Alumni Spotlight: Dr. Abby Metzler on Headache Medicine

Dr. Abby Metzler is a neurologist specializing in headache medicine. She completed her neurology residency at the University of Minnesota and a headache fellowship at the Mayo Clinic. She is the Program Lead for the M Health Fairview Headache Care Program and faculty at the University of Minnesota Medical School. 

Dr. Metzler came to medicine through an early interest in math and science. "I loved math; I was a math major in college. I got involved in projects using applied math in medicine." She also wanted to contribute to education. Before medical school, she joined Teach for America, a non-profit dedicated to teaching in low-income areas.  

Dr. Metzler says she fell in love with Neurology at the University of Toledo College of Medicine. When it came time to apply for a residency program, she applied all over the country and happily matched at the University of Minnesota. “I really liked the U of M program.  As a resident, you get to see patients at the VA, at a county hospital, private practice, or the academic center. You are really well-trained in what all the different parts of medicine look like.”  

As a neurology resident, she saw a lot of patients with headache disorders. The specialty appealed to her because she felt she could help patients return to their lives. She was also drawn to patient education, a core part of headache medicine. After completing a fellowship in headache medicine at the Mayo Clinic, she returned to the U of M as faculty. 

“When I joined the faculty, I was the only fellowship-trained headache neurologist. I still am, but we are growing our headache care program. We are expanding to three clinical sites,” she shared. “There is a real need for headache care nationally and here in Minnesota.”  

When it comes to patient care, Dr. Metzler is a big believer in shared-decision making. Rather than instructing a patient what to do, this approach affords patients an opportunity to investigate evidence-based options that best align with their values and lifestyle. Dr. Metzler added, “I think it is more motivating for a patient; they are more invested in their own healthcare. I think giving them that power can really improve their outcomes.”

Headache medicine has grown significantly in the past 15 years. Historically, treatments have often borrowed from other classes of medications, such as those for blood pressure, depression and seizures. While these medicines sometimes work, they are not specifically designed for migraine or other headache disorders. 

Dr. Metzler believes that there is now a pipeline for new treatments. Notably, since 2018, calcitonin gene-related peptide (CGRP) inhibitors have emerged as a promising treatment specifically designed for migraines. In addition, there is growing research on specific molecules that may cause headaches. 

“There is still a lot of stigma surrounding headache disorders,” says Dr. Metzler. “It is underdiagnosed and undertreated.” Migraine is one of the most common causes of disability, especially in women aged 20-50. Dr. Metzler shared that she sees a broad spectrum of patients, from those who experience migraine a few times a year to those who experience refractory headaches and have a more complex medical scenario. 

While advancements are being made, there is a need for more research in the field of headache medicine. Dr. Metzler serves as an advocate for Headache on the Hill, an initiative through the Alliance for Headache Disorders Advocacy aimed at bringing awareness to headache issues and increasing funding for research. She also participates in NIH-funded research and works to increase opportunities for clinical trials at the U of M. 

When asked what she would tell prospective students about neurology, Dr. Metzler shared this: “I think neurology is the most fascinating subject. Neurology makes us who we are. I don’t think it gets more exciting than that.”