Headache specialist and patient
Dr. Abigail Chua’s medical career began in nursing. That is where she first found she enjoyed working with patients who had headache conditions, like migraine. She later pursued her medical degree and ultimately completed her neurology residency training at Temple University in Philadelphia.
In 2015, she embarked on a Headache Medicine Fellowship at the Jefferson Headache Center, one of the few academic headache centers in the country. By becoming a board-certified headache specialist, Abigail joined an exclusive group of fewer than 600 doctors in the U.S. who are passionate about—and qualified to treat—this patient population.
Abigail, the patient
“Everyone’s migraines are so different and so personal that no two patients are exactly alike,” says Abigail. For her, the warning signs of migraine started during childhood. She remembers that she would get carsick often and that roller coasters were out of the question. She had episodes of gastric pain accompanied by headache, and vertigo had always been an issue.
In medical school, these symptoms began to affect her more often, she says: “I felt dizzy to the point of almost vomiting, couldn’t keep my eyes open, and had such severe headaches that I thought I was going to faint.” She also developed daily, continuous low-level head pain that persisted for years. The most difficult symptom was the false sensation of falling to the ground. If you’ve ever woken up suddenly after a dream where you felt like you were falling off a cliff, then you know the feeling. For Abigail, this brief, terrifying feeling occurred multiple times a day and continued for years.
The symptoms she was experiencing were consistent with a specific type of migraine disease called vestibular migraine. Also known as migraine-associated vertigo, the prevalence of this condition is estimated to be between 1% and 3% of the general population, mostly affecting women.
Receiving a diagnosis of vestibular migraine typically occurs years after receiving a general diagnosis of migraine. The symptom most associated with it is frequent dizziness that lasts between five minutes and 72 hours. Treatment for vestibular migraine generally focuses on preventive medications including calcium channel blockers, tricyclic antidepressants, and beta blockers.
Over time, Abigail has learned to control her symptoms using a combination of trigger avoidance, good sleep habits, medical treatments, and massage therapy. But it’s not always easy, she says: “I treat headache patients every day and I know what I should be doing to manage my own migraines. But life gets busy and sometimes taking care of yourself takes a backseat to everything else you need to manage. I just take it one day at a time.”
Abigail, the doctor
Dr. Chua earned her medical degree from the Philadelphia College of Osteopathic Medicine. Most doctors in the U.S. are M.D.s—doctors of medicine—but many are D.O.s—doctors of osteopathic medicine. Osteopathic doctors learn the same medical science, and train in the same residencies and fellowships as M.D.s. They practice in all areas of medicine, including internal medicine, surgical specialties, neurology, and headache medicine. The major difference is that D.O. training focuses on a whole-person approach to treatment and care, emphasizing the importance of partnering with patients on their overall health.
A unique aspect of osteopathic medicine is osteopathic manipulative medicine (OMM), which is hands-on care including stretching, gentle pressure, and resistance used to diagnose, treat, and prevent illness. This is different from physical therapy, massage, or chiropractic treatment and can be very effective for some people with headaches. Not every D.O. practices OMM, so it is important for patients to ask.
Abigail is now a headache specialist at Hartford HealthCare Headache Center in Connecticut, and is also associate program director of their Headache and Facial Pain Fellowship Program, one of the few such programs in the country. She works with seven other headache specialists and incorporates a multidisciplinary approach to headache care.
“Migraine and headache conditions are so complex that treatments cannot be one-size-fits-all,” she says. “What works for one patient may not work for others.” In addition to her clinical work, Abigail is also assistant professor of neurology at the University of Connecticut School of Medicine, where she teaches headache medicine to neurology residents and students.
Abigail, the advocate
Headache on the Hill (HOH) is a two-day event sponsored by the Alliance for Headache Disorders Advocacy (AHDA), organizing participants to meet with their representatives in the House and Senate.
Abigail recently joined 160 patients, doctors, and caregivers for the 2018 event. After an in-depth training session, the attendees are prepped to spread a unified message and an “ask” for their members of Congress. While each year the “ask,” an actionable item related to the cause, is different, the overall message has been the same. The mission of AHDA is to “advocate consistently for increased recognition of, and more equitable federal policies towards, Americans with disabling headache disorders.”
Abigail was in a unique position to share her perspective as a doctor and as someone living with migraine. Her favorite moment of HOH was meeting other headache advocates from around the country. “I think that hearing the individual stories of other Connecticut advocates was so important,” she says. “It enabled us to present a united purpose and really drove home our cause with the State Representatives.”
A doctor-patient perspective on the doctor-patient relationship
Despite the personal pain of migraine, Abigail is thankful for the unique perspective it gives her when treating patients. She feels that doctor-patient interactions are best when both sides feel there is a real team approach. The relationship requires open and honest communication to find the best individual treatment for an intractable disease.
Abigail laments that one of the biggest constraints in modern medicine is the time limitation that she and all doctors have with patients. She believes in the importance of having a comprehensive initial consult with new patients, and encourages patients to be organized with written updates and questions, to help ensure future appointments are efficient and provide customized care.
What the public needs to know
“Unfortunately, there is so much stigma attached to chronic pain conditions and migraine is no different,” says Abigail. “I wish there was a better way for people without migraine and headaches to understand how truly devastating these conditions can be. People with migraine and other headache conditions should be able to focus on getting well, not working to prove that they are ill in the first place.”
Dr. Chua’s advice to someone who has migraine and headaches:
- Don’t ignore them. Seek care from your primary care provider or see a specialist.
- Don’t hide them. Talk to your friends and family about what you are experiencing. There is no shame in having migraine or headache.
- Don’t overmedicate. Taking abortive/acute treatments for more than three days a week can lead to more frequent headaches that are harder to treat.
- Don’t think you are alone. There are millions of people, just like you, fighting for headache freedom. Join a support group or connect with other people with headaches online.
- Don’t give up hope. There are many resources and treatment options available to you.
American Migraine Foundation: americanmigrainefoundation.org
List of Headache Specialists in the U.S.: bit.ly/headachedocs
Follow Dr. Chua on Instagram: instagram.com/headachedoc_chuact