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Beth Morton Profile picture
@beth_morton
Sep 18, 2022 • 12 tweets • 6 min read • Read on X
For this week’s #MigraineChatAMA on Headache Specialists (HAS):

HAS are healthcare providers who completed a year fellowship in headache medicine and become board-certified through an accreditation organization (@UCNSorg). (ucns.org/Online/Online/…). /1
Others might call themselves HAS if they complete add’l qualifications like the @NHF Added Qualification in Headache (headaches.org/aqh/). Other healthcare professionals might regularly attend edu/prof meetings on headache treatment to improve knowledge.
#MigraineChatAMA /2
DYK - HAS are not all neurologists *and* not all neurologists are HAS? A neurologist’s training in headaches or migraine is pretty minimal. Neurology encompasses a broad range of neuro conditions; they may specialize in ones other than headache/migraine. #MigraineChatAMA /3
Among undergrad med school students, the commonly cited stat is that they receive 4 hours of headache training, on average.

Some research on headache training:
1: …adachejournal.onlinelibrary.wiley.com/doi/abs/10.111…
2: …adachejournal.onlinelibrary.wiley.com/doi/abs/10.111…

#MigraineChatAMA /4
When should you see a HAS? Most people with infrequent migraine attacks can get away with seeing their PCP/GP to start.

However, it’s worth seeing a HAS if:
-prescribed or OTC treatments aren’t working or you’re using acute treatments >10x/month
- cont ⬇️

#MigraineChatAMA /5
Also worth seeing a HAS if:
- symptoms are worsening despite treatment
- you have new/unusual treatments
- your first headache (migraine) occurred after age 50, an illness or injury
- attacks are disrupting/disabling to your daily life
everydayhealth.com/pain-managemen…

#MigraineChatAMA /6
What issues might you run into seeing a HAS? First, there aren’t enough of them: ~700 in the US for the 40 million (ish) people with migraine. Worldwide, access is even worse. This means difficulty finding one, long wait times, and traveling long distances.
#MigraineChatAMA /6
Some sites for finding a HAS:
1: headaches.org/resources/heal…
2: americanmigrainefoundation.org/find-a-doctor/
3: headachedoctors.net

There are online HAS clinics in some countries (eg @neurahealthco). They can help diagnose & offer treatments that don’t require in-person visits. #MigraineChatAMA /7
Did this #MigraineChatAMA thread spark any additional questions on finding/seeing a HAS? Let me know or share your thoughts.
(My numbering is off after moving stuff around due to tweet length limits. Sorry about that!)
Also, errors are mine!

But thanks to @CSWhiteMD for letting me check a few things with her. 💜
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More from @beth_morton

Beth Morton Profile picture
Nov 18, 2022
Friends, I’m going to do an impromptu #MigraineChat office hour to help anyone who wants to get started with - or learn more about - the MigraineChat Discord group. I’ll be online at 1:30p ET.

If you want to join, please DM me and I will share the Google meet link.
I’ve done no planning & will do a more formal tutorial later, so this might be a little chaotic. Right now, Discord is the next most organized place to join #MigraineChat besides Twitter.
New people have joined in the past few days, but I worry the “accept rules to enter” thing is throwing people off. Discord can be overwhelming at first, too.

I want to make it as accessible as possible, but understand it isn’t ever going to be for everyone. #MigraineChat
Read 4 tweets
Beth Morton Profile picture
Nov 5, 2022
This week’s #MigraineChatAMA invited Qs about the relationship between sleep disorders and #migraine.

Nothing shared is medical advice. Please talk to an HCP before making changes to your migraine treatment. Errors are mine. #MigraineChat /1
What is the relationship between sleep and #migraine? “[T]he exact nature and direction of the association remains enigmatic; migraine may be the result of sleep disruption, but also sleep disruption may trigger migraine,... [cont.]
#MigraineChatAMA /2
"...or migraine and sleep disruption may be symptoms of an unrelated medical condition, or they might be two intrinsically related phenomena with shared pathophysiological mechanisms.”
…alofheadacheandpain.biomedcentral.com/articles/10.11… #MigraineChatAMA /3
Read 32 tweets
Beth Morton Profile picture
Oct 23, 2022
This week’s #MigraineChatAMA invited Qs abt rebound headache: a topic I wish was more rigorously studied for lots of reasons. The research in this thread is not w/o limitations or issues.

Nothing shared is medical advice. Talk to an HCP before making changes. #MigraineChat /1
Medication overuse headache is the ICHD-3 term. Unofficially, it is often referred to as “rebound” headache. Some organizations are trying to get the name updated to medication adaptation headache (to avoid the stigma of blame). For space, I’ll use rebound. /2 #MigraineChatAMA
How common is rebound headache (HA)? A “true prevalence that is unknown, partly resulting from various changes in diagnostic criteria, but estimates are in the range of 0.5 to 2.6%.” /3 #MigraineChatAMA
ncbi.nlm.nih.gov/books/NBK53815…
Read 39 tweets
Beth Morton Profile picture
Oct 16, 2022
This week’s #MigraineChatAMA covered acute CGRPs (gepants). There weren’t a lot of questions, so I threw in a few extra resources. There are Qs for the #MigraineChat community at the end.

Nothing here is medical advice. Talk to your doc before making changes. #MigraineChatAMA /1
Do acute gepants work for those w/chronic migraine (CM)?

Clinical trials typically look at ppl w/episodic migraine first: either excluding ppl w/CM or not enrolling enough to obtain reliable results for the CM subgroup. #MigraineChatAMA
/2
I couldn’t find studies of gepants for acute use in CM. Anecdotally, though, yes! The #MigraineChat community has shared experiences w/Ubrelvy & Nurtec as acute treatments even for those with chronic migraine. #MigraineChatAMA /3
Read 17 tweets
Beth Morton Profile picture
Oct 8, 2022
Two weeks ago, I posted the #MigraineChatAMA topic: #CGRP preventives. You had great questions. Some I couldn’t answer satisfactorily, others too big to summarize adequately in a thread (i.e., I’ve give an example study for one CGRP, but other research exists). /1
Quick notes: This is not medical advice, just meant to get you pointed in the direction of things to discuss with your doctor. Also, due to space, terms are defined then abbreviations used. Studies may not use brand names (e.g., erenumab, not Aimovig). #MigraineChatAMA /2
Is it worth ⬆️ Aimovig from 70mg to 140mg if you’ve seen severity ⬇️ but not frequency?

This Q is a little tough to answer because so many of the original studies looked at reduction in monthly migraine days (MMDs) as their main outcome (freq, not severity). #MigraineChatAMA /3
Read 36 tweets
Beth Morton Profile picture
Sep 25, 2022
Week 2 #MigraineChatAMA - #migraine types: You had some tough Qs & I don’t have all the answers. Just because I didn’t find them in my search, doesn’t mean they don’t exist. If you have reliable sources of information, please share. Errors are mine. For more info, click links. /1
Types: 2 main types are migraine without aura (MwoA) & migraine with aura (MwA). Under MwA are migraine w/: typical aura*, brainstem aura, hemiplegic & retinal migraine. *Migraine w/typical aura also incls migraine without headache. migraineagain.com/10-types-of-mi…
#MigraineChatAMA /2
Types, cont: menstrual migraine (MM) is a subtype under either MwoA or MwA. If attacks happen only during menses = pure MM. Migraine attacks during menses and other times = mensturally-related migraine.

MM can be tougher to treat.
healthline.com/health/migrain…
#MigraineChatAMA /3
Read 24 tweets

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