Miller School Headache Specialists Showcase Work at American Headache Society Annual Scientific Meeting
Summary
- University of Miami Miller School of Medicine headache specialists presented research at the American Headache Society Annual Scientific Meeting.
- Dr. Teshamae Monteith, chief of the Miller School’s Headache Division, discussed migraine stigma and evolving language.
- Dr. Lisa Smirnoff presented research on the intersection of sleep and migraine.
Headaches are often considered one of life’s little inconveniences, the byproduct of busy, stress-laden lives. But they can be significant health issues. Migraine, for example, is a serious neurological condition and can be difficult to treat.
Fortunately, new medications are improving quality of life for migraine patients. These drugs, including atogepant and rimegepant, block a pain-signaling molecule called calcitonin gene-related peptide (CGRP), which has long been implicated in migraine pain. CGRP inhibitors were one of several big topics at the recent American Headache Society Annual Scientific Meeting, which featured a number of University of Miami Miller School of Medicine researchers.
“This headache meeting presents incredible opportunities to advance patient care and foster cutting-edge research,” said Teshamae Monteith, M.D., professor of clinical neurology and chief of the Headache Division in the Department of Neurology at the Miller School. “Building on the migraine and headache awareness month in June, the gathering also emphasized the synergy between specialists and broader public awareness.”
Fighting Migraine Stigma and Severity
People who experience migraine often deal with both a chronic neurological disorder and social stigma. Migraines can be debilitating but are invisible to everyone but those experiencing them. Some people trivialize these painful episodes as “just headaches.” As a result, some people who suffer from migraine can experience discrimination and feel shame about their condition.
At the Annual Scientific Meeting, Dr. Monteith presented a study, “Shifting the Narrative: Trends in Stigmatizing Language and Sentiment Towards Migraine Treatments on Social Media,” that examined how the language used to describe migraine and treatment have evolved.
“While we found a limited change in destigmatizing language, the sentiment around treatments, especially CGRP-targeting ones, has grown more positive,” said Dr. Monteith. “In addition, the sentiment around migraine symptoms has also shifted more positively in the CGRP era, suggesting there is hope and an overall better feeling towards advances in migraine care.”
Dr. Monteith has worked on a number of studies that assessed atogepant and rimegepant efficacy, as well as how the condition affects patients. At the conference, she presented a poster, “Comparison of Migraine With and Without Aura in a Cohort of 31,715 Patients: Disease Characteristics and Response to Remote Electrical Neuromodulation (REN) Treatment.”
Some patients experience a migraine aura such as flashing lights or obscured vision before or during migraine attacks. Dr. Monteith’s research evaluated the differences in disease severity between people who experience migraine with aura versus those who have migraines without aura. In addition, the researchers investigated the efficacy of REN, a wearable device designed to prevent and relieve acute migraine attacks.
“In our large data set, we found that migraine with aura is a more severe disease,” said Dr. Monteith. “There is a greater percentage of patients with moderate to severe pain, more associated symptoms and more disability compared to migraine without aura. Still, both groups responded well to REN.”
Migraine and Sleep
Headache medicine is closely aligned with a number of other fields, including neurology and sleep medicine. Liza Smirnoff, M.D., assistant professor of clinical neurology at the Miller School, was eager to see emerging research on how sleep — or the lack of it — impacts migraine patients.
“Many of our patients experience sleep disorders,” she said, “which can significantly worsen their migraine symptoms and can even cause refractory headaches.”
Refractory headaches are often intense, occur frequently and resist treatment. Dr. Smirnoff co-chairs the American Headache Society’s Refractory Headache Group and helped introduce the refractory headache session at the conference.
Emerging Leaders in Headache
Alexandra Cocores, M.D., assistant professor of clinical neurology in the Miller School’s Headache Division, presented research conducted through the society’s Emerging Leaders Program, which provides mentorship and other support for early-career physicians. The collaborative project looked at ways to better disseminate treatment through primary care clinicians.
“Most headache patients go first to their primary care doctor and only a small fraction get to a neurologist,” said Dr. Cocores. “An even smaller fraction get to a headache specialist. The society realized we need to work at the primary care level to improve awareness around this disorder, including treatments, reduced stigma and improved advocacy.”
Dr. Cocores also moderated a frontline session on global health, “Overcoming Barriers to Headache Care in Low- and Middle-Income Countries – The Story of Kenya and the Philippines.” During the session, International Headache Society president Rami Burstein, Ph.D., discussed ways to standardize migraine care, including in resource-poor communities.
Despite being relatively early in her career, Dr. Cocores has a long history with the society. She appreciates the support she has received along the way.
“It’s been helpful for me to get involved when I was a medical student, a resident, a fellow and now as faculty,” she said. “They offer some excellent educational and early-career resources and it’s been great to be able to take advantage of those.”
Tags: cluster headache, Department of Neurology, Dr. Alexandra Cocores, Dr. Liza Smirnoff, Dr. Teshamae Monteith, headache medicine, migraine, neurology