"Migraine is a Tremendously Rewarding Disease to Treat"

"Migraine is a tremendously rewarding disease to treat,"
was the start of headache specialist Christopher Gottschalk, MD's answer to our request for clinical pearls about treating migraine in primary care.

In the same vein he emphasized the relief clincians can offer to patients with migraine, a treatment outcome often different from what is possible in "many other chronic diseases where the best you can hope for is stabilization or slowing the rate of decline."

In this short video interview, Gottschalk offers 3 important messages for primary care clinicians who are committed to treating patients with migraine and speaks with true pathos about the opportunities to improve quality of life.


Christopher H. Gottschalk, MD, is professor of clinical neurology, director of headache medicine, and section chief, general neurology, at the Yale School of Medicine in New Havent, CT. Gottschalk also is current president of the Alliance for Headache Disorders Advocacy.


The following has been lightly edited for clarity and style.

Patient Care Online. Would you leave these primary care clinicians who read our website with 3 thoughts or clinical pearls for those who are looking to improve or enhance their own treatment of migraine patients?

Christopher Gottschalk, MD. Sure, I think first and foremost is just that migraine is a tremendously rewarding disease to treat. That this is an enormous source of burden on both patients and their families and their coworkers. Because it is recurring, temporary, partial, or complete disability that affects everyone around you, not just the patient. But treating it provides an enormous amount of relief and gratitude and happiness, quite frankly, which is not the case in many other chronic diseases where the best you can hope for is stabilization or slowing the rate of decline, etc. So, understanding the basic principles of good treatment actually makes this an extraordinarily positive experience.

Part of doing that is this business about recognizing that pretty much anything that comes into a doctor's office and looks like headache is almost certainly migraine. But many of the ideas we've grown up with about sinus headaches, tension, headaches, etc, are just misnomers for migraine. So, [primary care clinicians] seeing migraine and all of its different forms more often will help them to get to effective treatments more of the time.

And lastly, one of the most important aspects of treatment remains effective acute treatment. There is a tendency, I think, to think somebody has headaches a lot, they need prevention, and that's about it, which really doesn't tend to work that way. If you are able to give people the tools to extinguish an attack consistently and well. Just doing that can reduce the burden of the disease in half. And so, knowing what the tools are, how to use them and applying them consistently makes for a very rewarding experience.


For other videos in our interview series with Dr Gottschalk:

Primary Care is the Answer to the Migraine Care Gap, Says Headache Specialist

CGRP Inhibition for Migraine: Side Effects are Few but Pay Attention for These

Oral Gepants: Christopher Gottschalk, MD Tells the Origin Story, Highlights Broad Efficacy

Migraine Medicine Transformed: Christopher Gottschalk, MD Discusses How We Got to CGRP Inhibition

Before Migraine Was a Disease: Headache Expert Christopher Gottschalk, MD, Remembers his Roots