Dear Doctor: Risa Ravitz
The neurologist whose digital practice offers high quality care and convenience
Dr. Risa Ravitz is poised to have a big year. A neurologist who focuses on treating headaches and migraines, Dr. Ravitz recently opened City Neurology, a membership-based practice designed to meet the needs of busy, digitally-inclined New Yorkers using technology to deliver headache and neurological care via a telemedicine platform in a focused efficient manner. While it can be difficult to pinpoint the root cause of headaches and migraines, Dr. Ravitz takes a compassionate and highly communicative approach, sharing evidence-based data with patients, and diving into potential mental and emotional causes for a holistic treatment. Read on to hear more about how she approaches the often elusive world of neurology, her vision for the new practice, and more!
“I had several doctors in my family who were role models for me. I always loved science, which provided a natural segue into medicine, and I enjoyed interacting with people. When I came across neurology, I was immediately fascinated with the variety of different approaches to studying the brain — from the physical to the neurological and the metaphysical. You have to do what you like, and I continued to gravitate toward neurology; it kept me engaged.”
Neurology on the Brain
I did a fellowship in headache medicine and was struck by how people perceive pain. I saw young females mostly (we still don’t quite know why they have greater frequency of headaches and migraines) and it was a population of patients who wanted to live busy, productive lives, but were debilitated due to pain. Five-to-eight percent of ER visits are due to headaches, which shows how serious these can be for many people.
I’m excited about and interested in my work every day, and I feel very lucky. It’s really true that the brain is the final frontier of medicine. It still has an element of mystery, which keeps me motivated; we have so much still to learn.
Headaches: Causes and Treatments
Communication plays a big role in my work. People like to hear a specific diagnosis and understand what to expect from treatment. I’m constantly getting asked by my patients, what causes this? I find myself frequently managing expectations because New Yorkers are very sophisticated and ask lots of probing questions.
It’s important to remember that not all answers can be found by Google search, and even at the clinic, we can’t always get to the definitive root cause. Medicine is incredible, but it doesn’t always address the root cause of symptoms.
I want to both give the patient tools to solve the problem and discuss things like sleep, stress, and exercise, all of which are relevant to understanding and treating headaches.
That said, there are several evidence-based causes for headaches and migraines, such as irregular sleep patterns. A lot of people get headaches on the weekends because even though they may be getting more sleep than during the week, the number of hours and timing is irregular. Dehydration is a big factor as well, as is overuse of — or withdrawal from — caffeine. People should also be eating regular meals. When it comes to diet, I don’t believe in cutting out entire food groups, but my general philosophy is if it works for you, do it. Of course there are some known culprits, like tannins and sulfites, which can be found in deli meats, aged cheese, and wine — as well as MSG, which is frequently found in takeout. For some, MSG can trigger a migraine instantly!
In terms of treatment, Botox is one that works very well for headaches, and people love it. It was actually found to treat headaches by accident, when women who were using it cosmetically found that it had the benefit of helping with their headaches!
A New Model for Medicine
In addition to continuing to maintain my private practice, Downtown Neurology, I recently launched City Neurology, a telemedicine platform to treat patients that’s coupled with educational content from science and medicine experts across various channels — YouTube, podcast, and a blog. I believe the future of medicine will be much more digital and online. People really value convenience and seamless integration into their daily use of technology. My patients are busy, so why not meet them where they are? If that’s in their phone, it should be easy for them to chat with a doctor or get a prescription refill there.
One aspect of the mind that I’m particularly interested is behavioral patterns. As we get older, we fall into these patterns more. For example, if you’ve had an experience where you’ve argued with a parent on the phone, the phone ringing with your mom on caller ID may trigger agitation or anxiety. It’s natural to memorize things by associating them with what we know, but we sometimes need to fight against our our inclination to react quickly to triggers.
This in mind, my vision is to build a tiered program where people can see a nutritionist, practice meditation, and consult with a life coach all in one place to help them alleviate symptoms and address behavior patterns they want to change. I was struck by the fact that my medical school curriculum did not include coursework on nutrition, stress, or mindfulness, yet these have become huge factors in understanding and treating a number of ailments. There is also a metaphysical and spiritual component that isn’t as widely discussed. Combining western advances like imaging and medication, this is a whole new frontier I’m looking forward to exploring.
I love what I do because…I get to have brutally honest conversations with people in a way that most people don’t in their work. It’s a privilege to see people in an environment where they feel comfortable enough to be completely honest.
If I weren’t a doctor, I might be…a pro surfer or an oceanographer. I grew up in South New Jersey and love the ocean.
I feel looked after when…somebody makes me lunch.
Everyone could use a little more…love!
NYC Neighborhood: I love the Upper West Side for it’s quiet, local feel and the proximity to the park.
Relax ritual: Taking a yoga class or watching a movie.
Travel destination: I love going surfing in Southern California.
You can learn more about Dr. Ravitz and City Neurology here!
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