oh, yeah, all the day and your headaches back, you know, totally joking around, but they weren’t, you know, they were they were busting my chops a little bit about that, but that it’s all in good fun I you know, but they understood the pain because there were times when I would get in attack at work, you know, two or three in the morning. And they’d see me sitting up, you know, sucking oxygen down, you know, sitting on the back step of the of the fire engine or two in the morning. So they knew what was what it was about. Yeah, yeah, it was all it was all good, though. In the end. I was pretty lucky, though, to be honest with you to get to have access to that oxygen at work. City of New York graciously supplied it for me at work.

JC – Do you think that the joking and the chop busting is a way of people trying to understand something that they may not understand?

JM – It’s hard to tell, you know, who’s what, you know what their intention was? But I mean, I didn’t feel any hard feelings. You trust these guys, you trust these guys that you like when you go out the door, so it’s kind of a different kind of relationship.

JC – I know, you’re a big advocate. So you’re very open now with your story of cluster and headache and pain. Was there a time that as a man, you didn’t feel like you could be as open about what you were living with and struggling with?

JM – It was a little tough at first, and the stiff upper lip thing was kind of the mantra with a lot of people and you know, my family. So I always try to always try, it didn’t always work, but we try to keep that stiff upper lip. But when I’m having an attack, I don’t want anybody to see me because it’s not it’s not pretty. You know, in tears with the pain, it’s that bad. It’s embarrassing for me like I don’t want anybody to see me, it just brings up a lot of emotions when I’m in that position and I really don’t want anybody to see me like that. But yeah, I’ve kind of moved on past that I really I it doesn’t bother me anymore that you know at this point, I really don’t care. You know what anybody thinks about my manliness or I’m in pain you know, if I stabbed somebody in the eye with an ice pick anybody else that was standing there watching me having the pain and maybe they truly understand what it was like.

JC – I know that many people living with constant head pain look for anything that can help relieve symptoms. I asked Dr. McAllister his thoughts about two treatments that know generates a lot of discussion in the cluster headache community: “Magic Mushrooms and Marijuana”

PM – There is an emerging literature on what’s known as micro dosing. So psilocybin in which is the stuff of hallucinogenic mushrooms, when taken in non hallucinogenic doses, which is very interesting, because some patients would be afraid I don’t want to hallucinate I don’t want to have a trip. If you use a fairly small dose, such as 200 micrograms, and it’s not every day, during the cluster, it’s usually twice a week tends to decrease the number of attacks and sometimes eliminates or gets someone out of the cluster entirely. The beside being illegal in most states, so those silicides is now legal in the state of Oregon. It has no lethality. In other words, one cannot overdose from psilocybin or magic mushrooms. Marijuana, medical or otherwise has become incredibly popular, and many of my patients come in asking about that. What I tell them is sort of the pluses and minuses. There’s very, very little scientific literature to suggest good or bad, we just don’t have the data. That said, in my state, we are allowed to certify folks for medical marijuana. My experience with it has been mixed. Again like psilocybin there is no lethality of marijuana, one cannot overdose. So conceivably you can think of it as probably safer than many The pharmaceuticals we use on a day to day basis, the problem I found is that not everybody gets better with it. It’s a very mixed group. Some folks it increases anxiety or makes them lethargic.

JC – It is so important for people living with head pain to work their healthcare providers to find the right combination of treatments that work for them. Remember we are the experts in our experiences and we need to approach medical care as a partnership. Having advocates like Joe in our community make this easier for many of us.

First, I want to thank you as a New Yorker for what you did after 911. So it was something that really impacted not only the country, but you know, our area, as you know, deeply. So I know you do a tonne of work helping to raise awareness on how headache and cluster and different types of diseases came came about because of exposure to different things during 911. Can you talk a little bit about your advocacy and about the either the trauma from 911 that’s caused this, is it the chemicals?

JM – My advocacy journey started in 2015. I had just retired a few years before that. My brother Dan, who’s also a New York City, firefighter, he he had cancer from 911, him as well as another 30 something year old guy in my firehouse actually developed the same kind of cancer and there was quite a few other firemen and police officers and people that I knew that worked on a pile that had cancer or had passed, or were still battling. The effort to get the 911 bill extended was still going on. I had gotten a notification to that there were going to be a rally at seven world trade. And I just said, You know what, I’m going to go, I’m going to go down and you know, and be part of the rally I met. There, I made up a few firemen, a couple guys that I worked with. So we went we visited some congressmen and you know, the rest is history after that, the bill got passed temporarily another five year bill and the year after that I was up to two years after I went to my first cluster headache conference. There I met Dr. Bob Shapiro from the Alliance for headache disorders and he got me in there to advocate for for people with headache disorders. I said, Yeah, I can do that. I’ve done few, a few meetings. I’d love to jump in on that. So I started working with cluster busters for headache disorders to advocate headache on the hill, a once a year event in Washington, where we try to get our lawmakers to listen to us and get funding and change the laws to benefit people that are suffering from headache disorders. The problem is that science doesn’t really know exactly what causes it. I got them after working on the pile for six months. But yeah, as far as the chemicals go, and headaches that they know that there is a higher rate of migraine, and headache disorders, from people that were exposed to toxins from 911, and also from burn pit exposure. That’s something that we’re working on too, with the Alliance for headache disorders to get more, more attention on that and more research and hopefully, you know, some more help for people that are suffering.

JC – what would you tell to you know, guys right now that might not be at the point that you are, if they’re having head pain, and they’re banging their head against the wall or putting their head in the freezer, which is something I did early on during my migraines. What would you tell other guys.

JM – I would say there’s a lot of other people that have going through what you’re going through, you’re not alone. Seek help, seek help with not only through your doctors, but online and and in particular like it whether you’re a migraine or cluster headache, patient, there are seminars to go to. It’s okay to tell, you know, to tell people that you’re in pain, you know, that your pain is real, it’s okay to show that you’re in pain, you’re human, we’re all human. I understand how it crosses your mind when you know when you just want to end the pain that you actually think about ending your life but I have to stress this. There is help there is you know, there’s life that the headache is temporary and there’s so much more to live for after and you’re not alone. You’re not alone in this. And if you ever feel desperate, and I’ve come across people that do feel desperate reach out there’s plenty other people out there that would be willing to help.
I’ve met so many great people through the advocacy work. It emerged my life definitely, you know, not only from you know, relief with the from the pain but I just I made friends and connected with people. It’s priceless to sit and to talk to somebody that truly understands what you’re going through.

JC – As a reminder if your pain is causing you to think about harming yourself there is help. In the United States you can call the National Suicide Prevention Lifeline: 800-273-8255
It can be hard to share the extent of your pain with someone else, especially when as men, we are taught to not show others our pain.
If a former New York City Firefighter and September 11 first responder can ask for help, you can too. Joe’s personal and professional sacrifices, and advocacy remind us that there is always help. That we are not alone on this journey, and that it is not weak to get the care and support we deserve.
If you or someone you know needs more information about the different types of head pain, how to get diagnosed and how to manage, listen to our Talking Head Pain audio guides.

Episode 3: Leading with Migraine Transcription

JC: Joe Coe

LJ: Lori Johnston

LJ – The new neurologist in California wanted to start me on new medication and stop the medication that I had previously, and during that time, the migraines just seemed to intensify. And it was almost as if they were on top of each other. I would finish a migraine and another migraine would start. I was an executive at Amgen at the time and I didn’t want anyone to know that I was having migraine and that I was throwing up or that I was having a difficult time reading the presentations..

So I found a bathroom in the basement of our executive building and I would get  sick. And then I would sit on the floor up against the wall, leaning my head against the cold tile to see if I could at least have something subside, it became so intense that I ended up having my doctor, he suggested injecting nerve blocks, to see if the pain would subside.

I can remember sitting there on the table with my arms crossed in my head down, and receiving the injections. The injections were not  were painful, but I looked up and tears were just streaming down my face because I was so desperate for anything to stop the pain, I wanted the pain to go away.

JC – That desperate attempt to do anything to alleviate pain is something all people living with head pain can relate to. Hi I’m Joe Coe, host of Talking Head Pain, where we confront pain head on. In this episode we speak to Lori, a member of the leadership team at a biotechnology company, about managing a career while living with migraine.

LJ – I’m Lori Johnston. I’m the Chief Human Resources Officer for Amgen, which is one of the largest global independent biotechnology companies. But I’m also a Mom. I’m a grandmother. I’m a sister, a friend, a wife, daughter. So I’m lots of things, but professionally, that’s what I am.

JC – That’s really important to highlight who we are outside of our professional roles, because we get defined way too much in our society. So really appreciate you highlighting that. Do you remember when you first started to get migraine? How long did it last? And how did it start?

LJ – Well Joe, I think that migraine started for me probably back in my teenage years. But when I first became diagnosed was about 14 years ago. And I was having a series of migraines that were just increasing in their intensity. And that’s when I talked with one of my doctors, and he sent me to a specialist to see if I could get some help.

JC – So you lived all those years with something that you may not have known was migraine. I think a lot of people can relate to that. What are your migraine symptoms like for you?

LJ – Well, most of my migraines tend to happen at night in the middle of the night, and I wake up with searing pain, nausea, usually I’m in, I  have an aura I have, you know, you can see that it’s kind of coming down and finishing. I am unusual, I think – in the fact that I can’t really lay down during a migraine so I know I need to get up. I either stand against a wall or I sit against a wall or I sit up in a straight chair, seeing if the pain and the nausea will subside. It typically doesn’t. So you continue with a migraine for quite some time. And I do experience things like nausea and on occasion vomiting as well. So it tends to be a pretty painful and situation difficult situation for me.

JC – Can you go into a little bit more detail about how you got a diagnosis and what helped you get that diagnosis?

LJ – Certainly, I started having migraines to the point where my primary care physician when I was talking to him, at first Joe, I thought these were just headaches, very bad headaches. And then I started talking about my symptoms. And when I started throwing up and there was nausea, I just knew that something wasn’t right. And I really hadn’t heard very much about migraine at all. And my primary care physician sent me to a neurologist, and he immediately diagnosed me and started talking about migraine. And in a way, it was one of the most challenging times but in a way it was also one of the most liberating times because I finally felt I had something that I could research and I had someone who understood and I wasn’t just doing bad things that resulted in a very bad headache. To have a doctor say to me, this is a neurological disease. And  it probably won’t go away on its own was just liberating.

JC – It is important to highlight this aspect of Lori’s story. For many of us it takes visits to different doctors to get a proper diagnosis. And if we lead busy lives and careers we might not want to slow down to take time to do this. You deserve to understand your disease and find ways to manage it. I also wanted to know whether she experiences something else that is very common among others in the head pain community. Have you had any trouble explaining the pain that you experienced with migraine, or what even migraine is to others?

LJ – You know, Joe, when I think about it now I really didn’t explain to many people at all what I was going through because I didn’t know how to explain it. It felt like I sounded weak, or I might be just trying to say I have a headache. And I talked to my husband, but even today, he’ll say, I’m not sure I ever really understood what you were going through. My mom and dad knew I had migraine, but not much more than that.  We have four girls, we have grandkids. And it just wasn’t something I felt I should, for whatever reason, be explaining to the girls. And it just it felt like I was giving excuses. So I didn’t want to do it. I didn’t want to talk about the pain

JC – It’s very common. Has migraine impacted your interaction with your family or friends, you started to talk about this a little bit?

LJ – Well, when I was diagnosed with migraine, I was an executive. So I was an executive in human resources at the time working for, you know large companies. So I tried to be present for all of the girls activities. But what I found Joe and looking back on it now, it was almost like I was looking through a muddy glass, or I was living life through something that didn’t allow me to be as present or the memories as vivid. And often times the girls will talk about something and I’ll think was I there? Was that a migraine day was that what was happening because I don’t feel I can remember things as vividly. Now as the migraines have lessened, I realize how much I missed. By things not being as clear, I almost felt that I was walking through a fog.

JC – That’s a really powerful image. Why didn’t you want people to know that you were living with migraine? Have you felt stigma around migraine?

LJ – I thought someone would accuse me of being weak. And I grew up kind of Texas tough. We grew up as a family when you know something happened. You were just you know, you kind of suck it up Buttercup. You just sort of shake it off. And I felt that I would be labelled as weak and incompetent. And I did not want that, and the way that I worked through that is realizing that what I was going through was not just going to magically disappear, if I sucked it up, that I really had something where my body was reacting very differently than everyone else’s body.

JC – I’m not surprised that Lori felt she would be perceived as weak, I think we have all feared that, I know I have. As someone who part of the leadership team of a large company, I wondered what it was like when Lori opened up about her health journey with her colleagues.

LJ – The first time I told my patient story in front of our entire leadership team. I told them that I was scared to death. I thought I might end up being fired. You know, when my mind just ran away from itself, I would think about being fired. And I thought, How crazy is this? I’m a head of HR, what am I going to do – fire myself? You know, for having migraine. This is crazy. But a lot of times our stigmas come from the fact that we are silent. We’re silent sufferers. We don’t get to talk about our disease. And when you’re able to talk about it, and people are able to see what you go through and what you do. There’s strength in that. And I’m hoping through that, that we can break those stigmas of silence.

JC – Have you ever Lori had to ask for accommodations at work?

LJ – This may sound odd from the head of HR, but I haven’t asked for accommodations. And part of that Joe goes back to the point of I didn’t want people to know that I had migraine. In fact, when I finally told our CEO that I suffered from migraine, he was shocked. He cannot believe that I that is something I’ve been living through. But I do believe as well that my job in the way that I was able to manage things allowed me to have a bit more flexibility than what might normally exist for someone who as an example would be working on the manufacturing floor. So I was able to work at different times early in the morning, late at night, on the weekends, those things are accessible to me to be able to do.

JC – How does Amgen help employees that live with headaches and migraine?

LJ – Well, the first thing I would say Joe is creating panels and discussions where you can do exactly what we’re doing here, which is share your story here about patients. We always have meetings with patients coming in, which I think is, is just phenomenal, because it does share with you the patient journey and what people are going through. But in addition, just for our employees, it’s making sure that we have the proper benefits so that different management programmes and plans can be adhered to. We have when we were in offices, we’re not there today. But when we were in offices, we also have put in place dark rooms in many of our campuses and locations. And then just focusing on health and wellness. Because I think as you said, that’s such a big part of who we are right? allowing ourselves to self care.

JC – It’s great to hear that Amgen does this because we need more large companies really pushing this to make it normal for people to take that time to really invest like you said earlier Lori in the individual, knowing that there are a whole person and that a balanced person is happier. I think a lot of people would be interested in how you manage migraine and develop a career. So what is good management and good for lack of a better word of migraine mean for a person’s career of migraine mean for a person’s career?

LJ – Well, I’m not going to tell you it was easy. I feel like I dedicated a lot of attention to it. So what I would do is really manage my life around ensuring that I could deliver on the jobs that I had and the roles that I had. And that sometimes meant that in the evening, I needed to study my notes again for a key meeting. Or it would mean on the weekends I needed to rest, and if things were really bad. You know, I did have the flexibility where if a Saturday was better for me or a Sunday was better for me. But a Friday wasn’t so good. I might be able to take off a Friday afternoon and focus my attention on the weekend. So there was some flexibility there. But I would also tell you that it just wasn’t easy. I would certainly set my limits and not do things if I felt they were optional. I do believe that flexibility can help people who are managing their life, some are managing diseases, some are managing just their responsibilities of being a working parent or caring for the elderly. And I saw this through the pandemic that we became much more empathetic as an organization on allowing people to work the way they need to work. I also do believe that the pandemic created stress as well. And I think our focus on well-being and ensuring that you take walks and you have breaks is actually really good. And very important.

JC – It is reassuring to know that you can move up in your career or break barriers when you are also managing migraine. Hopefully, more places of employment can learn to be empathic and caring like Amgen. I thought it was important to speak to Lori about how living with a chronic disease like migraine can actually help her be better at her job. This is an area we often don’t think about.

Lori, how is your experience as a patient informed or impacted your work as an HR executive that helps other people in your work as an HR executive that helps other people?

LJ – Joe, this really came home to me with a friend of mine. So I have a really good friend who has stage four cancer. And I was meeting him for a coffee, tea for me, I don’t drink coffee, but we were meeting and sharing in a coffee and tea together. And he said, you know, Lori, before I had cancer, I thought I understood what it felt like. And he said, I realized now, I absolutely had no idea. And I feel that way, as a patient. I work in a biotechnology company that has patients at the center of what we do. But I do have to say, Joe, that until I became a patient, and when had everything happened from trying to get medications through a pharmacy to opening up and telling my story, I’m not sure I really understood what patients go through. And I think it just makes me more aware of what people are walking through. And many people, many people deal with some type of disease, either chronically or temporarily. And I think the more compassion we have for that the better we’ll be.

JC – Compassion is key. We are fortunate that Lori is using her platform to help raise awareness for all of us living with migraine. Here are Lori’s parting words to us.

LJ – There’s so many things I wish I could say about living with migraine. But I think at my core. What I want people to know is there are so many people that are suffering from migraine and what you’re missing out on as a society is that bravery courageous at the people that advocate, survivors, thrivers and not to be dismissed. I don’t think migraine pain needs to be dismissed. It’s a whole group of people that I admire. I would say is don’t give up. There are so many companies, individuals, , foundations, like yours, that are really working on behalf of patients. And the science, biology and even technology are advancing. And I just believe that we shouldn’t give up, we should hope. And we should advocate. And I think that’s what you’re doing. And I’m impressed with what you’re doing. And I’m impressed with what companies like ours are doing. Well, I do want to thank you, Joe, I want to thank you, for making it easy to talk about migraine. And also, I want to thank you, and Global Healthy Living Foundation for the work that you do for patients like me, and how you advocate for us.

JC – Talking with Lori felt like speaking with friend I’ve known for decades. From the moment the interview started her presence was calming and reassuring. Knowing that she is a leader in Human Relations gives me hope. Hope that other HR professionals will follow her lead and create the workplaces that we need be productive and thrive. Lori’s story teaches us that no matter who you are in the migraine and headache community, we all have similar struggles, and using our voice is one way to overcome them. If you need further information about migraine, whether that’s medical or non medical treatments, or how to manage in the workplace, our free audio guides can help

Welcome to this audio guide for Head Pain produced by the Global Healthy Living Foundation. Whether you or someone you care about have migraine, or think you or they might have migraine, these audio guides are designed to help you make sense of the headache and other symptoms. Accurate information will help you work together with your health care professionals to hopefully have fewer and less severe episodes. Please remember that headache of any kind is a medical issue and always talk to your health care team if you have a headache that bothers or worries you.

In this audio guide we’ll discuss what migraine is and what makes it more than “just a headache.” In every audio guide we provide information that has been checked by medical professionals specializing in the treatment of migraine and other headaches and people living with migraine who understand what it is like. Suggestions for care are based on guidelines from the American Academy of Neurology and the American Headache Society.

Most people get a headache at least once in their lives, whether from a viral infection, allergies, a bump on the head, or a stressful day. Many people, however, have headache attacks much more frequently—from a few times a year to two or three times a month, three or four times a week, or even every day. These more frequent and recurring headaches are often episodes of migraine, a medical condition that affects 1 out of every 8 people in the United States.

Not every headache that happens repeatedly results from migraine and other headache conditions exist, although these are much less common, you can find out more about that in our diagnosis audio guide episode. What is most important to remember is that getting headaches regularly is not something to brush off or let others brush off for you. Repeat headaches from any causes—migraine, injury, or anything else are a medical problem that can be treated, and anyone with regular headaches of any kind deserves relief.

So, who are the 1 out of every 8 people with migraine and could one of them be you?

Although migraine is more common in women, it is just as unpleasant and painful for the 1 out every 16 men living with migraine. Migraine can occur at any age and is most common between the ages of 18 and 44. Anyone can develop migraine, but it is more common in people who have family members with migraine and in people with sleep disorders, epilepsy, depression, or anxiety. When you talk to your health care team about diagnosing your headache condition, , it is important to share information about you or other people in your family who have any of these conditions. We’ll cover that in more detail in audio guide 2.

How do I know if a headache is a migraine?

The headache of a migraine episode is often described as a throbbing pain on one side of the head, but it can occur on both sides. Sometimes migraine attacks don’t include a headache and are still just as awful as the ones that do. This is because migraine episodes are more than the headache. By definition, other symptoms occur during a migraine attack.

Those other symptoms include changes in vision and being very sensitive to light, sound, and smell or having nausea and vomiting. Many people also have fatigue, sleepiness, and mood changes or feel lightheaded, weak, or numb. Difficulty thinking or concentrating, or brain fog, may also happen. Movement or physical activity usually makes the pain. Often a migraine makes people—especially children and teens—seek out a quiet dark space where they can be as still as possible. Some people find sleep helpful, and others find the pain and other symptoms keep them from sleeping.

It is important to recognize that not everyone has the same symptoms as other people. And even though most people with migraine can describe their typical attack, not every migraine episode—even in the same person—is always the same.

How long do migraine attacks last?

Some people notice vague symptoms of fatigue, irritability, or brain fog before an attack begins—This is the prodrome. A stiff neck, nausea, and changes in appetite are also noticed by some people. Whether a person has a prodromal period or not, they may also have a noticeable pattern of symptoms—called aura—a few minutes to an hour before the painful headache and other symptoms. Usually this is changes in vision with zigzag, wavy lines, and halos distorting shapes and images, changes to other senses, or difficulty speaking or moving. About 1 out of every 3 people with migraine has aura with some or all migraine attacks, but most people never experience aura and only some experience prodrome.

The attack phase may last anywhere from 2 hours to 3 days and includes the headache of moderate-to-severe pain; sensitivity to sound, light, or smell; and nausea or vomiting. Brain fog and severe fatigue are common. This is when many want to escape to a quiet dark place where they can be still.

After the attack, there might be a postdrome during which people feel groggy or just not quite right for a while. They may have remaining sensitivity, fatigue, mood changes, and brain fog.

So, what causes all this?

We are still learning what causes migraine. Current research suggests that it is mostly genetic with environmental and lifestyle factors affecting severity and frequency.

The biologic process of a migraine attack starts with overactivity in a part of the brain called the brainstem, which connects the brain to the spinal cord. During that overactivity, certain substances are released, and nerves and blood vessels react in ways that cause the sensory changes and pain of an attack. Some of the newest migraine medications affect those released substances directly; we discuss this more in guides 3 and 4.

You may also have heard about migraine triggers—that having a glass of red wine or eating chocolate make migraine attacks happen. The latest research shows, however, that even if certain foods, drinks, and environments make a migraine attack more likely, these are not the actual cause of the attack. It has also become clear that what triggers, or makes an attack more likely, for one person may not be a trigger for another person. In other words, your triggers are not necessarily my triggers.

Also, sometimes what seems like a trigger for a migraine attack, like craving and then eating chocolate or other sugary foods, may actually have been triggered by the migraine attack and not the other way around. Migraine can make you more sensitive to things like spicy foods, so you notice the spiciness more if a migraine is coming on then you would otherwise. Unfortunately, this can lead people to blame themselves, thinking “I shouldn’t have eaten, drunk, or done (fill in the blank).

What is useful about triggers is that if you do identify something that often happens right before an attack or makes an attack worse, you can try to find ways to avoid it. To identify YOUR triggers, keeping track of your migraine attacks with a headache diary can be very helpful. As we’ll discuss in audio guide 2, this can also help your health care team find a correct diagnosis for your headache and guide treatment options for you.

Keeping a migraine diary has become easier because there are apps for that! Of course, you can also use a simple notebook and pen. To keep a headache diary, the essential items to record are:

• the date and time it started and ended
• for each day it lasted how did you function? Many find the “stoplight” approach helpful
  • A red light for stopped functioning
  • A yellow light for slowed or decreased functioning
  • A green light for your normal functioning

It is also essential to record:

• where the pain was
• what other symptoms you had
• what medicine you took and how it worked
• whether you were taking any other medications

It can also be helpful to record:

• how well you slept the night before
• whether the stress you’ve been experiencing was mild, moderate, or high
• whether you had been drinking water (staying hydrated)
• whether you had been eating regular meals
• if you ate or drank something known to trigger migraines for some(red wine, chocolate, aged cheeses, or highly processed foods)
• what activities you were doing before the attack, such as
  • a longer than usual workday
  • a late night out with friends
  • vigorous exercise or missing regular exercise and
  • any other change in your usual routine
• environmental factors like
  • bright lights
  • screen time
  • changes in the weather
  • noise levels or
  • exposure to chemicals, like cleaning solutions or drying paint
• for people who menstruate, where you were in your cycle
• and anything else that you frequently notice during an attack

Understanding any pattern to your migraine can help you avoid the things you have control over and lead to better health overall. However, it is rare that lifestyle changes alone eliminate migraine attacks. Remember that migraine is a biologic disease–not about what you do or don’t, but about how your brain chemistry is working.

Now you know the difference between headache and migraine, and if you feel as though you may suffer from migraine, you can find information in our Migraine Diagnosis audio guide. If you have already been diagnosed and are wanting more treatment options, listen to our audio guide on Migraine Medication Options for migraine. We also discuss lifestyle changes and medication alternatives in Non Medical Migraine Therapies audio guide, and the common challenges of migraine in our Managing Migraine in the Workplace audio guide.

For more medical information and advice about your own migraine treatment speak to your doctor.

Welcome to this audio guide for Head Pain, produced by the Global Healthy Living Foundation. Whether you, or someone you care about have migraine, or think you or they might have migraine, these audio guides are designed to help you make sense of the headache and other symptoms. Accurate information will help you work together with your health care professionals to hopefully have fewer and less severe headache episodes. Please remember that headache of any kind is a medical issue and always talk to your health care team if you have a headache that bothers or worries you.

In this audio guide, we discuss getting headache disorders diagnosed so they can be properly treated. In every audio guide we provide information checked by medical professionals specializing in the treatment of migraine and other headaches and other people who have migraine and understand what it is like to live with recurring headaches. Suggestions for care are based on guidelines from the American Academy of Neurology and the American Headache Society.

Almost everyone will have a headache a few times in their lives. Often, these are symptoms of another illness, but when headaches keep happening in the absence of other illness, it may be a headache disorder. Getting headaches regularly is not something to brush off or let others brush off for you. Repeat headaches from any causes—migraine, injury, or anything else are a medical problem that can be treated, and anyone with regular headaches of any kind deserves relief.

Why Should You Get a Diagnosis?

Getting a specific diagnosis for whatever is causing repeat headaches is an opportunity to find the best treatments for you. Different headache disorders respond to different medications and each person responds better to some medications than others.

It is also important to know that misdiagnosis of headache disorders is not uncommon. Many people with migraine, for example, are told they are having headaches from allergies or sinus conditions. If your physician is not paying attention to the more subtle signs of specific headache disorders—like eye tearing, neck and shoulder pain, scalp tingling, light sensitivity, or nausea—they may be mistaking one headache disorder for another or think the headache is caused by an unrelated problem.

That’s a missed opportunity to get better, more effective treatment and to stop using (and paying for) treatments that are not working for you.

Let’s Talk About Access to Health Care

Before talking about getting your headache disorder diagnosed, we want to acknowledge that for many people, this is limited by poor access to health care or poor treatment within the health care system. In the United States, many people do not have insurance or cannot afford to see a doctor. If this is the case for you, we hope that these audio guides will provide at least some useful information you can still use to care for yourself—because you matter.

We also recognize that structural racism and discrimination occur within the health care system, and this can make it more difficult for Black people and members of other marginalized groups to make use of the information we are sharing. We know studies have shown Black people are less likely to receive appropriate diagnosis or treatment for migraine headaches in emergency rooms and are also more likely to be perceived as a so-called difficult patient if they self-advocate for proper care. Although no profession or individual is immune from bias, there are health care providers working to change this. We encourage you to continue educating and advocating yourself and others. Finding a physician who welcomes this may be the first step on your journey to improving your headache condition.

Many people with chronic conditions of any kind also find networking with others who have the same health condition and advocacy can help fight stigma and isolation. You may feel you do not have a lot of time or energy to do this, and that is okay. If you do want to explore this further, we have resources available at ghlf.org.

If you can, how do you get started?

If you have a regular health care provider, talking to them about your headache episodes is a great first step. Let them know as much as you can about your headache attacks. In audio guide one, we talked about keeping a migraine diary that includes:

• when and where pain occurs
• what, if any, other symptoms come with before, during, and after
• how long your symptoms last
• if symptoms affect your day-to-day activities
• what medications you have tried and whether those help
• any other medicines you take, and
• any other consistent patterns you see.

Sharing your migraine diary with a health care professional can give them a very clear pattern that they may be able to connect to specific headache disorders.

Together you and your health care team may be able to identify a likely cause of your headache episodes and treatment options to try. You may also decide to consult a neurologist or headache specialist. Neurologists specialize in brain and nerve conditions, including migraine and headaches. Headache specialists have completed specialized training for diagnosing and treating headache disorders. If you live in an area where neurologists or headache specialists are not available, you may be able to have a telemedicine appointment with one or may be referred to a pain management specialist.

The American Migraine Foundation and the National Headache Foundation offer lists of health care providers in who are experienced in treating migraine and other headache conditions. You can visit their websites: americanmigrainefoundation.org or headaches.org.

How Are Headache Disorders Diagnosed?

At this time, there is no blood test, x-ray or MRI study, or procedure (such as taking a person’s blood pressure) that can objectively determine if a person has a headache disorder or what kind of headache disorder they may have. Headache disorders are diagnosed clinically–by recognizing patterns common to specific disorders AND by making sure something that can be tested objectively is not the cause.

Your health care provider—whether they are your primary care doctor, a community health care person, a neurologist, or a headache specialist—will first want to know more about your headache episodes. As we’ve mentioned, having a headache diary to share can make this process easier, and your health care professional may still want to ask more questions or for more details.

The first step in diagnosis is understanding your unique pattern of headaches:

• how does the pain feel to you? Is it a dull ache that worsens into throbbing pain or a sensation of being stabbed?
• how intense or difficult to tolerate is your pain? (often on a 0-10 pain scale)
• does the pain worsen with movement?
• where on your head does pain occur? Behind one or both eyes? At the front or back of the head? With neck and shoulder pain?
• do other symptoms come right before, during, or after the headache? For example,
  • changes in vision or other senses?
  • nausea or vomiting?
  • sensitivity to lights, sounds, or smells?
  • dizziness or feeling weak or numb?
  • difficulty thinking or speech changes?
  • balance issues?
• how long do your symptoms last, from first signs until being able to return to normal activities?
• how often do you have headache episodes? Every few months? weeks? or days?
• how many days each week or month do you have NO pain or discomfort?
• do your symptoms interfere with:
  • sleep
  • work
  • household chores
  • exercise
  • leisure activities
• do your symptoms occur only in some environments (such as at your work site) and not others?

Your doctor may also ask whether you’ve noticed any stressors, foods, drinks, activities, weather conditions, odors, or other factors that seem to set off your attacks.

Both to recognize patterns in your headache episodes and to determine other illnesses are not the cause, it is important to discuss your and your family’s medical history. This includes:

• high blood pressure, heart conditions or stroke
• epilepsy, depression, anxiety, or panic attacks
• asthma, anemia, or diabetes
• chronic pain, fibromyalgia, neck and shoulder pain
• surgeries, injuries, and other conditions.

It is also important to discuss prescription and over the counter medications you use as well as other substances, including alcohol, cigarettes, and caffeinated beverages like tea, coffee, sodas, or energy drinks. All of these can cause or worsen headaches and associated symptoms.

To make sure another condition is not the cause of your headaches, it is likely that your doctor will want to do a blood test to rule out thyroid problems, diabetes, infections, or exposure to toxins. Depending on your age or overall health, a CT scan or MRI or your head and neck may be ordered to check for any problems with blood vessels or the presence of any growths or tumors, although these are rarely found. Usually, imaging studies are done only if your headaches began after age 40 or if your headache pattern has changed. Although uncommon, if you have other signs of infection or nervous system, your doctor may also want to take a sample of your spinal fluid to evaluate.

Is It Migraine?

Migraine is, by far, the most common cause of recurring headaches. If other problems have been ruled out and you have had 5 or more headaches that were at least 4 hours long and came with nausea or vomiting OR sensitivity to light or sound, migraine may be diagnosed.

The good news is that there are more specific, effective, and safe medications to treat migraine that ever before, you can learn more about these in our Migraine Medication Options audio guide. If you already use medication or are not wanting to try that route just yet, you can learn more in our Non Medical Therapies audio guide. We also discuss more practices of everyday life in our Managing Migraine in the Workplace audio guide. If you are still unsure about the difference between migraine and headache, you can find out more about the differences in our What is Migraine audio guide.

For medical information and advice about your own migraine treatment, speak to your doctor.

Welcome to this audio guide for Head Pain, produced by the Global Healthy Living Foundation. Whether someone you care about or you have migraine or think you or they might have migraine, these audio guides are designed to help you make sense of the headache and other symptoms. Accurate information will help you work together with your health care professionals to hopefully have fewer and less severe headache episodes. Please remember that headache of any kind is a medical issue and always talk to your health care team if you have a headache that bothers or worries you.

In this audio guide, we go over medication options.In every audio guide we provide information checked by medical professionals specializing in the treatment of migraine and other headaches and other people who have migraine and understand what it is like to live with recurring headaches. Suggestions for care are based on guidelines from the American Academy of Neurology and the American Headache Society.

Almost everyone will have a headache a few times in their lives that may simply be symptoms of another illness. Headache disorders–repeat headaches in the absence of other illness—are something different, and not something to brush off. Repeat headaches from any causes—migraine, injury, or anything else are a medical problem that can be treated, and anyone with regular headaches of any kind deserves relief.

For the most common headache disorder, migraine, there are more effective and safe medications then every before. Many of these may be helpful for other headache disorders, but in this guide, we focus specifically on migraine treatment.

Remember that not every medication will work for every person, and you may need to try different treatments or combinations of treatments to see what works for you. Lifestyle changes such as healthy sleep, exercise, and eating well may also be needed and we cover those in guide four. If you have other health conditions or are taking any other medication, herbal or vitamin supplement, or use cigarettes, alcohol, or other drugs, it is essential to include that in a conversation with your health care provider about what medication is appropriate for you. If you think you may be pregnant or plan to become pregnant, you should let your health care provide know right away, because some medications that treat migraine may not be safe to use.

Treatments for migraine come in two basic flavors–acute and preventive. Acute treatments are taken during a migraine attack to reduce the length and severity of an attack. Acute treatments taken by mouth may not work that well for people with nausea and vomiting that can affect how well (or if) a medicine is absorbed. There are, however, acute treatments available as nasal spray, injection, or suppository. Preventive treatments are used to make attacks happen less often and these may be pills, nasal sprays, injections, or infusions. There is a non-medication option call neurostimulation that we’ll discuss too that can be useful in both acute and preventive treatment; sort of a chocolate-vanilla swirl. In 2021, there are also two medications in development that may work for acute and preventive treatment.

Over the counter treatments for acute migraine treatment include anti-inflammatories and analgesics like aspirin, ibuprofen, naproxen sodium, indomethacin, and acetaminophen. These are more commonly known by brand names Advil, Aleve, Motrin, Indocin, and Tylenol. All may be helpful for milder attacks but are usually not effective for moderate-to-severe migraine episodes. Combinations of these drugs are also available, and these may be somewhat more effective. Some combinations include caffeine, and although that may make them more effective, it also has a higher risk for what is called rebound headache or medication-adaptation headache–a condition in which taking headache medications more than 3 or 4 times per week increases the frequency of headaches. If you find you are taking medicine for your headache attacks more than 3 times a week, it is a good idea to consider preventive treatment.

The most prescribed acute migraine treatments are the triptans. These medications block serotonin—one of several chemical signals released by nerves during a migraine attack. Triptans also affect blood vessels and nerves in other ways that helps to reduce the pain and other symptoms of migraine attacks. Triptans are available as pills, nasal sprays, or injections and are more effective when used early in a migraine attack. Injected triptans may cause a reaction at the site where the needle enters. Other side effects may include dizziness, drowsiness, muscle weakness, or nausea. Because triptans affect blood vessels and blood flow, they are not recommended for use in people with heart conditions, diabetes, high blood pressure, high cholesterol, obesity, and other conditions or people who smoke.

The newest acute migraine prescription treatments—for which there are no generics yet—are more targeted to migraine. Because these are still brand-name treatments, they can be difficult to access and expensive. For reimbursement to be authorized, a person may have to show they have tried two or three other treatments without success or cannot take anything else for safety reasons. The newest acute treatments are rimegepant, branded as Nurtec; ubrogepant, branded as Ubrelvy; and lasmiditan, branded as Reyvow. Rimegepant and ubrogepant are in a new class of drugs that block the activity of calcitonin gene-related peptide, or CGRP, which is also released during migraine attacks. Both are taken by mouth and may cause nausea. Ubrelvy may also cause sleepiness. These drugs, so far, seem to be safe in people with heart conditions or risk factors for heart conditions.Lasmiditan affects serotonin without affecting blood vessels, so it can be used by people who cannot use triptans. However, lasmiditan, which is taken by mouth, has other serious side effects, including dizziness, fatigue, sedation, nausea and vomiting, muscle weakness, and a small potential for addiction. Lasmiditan can also cause driving impairment and should not be used within 8 hours of driving.

For people who cannot take or access triptans, gepants, or lasmiditan, other prescription treatments are available. These include stronger anti-inflammatory medications like prednisone or dexamethasone. These steroid medications, howver, should only be used for a short time because of serious side effects that come with long-term use. A combination of acetaminophen, isometheptene, and dichloralphenazone—more simply called by its brand name Midrin—may be effective but also should not be used by people with heart disease or heart disease risk factors. Ergotamine plus caffeine is available as a pill but has the same issues as over the counter medications with caffeine. Dihyrdroergotamine, branded as D.H.E. 45 or Migranal, is available in nasal spray or injection and may be useful when migraine is long-lasting or very frequent. Neither ergotamine nor dihydroergotamine are recommended in people with heart disease risk factors. Some anti-nausea medications can be effective for migraine even if you do not experience nausea and may be even more helpful if you do. Anesthetics such as lidocaine nasal spray have very short-lasting effects and may be used while waiting for other medications to take effect. Opioid analgesics, such as codeine, are rarely used for acute migraine treatment when nothing else is effective or safe. Opioids carry a strong risk for dependence and addiction with strong side effects like constipation, drowsiness, nausea.

If you have 15 or more days a month with headache pain, your migraine is considered chronic and preventive treatments may make your attacks less frequent. If you have 0 to 14 days with headache each month, your migraine is considered episodic. People with episodic migraine who have attacks on a weekly basis are also very likely to benefit from preventive treatment, although, unfortunately, they often do not receive it.

The newest preventive treatments for migraine are also the first developed specifically for migraine. These are monoclonal antibodies that inhibit activity of CGRP, including erenumab, branded as Aimovig; eptinezumab, branded as Vyepti; fremanezumab, branded as Ajovy; and galcanezumab, branded as Emgality. Three of these, Aimovig, Ajovy, and Emgality are injections you give yourself at home once a month or once every three months. Vyepti is an infusion you receive in a 2-hour outpatient visit to a health care provider once every three months. All are considered safe for people with heart disease or heart disease risk factors. Side effects include soreness at the injection or infusion site, rash, and constipation. High blood pressure and severe constipation have been seen after treatment with Aimovig. Like the gepants and lasmiditan, these are still brand-name nongeneric drugs that can be difficult to access.

Several other prescription treatments, developed for other medical conditions, have been found to also be useful in reducing the frequency of migraine attacks.

Botulinum toxin A—or Botox—well known for its cosmetic effects prevents migraine. Four to six injections are given in four to six areas of the head and—16 to 36 injections—every three months. It is essential to have a well-trained headache or pain specialist give the injections. Improperly injected botulinum toxin can spread away from where it is needed and cause complications. Often, two or three injection cycles over 6 to 9 months are needed for botulinum toxin to reach its full effect. Side effects include injection site reactions.

Anesthetic nerve blocks are the injection of anesthesia, sometimes with anti-inflammatory drugs, around a nerve involved in the migraine process. Nerve blocks work well to provide pain relief to specific areas and reduce or eliminate migraine for people who have not had relief from other treatments. These should be given only by neurologists or anesthesiologists specializing in headache or pain treatment. Improper injection of anesthesia can result in permanent damage to a nerve.

Many antidepressants and antiseizure medications affect some of the substances involved in the migraine process also prevent migraine. For people who have depression and migraine or epilepsy and migraine, these may be excellent choices. Drugs that treat heart disease or blood pressure problems, such as beta blockers, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers have also been found to prevent migraine attacks. For those with heart disease or heart disease risk factors, the pros and cons of these drugs should be weighed carefully.

For people who menstruate, and have migraine attack frequency timed with their cycle, birth control pills or hormone replacement therapy is sometimes considered as a way of making migraine less frequent. This is advised against for people who have migraine with aura or who are in the period of and around menopause, when stroke risk is higher because these treatments increase stroke risk.

All these drugs have their own side effects, and a drug that works well for one person may be entirely unhelpful for another. Shared decision making with your health care team will allow you to make well-informed choices and be prepared to change those decisions if necessary. Always ask:

• Why do you think this treatment will make me feel better?
• How does this treatment work to improve my symptoms?
• What side effects should I be aware of or worried about?
• How soon can I expect to feel relief of my symptoms?

Last, let’s talk about neuromodulation—devices that use electric pulses—for acute and preventive migraine treatment. An advantage of this non-drug option is that there is no risk of medication-adaptation headache. A disadvantage is that the devices can be expensive and may be difficult to have reimbursed by insurance companies.

The Cefaly device is available over the counter and is worn on the forehead for 60 minutes during a migraine attack. For preventive treatment, the device is used for 20 minutes every day.The prescription Nerivio device delivers remote electrical stimulation (REN) device to the upper arm, typically for 45 minutes of stimulation during an attack. This is the only device approved only for acute treatment. The prescription gammaCore Sapphire device is held at a specific spot on the neck for two pulses, two minutes long as soon as an attack begins and can be repeated twice over two and a half hours, if needed. For prevention, it is used three times a day, every day. The SAVI device is held to the back of the neck to deliver 3 pulses of magnetic stimulation, which can be repeated every 15 minutes for up to 1 hour. For prevention, two pulses are used in the morning and night, every day. The company that produces SAVI filed for bankruptcy in 2020, however, so it is unclear how long the device will be available.

Side effects are rare and include tingling, warmth, redness, itching, muscle spasms, and mild discomfort where treatment is performed. With SAVI device brief light-headedness, dizziness, ringing in ears, and nausea also occurred. If you have implanted medical devices, such as pacemakers, , cochlear implants, or any other device that has an electric battery or signal, you should not use these for migraine treatment. People with any metal in their skull—other than dental fillings—should consider only the Nerivio remote electrical stimulation device.

There are other non-medical treatment options that you can try before taking the step to any of the procedures of medications, you can find out more at our Non Medical Migraine Therapies audio guide. If migraine is affecting your career, find out how to navigate that in our Managing Migraine in the Workplace audio guide. If you are unsure of the difference between headache and migraine, we make it simple for you in our What is Migraine audio guide, and we also discuss the next steps to getting diagnosed in our Migraine Diagnosis audio guide.

For medical information and advice about your own migraine treatment, speak to your doctor.

Welcome to audio guide four for The Migraine Show, produced by the Global Healthy Living Foundation. Whether you, or someone you care about have migraine or think you or they might have migraine, these audio guides are designed to help you make sense of the headache and other symptoms. Accurate information will help you work together with your health care professionals to hopefully have fewer and less severe headache episodes.

The good news is, there are more effective, safe treatments than ever before. There is also more evidence than ever that a combination of medicine and a healthy lifestyle are the most successful approach to managing migraine. In this audio guide we share lifestyle changes you can make, integrative therapies you can try, and other ways of living well with migraine.

In every audio guide we provide information checked by medical professionals who specialize in migraine and other headache disorders. The guides are also reviewed by people who have migraine and understand what it is like to live with recurring headaches. Suggestions for care, including the lifestyle changes we talk about today, are based on guidelines from the American Academy of Neurology and the American Headache Society.

As you try lifestyle changes and integrative treatments, you will find some work better than others—not only for your migraine, but also for you as a person. We recommend trying one change at a time for a few weeks. Keep notes, ideally in your migraine diary. That will give you a record of what does and doesn’t work. Share the things you are trying with your health care team, just like you share your overall health information. Not every treatment works well with another and your health care team may have experience and knowledge about combinations that could be unhealthy.

Please remember—headache of any kind is a medical issue. Always talk to your health care team if you have a headache that bothers or worries you–that goes for headache treatments too–whether medicine, exercise, or sleep habits. If something you try doesn’t feel right, work with your doctor to find out what is best for you.

There is increasing evidence that a healthy lifestyle protects the brain, reduces migraine frequency and severity and even has a role in preventing other brain diseases like Parkinson’s and Alzheimer’s.

Dr. Jennifer Robblee and Dr. Amaal Starling, are neurologists who specialize in headache disorders at the Mayo Clinic in Scottsdale, Arizona. They created the easy-to-remember acronym SEEDS for self-care techniques to help reduce migraine attacks.

S is for Sleep. Not enough—or too much—makes migraine attacks more likely. The healthiest sleep habit for most people is 7 to 8 hours every night. You can make that more likely by developing a sleep routine. Turn off electronic devices 1 hour before going to bed and set a consistent bedtime and wake time for every day, even on the weekend. If consistent sleep is hard to achieve or you feel tired during the day, talk to your health care team. Consider specialized cognitive-behavioral therapy for insomnia, which is a short-term therapy proven safer and more effective than medicines to aid sleep.

E is for Exercise. There are almost too many benefits of regular exercise to list, including reducing heart disease risks, improving brain health, maintaining a healthy weight, and sleeping better—all of which also improve migraine. Exercise can also help with stress management and improve your mood. Aim for 150 minutes of moderate exercise each week—whether that is in 5-minute walks twice a day or 50 minutes of a vigorous work out three times each week. What exercise you do and how often you exercise is less important than finding something that you enjoy enough to do regularly.

The second E in SEEDS is Eating and drinking. Eating regular heart-healthy meals, drinking plenty of water, keeping alcohol intake moderate, avoiding caffeine, and not smoking all reduce migraine frequency. These also help you stay healthy in general. Avoid skipping meals over or overdoing it at a single meal. Drink one 8-ounce cup of water 8 times a day to stay hydrated. Keep alcohol intake moderate—one to two drinks per day or less—and avoid caffeinated drinks. If you do drink coffee, tea, soda, or energy drinks containing caffeine, try to keep the amount small and regular. Changes in caffeine intake can cause migraine attacks. If you smoke cigarettes or cigars, your health care team can help you access resources to help with stopping.

D is for Diary. We’ve talked in earlier audio guides about the importance of keeping a diary of your migraine attacks to help you and your health care team know the ins and outs of your migraine and your migraine treatment as it affects YOU. Record the day and time an attack starts and ends, what medicine you took—if any—and how well it worked, and how the attack affected your ability to keep doing your usual activities.

The second S is for stress management. Stress is a big migraine trigger for many. Of course, the idea of managing all the stress in your life may even make you laugh. So much of what causes us stress is outside our control. Still—it is possible to reduce the stress and find healthy ways of coping with the stress you can’t reduce. Exercise, gardening, other hobbies, meditation, yoga, tai-chi, mindfulness, and relaxation techniques are all know stress-reduction tools you can experiment with until you find what works for you.

In addition to sowing SEEDS for success with self-care, integrative—nonmedication—treatments may help make migraines less frequent or less severe.

Cognitive-behavioral therapy is one of the best proven methods for improving migraine. This therapy helps people control the thoughts and reactions they have about their pain, which can reduce the stress of having to handle something so difficult. Cognitive-behavioral therapy reduces stress and improves mood. If, like so many people with migraine, you also experience depression or anxiety, cognitive-behavioral therapy will likely also help with these.

Although there is certainly a psychologic component to how we perceive the pain we experience, the fact that therapy is helpful does NOT mean migraine is “all in your head.” Migraine is NOT a psychiatric disease or psychological problem—it is a biological and chronic disease—suggestions that it is anything else are part of the stigma we are working to change.

No matter what chronic condition a person has—epilepsy, diabetes, or high blood pressure managing stress and emotions helps people manage chronic health conditions.

Biofeedback is another integrative technique that can help with migraine, although it can take a long time to become effect because it is a learning process. A trained biofeedback therapist uses small electric monitors to help you learn to recognize changes like muscle tension, body temperature, and breathing and heart rates. As you learn to recognize those, you can address pain sooner and may be more able to address and manage it.

Some people find massage to relax muscles and the mind is helpful. The ancient technique of acupuncture is also helpful for some, although there is no clear evidence of why this is so.

Devices that modify the light you are exposed to may also help. Glasses that block blue light have become more commonly used and more commonly available, but most were not designed specifically for people with the light sensitivity of migraine. Two companies that do produce glasses specifically for people with migraine are TheraSpecs and Axon Optics.

Another light-related integrative treatment is the Allay Lamp, which uses a very specific wavelength of green light. Some research suggests this can decrease pain during a migraine attack. Some people say using the lamp regularly also decreases the frequency and severity of migraine attacks for them.

There is limited evidence that any herbs, vitamins or supplements help with migraine. Butterbur has the best evidence—but can be dangerous and harmful to your liver if it is not free of pyrrolizidine. Because this chemical can contaminate butterbur, you must have your liver function closely monitored by a doctor if you use it. Riboflavin, vitamin D, magnesium, or feverfew may also help with migraine and are generally safe to try. Always tell your health care team about any supplements or over the counter medications you use because they may interact with migraine medications or not work at all. Vitamins, supplements, and herbs are not regulated as strictly as medication and the quality and potency can vary widely.

There is a stigma around migraine that causes many people—perhaps even your loved ones—to brush it off as nothing serious. But whether you’ve lived with migraine for years, just recognized your attacks are migraine, or just started having them, you know it is so much more than a “just a headache.” It is not uncommon for migraine to be severe enough to prevent people from working, doing household chores, or attending family and social events. Migraine can take a dramatic physical and emotional toll.

Educating yourself, your support network, your coworkers and other people can be helpful in overcoming this very negative aspect of headache. You can join support groups and patient advocacy organizations that help you do this. Participating will put you in touch with people who have similar experiences, making isolation less likely, because you will know that you are not alone.

If you are wanting to know more about medication, listen to our audio guide on Migraine Medication Options. If you are wanting to know more about migraine listen to our audio guide on What is Migraine and our audio guide on Migraine Diagnosis. If you are needing further guidance of managing migraine in social settings, listen to our audio guide on Managing Migraine in the Workplace.

For more medical information and advice about your own migraine treatment speak to your doctor.

Welcome to audio guide five for The Migraine Show, produced by the Global Healthy Living Foundation. Whether you or someone you care about have migraine or think you or they might have migraine, these audio guides are designed to help you make sense of the headache and other symptoms. Accurate information will help you work together with your health care professionals to hopefully have fewer and less severe headache episodes.

In this audio guide we address a key challenge for many people with migraine—how it is affected by and affects our work and workplaces. As in all our audio guides we provide information checked by medical professionals who specialize in migraine and other headache disorders. The guides are also reviewed by people who have migraine and understand what it is like to live with recurring headaches. For this guide, we also use information from Migraine in the Workplace: What Employers and Employees Need to Know, which includes survey data about migraine from over 800 different workplaces.

Our workplaces are complicated mixtures of people with different backgrounds and life experiences. There are also many different types of workplaces and work cultures. Some work teams interact and feel as close as families–for better or worse! Others have a more detached approach but still with team loyalty. Some are cut-throat competitive.

But, whatever type of workplace you are in and whatever workplace culture you have, if you think of six coworkers, it is likely that 1 of them also has migraine.

Surprised?

We wouldn’t blame you if you are because migraine is a chronic condition that carries stigma (negative responses of others and society). As a result, many people—perhaps you too—say nothing about their migraine attacks at work. In the Migraine in the Workplace survey, three of every four people with migraine said they were reluctant to share their condition with their manager or call in sick when having a migraine attack. Only one in five people with migraine said their workplace was often understanding of the condition.

Some of the stigma of migraine in the workplace comes from simply misunderstanding or lack of shared experience. The five of six people who don’t have migraine may think migraine attacks are “just a bad headache,” and fail to understand why someone would need to call out sick because of one. They may not understand that a migraine attack can make it so hard to do your job that you might as well not be there. Because of this, if you do work through a migraine attack—which two out of three workers with migraine said they’d been made to do—your coworkers may perceive your work effort and you negatively (perhaps even as negatively as they perceive calling in sick for “just a headache.”)

The one in six who has migraine knows better—we know that not only the headache, but also the other symptoms of a migraine attack are excruciating. We know that sometimes just trying to sit up when you are having an attack can make a person vomit, that the slightest bit of light (artificial or natural) can make you feel as though your eyes were stabbed repeatedly, and that every sound can reverberate inside your skull like an electric shock.

And most of us are aware of the lower productivity that occurs while working through a migraine attack—at least that is what 93% of the people with migraine who were surveyed said. And almost one in five said they believed they had lost a job because of their migraine. No wonder people are quiet about migraine in the workplace.

Even if coworkers and managers don’t react negatively to your taking sick days or being slowed down at work because of migraine, the worry that they might is real.

And, of course, this causes stress—ironically, the most common trigger of migraine attacks. Other environmental factors also play a role in triggering migraine attacks or making them more frequent. The lighting, sounds, and smells of workplace can also trigger migraine attacks or make them more frequent. The workplace set up–how you sit, stand, or move throughout your workday–can also affect migraine, which is made more frequent by neck and shoulder pain, poor posture, and other conditions that affect muscles and nerves.

It is important to pause here and remember that some people have migraine that is so severe and occurs so often that they are not able to work. And because migraine, despite being the second most disabling disease worldwide, is not included in the Social Security Disability Benefits “blue book,” it can be very challenging (although not impossible) to get disability benefits because of migraine.

For people with migraine who are able to work, there are things we can do to improve the work environment for ourselves and others in ways that will help reduce migraine triggers.

The idea of migraine as, “just a headache,” and the stigma that goes along with that are, as we noted, most often caused by a lack of knowledge. For example, of human resources professionals who responded to the survey, almost all (95%) said that migraine affects use of sick days and productivity when people are present, but almost half (43%) also believed people can work with a migraine attack.

This means sharing knowledge and educating people about the realities of migraine and migraine and migraine attacks is an important way to make things better for people with migraine in the workplace. If you have enough support and feel comfortable doing so, you can share The Migraine Show and other Global Healthy Living Foundation resources with your managers, coworkers, and HR teams. Some of our resources, including Migraine in the Workplace: What Employers and Employees Need to Know can be printed and left in a break room for others to see.

If there is health and wellness group within your workplace, you can suggest that they learn about migraine and share information about it with everyone in the workplace. Hearing about migraine as a serious problem from others may make it easier for anyone in the workplace to talk about it openly. Some companies have affinity groups, and you could start one for people with migraine. If there is a health and wellness fair, you could ask to be part of it and share information with people.

Raising awareness—which we understand not everyone will be able to do—can also make it easier to request accommodations, which are work modifications that may make it less likely that work will provoke a migraine attack and that you’ll be more able to deal with a migraine attack that does occur at work.

These accommodations should be made available to you whether you can participate in education efforts or not. Why? Because it is well recognized that workers who receive what they need from their employer are more productive. Feeling cared for and appreciated by an employer leads to employees who are more engaged with their work, and employees who are highly engaged are more productive. Companies with higher levels of engagement are more profitable. Expressing care is more than a good benefits package, education to reduce stigma, health and wellness programs–it also involves managers checking in on employees personally if they know the employee has a chronic health problem.

AND

According to the Americans with Disabilities Act, it is also the law that companies must make accommodations for workers with migraine (and other chronic illnesses) provided that the employee is able to do the core requirements of the job with those accommodations in place.

What are the accommodations that work well for people with migraine?

• Replacing bright fluorescent lights above a desk with softer lighting from a desk lamp
• Computer monitor screens or blue-light blocking glasses can be ordered for people who spend long hours in front of a computer screen.
• Strong perfumes can be prohibited in a workplace
• People with migraine can be seated away from kitchens and break rooms and given preference for quieter offices
• Quiet, dark rooms can be designated where people can go for a break if they feel a migraine attack coming or are having one. Evidence strongly suggests that the earlier a migraine attack is treated, the more quickly it goes away. If workers can time in a quiet, dark room, they may be able to return to being productive.
• People can be encouraged to use sick time when they have a migraine attack instead of feeling guilty about doing so.
• Flexible work hours can be a very important accommodation for people with migraine. When possible, the option to work from home after an attack may increase productivity.
• Regular breaks to eat, stay hydrated, and exercises are also beneficial.
• Ensuring there are breaks between meetings— especially important now that meetings are often via video conference that require screen time. Making sure people feel comfortable turning off the video camera instead of making eye contact with a screen may be helpful.

Finally, because most working Americans receive our health care benefits from our employers, our employers can act when benefits don’t meet the needs of their employees. In the Migraine in the Workplace survey, 22% of employees with migraine said that their migraine treatments prescribed by their doctor had been denied by insurance companies. Two out of three human resources professionals said that when employees were denied coverage, the employer would pay for the medicine anyway—something many employees don’t realize.

Work is necessary for survival for most people. For many it is also a source of satisfaction–the pleasure of a job well done, the camaraderie of a team. This shouldn’t be denied to people just because they have migraine. We can all work together to make the workplace better for people with migraine instead.

If you need further information on migraine, listen to our audio guide What is Migraine to find out the difference between headache and migraine, how to get diagnoses in our Migraine Diagnosis audio guide, for treatment options, refer to our audio guides on Migraine Medical Options and Non Medical Migraine Therapies.

For more medical information and advice about your own migraine treatment speak to your doctor.