Two Generations, One Shared Disease: A Conversation with Mother and Son

Summary

Podcast Summary: "Two Generations, One Shared Disease: A Conversation with Mother and Son"

Podcast Information:

• Title: The Head Start: Embracing the Journey
• Host: Nora McInerny, iHeartPodcasts
• Description: A platform for open and honest conversations about living with chronic migraine, featuring doctors, experts, and everyday individuals sharing their experiences, coping strategies, and victories to build a supportive community.
• Episode Title: Two Generations, One Shared Disease: A Conversation with Mother and Son
• Release Date: July 23, 2024

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Introduction

The episode begins with Nora McInerny setting the stage for a heartfelt and deeply personal conversation about chronic migraine—a condition that not only affects individuals but also reverberates through their families. She emphasizes the importance of sharing these experiences to foster optimism and support within the community.

Notable Quote:

"Life sometimes has a way of blindsiding you with a feeling of being overwhelmed at the worst possible time."
— Nora McInerney [00:02]

Guest Introduction

Nora introduces the unique setup of this episode—a dual conversation featuring both a mother, Angel Pashal Harmon, and her 23-year-old son, Xavier. This mother-son duo brings a dual generational perspective to living with chronic migraine, offering listeners a comprehensive view of how the condition impacts different life stages.

Additionally, Dr. Laurel Short, a nurse practitioner specializing in headache management, joins the conversation to provide a healthcare professional's perspective on treating chronic migraine and addressing patient fears.

Notable Quote:

"It's one thing as a parent to deal with your own struggles... but to watch your children... go through theirs can be excruciating."
— Nora McInerny [02:26]

Conversation with Dr. Laurel Short

Dr. Laurel Short discusses her approach to treating patients with chronic migraine, highlighting the importance of personalized care and open-ended communication. She emphasizes understanding each patient's unique experience to create effective treatment plans.

Notable Quote:

"Migraine is a chronic disease, and it requires shared decision making between the provider and the patient."
— Dr. Laurel Short [06:35]

Interview with Angel and Xavier

Angel's Journey: Angel shares her experiences managing chronic migraine while balancing her roles as a mother and a professional leader. She discusses how her condition has made her a compassionate leader, fostering transparency and understanding within her team.

Notable Quote:

"I lead by example, so they can tell if my speech is off or if I start work very early."
— Angel Pashal Harmon [08:22]

Angel also reflects on the challenges of parenting a child while dealing with chronic migraine, describing moments where her condition disrupted daily life and affected her children.

Notable Quote:

"I miss those everyday things... there are those moments in time."
— Angel Pashal Harmon [10:17]

Xavier's Perspective: Xavier offers his viewpoint as a young adult dealing with chronic migraine, discussing the triggers that affect him and his experiences navigating school and social interactions. He highlights the emotional toll of witnessing his mother's struggles and the solidarity they share.

Notable Quote:

"It's very interesting, like hearing her talk about these things in retrospect from her side. It sucks to hear."
— Xavier [16:03]

Generational Differences in Addressing Chronic Migraine

The conversation delves into how different generations approach chronic migraine, with Angel representing an older generation that often feels compelled to "suck it up," and Xavier embodying a younger generation more open to discussing and seeking help for their condition.

Angel's Insights: Angel discusses the societal expectations placed on her generation to manage pain silently and the importance of advocating for oneself to break these stigmas. She shares her efforts in migraine advocacy to normalize these conversations.

Notable Quote:

"We’re going to fight, we’re going to suck it up... there are times where you just can't, and that's okay."
— Angel Pashal Harmon [20:00]

Xavier's Reflections: Xavier acknowledges the shift towards more openness in his generation but confesses his own struggles with vulnerability and seeking help, reflecting on the balance between societal acceptance and personal reluctance.

Notable Quote:

"I've always avoided communicating with people because I just... it's a combination of shame and stubbornness and ego."
— Xavier [22:13]

Challenges in Treatment and Healthcare Experiences

Angel shares the difficulties she has faced in accessing effective treatment, including long wait times for medication approval and experiences of bias in the medical field. She highlights the compounded challenges of navigating healthcare as a Black woman with chronic migraine.

Notable Quote:

"Finding someone who believes that I'm struggling... when my husband is with me."
— Angel Pashal Harmon [25:02]

Dr. Laurel Short addresses common fears patients have regarding treatment, such as stigma and concerns about procedures. She advocates for open communication and emphasizes the importance of discussing all available treatment options to alleviate patient fears.

Notable Quote:

"It's really fortunate that we have more options for chronic migraine treatment than we used to."
— Dr. Laurel Short [13:14]

Mother and Son Relationship in the Context of Chronic Migraine

The shared experience of chronic migraine has created a deep bond between Angel and Xavier. They discuss how navigating this condition together has fostered solidarity and mutual support, reinforcing their familial connection.

Notable Quote:

"We’re hurting together. So at least nice to know, like, hey, I'm not alone in this."
— Xavier [28:45]

Angel emphasizes the importance of demonstrating resilience and compassion to her sons, hoping to instill in them the understanding that needing help is normal and that their condition does not define their worth.

Notable Quote:

"Living with migraine doesn't make them broken or inferior."
— Angel Pashal Harmon [30:39]

Concluding Reflections

Nora wraps up the episode by highlighting the importance of vulnerability and support in managing chronic migraine, especially within families. She underscores the significance of breaking down the barriers that prevent open discussions about the condition.

Notable Quote:

"We can move past this idea that they can just... there are some times where you just need to rest."
— Angel Pashal Harmon [30:43]

Nora encourages listeners to seek help and engage with headache specialists to explore effective treatment plans, fostering a community of understanding and support.

Key Takeaways

• Generational Perspectives: Different generations approach chronic migraine with varying attitudes towards vulnerability and seeking help, highlighting the need for intergenerational understanding and support.

• Healthcare Challenges: Accessing effective treatment is fraught with challenges, including long approval times and experiences of bias, particularly for minority populations.

• Family Dynamics: Chronic migraine affects not just individuals but also their families, creating both challenges and opportunities for deeper connections and mutual support.

• Advocacy and Openness: Breaking the stigma around chronic migraine through advocacy and open conversations is crucial for effective management and support.

Final Thoughts

This episode provides a nuanced exploration of chronic migraine's impact across generations within a family. Through the candid discussion between Angel and Xavier, listeners gain profound insights into the emotional and practical challenges of living with an invisible disease. Dr. Laurel Short's professional perspective further enriches the conversation by addressing treatment strategies and patient-provider dynamics. The heartfelt narrative underscores the importance of community, understanding, and continuous advocacy in managing chronic migraine.

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Additional Resources:

• For more information on Botox as a treatment for chronic migraine, visit AbbVie's Product Information.

Transcript

[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.

[Botox Safety Information]

Indication Botox Onobotulinum Toxin A 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 episodic migraine. Important Safety 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 and 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.

[Nora McInerney]

Hello and welcome back to the Head Start Embracing the Journey. This is season two of our podcast where every episode we meet a new person who is living with chronic migraine and spend some time walking their journey with them. But in today's episode, which is our last of this season, I can't believe it. We actually have two people to talk to. It is one thing as a parent to deal with your own struggles to put a smile on and push through your day so that your kids don't have to worry about you. To bear your own struggles is one thing, but to watch your children, even if they're now grown adults, go through theirs to see them face obstacles. It can be excruciating because it sometimes feels like it is our job to keep that from happening, to keep life and all of life's issues at bay. My mom still thinks and talks about the worst flu I ever got. That was over 30 years ago. And I can tell that the memory still hurts her, even though I. I barely remember it. Today's episode is about a mother and a son who are all too familiar with chronic migraine, both of whom have seen the other through some of the hardest parts of their journey. Today you're going to meet angel and Angel's 23 year old son, Xavier. We've actually never done an episode like this before and so I'm really excited for you to hear it. It's a special opportunity to connect with two people whose migraine journeys are intertwined and a particularly impactful conversation for anyone whose family shares the experience of chronic migraine each episode. We are also joined by my friend and colleague, Dr. Christopher Ryne. But not today. Today we have another special guest. We have a nurse practitioner who is on the front lines of treating people with chronic migraine, Dr. Laurel Short, who on top of being a family nurse practitioner, also has an added qualification in headache certification. Laurel, welcome to the Head Start.

[Dr. Laurel Short]

Hi Nora, thank you for having me.

[Nora McInerney]

So Laurel, we have had lots of opportunities to get a doctor's perspective on things with my co host, Dr. Rhine. I am very interested in getting your point of view as a nurse practitioner as well to see if you get to see a different side of things. How do you approach different patient journeys when experiences differ so widely?

[Dr. Laurel Short]

And my experience, it's very common for individuals with migraine disease to experience differences in the pattern of their symptoms. And so I feel like it's a big part of my job as a healthcare provider, especially at the first visit, to spend adequate time with the patient and ask very open ended questions. I typically start with just asking the patient to tell me the story about their migraine attack. So because everyone is coming from such a different background and I want to understand how this has impacted their life because that's really important. And so kind of a key or a nugget out of that is by asking patients kind of turning the question around instead of saying how many days per month are you having headache days? Because honestly most patients are so stoic and they've really been pushing through a lot of as I like to turn the question around and say how many days per month are you crystal clear? And by that we mean how many days have you not experienced a headache or migraine attack, and that gives us a good starting point that we can then keep coming back to. Patients often tend to focus just on their worst days. And so I want to get a good picture, you know, about how they're feeling all the time, so I can set the appropriate treatment plan for them. And we need to remember that migraine is a chronic disease, and it requires shared decision making between the provider and the patient. And I really feel like that's something that nurse practitioners do very well because that's the foundation of our training is chronic disease management. So reassessing those treatment plans as we move along with the patient allows for that partnership.

[Nora McInerney]

So as a chronic migraine journey continues, it's important, obviously, for people to have proper access to care, but there's also just the knowledge of who to go to in order to be seen by the right people.

[Dr. Laurel Short]

Absolutely. So two strategies patients might want to use are, one is just talking to the primary care provider, because there may even be a headache specialist that that PCP can refer them to. And secondly, there is a wonderful online directory through the National Headache foundation where patients can look for somebody who has a certification in headache, and that may be a neurologist, but it may be someone like me who's a primary care provider who has gone on to do additional training and certification in headache. And so that's a really nice resource patients can put in their zip code and look for someone who's close to them.

[Nora McInerney]

Thanks, Laurel. Okay, let's get into my conversation with angel and Xavier. So, angel, we like to start this out on a very serious note. So what are you watching right now on tv? I need some show recommendations.

[Angel Pashal Harmon]

I'm not a big television watcher, but I grew up watching soap operas with my grandmother who raised me, and I still watch General Hospital to this day.

[Nora McInerney]

That is the perfect answer. I love that. So, angel, you have one of the hardest jobs in the world, which is being a mom. But you are all also a boss, which means you have to juggle a lot and manage your chronic migraine. How has your chronic migraine been a defining part of that journey?

[Angel Pashal Harmon]

I would say that it's made me a compassionate leader. I have a team of six individuals, and I show up in my true self. They know I'm not 100%. In fact, I had to take leave today. And yesterday I thought I could work, and I said, just give me a couple hours. And one of my leads in the team said, angel, you rest. I've got you. Nothing going to happen while you're gone. And I lead by example, so they can tell if my speech is off or if I start work very early. They know I probably didn't sleep the night before. And I think that leading through grace and transparency has made me the leader that I am.

[Nora McInerney]

That is like, exactly what, in my opinion, leadership is and how it should be. Everybody deserves a compassionate leader. Angel, you mentioned leadership in a professional sense, but I also do want to hear about your experience as a mother as your kids are growing up and you are unable to avoid the stress of life. Children are wonderful. But I'm interested in how having chronic migraine impacted or informed your parenting as.

[Angel Pashal Harmon]

Your sons grew up a very long time. With Xavier, I was a divorced mom. I became a divorced mom when Xavier was 6 weeks old. And so it was just me. I didn't have a choice. I had to show up. I had to be present. So there was many a times I would be laying in the bed and he would be in the bed playing. He loves to draw, and so he did a lot of droning.

[Nora McInerney]

Chronic migraine is unpredictable, and it can really be an interruption to your plans and your life. Were there any moments that you remember, any special moments where chronic migraine got in the way?

[Angel Pashal Harmon]

It's the everyday moments for me. There are so many times, like yesterday, I had a migraine attack, and Xavier came in the room. And the only reason why I know he came in the room is because I felt his kiss on my forehead. I can tell difference between my son's kisses, who they are by their kiss. When I'm laying on the couch, I think he touched my hand for a second, and I was like, no. And I just rolled back over. So I miss those everyday things. With my youngest son, Zion, he had a football game, and I was having a migraine attack, and all I was trying to do was get out of the stands. And some of the parents saw it was happening, and they walked me to the car, and my brother, his partner, had to drive me home. When I have to miss those moments hurt the most, because there's those moments in time.

[Nora McInerney]

Yeah. Yeah. Are there other migraine attacks that are as memorable or as visceral as that one?

[Angel Pashal Harmon]

One that stands out is I don't remember where Xavier and I were going, but we were on the way home, and I had a migraine attack and I was afraid to drive, and Xavier wasn't driving in. I knew that I had to get us home. And when I looked at Xavier and I saw how defeated he felt because he couldn't drive me. It broke my heart. It's not his job to protect me. It's my job to keep him safe. And so that really stood out for me.

[Nora McInerney]

Thank you for sharing these. I know it's so hard to revisit some of these moments, and I know it'll be really helpful for listeners.

[Angel Pashal Harmon]

Of course, you know, when you asked about a memorable moment, I it's hard because it's a lot of responsibility on Xavier. He is older than Zion, and maybe a year ago my husband was here, but I think he was working. Later he remembered, but I had a migraine attack and Xavier had to find me on the floor. That was a lot to have to digest.

[Nora McInerney]

So this is a great place to bring Laurel back to the conversation. Laurel angel has had to navigate both parenting with chronic migraine and trying to find a treatment plan that works for her. And there's one consistent theme that we've seen come up with every guest on the show, which is some hesitation or even sometimes fear around seeking treatment for their chronic migraine, whether it's the fear of procedures or lack of awareness about the treatment or a fear of how they will be treated. Since you're the one often managing the treatment, how do you address people's fears in these scenarios?

[Dr. Laurel Short]

Absolutely. I think number one is addressing that fear of stigma or the fear of am I going to be kind of brushed off or am I going to be listened to? And so that gets back to what we talked about in the beginning of just being open and having a good connection with the patient. And that's really the key. It's really fortunate that we have more options for chronic migraine treatment than we used to, so we can spend some time going through what the different treatment options are and deciding together what's going to be the best fit for the patient. And I think that naturally then alleviate some of the fears of a procedure or a needle or even a regimen that the patient might have, because we can talk through it and then make sure that we're both comfortable with the plan moving forward.

[Nora McInerney]

We'll be right back after the break with more from Xavier and Angel.

[Botox Safety Information]

Can Botox on a botulinum toxin a help if I have chronic migraine 15 or more headache days a month each lasting four hours or more.

[Dr. Laurel Short]

Botox prevents headaches in adults with chronic migraine.

[Nora McInerney]

It's not approved for adults with migraine who have 14 or fewer headache days a month.

[Botox Safety Information]

It's the number one prescribed branded chronic migraine treatment.

[Botox Information]

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 Safety Information]

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. This is our conversation with Angel Pashal Harmon and her son Xavier. We actually have Xavier here who as I mentioned at the top of the show, is 23. And it is such a, I don't want to say a treat, but it really is. I mean, for our audience to have these two sides of similar stories is really important. Xavier, how does it feel to hear your mom describe this?

[Xavier]

I want to say eye opening because I mean, it's my mom. I know these things. But it's very interesting to see her side of these events because I remember not being able to drive her home and how like I felt bad, for lack of a better word, just awful. I remember these events and while like in the moment it's awful and then eventually these things pass and I kind of like I move on until the next thing happens. So it is very interesting, like hearing her talk about these things in retrospect from her side. It sucks to hear.

[Nora McInerney]

Yeah.

[Xavier]

But I do appreciate hearing it though. I'm glad it's gonna be talking about it. So yeah, yeah.

[Nora McInerney]

Can you, Xavier, give us an insight into your migraine experience? What triggers a migraine attack for you?

[Xavier]

Bright lights, loud noises, the weather, slightly changing, stress? Definitely.

[Nora McInerney]

We asked your mom earlier to share memorable migraine attacks that she experienced for you. Is there a particular migraine attack that you remember? And can you tell us where you were, how it came on and how you felt?

[Xavier]

There's definitely a few that stand out to me. One of the ones was just full on migraine attacks every day in class. So there'd be times I would be late to class or I just simply couldn't show up. And it didn't help that the classroom was one of those classes where like, it's like super big with all the lights and talkative students.

[Nora McInerney]

Yeah.

[Xavier]

So the whole time I'm trying to listen to, I forget what the subject was. Something computer related with a giant light right above me. When students would not stop talking, it felt like a spike going through the back of my eye. But that's just one instance. There's like, I can think of other instances and where, like my mom said, like, in normal life moments, like I'm hanging out with my friends, hanging out with my girlfriend, or I'm talking, just doing normal things and all of a sudden these migraine attacks, they hurt. Like it's. Sometimes it comes out of nowhere. Like sometimes I'm able to hide it, like a small wince or whatever. But sometimes it gets real bad and I have my friends worrying about like, say, you good? I'm like, yeah, no, I'm not. But you know, yeah, but I'm going.

[Nora McInerney]

To tell you I'm fine so that you don't worry about me.

[Xavier]

Right. Because I don't want to talk about this.

[Nora McInerney]

Yeah.

[Xavier]

So, yeah, just that whole week just having to deal with that.

[Nora McInerney]

You're talking about getting, you know, these migraine attacks while you're also, you know, in the best years of your life. Right. You're young, you've got like, you're in college. And how do you navigate that? Specifically, as a student, do you think the professors understand? Do the other students in your class get it?

[Xavier]

The other students, they can tell if they ask because, you know, I only talk to so many people. Nobody stops at, are you okay? Yes or no? Oh, I'm sorry. They're back to work. But professors have been pretty understanding about it. As long as I tell them what's going on, they're really chill. But I do remember, like last semester it was getting real bad and I missed a few days. Again, I told my professor, but like it or not, life goes on. I have to get a good grade in these classes. So I showed up. I was still wearing sunglasses. And I'm not kind person who likes wearing sunglasses indoors, but I had to. And I told the professor like beforehand, class started like, that's why I'm wearing them. She understood because I know there's some professors like no hats, no sunglasses, that kind of thing. But as long as they tell them what's going on, they've been pretty. They've been pretty understanding.

[Nora McInerney]

I'd love to get your perspectives on the generational differences and how you think about, feel about, talk about chronic migraine. You're living it in different ways. You're in different life phases. But you've also worked through this together and walked it together. I think people assume that Gen Z is more apt to talk about things, address them, like break stigmas. But I'd love to hear that from the two of you.

[Xavier]

Mom, you can go first. I still need to think about that question.

[Angel Pashal Harmon]

Okay, okay, I'll go first. Is the older person here. I was raised by my grandmother, so going to the doctor for every little thing, which is not something that you did. And it's also a part of the socioeconomic environment as a housekeeper. So it's not like I had ready accessibility to healthcare. She tried all the things, the peppermint oils, the ice packs, all the little things. Try and help me with my migraine attacks. The generation from which I'm part of, I would say it's a. I am the generation of, you know, we're going to do all the things that our baby boo parents didn't do. So we're going to fight, we're going to. We're going to suck it up and we're going to do it. And so what I've tried to show Xavier is that yet there will be times in Zion as well. There are only times that you have to push through. There are times where you will have to go to class with your sunglasses on, with your head down to get through, but there are times when you just can't, and that's okay. And here in Xavier, talk about that situation with the professor. I have asked Xavier, tell your professors that you have migraine attacks. And he didn't want to be labeled a certain kind of way. Mom, I'll figure it out. That's what they were saying. I'll figure it out. And I was so proud when he finally decided to let a professor know that I'm struggling right now. So the only way I could get to where I acknowledge my chronic migraine, whether it be because I was in graduate school and I had to tell my professor, I need more time to read all these documents, is because I wanted to set the example there. I couldn't ask him to do what I wasn't doing, so I had to reteach myself. And then also being involved in migraine advocacy organizations where I was taking that mask off and making discussing chronic migraine normative for those of us who live with the disease. Does that help you, Xavier?

[Xavier]

You kind of spill all my secrets with the whole I'll figure it out. But that is very much something was going to touch on because, like, my generation is very much a lot more accepting to different kinds of, like, disabilities and all that kind of stuff. But despite that, like, my friends have always been, like, very open if they, like, hey, you're trying to do something. I can't. My head hurts. I don't. I still don't really call them migraine attacks and just say, oh, my head hurts. Because like she said, I just. I don't want to be seen as some kind of way, like. Like, oh, I just can't because I'm lazy or something. So I've always avoided help. I've always avoided communicating with people because I just. It's a combination of shame and stubbornness and ego. So I've always been like, I'll figure it out. So just recently, I've been starting to talk to my school, like, my teachers and professors about it, and they've all. They've. All of them has been very open about.

[Nora McInerney]

Yeah, I think angel, when you're raised by the baby boomers, no offense to my mother or any of the boomers, but, you know, it's like we really were kind of, like, raised to be, like, just, like, tough it out. You're fine, get up. It doesn't matter. Everything's fine. And I think it is so important, especially when, you know, we have sons, that we, like, create that space where it is okay for, like, people to share their struggles. Specifically men, too. Right. Because it's such a toxic environment for, like, our boys to grow up into men who believe, like, they have to be, like, tough and that being tough is somehow at odds with, like, their humanity. So I appreciate you both speaking to that. I want to talk a little bit about treatment. Have you had different experiences with headache specialists along the way? Did they approach you differently, offer you different treatment options? Tell me about the sort of journey to managing these migraine attacks.

[Angel Pashal Harmon]

Well, for me, I have gone through a lot of different neurologists, headache specialists, the general practitioner route, having to try all the different medicines to get approval to try yet another medicine. I have one that took me over a year to get approval. One of the more common is be a bullied in the medical field. That's a long debate around and conversation on black women in pain. And I. Whether it be maternal help or even in migraine. And that has been a challenge, finding someone who believes that I'm struggling. And to add an additional layer to that, when I go to the hospital and I've gone to error without my husband and the way I'm treated And the way I'm treated when my husband is with me. My husband is Caucasian, and so that has been one of the most challenging things.

[Nora McInerney]

Yeah. Thank you for sharing that. I'm so sorry that that is your experience. And I also think it's really important for people to hear that and to. It's one thing to read reports and read headlines, and it's another to hear it from a person who's experiencing it. So thank you. Laurel angel and her son shared a really interesting perspective on the generational differences living with chronic migraine. But from your point of view as a nurse practitioner, do you approach different generations differently when you're talking diagnosis and treatment?

[Dr. Laurel Short]

Yeah, it's a really interesting concept, and I don't think I approach them differently necessarily, but I do notice some differences in how different generations may share their symptoms. And certainly even within generations, we just have different personalities. Right. But I think the younger generations do feel a little more open to share how chronic migraine is affecting them both physically and in their emotional health. And I find that helpful. And I have personal experience with this as well. I grew up watching a parent with chronic migraine. My father has chronic migraine, and so I kind of observed how his generation kind of navigated the disease versus some of the younger patients that I work with.

[Nora McInerney]

I also want to ask you as a healthcare provider, why some healthcare providers might hesitate to recommend certain treatments for certain patients.

[Dr. Laurel Short]

Yeah, it's interesting because while this is such an exciting time in migraine care, we have many more options than we used to. However, I still see clinicians hesitating to offer newer therapies at times. And I think there's multiple reasons for this. One could be that the clinician is concerned about the cost to the patient, that maybe the patient won't be able to access it. So I just won't even offer it because I don't think they're going to be able to afford it or they're maybe hesitant about the process of insurance approval. I think we heard your guest talk about taking a year to get access to medication. And so I see that as part of my job, though, is to go through that process. We can't let that be a barrier to offering it to patients, in my opinion. And then thirdly, I think some providers see these newer options as a, quote, last resort for patients. We should be talking about migraine specific therapies and really upfront and offering what we feel is the right option for that patient. So one specific thing to note for our audience listening today is that after receiving a prescription, there may be some specific programs or assistance programs from a manufacturer that will allow that therapy to be affordable to them and help bridge the medication cost. And hopefully many providers are aware of that too. But again, I think that patients should advocate for themselves and ask directly, hey, is there an assistance program I can use or is there anything that could make this medication more affordable to me?

[Nora McInerney]

I wanna talk about your relationship. Mother and son. I also have sons. It is so special. And I'm wondering how, like, this shared experience that you have, not just, you know, a parental child relationship, but this shared chronic migraine experience, what do you think it's done for your relationship?

[Xavier]

One thing I do know is as much as it sucks to see my mom struggling, there's like some solidarity within it. So it was like, like, I'm hurting, she's hurting, we're hurting together. So at least nice to know, like, hey, at least I'm not alone in this. Not that I ever felt alone with her. When growing up, when it was just me and my mom, we had this thing as just like two people, one family. Always do the little hand thing. And they mainly just apply to like, you know, mom's not looking, but also kind of, you're not doing this alone.

[Angel Pashal Harmon]

Xavier did the two fingers, one family. It made my heart smile. I did that when it was just me and him, and that was letting him know that we were okay, that we would be okay just being us. We were a perfect family just the way we were. Seeing how he relates that to us, living with chronic migraine, maybe I'm doing something right in this mom thing because it is the hardest job and. But it's the best gig ever, is what I like to say. What I also hope is that Xavier and Zion both see that living with migraine doesn't make them broken or inferior. And in some ways it gives them an insight and a level of compassion for others that I truly always see in Xavier. What's most important to me with bringing Xavier into this work of advocacy is that men deal with migraine the way Xavier behavior deals with migraine, whether they are in a toxic masculinity situation or it's a tough it out. Even with a mother who tells him it's okay, he internally still does this. And so the more that we add men to this much needed conversation, I think the more we can move past this idea that they can just. My son calls it, I'm just going to tough it out, mom. But there are some times where you just need to rest I am hopeful that that is something that both my sons learn.

[Nora McInerney]

Beautiful. That was perfect. And you are such a good mom.

[Angel Pashal Harmon]

He'll make it easy. Thank you son.

[Nora McInerney]

As parents we are wired to want to prevent our children from experiencing any difficulties. We want to smooth the path for them, clear the obstacles, make sure that they're direct journey is safe and pleasant. But that's not always possible. And so I very much appreciated Xavier and Angel for both joining us on this episode and so generously sharing their experience as a mother and a son who are all too familiar with chronic migraine. Like angel pointed out, the idea of being strong for our kids can sometimes backfire. It can put undue pressure on them to fake it till they make it, when really it is a very human, very normal thing to need help, to need a break, to need rest, to need each other. Thanks for listening to the Head Start Embracing the Journey. This was season two. We hope that you found something worthwhile here with us today and in this season. I am so happy to be a part of creating this community for all of the US and especially for people living with chronic migraine. If you haven't found a treatment plan that is working for you, please reach out to your headache specialist to explore your options and stay tuned for more important safety information. The Head Start Embracing the Journey is hosted by myself, Nora McNerney and executive produced by Yvonne Sheehan. Our EP of post production is James Foster, our supervising producer is Sierra Heiser, our writer is John Irwin and the show is mixed by Nick Cipriano for Bang Audio, Post Original Music by Sound, Cat Productions and Artlist.

[Botox Safety Information]

Important safety information continued There has not been a confirmed serious case of spread of toxin 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 as Myobloc Rimabotulinum toxin B Dysport Abobobotulinum toxin A Zeomin Incubotulinum toxin a Jeuveau Daxify Daxibotulinum toxin a Lanm or Latibo Ledibotulinum toxin awlbg this may not be a complete list 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, 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 planned 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 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 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 relaxant, 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 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. If you are having difficulty paying for your medicine, ABBVIE may be able to help. Visit abbvie.com patient access support to learn more. Can Botox Onobotulinum toxin a help if I have chronic migraine 15 or more headache days a month, each lasting four hours or more.

[Dr. Laurel Short]

Botox prevents headaches in adults with chronic migraine.

[Nora McInerney]

It's not approved for adults with migraine who have 14 or fewer headache days a month.

[Botox Safety Information]

It's the number one prescribed branded chronic migraine treatment prescription.

[Botox Information]

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 definitely 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 botulism Lineum toxins as these may increase the risk of serious side effects.

[Botox Safety Information]

Ask your doctor and visit botoxchronicmigraine.com or call 1-844botox to learn more. This is an I Heart Podcast.