Interview with Susan Hutchinson, MD, author of “The Woman’s Guide to Managing Migraine: Understanding the Hormone Connection to find Hope and Wellness”.
Dr. Able: “This is Dr. Able introducing and talking to Dr. Susan Hutchinson, who is a board certified family physician with a sub-specialty in headache. She just wrote a very good book called “The Woman’s Guide to Managing Migraine: Understanding the Hormone Connection to find Hope and Wellness”. Susan, thank you so much for agreeing to this interview.”
Dr. Susan Hutchinson: “You’re welcome, it’s a pleasure to be with you.”
Dr. Able: “Tell me, what motivated you to write this book?”
Susan: “Well, what I was finding is over the years and focusing on headache patients in my practice, there seemed to be, on the one hand neurologists who these headache patients were being referred to and often the women would point out to the neurologist if there was a hormonal connection to their migraines and the neurologist would say, “ Well, I don’t do anything with hormones, go back to the gynecologist or your primary care physician.” The patient would then go back to the gynecologist who said “I don’t know anything about migraine.” And so there seemed to be a need to bridge that gap in that for many women, in fact about 60% of women migraineurs there is a hormonal connection to their migraines and specifically there appears to be a worsening of the migraines around their menstrual period and in some cases ovulation and this was a need that I think needed to be addressed. And so part of the reason for the book was to empower women with the information that they could then use and take to either the neurologist or their primary care physician or their gynecologist and say “Look, I was reading about these things. Could we try some of these things?” Because I think, medical practices today often there is such a scarcity of time and often patients are being booked every 15 minutes. So the idea was to give women migraine sufferers the information they need and then hopefully that can open up dialogue with their physicians and help ultimately create in better care for them and less burden of the migraines in their lives.”
Dr. Able: “Well Susan, how is it that you know this connection and these neurologists and obstetricians and gynecologists do not?”
Susan: “Well, I think it is my background and training which is why I felt it was important to bring this book to market and specifically I am board certified in Family Medicine, starting practice in 1985, but very quickly for me and I think this is true for many women primary care physicians, we very quickly do a lot of gynecology and women’s health in our practice. For example, there are many women and I’m sure that this is true all across the country, if they are a woman family physician and then they are in a practice with male family physicians, women naturally gravitate towards the women providers for their gynecological care. And I think for their care in general, you know things like birth control and talking about your periods, I think women also are more comfortable opening up to women when it has to do with thinks like depression, complaints about fibromyalgia, I think they feel their complaints are less likely to be dismissed. So, I already had a lot of women’s health background and I was actually recruited to join a large women’s OBGYN group in Irvine in Orange County and so for eight years I became part of a large women’s healthcare group and our goal was complete, comprehensive care for female patients. So that a woman could come to see us for all of their needs and within that practice I was allowed to start a headache and mood focus to my practice, but in a sense, I had a practice within a practice. And I felt there was a real need there in that not just neurologists were referring to me since they didn’t want to do anything with hormones, but also even within the group I was in, the OBGYN’s were referring to me, the internal medicine. So I began very passionate to try to take care this group of women, if you will, that had migraines that often, these migraines were complicated by hormonal issues and other comorbid conditions such as depression.”
Dr. Able: “What’s the take-away message for a woman reader?”
Susan: “Oh, yes, no, I try to be extremely practical and for example, my approach to menstrual migraine is carefully outlined in the book and I’ve already had feedback from the book as I do put my email on the book and I would like for your feedback and already women are telling me “Based on your book, I’m going to the store and getting this herbal supplement or I’m doing this.” And in a nutshell, there’s a lot more detail in the book, but I look at specific hormonal regimens that I think can be helpful and this is not just based on my experience, this is actually based on clinical studies. And then I also talk about the role of herbal prevention including magnesium for prevention of menstrual migraine, I talk about where nonsteroidals such as Aleve or Motrin might fit in. I talk about traditional preventives, so I think there is extremely specific information that that woman patient can then put into practice. Some of the things she can do don’t require a prescription or even a visit to her doctor. But some of them then at least can open up at least specific dialogue and hopefully lead toward better more effective medical management. “
Dr. Able: “Well, I can see how that would empower a woman, that she could do something on her own and see how it works and then go back to her doctor and discuss it”.
Susan: “Yes, and I think that’s again, that’s why I wrote the book because many women, they might be in small rural communities all across the country where there isn’t even such a thing such as a headache specialist. And so, this can give them the information hopefully to work with their gynecologist and or their primary care physician and perhaps not even need to see a neurologist for management of their menstrual migraines.”
Dr. Able: “So now, even if you’re not a woman who suffers from menstrual migraine would this be a benefit to other people?”
Susan: “Yes, I think it can be a benefit in several ways. One is that there is a lot of specific information about treatment of migraine in general, what causes migraine, because we know from studies patients don’t just want medications for their migraines. They want to know what causes them, “What can I do to avoid them? Why do I have them?” So even for a woman headache sufferer who either doesn’t know if her headaches are migraine or she doesn’t really think there is a hormonal connection, I think it still could be very helpful. An in addition, I tried to include information that I think would be helpful for the non-migraine family member, the co-worker because certainly migraine cuts across the effect of not just the patient, but it could affect the dynamics of the family, the work situation and I think often co-workers or family members. They’re perplexed because they don’t quite understand the disability that’s associated with migraine and for example they often say “it’s just a headache, get over it.” So I think this can also empower and give information to people that are affected by those that have migraines.”
Dr. Able: “So many times headache is considered part of PMS and it’s just dismissed. Do you have a section on that?”
Susan: ”Yes, I do, and I think I made it clear in my book that headache is not just part of PMS and I was certainly affected by that thinking years ago and I can remember countless times women would come in to see me and I would be doing their annual PAPS smear also known as the Well Women Exam and they would start telling me about these bad headaches with their periods. And I would look back at the original history forms and they never even marked the box that said “headache” and I said why did you never even tell me about these before? And they said” Well I thought there was nothing I could do for them. I thought it was a burden I just had to accept.” And I’ve actually had patients tell me that their male gynecologist said “You know, Honey, it’s just a headache, get over it.” So I think for years women have been taught that yes, headache is just part of the whole PMS set of symptoms. But now we know that migraine is completely separate from that and for most women if they get a predictable headache with their period, almost 100% of the time, that would be menstrual migraine and that needs to be looked at and treated separately than PMS.
Dr. Able: “I understand too, that you’re going to do some programs called Destination CME with Primary Care Network. Could you explain what your role in that is?”
Susan: “I’ve actually been a speaker for Primary Care Network for a number of years and they’re known for putting on very high quality, interactive engaging programs for Primary Care. But, this is going to be different because it is going to be much more focused on those difficult, challenging, complicated patients in our practice and these are going to be located in destination areas. I know one of the locations is Hilton Head, for example, another one is Captiva Island, Florida and this is designed for providers that really want to go beneath the surface and try to get very practical information on how to treat these challenging patients in our practice and it’s not pharmaceutically sponsored. And what’s really unique about this is there is only going to be three of us that are speakers or presenters and we really want to encourage participants to come with case studies, come with questions. We’ll be breaking into workshops and I know for me when I look at my schedule, there’s a small percentage of my patients that creates most of the problems for myself and my staff. And a typical patient comes to mind that perhaps comes in and yes, they have migraines, but they have fibromyalgia, they have depression, they may have issues going on in their home and sometimes they come in and they just have that depressed look and you feel nothing you can do helps them. And it’s those kind of patients that really, I don’t know the exact statistics, but I would say that probably for many of us, probably 3-5% of our practice, you know, brings us 95% of our problems. And so, I think that’s what we want to do in this, is really focus on those difficult, challenging, complicated patients in this on a very interactive format.
Dr. Able: “So you do have answers so that people like that can be helped?”
Susan: “Oh, I think so, I think that those of us that are presenters, the three of us, we have a lot of experience with this type of patient and yes, we may not have a miracle cure, but I think that we can work with the participants and engage together and say “You know, what’s the best way to approach these patients? “ Particularly when you’ve got all these different conditions and we’ve got a lot of psychological issues going on along with the more straightforward medical issues and some of the topics we’re going to cover would be Migraine Headaches, Diabetes, Drug Addiction, patients that are narcotic seeking, how do you deal with them? And again, many of these patients having comorbid conditions, so they don’t just come in with one condition and how do we work with these kind of patients in an effective way, particularly in a busy primary care setting?”