I am Dr.
Amanda Tinsley, a board-certified headache
specialist and neurologist at MedStar Georgetown University Hospital.
I treat adult
patients with neurological conditions and I specialize in headache disorders.
So I have adult patients
that are young adults, old adults and everything in between.
From all walks of life and all backgrounds.
Because migraine is the most common primary headache disorder
and migraine is three times more common in women,
the majority of my patients are women.
But migraine is also very common in men as well.
6% of men have migraine.
So, I approach patients
with compassion and dignity as if they were my own family member.
Now, when it comes to headaches, there's really two ways that I approach
headache medicine.
One way is
offering patients the
tools when they're having a migraine attack, a medication
they can reach for in that moment to really break the pain and
restore their function so they can go back to doing what they need to do that day.
The other side of treating migraine
is to prevent the headaches in the first place.
And so to do that, we focus on nonpharmacologic therapies like lifestyle
modifications, getting good sleep, reducing your stress levels,
that's a big one,
and staying hydrated,
limiting caffeine and alcohol intake.
Good, healthy living, and then also scheduled therapies
that patients take to try to prevent the overall headache burden.
I decided on headache medicine
because I'm very passionate
about it and it's really an unmet need in the neurology space.
We have a shortage of neurologists.
Headache is very common.
There's even more
of a shortage of headache specialists.
So I kind of saw it as this unmet need and opportunity
to make an impact on the lives of those living with migraine and other disorders.
It's a very exciting
time for headache medicine.
Probably the most exciting is in the area of migraines.
We're starting to understand more what causes
migraine and what's actually happening on the molecular level
during an attack.
And this has led to more tailored, targeted therapies for migraine.
So, since 2018, we have a whole new slew of migraine treatments
that are very effective without a lot of side effects.
My favorite part of my job is when I can take patients off of medication.
So, often when I meet patients, they're miserable,
they're having frequent headache attacks that really
impact their quality of life.
And so, you know, we work together to
develop a treatment regimen that works for that patient.
And I always want to give patients the tools to
handle a migraine attack when it happens so that it doesn't interfere
with their life and their work and their joy.
So I always want to give patients
an acute therapy they can reach for.
But as far as a preventive schedule therapy, if patients are doing
really well, I love to be able to take them off of that down the road.
So, it's really satisfying when we get to that place.
MedStar Georgetown Headache Center is a very unique and special
because it is the largest academic headache center in the DMV area.
All of the physicians are board certified in headache medicine.
I mean that we've undergone rigorous training in the field
and we are aware of all the complexities of treating headache disorders.
And we use evidence-based therapies that have been shown to be effective.
We also do clinical research to better our understanding
of headache disorders and develop new and improved treatments.
There are so many things I love about my job, but
probably my favorite
part is when my patients do well.
So, it's really fantastic
when I meet someone
and they're miserable with their migraines to kind of go on this journey with them
and see their headache disorder
evolve and over time improve and then one day they don't need
all of their medication.
Comorbidity is defined as two
or more medical conditions that occur together.
So, for example, patients
with migraine are twice as likely to have vitamin D deficiency.
So, Vitamin D deficiency is considered a comorbidity of migraine.
There are many conditions that are
comorbid with migraine.
You have cardiovascular conditions
such as stroke and heart attack. Psychiatric conditions like
panic attacks, depression, anxiety.
Other neurological diseases like epilepsy, sleep disorders is a common
one, insomnia, sleep apnea, restless leg syndrome,
inflammatory conditions like rheumatoid
arthritis, asthma, allergies, and then other chronic pain syndromes
as well, like fibromyalgia.
So, some patients have comorbid condition
with their migraine and some patients don't.
Comorbidities are very common with migraine.
And many patients will
experience at least one comorbidity in their lifetime.
As the headache frequency and the intensity of
the pain attacks increases,
the risk of comorbidities increases as well.
So, for example, a patient that has episodic migraine, meaning fewer than
15 days of headache monthly, has about a 20 percent
chance of having depression.
But a patient that has chronic migraine, meaning 15 days or
more per month of headache, then that risk.
shoots up to 30 to 50% of having depression.
It's important to
recognize
Co-Morbid health conditions with migraine
because having a comorbidity could impact the treatment of migraine.
It can limit the options that we have.
Patients also may be on different medications for
their other health conditions
that could potentially interact with migraine therapies.
That's a consideration we have to think about.
And also it can help with prognosis.
So we know that patients that have migraine and
depression, if their depression worsens, then they're at risk for progression
of their migraine disorder.
It's important to consider the comorbid condition
with migraine when it comes to management, because it can impact
the diagnosis and the treatment.
For that patient, for example,
if a patient
has sleep apnea, that can lead to headaches.
So, if a patient has both sleep apnea and
migraine, and they're having a worsening of their headache disorder,
you have to make sure that both their sleep apnea
is well-controlled and their migraine is controlled as well.
So, that can make it a little bit harder to figure out what's
making the headaches worse.
Is it the sleep apnea? Is it the migraine?
As far as treatment goes,
there are some limitations to
the medications we can use in certain comorbid conditions.
For example,
we often use Triptans, a
drug class that
was designed for acute migraine treatment,
but that could be dangerous in a patient that
has co-morbid cardiovascular disease.
So, we need to take that into consideration.
And then you also have to think
about drug-drug
interactions, because a lot of patients
may be on medications to treat their co-morbidities.
And you have to think about
a potential interaction with a migraine therapy that you might consider
adding to that patient's regimen.
And then the final reason to
consider it is for prognostic reasons.
So, patients
that have a worsening of one of their co-morbidities
can be a risk factor for progression of their migraine
disorder.
Headache specialists will be thorough
and take a detailed medical
history in order to uncover any
previously diagnosed
co-morbid health conditions or undiagnosed co-morbidities.
That may impact their migraine management.
And if a patient does
have a comorbidity, it's important that that is successfully addressed.
So, sometimes we can treat migraine and a
co-morbid condition
with one single therapy, which is great.
Sometimes we need to refer patients
to another specialist for further
evaluation and treatment
of a possible co-morbidity.
Just like most medical conditions, lifestyle factors
play a role in management.
And so when it comes to migraine and co-morbidities, it's important to,
you know, get good sleep, get regular sleep, quality
sleep, you know, reduce stress levels,
stay hydrated, limit caffeine and alcohol.
Those types of lifestyle
modifications can be really
important in overall health and
management of migraine.
Researchers are still collecting
data on the various comorbid conditions that are
associated with migraine.
There's more research that needs to be done
into what
actually causes comorbidities.
You know, is
this that comorbid conditions and migraines
share similar underlying mechanisms?
Or is it that one causes the other or vice versa?
Is it that the treatment that we use for migraine actually causes complications?
For example,
some patients may overuse anti-inflammatory medications
to treat their migraine attacks and then develop gastric
ulcers. And so is gastrointestinal disease
comorbid with migraine because of the treatment?
So exploring these different pathways
will provide insight and
clarify what's actually happening in our migraine patients
and hopefully lead to improved therapies.
So that
is a great question for which there is not a simple answer.
We still do not fully understand what happens on a molecular level
with migraine, although there has been a lot of advances in that area.
One hypothesis is that the comorbid conditions
share common or overlapping
genetic or biological mechanisms with migraine.
Another theory is that there is
a unidirectional relationship, meaning that
one of the conditions actually is causing the other.
And a third theory is that they both cause each other.
So, there's still more research that needs to be done
to really fully elicit what's going
on with co-morbidities in migraine.
The MedStar Georgetown Headache Center,
we focus on treating the entire patient, even though we're very passionate
about headache medicine, we realize that everything is connected.
So, we will take a detailed history, we'll be very thorough and try to uncover any
underlying co-morbid conditions.
Sometimes these have been previously diagnosed.
Sometimes we're the ones to diagnose them.
I can't tell you how many times I've diagnosed
sleep apnea when patients come to me with headaches.
And we will address these.
Whether we are able to do them on
our own or if we want to call in our colleagues.
One of the great things about working at MedStar
Georgetown is that we have access to expert services, subspecialists,
subspecialists in all these different fields of medicine.
Patients self-refer. They can also be referred
by their primary care provider or another specialist.
The advantage to coming to MedStar Georgetown Headache Center
for your headaches is that we are passionate and we are dedicated.
We focus on treating your headaches.