The Sympathetic Doctor

In the fall of 2017, Katie Buckman was in her first semester of medical school, excited to be on the way to fulfilling her dream of becoming a physician in the rural Pacific Northwest. When her episodic migraine attacks turned chronic soon after school began, she wondered whether her dream would ever come true.

Katie had episodic migraine attacks as a child, but got a reprieve when she was a teenager. In her 20s, Katie’s attacks returned episodically—at first. Right after she began medical school at Pacific Northwest University of Health Sciences (PNWU), the frequency quickly increased to three or four attacks each week.

“I have lots of different triggers, but stress is one of them,” she says. “And starting medical school, especially the first and second years, were the most stressful years of my life. It got to the point where I was so far behind in my studies, I almost felt like I had to drop out of school.”

Migraine attacks caused Katie to miss class and, even when attacks hit outside of class time, the pain and sensitivity to light made studying “almost impossible,” she says. And the format of the content for her classes—largely delivered on screen—added even more difficulties, as bright light can be a trigger for attacks. “It wasn’t possible to look at screens. All of it combined kind of stopped me from being able to study as much as I needed to.”

Hurdles to migraine treatment

Finding migraine treatment was extra difficult because Katie didn’t have a doctor since she had just moved to a new town for school. Between providers being unable to take on new patients and a health insurance plan that wasn’t accepted by many offices, it took a long time to find someone to oversee her care. After working with a primary care physician and trying different preventive medications with no relief, Katie was referred to a neurologist. Still, she struck out with every medication she tried.

“Then, luckily, that was when those new [CGRP] monoclonal antibody treatments came to the market,” she says. The first one she tried “reduced the number of migraine [attacks] I was having, just dramatically. It felt like a lifesaver.”

Despite finally finding an effective treatment, Katie faced another hurdle: Her insurance plan does not cover the medications that are most effective for her. Fortunately, for now, her primary care provider is giving her enough samples of the medications she needs.

Learning to stay present during a migraine attack

The havoc migraine wrought on Katie’s life before she found an effective treatment increased her anxiety.
“There was anxiety that comes along with it because I never knew when I was going to have a migraine and how long it would last,” Katie shares. “When I was actually having the migraine, laying in bed, all I could think about was everything that I was missing… Stressing out about exams coming up and how I wasn’t able to prepare for them as much as I want to do because of the migraine.” That led Katie to ruminate on difficult questions, like “When is it going to end? And how am I going to do this?”

Finding a way to let go of the worrisome thoughts became a key part of Katie’s coping strategy, which she still uses during attacks. Using meditation and mindfulness practices, she first started by “just accepting that I had a migraine, and that there was nothing that I could do about it.” She then focuses on “trying to relax as much as possible and let all of those thoughts go and just focus on getting better. And that was something that took a really long time to work on.”

Practicing gratitude has also been a helpful coping tool. She is immensely grateful for her migraine-free days. She even has been able to volunteer regularly at a local free clinic because “it felt like I had so much extra time compared to having a migraine or severe headache every day.”

Connecting with other medical students with migraine has been helpful, too. “It’s comforting to know that you’re not alone in this unique situation of being in medical school and having migraines,” Katie says.

Advice on talking with doctors

Katie’s experience as both patient and soon-to-be provider gives her unique insight into the doctor-patient relationship. Her main advice to people with migraine is to be as candid as possible about how migraine impacts their lives.

“I think a huge thing for my doctor was for him to know how exactly it was impacting my life as opposed to just stating that, you know, you’re in pain,” she says. Talking about how migraine impacts your everyday life “conveys a little more of the suffering that people are going through, as opposed to just the standard, you know, rate your pain, 0 to 10.”

She also advises people with migraine to talk about what migraine is keeping them from doing. Using herself as an example, she says, “I want to be able to study and keep up with school. And so the goal is to find a therapy that’s going to hopefully reduce the number of migraine episodes that I’m having, but if not, then find a way to get the pain under control to a point that I can be functional.”

Katie learned in her experience with chronic migraine how important it is to be persistent when looking for a treatment. “It can definitely be frustrating to find the right therapy that works, but just keep trying… For a while there, I was feeling really hopeless trying to find a therapy that works for me. And then when [the medication that helped] came along, it felt like all that time had paid off.”

She also learned to be gentle with herself, especially during a migraine attack. A big component of her mindfulness during an attack is “just accepting that it’s happening, and to not stress about things that I’m missing, that might make the migraine worse, and just focus on taking care of myself and to get better.”

Becoming a better doctor because of chronic migraine

Spending her first two years of medical school with chronic migraine was incredibly difficult, but Katie knows it will make her a better doctor. Now in her fourth year, Katie shares that “I’m actually in a weird way grateful for [developing chronic migraine in medical school] because I think that it definitely makes me more empathetic as a provider.”

When her migraine attacks were frequent and the preventives weren’t helpful, Katie went to her doctor in tears because she thought she was going to have to give up her dream of becoming a doctor herself.
That doctor showed her a remarkable level of empathy. “He just put his laptop down and grabbed my hand and said, ‘You’re going to make it through this. And you’re going to be stronger and a better doctor for it because you will be able to understand where your patients are coming from.’”

“That was an amazing moment. And it really just kind of provided me with comfort, you know, that I’ll make it through it and that there’s actually some benefit to the suffering.”

— Kerrie Smyres