Congratulations to Miriam Segal, MD, who is now board certified in Headache Medicine, earning the distinction of United Council for Neurologic Subspecialties (UCNS) diplomate. Dr. Segal’s achievement is unique because she is also board certified in physical medicine rehabilitation and brain injury medicine, a distinctive background among most other physicians earning this certification. She is an attending physiatrist at MossRehab Elkins Park Drucker Brain Injury Program and the Brain Injury Medicine Fellowship director at MossRehab.
We talked with Dr. Segal about her new certification and background as well as her interest in headache medicine and how it relates to her current practice in brain injury medicine.
Tell Us About Your UCNS Headache Medicine Certification.
The UCNS is a nationally-recognized certification for emerging neurologic subspecialties. Headache medicine is among its various subspecialties. Achieving certification in this area recognizes that I met the requirements and standards of knowledge set by experts in this subspecialty and I am now board-certified to practice in this field.
What is Your Medical Background and Training?
My educational background includes training at the New York University School of Medicine where I obtained my medical degree in 2002. I also completed a four-year residency and became board certified in Physical Medicine & Rehabilitation (PM&R), also known as physiatry, in 2002. As I chose to focus on the rehabilitation of patients with brain injuries, I completed a brain injury medicine fellowship at John F. Kennedy Medical School in New Jersey in 2008 and became board certified through the American Board of Medical Specialties in 2014.
I am also a member of several professional societies where I have presented papers and attended meetings and educational seminars, including:
You Predominately Treat Patients with Brain Injuries?
The majority of my patients have traumatic brain injuries as well as acquired brain injuries, such as strokes, brain bleeds, or brain tumors. I treat patients in both the outpatient clinic and the acute rehabilitation Drucker Brain Injury Center at MossRehab Elkins Park, inpatient rehabilitation unit. In the outpatient clinics, a good portion of patients has mild traumatic brain injuries, typically known as a concussion. The number one complaint of patients experiencing a concussion is a headache, making headache treatment a large part of what I do.
You Are Among the First Doctors Board Certified in Physical Medicine Rehabilitation, Brain Injury Medicine and Headache Medicine?
Most doctors who pursue the headache medicine certification are neurologists who completed fellowships in this field, with very few numbers from other backgrounds such as PM&R like myself. What is unique is that I am board certified in PM&R as well as brain injury medicine. I am not aware of any doctors that share this background taking the headache medicine boards.
As the headache medicine subspeciality is rather new, the accrediting body allows for grandfathering, which means that if you’ve practiced in that field for several years, completed continuing medical education, possess a certain amount of knowledge, and meet other criteria, you can sit for the board examinations even if you haven’t completed a UCNS-accredited fellowship in headache medicine. As I’ve been practicing for quite some years in brain injury medicine, treating patients with headaches, and taking continuing courses for headache medicine, the UCNS allowed me to sit for these boards. It was a bit intimidating as the UCNS specified that doctors who completed a fellowship program in headache medicine have a higher chance of passing. So, I am proud of myself for obtaining this certification. I’m probably among the first physicians to be board certified in PM&R, brain injury medicine, and headache medicine!
Why Did You Pursue This Certification?
In my practice, I’ve done quite a bit of headache medicine as headaches are a major complaint of my patients with brain injury. In the last few years, I’ve taken a deeper dive on this subject by reading and attending professional meetings to educate myself. My goal was to attain skills that would better help my patients. I’ve become involved with the American Headache Society and joined its post-traumatic headache interest group where I enjoyed discussing post-traumatic headache with other experts in the subject. I decided that a good way to learn even more was to become board certified in headache medicine, which has been a nice achievement. The best reward is improving the lives of my patients suffering from headaches.
Being a migraine sufferer is another motivating factor. It makes me more empathetic toward my patients because I know what it is like to have debilitating migraine attacks. Patients with migraines can have symptoms up to 24 hours before the actual attacks, and even after the migraine, people may experience what we call a postdrome or a “migraine hangover”. Just one attack can result in three to four days of diminished productivity or function. Migraines can affect a person’s work, relationships, lifestyle, overall function, and quality of life. If you’re a modern person, you are busy with a job or a family. It’s debilitating to be out of commission, not to mention physically painful.
What Does This Certification Mean to You and Your Patients?
Treating post-traumatic headaches is part of what we do as brain injury specialists. Many people suffer from headaches and headache-related disabilities, but more so patients with brain injuries. When we run out of tools in our toolbox, we refer our patients to headache medicine specialists. As there are not many specialists, it may take months or even longer for a patient to get an appointment. Delays in treatment are one of the factors that pushed me to start doing more headache management. When patients are suffering from headaches, it is worth the effort to get them treatment sooner.
As I have gained confidence and more skills, I’ve been able to help my patients and reduce the waiting time to access a headache center by getting treatments going myself. Initially, it started with giving BOTOX injections. As I have already been administering them for other conditions related to brain injury, I learned the protocols related to headaches and started doing that for patients. That’s where I gained the momentum to add more tools to the toolbox so I can treat my patients more efficiently. There have even been a few of my patients with whom I’ve been able to pick up on more unusual headache syndromes.
Will You Expand Your Practice to Include Headache Patients?
I’ll start accepting more patients who don’t necessarily have a brain injury but struggle with headaches. I had already started doing that a little bit even before becoming certified, but now I will probably build a headache practice at MossRehab. I don’t know how quickly that’s going to happen because I already have a busy brain injury practice and will need a team of therapists to help. I’m still basking in the fact of receiving my headache medicine certification. It’s exciting!
Was It Challenging to Achieve this Certification During the Pandemic?
In February of 2020, I signed up to take these boards thinking that would give me eight months to study. Then, in March, COVID happened. It is a crazy time in the world. Personally, I’ve had struggles for the last few months; it was no easy feat to get my certification. I’m proud of it because I studied a lot and not being a board-certified neurologist or having completed a residency program in neurology or a fellowship in headache medicines, put me at a disadvantage. I’m now in a unique position being board-certified in headache medicine as well as PM&R and brain injury medicine.
Do You Think Enough Attention Is Paid to Headache Medicines and Treatments?
Headache medicine is getting a bit more attention these days. There’s been an explosion of new treatments in the last few years that are game-changers, particularly in the treatment of migraines. It is an exciting time for headache medicine, and I think that it’s garnering more attention.
What are Some Headache Medicine Breakthroughs?
The biggest ones are drugs that inhibit a chemical in our bodies called CGRP (calcitonin gene-related peptide) that plays an important role in the pathophysiology of a migraine. For many patients, these drugs significantly reduce the number of migraine attacks. It’s extremely well-tolerated in addition to being very efficacious. There are also some new medications for abortive purposes, meaning that they don’t prevent but can help stop a migraine attack. For a long time, the most effective medications for aborting a migraine weren’t suitable for individuals with any vessel disease, coronary artery disease, or anything similar to that. So, these are new options.
A lot of new developments exist in the area of neuromodulation. A few devices are on the market are FDA-approved not only for migraine treatment but prevention. Of course, BOTOX injections are becoming more widely available to patients.
What Advice Can You Give to Someone Suffering from Migraines?
Patients with migraines and headaches could benefit just from education. Different behaviors can empower people to decrease their symptoms. I think an improved level of awareness among patients would be beneficial in treatment. Websites such as the American Migraine Foundation can serve as resources. And, as previously mentioned, several new treatments are on the market. Migraine sufferers should go to a headache medicine specialist since there are more options than just a few years ago. Headaches and migraines are not something a person should suffer from anymore.
Request an appointment with Dr. Segal.
Read about the MossRehab Traumatic Brain Injury Program.
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