Dr. Mina: The Empathetic Headache Neurologist Behind @MigraineswithMina (Part 1)

Welcome to Chronically Peachy, a podcast co-hosted by Sophia Fang, founder of Peachy Day,

and Bernadette of @ChronicAccounts. This space exists for honest conversations that keep it real and peachy about living alongside migraine. 

We share unfiltered stories, break down migraine hot topics, and uplift community conversations with neurologists, experts, and advocates. If you’re looking for validation, accessible info, or just two friends who genuinely get it, you’re in the right place!

About This Episode

In this episode, Bernadette and Sophia sit down with Dr. Mina or @MigraineswithMina, a board-certified headache specialist, social media icon with over 170,000 followers, and a person living with migraine herself.

Dr. Mina talks about what drew her to headache medicine, how lived experience has changed the way she treats patients, and why she genuinely looks forward to appointments with patients.

Growing up in a medical family — and finding her own reason

Dr. Mina grew up in a family of physicians. From an early age, she learned from her parents’ heroic actions that caring for someone else sometimes means putting them before your own family. As a child, that meant wondering why a parent was home late. As an adult, it became something she deeply respects.

Medicine wasn't a career she chose so much as a world she already lived in. But headache medicine came later and for reasons that are deeply personal.

Dr. Mina personally lives with episodic migraine, and she has family members who have more disabling forms. She grew up watching migraine be brushed off, stigmatized, dismissed, so she entered the field to do something about that.

"I've seen this firsthand. I've seen how stigmatized it is, how people just brush it off all the time."

The stigma that exists inside headache medicine itself

Here's something most people don't know: choosing headache medicine as a specialty carries its own stigma within neurology itself.

When Dr. Mina told mentors she was going into headache medicine, the response was skepticism. Do something that's real neurology. The implication was that treating migraine and other headache conditions wasn't serious, complex, or worthy enough to dedicate a career to.

That attitude, she says, is a significant driver behind the nationwide shortage of headache specialists, with only about a thousand certified in the entire country. And rather than deterring her, it became fuel.

What Dr. Mina experienced in her patient interactions told a completely different story. Working with migraine patients was so fulfilling. Across multiple training programs and different cities, that pattern held. The gratitude was different. The depth of relief when she helped a patient find something finally worked was different.

"I actually look forward to those patient interactions. This is definitely something I'm not going to get burnt out with."

Why lived experience changes everything in the exam room

Dr. Mina has episodic migraine herself, and he'll say it plainly: never trust a headache specialist who doesn't have headaches.

For her, it isn't just about empathy as a clinician: it's about the specific questions you think to ask, the things you don't forget to cover, the moment when you can genuinely say, “That happens to me too,” and truly mean it. That kind of exchange builds trust much faster than credentials on a wall ever could.

In practice, it also means she thinks in layers. Not just the rescue medication, but nausea coverage. Not just the treatment plan, but the most disabling symptom as the starting point. Light sensitivity? She's asking about migraine glasses. Brain fog? She's thinking about what cognitive load looks like across the week.

The biggest barrier she faces every day

Ask Dr. Mina what her biggest challenge is and the answer is immediate: insurance.

Newer, more effective migraine treatments, especially CGRP medications, are frequently denied by insurance on the first attempt. A large portion of her days are spent writing appeal letters, navigating prior authorizations, and fighting to get patients medications she already knows will help them. Sometimes those are treatments that patients tried as samples and responded to well.

"When I know a medication is going to be so good for a patient and they've tried a sample and it works amazingly — and I can't get them that treatment — that's disheartening."

Beyond insurance, there's an education gap that starts long before a patient ever reaches her. Most people don't know headache specialists exist. Primary care physicians, often undertrained in migraine, reach for harmful options like opioids or butalbital-containing medications, instead of preventive care or a specialist referral. And by the time patients finally arrive at her office, most already have chronic migraine as well as medication overuse headache layered on top of it.

The first fifteen minutes of almost every new appointment with a patient is migraine education: Dr. Mina carefully walks through why preventive medications matter, what central sensitization means, why treating every single attack without a prevention strategy is like trying to put out a fire you keep lighting yourself.

Dr. Mina feels immense personal responsibility towards her patients. In fact, she recently woke up at 3am, because she realized that she'd forgotten to tell a patient to stop their daily Tylenol use. She called the next morning. The patient was stunned that any doctor had followed up about something so "small."

It wasn't small. And Dr. Mina knew it.

The four phases of a migraine attack

One of the most important things Dr. Mina educates patients on is that a migraine attack has up to four distinct phases and most people only know one of them.

Prodrome happens hours to days before the headache. It's driven by hypothalamus activation and shows up as mood changes, fatigue, food cravings, brain fog, neck stiffness, yawning, or needing to urinate more frequently, amongst other symptoms. Because there can be no head pain involved, many people don't connect these symptoms to migraine at all.

Aura occurs in the minutes before an attack for some people with visual disturbances like spots, zigzags, or blurred patches, or sensory symptoms like numbness and tingling. However, not everyone experiences this phase.

The attack itself is what most people picture: throbbing head pain, nausea, light and sound sensitivity, worsened by movement, lasting anywhere from four to 72 hours or longer.

Postdrome is the migraine “hangover” — the heavy fatigue, brain fog, and difficulty concentrating that lingers after the main symptoms fade.

Understanding the full picture matters clinically, too. When Dr. Mina asks about headache days, she's trying to understand total disruption: not just hours of head pain, but the day before and the day after, the cognitive load, the whole thing.

We also share our preferred framework with the stoplight pain system green, yellow, red) for measuring migraine burden. Green means you’re functioning well, yellow means you’re experiencing some symptoms but can still function, and red means you’re having a really bad day.

Central sensitization: why early diagnosis really matters

This is the concept that ties everything together.

Every person has a threshold for migraine. When attacks go untreated or undertreated that threshold lowers. The brain gets better and better at triggering attacks, until even small stimuli are enough to tip things over. This is central sensitization: the brain has learned migraine, and it keeps practicing.

"Your brain learns migraine. And we love to do things we've learned to do."

This is why getting an accurate diagnosis early matters so much, not just for quality of life right now but also to prevent escalation from episodic to chronic migraine. Some of the most common misdiagnoses are sinus issues and inner ear problems. People can spend years at the ENT, getting treated for the wrong thing, while their migraine threshold rapidly drops.

What's coming — treatments to watch

For patients who haven't responded to CGRP medications or other current treatments, Dr. Mina shares some research innovations that show great promise:

PACAP antibodies are in clinical trials. PACAP is a neuropeptide that, like CGRP, appears to play a role in triggering migraine. Early signals suggest it may help people who haven't responded to current CGRP therapies, which would be meaningful for the most treatment-resistant cases.

Advanced neuromodulation continues to evolve. The Reclaim Trial is investigating craniofacial stimulation via implanted devices, occipital and frontal, specifically for treatment-resistant migraine.

Biomarker and AI research is still in early stages but aimed at something important: identifying who will respond to which treatment before the trial-and-error begins, and detecting prodrome symptoms a patient might not even recognize as migraine-related.

"Let's do this again in five years — hopefully we'll have more exciting things to tell people."

There's never a wrong time to see a headache specialist

Dr. Mina's message for anyone on the fence: go. Even if your migraine attacks are infrequent and relatively manageable, a single visit ensures you have the most current information and the best options available to you. You can ask your primary care physician for a referral, search the American Headache Society directory, or access telehealth specialists if local options aren't available.

And if you've been dismissed before by a doctor, that doesn't mean the right care isn't out there.

Part two of this conversation covers Dr. Mina's advocacy work, how she uses social media to challenge migraine myths, and what she most wants people living with migraine to hear.

Migraine care shouldn’t feel like a full-time job.

If you’re living with migraine, you deserve more than guesswork and rushed appointments.

Peachy Day is a migraine prevention app, designed to lighten your load. You can:

• Log in 1 minute a day, even during attacks

• Get personalized health insights on a color-coded calendar

• Make the most of your doctor’s visits

• Get migraine predictions to prevent future attacks

• Build confidence in how you understand and talk about migraine

  
  

Our team brings together 125+ years of experience as migraine patients and 50+ years as headache neurologists, including the founder of Stanford and USC’s Headache Clinic.

Download Peachy Day for free on the App Store or Google Play. 🍑