Physical Therapy as a Migraine Treatment

Summary

In this episode of 'Spotlight on Migraine,' physical therapist Dr. Sam Kelus discusses the role of physical therapy in managing migraines. He explains various techniques like exercise, manual therapy, and modalities to reduce migraine frequency and intensity. Dr. Kelus emphasizes the importance of a collaborative approach, tailoring therapy to the patient's needs and goals. He also addresses potential risks and the importance of finding a specialist in headache disorders for effective treatment.

Takeaways

• 👨‍⚕️ Physical therapy can be a beneficial treatment option for migraine sufferers, aiming to reduce the frequency, intensity, and duration of migraine attacks.
• 🏋️‍♀️ Various physical therapy techniques such as exercise, manual therapy, and modalities like heat and cold can be used to manage migraines.
• 🧠 The goal is to desensitize the neurological system that triggers migraine attacks, making the patient more resilient against them.
• 🤔 Potential benefits of physical therapy for migraine include decreased attack frequency, improved management strategies, and a reduction in reliance on medication.
• 🔍 Physical therapists can employ lifestyle interventions and stress management techniques to help patients better manage their migraines at home.
• 👩‍⚕️ Physical therapy has evolved to treat a wide range of conditions, including neurological disorders like migraines, beyond just musculoskeletal issues.
• 🚫 There are minimal risks associated with physical therapy for migraines, though some interventions might temporarily exacerbate symptoms.
• 🤗 A collaborative approach between the patient and therapist is crucial for tailoring treatments to individual needs and goals.
• 📈 Physical therapy is more effective as a preventative measure to reduce the occurrence of migraines over time rather than as an acute treatment.
• 🌟 For those with vestibular migraines, physical therapy interventions may focus on exercises that stimulate and integrate vestibular information to reduce triggers.
• 📝 The first visit to a physical therapist involves a thorough discussion of the patient's migraine experience, potential triggers, and a physical examination to identify issues that may contribute to migraines.

Q & A

What is the main focus of the 'Spotlight on Migraine' episode?

The main focus of the 'Spotlight on Migraine' episode is to discuss how physical therapy can be a helpful treatment option for people living with migraines.

Who is the guest speaker in the episode and what is his profession?

The guest speaker is Dr. Sam Kelus, who is a headache physical therapist with an extensive background in neurological disorders and is an expert on treating and managing chronic pain.

What are some ways physical therapy can affect migraines?

Physical therapy can affect migraines by reducing the frequency, intensity, and duration of attacks through various strategies like exercise, manual therapy, and modalities.

What potential benefits can people experience from using physical therapy to manage migraines?

Potential benefits include decreasing the frequency of attacks, providing strategies to manage them independently through non-pharmacological means, and improving the body's ability to reduce triggers.

What is a reproduction resolution technique as mentioned in the script?

A reproduction resolution technique is a method used during physical therapy where the therapist attempts to reproduce the patient's familiar headache through manual techniques and then resolve it with the same technique.

How does physical therapy approach lifestyle interventions for migraine management?

Physical therapy approaches lifestyle interventions by providing strategies for stress management, grounding techniques for vestibular migraines, and promoting physical activity to help manage migraines at home.

What is the role of physical therapy in the acute management of migraines?

Physical therapy can be used acutely to lessen symptoms, but it is more commonly seen as a preventative measure to decrease the frequency of attacks over time.

What should someone do to prepare for their first physical therapy session for migraine?

Someone should prepare for their first session by recording information about their migraine frequency, perceived triggers, and what helps alleviate their symptoms.

Does insurance typically cover physical therapy for migraines, and what might the cost be for out-of-pocket sessions?

Insurance should cover physical therapy for migraines, but there might be requirements like referrals or prior authorization. For out-of-pocket costs, a typical session might be around $200 for an out-of-network provider.

What advice does Sam Kelus give to those who have had negative experiences with physical therapy for migraines?

Sam Kelus advises those who have had negative experiences to try again with a different physical therapist, emphasizing the importance of finding a provider who understands their diagnosis and communicates effectively.

What is the first step recommended by Sam Kelus for individuals to start managing their migraines at home?

The first step recommended is to start becoming more physically active, finding activities that align with their values and that they enjoy, to help reduce the impact of migraines.

Outlines

00:00

🤔 Introduction to Physical Therapy for Migraines

The video begins with Molly O'Brien introducing Dr. Sam Kelus, a physical therapist specializing in headache disorders. Dr. Kelus discusses how physical therapy can be an effective treatment option for migraines, aiming to reduce the frequency, intensity, and duration of attacks. He explains that various techniques such as exercise, manual therapy, and modalities can be used to desensitize the nervous system and prevent migraine triggers. The potential benefits of physical therapy for migraine management are also highlighted, emphasizing non-pharmacological strategies for better headache control.

05:02

🔍 Exploring Physical Therapy Techniques and Risks

Dr. Kelus elaborates on additional physical therapy methods for migraine management, including lifestyle interventions and stress management strategies. He addresses the risks associated with physical therapy, noting that while there is no inherent risk, some interventions might trigger migraines. The importance of communication with the therapist to modify treatment plans and avoid triggers is emphasized. Dr. Kelus also discusses the suitability of physical therapy for individuals with comorbidities like hypermobility syndromes or POTS, and the need for a tailored approach in such cases.

10:05

🏥 Understanding the Physical Therapy Process

The conversation shifts to what a first visit to a physical therapist looks like for migraine sufferers. Dr. Kelus clarifies that no imaging is typically required unless there has been a recent trauma. The initial session involves a detailed discussion about the patient's migraine experience, potential triggers, and an assessment of range of motion and muscle issues. He introduces the concept of 'reproduction-resolution' techniques, which aim to replicate and then alleviate the headache through physical therapy methods. The session's end involves discussing lifestyle management and setting a treatment plan.

15:05

💡 Getting Started with Physical Therapy for Migraines

Dr. Kelus advises that finding a specialist or a therapist familiar with headache disorders is crucial. He explains that in most states, direct access to physical therapy without a referral is possible. He also discusses the financial aspect, noting that insurance usually covers physical therapy for migraines but policies vary. For out-of-pocket costs, he provides a general idea of session pricing. He encourages patients to track their migraines and related information to aid in the therapy process.

20:08

🌟 Final Thoughts on Physical Therapy for Migraines

In conclusion, Dr. Kelus emphasizes the importance of finding a physical therapist who understands migraine disorders, as previous negative experiences with physical therapy might be due to a lack of specialized knowledge. He suggests that becoming more physically active is a beneficial starting point for migraine management. The conversation wraps up with a reminder to listeners about the value of trying different providers and maintaining open communication to achieve the best outcomes with physical therapy for migraines.

Keywords

💡Migraine

Migraine is a neurological disorder characterized by recurrent moderate to severe headaches, typically with throbbing pain, nausea, and sensitivity to light and sound. In the video, Dr. Sam Kelus discusses how physical therapy can be a helpful treatment option for individuals living with migraines, aiming to reduce the frequency, intensity, and duration of attacks.

💡Physical Therapy

Physical therapy is a healthcare profession that helps individuals manage pain and improve movement by restoring, maintaining, and promoting physical function and overall fitness. The video emphasizes physical therapy as a non-medication approach to managing migraines, using various techniques such as exercise, manual therapy, and modalities.

💡Exercise

Exercise is a physical activity that is planned, structured, and repetitive to improve or maintain one's physical fitness. In the context of the video, exercise is one of the strategies used in physical therapy to help reduce the impact of migraines, potentially by influencing the neurological system's sensitization.

💡Manual Therapy

Manual therapy in physical therapy involves the use of hands-on techniques to assess, treat, and prevent pain and dysfunction. It can include mobilization of joints and soft tissues. The video mentions manual therapy as a method that might be used to help manage migraine conditions.

💡Modalities

Modalities in physical therapy refer to various physical agents or interventions used to promote healing, reduce pain, and improve function. Examples include heat, cold, and neuromodulation. The video discusses how modalities, particularly neuromodulation, can be part of a physical therapy regimen for migraine relief.

💡Neurological Disorders

Neurological disorders are conditions that affect the nervous system, including the brain, spinal cord, and nerves. Migraines are discussed in the video as a type of neurological disorder, and Dr. Kelus has a background in treating such disorders, emphasizing his expertise in managing chronic pain.

💡Chronic Pain

Chronic pain is pain that persists or recurs over a prolonged period, often beyond the expected period of healing. The video focuses on the management of chronic pain, specifically migraines, through physical therapy techniques aimed at reducing the frequency and intensity of pain episodes.

💡Lifestyle Interventions

Lifestyle interventions are changes in daily habits and routines that can improve health and well-being. In the video, Dr. Kelus talks about lifestyle interventions as part of physical therapy for migraines, such as stress management strategies and grounding techniques, to help patients manage their condition at home.

💡Vestibular Migraines

Vestibular migraines are a type of migraine that can cause vertigo or dizziness. The video briefly touches on the management of vestibular migraines with physical therapy, suggesting that while the evaluation process is similar to other migraines, the interventions may focus on the vestibular system.

💡Direct Access

Direct access in physical therapy refers to the ability of patients to receive physical therapy services without a physician's referral. The video mentions that in most states, patients can directly access physical therapy services for conditions like migraines, which can be particularly beneficial for those seeking alternative treatment options.

Highlights

Physical therapy can be a helpful treatment option for people living with migraine.

Physical therapy aims to reduce the frequency, intensity, and duration of migraine attacks.

Different strategies within physical therapy can help manage various headache types.

Potential benefits of physical therapy for migraine include decreased attack frequency and improved management strategies.

Physical therapy techniques may include exercise, manual therapy, and modalities like heat and cold.

Lifestyle interventions and stress management are also part of physical therapy for migraine.

Physical therapy has evolved to treat a variety of conditions beyond just musculoskeletal disorders.

Modern physical therapy is patient-centered and collaborative, focusing on the patient's goals and values.

There are potential risks with physical therapy, such as occasional triggering of migraine attacks.

People with additional comorbidities like EDS or POTS may need to be cautious with physical therapy.

Individuals with neck pain alongside migraine may benefit the most from physical therapy.

Physical therapy is viewed more as a preventative measure for migraine rather than an acute treatment.

For vestibular migraine, physical therapy focuses on exercises that stimulate the vestibular system.

The first visit to a physical therapist involves a thorough discussion and physical examination.

Insurance coverage for physical therapy varies, but most policies should cover treatment for migraine.

Patients do not always need a referral to start physical therapy, depending on state regulations.

Becoming more physically active is a key recommendation from physical therapists for managing migraine.

It's important for patients to find a physical therapist who specializes in or is knowledgeable about headache disorders.

Transcripts

welcome to Spotlight on migraine hosted

by the Association of migraine disorders

in this episode of Spotlight on migraine

physical therapist Dr Sam kellus

explains how Physical Therapy can be a

helpful treatment option for people

living with migraine he talks about

various Physical Therapy techniques

possible benefits and how to get

started hello and welcome to Spotlight

on migraine I'm your host Molly O'Brien

one of the most common questions people

ask is how can I manage migraine without

using medication well today we're going

to discuss one of those options Physical

Therapy I'd like to introduce Our Guest

Sam kelus Sam is a headache physical

therapist at cleos Physical Therapy Sam

has an extensive background in

neurological disorders and is an expert

on treating and managing chronic pain in

2021 Sam started his own practice to

help people living with headache

disorders Sam thanks so much for joining

us I'm great Molly thank you for asking

and ask me to join you today so as we

dive in I just want to mention that in

your practice you focus on phys physical

therapy for headache relief and I do

want to mention that we're going to talk

about migraine tension type headaches

and neck pain for our audience out there

so let's dive in how does physical

therapy affect migraine and one is by

trying to reduce the the frequency the

intensity and the duration of attacks

and there's different strategies we can

utilize to really help patients with

each kind of area or I guess like

parameter of their their headache type

um there's different ways we influence

that whether it's through exercise

manual therapy or using modalities and

we're trying to really change how

sensitized your neurological system is

that keeps triggering these attacks so

what are some of the potential benefits

that people can experience if they use

physical therapy to help manage migraine

and headache yeah now I do want to

clarify that physical therapy isn't

necessarily a specific technique or

intervention or philosophy because

there's a lot of different approaches

within within this Physical Therapy

itself is a profession so there's many

different you know thoughts about how we

help people uh with chronic pain

um back for like the benefits the

benefits we're looking at is to

obviously decrease how frequently you're

having attacks and they give you

strategies to better manage them

independently through

non-pharmacological means so that again

exercise manual Therapies and modalities

modalities I'm referring to like hot

cold and neurom modulation especially

with that being so so big today you

mentioned a couple methods using hot and

cold using exercises are there any other

techniques or methods that a physical

therapist might use to help someone

manage migraine yeah one of the skills

we have that we're able to help help

people with migraine better manage their

condition is you know doing lifestyle

interventions or giving them different

strategies to manage at home whether

that's grounding techniques if they have

vestibular migraine or giving them

Stress Management strategies where they

were in you know under a large amount of

stress whether at work or with family

and how to come down from those stresses

so they don't trigger attacks and make

them more resilient overall so that'd be

more like the the lifestyle side of of

healthare okay and I want to just go

back briefly a lot of people might have

an outdated view of what physical

therapy is they might think one specific

type of person is the only typee of

person that can utilize Physical Therapy

can you give us just kind of a brief

overview of what physical therapy is and

and it sounds like a lot of people can

benefit yeah so a lot of people can

benefit once upon a time it was more

that physical therapy kind of solely

focused on muscular skeletal disorders

um or people that were kind of more

infirm and needed a lot of help getting

in and out of bed but over the years and

as research has grown our our expertise

is expanded into multiple domains

whether it's neurological disorders like

migraine or vestibular dysfunction

muscular skeletal uh Burns un oncology

care there's a lot of different uh

groups of people that we can help with

physical therapy physical therapy now

has become more modernized and we have a

different different more a more holistic

approach to seeing patients and it's

much more patient centered so we really

consider you know what the patient goal

is what their condition is their values

um and taking really into account like

how do they want to get better and it's

more of a collaborative process now oh I

love that it's a collaborative process

it's not just here's the exercises go do

them I'll see you next week you know

we're not going to get the benefits of

the physical therapy if we're not

communicating on what's working for you

and what's not especially with migraine

because some of our treatments might

actually make you feel worse at that

time or the day or two later we need to

talk about okay is this you just didn't

have a good response to that particular

intervention is it everything we're

doing is irritating your condition and

do we really need to work together to

modify what we're doing or is no I think

that's just an outlier let's try it a

few more times and and make some changes

here and there to make sure we're not

constantly triggering attacks with

interventions let's get back on track to

uh we talked about a little bit of the

benefits of physical therapy for

migraine and managing headache let's go

into some of those risks because you

mentioned some people might actually get

worse before they get better or some

interventions uh might actually trigger

attack so talk to us about some if there

are any potential risks there's no real

risk with seeing physical therapy for

migraine you might get occasionally get

triggered from attack but you can also

get triggered by attacks just because it

was that day of the week and we don't

really know why so we can always

correlate everything to physical therapy

that's why that collaborative

communicative communication with your

therapist is really important now there

are times where make sure that you know

if every time they do a certain exercise

or a manual therapy technique it's like

now I feel way worse after that then

they need to change that treatment

approach and avoid that activity because

obviously that's something that we want

to avoid now does that mean we can't

ridit it it later if we think it's an

appropriate exercise or treatment yes we

can but maybe that's something that

you're just not ready for and we need to

get back to it um some other people that

might need to be a little more cautious

about getting into physical therapy is

people with like additional

comorbidities like hypermobility

syndromes like EDS or who have pots it's

not like Physical Therapy can work with

those individuals as well and those

individual conditions but when we have

migraine as well as pots as well as EDS

and a lot of patients that I see have

all three conditions that we need to

work together on really figuring out

okay where do we want to start really

focusing what treatment might irritate

another condition and how do we prevent

that can you talk to us about um is

there any type of person that might

benefit the most from utilizing physical

therapy and on the flip side is there

anyone that might not benefit or uh just

really should not try physical therapy

for migraine or headache yeah um for the

people that would benefit the most I

think if you're having neck pain with

your headache whether it comes on before

during or after there's a a higher

potential benefit of physical therapy

just because the neck seems to be

involved in some way whether it is a

primary Trigger or it's being referred

to from migraine which can also happen

so sometimes we have neck you can have

neck pain with migraine but that doesn't

necessarily mean anything is wrong with

your neck but we can't do that until we

screen for it right um then there's

other things that we can do as far as

let's say you don't have a neck problem

but we're able to stimulate or trigger

your familiar headache we can do manual

and exercise interventions to help with

that and let's say I there's like a

patient I saw last week that I wasn't

able to reproduce their headache in any

way typically if I'm not able to produce

any types of symptoms those people are

less likely to benefit from the Hands-on

Physical Therapy of every session but

what they would benefit more from is

getting on a if they don't already do it

a regular physical activity program both

generalized like aerobic and generalized

strength and then a neck and shoulder

specific strength

program okay I like that idea I I need

to get in

there um do you look at physical therapy

as an accuse or preventive option for

migraine or is it both I look more to

physical therapy as a preventative

measure so we're looking to decrease

your attacks over time so to help

prevent them and improve your body's

ability to reduce triggers but it can be

used uh acutely as well I've had

patients come in with a migraine attack

and be able to leave without one um I

feel that's more that's not a common a

common occurrence though I feel like

once they come in with with a migraine I

can lessen some of their symptoms but

not abort them completely um so it can

be used as an acute but I don't think

it's a a strong um a strong part of

physical therapy and the management of

migraine I think we're looking to help

you on the long term so reducing

headaches from you know 15 20 days a

month and getting you down to you know

less than eight less than four a month

okay and you had earlier mentioned a

little bit about vestibular migraine and

physical therapy for V vular migraine

are the approaches the same are they

different can you briefly tell us a

little bit about that yeah as far as the

evaluation goes I think the evaluation

should be the same I'm I'm going to be

looking for those types of triggers and

symptoms during the

examination what would change over the

course of that plan of care would be the

types of interventions or exercises that

you're doing are meant to more stimulate

your vestibular system and how your

brain um integrates that vestibular

information

from the ears the eyes and the upper

cervical spine um to decrease that

cervical Trigger or decrease that

vestibular trigger for

you can you and obviously every Clinic

is different but overall in general if

someone is interested in utilizing

physical therapy for migraine or

managing their headache can you walk us

what a first visit looks like do we just

walk right in and hop on a table do you

need x-rays or Imaging um is it more

about the conversation what does the

first visit look like so I don't need an

x-ray or MRI or anything the only times

I would really want that information

first is if you just got out of a

traumatic injury that's either

exacerbated your headache condition or

is cause your headache condition so like

a whiplash injury concussion a fall down

the stairs that we really need to make

sure that structurally everything is

okay and safe to use Physical Therapy

interventions because sometimes it might

not be until that itself is corrected

and that might mean surgery or other

medical type care before you come to

physical therapy um so a first session

with me you know somebody comes in once

you know they we do our intake they fill

out all their paperwork and then we sit

down and usually the first 20 minutes 30

minutes of a session is really going

through this objective what is their

experience with migraine how does it

present to them what is their pain like

do they actually experience just

migraine or they're experiencing other

headache types with migraine because

that is also pretty common to also have

Tension Headache or something else going

on and differentiating those two

headaches and what the potential

triggers are and if they don't have

triggers we go into okay we need to

start tracking this while we're in

therapy together so I can see what

mightbe is benefiting you and what is

not benefiting you and really help kind

of hone in on certain treatments and

what's going to be most effective for

you because I don't want to give you

know four or five exercises fix this

sleep pattern talk about this diet issue

if I only needed to talk about one or

two issues I'd rather just focus on one

or two issues

and once we kind of once I we go through

this subjective which that gives me a

lot of information on what I want to do

with my physical exam we get into the

physical exam I generally I look at um

range of motion uh muscular SK or other

muscular scill issues like trigger point

uh joint Mobility which is a little bit

different than range of motion um and

then the newer technique that's utilized

is what's called A reproduction

resolution technique or test where we're

trying to see if we're able to reproduce

your familiar headache with that's

migraine or attension type headache and

reproduce that with this manual

technique and then also resolve it with

that same technique wow that sounds

fascinating it's pretty fascinating um

and it's it's it's actually the

treatment itself which is uh really cool

and and fun to see as well but once we

get through that physical exam we sit

down we talk about what I think we might

need from a lifestyle management

perspective okay these are the areas

where we want to start focusing at home

here's what I think we need to do in

physical therapy and this is how long I

think the treatment plan is going to be

and here's what might cause us to take

longer to achieve your goals if like

certain things come up or you're not

responding well or certain exercises are

becoming problematic where I thought

they would be uh effective they are

actually not helping us and a lot of

things you said seem to me like it's

it's really good for people to listen

watch read this before they head into a

physical therapy appointment because if

they have an idea of what's coming then

they can prepare and and maybe get more

out of their first session or

appointment whatever it is just to be

prepared yeah I think the biggest things

is to be prepared is that you know if

you're not already doing it now and

you're you're having you're having

frequent migraine or other headache

attacks is to start recording that

information how many days a week you're

doing it uh any perceive triggers uh

what medications or other things are

helping you feel better whether it's

like laying down a hot shower a ice pack

on the head that information can really

tell us how you're managing at home and

also give us a a point of reference of

okay this is where you are when you came

in where are we trying to get you to are

you at 16 headache days a month great

okay we go through our treatments oh now

you're kind of going up this doesn't

seem to be working should we stop or are

we seeing that you're getting better but

something seems to be missing what other

treatments can we start doing or are we

starting to notice you know what your

headache days haven't changed but you're

taking less medication to get rid of

your headache and now you're just using

your you know neurom modulation device

or now you're just laying down in bed

for an hour or two and getting up and

you feel like you can still participate

in the rest of your day right so because

just just having less headache days

isn't the only way to measure success

sometimes it's are you accomplishing

more are you able to you know go out

longer for longer periods of time with

your family and friends are you able to

eat certain foods or um get more rest

than you usually are certain things show

improvements before necessarily that

headache days

improve so Sam along those lines of

preparing for your first session kind of

giving people an idea of what they can

expect how can someone actually get

started doing physical therapy for

migraine and or headache do we need a

referral slip from our Primary Care um

can we just walk in can you call up

anybody you want do you look for a

specialist how can you go about getting

started I would definitely look for a

specialist um or at least somebody that

is familiar with um neck pain preferably

headache but there's not many in the US

that Focus specifically on headaches I

only know five other therapists in the

in the United States that specifically

do that at least that those are the ones

I've been able to find online um I'm

sure more are out there they're just

their presence online isn't as as strong

as some other people um you don't need a

a prescription to get started with

physical therapy in Most states you can

just call the clinic and ason

evaluation um like here in in

Pennsylvania I can treat patients with

for 30 days without a prescription if I

feel like treatment plans are going to

go over that then I reach out to the

physician um and get that prescription

if I don't already have it okay good to

know and yes thank you for clarifying

because it is obviously every

circumstance is different and every

state is different especially with

insurance yeah I think the majority of

states have direct access now now so you

can just go to physical therapy now that

specific Clinic might say we're not

going to see you until we have that

that's just part of their policies and

procedures um but in most States no you

do not need to um I wouldn't just go to

Every like we were saying like I was

mentioning before I wouldn't go to just

any physical therapist I would try to

find people that specialize um I know in

more rural communities that might be

even more difficult but that's not

something that those therapists should

be able to reach out to somebody like

myself or other play people that are

experts in the conditions because we're

more than happy to help you know guide

them on possible treatments and and

reach those patients that we can't

necessarily provide care to because of

our Geographic

locations because we were kind of on

that track let's talk a little bit about

how we mentioned that insurance is

different for everyone but from what

you've kind of seen in your practice

giving kind of a ballpark generalization

does insurance cover physical therapy

for migraine um and for folks who might

pay out of pocket what are we looking at

for a typical session just in general if

you can yeah um Insurance should cover

physical therapy for a migraine because

we wouldn't really say there's not like

that limitation just because of the

diagnosis that we're not being able to

treat for physical therapy um so they

would there's other issues that the

insurance company might want like they

might want you to start with a referral

first and they would not cover um

sessions that weren't being referred to

um you might also require prior

authorization that's dependent on the

insurance provider you have so before

you even go to physical therapy your

doctor needs to provide or submit uh

prior authorization so you get

permission to physical therapy from your

Provider from your insurance

provider um and there's a lot that can

kind of go into with that here in my

clinic I'm an out of network provider so

what that means is that P patients

provide uh payment to me up front and

then we're submitting um reimbursement

claims back to their insurance provider

um I'm somewhere in like the median of

prices for out of network cost which was

about $200 for a one hour session Okay

so

I feel like we've covered a lot here and

I want to give people just a little

tidbit to get them started get them

excited about using physical therapy for

migraine are there any uh tools

approaches stretches is there anything

that we might be able to do at home to

help

us as we incorporate these tips into our

daily life to maybe help reduce the

impact of migraine or is there anything

that's safe you know this is a one- siiz

fits all so want to make that clear but

is there anything that people can start

to do at home um to help them with

migraine yeah I think the biggest thing

to start doing from a physical therapy

perspective is to start becoming more

physically active I don't want to

necessarily say exercise because that

can mean different things for different

people and I feel

like we've gotten to the point with a

lot of people accusing people of not

exercising enough and that becomes

patient blaming and it's really hard to

exercise when you have a chronic pain

condition but I want to find ways for

start to start becoming more physically

active whether it's just walking playing

with your kids gardening that's always a

good place to start because physical

activity is really necessary for the

body because it has a lot of different

effects both physiologically and and

neur neurologically and how movement and

exercise affects our brain how we work

to integrate different sensory type

information so that's the best place to

start because we're trying to get you

back to becoming more physically active

so that's really the best places find

what works for you right now so you can

start in that process of becoming more

physically

active okay and I love that too it's

becoming more physically active it

doesn't necessarily mean exercise

because we all look at exercise

differently and gardening is not easy no

no it can take a lot of time to and it

can be you know exhausting and tiring

dur the day you're doing a lot of

movements and I mean I like gardening so

uh definitely encourage that I mean I

and I also like I prefer exercise but if

that's not what that person wants well

then we need to find something that

aligns with what I think they need but

what fits their values and that that

again goes back to that collaborative

process of okay I know what I think you

need how do we fit that into the

lifestyle that you want to live yeah

because if they're not going to do it

then it's no one's going to see

Improvement so you want to make sure

it's something that a person is going to

do and enjoy

hopefully all right samel as we wrap up

our conversation ation here which has

been so interesting and thoughtful I'm

curious if you have any final thoughts

for our followers out there about

utilizing physical therapy to help

manage migraine yeah I think one of the

big things that I've come across over

the last uh two years trying to help

people with migraine and other headache

disorders is that they've tried physical

therapy before and it didn't work for

them or it made them feel a lot worse

and that's really common especially when

you get a provider that doesn't really

understand uh headache disorders very

well and when I came through PT school I

think we just learned about something

called cervicogenic headache where the

neck pain was being referred into the

head and that can be misinterpreted at

for people with migraine where they're

having neck pain it's causing a headache

well that's not the same thing even

though the neck is part of their problem

in that headache the condition is a

little bit different and there's more

neurological involvement for somebody

with migraine so even though you've gone

to another provider that doesn't mean

that they really understood your

diagnosis and if they were falling short

and providing you good interventions

because they didn't understand the path

of physiology of what you were dealing

with that's probably why they were

missing the mark and making it worse so

always try to you can always look for a

new physical therapist each physical

therapist you see will not be treating

the same exact way as a person you

previously saw just make sure that that

person you feel safe and comfortable

communicating with and you feel like

they are listening to you and your

concerns during

sessions that is absolutely such

valuable advice because I think people

dealing with chronic pain or health

conditions you get really discouraged

especially if you try to treatment and

it didn't work but try again especially

dealing with the provider you don't know

if the next provider is going to be like

that yeah it's true it's

tough well that wraps up this episode of

Spotlight on migraine I'd like to say a

big thank you so much to Our Guest Sam

kelus thank you so much for joining us

and giving us all of your Insight yeah

thank you so much for having me Molly

appreciate it it was such a good

conversation and to our followers out

there we really appreciate you following

along that wraps up this episode of

Spotlight on migraine I'm Molly O'Brien

and we'll see you next

time