Dear Doctor: Huma Sheikh
The research-focused neurologist on her work with the American Headache Society.
Dr. Huma Sheikh and I met in Union Square Park right outside of her office and around the corner from Mount Sinai — Beth Israel, where she also works on call. Dr. Sheikh’s love of both research and patient care is clear as she talks passionately about her experiences in both areas. As a neurologist who specializes in headaches and strokes, she also suffers from migraines herself, which allows her to connect with her patients on another level. Learn about this neurologist and her work concerning the interplay between migraines and strokes, as well as her quick tips for relaxation (including the one she loves so much that she tells all of her patients to do it, too)!
“When I graduated from high school, I got into a six-year pharmacy program. My dad is a pharmacist, so I initially began to follow his path. But when I started taking all the chemistry classes required, I realized that I really enjoyed biology much more, so I switched over to premed. In med school, I took an elective in neurology in my fourth year, and I fell in love with it. In neurology, you have to figure it out where the issue lies first — is it in the brain, the spinal cord, the muscle, or the nerve? This is different from other specialties. You have to be a detective using your patient’s history and exam to guide you. After that elective, I knew that was what I wanted to do.”
Specializing in Headaches and Strokes
In medical school, I started getting migraines myself. Due to this, during my neurology residency, I felt that I could relate to our patients better than some of the other residents. A lot of time in the clinic, the migraine and headache patients are hard to deal with because pain is such a subjective experience; it’s really hard to understand objectively because you cannot see their pain. I think the fact that I, too, have had that same experience helped me understand how they felt.
Researching Migraines, Strokes, and Contraceptives
There has been an abundance of research recently showing that women who have migraines are at higher risk of developing stroke. There’s still a lot that we need to figure out — like why strokes happens in young women between the ages of 25 and 45 who experience migraines. That’s not an age you’d typically think about having strokes. The underlying issue of why this happens has not been fully explained yet.
Together with one of my mentors from Harvard, where I did my Headache fellowship, I formed a sub-committee of the American Headache Society (AHS) — which works in conjunction with the International Headache Society. The committee was created to undertake projects that have to do with the interaction of migraine with vascular diseases, including stroke, intracranial hemorrhage, carotid dissection and others. Our most recent research project was to determine whether adding on estrogen-containing contraceptives makes an impact on the risk of stroke in women who have migraine.
There are two types of migraines — those with aura and those without aura. The patients who has migraine with aura are more likely to be at risk of stroke. The overall absolute number are thankfully low, about 1 in 400,000, but it’s higher than you would expect for otherwise healthy women in this age range. Because women have the highest rate of migraines during their reproductive years, and that is also the most common time when they are likely to need a contraceptives, so the question has been broached whether added birth control is giving them that risk of stroke?
As part of this AHS sub-committee, a couple of my colleagues and I did an analysis that looked at previous studies of women with migraines who were also taking estrogen-containing contraceptives. Unfortunately, a lot of the original research was done in the 1970–80s, when the estrogen in the oral contraceptives was at a much higher dose. Today, the doses are much lower, which we think is a good thing because at lower milligrams, stroke is likely to be less likely an adverse effect, but we do not yet have a good study that specifically looks at that question.
A lot of my patients with migraines ask whether it is safe for them to take an estrogen containing contraceptive. It’s a difficult and not always straightforward question to answer, especially if they have migraine with aura or their migraines are not well controlled.
We have to look at each patient individually to see if they have any other risk factors for stroke and if they have other options in terms of contraception.
If the contraception is being used for birth control or for other medical issues, like endometriosis or acne, they may not have many other options in terms of treatment. This is an area where we need a lot more research to give women better answers. Right now, I try to give my patients the available information so that we can make an informed decision together.
One of the goals of our sub-committee at the AHS is to develop registries on women in the U.S. who have migraines. By collecting data on a large number of women, we can have better information in the actual risks of stroke in these women.
Educating Other Doctors on Headaches
There are many regions of the United States that lack headache specialists. Most of them are concentrated in big cities. As a result, people go to their primary care provider or general neurologist for their headaches. Therefore, one of the other goals at the American Headache Society is to educate primary care doctors and neurologists about the pathophysiology, diagnosis, and treatment of headaches. We have two large conferences twice a year that doctors in other specialties can attend. There are also lectures and smaller discussion groups in addition to educational pamphlets that is available on the website, along with publications like the Headache Journal, and access to the social media channels.
On the Latest Headache Development
In the last couple of months, a new drug has been FDA approved. It is a preventive for migraine that targets a molecule believed to play an important role in the pathophysiology of migraine. Specifically, it is a cGRP inhibitor, called Aimovig. It’s the first of its kind, but there are three or four more similar ones in development that will be released in the next few months. So far in studies, it has done relatively well with only mild side effects. About 50% of patients noticed that around half of their headaches were improved.
The Pain of Headaches is Real
One of the main methods to determine if someone has control of their migraines is the number or frequency of headaches they get in a given month. Many patients tend to focus on the really severe migraine episodes that keep them out of work or social activities. However, people who have been suffering from migraines for a long time are used to working through smaller headaches that they do not necessarily consider a full blown “migraine.” They will often downplay how many migraines or headaches they are having.
Several patients also tell me that other people, including family and friends do not understand their illness because they just see a migraine as a headache; they should be able to take a Tylenol and move on. It’s really not just any old headache — migraines are a genetic disease with many other symptoms besides the severe pain. Many patients don’t talk about the severity of their disease because there is a stigma around it. It’s a disease that others cannot easily see. Since it’s so subjective and on the inside, it can be difficult to understand it unless you have experienced it yourself.
Lightning Round:
One thing I want my patients to take away with them after seeing me… that I understand where they are coming from and that they are heard.
If I didn’t live in NY, I’d live in…California, probably. I’d go the other extreme and be really laid back.
New York’s Best Kept Secret…is the hole-in-wall restaurants that have the best foods, like Freemans near Bowery or Tehuitzingo in Hell’s Kitchen.
Everybody needs a little self-care sometimes.
Favorites:
Relaxation ritual: I found this video on YouTube that shows you how to take 5–10 minutes to stretch out your head and neck. It helps me to de-stress at the end of the day. I recommend it to my patients all the time, and we do it together in my office sometimes!
Tips for patients: There are essential oils like lavender and peppermint that can be relaxing. I suggest rubbing them on your temples or on the back of your head in the evening, giving yourself a mini massage. Also, taking 5–10 minutes of mindfulness a day is amazing; there are so many apps now to try out mindfulness that are easy to follow.
App: I use Calm; it’s really helpful and easy to follow along.
Union Square Eats: Glaze is my go to for lunch Union Square. They have a salmon with brown rice with a Teriyaki sauce that is delicious but also very healthy. Their edamame topped with red pepper is yummy, too. I also love bringing my lunch to the park to eat, getting in sun during the day can be very relaxing and energizing.
Only in New York: Summer in the city is my favorite, I especially love the summer nights. Walking in the city, near the Hudson River on the westside with ice cream or gelato.
You can learn more about Dr. Huma Sheikh here.
Know a great female doctor in NYC? We’d love to meet her, introduce us here!
