Amaal J. Starling, MD, FAHS, FAAN
Neurologists are highly trained medical professionals who play a critical role in the healthcare system in helping patients of all ages manage their conditions that can affect every aspect of their lives. Each month, NeurologyLive® shines a spotlight on the work of one neurologist, highlighting contributions to their specific field.
Headache disorders such as migraine are a public health concern that affects diverse populations worldwide. According to a recent review published the Journal of Headache and Pain, investigators observed that healthcare disparities, treatment access, and medication availability are all concerning issues in headache medicine. Researchers suggest that experts in headache medicine should acknowledge the challenges that patients with migraine experience and work toward minimizing access to healthcare barriers in the future to achieve equity in care .1
In a recent conversation, Amaal J. Starling, MD, FAHS, FAAN, a headache medicine specialist and associate professor in the department of neurology at Mayo Clinic College of Medicine, discussed her role as a neurologist in the field of headache, including caring for patients who experience medication overuse headache and migraine with aura. Starling participates in clinical trials exploring novel therapeutics for migraines and has a special interest in exploring nondrug options for the treatment of migraines, including neuromodulation devices such as single-pulse transcranial magnetic stimulation.
Clinical Facts on Headache/Migraine
- 42 million patients in the U.S. have migraine and 52% of patients living with migraine disease are undiagnosed by a provider.
- Migraine affects 13% of the population, and 1 in every 4 U.S. households has someone living with migraine.
- 24% of patients living with migraine disease report headache so severe that they have sought emergency room care.
1. National Headache Foundation. Facts About Migraine. Accessed December 15, 2023. https://headaches.org/facts-about-migraine/
NeurologyLive: What are some of the main responsibilities you have in your role as a headache specialist at Mayo Clinic?
Clinically, I see patients with migraine and other headache disorders. For patients with migraine and headache disorders, I do initial consults, follow-up visits, and procedures for the treatment of migraine and other headache disorders. I am also involved in the concussion clinic where I see patients with postconcussion syndrome and posttraumatic headache. From a research perspective, my areas of interest are posttraumatic headache and neuromodulation in headache disorders. In addition, I am very involved with graduate medical education. I am the program director of the transitional year (TY) residency program. Our rapidly growing program will have 21 interns in the coming academic year entering categorical residencies in anesthesiology, dermatology, neurology, radiation oncology, and radiology. In the coming academic year, I will also be the incoming program director for the headache medicine fellowship.
Could you describe a typical day in your work as a headache specialist at Mayo Clinic?
I am an advocate all day—I advocate for my patients with migraine and other headache disorders; I advocate for my trainees in the TY residency and the headache medicine fellowship; and I advocate for my colleagues—if we don’t take care of each other, how can we take care of patients?
What motivated you to pursue a career in neurology, and when did you make this decision?
I have been obsessed with the brain since sixth grade. I studied neuroscience in my undergraduate studies at UCLA, did research in the neurosciences laboratory focusing on Huntington disease, and became very passionate about neuroscience and neurology throughout medical school. With regards to headache medicine, I have always been drawn to patients with invisible diseases like migraine; whereas, many clinicians would prefer not to see people with pain conditions.
So No. 1, I love the patient population. No. 2, the science of migraine and other headache disorders is absolutely fascinating and advancing exponentially. No, 3 the headache medicine community has become my professional home. My colleagues across the nation have been so kind, supportive, inclusive, and inspiring. It truly feels like a work family.
What do you find most rewarding about your work as a headache specialist at Mayo Clinic?
Advocating for my patients. I ask all my patients to let me walk with them on their journey towards improved wellbeing. It is my duty, honor, and privilege to tell them that I will never give up on them or say there is nothing I can do for them. There is always more we can do to improve the quality of life for each and every one of my patients. Pushing the limits of science in efforts to bring new treatment paradigms to improve the lives of those living with migraine and other headache disorders.
And advocating for my trainees. What a rewarding experience to train the next generation of leaders in medicine.
Amaal J. Starling, MD, FAHS, FAAN & Family
What are some of the biggest challenges you face in your role?
Time. There is simply not enough time to be a mom, wife, doctor, medical educator, researcher, etc.
Is there something that you wish more patients and clinicians at Mayo Clinic understood about the field of migraine?
People with migraine are the absolute strongest people I know. Migraine is a genetic neurologic disease. The disability from migraine is a result of the pathophysiology resulting in abnormal function of the brain. And, as our scientific knowledge expands exponentially, we will identify disease targets and novel treatment options for all people who live with migraine.
In addition to your work as a headache specialist, what hobbies or interests do you have outside of the clinic?
I am wife to my amazing husband, Robert. And mom to my 2 amazing boys, Mohsin (13) and Masai (4). We love to play board games, travel, and simply be together in happy times, sad times, and everything in between.
Following the recent 2023 American Headache Society’s (AHS) Scottsdale Headache Symposium, held November 16-19, in Scottsdale, Arizona, Starling sat down in an interview with NeurologyLive® to discuss how eptinezumab (Vyepti; Lundbeck), an FDA-approved humanized monoclonal antibody for migraine in adults, performed in a real-world study. She also shared what insights the study provides regarding the impact of eptinezumab on both pain and nonpain migraine symptoms, and how this contributes to patient well-being. Additionally, Starling spoke about the notable takeaways regarding the effectiveness of eptinezumab in improving daily living, work productivity, and overall satisfaction, in the cohort of highly treatment-experienced patients.
Transcript edited for clarity. Click here for more coverage on headache/migraine.
1. Raffaelli B, Rubio-Beltrán E, Cho SJ, et al. Health equity, care access and quality in headache - part 2. J Headache Pain. 2023;24(1):167. Published 2023 Dec 13. doi:10.1186/s10194-023-01699-7