Kita Williams, MD: There’s a benefit to having a multidisciplinary approach to the management of migraine. It’s not just for the PCP [primary care physician] or the neurologist to do. To have everybody on board is the best scenario for the patient. It’s been documented that for the medical prophylaxis for patients with headache, especially migraine, medicine alone is effective in only half of them. Additional strategies are also needed to help the patient. Sometimes people say, “We’ll do behavioral therapy,” but behavioral therapy alone is not more effective than the pharmacological therapy. When you have those 2 combined, then they’re superior to either by themselves.

To provide an appropriate therapeutic concept to patients with chronic and difficult-to-treat headache, an interdisciplinary approach is what’s often recommended. You have your neurologist, your physical therapist, your headache nurse, and even the psychologist or a psychiatrist. For instance, if a patient is experiencing musculoskeletal pain, maybe in the neck region—that’s very common with migraines, for patients to have this cervical pain—then physical therapy could be beneficial. When you think about a headache nurse and the role that they would play, they could be helpful in gathering this information regarding patient episodes or how this patient feels between episodes—monitoring the drug efficacy and tolerability. Because when the patient calls, if they’re not tolerating the medication, they’re going to speak with the nurse who’s taking care of the patient.

We’re looking at how everybody’s role is very important. You’ll often have a need for a psychologist as well because patients are experiencing depression. It’s very common for patients to have this emotional component when they’re dealing with chronic pain. Some can say what came first, the pain or the depression. Did the depression precede the pain, or did the pain come before the depression? At this point, when we’re managing the patient, we want to get them the help they need. That’s where the help from the psychologist comes in handy, because a combination of anxiety and depression can affect the patient. This access to a psychologist is helpful.

To summarize things, everybody in the whole picture is necessary: the primary care physician, the neurologist, the nurse who’s assisting, the psychologist, and the physical therapist all play a very important role in the management of patient with headache, and the patient is better served because of this collective effort.

Transcript Edited for Clarity