Dr. Serena Orr, a Calgary neurologist and an associate professor at the University of Calgary’s Cumming School of Medicine. She’s spent her career studying the physiology of migraine attacks, seeking to ease the suffering from the debilitating condition for millions of patients. Recently, she collaborated with researchers at the Hotchkiss Brain Institute and the Barrow Neurological Institute at Dignity Health St. Joseph’s Hospital and Medical Center in Phoenix, Arizona, to update treatment guidelines for migraines in emergency departments.
The recently revised guidelines, which Dr. Orr co-led, looked at 26 studies from the last nine years. Most of these studies were conducted in patients presenting to the emergency department for acute migraine therapy. The findings were published this week in “Headache: The Journal of Head and Face Pain,” marking a significant advancement in migraine care.
Dr. Orr has been a leader in migraine management, having co-written the 2016 guidelines that were later adopted in Canada. Beyond her own efforts, she’s vigorously lobbied the Canadian Headache Association and lobbied fellow neurologists and emergency room doctors. Her hope is to push them to adopt these new recommendations into practice.
Personally experiencing the challenges of a severe migraine attack provided me with important insight to the issue, Dr. Orr stated. I didn’t realize just how horrible it was until I witnessed it myself. It is super ironic.
In fact, migraines are now considered one of the most prevalent neurological diseases across the globe. Dr. Orr was surprised to learn that these debilitating headaches are primarily considered genetic in origin. Issues such as childhood trauma, environmental conditions, including weather and altitude, can exacerbate symptoms.
In her studies, Dr. Orr focused on the effectiveness of anesthetizing specific nerves to receive relief from chronic migraines. “The occipital nerves at the base of the skull bring in pain signals to the same area of the brain where pain signals from all over the head are coming in,” she explained. “By anesthetizing these nerves, patients get relief.” She further elaborated on the procedure, stating, “A needle at the back of the head and pushing in a local anesthetic for the nerves to numb the back of the head also changes the pain signaling from all over the head and the brain.”
When asked about patients’ acceptance of this more experimental treatment approach, Dr. Orr sounded optimistic. “I don’t think most patients would mind having needles applied by physicians or nurse practitioners,” she remarked.
Even with this advancement, Dr. Orr did temper expectations when it comes to universal effectiveness. “Does that mean it’s a cure for everybody? No,” she said. We don’t have anything for migraine that we know everyone will have a positive response to. In this case we’re confident it’s going to help a lot of people, thanks to good quality research.
Dr. Jennifer Robblee, a Barrow Neurological Institute neurologist and migraine specialist. She was one of the two principal investigators of the study with Dr. Orr. She highlighted the potential impact of these updated guidelines, stating, “This update marks a major change in emergency department migraine care and implementing these treatments can improve patient outcomes and reduce reliance on opioids.”
Armed with these advancements, Dr. Orr doesn’t stop her efforts for better migraine management practices implemented all over Canada. “They are American Headache Society’s guidelines but now that they’ve been published this week I’m in touch with Canadian organizations,” she said, expressing hope that these guidelines will soon receive endorsement from relevant entities.
