SUMMARY
Juliana H. VanderPluym, M.D., evaluates adult and pediatric patients with a variety of headache disorders, including migraine. Not only does she diagnose, manage and treat patients with migraine but she also engages in both professional education and research on this topic. Dr. VanderPluym's research interests and involvements include the study of new migraine treatments, nonheadache phases of migraine and disparities in access to headache medicines.
Focus areas
- Novel migraine treatments. In 2018, the first migraine-specific preventive therapy, calcitonin gene-related peptide (CGRP) antibodies, were approved by the Food and Drug Administration. Dr VanderPluym has been studying novel applications for these new migraine treatments, including their effects on interictal burden of migraine disease and application to status migrainosus.
- Nonheadache phases of migraine and migraine prediction. Dr VanderPluym has been studying the novel application of the King-Devick test, a rapid number-naming task, to explore different phases of migraine and predict the migraine state.
- Disparities in headache medicine access. In collaboration with researchers at Arizona State University, Dr. VanderPluym has been studying the trends in diagnosis and management of headache and migraine in Arizona Medicaid recipients. These trends are examined in relation to social determinants of health to explore potential health disparities in this vulnerable population.
Significance to patient care
Migraine affects approximately 12% of the general population. Despite its being so common, major gaps in care, including diagnosis and treatment, exist among patients with migraine. These gaps are magnified in vulnerable and underserved populations.
From a diagnosis standpoint, no biomarkers exist for migraine. Migraine is a clinical diagnosis, but its symptoms can overlap with those of other conditions. This is especially true if the nonheadache symptoms that occur during the prodrome and postdrome phases of migraine are considered. Identifying a tool to predict migraine attacks would facilitate personalized therapy and allow for pretreatment, making it possible for people to potentially avoid symptoms. Then outcomes would be optimized not only by preventing symptom development, but also by minimizing unnecessary medication exposures, adverse events and costs. Dr VanderPluym's research involving the King-Devick test seeks to better understand the full breadth of the migraine experience for patients. She is exploring the possible application of this test as a biomarker for the migraine state versus the nonmigraine state.
From a treatment standpoint, previously available migraine-preventive agents are not migraine specific but rather borrowed from other therapeutic classes such as anti-epileptic medicines, antihypertensives and antidepressants. The advent of the calcitonin gene-related peptide (CGRP)-blocking treatments has been very exciting given that they are the first migraine-specific preventive treatments. Their discovery has helped further delineate the pathophysiology of migraine. Exploring their application to various understudied aspects of migraine, such as the interictal burden and status migrainosus, is important to further understand migraine pathophysiology.
From a health disparity standpoint, little is known currently about the social determinants of health in relation to migraine and headache. The paucity of science and literature in this arena further exacerbates disparities for vulnerable populations and necessitates a deeper examination of the social determinants of health and lived experiences of communities with disproportionately poor migraine outcomes.
Professional highlights
- Editorial board member, Neurology, 2021-present.
- Editor, Current Neurology and Neuroscience Reports, 2020-present.
- Fellow, American Migraine Society, 2017-present.
- Board member, American Migraine Foundation, 2023.
- Treatments for Acute Episodic Migraine, grant funded by Agency for Healthcare Research and Quality, 2019.