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Migraine Headaches

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SARA LOMAX-REESE: In just a minute we are going to talk to the Einstein docs about migraines, those blinding headaches that can stop you dead in your tracks. We will be joined by Dr. Donee Patterson of Einstein's Department of Medicine, and Dr. David Roby, a neurologist and headache specialist at Einstein. Later in the show we will be joined by Dr. Ron Daniels, he is the architect of the upcoming State of the Black World Conference. We will get his take on the election and what we, as black people, should be demanding in the next four years, regardless of who is in the White House. Remember you can also listen online at www.900amwurd.com or on our new mobile app, which is free, so check that out on your iPhone or an Android. It is a free WURD app that you just download and we are in crystal clear digital sound. Right now I want to welcome Dr. Donee Patterson from Einstein Department of Medicine. Welcome Back.

DONEE PATTERSON, MD: I am so excited to be back, Sara, thank you. 

LOMAX-REESE: We are so excited to have you back. This is great information. You guys provide us with a wide array of really important, life-sustaining, life-enhancing information. Today I think it is very apropos to be talking about migraines and headaches because I think for a lot of people there's so much stress surrounding this election. We have been bombarded day in and day out with different critique and analysis, lies and truths and all kinds of stuff. Today it is appropriate to be talking about headaches and migraines.

PATTERSON: Absolutely. There is a lot of stress today. 

LOMAX-REESE: A lot of stress, which will hopefully serve us well in the coming days and months, but let's get into it, to talk about this question, this issue of migraines. Apparently it is very, very common. 29.5 million Americans are affected by migraine pain and symptoms, and I am curious, if you can start us off with, in terms of the African American community, is there any kind of health disparity or any kind of disproportionate rate of migraines in the black community versus other communities?

PATTERSON: Sure, usually migraines are broken down by sex and age, but there is a large amount of migraines in the African American population, a lot because of stress, but about 70 percent of people have a genetic component to their migraines. If your mother or father or brother or sister has migraines then you have a high risk of having migraines and so it does tend to run in families. Absolutely. It is really hard to find someone nowadays who has never had a headache. .I have been practicing medicine for about 14 years and I can probably count on one hand the amount of people that have told me they have never had a headache. Migraines, headaches in general are very common, about 45 million people have headaches. For those people who headaches is not really one of their major issues, I don’t want you to turn the dial because it is so common. Chances are you know someone that has a migraine and we want them to know what to look for and know that these people really suffer from it and to please help them. 

LOMAX-REESE: You are using headache and migraine kind of interchangeably. Is there a difference between a migraine and a headache? 


LOMAX-REESE: What is it?

PATTERSON: Yes, yes, yes. So what I was saying is about 45 million people have headaches. There's lots of different types of headaches, but migraines are, they have a specific symptom classification. If your headache is associated with nausea, if your headache is pretty intense and throbby pain, and it is usually one-sided, but it can be both sided, but usually this very intense throbby pain, it is often associated with light sensitivity, we call it photophobia. It is often associated with phonophobia, which is sound sensitivity and sometimes you can have nausea as well. In some cases, you can have what we call an aura and they tend to be more severe. We kind of classify them a little bit more severe and those are the people that see flashes of light or the zig-zaggy lines, or they have really, really bad sensitivity to hearing, or they have some numbness and tingling associated with their headaches. Migraines are very specific and if someone takes the time to really think about the symptoms they have they can really recognize what kind of headache they have. It does base what kind of treatment, how we treat you.

LOMAX-REESE: We are talking with Dr. Donee Patterson from Einstein and we are talking about migraines and headaches today. Is there a chronic element to migraines as opposed to headaches? I get headaches very infrequently, but when I do I usually get them on one side of my head. It's like behind my right eye or something, but it is very infrequent so I wouldn't necessarily say that I have migraines or even headaches on any kind of regular basis, but is that part of how you classify a migraine, is that it is chronic and recurring?

PATTERSON: No, some people may just have migraines two times a year and we classify chronic just that it happens over and over. It just kind of depends. Some people, Sara, you might be amazed to find out, some people have 15 migraines a month that last four or more hours of the day. That's a lot of headaches. That's half the month and the average migraine sufferer will miss two and a half days of work a month. That's a lot of missed days. Chronic to us means that it is ongoing. It doesn't necessarily say how intense it is, but just that it is ongoing and you kind of predict that it is going to happen over and over again. Fifteen days of missed work, that's why we thought it was so important to talk about this today because we want to tell people, I am amazed by how many people come to my office and they have had migraines for years and years. The photographer in the office today, I'm going to call him out, he tells me that he has had migraines for years and years, but never thought to get it checked out. We want people to know that you don't have to suffer. You don't have to take medications. I am not here pushing any medication at all, but there are some things that you can do to help yourself not suffer so much and lose so many days of work. We are still mothers. We are still wives. We still have to take care of things at home. It is very, very important that people don’t think that they have to suffer from this very chronic disease. 

LOMAX-REESE: Let's get into that in terms of treatment and prevention because I do know women who are absolutely flattened by migraines. They cannot work. They cannot function. Depending on the scale of severity, it ranges widely, it varies widely. What are some of the things, let's talk prevention first, can you do certain things that will strengthen, I don’t know, your brain or whatever the physiology that's affecting getting a migraine. What can you do to prevent these kinds of debilitating headaches?

PATTERSON: As I said, there is a genetic component. Some people can't totally prevent it. It may be hormonal. For example, girls after puberty, they get more migraines, some women in pregnancy, they may get migraines, etcetera, but what you can do is you can decrease your stress. You can avoid your triggers. It took me about four years to realize that one of the triggers for my migraines is garlic because I was a little bit in denial. But I know that -

LOMAX-REESE: Now how did you determine that?

PATTERSON: That’s a great question. I am so glad you asked me that. I kept a headache journal. Whenever I would eat pasta, I was like there is no way that I can be allergic to pasta. There's no way, but I realized that it was the garlic in it. So if my husband was to cook with a lot of garlic, sure enough I would get a headache, but I know that I can take something ahead of time or I know the amounts that I can eat now. My life is so much better that I am not constantly getting headaches because garlic is in everything, but with that said, we are putting a headache journal on our web site, on the Einstein web site so it is www.einstein.edu and there will be a headache journal for people to print out and to keep their symptoms in line and please take that to your doctor. The headache journal can really help to help people know what kind of symptoms that they're having. Yes, It is very important.

LOMAX-REESE: That is so critical, I think, for any kind of chronic disorder we are experiencing. A lot of times, I saw a statistic that said that black women in particular suffer at greater numbers from headaches and migraines, but they don’t go to see their doctor for those because they just assume that it will pass and they don’t need to and they'll just kind of suffer and make it through. I think the fact that there are tangible things that we can do is really important. I want to welcome Dr. Roby to the program and Dr. David Roby is a neurologist and headache specialist at Einstein. Welcome.

DAVID ROBY, MD: Good morning or good afternoon. 

LOMAX-REESE: Good afternoon. Good afternoon. Dr. Donee and I have been talking about some of the trends, the prevention strategies and things like that, but I want to talk to you about some of the physiology of migraines and headaches. As a neurologist, what is happening? Is it in the brain or is it in the skull? What is happening in the body that triggers headaches and migraines?

ROBY: Okay, well I would say certainly it happens in susceptible individuals and that's somewhat influenced by genes. Migraines run generation to generation through families. It is amazing. You can go four and five generations. That’s a piece of it. Then there are circumstances, if you miss sleep, skip a meal, change in weather, menstrual cycle, all of these can set the stage, and then migraines happen. There is in 20 percent of people a warning phase, often associated with visual changes or sensory changes. Then the headache phase. You mentioned the idea of a brain cause. There are brain changes, both in the periphery and sensory, that are part of a migraine experience that last in adults from four hours to 72 hours. 

LOMAX-REESE: Wow. We were talking about prevention in terms of like a headache journal and knowing what your triggers are, but are there other things that we can do from a prevention standpoint? You mentioned sleep and stress and those kinds of things, but what other things do you see as very effective in helping to prevent migraines?

ROBY: Well, for some people, they have been saying this for years, but stress can be a factor and it can culminate in a migraine. Some people get neck pain and that will transform into a migraine. Some people, physical therapy, stretching, conditioning, may alleviate migraine. For some people, foods, it has been emphasized in the past, but not as much now, but certainly red wine is a trigger and many migraine sufferers will have a handful of foods that for them within 30 minutes may trigger a migraine, but there are some people that have these bizarre elimination diets that go page after page and I find that that's, first of all, you just can't live on dirt forever, and it is just not necessary in most migraine sufferers. I would say also there is an early intervention like if you see the beginnings of it if you lay down in a dark quiet room, for many people, either no treatment or aspirin, may really work surprisingly well for them, but in other people they often need to resort to some kind of pharmacologic remedy.

LOMAX-REESE:  Yes, Dr. Donee?

PATTERSON: Sara, it can almost be anything. It can be a smell. It can be certain smells, cleaning solutions. It could be the amount of light or the kind of light you have in your office or the kind of chair you are sitting in, the kind of pillow. It really can be anything. That headache journal really can help people to know where their headaches are coming from. 

LOMAX-REESE: Can chronic migraines be symptomatic of a much more serious condition that should be looked into, Dr. Roby?

ROBY: I would say that there may be conditions that you could say masquerade or resemble a migraine. For example, a meningioma is a very slow-growing benign brain tumor, but some people will mistakenly be diagnosed with migraine until they have an imaging study and realize that they have a benign tumor that requires that treatment, but I would say in the vast majority of people the clues to migraine is it is often long standing, that they have no neurologic symptoms in between the attacks, and there is nothing to suggest a progressive disorder. In most individuals the history is very reassuring that you don’t have to worry about a life-threatening condition a like a tumor.

PATTERSON: We wanted to make sure that we emphasize today which symptoms to look for to contact a doctor. So Dr. Roby and I had talked earlier and we wanted to make sure that people were aware. Mild to moderate headaches that last for more than a few days, you should contact your doctor, but if you have a very severe headache, the worst headache of your life or a headache that wakes you, that's something to seek immediate medical attention. If you have headache that's associated with a fever, a high fever, or new symptoms like numbness, tingling, weakness, blurry vision, all those things we definitely want you to seek medical attention and a headache that occurs after an injury. So many times people have a pretty significant head injury and they know about it and they have major headaches afterwards, but they don’t contact a physician afterwards.

LOMAX-REESE:We are talking with Dr. Donee Patterson and Dr. David Roby from Einstein Hospital. We are talking about migraines and headaches today. Dr. Roby, I wanted to ask you about children and migraines and whether or not if you have a child who is experiencing headaches in some type of regular fashion what kinds of treatments and options should you seek out for them?

ROBY: Well, certainly there are millions of children who are affected by migraine and it can begin as early as under the age of five and these children are playing, all of the sudden may become pale, lay down, not want to play or go outside, not want to eat, some may even become nauseated or vomit. It can be dramatic, although they may not be able to verbalize or describe the symptoms as well as an adult, none the less, the parents will say, gee, you know, it reminds me of when I was a child. But certainly, adolescents, they often can describe and this may be triggered by participating in sports, bright light, as was mentioned, and these children often can be disabled, although in children migraines sometimes last as little as an hour or two, but certainly if it happens in school they may have to call the parents to have them go home and so certainly it is disabling. The GI upset is very common. Interestingly in children, migraine is a little more common to occur on both sides of the head. I think one of the keys is that children want to lay still. They want to be in a dark room. When you see this kind of repeatedly, once a month, once every couple months, especially if other family members are affected by migraine, I think that is enough to seek further attention.

PATTERSON: Did you want to comment on abdominal migraines that kids get?

ROBY: Sure.

LOMAX-REESE: Abdominal migraines? Is that like what a stomach ache?

ROBY: That's right and so we talked a little bit before about migraine may be associated with aura and the GI upset is a very big part of migraine, but in some people they seem to have just the GI upset without the headache and so they can go sometimes for years, you know, a mysterious, why are they so nauseated or vomiting so much and it comes to light that it is actually just an expression of migraine. Another feature those individuals often have motion sickness, so if they get in the car within a block or two they are getting motion sickness, even sometimes years before the headaches themselves start. 

LOMAX-REESE: Very interesting. We are going to have to take a quick break. We are talking with Dr. Donee Patterson and Dr. David Roby, both from Einstein, and when we come back I want to talk about treatment. I have heard antidotally, things like coffee and chocolate open the blood vessels and help to relieve migraines. So we can talk about both kind of "home remedies" and more serious pharmacological treatments for migraines. If you have a question you can give us a call. We will have a few minutes for calls, 215-634-8065 or 866-361-0900 toll-free. Don't go away. We will be back in just a minute. And we are back. You are listening to HealthQuest Live on this important November 6 election day. We are taking a pause for the cause and focusing in on health information right now between the hours of 12 and 1 on HealthQuest Live and we are talking about migraines today. If you or someone you love suffers from migraines, those like mind-numbing headaches then you should tune in. You should call in and check in. We are talking with Dr. David Roby. He is a neurologist and headache specialist with Einstein, and Dr. Donee Patterson, who is with the Einstein Department of Medicine. Dr. Roby, before we went to break, I raised the question of treatment. What are some ways that people who are suffering with migraines can actually treat this? I have heard antidotally coffee and chocolate and things that are kind of stimulants can help with migraines. What is the truth on that?

ROBY: Well, it is true that many patients do note relief even from a cup of coffee in the morning. In fact, if they don’t have their coffee they are doomed to get a headache. Chocolate gets mixed grades. We used to think that chocolate brought on headaches frequently, but now we don't think that so much of a trigger at least in most people. There are a number of over-the-counter medicines that if they are used not to excess they can be used reasonably, especially early on. It seems that you've got a window of opportunity that you can likely control the migraine, but if you wait too long you are doomed and the headache can last for a day or even several days. As you get to a more severe or long-lasting headache, there are many prescription medicines, one of the medicines that has kind of revolutionized treatment, they are called tryptans and they were introduced in the early 1990's and Imitrex is probably the most common and well-known of those. There are actually eight in that group. While only about 20 percent of all migraine sufferers have been treated with those, many individuals describe the result as almost miraculous and in 30 minutes to an hour, in 75 percent or so of the headaches, will get relief. The other huge development is preventative medicines. For example, Topamax right now is used in over a million migraine sufferers and the results are astonishing. For people that are really plagued with migraine, many migraine, half the people get a 50 percent decrease in the number of migraine and 20 percent have an 80 to 100 percent decrease, but obviously that would just be reserved usually for people with more then five or ten migraines a month or severe and disabling migraines. The milder ones that respond to over-the-counter medicines, lucky them, and they save a ton of money, but for the other people who have more debilitating migraine, fortunately there are choices both for symptomatic and preventative treatment.

PATTERSON: Sara, you may be surprised to find that some of the over-the-counter migraine medicines, they actually have caffeine in them.

LOMAX-REESE: Oh, interesting.

PATTERSON: That's part of it. The medicines that say migraine, not all of them, but some of them, and it really does help. It is like taking a sip of a caffeinated beverage and they may even tell pregnant women if they have migraines in their early trimesters to take a sip of caffeine. Some people do use it and then other people say that it is a trigger for their migraines. Caffeine is found on both sides of the table, so we have to kind of remember that. As far as Topamax, correct me if you think something different, Dr. Roby, but one of the side effects that I've found for Topamax, is that it actually has weight loss and so if some people are excited to hear about that, I don’t think that every body should be treated with Topamax, but the people that do qualify for Topamax, they are excited to find because not many medicines actually do that nowadays. 

REESE: So let me just ask a couple of more questions before we are out of time. Is there any connection between migraines or severe headaches and like aneurism or stroke? Because I think that whenever there is something going on in our head, at least if there is pain associated with it, you think this could be something really life threatening. Any connection there?

ROBY: With respect to aneurism that is certainly a very serious problem. It has been estimated that there are as many as 15,000 ruptured aneurisms a year in this country and unfortunately a fair number of them are not recognized. These people are sent out of emergency rooms, often with the diagnosis, oh, it's just a bad migraine. As Donee mentioned earlier, when someone has an explosive headache, at its worst intensity, right away, if you either faint or come close to fainting, if you have other family members who are known to have aneurisms, people say it is a sudden onset of the worst headache of my life, anything like that, absolutely you want to get to the emergency room. You want to get this evaluated quickly because it can be a very serious matter. 

LOMAX-REESE: Just give us what exactly is happening when you have an aneurism?

ROBY: An aneurism is a weak blood vessel. It is often small of the order of maybe a quarter of an inch or so, but it is a weakened defect in the vessel and can rupture and when it ruptures actually blood is pouring into the brain and so it may be near another structure so it may cause a droopy eyelid or double vision, but the point is, the release of blood raises brain pressure and it actually people can die right from the first ruptured aneurism. Certainly it is a very devastating event and prompts immediate attention.

PATTERSON: We wanted to make sure that we told people we don't want to be alarmists at all because most people, as we said, have headaches and they are not associated with any cause of death, but if you have had headaches for several years and they are pretty intense, we recommend that people at least have one imaging study in their lifetime and then they may need another imaging study if their headaches are getting worse or changing in any way, they have new symptoms of numbness, slurred speech. They should have updated imaging studies. People should be self advocates and say, okay, these are different symptoms. Is this something that I should have? I just want to encourage people that if they do have headaches see a primary care doctor and now they know that there are headache specialists so for more severe headaches please see a headache specialist, which is usually a neurologist. 

LOMAX-REESE: The last question I have is about age, because I know that headaches and migraines are more prevalent within certain age ranges and so if you, Dr. Roby, could speak to what's happening in our body chemistry that makes us predisposed based on our age.

ROBY: Well, I would say it is interesting particularly in women. Migraine may begin in childhood, but often they say 50 percent of migraine starts under the age of 20. Many migraine sufferers report with delight that during pregnancy migraine cuts them a big break and they may say I am just going to stay pregnant until I go through menopause.

LOMAX-REESE: Good luck.

ROBY: As they approach menopause, actually migraine in the majority, 90 percent of women, regresses. For most migraine sufferers they can enjoy their last decades of life either free of migraine or perhaps once or twice a year. There are rather dramatic changes, especially in women, through the life cycle. In men that's probably not so much true. They certainly don’t get pregnant, but actually as they get older they probably also continue to suffer with migraine even into the 70s and 80s. I don’t know if that's a payback, I am not sure.

LOMAX-REESE: I was just going to say if you have lots of children I am sure you are going to have lots of headaches. I don’t know if that strategy of staying pregnant all the time is a good headache relief. So we are just about out of time. I know that you can get more information on the Einstein web site and Facebook page. You guys have a special gift for our listeners. Why don’t you tell us, Dr. Donee?

PATTERSON: We do. For the first person who answers some simple migraine questions, if you listened today you should definitely get the answers. For the first person who answers it on Einstein's Facebook page, that's EinsteinHealth. They get a $25 gift card to one of our local ShopRite stores. 

LOMAX-REESE: Fantastic.

PATTERSON: Care of Einstein.

LOMAX-REESE: Well that's going to come in handy because we are right up on the holidays.

PATTERSON: Absolutely, Absolutely. 

LOMAX-REESE: Fantastic. Thank you.

PATTERSON: Make sure that you download or just print out the headache journal that we put on our web site, which is www.einstein.edu. You can also follow us on Twitter. I am @DrDonee on Twitter. We hope that you learned something and give us a call.

LOMAX-REESE: Don't you guys have an 800 number?

PATTERSON: We do. It is 1-800-EINSTEIN.

LOMAX-REESE: Excellent. Excellent. Well, I want to thank you, Dr. Roby, for being with us. I didn’t even know that there were headache specialists. This is great to know. I appreciate your time.

ROBY: Thank you very much.

LOMAX-REESE: Dr. Donee, as always, we are looking forward to continuing these conversations.

PATTERSON: We look forward to it and we have another one coming up on the 16th.


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