Search for tag: "headache"

Interviewer: Can you believe that there's a school actually called Headache School? And if you have headaches, you might want to go to this school. So we're going to talk to Dr. Jared Bartell. He's assistant professor in neurology. He's a doctor, but he's also an expert in headache. He did his fellowship in headache medicine, they call it and today we're going to find out more about the University of Utah Health Headache School, why you have one, what it is, and who can benefit. So Dr. Bartell, thank you for being on the show today. I do appreciate it very much.

Dr. Bartell: Thanks, Scot. Happy to be here.

Interviewer: Yeah. So tell me a little bit briefly, I just I'm curious. So headache medicine is what it's called, that you do. Explain the additional training you've had and what that means?

Dr. Bartell: Yeah. So I finished my neurology residency at the University of Wisconsin. And in neurology, you learn about all aspects of epilepsy, multiple sclerosis, stroke, various things that affect the central nervous system and the peripheral nerves too. But headache is certainly within that and we learn a lot about headache in residency. For those people that want to do more outpatient neurology, headache is really a big part of that.

So I spent this last year doing headache fellowship at University of Utah training with the guys there at the university. I learned about various procedures to use for headache, things like Botox, nerve blocks, the different types of medicines that you can use, both for prevention and for rescue of headaches. The nice thing about headache medicine these days is that there really are a lot of new treatments available within the last even couple of years there have been a number of new medicines that are all fairly expensive right now. Insurance tends to pay for them as long as you've tried a few other medicines first, but it's definitely an exciting time to be in the field as a provider of headache medicine, and it's been a great opportunity for me to help patients as well.

Interviewer: Yeah. That's pretty cool. I know headaches can really be debilitating to some people. It can really just really affect the quality of their life, their ability to enjoy life, their ability to do what they have to do. Headache School. So what is Headache School?

Dr. Bartell: So Headache School is a program that we are offering at the University of Utah, and in collaboration with Danielle Henry Foundation to educate patients and their loved ones about headache in terms of treatment and what causes them and just every aspect of headache.

Interviewer: And it's virtual and online, and you can find back episodes on YouTube. So there are a lot of different kinds of headaches. Why would somebody with a headache want to come to the Headache School or watch some of these videos? Why wouldn't they just say, "Just give me some aspirin. Tell me what it is I need to do to solve my headache"? Why are you finding people who are finding this interesting, and coming and showing up?

Dr. Bartell: So they're really a lot of headaches that . . . So you can think about just little everyday headaches that most people get as being responsive to an over-the-counter medicine like aspirin or ibuprofen or Tylenol. But unfortunately, a lot of people have much more severe headaches that really don't respond to those types of medicines. And that actually can get worse with chronic use of things like aspirin or Tylenol. And it can actually cause something called a rebound headache or a medication overuse headache. For people that have chronic migraine or chronic tension type headache or various other types of even more unusual headaches, those types of over-the-counter medicines aren't as helpful. And so educating patients on the different types of treatments, whether that's medicines or non-medication therapies can be really helpful in treating their headache condition overall.

Interviewer: Talked to one of your colleagues, Dr. Pippitt, and she is an expert with headaches as well. And she says that for the most part, a primary care physician can take care of most people's headaches. So it sounds like Headache School is for somebody who has really struggled and hasn't found that answer to their headache because they do have more of an unusual headache and this gives them access to some experts that might just specialize in that particular type of headache. Is that correct?

Dr. Bartell: Yeah. I think so. I think that's a good way of thinking about it. Most primary care providers are excellent in treating headaches. Sometimes it takes 2, 3, 4, or 5, 10 medicines until you really find the right medication fit for that person's headache. Everybody's headaches are a little bit different. Even if you have migraine, for instance, you can have 10 migraine patients lined up and all of their headaches are a little bit different. And the physiology of their migraine can all be a little bit different such that different medicines work for some people and not for others.

Interviewer: So somebody that might have gone through the process of trying to find some satisfaction or some treatment for their headache really could benefit from Headache School. I'm looking at, man, you've got so many episodes already. Just to cover some of them, the cognitive behavioral therapy treatment for headaches, yoga, for headache and migraine, contraception options in migraine, headache, the basics, acupuncture self-care for a headache, pathophysiology of migraine. Sounds like you cover a lot of ground. And what benefit does this help with somebody then if they hear the lecture? What does that information usually do? How does that impact somebody?

Dr. Bartell: So, in Headache School, we have the benefit of having a number of different speakers coming from different backgrounds talking about their view of what headaches are, how to treat them, we have a pharmacist that has given us several talks, we have multiple different providers that treat patients clinically that have their own medical background to provide. You could do a bunch of your own personal research online, which you might find various blogs and find anecdotal ideas as to what to do and what your headaches are caused by and different things you can try. But really looping into how doctors think about your headaches and how a pharmacist might think and how a psychologist might think about headaches can really be helpful in better managing your headaches.

There have been many years, decades and decades of research into headaches and it's not all intuitive. So you might think that you can treat all of your headaches with Tylenol, you take Tylenol three times a day. And this seems to knock down your headache just a little bit. But as it turns out, somewhat counter-intuitively, that can worsen your headaches. It can cause rebound headaches, it can cause some other problems, it can cause liver problems. Different medicines can do things like that, but it's really helpful just to touch base with the headache medical establishment to know what Western medicine thinks about headaches. We do try to incorporate alternative ideas too, and there are many talks on not just true Western medications and that type of thing, but also these alternative therapies that are available.

Interviewer: I love that you have all sorts of experts. I never really thought of that as an advantage, I just thought, "Well, you go to a doctor." Maybe you go to a doctor who's an expert with headache. But as you said, you've got pharmacists, you've got people like psychiatrists or people that can help teach you a cognitive behavioral therapy, or you have people that know about how exercise impacts headaches. So just a lot of different opinions on how to maybe reduce the impact of your headache or the frequency of your headache. So that's pretty awesome.

It's also pretty awesome too because many people they don't live in Salt Lake City, they don't have access to one of these specialists. They can just make an appointment, but they can go to the Headache School and they can watch the lectures and it sounds like they can interact with that individual. At the end, it's not recorded, they could ask them questions and boy, just really making yourself available.

Dr. Bartell: It's true. We see our clinic, especially now more than ever, patients from all across the region. We see people in Nevada and Wyoming, Montana, Colorado. And this resource especially it's on YouTube, so anyone can see it. You could live in a different country and you have all of the videos available for free at your own pace. One thing that you may not realize is that with YouTube videos, you can actually adjust the speed of them too.

Interviewer: Yeah. It gives you access to these experts. It gives you access to this great expert information. Briefly, I want to hit on the skill building session. So you say you have some skill building sessions. What do those look like on Headache School? I get a lecture, what's the skill building session?

Dr. Bartell: So we have a number of talks on various issues, things like progressive muscle relaxation, breathing exercise, guided relaxation. As of today, those are the most recent talks, but there are a number of courses that talk about these non-medicine options to treat headaches that you can just do on your own. You could do these multiple times a day, depending on what they are. And they can really help to have some synergy with the rest of the treatment that you're undergoing. It's one thing just to take a pill every day, but it's another thing to change your lifestyle in certain ways to really help to solidify the changes that your brain is undergoing as you're treating these headaches.

Interviewer: Headache school, it sounds like such a great resource and we will put a link to the University of Utah Health Headache School in the description for this particular podcast episode. Dr. Bartell, thank you very much for telling us a little bit more about Headache School. It's a great resource. Appreciate it.

Dr. Bartell: Thanks, Scot. Happy to be here. Appreciate it.

Interviewer: All right. Let's talk about chronic headaches. Dr. Bartel is an expert in headaches. He did a Fellowship in Headache Medicine, they call it. And for a chronic headache sufferer, man, it can really just impact your life in a lot of negative ways. How do you treat it? That's going to be the question we're going to answer today with Dr. Bartel. So first of all, what do you as a medical provider consider a chronic headache? What makes it chronic?

Dr. Bartel: So there are a lot of different types of chronic headaches. In a general sense, chronic headaches are headaches affecting somebody more than half of the month. So we tend to consider more than 15 headache days per month as a chronic headache.

Interviewer: And chronic headache sufferers, do the headaches last all day? Is it maybe just a half hour every day? What's that kind of look like?

Dr. Bartel: They can. It depends on the type of headache. So oftentimes, for instance, migraine headaches will last for many hours. There are certain types of headaches that do truly never go away, and some people have headaches every waking hour of their day.

Interviewer: So if you're having headaches 15 or more days a month, that is a chronic headache. Do you also look at the intensity of the headache when you're looking at a chronic headache? Is it kind of a balancing act, or is it really just purely how often are you having this headache?

Dr. Bartel: Yeah, certainly the degree of disability that is involved. Even if a headache isn't truly half of the month, we will often consider preventative medicine. If somebody has headaches at least four days out of the month, like once per week, and it's particularly debilitating or it really bothers them, we'll even sometimes try medication then. But oftentimes, we'll reserve at least some of the more involved therapies for people that have chronic migraine.

There's some evidence that there are a lot of medicines that help, a lot of different therapies that help for what we call an episodic headache, less than 15 days out of the month. They can work for both chronic or episodic. But we pay special attention to those that have headaches that are more severe or that are particularly debilitating.

Interviewer: So there's a difference between a chronic and an episodic headache insofar as what causes them and how you would treat them.

Dr. Bartel: Yeah, it's really a continuum. But between tension-type headaches, which are the most common type of headache, migraine headaches that tend to be the most common severe type of headache, there's cluster headache. There can be a chronic cluster headache or episodic cluster headache. In all of these, it really depends on how bad they are, how much this is affecting somebody's life. And we really use that information to help cater the treatment for everybody's different headache condition.

Interviewer: If somebody is genetically predisposed to a headache, are they just going to get them regardless of what kind of lifestyle decisions they're making? Or do those impact as well?

Dr. Bartel: Yeah, not necessarily. Certain things can reduce the likelihood of having chronic headaches. So things like effectively managing your stress. That's easier said than done, of course, but having certain various coping skills to help when you have a really stressful situation come up.

You can manage it by exercise. So for some people, exercise can make their headaches worse, but in general, exercise, when you do it fairly routinely, 5 days a week, 20 to 30 minutes a day, just enough to kind of get your blood flowing, your heart rate up a little bit, causing a little bit of sweating, that can all really help with reducing the likelihood of headaches.

Having good social support. Actually being married or in a committed relationship can actually be protective against headaches also.

Interviewer: Really? Wow.

Dr. Bartel: Yeah, as is it turns out. In general, just having a good social structure, social support system can be helpful for a lot of conditions, but headache is certainly one of them.

Interviewer: I like one problem, one solution. It doesn't sound like headaches are that at all.

Dr. Bartel: Unfortunately not. Yeah, it's not at all a one size fits all type of a condition. There are really so many different types of medicines, so many different types of alternative non-medication therapies that can be helpful. We try to really include the ones that we think are most likely to help each individual person, but we cater it to that person.

Interviewer: So for the person that has a chronic headache, if they wanted to try to treat it before going to a doctor, if they wanted to take a look at a few things to try to do it on their own, are there things that they could try before going to see the doctor? Dr. Bartel: Yeah. I think that trying to make sure that you're drinking plenty of water. You don't want to over-hydrate, but you want to make sure that you're drinking enough water. Getting enough sleep, regular sleep, every night is an important thing. Some people that have shift work jobs, that's difficult, but trying to get a good six to eight hours of sleep every night is really helpful.

Interviewer: Should somebody take a look at their diet? I mean, if they're eating a lot of sugar, for example, can that exacerbate a chronic headache? Dr. Bartel: Yeah, there are a lot of different food triggers for headaches, certainly. In general, there's no one diet that can help with headaches in a general sense, but trying to eat a little bit of protein when you have a headache can sometimes be helpful. Eating smaller meals throughout the day can also be helpful.

There are certain food triggers that can make headaches worse, things like MSG, monosodium glutamate. That's found in really every food these days practically, but also nitrates in certain cured meats, things like that.

Interviewer: So foods from our modern society.

Dr. Bartel: Pretty much, unfortunately. Yeah, there are really a lot of things. Simple carbohydrates can make headaches worse, just a lot of the sugars that we think about. But really, for everyone, it's a little bit different.

Interviewer: So it sounds like take a look at some of your lifestyle things. If some things have changed, like perhaps you're not sleeping as well or maybe you're hitting the candy bowl or the cookies a little bit harder than normal, could be some of those things that have all of a sudden brought on some headaches and a patient could definitely take a look at those and see if their headaches go away. Is there a time when a patient should not try to solve it on their own?

Dr. Bartel: Yeah, there are certain red flags that a doctor might think about to give us pause and want to recommend extra testing or at least more questions. So things like having stiff neck or fevers or just a change in your headache, generally, in the acute sense. So if you've had a certain type of headache for a long time and now all of a sudden there's something a little bit different about it, like you're just feeling kind of sick and you're just not feeling right, that can certainly be a red flag. It could just be worsening of your headache, but it could also be something else that's more threatening.

Having prolonged neurological symptoms with the headaches can be unusual. So it's one thing just to have a little bit of a visual aura before your headaches or numbness or tingling beforehand, but having prolonged symptoms like that isn't typical. It can be normal, but also it would be something to want to know more about from the provider's side.

Having weakness on one side is something that can happen with hemiplegic migraine, but it can also be a sign of other things happening in the brain.

Interviewer: Yeah, like a stroke.

Dr. Bartel: Exactly.

Interviewer: One of the signs of stroke is . . . yeah, wow. Okay.

Dr. Bartel: Having a new headache or kind of a changed headache in people that are a little bit older than age 50, for instance, can be a red flag also. There can be a lot of things that could be caused by, but that might indicate the need for imaging of the head.

Having a really sudden onset severe headache might be a reason to go into the ER for, which wouldn't be a bad idea because there can be bleeding in the brain. There can be a number of things that can cause that type of headache beyond just your standard tension headache or migraine headache.

Interviewer: Dr. Bartel, I don't know, after hearing those red flag headaches, I think I'm just going to go see a doctor and let one of you professionals work through it with me. It just sounds really complicated. It sounds like if I tried to get under the hood of my car and fix it is about the same thing as trying to diagnose a headache as well.

Dr. Bartel: It's difficult. I mean, it certainly can be. I think the main things to think about are if it's just a kind of a mild headache here and there that responds to ibuprofen, that's great. But you really want to be careful to not overuse your own research. If you're having headaches that are happening more often, certainly more than 15 days out of a month, it's probably a good idea to see a primary care provider to start with and then maybe see a neurologist or a headache expert otherwise just to kind of give you some tips and try to sort out what this headache is.

Kids and headaches, it's something I have parents bring their kids in for all the time. When is it time to worry? And when are there simple things you can do at home to make your child feel better?

Whenever kids get frequent headaches, parents often start thinking worst-case scenario. I'm often asked if a child who has frequent headaches needs an MRI to determine if they have a brain tumor or not. Only one in 4,000 children who have frequent headaches will have something in their brain. Ninety-nine percent of the time the headaches are due to more benign causes.

When we see kids with frequent headaches, some of the first questions we ask are to rule in or out that possibility of a brain tumor. Kids with brain tumors have severe headaches often that don't respond to pain medications or rest, or other symptoms, like dizziness, waking them up in the middle of the night with the worst headache of their lives, and vomiting, they're off balance when they're walking, have vision changes, and facial drooping. According to some studies, up to 50% of kids with brain tumors have no headaches at all but have other symptoms that raise big red flags for doctors that there's something wrong, including those vision and balance changes that I just mentioned.

So if it's not a brain tumor, why do some kids get frequent headaches? This shouldn't be shocking, but one of the biggest causes is stress. Many kids are super stressed out these days. They have academic pressure as young as preschool age. Often, there are families struggling with money issues, parents having marriage problems, older kids trying to keep up with what all their other friends are doing, especially in the digital world they live in. Social media puts a lot of pressure on teens that they really aren't able to handle.

Kids pick up on everything going on in their world. I have some patients as young as three suffering from anxiety because of things going on in their home environment. I've seen kids as young as one throw a temper tantrum if they don't get to play on the tablet or phone when they demand to. And I've got patients who are seven or eight, who are coming in for daily headaches because they're being bullied at school and don't want to go. Again, the teenagers stressed out from peer pressure that is only amplified these days with online video games and apps like Instagram and Snapchat.

Some of these kids with headaches do have migraines, but most have tension headaches. If your child is getting frequent headaches, what can you do? First, talk to your child and find out what's bothering them. Do it calmly though and let your child know you're concerned about them and that they're not in trouble no matter what the issue is. This helps them be more honest with you.

Find out if they can see okay. It's pretty common to have frequent headaches because of eye strain and needing glasses. And evaluate just how much screen time they're having. And if it's more than two hours a day, have them back off.

Make sure they're getting good sleep too. Doing meditation before bed and having a consistent bedtime routine will help with this.

If you still can't figure it out, then have them see their pediatrician who can help do a more thorough evaluation and provide some answers specific for your child's headache.

updated: January 13, 2023
originally published: July 22, 2019

Announcer: "Health Hacks" with Dr. Troy Madsen, on The Scope.

Dr. Madsen: Today's health hack is having an antibiotic in your bag when you travel. The antibiotic I really have in mind here is Ciprofloxacin. And the reason for it is urinary tract infections. So if you're female and you're traveling, you may have experienced this before. I mean anyone could experience it, but urinary tract infections are more likely in females. And if you're traveling and you experience a urinary tract infection, you know how miserable this can be.

If you're in a foreign country or just even another city, just trying to get in to find health care, interrupt your plans, getting the help you need to get a prescription for exactly what you know you need can be an incredible headache. So I think it's not at all unreasonable if you're going on a big trip or, you know, if you meet with your doctor just to ask them, "Can I get a prescription for an antibiotic to have on hand for this kind of situation?"

I think it's a reasonable thing to have. Typically you know when you have a urinary tract infection, and studies that have been done have shown that if a person feels like they're having a urinary tract infection, they're probably right.

So the health hack here is have an antibiotic on hand. Ciprofloxacin is one that I recommend that works very well for urinary tract infections. Take it with you when you travel. If you have symptoms of urinary tract infection, you can take this, avoid a trip to an ER or to some health care facility in a foreign country.

Announcer: For more health hacks, check out thescoperadio.com. Produced by University of Utah Health.

Announcer: Health Hacks with Dr. Troy Madsen on The Scope.

Dr. Madsen: Today's health hack is treating an ingrown toenail to prevent it from getting worse. So if you've ever had an ingrown toenail, you know they're pretty miserable. They get inflamed. Sometimes you need to have a piece of the toenail cut off, you need to have the infection opened up and drained, and you need to go on antibiotics. So if you can catch this early, you can save yourself a whole lot of pain and headache.

An ingrown toenail essentially happens when one side of the toe or one side of the toenail digs into the toe and it grows out. It causes that area to just get inflamed. So if you can get that corner of the toenail and somehow lift it up so it's not pushing into the skin, you can prevent it from getting worse.

The hack here is to use a cotton swab. You take that cotton swab, you pull the cotton off the end of it, throw the stick away, and then take that cotton and roll it up so it's kind of a little bit longer and thin, and then you lift the edge of the toenail up, slide that cotton up under it, and then leave it there. Do that every morning after you take a shower when the skin's a little bit softer. What that does is it lifts the toenail up away from that edge of the skin. It prevents the toenail from growing into the skin and getting worse. If you do that for about a week, you're going to be good. The toenail will grow far enough you're not going to have an ingrown toenail. You'll save yourself from having to have any sort of procedure done or having that drained.

Announcer: For more health hacks, check out thescoperadio.com, produced by University of Utah Health.

Dr. Gellner: Meningitis can be very scary to see your child go through. What are the types of meningitis and how is it treated? I'll discuss this on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Meningitis is an infection of the tissue and the fluids that surround the brain and spinal cord. There are two types of meningitis. There's viral and bacterial. Luckily, we don't see bacterial meningitis as much as in the past and that's in a large part due to three vaccines. The Hib and pneumococcal vaccines your child gets with their baby shots protects them from several types of bacteria that cause meningitis in young kids, and the meningitis vaccine that is required for middle school and high school protects them as teenagers.

The symptoms of bacterial and viral meningitis can look very similar and they are very scary. The biggest signs are that your child will have a splitting headache which is worse if they are in a lighted area. They will be unable to move their neck without moving their entire upper body. They may be confused, or if your child is a baby, they will be very fussy and they're constantly crying like they're in pain, and sometimes, it's a really high-pitched cry. It's a very odd cry. They will also be very nauseous and vomiting, sometimes projectile vomiting. Babies who still have their soft spot can have bulging there. It's pretty noticeable, so you'll be able to tell.

Meningitis can only be diagnosed with a spinal tap. This is done in the emergency room where they can take a sample of spinal fluid and test it in the lab to see if your child has meningitis. And if so, is it bacterial or viral? Your child may also have an MRI or a CT of the brain before the spinal tap is done.

Bacterial meningitis can be deadly, so it's extremely important to have them seen as soon possible. Treatment involves IV and oral antibiotics, and your child will also have blood tests done to make sure the infection is responding to the medicines. This is most definitely a hospital admission, and it could be for days or even weeks.

There's no medicine that can be given to treat viral meningitis, unfortunately. The most important treatment is to help your child stay hydrated, give pain or fever medicines, and let them rest. Since different viruses cause meningitis, it may take from two days to make them feel better or up to two weeks.

Both viral and bacterial meningitis can be passed from person to person, which is why it's important to teach your child how to cover their cough and everyone needs to wash their hands frequently.

Remember, all kids and adults can look and feel pretty horrible when they get sick, but the signs and symptoms of meningitis are pretty specific and recognizable, especially, the severe headache and the not being able to move one's neck without significant pain or vomiting. If your child has those, go straight to the emergency room to find out if they have meningitis or not. Quick thinking on your part can save your child's life.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: You get a crazy severe headache out of nowhere. ER or not? That's next on The Scope.

All right. It's time for ER or Not, where you play along and decide whether or not something that happened is worth going to the emergency room or not. We're with Dr. Troy Madsen. He's an emergency room physician at University of Utah Hospital. Today's ER or Not, you get a crazy severe headache out of nowhere. Just, bam, it hits you. Should I wait a few minutes, or should I think about going to the ER? ER or Not?

Dr. Madsen: I'm going to ask you a little more about this. Have you had a headache like this before?

Interviewer: No. This was just something, never experienced anything like this.

Dr. Madsen: Nothing?

Interviewer: No.

Dr. Madsen: Severe headache?

Interviewer: Yeah.

Dr. Madsen: All of a sudden?

Interviewer: Maybe mild headaches before, but nothing like this. It just all of a sudden, bam.

Dr. Madsen: Did it make you pass out or cause you to feel sick to your stomach?

Interviewer: It did not make me pass out. Caused somebody to feel sick to their stomach, sure.

Dr. Madsen: Okay. Yeah. These are typical questions I'm going to ask someone. Again, I'm imagining you're a family member calling me on the phone telling me, "I've had this severe headache. It just came out of nowhere. I've never had headaches before. Otherwise, feel okay." I'm going to say, "Go to the ER."

Interviewer: Okay. So severe headache out of nowhere, no other symptoms, still go to the ER?

Dr. Madsen: Yes.

Interviewer: Put a little nausea on top of that or passing out, then definitely.

Dr. Madsen: Absolutely.

Interviewer: I'd imagine go to the ER.

Dr. Madsen: Yes, absolutely. These are cases where the big thing I'm worried about is what's called a subarachnoid hemorrhage, which is bleeding in the brain. So you can have an aneurysm. Maybe 1% to 2% of the population, of all of us, just have possibly little brain aneurysms, just something we have and we may not know it. But these individuals that have severe, sudden headaches like this, the big thing I'm worried about is something rupturing with that aneurysm, bleeding out, and that's what's causing the severe headache.

Classically, what will happen is someone will say, "Out of nowhere I had the absolute worst headache of my life." They describe it as a thunderclap headache, just like that thunder just hitting you all of a sudden. Sometimes they may pass out. Sometimes they may feel very nauseated. They may have other symptoms as well with it, if the bleeding is severe, like difficulty speaking or weakness. But really, if you have that severe, sudden onset headache, you need to go to the ER to get that checked out.

Interviewer: So these aneurysms, otherwise completely healthy people could have them?

Dr. Madsen: They might, and that's the thing. It's not something where I'm going to recommend that people just go and say to their doctor, "Hey, I heard this guy say that maybe 1 or 2 out of every 100 people have these aneurysms. I want to get checked for this." Because most people go through their whole lives and it's never an issue. But in some cases, for whatever reason, there may be something about it, either it's large or it's been weakened for some reason, these aneurysms can rupture, and then can cause these severe symptoms.

Interviewer: Are there instances where you could have this sudden severe headache and it is something else? What I want to say first of all, if you do have this go to the ER.

Dr. Madsen: Yes.

Interviewer: But in the interest of not freaking everybody out, could there be other reasons?

Dr. Madsen: Oh, absolutely.

Interviewer: Okay.

Dr. Madsen: Just because you have this doesn't mean you've had a ruptured aneurysm. When studies have looked at it, they've found that about 10% of people who describe these thunderclap headaches, these very severe, sudden headaches, do end up having some sort of bleeding in the brain. That means the other 90% just had it. For whatever reason, it just came on. The big thing I'm thinking about in the ER is ruling out the bad stuff. Oftentimes, that means getting a CT scan of the head to look for any sign of bleeding there, making sure there's no sign of that, and we may have to do some additional tests as well.

But at the end of the day, 90% of the time or more, I'm telling people, "Hey, you had a severe headache. I don't have a great explanation as to why. I may look for other causes as well, but at least we know it's nothing very serious like this."

Interviewer: Then, that buys you some time to maybe look into the other reasons.

Dr. Madsen: Yes, exactly.

Interviewer: But definitely, those thunderclap headaches, go to the emergency room.

Dr. Madsen: Absolutely. Yep. I've seen cases of people who have come in, young, healthy people who have come in and said, "I've had this severe, sudden onset headache." We start the testing. Within 30 minutes they are not responding, because the bleeding has gotten so severe. We're getting the neurosurgeons down there emergently. So one of those things that I don't want to scare you with this, but severe, sudden onset headaches you want to take seriously.

updated: September 23, 2020
originally published: May 13, 2016

Dr. Miller: Painful feet, especially in the morning, could that be plantar fasciitis? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm here with Alexej Barg. He's an orthopedic surgeon here at the University of Utah and we're going to talk about foot pain as it relates to plantar fasciitis. Alexej?

Dr. Barg: Yeah, the plantar fasciitis, I'm originally from Switzerland and in Switzerland we call it the folks disease. Almost everybody in the country did experience this type of disease at least once in his life. Dr. Miller: What is it?

Dr. Barg: Actually, many people do not really know what it is. And I really do believe that plantar fasciitis is not a diagnosis. It's like a headache. A headache is not a diagnosis, it is just a symptom. And I do strongly believe that plantar fasciitis is also just a symptom.

Dr. Miller: Then it has multiple causes?

Dr. Barg: Yeah. Dr. Miller: Is it just pain?

Dr. Barg: It is the pain, but then you should figure out what is causing this pain and this is the most important part to plan the treatment. And maybe let me tell you what are the typical causes for plantar fasciitis.

Dr. Miller: Could we, before we talk about the causes, let's talk about what the symptoms might be. So if someone comes to you, how will they present with their problem before you look for the causes?

Dr. Barg: So, first of all, everybody can come with a plantar fasciitis regarding age. There is no big difference between genders. It can be female patient. It can be male patient. Typically, the patient presents with heel pain localized across the heel but with some radiating pain along, for example, the arch of the foot. These are the typical symptoms of plantar fasciitis.

Dr. Miller: Is it more common in people with high arches or what we call flat feet?

Dr. Barg: Yeah, the patient's with the flat feet do usually present with those pains, but there are also some different, some other causes. For example, for plantar fasciitis another cause can be the tightness of the lower leg muscles, especially on the back of the lower leg.

Dr. Miller: The calf muscles?

Dr. Barg: The calf muscles, exactly. And the second kind of common reason for plantar fasciitis can be the problem with the Achilles tendon. That means the Achilles pain can actually radiate to the plantar fascia so the people do think that the plantar fasciitis . . .

Dr. Miller: So it's a referred pain almost?

Dr. Barg: Exactly. Dr. Miller: So the typical person with what we would call the typical symptoms of plantar fasciitis, they experience that when they are putting weight on their feet? When they first get up in the morning and walk across the room or do they have that pain even at rest when they're not weight-bearing?

Dr. Barg: So usually the patient presents with two types of pain during the day. First of all, early in the morning so they have some problems getting into their shoes. For example, to get out of the house to walk to the car and during the day they're getting better. However, if they are all day on their feet at the end of the day they usually experience the same pain after they are weight-bearing on their feet.

Dr. Miller: So it sounds like there are different causes. There must be different treatments.

Dr. Barg: Yes, there are. So, first of all if the patient has a flat foot deformity then you should try to correct the flat foot deformity. In most cases, there is no need for surgery. For example, you can prescribe custom-made shoe insoles with some medial arch support. Most commonly, I also recommend the physical therapy. The physical therapy helps to reduce the local pain. And when we speak, for example, with the patient with the tight calf muscles there are some very specific exercises you can prescribe to the patients to elongate or to strengthen the calf muscles which may help to get the pain relief.

Dr. Miller: Now, I've seen some of my patients with plantar fasciitis who've seen physicians or podiatrists who treat that using a ball they roll up and down their feet. I don't quite know what that's for.

Dr. Barg: It helps actually. It helps even better if you put this ball in the freezer or in the fridge because then it's cool. What is even more important is to try and strengthen the plantar fasciitis. And the doctors can show them in the clinic how to do that or the patient can go to the physical therapist and the physical therapist can teach the people how to do that. Very important those stretching exercises should be done at least 10 times a day.

Dr. Miller: So for the calf or the bottom of the foot?

Dr. Barg: It's for the bottom of the foot. It's hard to describe how to do that. So what you usually do is bend your knee and you put your foot on the contralateral. That means the other ankle and pull on your toes so you try to flex the foot. You try to bring the plantar fascia in tension. And then you go with your thumb over this fascia, which is actually quite painful. So therefore I do recommend to do it just one minute or two minutes, but it's better to do it 10 times a day. Dr. Miller: So it's self-massage?

Dr. Barg: Exactly.

Dr. Miller: So it's basically massage of the sole of the foot while the foot is flexed. And how effective are the treatments if done correctly?

Dr. Barg: It's very, very effective. I would say in 90 to 95% of all those patients with these very simple measures can get pain relief. And usually I'd like to see the patient maybe six or eight weeks after the initial treatment. Fortunately, the patient normally doesn't show up in my clinic then because that means they ignore the follow-up appointment because they are absolutely pain-free.

However, the patient that has remaining pain, if they are coming back, then I do recommend shockwave therapy, which is extremely effective in treating plantar fasciitis. However, I do not like to start with this therapy despite the fact that it's an effective therapy because this therapy is very painful. So you're using kind of ultrasound machine and it hammers on the insertion of the plantar fascia, which is painful, which induces inflammation and the inflammation induces in itself the self-repairing process for the plantar fasciitis.

Dr. Miller: So if it doesn't hurt it's not going to do you any good?

Dr. Barg: Exactly. Exactly.

Dr. Miller: Now, one final question. I've heard some people mention that they've had a bone spur and someone told them that was the cause of their plantar fasciitis. Could you comment on that?

Dr. Barg: In the meantime, we know exactly that the bone spur is not the cause of plantar fasciitis. Many patients coming to me say, "My family doctor told me to remove the bone spur." I would definitely not recommend to do it because if you do just remove the bone spur, first of all, you will not eliminate the pain, but you may weaken the plantar fascia and even rupture the plantar fascia while you do remove the spur, which can be a big problem for the patient.

Dr. Miller: So, basically, lots of people have bone spurs. That doesn't mean it's the cause of the problem.

Dr. Barg: Yeah. So when we take just 100 normal people off the street without any pain and do any radiographs of the feet, I'm pretty sure we would detect maybe 10 or even 20 people of these 100 asymptomatic people, meaning people without pain, and we will see in up to 20% some spurs of the heel bone.

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