Migraine diagnosis? Check. Next up? Navigating that “little thing” we call treatment. On this episode, Kat and Skye are joined by neurologist Juliana H. VanderPluym MD FRCPC, who specializes in headache medicine (and also lives with migraine!). Together, the trio travel the educational road of treating migraine by exploring the differences between acute and preventive medications, as well as bridge therapies. They also dig into the social determinants of health, the stickiness of setting treatment goals, tips for seeking emergency care, and Dr. VanderPluym shares a metaphor about the patient-provider relationship that Kat will be thinking about for a very, very long time.
You can also listen on our Spotify for Podcasters page and on Apple Podcasts.
Additional Reading:
8 Things That Lie Beneath the Surface of Life With Chronic, Invisible Illness
Episode Transcript:
Skye Gailing
Welcome to Health and (un)Wellness.
Kat Harrison
A podcast brought to you by The Mighty, where we put the human back in health. I’m Kat.
Skye Gailing
And I’m Skye, and we are your hosts for this season, Mighty With Migraine.
Kat Harrison
Between the two of us, our heads have over 33 years of experience being a pain in our brains.
Skye Gailing
Yours too? Let’s be best friends who wear sunglasses inside.
Kat Harrison
Now on to today’s episode, where we will be discussing the wide world of migraine treatments. Hello, Skye.
Skye Gailing
Hello, Kat.
Kat Harrison
We keep saying that we’re not medical experts on this podcast — but fear not, dear listeners — we invited one here to give you all the information that Skye and I are not qualified to give you. Would you do me the honors of introducing today’s guest?
Skye Gailing
I would love to. I have the pleasure to introduce the one and only Juliana H. VanderPluym M.D. FRCPC, who is an associate professor in the Department of Neurology within the division of headache at the Mayo Clinic Arizona. She received her doctor of medicine with special training and research from the University of Alberta Edmonton, Alberta, Canada, and also completed her residency training in pediatric neurology at the University of Alberta. She’s a board member of the American Migraine Foundation and has previously been a member of their editorial board. Among many leadership roles in the American Headache Society, she’s especially honored to have the opportunity to serve on the Diversity, Equity, and Inclusion Task Force. Her research interests include health disparities, headache education, novel migraine treatments, and non-headache phases of migraine.
Kat Harrison
I’m tired. Juliana, how do you do at all? Thank you so, so much for being here.
Skye Gailing
Yes, thank you.
Dr. Juliana VanderPluym
Thank you for having me, I should have given you a smaller bio.
Kat Harrison
You deserve all the spotlight, especially with a career as impressive as that. We have lots to talk about, so I don’t want to dilly dally. When we were doing our tech check, everyone, one anecdote that I really, really loved and I would love for you to tell our audience is how you got interested in headache disorders when you were in med school.
Dr. Juliana VanderPluym
I would be glad to. So, going back many years now, I initially started working in the medical genetics department. And I really liked medical genetics. And I really loved the patients. But I found it frustrating because we would meet them, we would diagnose them, and then that was kind of it. That was all we could do. I found the neurologic conditions that went along with a lot of the disorders really interesting. And so from there, I went into neurology. But there was this course that I attended, which was a headache residency course. And I found that as I was sitting in this course, it was the first time in a really long time that my mind wasn’t wandering. I wasn’t checking my phone, I wasn’t looking at emails, I wasn’t looking at patient messages and things like that. I was just sitting there and listening. And it just clicked. It made sense to me. And so from there, directly [and] immediately started looking for opportunities to figure out how I could find a space for myself in the world of headache medicine.
Skye Gailing
I love that story so much. And you mentioned your background being in medical genetics. Genetics is a side interest passion of mine. So I would love to hear more about the connection between genetics and migraine.
Dr. Juliana VanderPluym
Yeah, I mean, migraine is really common, and we believe it’s a genetic disorder. I mean, we know it to be a genetic disorder. And we see that it runs in families clearly. I mean, often when we see our patients, they will tell you: “You know, my mom has it. My sister has it. My brother has. My aunt or grandmother have it.”
Kat Harrison
Skye and I, we both have parents with it.
Dr. Juliana VanderPluym
Exactly. And often when the patient comes in, they’re like, “No, I don’t think anyone does.” The second appointment, often they come back and they’re like, “Actually, I started asking around, and oh, yeah, they do have headaches… just you know, they never mentioned it to anybody.” For that reason, we have interest in looking at genes that might be involved in it. We know it’s not just one gene that causes it but a combination of genes. And that’s probably what makes it a lot more complicated as far as us trying to figure out how to treat it as well.
Kat Harrison
I think part of what makes it hard, especially if it is genetic, if that’s playing into it, is this idea of… like, my mom has it. Is what works for my mom going to work for me? And I have found that very few things overlap to actually help us, whether it’s lifestyle changes or whether it’s medication. So I find that very interesting. Something that’s also great about you is that you do have a personal experience with migraine, correct?
Dr. Juliana VanderPluym
Yes, I have migraine as well. And my migraine experience is never going to be the same as my patients’ migraine experience, but it allows me to have perspective on what migraine is. It’s not just a headache. It is so much more than that. And I think, unfortunately, a lot of people don’t understand that and they really underestimate the impact that migraine can have on people’s lives.
Kat Harrison
Do you think that your personal experience with it has definitely played into your passion for the field and why you made that your life’s work?
Dr. Juliana VanderPluym
I think so. My partner had his first migraine with aura recently. He was lying there, and I was kind of coaching him through it and as he was going through it, he was just like, “If I didn’t have you here, I would be rushing immediately to the emergency room because this is terrifying.” And if you don’t understand where it’s coming from, or you don’t know what’s normal and what’s not normal, it can be pretty overwhelming.
Skye Gailing
I love that you said it’s not just a headache. Kat and I were talking earlier about, you know, as we were preparing for this podcast recording, we were like, “Ah, Juliana is so empathetic. You know, it stinks that she also lives with migraine.” But we just appreciate your approach to this and that you do care so much, and that you do have that personal connection. And it’s refreshing to see, too, as a provider.
Kat Harrison
I feel like “refreshing” is the optimal word there. Because quite frankly, I don’t know about you, Skye, but [that’s not been] my experience in health care most of the time. I’m not sure my neurologist has ever had one. It’s not his fault, right? I obviously don’t wish that on him. But I think if you just have never experienced it, even if you see someone in pain, even if you can see them struggling, you still don’t get it fully and how it affects someone’s life. But I’m curious, I want to go back to treatment with migraine — [when you get into it is] a very, very, very long journey. Your body changes, how the condition… your interplay with it changes. But I’m curious, if we think about someone who was just diagnosed with migraine who’s going to go and see a specialist, where do you even start with treatment?
Dr. Juliana VanderPluym
I like to break it down — when I’m speaking with my patients — into a few big categories. First is the type of treatment options that we have. We first want to think about the fact that migraine is a condition where we’re having these attacks on and off. So we need something in the moment of a headache attack to get relief. And so that’s what we call the acute or the rescue treatment, or the symptomatic treatment — so something to provide you relief in that moment. Now, we want to also reduce the chance of these attacks happening at all. And so that’s where we get preventive treatments. So that’s something that you’re taking in the background that reduces the chance of you having the attack, or reduces the severity of the attack. And then sometimes if you’re in a really bad attack that just won’t break, then sometimes we use something called a bridge therapy, which is maybe a bit more of an aggressive therapy that’s just done for a short period of time to try to sort of reset things so that that attack can break, or if you’re in a continuous headache, at least get you down to a more manageable pain level. So we have those big three categories.
I think it’s important to recognize that in people who have migraine — really everyone who has migraine — should have some sort of a rescue or acute medicine. Not everyone necessarily needs to have a preventive treatment, depending on how often they might get their attacks or depending on how severe their attacks may be. And then the other big way of categorizing treatments is into medication and non-medication based categories. Because we have to be mindful about the fact that there is not one treatment that is suitable for every single person who has migraine. And I think this loops back around to the fact that, as I said, it’s a genetic disorder that has so many different genes at play, plus environmental factors at play. So each person has to be looked at on an individual basis when we’re choosing amongst these categories.
Kat Harrison
Skye and I also haven’t been able to get over the fact that you taught us the word “bridge therapy.”
Skye Gailing
Yes.
Kat Harrison
I have tried a bunch of bridge therapies, but I didn’t actually know there was a term for it.
Skye Gailing
Yeah, I was like, “Oh, I just was given this medication for a week. Like once. That worked, I guess.” I had no idea it was part of a classification.
Kat Harrison
One thing that is equally frustrating and hopeful about when we think solely about medications is that up until around 2018, we didn’t actually have options for migraine-specific treatment. Hear that, everyone? 2018. Prior to then we’re using other classifications for medicine. Do you have any input on that?
Dr. Juliana VanderPluym
Prior to 2018, we were having to borrow medications from other disorders. So we were using anti-seizure medications, antidepressant medications, anti-hypertensive, so you know, high blood pressure medicines. Then we had a whole pile of miscellaneous ones that we would use as well. But then in 2018, a new category of medications came about which target this neurochemical that we shorten and we call CGRP. But that stands for a longer term: calcitonin gene-related peptide — so not a thing you need to memorize.
Kat Harrison
Mouthful!
Dr. Juliana VanderPluym
This new neurochemical was discovered back in the 1980s, and scientists found that this neurochemical was higher in people who had migraine. It went up as someone went into a migraine attack, and the more migraine attacks you had, the higher the level was. So they designed these medicines that can target that neurochemical, and now we have a few different types of medicines that do that. And some of them are for prevention and some of them are for acute or rescue medicine. And if we focus on the acute or rescue medicines, historically we’ve used you know, things like anti-inflammatories, non-specific pain medicines like acetaminophen or ibuprofen or things like that. Anti-nausea medicines, we do have some migraine-specific treatments in that category like the triptans or the ergots, but those don’t suit everyone. We have to really pick and choose for the person that’s sitting in front of us because there’s not going to be, you know, just one thing that we can say, “OK, this works for everybody.”
Kat Harrison
Let’s take a quick break and then dive back in.
Ubrelvy Migraine Mid Roll
Hi, I’m Ali Raisman. I’ve been living with migraine for a while. As an athlete and gymnast I was taught to just power through the pain. Now I use Ubrelvy or Ubrogepant to treat my migraine attacks. As soon as I feel a migraine attack, I take Ubrelvy, which provides me with quick relief. Once I get relief, I go on with my day. I’m partnering with Ubrelvy to share my migraine story.
Ubrelvy quickly stops migraine in its tracks within two hours without worrying where you are. Most people had pain relief and some even had pain freedom within two hours. Ubrelvy treats migraine attacks in adults and is not for prevention. It’s available by prescription only. Do not take with strong CYP3A4 inhibitors or if allergic to Ubrelvy. Allergic reactions can happen and may occur hours to days after use — get medical help right away if you have swelling of the face, mouth, tongue, or throat or trouble breathing. The most common side effects were nausea and sleepiness.
My hope is that by sharing my migraine story, and the relief I get from Ubrelvy, it can help someone else. Ask your doctor about Ubrelvy, the anytime, anywhere migraine medicine. Find more product information at Ubrelvy.com or call 8444-UBRELVY. Sponsored by AbbVie.
Kat Harrison
And we’re back. Skye, what’s been your experience with migraine med side effects? Getting prescribed [meds]? Insurance?
Skye Gailing
Yeah, so I’ve been taking different migraine medication since — well, not migraine-specific medication — since I was 13, when we started to try to treat migraine. I think I’ve been on every triptan in the class, which isn’t ideal for me; in part, well, I didn’t even know about like the stroke risk or anything. I was like, “How come I only get this many meds in like one pack?” I’ve had a tricky time balancing side effects, especially because I’m on other serotonergic drugs. So I have had, you know, issues with blood pressure, like skirting on early signs of serotonin syndrome, which isn’t ideal and it’s very, very scary. It took a long time for a doctor to finally give me a preventive, which I’m on that now. And I also take abortive and then I also take anything else to help in between. So really, I guess what I’m trying to say is I’m not well managed right now, but I’ve tried a lot!
Kat Harrison
My experience is very similar to yours, Skye. I have been on so, so many medications. I’ve had better luck with, I would say, acute [medications]. I feel like that’s never actually been my problem. Bridge therapies for me have been a little bit of a traumatizing experience to be honest. And I feel like they’re kind of hit or miss for a patient. I’m actually curious, Juliana, is that normal? Like, for instance, a nerve block — it worked for me one time, the second time I got an intractable migraine. Is that typical?
Dr. Juliana VanderPluym
It’s complicated trying to study treatments that are provided in the moment of really severe attacks. And it’s something that we’re trying to understand how to study better. But what we do sort of feel is that everyone has this threshold for having a migraine attack. And where you’re at, what kind of tips you into a migraine attack, is probably what is the underlying reason why sometimes you might respond to a treatment and other times you might not respond to a treatment.
Kat Harrison
OK, that makes sense.
Dr. Juliana VanderPluym
Because one day, you know, maybe your threshold was just lowered a little bit. And so the treatment you take is going to boost your threshold back up more easily. And other times your threshold might have been pushed down pretty low. So then when you try the same treatment, again, you’re kind of digging yourself out of a hole rather than starting from ground level as far as trying to get back to feeling good. And that’s why when we’re trying to have people use a rescue or acute or abortive treatment, whatever term you want to use, we can’t just use that one episode as the experience because each time is going to be a little bit different. So we want to get a general sense that if realistically you’re using it and more than 50% of the time, it’s really not helping you. Or you know, 75% of the time it’s really not helping you, then that’s probably not the best choice for you. But if 1 in 10 times it doesn’t work, then OK, maybe that was just not a good choice that one time but otherwise, it’s probably a relatively good option for you.
Kat Harrison
I feel like that is the hardest thing, I think, about finding a treatment plan that works for you. Because you can’t replicate it with the same success. There are a bunch of other things going on. Like as I age, my attacks have gotten way different. I moved from New York back to Michigan. The climate here, even though it’s not wildly different, still had an unfortunately negative effect on me. And I was actually thinking about when we first met you, you had said something that really stuck out to me that I wish more health providers talked about, which is the social determinants of health, and things that affect a patient beyond their control. So I would love for you to speak to that.
Dr. Juliana VanderPluym
Yeah, so I think where this often comes up, is that when we are thinking about migraine treatment, we often talk about lifestyle a lot. We talk about: What is the quality of your sleep? Are you exercising? Are you eating right? Are you getting good hydration? How is your stress management? And when you look at the context of lifestyle, that’s in your life. Now, what else is happening in that person’s life? How is their job? What are their job conditions? What are their housing conditions? Do they have access to healthy food? Do they have access to running or clean water? Do they even have electricity? You know, all these different things that we often take for granted. And unfortunately, a lot of people who are dealing with some of the biggest struggles, whether it’s based on their incomes, their housing situation, all that kind of stuff, are also the people who often actually have the highest burden of migraine. So there’s clearly a relationship there between social determinants of health or negative social determinants of health — really, we should say — and migraine, and that’s something we have to, you know, that I’m personally interested in, and I’m trying to understand better and what we can do. Because obviously, this is a societal problem, not just a doctor’s office problem.
Kat Harrison
I’m giving you all the snaps, because yes, I could not agree more. I think it actually brings up something I’m… Skye, [I don’t know] if you have ever thought about this, which is: What is an individual patient’s treatment goal? Because something that I’ve had to learn along the way is, and this is really hard as someone with chronic illness — you go to your specialist, and what you want is to never feel anything. You don’t want to feel symptoms, you want to be free of it, “be cured.” But I’ve had to realize over the years that for me, at least, that is an unrealistic treatment goal. I likely will always have some level of head pain, due to medical trauma I went through that led to my chronic migraine. Skye, do you find that you’re having to balance like, what is the goal?
Skye Gailing
Yeah, I mean, I’m really getting emotional thinking about… I’ve blamed [and] I continue to blame myself for a lot of my health issues and health goings on. Even though I’m like, “Well, I’m doing all these steps. I’m doing whatever, I need to be doing more.” And yeah, it’s hard to accept that my goal doesn’t look like “Oh, I’m healed, woo hoo.” Do I keep hoping that they’ll find the exact mutation that’s the cause for my other chronic illness? Yes, I would love to be cured. But yeah, it’s not a realistic treatment goal. It’s also hard because for over two decades of my life I thought, “Oh, I’m just lazy, or I’m just tired all the time, or I’m just getting injured a lot.” Like I had no idea that that was something that could be helped. But then when I got diagnosed… finding out the cause of all of that, and then I learned: no, it’s incurable. I’m still struggling to readjust, I think, my treatment goals.
Kat Harrison
Juliana, do you find what you’re treating patients that is a conversation that you have in terms of what is realistic?
Dr. Juliana VanderPluym
Yeah. So I think it’s extremely important to explore the individual’s goals, and sometimes I’m surprised, it might be something that they just want to be heard. They just want to be able to have someone listen to what they’re going through and confirm that what they’re experiencing is a true experience. It is a recognized experience. Often patients say, “I feel like this is all in my head, and no one’s really listening to me.” But the other thing that both of you mentioned is this idea of a sort of cure. And often what I’ve discussed with my patients is the fact that physicians are also frustrated that a lot of the conditions that we treat, whether it’s migraine, diabetes, asthma… we don’t actually have many diseases that have cures at the end of the day.
The way I always view it is I tell my patients, “We’re on a road trip together. I’m in the passenger seat, and you’re in the driver’s seat. So I’m going to show you on the road map, all the routes I think are safe, but you have to choose to turn on the car. You have to choose to put your foot on the gas. And if at any point, you don’t like the road we’re going down, you put your foot on the brake, you turn the car off, and we look at the map again.” Because we have to do this together. It’s a journey. We all wish we could get to that point of just being symptom-free, headache-free, feeling great. But unfortunately, that’s not how this disease works. And it’s a process to get to a point of finding where that person feels their best or feels, you know, that they can function and is happy at that level of disease — and hopefully it’s zero disease — but sometimes, as you’ve experienced, it’s not. It’s some degree of disease, but at a manageable level.
Kat Harrison
First of all, a really impactful metaphor I think, because I actually think that most people believe it’s the opposite. I think most people feel like their health care provider is the driver. And as the passenger, you say, “Oh, OK, yeah, I’ll try that.” This is actually a conversation I’ve had with many people in my life. And I feel like a big misconception when you’re dealing with a chronic condition is that as the patient, you have boundaries, and you have limits. I’ve definitely had to draw them for myself. But I felt a lot of freedom when I realized that that was my decision. That I was able to say, “Yes, I will do this. No, I will not do that.” And so that’s really impactful to think about the patient being able to dictate their care, because at the end of the day, we’re the ones living in the body, right?
We asked our community if they felt satisfied with their treatment plan. And the options we gave them were: yes, I’m seeing improvement; no, it doesn’t seem like it’s working, and then [if] parts of it [were working]. The results were pretty spread out: 42% said they feel like parts of their treatment are working. And I would say that’s like exactly where I am right now. What about you, Skye?
Skye Gailing
It depends on how optimistic I’m feeling on a given day, I think.
Kat Harrison
You can say it’s not working if you don’t feel like it’s working.
Skye Gailing
I feel like there’s more that could be explored. A lot of calls, phone calls, I need to make that I’ve been too tired and too much pain to make, which is another part of all of this. Yeah, I probably say I’m looking for something else.
Kat Harrison
Actually, I have a question. So if a patient is not happy with their treatment plan, do you think that that is a sign for a patient to find a new provider? Or is it just an opportunity to have a frank discussion where it’s like, “We need to try something new.”
Dr. Juliana VanderPluym
Having a discussion is always helpful, because I think it will depend on how that discussion is received, whether you need to explore having a new provider or not.
Kat Harrison
True.
Dr. Juliana VanderPluym
From the provider’s end, I can’t speak on behalf of everybody, but I think most of the time, we’re trying to do our best in a health care system that is stretched very thin. So I appreciate when patients will openly share how they’re doing. I appreciate hearing successes, obviously. But I also appreciate knowing when things aren’t going well. Because as a provider, that’s an opportunity for me to learn, obviously, and for us to engage and see how we can address things. Because there’s a lot of reasons why something may not be going well. And as you pointed out, there may be parts of it that are working and other parts that aren’t working, then I’m inputting information about, well, what’s the side effect profile of these treatments? Some side effects we want to use to our benefit, some side effects we need to avoid because you have other medical conditions. Then I have to think about you as an individual, you know, how old are you? Are you pregnant or planning on becoming pregnant? Are you breastfeeding? What other medical conditions do you have? Then I have to think about the cost of the medicine. I mean, I can recommend something, but if you can’t access it, or if it’s a non-medication based option, like biofeedback or cognitive behavioral therapy (CBT), and there’s no psychologist to do it with you, that’s not going to work. And then, of course, there’s the insurance part of the calculation, which, again, you can come up with a beautiful plan. But if insurance has stipulations that don’t match or are illogical or whatever, then suddenly that can throw the whole calculation out of order. And then most importantly, there’s the patient’s input. You know, again, I can design this beautiful plan that I think is beautiful. But if I present it to you and you say, “Actually, I don’t like injections at all. I don’t like needles.” OK, well, we have to readjust this whole calculation there.
Skye Gailing
And speaking of calculations, I know Kat and I talk about this very often, but the big question of: When is it time to go to the emergency room? In the last… I think it was March, I was in three different emergency rooms within three days. Two of those were on the same day. That was wild. But it’s, I think, a big question that all migraine patients face. I mean, you even mentioned your partner saying, “Oh, well, if you weren’t here, I’d be at the ER.” What advice do you have for patients who have to make that decision? Or what to do once they get there? Things like that.
Dr. Juliana VanderPluym
I think we’re talking more about when to go from a treatment standpoint. You’re having your usual symptoms, it’s your usual migraine attack, but you have tried your at-home rescue treatments, and they’re not working. It sort of depends on the resources in your area. But obviously, you do want to try to reach out to your local provider if you can, because they may have, as I said, things like bridge therapies that you can already have in place, potentially, to sort of try to initiate. That then prevents you from having to need to go to the emergency department. But if you don’t have those kinds of resources, then you’re in a circumstance where you often are having to escalate to access bridge therapies, basically, by going to the emergency department and unfortunately, for a lot of reasons, the emergency department isn’t the most pleasant experience for people who have migraine. The environment itself, you know, the lighting, the noise, the smells, that’s a lot. And then the people that you may encounter may not treat you very well. They may have this misperception that people with migraine are seeking drugs or that they are malingering or that they are basically just there to be a problem, which is, of course, not the case. But unfortunately, there are some people in the health field that again, just have a poor understanding and misunderstanding of what migraine is. It’s frustrating because many emergency departments unfortunately result in poor experiences. And if that’s the case, then you know, sometimes working with your doctor to have sort of a document that you can carry with you that says, “I have migraine. These are things I’ve received in the emergency room in the past. Please consider these as options for me in caring for me.” That can sometimes help, and then it has a number that the emergency room can call your neurologist. That can sometimes be a helpful thing if you are in a community where the emergency departments around you aren’t really familiar with migraine patients.
Skye Gailing
I love that idea.
Kat Harrison
It is very, very hot tip. When I was talking about treatment goals earlier, I would say, midway through my 20 years of living and chronic migraine, my goal was not to visit the ER. I was going once a month. And my goal was to create a preventive plan that allowed me to not go, and truly since then I’ve only had to go maybe twice. And it turned out it was usually connected to some type of other health issue. So for me, I just wanted to share that as a treatment win. You know, I made a goal. I wasn’t looking to never have a migraine again, but I made that a goal and my provider and I worked really, really hard to get there. So I’m very excited about that. But the last thing I want to ask because I think that Skye, you mentioned earlier — guilt or shame. I think a lot of time migraine patients feel difficult — like we’re being too pushy, or we’re having a hard time communicating because of brain fog. So I would love to hear some hope in the sense of, what do you like about treating migraine patients?
Dr. Juliana VanderPluym
You have this huge opportunity to make a difference. When we look at people who have migraine — for one, it spans across every age group, gender, nationality. I mean, it’s amongst everybody, it’s 12% of the general population in the U.S… that’s a lot of people. And often it’s affecting people in the peak years of their life when they want to be most productive, doing the most. When you take the time to engage with a patient who has migraine, and really work to try to put together a treatment plan, you can turn someone’s life around. You can give someone back a life that they were missing out on. And that’s huge. I mean, it’s tremendous. I have patients that come back just so that they can say “Hey, you know, like I’m doing well.” And that’s great. It’s what got me into this field — the opportunity to do something. Because there are a lot of things in medicine that, as I said, we just diagnose and that’s it.
Skye Gailing
Thank you so much, Dr. VanderPluym, for joining us for this episode. We learned so much from you today. I feel like we could talk for a million more hours and still not, you know, learn everything you have to teach. And thank you out there so much for listening. We hope you laughed and learned in equal measure and that your head is kind to you today.
Dr. Juliana VanderPluym
Thanks so much for having me. It’s such a gift to be able to speak about migraine, so thank you so much.
Kat Harrison
You are so welcome. We’re really thankful. I think you’re a rarity — I wish you weren’t a rarity in the sense of how you talk about the disease and how you approach your patients with a lot of compassion, but we’re lucky to have met you, so thank you.
Dr. Juliana VanderPluym
Well, thanks for having me.
Kat Harrison
Join us on our next episode where we will be talking about migraine, the ultimate third wheel in relationships.
Skye Gailing
No pressure to bring your best self, just your authentic one.
Kat Harrison
Because we’re here for you in sickness and in health. Download The Mighty app for more.