Profiles in Advocacy: Teshamae Monteith, MD

Part Two of a Continuing Series

October 26, 2009


Palatucci Advocacy Leadership Forum graduate Teshamae Monteith, MD, of San Francisco, CA, serves as an advocacy champion for improved headache treatment and care. An outstanding role model for other advocates, Monteith served her residency at the NYU Langone Medical Center for Adult Neurology, and continued with a fellowship in Headache Medicine at Thomas Jefferson University – Jefferson Headache Center, 2008–2009. Her activities were featured in a recent Capitol Hill Report post.

The following is a short Q&A with Monteith, to help you get to know an advocate for neurology.

What are your professional affiliations?
I am working on the second year of a clinical and research headache fellowship at the UCSF Headache Center, University of California, San Francisco.

Where did you attend medical school?
I attended the University of Miami Leonard M. Miller School of Medicine.

What is your subspecialty or area of interest?
My work focuses on Headache Medicine.

For what are you advocating?
I am advocating for the alleviation of headache suffering in active duty soldiers and post-deployed veterans. To that extent, my goal is to facilitate in the development of Headache Centers of Excellence. Headache centers has the potential of offering specialized headache care with the appropriate funding in translational research necessary to provide the most effective medications.

How did you get involved in this issue?
As a resident at New York University's Langone Medical Center, I was assigned a quality assurance project. I chose to focus on the clinical evaluation of veterans with headache disorders at the VA through which I rotated. Even though I handed in the assignment to graduate from residency, the work was not complete.

It is unfortunate that anyone should suffer from head pain, especially those with the greatest courage and commitment to our country. While I do not pretend to have all the answers, I am committed to finding the most optimal solutions.

How has the Academy helped you with your advocacy goals?
The American Academy of Neurology submitted a letter to the Department of Defense endorsing headache disorders as a research priority. The AAN has a distinguished reputation in Congress with major contributions, including the development of Traumatic Brain Injury, Epilepsy Centers of Excellence, and most recently through the development of the Brain PAC. Their endorsement was very helpful.

Mike Amery, the AAN's legislative counsel, accompanied me to several key legislative offices. The support of the Academy was essential in developing a strategic plan. In addition, features in Neurology Today®, AANnews®, and AANenews® were helpful in getting the message out there to colleagues in the field. Without the assistance and commitment of others, success would not have been possible.

The advocacy office helped me organize a meeting consisting of expert headache specialists, including some Palatucci advocates (William B. Young, MD, FAAN, Robert E. Shapiro, MD, PhD, and Kathy L. Gardner, MD). The meeting was held during the AAN's 2009 Annual Meeting in Seattle. We were able to disseminate information, develop novel approaches, and further develop my Palatucci Advocacy Leadership Forum action plan. It became clear that headache is a widely prevalent condition not only in post-deployed soldiers but also in the general population. We have much more work to do.

What are some of the advocacy activities you have been involved with?
I have met with about a dozen congresspeople and their staff to discuss the need to support headache research. To my surprise, I found that many of the legislative staffers who run the country behind the scenes are migraineurs. Too often, I found myself giving general headache advice to the staffer. It seems to me that headache is grossly underserved, even in individuals with economic means. It is clear that headache disorders are a widespread problem in need of a scientific, legislative, and socio-cultural remedy that may ultimately reduce suffering.

I developed an advocacy packet and submitted a request for research allocations for headache disorders with the assistance of the Alliance For Headache Disorders Advocacy and Palatucci advocates (Young, Shapiro, and Gardner), as well as my mentors Peter J. Goadsby, MD, PhD, and Stephen D. Silberstein MD, FAAN. My next project is to organize a Congressional briefing in headache disorders.

What is the biggest victory in advocacy you have had?
While traumatic brain injury is considered the signature wound of the conflicts in Iraq and Afghanistan, headache disorders in the most prevalent symptom. I believe my greatest victory was to show that headache is more than a symptom; moreover, it is a disorder of the brain with a complex biology that needs to be underpinned.
Through my Palatucci Advocacy Leadership Forum advocacy efforts, the Department of Defense recognized headache disorders as a significant and disabling health condition in military populations. As a consequence, headache disorders were added to the House Defense Appropriations Congressional Directed Medical Research Programs listing under Traumatic Brain Injury and Psychological Health for FY2010. This was a great win for the many suffering with headache. To add to the victory, posttraumatic headache and chronic migraine received peer-reviewed appropriations in the FY2010 Senate Defense Appropriations Bill.

What obstacles have you encountered and how did you overcome them?
Advocacy work may sometimes seem like a never-ending and lonely road. Politicians may not be interested, and your colleagues may not always seem to appreciate your motives. Keep the focus! There will be waves and waves of support coming your way in due time. The best way around this is to have patience, constantly re-evaluate, and maintain enthusiasm for the cause.

Time management is probably the most challenging. After all, advocacy has a way of stirring up unbridled passion. One has to be able to self-limit creative energy. A couple of effective ways to overcome time constraints is to focus on the action plan and ask honestly for support from other members. I found unexpected supporters, such as Kevin C. Brennan, MD, who picked up the phone, wrote letters, and encouraged others to do the same.

How can Academy members help with this issue?
Headache disorders are the number one reason why patients go to see a neurologist. Headache is important for all neurologists, because it affects so many of our patients.

  • The best way for members to help is to contact their legislators and request that they co-sign a "Dear Colleague" letter to the Department of Defense for headache appropriations for FY2011.
  • In addition, they should watch for legislation soon to be drafted in support of Headache Centers of Excellence. They should then contact their Representatives and ask them to support this as well.
  • I am happy to get any assistance I can from other members. Please contact me!

What advice would you give to somebody starting in advocacy?
I would advise them to find an issue that they are passionate about and to speak from the heart. They should know the facts, hold a vision, and keep an optimistic attitude. Trust the legislative process and do not give up. For further training, they should consider some of the many advocacy opportunities offered through the AAN.