Meet The Headache Expert

To design our new Headache and Migraine Treatment, Nurx partnered with neurologist and headache specialist Charisse Litchman, MD, FAHS.  A former Assistant Professor of Clinical Neurology at Yale School of Medicine, Dr. Litchman has been specializing in headache medicine for more than a decade, and is excited about the opportunity to make specialized headache care accessible to more people through telehealth. We talked to her about what people who experience headaches and migraines need to know, why she chose this field of medicine, and more.  

How did you decide to be a neurologist?

It was clear from day one of medical school that I would become a neurologist. The nervous system is what truly defines who we are as individuals — how we think, how we experience, how we perceive, how we interact with the environment and with others. Making the correct diagnosis draws on creative skills and treating a patient with neurologic challenges draws on our ability to connect with and understand our patients, which is what drew me to the field of medicine in the first place. The potential to improve our patients’ quality of life is limitless and the personal reward for making a difference is profound.

Did you encounter challenges as a woman doing neurology fellowship and training in what at the time was a male-dominated field?

I chose to train under two of the founding fathers of modern neurology, and the education and wisdom delivered were profound, but so too was the pigeon-holing of women into stereotypical roles, even as they trained alongside their male counterparts. There was no masking the misogyny, both from some of the physicians who trained us and even the patients. As a chief resident, I would enter a patient’s room with a male medical student and the patient would direct questions at the student rather than to me. While I admit those memories left an indelible mark, it makes the breaking of the glass ceilings even more glorious — now a woman is the head of that entire prestigious medical institution! So rather than harboring bitterness, I am buoyed by the progress we have made in a relatively short period of time and have hope that the playing field will be more level for my daughter, who is starting her residency now.

What led you to focus on headaches?

I chose headache medicine as a subspecialty because of the tremendous opportunity to improve quality of life for so many people. In neurology there are a lot of conditions in which you work to preserve neurologic function, like MS, ALS — although advances are certainly being made, with chronic neurologic conditions it’s often about keeping things from getting worse rather than achieving improvement. So it’s wonderful that with headaches you can actually make people better. I ran into a former patient not long ago, and she started crying as she told me, “You literally changed my life.” 

Do you or members of your family personally experience headaches? 

Yes, because I and several members of my family experience migraines, I truly understand the impact beyond pain alone — inability to function well at work, not being able to respond to your children as you would like to, missing social events as well as diminished enjoyment of even the simplest pleasures in life.  

How has the field of headache and migraine treatment evolved since you began specializing in it? 

How we treat headaches today is unrecognizable compared to even 10 years ago. In the past we had to rely on painkillers and medications borrowed from the treatment of other medical illnesses. Today we have multiple medications that were designed specifically to treat migraines. In the past we aimed for pain reduction, but today we aim to stop headaches entirely and to prevent them from starting in the first place.

The field of headache medicine only goes back about 25 years. Even though headaches and migraines are so common, it’s one of the newest fields of medicine. The field of headache medicine was born around the time that the triptan drugs emerged, because that was the first class of drugs that was designed specifically to treat migraines and provided significantly more benefit than what we had available previously. Now there are fellowships focusing only on training neurologists to treat headaches! 

Many believe that the reason why it took so long for the medical community to focus on headache treatment is that it’s primarily a female disorder. Some women sense that their migraines are dismissed outright or that men minimize the impact of their headaches because it is often associated with the menstrual cycle. And I think a lot of women do try to hide their suffering and harbor a sense of guilt for the impact on their families and coworkers.  It is in the nature of many women just to power through the pain. But women are more empowered now and they demand better care, as they should.

What should people who experience headaches or migraines know about their treatment options?

Headache sufferers need to know that there is help out there, different from what was available to their mothers. They need to feel empowered in seeking care and demanding the best treatments available. They also need to know that they are not alone—one in 4 women suffer from migraines. And they should know that there are even newer and potentially better options that will be available over the next two years.

What should the loved ones of people with migraines understand about this condition?

Chronic pain and suffering affects more than just the patient. Spouses, children and coworkers suffer if someone in their life is suffering from migraines. Sometimes it is hard for someone who has not had a migraine to understand the pain and disruption caused by it. The loved ones of patients should recognize that migraines are real and cause suffering and should encourage the migraine sufferer in their life to get help.

We’ve talked a lot about medication, but how much can lifestyle changes help with headaches?

I emphasize that getting migraines and chronic headaches under control requires a multi-faceted approach. Understanding and avoiding your food triggers and avoiding excess caffeine and alcohol can reduce headaches significantly and make the traditional medical approach more effective. Eating regularly, not sleeping too little or too much, avoiding or addressing stress, avoiding too much screen time, and exercising can make a real impact. For many patients, however, maintaining a healthy lifestyle and avoiding triggers will reduce but not alleviate their headaches entirely. The appropriate prescription medications (not simply pain-relievers) can stop migraines in their track and give patients their lives back.

What’s the best part of doing what you do?

The most fun thing is when I see the often rapid transformation of a new patient from a non-believer in the recommendations made to a partner in her own health care. Patients are often incredulous at the improvement in their headaches. They often don’t know what it’s like to live without headaches, and it’s not until the headaches are gone that they realize how big an impact the headaches have on them. Getting the right treatment is life-changing. In my practice, pre-COVID anyway, barely a day would pass without hugs and kisses from patients who had never dared to dream of a pain-free day. Now I’m excited to help more people achieve those pain-free days even if they don’t have access to a specialist, through the Nurx headache and migraine treatment plan.   

About Dr. Litchman

Charisse Litchman MD, FAHS is a neurologist, headache specialist, and medical advisor to Nurx. She received her undergraduate degree at Wesleyan University and her medical degree at Yale School of Medicine. After completing her internship at Yale New Haven Hospital, she completed her neurology residency at Cornell-New York Hospital. She began a solo private practice in general neurology and became board certified in headache medicine in 2008. A former Assistant Professor of Clinical Neurology at Yale School of Medicine, Charisse has published articles in headaches and multiple sclerosis and edited the first textbook on a rare soft tissue tumor. She has earned a certificate in Medical Editing and Writing from the University of Chicago. Charisse has three children and lives in Connecticut with her husband Mark and her two dogs.

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