Nearly 40 million people in the United States suffer from migraines, making it the second-most disabling condition in the world. In May 2020, Kayla Kaplan ’22 became one of the many Barnard students and recent graduates who joined the research team of Dr. Mia Minen ’03 to examine the current operations and treatments offered by headache infusion centers around the country.
During Kaplan’s time in Minen’s lab, the researchers studied headache infusion centers (“infusion” refers to the delivery of medication directly into the bloodstream through a vein) and the current barriers that prevent the development of new centers, with the goal of finding the next steps necessary to optimize care and access. “Studying the state of current treatment modalities with the goal of improving access and care can therefore have a tremendous positive impact on millions of people,” said Kaplan.
As a research assistant for Minen’s lab, which has become a mentorship home for Barnard neuroscience majors, Kaplan’s role was to analyze and interpret data collected from a survey distributed to representatives of headache infusion programs. She conducted descriptive statistics, organized data, and described results. The lab’s findings allowed researchers to identify several barriers that prevented existing centers from operating optimally — and ones that made it difficult to open new centers.
Kaplan said she joined Minen’s research team so she could “work closely with, and learn from, a practicing clinician-researcher in an exciting and expansive field of medicine.” She also gained insight into what a career as a physician could look like, as she determined what her future goals and aspirations would be.
Although she is no longer a research assistant in Minen’s lab, Kaplan still considers her a mentor. Kaplan plans to graduate from Barnard at the end of the fall 2021 semester and hopes to work for a year before applying to medical school.
Read more about her research and findings in the Q&A below.
How would you describe your research discovery to a lay audience?
This work focuses on the operations of headache infusion centers, which are clinical sites that enable people with migraines to receive treatment for acute attacks. Headache infusions provide an alternative to emergency departments (EDs), which often lead to higher healthcare costs, avoidable tests, and the use of particular medications, such as opioids, for migraine treatment, which go against current recommendations for which types of medications should be offered to people who have migraines. Additionally, headache infusion centers offer the benefits of headache specialists, patient histories, and a quiet environment better suited for people with migraines, compared with busy and bright EDs. We sought to investigate the current operations of and treatments offered by headache infusion centers and the barriers to developing new centers, with the ultimate goal of assessing and optimizing care and access.
To do this, a survey was distributed to two groups — the Refractory, Inpatient, and Emergency Care Special Interest Section and the Academic Program Directors group, both of the American Headache Society (AHS) — in order to reach representatives of headache infusion programs.
Our analysis of responses from representatives across the U.S. revealed several factors that [affect] patient access to infusion centers, including the [small] number of infusion centers, the concentration of centers in the Northeast and Midwest regions, and the limited hours of centers. Regarding medical care, infusion centers offer particular medications that are recommended by the AHS, but they could benefit from the identification and use of the best combination of infusion treatments. Further, our study elucidated several barriers to creating new infusion centers, including staffing shortages, space limitations, and administrative costs. These results identify areas in which future efforts can be focused to improve patient access and care.
What was your role?
I worked on analyzing and interpreting survey data. This entailed conducting descriptive statistics, organizing data into a readable format, and describing our results such that they could be contextualized and compared to current ED protocols and best practices, as recommended by the AHS and American Academy of Neurology (AAN).
Why are infusion centers important to study?
Migraine is the second most disabling condition worldwide and affects approximately 40 million Americans. Studying the state of current treatment modalities, with the goal of improving access and care, can have a tremendously positive impact on millions of people. Infusion centers in particular have the potential to offer more convenient, specialized, and affordable healthcare to patients, but they must be assessed for best practices and opportunities for improvement. By investigating the barriers to creating new infusion centers, we can elucidate the next steps to further expand the reach of care. Further, the shortage of headache specialists relative to the number of people with headaches and migraines motivates efforts to increase access to specialized and convenient care.
Who has been your biggest influence in STEM?
My principal investigator, Dr. Mia Minen, has influenced my thinking most in this area. Dr. Minen afforded me the opportunity to learn about the fields of neurology, headache medicine, and clinical research in general through both direct instruction regarding neurological conditions and, more regularly, by conducting research on migraines and treatments, participating in meetings and conferences with other clinician-researchers, and receiving feedback from Dr. Minen and others. Thinking of the process of scientific inquiry more generally, the students [I worked] alongside, and our varied perspectives and skill sets, emphasized to me the importance of both teamwork and diversity in a team.
What can this research tell us about the future of headache and migraine care?
This research outlines particular areas in which headache and migraine care can be improved. The finding that most of these centers exist in the Northeast and Midwest calls for the need to establish effective infusion sites in other areas of the U.S. More broadly, recent advances in migraine care may open the door for headache infusion centers to offer preventative — rather than only acute — care, which would expand both the role these centers play in migraine care and likely the resources needed to maintain them.
—MAYA GILBERT ’22