Caroline Stowe is a Nurse Practitioner and Clinical Team Lead at Nurx who is particularly focused on finding solutions for our patients with migraines and chronic tension headaches.
Caroline lives in Northern Virginia with her air traffic controller husband, two children (ages 8 and 5), two dogs, two cats, and an aquarium full of fish, and although she clearly doesn’t have a ton of free time, she enjoys horseback riding and reading when she can.
We chatted with Caroline to learn more about migraine treatment with Nurx, and what she sees as the advantages of telehealth for both provider and patients.
What’s it been like launching the migraine treatment service at Nurx?
Treating migraine patients is so rewarding and can be so much fun — it’s almost like a puzzle figuring out what’s going to work best for people. I love knowing we are creating access for people who might not have been able to get this care otherwise. I recently had a mom record the headache assessment videos with her young son on her lap. It’s great that moms don’t have to find a sitter or bring their child to an appointment to get great migraine care.
What is the experience like for our migraine patients?
After they submit their health history and the short video assessment, one of our medical providers reviews and then messages the patient about the recommended treatment plan. Some patients have received treatment before and know what works for them, but many are new to this. If they only experience 4 or fewer migraines a month we’ll usually start them on a triptan, which is a very effective type of medication for stopping migraines, along with anti-nausea pills if nausea is one of their migraine symptoms.
What about people who experience migraines more frequently?
If somebody experiences more than six migraines a month, or if they find that they are running out of triptans before their refill, then we offer them a preventive medication. Some people are reluctant to take a pill every day, and we don’t pressure them but do tell them about research that indicates that regular, severe migraines can cause changes to the brain, and that it’s better to take a daily prescription preventive than to be gulping down ibuprofen and acetaminophen all the time when headaches strike. Once patients use our migraine tracker, they often find they actually have more headache days than they realized. We discuss this with them at their 6-weeks follow up – and anytime they have a question or concern.
How do you find the right preventive for a patient?
There are a few different options, and we really pay attention to the whole picture of a patient’s health and life to find the right one. For example, topiramate is a daily pill that works well for a lot of people, but it can make birth control less effective so if a patient is on hormonal birth control and doesn’t want to use a backup method we would choose something else. There are two types of antidepressants that may work at preventing migraines, and those can be a good choice for patients who are also experiencing anxiety, though I should emphasize that we do not treat depression. Another option is a type of blood pressure medication called a beta blocker.
We have plan A, B, and C, so don’t feel like you’re stuck on Plan A — we will find the right plan for you. Really and truly the majority of our patients feel so much better, and they’re not eating over-the-counter meds and hurting their poor kidneys and livers anymore. People are so grateful.
What about the injectable medications that are advertised a lot on TV?
Aimovig and Emgality are monthly injections you give yourself at home, and can be a good option for people with severe or stubborn migraines, but before we prescribe them the patient should have tried two or three of the daily pill preventives and had them not work. Insurance won’t cover the injectables otherwise. Nurx doesn’t send these out from our pharmacy but we can call in the prescriptions to a local pharmacy near you. These medications are expensive without insurance but if you don’t have insurance we may be able to help get you payment assistance.
Have migraines affected you personally?
Yes, and that’s one of the reasons I feel so strongly about increasing access to good migraine care. Growing up my mother experienced migraines, and there were many days when we had to tiptoe around. There weren’t great treatments available then and headaches were just part of her life. Now, my identical twin sister, who is a busy lawyer with three little boys, struggles with migraines and has zero time to see a specialist. So now she is a Nurx patient and finally has her migraines under control.
What do you want the Nurx community to know?
To our patients with migraines, by the time you get to us you’ve suffered, you know what it feels like, and you know how it affects your life so don’t feel bad reaching out asking all of your questions and telling us everything. The more we know the more we can help you. I know you may have had past providers tell you you’re being too dramatic, and women in particular are often told we’re being too much and to calm down, but to us there is no “too much”. We are here to help and we will work with you. I hope patients know how much our provider team and our nurses want them to be happy with their care.
What do you like about working at Nurx?
Like most medical providers I started doing this work because I love to help people feel better and live healthier, and Nurx helps me reach patients in a unique way. They can always reach out to a nurse or a provider and get a response. As a patient I’ve never had a medical provider I can get a quick response from like that.
Our patients tell us how grateful they are for what we do. One time when I was working in-person at a clinic on the eastern shore of Virginia I saw a low-income family that had a little boy with pneumonia. I treated him and he got better, and later they returned with a thank you gift in a brown bag. I opened the bag and there was a mango inside and it was the best thing ever. Ever since then when I’m working hard I’ll think “I need a mango moment today,” and I have had more of those “mango moments’ at Nurx than anywhere else.