The Science of Migraine: “It’s All in Your Brain” – Part 2

0:25 okay
0:25 the nice thing with the aura is there’s
0:27 actually studies
0:29 where we can see the electrical wave we
0:31 can actually observe it
0:32 so can we see the migraine attack not
0:35 the aura just a migraine attack
0:37 and i’m delighted to say that now we can
0:40 actually see
0:41 things happening in the brain with
0:43 advanced techniques
0:45 let’s let’s have a look at this this is
0:48 this looks like weird this is a study
0:51 this is a full month
0:52 on a one woman that went to the
0:54 functional mri
0:56 every day every morning she had a
0:58 functional mri
0:59 and she was um presented with different
1:02 things
1:03 uh a strong smell some irritation uh of
1:06 the nose
1:07 and also a visual checker board and you
1:10 can see in red
1:12 she had three migraine attacks and in
1:14 lavender
1:15 it was the day before the attack and in
1:17 kind of pinkish
1:18 it was after the attack so the we call
1:21 that sometimes the pro drone the pose
1:23 drone
1:24 it’s like before and after the attack um
1:27 and during the attack you can see that
1:29 the the lines uh the colored lines go up
1:32 so she had a height and the an enhanced
1:35 perception
1:36 of vision of smells which is exactly
1:38 what you expect during
1:40 a migraine and so they could record what
1:42 was going on
1:43 inside the brain during this
1:47 so what did they see okay so now we have
1:50 to look at the brain
1:51 i i put a picture there so you can see
1:53 the whole head so you have an idea
1:55 where those yellow dots are
1:58 the yellow dots are where there was more
2:01 blood so that suggests that something
2:03 is going on there there’s some activity
2:05 so before the migraine
2:07 the hypothalamus which is a zone that is
2:10 deeply linked
2:11 with our hormones and our balance in the
2:13 body
2:14 the hypothalamus was actually uh
2:17 active and we saw that this hypothalamus
2:20 zone was talking
2:22 quite strongly to what we call the
2:24 trigeminal necklace
2:26 we’ll talk more about that but this is a
2:28 zone that computes
2:30 all the sensation of you guessed it
2:33 the face and the neck and the sinuses
2:37 so it’s like this zone the hypotenuse
2:39 was talking to
2:40 the zone that that just collects all the
2:42 sensory information
2:44 of our head and then during the attack
2:46 there was a
2:47 another zone the middle red dot uh
2:50 we call it the pons um and we don’t know
2:53 exactly what that is we we think maybe
2:55 it’s a
2:56 it’s a moderation it’s a modulator this
2:58 zone
2:59 there are pain control centers there and
3:01 also serotonin
3:04 nuclei or serotonin places okay so sorry
3:07 for the medical jargon
3:09 but i wanted to show you this because
3:11 this really tells us
3:12 that there’s something going on inside
3:14 the brain during a migraine attack
3:16 that we can see it and this has been
3:19 actually shown in previous studies so
3:21 it’s not
3:21 just a study this replicates other
3:24 findings
3:25 okay so so we know something’s going on
3:29 um and then what you know if you have
3:31 migraines i have migraines i know the
3:33 pain
3:34 um and you feel the pain somewhere but
3:37 sometimes you will feel it in your
3:38 temple in your eye
3:40 typical but other people feel it in
3:42 their sinuses
3:44 in their necks in their jaw so where
3:47 does the pain come from because all
3:49 those things are normal you know your
3:50 eye is fine your neck looks
3:52 okay um so where does the migraine pain
3:55 come from
3:57 here’s that word again trigeminal that
3:59 means three
4:01 gemini or three triplets if you wish for
4:03 the three branches of this big nerve
4:06 that carries all the information from
4:09 the face
4:10 but also the teeth and the sinuses and
4:12 the eye
4:13 and the nose and and everything um
4:16 and it goes to a center in the brain
4:19 this little dot i showed before the
4:20 necklace
4:22 um so all those branches they take a
4:25 signal for touch
4:26 and pain and vibration and hot and cold
4:28 they just take all of that to the center
4:31 but the interesting thing is that those
4:34 those nerves or those branches
4:36 do not carry information only from the
4:39 eye or the sinuses or the teeth
4:41 they also carry information from the
4:43 meninges
4:44 and arteries inside the head
4:47 so inside the head the brain itself
4:50 okay i know when you have a migraine you
4:52 can feel like your brain is going to
4:53 explode
4:55 the brain doesn’t feel any pain what
4:57 feels pain
4:58 is meninges and blood vessels arteries
5:01 and veins
5:02 you can remember that if you think about
5:04 meningitis
5:05 an infection of the brain a super
5:07 painful big headache there
5:09 or rupturing an aneurysm you know having
5:11 a bleed and
5:12 a brain hemorrhage that’s very painful
5:14 too
5:15 so inside the head meninges and arteries
5:19 are
5:20 painful they can sense pain that’s what
5:22 they do
5:23 and the nerves that are connected there
5:25 are the same nerves from the same
5:26 branches
5:27 that connect to your temple and eye and
5:30 neck and sinuses
5:31 so do you see do you see something
5:33 building building here
5:35 the cause of the pain in migraine is
5:37 most probably
5:39 an inflammatory soup of peptides
5:42 proteins that are released on the
5:45 meninges and the arteries
5:47 inside your head okay so those peptides
5:51 are released
5:52 by the same nerves that actually feel
5:54 the pain that’s interesting you can
5:56 imagine like this electrical wire that
5:59 can actually sprinkle cayenne pepper
6:01 on your meninges and that creates the
6:03 pain
6:04 that you feel and with that pain comes
6:07 the hypersensitivity sometimes the
6:09 pulsation
6:10 sensation that you have so that is the
6:12 cause of the migraine headache
6:14 that’s an inflammatory soup that is
6:16 released near your meninges
6:18 and arteries and this soup causes
6:21 inflammation
6:22 so that means that the blood vessels
6:24 dilate and some people can actually see
6:26 during a migraine that their vessels of
6:28 the
6:28 face and the head become dilated um
6:32 before we thought that the dilation was
6:34 causing the pain
6:36 but now we know that the mechanism is
6:38 that there are those peptides
6:40 and they cause the pain and because of
6:42 dilation
6:43 together okay
6:46 so now we said a lot already about the
6:48 genes
6:49 and the proteins and the pain and the
6:52 trigeminal nerve
6:53 so now let’s talk about the neck because
6:56 a lot of people with migraine
6:57 including myself have neck pain during
7:00 an attack and so they think that
7:03 something’s wrong with their neck
7:04 and that the neck should be fixed
7:07 properly
7:08 um so should is is the cause of migraine
7:11 in the neck and that that’s a perfect
7:13 example to introduce
7:15 the ping-pong theory so let’s talk about
7:19 the myocardial infarction you know the
7:21 heart attack
7:22 everybody knows kind of a social
7:25 something that people know
7:26 that when you have a heart attack you
7:28 can feel pain in the chest but also
7:30 pain in the left arm left arm is okay
7:33 it’s just it’s the same networks cause
7:36 the pain
7:36 in the arm and the heart so we call that
7:40 a referred pain a pain from somewhere
7:42 that’s feel that’s felt somewhere else
7:46 so now what we have to understand is
7:48 that the head and the neck
7:49 are deeply connected those electrical
7:52 wires are
7:53 i talked about those that take care of
7:55 the eye and the temple
7:57 they actually take care of the neck as
7:59 well they connect
8:01 so the the big wire that comes to your
8:04 eye and temple
8:05 is connected to the same place that
8:07 connects to the back of your head
8:09 so it’s a two-way road and by the way
8:12 there’s another zone that’s connected
8:14 it’s the zone of the jaw all right so
8:16 those nerves also connect
8:18 all the same place in this trigeminal
8:21 nucleus
8:22 um so that means that the pain of
8:25 migraine
8:26 can come from the soup in this area
8:29 and can actually be felt at the back of
8:31 the head
8:33 but the the process can also be reversed
8:36 so you can actually have tension in your
8:38 neck
8:38 that triggers the migraine attack
8:41 because it irritates the system
8:43 so it’s both ways are possible
8:46 so if i look at my own case um i i’d
8:49 never have neck pain very rarely or if i
8:51 do have it
8:52 both sides at the back of my head when i
8:54 train too hard and it’s not a migraine
8:56 but during the migraine i have pain only
8:59 on the right side and usually it comes
9:01 after all the rest of the migraine
9:03 attack has started
9:05 so it’s really a two-way road and we
9:08 have to understand that it can go both
9:10 ways
9:11 interesting isn’t it because that’s true
9:15 for so many other things so now that
9:18 i’ve talked about the neck
9:20 you can apply the exact same thing to a
9:23 lot of other things for example
9:25 um your your brain if you live with
9:27 migraine has to compute tons of
9:29 information every day
9:30 so there’s the stress stress can be
9:33 anxiety can be also mental load
9:35 how many decisions you make per day
9:38 inflammation
9:39 if you live with an inflammatory
9:40 condition emotions
9:42 you know like how we react to difficult
9:45 emotions related to others
9:48 every sensory input so that means is
9:50 there a pain in your neck is there
9:51 inflammation in your sinuses
9:53 uh hormones how is the sleep you know
9:55 the sleep um
9:56 allows the brain to function better all
9:59 of those things
10:00 influence the migraine brain that has
10:02 this particular software
10:04 and the ability of triggering this
10:06 attack with the soup
10:09 okay so that leads us to the migraine
10:11 threshold theory that we
10:13 do teach a lot in headache clinics we
10:15 tell people that
10:16 they they can have multiple triggers and
10:19 that those triggers accumulate and they
10:20 combine
10:21 so the perfect example is if you had a
10:24 stressful week
10:25 and then you have a long friday and then
10:28 you you don’t hydrate
10:29 you eat crap and then eventually you
10:32 decide to go
10:33 out you have alcohol and the next
10:35 morning boom you didn’t sleep very well
10:37 you don’t take your coffee you take your
10:39 breakfast later
10:41 and then you have the migraine attack so
10:43 that’s one example but there are many
10:45 others you know you exercise
10:47 on the ski slope and it’s very very
10:49 bright lots of light and then your
10:51 neck gets tense all of those things
10:53 combine to trigger the migraine attack
10:56 uh and then the cascade and then the
10:58 inflammation and so on
11:01 there’s another condition that works a
11:03 little bit like that
11:04 it’s i’m going back to asthma so asthma
11:08 is actually a hyperextendability of the
11:10 lung during an asthma attack there’s a
11:12 lot of inflammation
11:13 migraine is hyper excitability of the
11:16 brain
11:17 so you can have mild asthma where you
11:19 know you get rid of the cat you’re good
11:22 you just manage your allergies you’re
11:24 good but then
11:25 you have severe asthma where you need a
11:27 bunch of treatments and a pneumologist
11:30 to help you the same goes with migraine
11:32 you can have
11:33 migraine treated by stopping you know
11:36 alcohol for example
11:38 or you can have migraine that gets
11:40 better if you just lower your
11:41 exercise intensity but a lot of people
11:45 have migraines that actually they live
11:47 perfect pristine saintly lives and
11:50 still they have migraine because just
11:52 living is too much for their brains
11:54 and they need medical care and
11:56 prevention
11:59 so this brings us to a bit of a
12:01 different topic
12:02 it’s not necessarily about the cause of
12:04 migraine we’ve covered that
12:06 but it’s about how those different
12:08 softwares influence
12:10 the different types of people with
12:11 migraine so you can have migraines a few
12:14 times per year if you’re lucky
12:16 and then that we call that low frequency
12:18 episodic
12:19 so that means that some lucky people
12:22 have very
12:22 occasional migraines may be triggered by
12:25 very precise things
12:26 and they might not require medical care
12:29 at all and those people
12:31 sometimes you know just take their own
12:33 example and say oh i treated my migraine
12:35 by
12:36 whatever they’re doing um but then there
12:38 are
12:39 more severely affected people who have
12:42 more frequent migraines
12:44 and then the brain starts you know being
12:45 in the pre or post migraine on a regular
12:48 basis
12:48 we call that frequent episodic and then
12:51 you have the chronic migraine so that’s
12:53 the state where you’re always somewhere
12:55 in between you know
12:57 you just you’re just back from a
12:58 migraine or you’re starting a migraine
13:01 and you have very rare headache-free
13:03 days and
13:04 very frequent migraines and sometimes
13:05 very severe
13:07 so this is a continuum this is a
13:09 spectrum
13:11 and which we usually separate people
13:13 according to their frequency
13:14 and also the presence of a headache free
13:16 days
13:18 so that means that for some people uh
13:21 when we care for migraine we want to
13:23 care for the brain
13:24 right of course we want to address the
13:27 triggers
13:27 we want to make the brain you know in a
13:29 good place
13:30 so you have to find this balance between
13:33 avoiding triggers which is very very
13:35 stressful
13:36 or just promoting healthy behaviors
13:39 that can be a bit more empowering so
13:41 this little lady here
13:43 superhero of migraine she does the whole
13:45 thing
13:46 and then she puts her brain in a nice
13:49 place
13:50 and maybe she controls the migraine
13:52 situation with that
13:53 but for some people even doing that is
13:56 not enough
13:57 because when you fall in a migraine
13:59 chronification so that means people
14:02 maybe some of you have this they started
14:05 having migraines when they were young
14:06 or you know anywhere in their 20s and
14:09 they had
14:09 occasional migraines everything was okay
14:12 and then eventually
14:13 sometimes something happens we know
14:16 sometimes we don’t
14:17 and then you fall into the chronic
14:19 migraine state
14:20 so this brain that has the software that
14:23 triggers attacks
14:24 becomes just in a cycle where everything
14:27 is
14:28 is completely you know like uh unstable
14:31 so you have you lack sleep uh you tense
14:34 your muscles
14:35 your relationships with your family your
14:38 workplace become a little bit tense
14:40 you’re missing stuff you have to um
14:42 compensate for that
14:44 and then what you do you try to take
14:46 medications
14:47 you fall into medication overuse maybe
14:49 you drink more caffeine
14:51 and then you cannot exercise and then
14:53 you cannot cook and then you
14:54 so this is the vicious circle of chronic
14:58 migraine and this is not easy to break
15:00 as
15:01 some of you might know so many vicious
15:04 circles there
15:05 overuse sleep mood
15:08 sinus and jaw and neck pain the big trio
15:11 so this can actually put people in a
15:13 very tough place
15:15 so that’s what i call the ping-pong
15:17 theory and if you understand
15:19 this cause of migraine thing then you
15:22 can actually picture
15:24 how migraine should be cared for
15:27 and i know a lot of people with
15:29 migraines say i don’t want to take pills
15:31 which perfectly understand you know it
15:33 makes a lot of sense you don’t want to
15:35 take anything chemical in your body
15:37 and why would you do that um so
15:40 actually stabilizing the lifestyle is
15:43 always a very good thing
15:45 and it works both ways so the ping pong
15:47 theory leads to the fact
15:49 that you can either raise the tolerance
15:52 of the brain
15:53 itself right to make it more resistant
15:55 to the migraine
15:57 or you can decrease the load in the
15:59 periphery you can manage the triggers
16:02 and both are good so the stabilizing
16:04 lifestyle works both ways
16:06 it actually stabilizes your brain and it
16:09 also decreases the triggers so that’s
16:10 good
16:11 medications that we give and prescribe
16:15 can actually change this chemistry
16:17 electricity software balance of your
16:19 brain
16:20 and higher your threshold so your brain
16:23 does not trigger the attacks anymore
16:26 exactly like asthma
16:27 people with asthma will take different
16:29 things to kind of quiet down their lung
16:32 so medications and migraine work that
16:34 way
16:35 are they perfect absolutely not um are
16:38 they
16:38 effective for everyone absolutely not
16:40 but they can really help the brain to
16:42 stabilize
16:43 and then of course if you have sleep
16:45 apnea well treating the sleep apnea
16:48 might actually
16:49 help your brain if you have absolutely
16:52 big like
16:52 neck issues shoulder issues absolutely
16:55 seeing
16:56 someone to take care of your neck with
16:58 exercises or with
16:59 different approaches can help and if you
17:02 do not tolerate gluten
17:04 it makes sense to stop gluten but you
17:06 can understand now
17:08 that for every person there is actually
17:10 a mix of things
17:11 so it it’s impossible to to just know
17:14 from the start
17:15 you know what should be done and usually
17:18 just managing stress and drinking more
17:20 water
17:20 it’s very good but it might not be
17:22 enough
17:24 so when we manage migraine in the clinic
17:28 usually we do the behavioral part which
17:30 is everything related to
17:32 lifestyle and and natural things um
17:35 acute therapy and preventive therapy
17:38 so i want to say if just a few words i
17:40 said i wouldn’t talk about treatments
17:42 but some of you might be very curious
17:44 about those treatments um
17:46 how do medications and botox and cgrp
17:49 antibodies work
17:50 medications might be propanolol
17:53 amitriptyline verapamil
17:56 topamax or to pyramid all those
17:59 medications
18:00 change the chemistry of the brain one
18:02 way or another
18:03 and stabilize it for some people botox
18:06 is interesting because botox actually
18:08 stops the the nerves from releasing the
18:12 inflammatory soup
18:13 it stops the release of the peptides
18:16 like cgrp for example we’ll talk about
18:18 cgrp
18:20 so botox acts you know it not inside the
18:22 brain it acts
18:23 in the periphery remember the ping-pong
18:25 game so it actually quiets down
18:28 the nerve terminals um and also maybe
18:31 releases or relaxes some
18:33 tight muscles but that’s not the key
18:34 thing so it relaxes it
18:36 it stabilizes the nerves of the head and
18:39 neck
18:40 and to decrease the sensory load we
18:42 think
18:43 on the brain cgrp is one
18:46 of the things in the inflammatory suit
18:49 it’s a peptide
18:50 right and there’s a lot of focus on this
18:52 peptide
18:53 uh in these days because we we have
18:56 successfully companies have successfully
18:59 targeted this peptide with
19:00 antibodies the antibodies block the
19:04 peptide
19:04 okay so they they prevent the peptide to
19:07 to act
19:08 or they bind a receptor and they stop
19:11 this kind of cgrp
19:12 interaction that plays a role in
19:14 migraine
19:15 so this is how our preventive
19:17 medications work
19:19 there will be more seminars about this
19:21 but just just to explain a little bit
19:23 now that you’ve seen the cause of
19:25 migraine how we target it
19:27 using different chemical uh things to
19:30 stabilize the brain
19:32 so you can imagine just to illustrate a
19:34 bit what i mean
19:35 um that your personal therapeutic plan
19:39 will be very different depending on who
19:41 you are so here i show you two
19:43 completely fictional examples
19:45 damien um till damien’s a guy he’s 48
19:49 men have migraines too he’s a hyper
19:52 achiever
19:53 on the anxious side he uh he really
19:55 wants to do things perfect
19:57 uh he has hypertension um and he he
20:00 doesn’t sleep very well
20:02 uh poor damien and he drinks tons of
20:04 caffeine to go through the day
20:06 and then when he has a release after a
20:08 big rush at work then proof the migraine
20:10 hits
20:11 uh when he’s exhausted uh when he trains
20:13 very hard
20:15 and then nsaids are anti-inflammatories
20:17 do not fare very well with damien
20:19 and this guy has eight to ten days per
20:21 month of migraine
20:23 so he has frequent episodic and then we
20:25 have cynthia
20:26 cynthia is a completely different person
20:28 she’s a woman she’s 32.
20:31 she had a tough childhood she has a
20:33 history of depression
20:35 she has fibromyalgia she’s a bit
20:36 overweight um
20:38 she also has insomnia insomnia is very
20:40 common with migraine
20:42 she did stop caffeine she probably has
20:45 some degree of analgesic overuse because
20:47 she has frequent headaches and she
20:49 treats them
20:50 with tylenol and nsaids and tryptons and
20:52 she tried two preventives and
20:54 she doesn’t know where to go uh from
20:56 there so the plans for damien and
20:59 cynthia will be
21:00 very different right damien probably
21:02 needs a bit of education about how to
21:04 manage stress
21:05 how to to improve sleep maybe
21:08 address the caffeine issue um and then
21:11 maybe treat the attacks better
21:13 and we could give him a preventive and
21:15 take care of the hypertension and the
21:17 migraine at the same time
21:19 cynthia would probably need help with
21:21 exercise to adapt exercise for her
21:24 so she can deal with fibromyalgia better
21:26 she would maybe need a bit of
21:28 psychotherapy
21:29 to address the emotions and she needs a
21:32 better preventive so maybe
21:33 cynthia would be a candidate to get
21:36 botox or a cgrp antibody so
21:38 those are different types of patients we
21:41 usually discuss
21:42 in doctor’s meetings uh to illustrate
21:45 how migraines should be
21:47 managed according to who you are and not
21:50 according to
21:51 cures or recipes or you know like uh
21:54 one-size-fits-all approach so this is
21:58 where the migraine tree comes
22:00 um on the migraine canada website you
22:02 will see
22:03 this migraine tree it’s been designed
22:05 for us um
22:07 and it illustrates this diversity of
22:10 options actually
22:11 so in the roots you can see who you are
22:13 as a person with migraine
22:15 are you you know are you a woman with
22:17 hormonal issues are you a child
22:19 um what type of migraine do you have um
22:22 what’s your psychological background
22:24 what’s your medical background
22:26 so all of this roots you know goes on on
22:28 on
22:29 what what is your system like then in
22:32 the trunk
22:32 the core is what every person with
22:34 migraines should know so everyone if you
22:36 want to have a look at this category
22:38 this this
22:38 those posts this is all about what i
22:41 just said today the cause of migraine
22:43 what’s a placebo response it’s important
22:45 to understand that
22:46 how to do a diary you know what is an
22:48 acute treatment the preventive treatment
22:51 basics really and then you go into the
22:53 branches
22:54 all the branches are equal you know so
22:57 and i didn’t put alternative treatments
22:59 there i put
23:00 self-care and lifestyle uh social life
23:03 how to deal with
23:04 workplace the partners uh children
23:07 um how to break the attack how to
23:09 prevent the attacks
23:11 and then the world of devices and
23:13 neuromodulation
23:14 we don’t have a lot of that in canada
23:16 but it’s coming and the world of
23:18 procedures and injections some some
23:21 procedures
23:22 and some devices might actually be acute
23:25 and preventive so it’s a bit complicated
23:27 but
23:28 overall i invite you to explore those
23:31 branches
23:31 and i hope you find what you seek on
23:34 particular treatments
23:36 so that’s that’s the vision of migraine
23:38 a very holistic approach
23:39 that includes everything that can help
23:41 you get better
23:44 so i just a few examples what you can
23:46 find in the branches
23:47 you know about the for example lifestyle
23:50 is all about
23:50 uh physio exercise sleep management um
23:54 life situations we’re building that
23:56 category so uh
23:58 how to deal with school how to deal with
24:00 travel uh
24:01 the acute how to use the acute how to
24:03 combine them
24:04 uh how to avoid overuse and then the
24:07 world of prevention
24:08 and uh procedures and and and blocks and
24:11 things like that
24:12 so will that replace an actual
24:15 psychologist or an
24:16 actual nutritionist no it won’t but it
24:18 will give you a little bit of basics
24:21 to grasp a little you know how you can
24:24 tailor your own plan so in conclusion
24:28 uh you’re so good you have to have
24:30 stayed here with me listening to all
24:32 that
24:32 scientific stuff um i really hope
24:36 that i demonstrated to you that migraine
24:39 is
24:39 a neurological disorder right it is not
24:42 just a headache
24:44 it is not imaginary it is not in your
24:46 head
24:47 it is a question of genes and proteins
24:50 and software it is very diverse
24:53 both on symptoms on triggers and on
24:56 treatments
24:57 so you cannot just rely on this person
25:00 on this forum who said that this worked
25:03 maybe it worked for this person maybe
25:05 not for you
25:06 so you really have to um look at your
25:09 situation
25:10 to find your options so you’re not crazy
25:13 you’re not crazy
25:15 you’re not alone absolutely not even if
25:17 you suffer from chronic migraine
25:20 i mean one to two percent of the world’s
25:22 population
25:23 is like you so you’re not alone it’s
25:25 just because no one talks about it
25:26 that’s why i’m here uh to talk with you
25:29 and to share with you migraine is
25:31 disabling not for everyone
25:33 okay but if you have a lot of it it can
25:36 ruin a life
25:37 proper right it can take away from you
25:40 your job
25:41 your social activities your travel your
25:43 sports
25:44 so if you are disabled by migraine
25:46 believe me you’re not alone
25:48 you deserve care like any person living
25:50 with a chronic condition
25:52 diabetes asthma so if if if you look for
25:55 diabetes and asthma and cancer or
25:58 all those things there are programs for
26:00 them
26:01 right there are uh diabetic educators
26:04 nurses um specialists clinics
26:08 so treatment actually must be adapted to
26:11 your situation just like for
26:13 any chronic disease so why on earth
26:16 are waiting lists for headache cleaning
26:18 so long
26:20 well there’s not only a stigma on
26:23 patients with migraine there’s also a
26:24 stigma
26:25 on migraine in general and that includes
26:29 migraine as a scientific topic and
26:31 migraine as a clinical specialty
26:34 let me tell you a lot of us headache
26:36 specialists
26:37 have been stigmatized we have been
26:39 treated as the poor child
26:41 of neurology all right and this is
26:44 probably because people we we didn’t
26:46 have proof we didn’t have science we
26:48 didn’t know
26:49 20 25 30 years ago but now
26:52 and we have what i’ve shown you i think
26:55 it’s time for migraine and other
26:57 headaches
26:58 to gain a little bit more of attention
27:01 and to
27:03 be considered as a serious neurology
27:05 specialty
27:06 and also other specialists can help
27:08 people with migraine
27:09 so if you wonder why your doctor doesn’t
27:11 know any of this
27:12 they probably know more than most of
27:14 doctors now
27:16 um well it’s because they’re not trained
27:18 this is not part of the typical
27:21 med school program you know this is not
27:24 part of the training of many gps
27:26 so this has to change um also we’re
27:29 working on a database of headache
27:31 clinics
27:32 to build a clinic locator but we have to
27:34 define what clinics are
27:36 ideally a clinic would be a place where
27:38 you can find you know a nutritionist
27:40 that gets migraine a psychologist that
27:42 gets migraine a physiotherapist that’s
27:44 good with the neck and shoulders
27:46 but those multi-disciplinary clinics do
27:48 not exist
27:49 for migraine or very very rare in canada
27:52 so we need more of that
27:53 so you can get better not only with
27:55 pills but also
27:57 with scales okay so we need to improve
28:00 the system
28:02 we need to to to break the stigma
28:05 we need to unite and speak up and get
28:08 organized that’s what migrant canada is
28:10 about
28:11 we need to increase awareness in schools
28:13 workplace politics
28:15 and we need to organize
28:17 multi-disciplinary programs
28:19 with nurses and psychologists and
28:21 physios
28:22 to help you take care of your brain this
28:24 exists
28:25 for cancer it exists for diabetes it
28:27 exists for asthma it exists for
28:30 arthritis it exists for parkinson’s
28:33 disease
28:34 so we should have it for migraine but we
28:36 need your voice and you we need your
28:38 support to have this happen
28:41 so a call to action for now just stay
28:44 tuned on facebook
28:45 this is the key social media that we’re
28:47 managing at present time
28:49 uh you can please share facebook uh
28:52 share and speak up
28:53 uh recommend our tools if you like them
28:56 recommend our resources uh
28:58 bring this to your doctor make your
29:00 doctor aware that we exist
29:02 don’t hesitate to talk about migraine to
29:04 your networks don’t be ashamed don’t
29:06 feel guilty
29:08 uh participate to our surveys we want we
29:10 will poke you a little bit to have some
29:12 insights um
29:13 we want to to know how to act on your
29:16 behalf
29:17 um volunteer with us uh we are looking
29:19 for different volunteers all the time so
29:21 never hesitate even if it’s just to
29:23 write a little thing or to make a put a
29:26 poster at your workplace or
29:28 something that can increase awareness
29:32 and uh and then together i think in a
29:34 few
29:35 months and years this will build up and
29:37 the migraine the care for migraine in
29:38 canada will be better
29:40 thank you for bearing with me i know
29:43 this was a long
29:44 talk uh probably too long very very
29:47 scientific based
29:49 but i really hope that you enjoyed it
29:51 that you found it
29:52 helpful that this will help you manage
29:55 migraine
29:56 or care for the person with migraine
29:58 that’s close to you
30:00 so be well thank you and i hope i’ll see
30:03 you again for future webinars
30:09 [Music]