Sweat and Resilience: Balancing Chronic Migraine with Fitness Goals

Summary

The Head Start: Embracing the Journey Episode Title: Sweat and Resilience: Balancing Chronic Migraine with Fitness Goals
Host: Nora McInerney
Guest: Ivelisse Rivera Salgado
Release Date: May 20, 2025

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Introduction

In the season three premiere of The Head Start: Embracing the Journey, host Nora McInerney delves into the intricate balance between managing chronic migraines and maintaining fitness goals. This episode, titled "Sweat and Resilience: Balancing Chronic Migraine with Fitness Goals," features a heartfelt conversation with Ivelisse Rivera Salgado, a Botox-treated chronic migraine patient and a prominent figure in the health and wellness space. Alongside insights from Dr. Christopher Rhine, a headache specialist, the episode offers a comprehensive exploration of living a "soft life" amidst the relentless challenges posed by chronic migraines.

Meet the Guest: Ivelisse Rivera Salgado

Nora introduces Ivelisse Rivera Salgado, highlighting her multi-faceted background as a former athlete and military service member. Ivelisse’s journey from active duty to becoming an advocate for chronic migraine sufferers is both inspiring and relatable. She shares her experiences with chronic migraines, the emotional toll of the condition, and how it intersects with her passion for fitness and wellness.

Ivelisse Rivera Salgado [06:01]: "This is my first little podcast, and I can't wait to share my story and my experience with everyone."

The Intersection of Fitness and Chronic Migraine

The discussion begins with Ivelisse addressing the paradox of maintaining fitness routines while grappling with chronic migraines. She explains how her early introduction to Pilates during her military service became a pivotal part of her coping strategy, especially as running—a once-beloved activity—became a migraine trigger.

Ivelisse Rivera Salgado [10:40]: "For me, my triggers would be getting really hot. So that was like working out. Like most workouts, you're gonna get really hot."

Nora reflects on the military origins of Pilates, emphasizing its role in rehabilitation and core strengthening, which clashed with Ivelisse’s initial perception of fitness as a mandatory, sometimes detrimental activity due to her migraines.

Personal Experiences with Chronic Migraine

Ivelisse provides a vivid account of her migraine attacks, recounting an incident during her mother's 50th birthday celebration at a theme park. She describes the onset of symptoms—visual disturbances and escalating pain—and the difficult decision to isolate herself to manage the attack, highlighting the invisible nature of her condition.

Ivelisse Rivera Salgado [18:07]: "When I felt... the floaters in my vision, I stepped away because I'm like, I don't want them to see me like this. I'm not trying to ruin the birthday, but I had to separate myself."

Emotional Management and Self-Compassion

Ivelisse candidly discusses the emotional challenges of living with an invisible illness. Initially, she struggled with denial and secrecy, fearing judgment and misunderstanding from others. Over time, she learned to embrace self-compassion and transparency, recognizing the importance of conveying her condition to foster empathy and support.

Ivelisse Rivera Salgado [19:38]: "I learned to be kind to myself and learned to give myself grace and also learning to be transparent with people."

The Treatment Journey: Embracing Botox

A significant portion of the episode focuses on Ivelisse’s treatment journey. After numerous unsuccessful medications and the emotional exhaustion of seeking effective treatment, she discovers Botox therapy through a neurologist who shared her military background.

Ivelisse Rivera Salgado [23:12]: "He looked at me and he's like, have you heard of Botox for chronic migraine?"

Ivelisse describes the Botox procedure as straightforward and effective, noting a marked reduction in her headache days over six months of treatment.

Insights from Dr. Christopher Rhine on Botox

Dr. Rhine provides an in-depth explanation of Botox as a preventative treatment for chronic migraines. He outlines the FDA-approved protocol, including the fixed injection sites and the treatment schedule. Dr. Rhine emphasizes the importance of patient dedication to the treatment regimen to achieve optimal results.

Dr. Christopher Rhine [26:04]: "Botox prevents on average eight to nine headache days a month at 24 weeks versus six to seven with placebo."

He also addresses common misconceptions and concerns about Botox, such as fear of needles and cost, reassuring listeners about the procedure's safety and insurance coverage.

Defining Chronic Migraine and Identifying Triggers

To provide clarity, Dr. Rhine defines chronic migraine and differentiates it from episodic migraine, stressing the significance of accurately tracking headache-free days for proper diagnosis.

Dr. Christopher Rhine [16:16]: "Chronic migraine is defined as 15 or more monthly headache days and eight of those days meeting the criteria for a migraine headache."

He further elaborates on common migraine triggers, including stress, hormonal changes, environmental factors like barometric pressure, strong scents, and loud noises, underscoring the importance of identifying and managing these triggers.

Building Resilience Through Consistency

Ivelisse shares how adapting her fitness routine to accommodate her condition has been instrumental in building resilience. She emphasizes the significance of consistency and self-trust, advocating for gentle self-discipline rather than punitive measures.

Ivelisse Rivera Salgado [12:22]: "Sticking to your goals and actually doing what you say you're going to do, it actually makes you trust yourself."

Nora commends this approach, highlighting the cultural pressures to constantly do more and the necessity of slowing down to care for oneself.

Inspirational Takeaways

In the episode’s concluding segments, Ivelisse reflects on her love for fitness as a form of self-expression and gratitude for her body’s capabilities. She encourages listeners to persevere through their challenges, advocating for self-kindness and the recognition that everyone's journey is unique.

Ivelisse Rivera Salgado [29:10]: "You have to have the rain to see the rainbow."

Nora echoes this sentiment, praising Ivelisse's resilience and her ability to inspire others facing similar battles with chronic migraines.

Conclusion

"Sweat and Resilience: Balancing Chronic Migraine with Fitness Goals" offers a profound exploration of living with chronic migraines while striving to maintain a healthy, active lifestyle. Through Ivelisse Rivera Salgado's candid storytelling and Dr. Christopher Rhine's expert insights, the episode fosters a sense of community and support for those navigating the complexities of chronic migraines. Nora McInerney successfully ties together personal experiences with medical knowledge, providing listeners with valuable strategies and hopeful perspectives on managing their health journeys.

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Notable Quotes:

• Nora McInerney [02:43]: "It is hard to slow down, but if you have chronic migraine, you know that the body keeps the score and the body also calls the shots."

• Ivelisse Rivera Salgado [12:24]: "Soft living is being kind to yourself, but holding yourself accountable."

• Ivelisse Rivera Salgado [26:04]: "Every single time I say what I say I'm gonna do, that's building trust within myself and just, like, slowing down."

• Ivelisse Rivera Salgado [29:10]: "You have to have the rain to see the rainbow."

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Key Topics Covered:

1. Introduction to Ivelisse Rivera Salgado and Her Journey
2. Balancing Fitness and Chronic Migraine
3. Personal Experiences and Emotional Management
4. Treatment Journey with Botox
5. Expert Insights on Botox from Dr. Christopher Rhine
6. Understanding Chronic Migraine and Identifying Triggers
7. Building Resilience Through Consistent Self-Care
8. Inspirational Reflections on Fitness and Gratitude

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This episode serves as a beacon of hope and a resourceful guide for individuals grappling with chronic migraines, illustrating that with resilience, proper treatment, and self-compassion, it is possible to lead a fulfilling and active life despite chronic health challenges.

Transcript

[Ruby]

Ruby.

[Nora McInerney]

Life sometimes has a way of blindsiding you with a feeling of being overwhelmed at the worst possible time. That's why you have your self care, your coping strategies. That's why you have us. I'm Nora McInerney and this is the Head Start Embracing the Journey, a podcast where we'll be taking all those things you usually save for your friend group out into the open so we can all find a bit of optimism for those battling chronic migraine. These conversations are going to be even more helpful and relatable, so definitely stick around. This show is brought to you in partnership with AbbVie. So first let's hear some important safety information and stay tuned to the end of the podcast for more Foreign.

[Botox Announcement]

Botox is a prescription medicine that is injected into muscles and used to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting four or more hours each day in people 18 years and older. It is not known whether Botox is safe and effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month or or episodic migraine. Important Safety Information Botox may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems. Anytime hours to weeks after injection of Botox, problems swallowing, speaking or breathing due to weakening of associated muscles can be severe and result in loss of life. You are at the highest risk if these problems are pre existing before injection. Swallowing problems may last for several months. Spread of Toxin Effects the effect of Botulinum toxin may affect areas away from the injection site and cause serious symptoms including loss of strength, an all over muscle weakness, double vision, blurred vision, drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing and trouble swallowing. Please stay tuned for additional important safety information within this podcast. Today's guest, Ivelisse Rivera Salgado, is an actual Botox patient who was on prescribed therapy when she shared her story. Changes in therapy status may have occurred since that time. Ivelisse was compensated by Abbvie for sharing her story.

[Nora McInerney]

Welcome back everyone for season three. Yes, I said it. Season three 14 episodes of Great stories later. If you are new here, we have two seasons ready for you to go back and binge. But today we are talking about health, wellness and what it means to live a soft life in a hard world. I am, as you may know, a recovering girl boss. For many years I thought that more was more and more was required. I had to work more do more, be more. I had to be perfect. I treated myself like a machine that should have maximum output with minimal input. Sleep was optional. Food was an afterthought. Working out was essential, but only because I needed to be thin because thin was a form of perfection. Of course. Don't worry, I am fully rolling my eyes at that now. I kept my days filled to the max with back to back to back meetings and projects. I Woke up at 5. I went to the gym. I came home to get my kids ready for school. I worked a full day and then opened up my laptop to keep working once they were in bed. From the outside, things looked pretty good. On the inside, they did not feel good. I did not feel good. I was scattered and stressed. I was not connected to my body or really to myself in any way. It is hard to slow down, but if you have chronic migraine, you know that the body keeps the score and the body also calls the shots. It can make you slow down even if you don't want to. It took a lot of time for me to deprogram and reprogram myself for exercise to become a part of my day that makes me feel good instead of just something I do to look good, to feed myself like I am a beloved friend. Because I should be a beloved friend to myself. We all should. This is one reason why I'm so excited to share this conversation with you today. Because today's guest today is a star in the health and wellness space, but she's not the type to tell you that you need to rise and grind and squeeze the most out of your day. She's not here to punish you or judge you or tell you that you're doing it wrong. She is here to encourage you to live a softer life. And especially if you're living with chronic migraine like our guest, your body deserves every bit of extra grace and attention that you can give. Today's guest is Ivelisse Rivera Salgado and I cannot wait for you to hear our conversation. But first, a familiar voice of the show. Guys, he's back. My good buddy and the headache specialist who has been guiding us through all of these episodes with his perspective and his advice. Dr. Christopher Rhine. It has been a while.

[Ruby]

Hi Nora. It's great to be back on the show. I'm excited to listen in to the conversations that you have with Ivelisse. I don't think we've talked about the important and oftentimes challenging relationship between fitness and chronic migraines, so I'm looking forward to this One.

[Nora McInerney]

All right, well, let's meet Ivelisse. Ivelisse, great to finally meet you.

[Ivelisse Rivera Salgado]

Nora, I just want to say, like, I am so happy to meet you. It's such an honor to be here. And, you know, this is my first little podcast, and I can't wait to share my story and my experience with everyone.

[Nora McInerney]

Me too. I have seen your recipes. The things that you make, the things that you suggest. They're not just beautiful, but really good for you. I am not a cook. I did bake bread earlier this week.

[Ivelisse Rivera Salgado]

Oh, so you're a chef.

[Nora McInerney]

I am not the person in my family who cooks, but my husband cooks. So what are recipes that you would suggest? Things you've made recently that are easy enough for a busy person who has a wife who can't cook and children.

[Ivelisse Rivera Salgado]

I'm gonna go with the burger bowl. I love a good burger bowl. I love the fact that the only thing you truly have to cook is the meat. Like, I do frozen fries. I'm not doing the fries from scratch. So I just pop in some frozen fries in the air fryer, simultaneous start cooking the meat, and then you just assemble it with the lettuce and the tomato and the onion, and there you have it. You're a chef. Okay.

[Nora McInerney]

This is why you're popular, because you're making it easy.

[Ivelisse Rivera Salgado]

No, see, I think, you know, I was born with the. What is the quickest way possible, the easiest way possible for me to get this done? I think it's because I have a mom who. She loves to make things from scratch. She's made everything, my whole life from scratch. Prom dress. We had chickens. She would make bread. I witnessed the extra steps, and I'm like, I'll just go to the store. So I like the shortcuts. I like to do things quick and easy.

[Nora McInerney]

Okay, you say that, but you are also a person who has done so many impressive and difficult things, like you were an athlete. You served in the military, which. Thank you for that. Thank you for that. All of that is, like, so physically demanding, so mentally demanding in so many different ways. What do you think it is about fitness, nutrition, wellness, and how you talk about it that resonates with people?

[Ivelisse Rivera Salgado]

When I first started my journey on social media, I was just doing, like, little vlogs, like, just silly things. But within the past couple of years, I'd started to become a little bit more open about my health journey or what I was struggling with, and. And that's when I found that people really started to connect with me. I was shocked because I do this thing where I think that I'm the only person in the world that is dealing with how do I start my fitness journey? And then when I started to talk to the camera, talk to social media, like I would talk to my diary or talk to my friend, that's when I found that people would resonate with me. I mean, I got a message from somebody that said, hey, I followed you because you were funny, used to post funny vlogs, but you started posting your fitness and your wellness and it motivated to start my health journey.

[Nora McInerney]

Yeah. Isn't that incredible? It's like you're in Dallas and you are a part of people's lives around the world.

[Ivelisse Rivera Salgado]

Yeah, it's. It's crazy.

[Nora McInerney]

Going back to your experience in the military. When you are in the service, you are on a schedule. Somebody else is making sure you are doing everything. What made you want to share your, you know, civilian fitness journey with people? Especially the part that intersects with that chronic migraine journey?

[Ivelisse Rivera Salgado]

Well, I love that question. And you know, when I was in the military, yeah, it was people controlling my schedule. And you know, they're like, you have to wake up at 5am, you're, you're running 10 miles or you wake up at 5am, you're doing push ups. And I don't naturally want to do that at 5am So I really wanted to share my journey because most people couldn't really relate to like the being forced to work out. When I was active duty military, that's when I first started getting my migraine attacks. It made me hate fitness. Sometimes I would have to work out with a migraine and especially with something that is an invisible disease. This is an invisible illness. And so there's no physical manifestation of what's happening to me right now. So, you know, people would think I was being dramatic, so I would try to like push through. It actually made me hate fitness at first because it, it was a trigger for me actually, like running, which was devastating for me because I, I used to be a huge runner. I used to run a lot. I used to love running.

[Nora McInerney]

What are your chronic migraine triggers?

[Ivelisse Rivera Salgado]

Well, I have a bunch, but to name a few. For me, like, my, my triggers would be getting really hot. So that was like working out. Like most workouts, you're gonna get really hot. Which is why when I was actually active duty military, I started doing Pilates. Before it was cool. Before it was cool, you guys, I was doing Pilates.

[Nora McInerney]

It was developed as a military exercise. Wait, was it for after, after World War One for disabled veterans to, like, build up their core strength so they could, like, live independently.

[Ivelisse Rivera Salgado]

Yeah, I'm about to tell everybody that.

[Nora McInerney]

Yeah, it was a hospital workout.

[Ivelisse Rivera Salgado]

Wow. That's actually. I actually love that.

[Nora McInerney]

Look it up, Joseph. Pilates. He was like, I gotta do something for disabled veterans, and I gotta get them, like, feeling good and capable. And it's all about your core.

[Ivelisse Rivera Salgado]

And it is.

[Nora McInerney]

And meanwhile, I go to Pilates and I'm. I'm a danger to myself and others at Pilates. What does fitness and wellness do for you now with your chronic migraine?

[Ivelisse Rivera Salgado]

Yes, I love that question. I don't know how to describe it. Like, when. On the days where I do have a migraine attack, I will tailor my workout to be less intense. I'll do something in the ac. I won't go outside. I'll walk on the treadmill. I'll do a light walk. Because to me, it's not really about the intensity of the workout. It's more so keeping that consistency and making sure that I am a dependable person to myself. Because I've learned that, you know, sticking to your goals and actually doing what you say you're going to do, it actually makes you trust yourself. So that. That has helped me a lot.

[Nora McInerney]

It's that soft living you talk about.

[Ivelisse Rivera Salgado]

Soft living is being kind to yourself, but holding yourself accountable. For me, it's like doing little tasks that I said I would do. If I say I'm gonna make my bed in the morning, I do. If I say I was gonna go to the gym, I do. And, you know, it's the small tasks like that that make you feel like you can trust yourself, that that's what adds up. So every single time I say what I say I'm gonna do, that's building trust within myself and just, like, slowing down.

[Nora McInerney]

It's hard to slow down. It's hard to slow down. Especially in a culture that wants you to do more. That's such a beautiful way of saying it and such a beautiful way of, like, being gentle with yourself and saying, you know, I'm trying to make sure that I'm a person I can trust. And if walking on the treadmill is what I'm doing today, then that's what I'm doing, and that's what I'm doing. Yeah, that's great. You mentioned heat is your trigger. What are your other triggers?

[Ivelisse Rivera Salgado]

Perfume. Really, really strong perfume. Or strong scents. Loud, abrupt noises. So if I'm, like, sitting on the couch reading a book and my dog barks a migraine attack will come on and those are triggers that I really can't control. Like, I don't know when my dog is going to just randomly start talking. So perfumes and scents like those, I kind of can tailor my life around them. However, I will say I've been to places where people just love cologne and they love perfumes. And I'm not mad at it.

[Nora McInerney]

Yeah, I'm not mad at it. I do. It does bring me back to like my middle school days where I was like, if one spray is good.

[Ivelisse Rivera Salgado]

I used to go to like the stores in the mall and I'd have like all the colors, like the pink, the blue, the purple. And it's just crazy because I had no idea that something like that would affect somebody in such a negative way. But now that I'm living with chronic migraine, I am very aware of those kind of things.

[Nora McInerney]

After the break, I'll be back with Dr. Rhine, so stick around.

[Botox Announcement]

Can Botox Onobotulinum Toxin a help if I have chronic migraine 15 or more headache days a month, each lasting 4 hours or more? Botox prevents headaches in adults with chronic migraine. It's not approved for adults with migraine who have 14 or fewer headache days a month. It's the number one prescribed branded chronic migraine treatment.

[Dr. Christopher Rhine]

Prescription Botox is injected by your doctor. Effects of Botox may spread hours to weeks after injection, causing serious symptoms. Alert your doctor right away as difficulty swallowing, speaking, breathing, eye problems or muscle weakness can be signs of a life threatening condition. Patients with these conditions before injection are at highest risk. Side effects may include allergic reactions, neck and injection site pain, fatigue and headache. Allergic reactions can include rash, welts, asthma symptoms and dizziness. Don't receive Botox if there's a skin infection. Tell your doctor your medical history, muscle or nerve conditions including als, Lou Gehrig's disease, Myasthenia gravis or Lambert Eaton syndrome, and medications including botulinum toxins as these may increase the risk of serious side effects.

[Botox Announcement]

Ask your doctor and visit botoxchronicmigraine.com or call 1-800-44-BOTOX to learn more.

[Nora McInerney]

Welcome back to the Head Start embracing the journey. Dr. Ryan, I want to bring you back in here. Being the first episode of this season, can we go over some common terms and definitions that often come up when we're addressing chronic migraine? I think it would be helpful for the listeners and also for me. First, let's just define what chronic migraine is and how it's different than episodic migraine.

[Ruby]

Let's do it. So chronic migraine is defined as 15 or more monthly headache days and eight of those days meeting the criteria for a migraine headache. Those headaches need to last for four hours or more. Less frequent would be considered an episodic migraine. To help put that into context of people's actual lives, it's important to look at the number of headache free days that you've had per month and not just the number of migraine attacks per month. Many times people don't have a true count for their headache date. Confusing those two things. For example, you may have only counted four headaches or migraine attacks last month. But when you look at the actual number of days you didn't have a headache or migraine attack, it could have been only a few. So getting a clear picture of the headache days you have each month is key to helping your doctor understand what you're experiencing and making the right diagnosis.

[Nora McInerney]

Okay, that's an important difference to point out. So we have chronic migraine, which is a distinct disease associated with frequent headaches and migraine attacks. What are some common triggers for the symptoms of chronic migraine?

[Ruby]

So important to talk about triggers, Nora. So let's get into it because it's a huge deal. Triggers can include increases in stress, changes in hormones. There can be external triggers that can set off those hormones, like barometric pressure, changes in weather, changes like extreme heat or cold. There can be even triggers like specific smells. Sometimes folks have a hard time with things like cleaning agents or particular perfumes. There are different types of light exposures or sound exposures that can set off migraine attacks. And so understanding those triggers is really critical.

[Nora McInerney]

Thanks, Dr. Ryan. Let's get back to Ivelisse for our listeners. Can you describe how your migraine attacks feel? How do they come on? What is the experience like for you?

[Ivelisse Rivera Salgado]

For me, the most recent one that comes to mind was for my mom's 50th birthday. We were at a theme park and it had all the triggers for me. Heat, smells, you know, loud noises, you know, I was having fun. And all of a sudden the migraine attacks started coming on. I started seeing floaters, like little specks in my vision. And it just progressively starts to get worse for me. I'll get, like, indications that it's coming on and that's when I'll, like, know, like, okay, I need to go sit down. I need to try to cool off. But at that point, like, it's coming. I ended up having to leave the theme park. Early, my family was still there. Like, they're enjoying their time. You know, Like, I. I completely separated myself when I felt. When I had the floaters in my vision, I stepped away because I'm like, I don't want them to see me like this. I'm not trying to ruin the birthday, but I had to separate myself, and I had to go back to the hotel and have my migraine attack by myself. And usually when I do have those and I'm able to get to a room, I make it dark, I make it cold. But I do like to get under the covers or, like, have something weighted on me, maybe for, like, the. The comfort of it, and I'll just be in the dark waiting it out.

[Nora McInerney]

That means you're missing out on. On.

[Ivelisse Rivera Salgado]

Oh, yeah, things.

[Nora McInerney]

Right. You're missing out on life. Moments with. Of your own and, you know, with people you love. How do you manage that emotionally?

[Ivelisse Rivera Salgado]

At first, I didn't. I didn't manage it emotionally. I had no tools in my toolkit to make myself feel better. But as time went on, I learned to be kind to myself and learned to give myself grace and also learning to be transparent with people. Because at first, I didn't want anybody to know that I had chronic migraine. I really tried to keep it a secret for a very, very long time because I was, for lack of better words, like, embarrassed. As somebody who was always fit, active, upbeat, life of the party. I did not want to be the person with a disability. But that's the thing about disabilities and invisible illnesses like chronic migraine. They don't discriminate. Like, it could happen to anybody, and it happened to me. So just managing it emotionally, just like, being transparent with people and saying, hey, this is something that I deal with, because letting them know that, like, if I have to cancel plans last minute, they'll be understanding. But if they have never had knowledge of me having these chronic migraines before, I feel like they might think that I was lying or something if I, like, randomly canceled last minute.

[Nora McInerney]

Yeah. Yeah. It's like building that empathy for yourself, I think, also helps you extend that to other people.

[Ivelisse Rivera Salgado]

Absolutely.

[Nora McInerney]

When were you officially diagnosed?

[Ivelisse Rivera Salgado]

I was officially diagnosed when I was 20 years old. My chronic migraine first started in 2015, and I didn't get officially diagnosed by a neurologist until 2016. Like, I had an inkling, but something about getting that diagnosis, like, something about it. I just left feeling so seen, so empowered. Ready to tackle this disease. Like, ready to tackle it.

[Nora McInerney]

Yeah. I'm assuming there's kind of a journey to finding the right treatment. What was your journey like?

[Ivelisse Rivera Salgado]

Well, I will say that for me, like, the whole treatment journey taught me being resilient. I had never experienced something so mentally and emotionally taxing and draining in my life. Because when I first started seeing a neurologist, I'm like, okay, maybe we'll get along. Like, maybe she'll listen to me. And she's like, okay, we'll try this. So I tried, tried a medication, didn't work. And she's like, okay, we'll try this one. I tried. It, didn't work. And I tried so many different medications. And at one point just wanted to stop because I was getting side effects from these medications. In addition to still getting my migraine attacks after that, I remember showing up to my next appointment being like, I need something else. And I actually ended up looking for another doctor. And I think that that's really important, too, because I felt bad at first. I was like, man, I don't want her to be mad at me. Which is so ridiculous thinking back, you know, that's so ridiculous.

[Nora McInerney]

I don't want you to be mad at me.

[Ivelisse Rivera Salgado]

Yeah. I'm like, I didn't want her to have her feelings hurt, which is, looking back, ridiculous. Because it's my job to make sure that I get proper care.

[Nora McInerney]

Figuring it out feels like, so isolating, which is also so heartbreaking. And I think that's why it is so generous of you to be here with us and be sharing this experience with us, because there is somebody listening to this who is feeling that way, who needs to know. Like, it's not just them.

[Ivelisse Rivera Salgado]

No, it's not just them for that. Absolutely.

[Nora McInerney]

Yeah.

[Ivelisse Rivera Salgado]

But I got a new doctor, and I remember walking into his office and he's like, in the military, just like me. He looked at me and he's like, well, have you heard of Botox for chronic migraine?

[Nora McInerney]

I am curious. I want to hear your take on the treatment procedure itself.

[Ivelisse Rivera Salgado]

The neurologist office was three offices down from where I worked because I was a radiology tech. So I would schedule my appointment, and then I would just be like, hey, I'm going to go get botox for my chronic migraine. I'll go to the appointment. I get 31 shots. It takes about 10 minutes, and I get to go back to work. I don't have to worry about taking something every day. I don't have to worry about, you know, when. When's the next refill?

[Nora McInerney]

Yeah. And you just sit down.

[Ivelisse Rivera Salgado]

They do it and I go back to work.

[Nora McInerney]

So tag me back in. Dr. Rhine Ivelisse has shared how Botox has helped reduce her headache days. Can you tell us more about Botox as a treatment option for chronic migraine?

[Ruby]

Absolutely, and I've been familiar with Botox for a long time. In fact, Botox has been an FDA approved treatment for chronic Migraine for around 15 years now. It may not be what you initially think of when you hear Botox, but it's been a part of our arsenal as a preventative treatment option for a long time. Botox is a prescription medicine injected into muscles and used to prevent headaches in adults with chronic migraine which is 15 or more headache days per month, each lasting for four or more hours. Botox is not approved for adults with migraine who have 14 or fewer headache days per month. Effects of Botox may spread hours to weeks after injection causing serious symptoms and so you want to alert your doctor right away as difficulty swallowing, speaking, breathing, eye problems or muscle weaknesses can be a sign of a life threatening condition. Patients with these conditions before the injection are at higher risk of those effects and side effects might include allergic allergic reactions, rash, breathing problems and dizziness, neck and injection site pain and headache. Don't receive Botox for chronic migraine if there's a skin infection and tell your doctor your medical history, muscle or nerve condition history like als which is Lou Gehrig's disease, Myasthenia gravis, Lambert Eaton syndrome, any medications including other botulinum toxins that you might be utilizing as they may increase the risk of these serious side effects. It's important for you to talk to your doctor or have headache specialist about the important safety information you'll hear throughout this episode and in the link to the product information.

[Nora McInerney]

Ivelisse was able to see some changes with the number of headaches eventually becoming manageable about six months into her Botox treatments. How does Botox help prevent headaches in chronic migraine and how important is that dedication to treatment for feeling the full effects of the Botox treatment?

[Ruby]

Awesome question and it's one that I get all the time. Nora in the data that was presented to the FDA, Botox prevented on average eight to nine headache days and probable migraine days a month at 24 weeks versus six to seven with placebo. Patients may see results as soon as four weeks, but the full effect should be evaluated after two treatments six months. So the Botox experience is going to be different based on the patient. This is one of my favorite things to do with patients because there's such a preconceived notion around what Botox is and what the process is to go through with Botox. The first thing we need to understand when it comes to Botox for chronic migraine is that there is a fixed injection protocol. So we talk to patients about that experience. We let them know that they're going to be seated in a clinical setting. Maybe it's a procedural suite like I use here at the hospital that I work out of, or maybe it's your physician's office. Botox is injected in 31 sites into seven muscle groups that the FDA has approved. Those areas are going to be in the head and neck. You start with two treatments, and those are going to be 12 weeks apart, and then we continue every 12 weeks thereafter. We do this every three months, four times a year for about 10 minutes each when you come in for a session. We try to fit treatment into people's busy schedules as much as possible.

[Nora McInerney]

All right, so one last thing that I need your POV on. Dr. Rhine. There is sometimes hesitancy and misconception around Botox. What is the usual response when you first bring it up as a treatment option for your appropriate chronic migraine patients?

[Ruby]

Understandably, patients always have a bit of hesitancy. When I first bring up Botox, patients are going to ask, what's the experience like? How effective is that therapy? Cost tends to be a hurdle for some patients, and oftentimes they're surprised to hear that most insurance providers, as well as Medicaid and Medicare programs, do cover Botox for chronic migraine. I'd advise patients interested in Botox to contact their insurance providers. I think it's really important for patients to know that providers are not allowed to contact insurance on their behalf to find out costs or benefits associated with a particular therapy, Botox or otherwise. Additionally, there are patient support programs like the Botox Savings program, which I'm a huge fan of. This helps eligible commercially insured patients to save on certain out of pocket costs related to both Botox medicine and the injection procedure.

[Nora McInerney]

All right. I'd imagine the fear of needles comes up for some people too, right? Is that a common concern or is that just my own projection?

[Ruby]

Not projection, Nora. I have a lot of patients that have the same concerns as Evie being nervous about the needles when coming to their first treatment. But some of my patients describe the injections as feeling like tiny pinches. And from what I've seen with my patients, most people get comfortable with the process after the first treatment.

[Nora McInerney]

Dr. Ryan, thank you, as always.

[Ruby]

Thanks, Nora. Really excited to be here. Excited to talk some more this new season that we're kicking off.

[Nora McInerney]

All right, one last question for you, Ivelisse. Why do you love fitness and wellness so much?

[Ivelisse Rivera Salgado]

The way that I express myself, it's an outlet for me. It's a celebration of what my body can do. I'm. I'm so grateful that I'm able to walk on the treadmill. I'm so grateful that I'm able to lift 20 pounds. I'm so grateful that I'm able to squat, whatever. You know, that for me, when I put it in that perspective, it's like, okay, get up and go workout. Get up and go move your body. Because there are people right now dealing with something that would just love to trade places with you. And I feel like it's foolish of me to understand that perspective and then not move my body. If you are somebody that's struggling with your health or chronic migraine right now, just keep going through the motions. If you have to chop your day up into little segments, do that, but you'll get through it. You. You have to have the rain to see the rainbow.

[Nora McInerney]

Oh, that was beautiful. That was really beautiful. Do you see what I mean about this conversation about her energy? Ivelisse, in one conversation, made me feel so much better. I sat down to this conversation in quite a frantic week on quite a frantic day, and her calm energy softened me. And what makes her even more incredible is her story. She started out in the military, stepping into active service with so much dedication. And when life threw her a big challenge, chronic migraine, she didn't let that stop her. She kept going. She kept advocating for herself. She kept showing up. She is an inspiration, and I hope that it gave you permission and encouragement to live a softer life. To be softer with others, of course, but also with yourself. Thanks for listening to the Head Start. Embracing the journey. We hope you found something worthwhile here with us today. A new coping strategy, a relatable story, the comfort of knowing you're not alone. I'm so happy to be a part of. Of creating this community for all of us and especially for people living with chronic migraine. If you haven't found a treatment plan that is working for you, please do reach out to your headache specialist to explore your options. I truly hope this has helped you find a bit of comfort and maybe a smile.

[Botox Announcement]

Maybe.

[Nora McInerney]

See you next episode. And stay tuned for more important safety information. The Head Start Embracing the Journey is hosted by myself, Nora McInerney, executive produced by Yvonne Sheehan. Our Head of Post Production is James Foster, our researcher is Sierra Kaiser and our writer is John Irwin. The show is mixed by Michael Hardman. Original music by Soundcat Productions and Artlist.

[Botox Announcement]

Important safety information continued There has not been a confirmed serious case of spread of toxins in effect away from the injection site when Botox has been used at the recommended dose to treat chronic migraine. Botox may cause loss of strength or general muscle weakness, vision problems or dizziness within hours to weeks of receiving Botox. If this happens, do not drive a car, operate machinery or do other dangerous activities. Do not receive Botox if you are allergic to any of the ingredients in Botox. See Medication Guide for ingredients. Had an allergic reaction to any other botulinum toxin product such Myobloc Rimabotulinum toxin B. Dysport Abobobotulinum toxin A Zeomin Ingobotulinum toxin A Jeuveau Probotulinum toxin A xvfs Daxify Daxibotulinum toxin a Lanm or Latibo Ledibotulinum toxin awlbg this may not be a complete list of of all botulinum toxin products. Have a skin infection at the planned injection site. The dose of Botox is not the same as or comparable to another botulinum toxin product. Serious and or immediate allergic reactions have been reported including itching, rash, red itchy welts, wheezing, asthma symptoms, dizziness or feeling faint. Get medical help right away if you experience symptoms. Further injection of Botox should be discontinued. Tell your doctor about all your muscle or nerve conditions such as ALS or Lou Gehrig's disease, Myasthenia gravis or Lambert Eaton Syndrome as you may be at increased risk of serious side effects including difficulty swallowing and difficulty breathing from typical doses of Botox. Tell your doctor about all your medical conditions including if you have or have had bleeding problems, have plans to have surgery, has had surgery on your face, have weakness of forehead muscles, trouble raising your eyebrows, drooping eyelids and any other abnormal facial change. Are pregnant or plan to become pregnant. It is not known if Botox can harm your unborn baby, are breastfeeding or plan to. It is not known if Botox passes into breast milk. Tell your doctor about all the medicines you take, including prescription and over the counter medicines, vitamins and herbal supplements. Using Botox will with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received Botox in the past. Tell your doctor if you received any other botulinum toxin product in the last four months have received injections of botulinum toxin such as Myobloc, Dysport, Xeomin, Jeuveau, Daxify or Letibo in the past. This may not be a complete list of all botulinum toxin products. Tell your doctor exactly which product you received. Have recently received an antibiotic by injection Take muscle relaxants, take an allergy or cold medicine take a sleep medicine, take aspirin like products or blood thinner. Other side effects of Botox include dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, eye problems such as double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eye eyelids and dry eyes, drooping eyebrows and upper respiratory tract infection. For more information, refer to the Medication Guide or talk with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov MedWatch or call 1-800-FDA-1088. Please see Botox full product information including boxed warning and Medication Guide by clicking the link provided in the podcast description or by visiting www.rxabv.com PDF botoxpi.PDF. if you are having difficulty paying for your medicine, AbbVie may be able to help. Visit abbvie.com patient access support to learn more. Chronic migraine is 15 or more headache days a month each lasting 4 hours or more. Botox Onobotulinum toxin a prevents headaches in adults with chronic migraine. It's not for adults with migraine with 14 or fewer headache days a month. It prevents on average eight to nine headache days a month versus six to seven for placebo.

[Dr. Christopher Rhine]

Prescription Botox is injected by your doctor. Effects of Botox may spread hours to weeks after injection causing serious symptoms. Alert your doctor right away as difficulty swallowing, speaking, breathing, eye problems or muscle weakness can be signs of a life threatening condition condition. Patients with these conditions before injection are at highest risk. Side effects may include allergic reactions, neck and injection site pain, fatigue and headache. Allergic reactions can include rash, welts, asthma symptoms and dizziness. Don't receive Botox if there's a skin infection. Tell your doctor your medical history, muscle or nerve conditions including als, Lou Gehrig's disease, Myasthenia gravis or Lambert Eaton syndrome and medications including botulinum toxins as these may increase the risk of serious side effects.

[Botox Announcement]

Ask your doctor and visit botoxchronicmigraine.com or call 1-800-44-BOTOX to learn more.

[Ivelisse Rivera Salgado]

This is an I Heart Podcast.