Session 31 Dr. Kristen Sahler is a community-based Neurologist who specializes in headache medicine. She has been practicing for four years outside of her fellowship and she shares with us what drew her to it and her advice if you're interested in it. [01:28] Her Path to Headache Medicine Kristen knew she was going to be a neurologist when she was fourteen years old having been motivated by having a family member with Tourette's syndrome so very early on, she was learning about it and about the brain and got fascinated by all of it. She then hyper-focused on that pathway and never gave up on it. As for getting into headache medicine, it wasn't on her radar until her third or fourth year of medical school on her neurology rotation where she was sent to see a headache consult. She became fascinated by the patient's story and thought her interesting visual aura was cool and learned about migraine. By the end of medical school, Kristen has already carved out that headache was the field for her which was confirmed as she went through residency every step of the way. What she likes about the field is how interesting it is having all these strange phenomenon and visual disturbances. But essentially, she has always been interested in the central nervous system and in neurotransmitter systems which hearkens back to his brother with Tourette's syndrome. With migraine, it's predominantly common with the serotonergic system which she's interested in. "I like that there were so many treatment options and that we could really turn the course of someone's life around." Additionally, she was interested in Parkinson's disease being a neurotransmitter-based disease but she didn't feel as much excitement seeing the inevitable decline of patients experiencing it since you can't change the course of their disease. Whereas a lot of the other primary headache disorders have disorders that can change people's lives taking them from being completely disabled an in pain everyday to nearly pain-free. [04:37] Traits that Lead to Being a Good Headache Specialist Kristen cites patience as the one skill she uses the most day-to-day considering how headache patients don't give the greatest history. You don't always know how to describe they're feeling so you need to guide them through it to get the information out of them that you need. Another trait is liking the detective work because there are so many things that can cause a headache and not each one is a migraine or whatnot so you need to be able to fuss out what the underlying causes are. Lastly, you need to okay with psychiatry because there's a lot of overlap between headache disorders and psychiatric disorders. In particular, migraine is comorbid with anxiety, depression, and bipolar so she sees a lot of people with psychiatric co-morbidities which she's not managing but she needs to be able to be patient with them ad help them cope through these things. "If you're somebody who does not like to deal with psychiatry, it's probably not a good field for you." Alternatively, if you're really interested in psychiatry, you could choose to manage both issues. In neurology, they study a good amount of psychiatry so you could choose to be a headache specialist and also manage their anxiety or depression and just choose to do both. Kristen though doesn't like to manage the psychiatric issues because she feels she's not up-to-date on the management side of it but she's comfortable seeing patients with those diseases. Kristen says she never thought of any other specialty pulling her from her path to neurology. Although she was interested in some fields but she never once thought they were the right field for her. She thought psychiatry was interesting but when she looked to the day-to day of what a psychiatrist does, she knew it wasn't for her. She thought internal medicine is the best field because for her the most impressive people went into internal medicine. She practically thought of them as rock stars but