community — The 20/20 Podcast

Despite being a common chronic illness, migraine headaches are often misunderstood. How do people live with this condition, and how can we support the people who suffer from it? In this episode, Dr. Harbir Sian talks to Amy Mowbray, founder of the large online migraine community called The Migraine Life. Amy shares her journey in dealing with chronic migraine. She also helps us understand what it means to live with a chronic condition and the role that eye care professionals can play in helping our patients with migraine. Full of insight, learn more about migraines and how you can help.

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Living With Chronic Illness: A Patient’s Perspective Of Migraine With Amy Mowbray

My lovely guest is Amy Mowbray from The Migraine Life, which is an Instagram-based migraine community. You may be wondering why I'm having somebody on from a migraine community. This conversation is so relevant for us as eyecare professionals. I've only started to learn how relevant it is over the last maybe year or so. The more conversations I have, the more I'm learning how important it is for us to talk to our patients to uncover the types of symptoms and things that our migraine patients are dealing with and learn how we can help them.

There are some amazing tools right at our fingertips at our disposal to help our patients who suffer from migraine. Dr. Charles Posternack, the President of Avulux, explained this technology that is so valuable and available to us. What I thought was going to be so amazing and helpful is to hear from the patient, a migraine sufferer herself, about how this technology has helped her and what her journey has been through migraine. Thank you, Amy, for joining me on the show. I appreciate you taking the time to come and share your journey with us.

Thanks so much for having me. I'm excited to hopefully educate people about migraine and share my own experience with Avulux in managing my sensitivity.

Thank you very much. You are from England. Why don't you tell us a little bit about yourself? Lead us into what has been your journey with migraine. When did it begin?

I grew up in Surrey, outside of London in the UK. Growing up, I never had a migraine. It wasn't part of who I was. I was healthy, went to school, played sports, and socialize with my friends. Luckily, I went through school and university without migraine pain as a part of my life. At the age of 21, I woke up one day with head pain. I thought I had this delayed hangover from New Year's Eve. I thought I had a bit too much over Christmas time. “What's going on?” Sadly, that head pain never went away. I've had continuous head pain for many years now.

That's where my migraine journey started. I had all these initial tests to rule out anything sinister. I went to my opticians and neurologist. They ruled out blood disc and all the other nasties you can have. Several months later, I was diagnosed with chronic migraine. I had a few episodes of tension headaches before at times of stress after turning in my dissertation but never like this migraine as it were. I've been spending many years trying to reduce the level of migraine I was having and also learn to live with it at the same time.

I want to touch on the whole learning to live with it. That's an unfortunate part of it. You have to accept that this is going to be part of your life and continue to endure it. Once you discovered that it is a migraine that you're dealing with, what are some of the triggers and symptoms you experienced, and the frequency of the headaches?

It probably makes sense if I start with the frequency first. I have what's called chronic migraine, which means I have fifteen or more headache days per month. For me, I had 30-plus. A part of the diagnostic criteria for chronic is fifteen or more headache days per month of which, at least eight is the nature. This must go on for more than a three-month period. This is such a different disease. I see it very differently from your typical migraine. Everyone knows someone who's got a very infrequent episodic migraine where they have one attack every six months or so. This is completely debilitating. The World Health Organization recognizes it as the same level of disability as people with quadriplegia or active psychosis. It's huge.

Migraine: There's so much more than just being offered paracetamol by your doctor or being told it will go away. There really is so much you can do to help.

When I was at my worst in the first few years, I was having daily head pain and symptoms. About twenty days of the month, I was also having full-blown attacks on top of this. That has reduced in frequency. I still have daily head pain but my attacks have reduced by about 50%. I'm having attack days about ten days a month. They are also less severe and shorter in duration in general. It's encouraging but it's still obviously a huge impact in terms of disability and what I’m able to do day-to-day.

The triggers for me have been tricky. If you're at the end of the spectrum as I am with chronic, it's harder to distinguish. You're always somewhere within the migraine cycle. All the basics we know help with managing migraine in terms of good sleep, good hydration and eating regularly, if I don't do those very well, it often triggers my head pain. Stress has been a big one for me as well. If I have probably an acute episode of something stressful, that's almost the most obvious trigger to cause a quick attack.

Avoiding triggers and doing the basic daily activities like hydration, sleep, and all these things are important. I follow you on Instagram. I can see you've experienced different treatment modalities. I'd like to hear what your experiences have been as far as certain treatments and prescription medications you can remember that have been part of your routine as well.

Migraine management from a medical perspective is split into preventative and acute treatments. If you’re having more than 4 or 5 attacks a month, normally, you'll be offered preventative treatment. I initially tried all of the old-school migraine preventatives. They are all medications that were designed for other things. They're epileptic drugs, antidepressants, and blood pressure medications.

They're all things that weren't designed for migrant patients that I found as trial and error. This helps reduce the burden of headaches in some patients. I try amitriptyline, topiramate, pravastatin. I've tried a whole host of them. Unfortunately, they didn't make any difference in managing my pain and all my migraine symptoms. A few of them came with awful side effects. It’s almost worse. At one point, I was more unwell from side effects and medication than I was from migraine itself.

I then progressed to trying some injectables. I had Botox for chronic migraine. I had occipital nerve blocks where they inject into the back of your skull, essentially. At the same time, I was managing acutely with nonsteroidal, naproxen, ibuprofen and triptans, which is a class of drug designed specifically for migraine. I also added neuromodulation devices. The main one that has been beneficial for me is the Cefaly device, but there are other ones like the sTMS, the gammaCore device, and the Nerivio in the US. There are different options. This is only getting more advanced as research and technology come on.

The game-changer for me in terms of medical treatments has been with the anti-CGRP drugs. This is the first class of drug that has been designed specifically for migraine patients. They found that during a migraine attack, a special chemical is released in the brain. In a very simple layman's term, this medication blocks the receptor. That has been the thing that's reduced my attack days from 20 to about 10 days a month. That is still ongoing. There are different variations of that drug that are available to patients.

Wearing sunglasses all of the time is a very easy trap to fall into. As a chronic migraine patient, it's the same as wearing earplugs. If you live in earplugs and then you take them out, the whole world is so loud all of the time.

That's probably on the medical side. I've also tried other tools. I almost call it my migraine toolbox, which includes some of the devices. It also includes clever ice packs you can wear and mold around your head and neck, which provide huge amounts of relief. Ice helps me greatly during migraine attacks. I also have eye masks, Avulux glasses, earplugs, and noise-canceling headphones. It takes you a while to figure out what works for you. The toolbox is almost as helpful as my acute medication in managing attacks.

The other side of things I've tried has been all the alternative therapies. That could be a whole focus in itself to discuss all of that. Out of all the different things I've tried, there’s nothing that helped me massively. I'm working with a physio to help with posture intention and rebuild some of the muscle in my body that's not as strong as it could be, primarily from spending so much time in bed for years and building up the strength again that way. There's so much more than being offered paracetamol by your doctor or being told it will go away. There is so much you can do to help. It's just trying to find out what is going to help you.

The trial and error aspect of this whole thing is incredible. It's not a new condition by any means. We've known of this for so long but as a society and as medical professionals, we understand this so poorly still. We have to say, “Let's try this other medication that's got this long list of side effects.” It's incredible that that's where we still are to some degree. There's a lack of understanding and awareness.

I felt like the lights were turned on for me. When I see patients write on their sheet, "I get migraine," I'll be asking them about, “Do you get headaches?” They say, “I get migraine quite regularly.” I'll dig in a little more, “Tell me about the symptoms. Tell me what you think the triggers are.” It blows my mind how little I knew about how many of my patients were suffering from this stuff. My level of empathy has gone up so much. I'm like, “I can't believe that you guys have had to deal with it.” Few patients who suffer from migraine have had to deal with this.

It blows my mind that optometrists don't because a headache is such a common thing when there is eye strain or difficulties. When you look at how much time in medical school the doctors have spent on migraine, under 3 or 4 hours in the whole medical training is spent on primary headache disorder. You think, "It makes sense. If the doctors haven't been given it, why would the optometrist be given it?" There's this huge lack.

There's one thing which I'm preaching to my colleagues. One thing we were taught as optometrists is that we are the experts on light. The foundation of optometry is refraction, which is light being bent in different directions. We are supposed to be experts on light. If light is one of the key triggers of migraine, then we should be understanding how we can help to modulate, reduce or facilitate the light part of the triggering system. That's how we could start to begin to talk about Avulux and how it helps. Light has been shown to be a trigger for 60% of migraine attacks. If we know how to control that, eye care professionals can be a big part of helping our migraine patients.

You mentioned Avulux in your toolkit there. You're wearing a pair. If you're not watching, go to YouTube. You can see the glasses that Amy is wearing. They look like a nice lightly tinted pair of sunglasses but they come in a lot of different frame styles. I'll tell a little bit from my perspective but I would love for you to share with me and the audience where this has fit into your toolkit.

Migraine: One of the symptoms of migraine, which is the very first stage, or even when people are in an aura, is aversion to light.

Firstly, it's important to explain. For migraine patients, light is pain. We call it photophobia. There's this misconception that it's a little bit irritating or I don't like the bright lights. Light to migraine patients causes pain. There are lots of research to show this. That's the first thing. The second thing is the trigger versus the symptom. That's tricky, especially if you're chronic like me. Not only is a horrible bright light in my eye will likely to trigger an attack. It also can be an early warning sign that an attack is already in progress.

One of the symptoms of migraine, which is the very first stage or even when people are in an aura, is this aversion to light. If that light is there, it can speed up the attack side further and draw you into a full-blown attack. For me, light sensitivity was always an issue. In hindsight, I probably spent a lot of time making it worse by wearing sunglasses all of the time, which is a very easy trap to fall into as a chronic migraine patient.

It's the same as wearing earplugs. If you live in earplugs and you take them out, the whole world is so loud all of the time. I tried different glasses. I tried the plastic FL-41s. I've tried the blue light blockers. I've tried quite a few. If I'm honest, I was skeptical when Avulux reached out to me. I was like, “No, I've tried that. I’ll just wear my sunglasses. I'm fine. Leave me alone.”

Avulux is different. They not only block blue light. They absorb 97% of all wavelengths of light that have been found to be irritating to migraine. That's the blue, the red and the amber. There is some interesting research about the benefits of green light for migraine patients. Avulux allows in the green light while blocking all the other harmful lights. They take all the bad stuff out and let all the good stuff in for migraine patients. They have amazing clinical science that backs all these claims as well. It's one of these things where as soon as I tried, it was an instant, “Wow.”

It's hard to explain because you do have to experience it for yourself. It takes all of the burn and the pain out of light for me and so many other migraine patients. You can see there is a slight tint to them but they don't distort color in the same way that the traditional FL-41s make everything red. It's not a very nice switch. The main benefit is having reduced light sensitivity and the help that has on migraine as a whole. Day-to-day, if you're watching a film or if I'm looking at you on the screen, it's nice to see you in color you should be rather than distorted as well. That's a huge bonus for them.

If you do not suffer from migraine and the light sensitivity that comes with it, I don't think there's any way to truly know that light hurts. That is such a foreign and strange concept that light hurts. A lot of patients try to express that but they can’t vocalize or verbalize it that way.

If I turned on a light early in the morning to someone who doesn't have a migraine, your eyes are adjusting. You don't like it but it doesn't cause pain. It's not painful. It's like, "We don't like it. The contrast and shock are a bit much." Whereas for migraine patients, it intensifies the pain.

What we understand about this physiological pathway there is that the melanopsin cell being released by retinal cells is found to be the culprit for the pain pathway, not just the light pathway but the actual pain pathway. These Avulux lenses reduce the transmission of the certain wavelengths of light that trigger that melanopsin pathway. That's blue, amber and red. Those are the three. Green was shown to be soothing, calming or helpful. They allow in the green which is so cool. That makes it a very unique and precise filter.

If something's reducing the impact and burden of migraine and reduces their medication, it's as good as treating it with something else.

A lot of people say, “It's just a tinted lens,” but it's a very unique filter that allows in certain wavelengths and doesn't allow in others. You mentioned the FL-41 which blocks certain wavelengths of light, the blue wavelengths primarily, including the green as well. Someone could say, “It's helpful. It's blocking blue,” but it's also blocking the light that we want to have come through that's been shown to be helpful. It's also not blocking the red and the amber.

I know a lot of practitioners and colleagues of mine out there use FL-41 quite frequently. This is something that will hopefully help them open their eyes a little bit to the importance of modulating certain wavelengths of light. We are the experts on light, so this is our opportunity to be precise about how we're using light and preventing it from causing harm.

Some of the interesting things you are speaking from your personal experience are powerful for someone who has suffered severely from migraine for years. Some of the stats that Avulux shares are pretty amazing, 90% of their subjects find relief and are able to continue with their daily activities. You've shared with me about how these migraine lay you out. You are out for days and can’t function. The fact that 90% of people in that type of situation are able to continue with their daily functionality is huge for their own productivity and the economy, in general. How many millions or billions of dollars are lost from lack of productivity due to migraine?

The thing that hit home for me as a healthcare practitioner is the statistics show that 74% of Avulux wearers were able to reduce or eliminate their usual medications. We talked about how crazy some of the side effects can be for these medications. They were trial and error. Who knows what the long-term effects will be? If three-quarters of people can stop or reduce their medications, that was powerful. That was huge. These are important things for people to know.

Part of the challenge Avulux has is getting people to see that the glass is not the same as the blue light glasses you could buy on Amazon but a medical treatment for migraine. That's what it is. I’m not sure if they are allowed to say that. If something is reducing the impact and burden of migraine and reducing their medication, it's as good as treating it with something else.

Going back to the impact on the economy and the burden, Avulux has initially enabled me to start working again. Before Avulux, I had to do everything on my phone. People are always amazed of my page. I did everything on my phone. I couldn't look at a laptop. I could barely cope with a small iPad. TV was completely out of the question. To do any proper work, you need to be on a laptop.

Since Avulux, I've been able to use a laptop. I still have it timed down nicely with all my filters on. I'm talking to you now on a laptop. I'm able to do small amounts of work. The benefit is huge. They also have helped me tremendously in the autumn and wintertime, which for many migraine patients is challenging with light because from 4:00 PM, it gets dark. Thankfully, it's getting lighter again but the contrast is challenging.

Migraine: Light contrast and shock for migraine patients actually intensify the pain.

When it's dark outside, there is suddenly this need for artificial light inside. Before Avulux, from 4:00 PM onwards, I would find it hard to function with anything. I couldn't cook. I couldn't prepare a meal because I had to have these big lights on. I would have lamps on in the room and use pieces of furniture or cushions to block the direct impact. That's how bad light is affecting people with migraine. You're moving chairs or sitting with your back to the lamp that is in the back of the room.

Now, it's not a problem. I can cook again. I can watch TV in the evenings. I can speak to my friends and see them. It has a huge impact. Unfortunately, for me, it has never been like I put them on and my attack disappears, but my actual level of function and what I'm able to do and achieve in a day and not be stopped or interrupted by migraine rearing its ugly head is huge with the help of Avulux.

There are two sides to how much we take those little things for granted. Someone in my position who doesn't suffer from migraine can cook a meal with all the lights on or watch something bright on my phone. There are so many people out there who are unable to do those basic simple things because they're suffering from a migraine attack. The other thing is we might think it doesn't sound like that much of an improvement if you're able to cook a meal. That is a huge improvement in your quality of life to go from being bedridden or closed up in a dark room to being able to communicate with the outside world. That's a massive difference.

You have to remember as well that I'm at such a severe end of migraine. If you're someone who has five attacks a month, and the rest of the time, you're free. Maybe there is the difference of you wear them when you're watching something flashing or you go to a bright supermarket that's a trigger. It might be that's all you need to do and the attack doesn't develop and you're not triggered by light.

That's amazing to see that something so simple like a pair of lightly tinted glasses can be so beneficial. You mentioned being careful on how we phrase things being medical devices. In Canada, Avulux does have Health Canada approval as a class-one medical device. It's safer to call it a medical device here. That is technically classified as a medical device used to treat light sensitivity. The primary function of that is for patients who suffer from migraine and have light sensitivity as a trigger.

It is that changing imperceptions though, but you have to be careful.

That's the conversation that we're going to have about this lens with my colleagues. Since we're talking about it being a class-one medical device, in Canada, it's available as non-prescription and prescription. Anybody out there who are optometrists or opticians, you can order these lenses with single vision and progressive lens prescriptions.

You can edge them yourself or at the lab. You can buy them pre-made like what Amy is wearing or as uncut and put them into lenses or frames for your patients who would like to have a pair in their own frame. Is there anything else you want to share regarding Avulux? Are there any other little details or pieces of information that you think would be helpful?

The only real motivation we have for growth is to spread awareness and for other people to not feel alone with migraine.

Something that comes up quite a lot has to do with the pressure. Lots of migraine patients struggle with any pressure on the sides of their head, on the temples or on the bridge of the nose. It's not something I hugely found a problem with sunglasses before but sometimes the pressure was a lot, so it's worth mentioning. The frames are extremely lightweight.

They have released their featherweight frames. They're almost as light as glasses can be. If you do struggle or you're worried about the pressure being a trigger in itself wearing them, then have a look. There are so many different frame designs you can choose from, and different ones that are lighter and hopefully, won't be triggering in that sense.

If you sit there with migraine and light is a big deal, you probably couldn't care less what they look like on your face. Honestly, if they help, they help. They have released so many cool colors, designs and styles. We're allowed to look good as well as feel better too. Have a look at their website for all the different frames and color options because there are so many to choose from.

That's important too. It should look good. Just because it's a medical device doesn't mean it has to look ugly. Also, in Canada, you can use your own frame. If you happen to be shopping around and find a nice frame, ask the eye care provider to order the lenses and put them in that frame for you. You have that full flexibility to put them in any frame you want, whatever look you're going for.

If you want to learn more about Avulux, it's Avulux.com or Avulux.ca. You can reach out to me on Instagram @HarbirSian.OD. You can reach out to Amy. Amy, we're going to talk about your Instagram and your online presence. I'd like to talk more about it. First, why don't we start with what is your Instagram handle?

It's @The_Migraine_Life.

You've done such an amazing job of building this platform and becoming this ambassador and this advocate for others who suffer from migraine and other chronic conditions because there's some overlap there. When did you start to build this presence on this platform? How did you build it?

I started the page in 2016. I'd been ill for just over a year. It was during one of my worst attacks that the idea came to me. I had an attack that go on for about two and a half weeks. I was completely in bed and unable to do anything, so my mind is wandering away. At this point, I have never met, spoken to or heard of anyone else who had chronic migraine. It's not something that any of my friends or family have ever had. I didn't know it existed for anyone else. I thought, “I've got this awful thing and no one understands and gets it.”

Migraine: It's never been about growing. It is to spread awareness and help other people not feel alone with migraine.

Initially, when I started my page, it was to see who else was out there. At the time, I don't think they were many other migraine pages or even chronic illness pages that I was aware of. I'm sure there were a few. It has come on so much in the last few years as Instagram and social media has developed. At the time, it was very new and basic.

I would post a picture. It was almost anonymous. I didn't share any photos of me. It was things I have created or sharing resources I have found. Slowly, I built this small but lovely community of people. There were a few hundred of us, which at the time feels like so many people. I said something that I experienced, thinking nobody else in the world understands. They have told me they experienced the same thing. They are my age and living in America. They’re not someone so unrelatable to me.

It developed from there. I'm lucky that I've always felt quite comfortable being open and talking. I've never felt particularly uncomfortable or nervous about filming myself talking. I've always been a bit of a performer since I was young. It comes naturally to me and that doesn't faze me. That helps people get to know me and relate to me. It also allowed me to share with the community the real me and some of the more vulnerable sides of living with chronic illness. It developed to where we are now. There are 20,000 of us on Instagram now, which is huge.

Many people always ask about growing and things. I've grown quite slowly and steadily but it has never been about growing. If I think of hundreds of people in a room, all sitting and talking about chronic migraine, that's amazing. There's quite a lot of emphasis on growing to hundreds of thousands. The only real motivation I have for growth is to spread awareness and for other people to not feel alone with migraine. It's amazing that we have grown, but it's having that community and space to talk openly about my own journey. If we raise awareness and help educate others along the way, then that's awesome.

You’re right. If you think about having a few hundred migraine sufferers, that sounds like a lot of people. Here you have 20,000 on Instagram. I go through your Instagram and follow you. I see the engagement and how much what you're sharing helps other people. If I have any takeaways from what I see from you, one of them is you started with providing value. Your goal was simply like, “Let me share useful information and see if it helps people.” If you start with that, that's always going to be the most authentic thing.

The authenticity in your case is so key. You're so open with sharing thoughts that maybe a lot of other people wouldn't be comfortable sharing about the fear of getting a migraine or the trauma. When you get a migraine, it reminds you of the bad days and sharing that stuff. Do you feel that authenticity has been helpful for you to build this community?

Being myself has allowed this community to grow. It's not that it's a sales thing but people buy from people. People follow you for the same reason, for being who you are. I see this all the time in the chronic illness community, where people start pages. They try and be like somebody else's page. If anyone says, “I'm starting to think of getting into an advocacy for migraine,” I’m like, “Be yourself. Share what's important to you. Share your truth and what you're trying. People will like that and relate to that because it's personal to you.” That's important if you're thinking of starting a page. It is how my page has grown.

Migraine is this neurological disorder all on its own. People who live with migraine have migraine all of the time, even when they do not have a migraine attack.

What you're saying about fear and the impact on people's mental health, I still find that hard to talk about. It doesn't come as naturally to me, but I see the power every time I share about it. It's not always the mental health side. It's always the weird stuff. The things that you think, “I'm experiencing this symptom. I have this thought before I do something because of migraine. No one else will relate to that.” It's always those things. I'm receiving all these DMs or comments. People have been waiting for someone else to acknowledge it. There is so much power in that. That's what motivates me to be open and say, “I am so fearful because of X, Y and Z,” and share and be honest.

It's powerful that you do that. You help others realize that they're not the only one dealing with that or it is okay to speak openly about that thing. We talked about providing value, being authentic, sharing and being open. If somebody else out there wanted to create a platform and become an advocate or share valuable information in whatever industry they're in, the key things I have taken away here are to provide value and be authentic. One of the things you said is being comfortable on video or camera. Maybe that goes at the top of the list because otherwise, nobody is ever going to get this information from you.

It is, but if you're not, you don't have to be. I have a friend who has a chronic illness account. I've made friends with her through being on Instagram. She isn't comfortable. She doesn't love being on stories. She isn't one for being chatty and open, probably oversharing at times. She communicates through her blog and writes amazing articles and stuff people relate to. It helps, especially on Instagram. It's such a video platform. There's all this pressure to be making Reels. We can't all have as crazy transitions as you. You’re killing it with Reels.

If that's not you and you don't want any extra stress or pressure when you're chronically ill, and filming can feel like the last thing you want to do, find something that does work for you. It doesn't have to be filming yourself and talking. It can be a podcast even if it's just your voice or taking part in research or writing. There are so many different ways you can be an advocate without being visually on screen.

There are other platforms and other ways to make a difference if that's your goal. I read something that I'm guilty of. I wanted to clarify this. That is saying migraines instead of migraine. If you wouldn't mind quickly clarifying that for everyone.

People always refer to migraine as migraines. Even when you said it, I have to stop myself from interrupting because it's not always helpful. Most of the time, when you referred to it before patients and they've got migraine. It wouldn't be helpful if you always corrected your patients and say, “It's migraine.” Migraines is with an S because we think of headaches. That's what we think of migraines.

The problem is migraine is this neurological disorder all on its own. People who live with migraine have migraine all of the time, even when they're not having a migraine attack. If I say, “I've got migraines,” I might be in a migraine attack at the moment. For example, if we think of something else like epilepsy. We don't say, “Someone's got epilepsies.” We say, "They have epilepsy."

All of the time, we don't think, “You only have epilepsy during an epileptic fit or a seizure.” They live with epilepsy all of the time. The importance is more towards the chronic or the high frequent episodic that we are managing migraine. I'm managing migraine all day, every day, even when I'm not in attack. I'm preventing the buildup of an attack. I'm managing triggers. I'm doing so much. That's why it's important. I always say, “Drop the S. We help reduce the stigma and see it as this neurological disorder all on its own.”

Migraine: People buy from people, and people follow you for the same reason: for being who you are.

That is helpful. Thank you for clarifying that. Even for me, I know that it's supposed to be migraine but I never understood or I never asked why do we want to make that distinction.

I have a Reel on my page, which is far more sustained from what I just rambled.

What you said was perfect. This is the platform for you to share openly in long-form if you like because that's the whole point of the show. I'm going to go look for that Reel. If you don't mind sharing it with me, I'll put them on my page as well. It’s important to start thinking about migraine as this chronic thing that you're dealing with every single day.

Epilepsy may be a good analogy in some cases, maybe not in others, but in the sense that a person who has epilepsy always has it. Whether they're having a seizure or not, they still have the condition and the same goes with migraine. Just because you're not having an acute attack doesn't mean you don't have the condition that you're dealing with all the time. It is a very important distinction. Is there anything else that you would like to share before we wrap up, Amy?

If you have migraine or you have a patient with migraine, I know how isolating and lonely it can be. It can feel so overwhelming. I want to remind people that there are so many different treatment options, things and tools you can try like Avulux. Hold onto some hope that you can improve. Hopefully, my own story of being completely bedbound and debilitated but working and functioning so much better gives you some hope. Keep going.

Those are nice motivating words and words of encouragement for those who are dealing with this and suffering. Thank you for being the advocate and that voice to support those who are dealing with this condition, and helping share more information and knowledge for those people like me who are slowly becoming more enlightened of it. Thanks for joining me on the show, Amy. I appreciate you coming on and sharing all your insights.

Thanks so much for having me.

Thank you, everybody, for all the support. We will be back for another episode. We'll see you soon.