Migraine Headaches with Dr. MaryAnn Mays

Today, we have a wonderful episode planned. We are honored to have with us, Ms. Maeve Pascoe, a rising star in the field of Neurology and MS-5 at the Cleveland Clinic Lerner College of Medicine and bound for Neurology Residency at the University of Michigan.

With her today is our faculty expert and one of our esteemed colleagues in medical education and a world’s expert in Migraine Care, Dr. MaryAnn Mays. Dr. Mays is a beloved member of our teaching faculty in the Neurology Institute, former PD of the Neurology Residency, and now Vice Chair for Education in the NI at CCF. She also holds the appointment of Professor at Cleveland Clinic Lerner College of Medicine within CWRU.

Thank you both for working on today’s show.

To our honored guests, please take a moment to say hi, tell us about yourselves, and start right in on the questions.

Question 1 (Maeve):

What distinguishes migraine headaches and how often do patients see primary care providers for migraine headaches?

(Dr Mays) Response

Question 2 (Maeve):

What are the distinctive features of migraine headache, and what signs indicate that your patient may be experiencing one?

(Dr Mays) Response

Question 3 (Maeve):

You mentioned migraine phases; what are the phases of a migraine, and what symptoms may arise in each phase?

(Dr Mays) Response

Question 4 (Dr. Wardrop):

What would your typical differential diagnosis be for a migraine headache, and how would you differentiate between these other types of headaches?

(Dr Mays) Response

Case Presentation (Maeve):

So, we have a patient, a 41-year-old female with no significant past medical history aside from occasional debilitating headaches during times where she is stressed or gets little sleep. They typically occur 1-2 times a month. These are characterized by flashes of light in her vision, followed by a throbbing pain over the right side of her head and nausea for several hours, and a subsequent period of fatigue. The headache does not worsen with positional adjustment and gets better with rest and time. NSAID analgesics are not very effective, so the patient does not take them often. Her only other medication use is oral contraceptive pills (OCPs).

Question 5 (Maeve):

What aspects of her presentation make you concerned for migraine, and how would you screen her for migraine?

(Dr Mays) Response

Question 6 (Dr. Wardrop):

This patient has aura. How and why do auras occur, and are there any special considerations the primary care provider should be aware of?

(Dr Mays) Response

Question 7 (Dr. Wardrop):

What strategies for migraine treatment exist, and what would you recommend for this patient?

(Dr Mays) Response

Question 8 (Maeve):

What migraine treatment research is currently being done, and what treatments can we expect on the horizon?

(Dr Mays) Response

Case Wrap-up (Maeve):

So ultimately, our patient has migraine headache with aura, and interventions such as sleep hygiene improvement, alongside pharmacotherapies such as triptans or gepants, would be recommended. In the future, with ongoing research for new targets for migraine treatment, we might be able to offer additional solutions in the form of drugs or devices to provide further relief and potential for migraine freedom!