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If you’re suffering from headaches and…
Date Recorded
June 25, 2021 Health Topics (The Scope Radio)
Brain and Spine Transcription
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. MetaDescription
If you’re suffering from headaches and over-the-counter medication doesn’t seem to help, education may be the answer. The University of Utah Health Headache School aims to help you get relief from migraines and chronic headaches through video courses and virtual courses with headache experts. Dr. Jared Bartell describes how you can participate in the free program and start getting relief from your migraines.
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Headaches are very common, with many treatment…
Date Recorded
June 18, 2021 Transcription
Interviewer: Today, we're going to talk about how you can go into your primary care physician and talk to them about headaches, so you can finally get that relief.
Dr. Karly Pippitt is a primary care physician, but she's also a headache specialist at University of Utah Health, so she understands both the perspective of a primary care physician and a headache expert. So, hopefully, we'll be able to bring those perspectives together to find out how to talk, how to prepare, and other things like that. So the first question is, what kind of barriers do people run into when they're trying to talk to their doctor about headaches?
Dr. Pippitt: I think probably one of the biggest barriers, when talking to primary care, is time, right? I mean, if I go to my primary care doctor, I probably have four or five things that I want sort of checked off my list to get taken care of, and this is just one in a list of a number of things. And what I have learned is that what's really important is you need to make a visit that is dedicated to your headaches. This is a problem that deserves the appropriate amount of time. So you need to go into it with that perspective if your provider doesn't guide you to that already.
Interviewer: I've been fortunate. I know people that have had severe headaches. And when we talk about headaches, are we talking just about headaches in general, or are we talking about migraines? I mean, what type of headache is it generally that people seek help for?
Dr. Pippitt: So most people I would say probably seek care for migraines, but I think one thing I've been very impressed by is how much people don't talk about headaches. And in my role at the Headache Clinic, I'll sometimes ask people questions about their headaches and they'll say, "No one ever asked me that before."
Interviewer: Yeah.
Dr. Pippitt: And it doesn't seem like a particularly earth-shattering question that I've asked them. So I think that's a pretty important thing is that if your headaches, migraines or not, are impacting something in your life, right, like it's keeping you from work, it's keeping you from school, it's keeping you from anything like that, that means you should talk about it.
Interviewer: Yeah. If you kind of take an inventory and you're like, "Yeah, that is kind of an issue." Because we all get just kind of one-off headaches, a lot of people do. And that's not what we're necessarily talking about here, or is it?
Dr. Pippitt: I think it can be. I think if it's not a one-off as much anymore, but like, "Hey, wait a minute, I think that's kind of been every day. And yeah, maybe I can get done what I need to do, but maybe I can't quite focus as well, or maybe I'm a little more irritable at home with my partner, with my family, and I don't really like that." Those are things you should talk to someone about.
Interviewer: All right. So make that appointment with your primary care provider and just make it just about headaches if that's what you want to tackle with your primary care provider. Then what would you recommend that a patient do to start moving towards maybe managing them a little bit better?
Dr. Pippitt: Yeah. So when you go in for that appointment, be ready. So most people who have headaches have more than one type of headache. This is sometimes I think if you don't have headaches or don't have frequent headaches, you don't think about this very much, but go in ready to talk about that. Maybe I have this sort of low-level headache if I don't eat enough that day or if I go a little bit late on a meal or don't stay super well hydrated, but maybe I get a really bad headache if a storm comes in or if I haven't slept very well for a couple of nights in a row. So be ready with sort of all of those different types of headaches and especially coming in with a diary. So I've seen all sorts of different diaries. There are apps for your phone that you can use. You can write these down on a calendar or just on a notepad. But you want to keep track of the frequency. So how frequent are you having headaches? How bad are they? So did you have to go home from work, or were you able to keep doing what you wanted to do that day? How did you sleep the night before? How active had you been? And then what did you take, and did it help or not? These are all important things to just sort of get a bigger picture, because we all think we remember. "Oh, I think I had a couple of headaches last month." But sometimes when you write it down, it can be pretty striking how frequent you might be having headaches.
Interviewer: Yeah. So go in prepared. It's going to take a little time beforehand. How long would you recommend somebody do the diary before then they actually go and talk to their doctor?
Dr. Pippitt: I'd probably say somewhere around six to eight weeks. Some of it depends on how bad your headaches are. So I think if your headaches are really pretty debilitating and you're having to miss work, then you might not want to go for quite that long. But at least a good couple of weeks of volume of extra information so that then you and your provider can look at that together to determine what might be the next appropriate step.
Interviewer: Okay. And you had mentioned that there are some apps out there and they tend to ask the questions that are going to be the most useful in that appointment. Most of them are pretty good, or do you have a recommendation?
Dr. Pippitt: The one that I've used the most is called My Migraine Buddy. It seems to be the most user-friendly. It actually prints out some nice, pretty charts that talk about how frequent, how intense was the pain, and things like that. That's the one I've heard the best reviews from patients.
Interviewer: Yeah. And when a patient comes in with that information to you because, as you mentioned at the top, you're a primary care physician, but you have also taken extreme interest in headaches and have educated yourself to the extent that maybe the common primary care physician has not. Are you kind of struck by when they come in with that information? Does that truly make it easier for the regular primary care physician?
Dr. Pippitt: Oh, absolutely. I mean I think anytime you come to me as a primary care doc and have information about when your last labs were, about your family's medical history that's really detailed, I'm never going to be upset about that. That is like a gift when you walk in the door.
Interviewer: Okay. So the person brings that in, they bring you some great information, and then at that point, you would review it, and you would likely come up with a treatment plan. Are we at that point yet?
Dr. Pippitt: Yeah. Absolutely. And treatment, we usually break down into two big categories. So one is rescue or acute treatment. So if you're having such intense headaches or migraines and whatever you're trying over the counter isn't working, that's sort of step number one, one thing we could treat. And then I think the second aspect of that is prevention. So if you're having really terrible migraines every week, that lasts for two or three days, well, then we should do something to try to reduce that frequency. So talking to them about what the options are, what might make the most sense based on their particular set of circumstances.
Interviewer: So if I'm a person with a headache and I've gone to my primary care physician and I know maybe they've had like a day or two of training, right, and maybe they have educated themselves off and on throughout their practice, how often can a primary care physician that's kind of got that base level of headache knowledge really solve a problem?
Dr. Pippitt: I think we are well equipped to solve the problem. There are a lot of good migraine medicines that have been out there for a while. And I would say before you escalate to a specialty level of care, unless there's something unusual or concerning about your headache in particular, but you should be able to try at least a couple of rescue medications with your primary care provider and at least a couple of prevention medications. I think it's important to always keep in mind there is no magic cure for any of this. There is no snap of my fingers that is going to make this go away. So patience is really important. If you come in with a migraine a week for a year, it's going to take some time to get at that. So being patient and having reasonable expectations about the outcome, I think is important going in.
Interviewer: Yeah. That can be important. I know some people personally that they have headache issues and they've gone to their doctor and then they felt like they weren't able to solve it so then they just gave up. So I think kind of realizing that it sounds like it's a process, where maybe a few treatments might need to be tried would be useful. At what point then would you want to consider going to more of a specialized headache care center?
Dr. Pippitt: I think if you've tried a couple of things with your primary care and you're not making any headway, if you'll pardon the pun, I think that's the time to think about talking to someone else. It's an okay thing to ask your primary care provider. Just be forthright and say, "At what point do you usually refer patients to a specialist?" I think most of us have a level of comfort with different medical conditions, like I'm clearly going to take care of a lot of things in my primary care practice that are headaches that some of my partners will not, but they'll take care of some things that I would probably send to a specialist as well. So I think asking your provider when. I think it's important that you've tried something, though. I occasionally will see patients in our Headache Clinic who've never tried anything before. They've never tried a prescription rescue medicine. They've never tried a prescription preventive medication. And while that's particularly lovely for me in the Headache Clinic, I would say it's not a good use of a pretty limited resource, because we're there to really take care of patients who've tried quite a few things and are not making any progress.
Interviewer: So we talked about how to talk to your doctor, your primary care physician about headaches, make that diary. It sounds like have a little bit of patience with them as they work through a few treatment options. Are there some other keys to getting that correct diagnosis and treatment from a primary care provider?
Dr. Pippitt: I think you as the patient are the one who knows your history best. So I think we worry that maybe the right questions aren't being asked. So if there's some symptom or something you're experiencing that you don't know if my hand tingling, before I get a migraine, has anything to do with it, bring it up, pay attention to those things. Really ask the questions when you go in so that you're well informed about your own condition, because that helps your provider make the correct diagnosis. MetaDescription
Headaches are very common, with many treatment options available. Yet, many people suffer with headache pain without ever speaking to a doctor. Don’t suffer in silence. Learn the best strategies to prepare for a discussion with your doctor about your headaches so you can get the best treatment for you.
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Men get migraine headaches but aren't…
Date Recorded
May 18, 2021 Health Topics (The Scope Radio)
Mens Health
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Even though migraines come from the brain,…
Date Recorded
March 22, 2021 Health Topics (The Scope Radio)
Womens Health
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As a parent, you worry when your child feels ill.…
Date Recorded
January 13, 2023 Health Topics (The Scope Radio)
Kids Health Transcription
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. Stress Headaches
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. Relieving Tension Headaches
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 MetaDescription
As a parent, you worry when your child feels ill. If your child is suffering from painful, chronic headaches, you may assume the worst. But the cause of your child’s pain may be something much more simple. Learn how stress, anxiety, and screen time may be causing your child’s headaches and how to prevent them.
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Headaches, back pain and abdominal pains are some…
Date Recorded
June 24, 2016 Health Topics (The Scope Radio)
Family Health and Wellness Transcription
Interviewer: Three symptoms that don't seem serious but could be. We'll talk about that next on The Scope.
Announcer: This is, From the Front Lines with emergency room physician Dr. Troy Madsen, on The Scope.
Interviewer: Dr. Troy Madsen's an emergency room physician at University of Utah Health Care. Today, three symptoms that don't seem serious but could be. We're talking about signs that you might have a serious medical condition that a lot of people ignore because we're kind of numb to these things.
What are the big three? Let's start with number three. In no particular order, or is this in order?
Dr. Madsen: This is in no particular order at all.
Interviewer: Okay.
Dr. Madsen: Just the three things I thought of as we talked about this that people often don't take very seriously but when they come in sometimes we can find serious things going on.
First one on the list is headaches. And when we're talking about headaches, I think a lot of us are used to headaches. We work, we get tension headaches, sometimes we just don't feel quite right, a little nauseated. But I oftentimes find that people with headaches just feel like "I've just got to tough it out," just get through it and it will go away.
Interviewer: Right, it's a headache, everybody gets them.
Dr. Madsen: Exactly. And, sometimes headaches are a sign of something very serious going on. A lot of times, the red flags with headaches are, headaches that come on very suddenly, very severe, maybe make you feel more nauseated then maybe you've been with previous headaches, certainly if you're passing out because of headaches. Another interesting thing with headaches that's more serious is if it wakes you up in the morning, like you get a headache and you wake up and this headache is the thing that woke you up.
Interviewer: Okay.
Dr. Madsen: And that's often a sign of something going on in the brain, maybe a brain tumor or something like that that can be a more serious thing. So a reason to, certainly if it's a sudden onset severe headache, get to the ER, if it's a headache that's waking you up in the morning, something to talk to your doctor about, they may want you to come to the ER or get some sort of imaging of your brain to see what's going on there.
Interviewer: And it might not be a bad idea if you just kind of always have headaches to talk to your doctor about it because that's not a fun way to live.
Dr. Madsen: Yeah, you're exactly right. We do see cases like that, too, of people who come in the ER who say "I just get migraines all the time" and they could be on medication to prevent that, to prevent that ER visit and make their life much more comfortable.
Interviewer: All right, number two on three things that don't seem serious but could be.
Dr. Madsen: Yeah, so number two is back pain. And back pain is another one of these things you figure "Tough it out, I get pain in my back, maybe I was doing some lifting, something like that." But one of the really, really serious things with back pain is an aortic aneurysm, or a tear in the aorta. And classically with that, people will have pain that starts in their chest and goes though to their back and it's like a tearing pain, maybe it's down in their abdomen and they feel some pain in their back as well with that.
Interviewer: So upper or lower back it sounds like.
Dr. Madsen: Exactly.
Interviewer: Doesn't have to be just back from where the heart is.
Dr. Madsen: No it doesn't.
Interviewer: Even though it's a heart thing you're describing.
Dr. Madsen: Well it's related to the heart. The aorta is the main vessel that delivers blood from the heart to the body. So yeah, it is related to the heart. The heart is squeezing blood through there, so people sometimes just have just severe back pain with an aortic aneurysm or a tear in the aorta and that's something that's extremely serious, you've got to get to the ER, get that checked out. And typically with that, they just have sudden onset severe pain. That's how they describe it. Just a sudden onset pain feels like a tearing or a ripping sort of pain.
You know with back pain as well, you can have issues like cancer, tumors in the spine, things there that will cause you pain that's often more severe when you're lying down or certain positions. It's a little more rare, but that would be something to see your doctor about. They could get an x-ray of your back, sometimes they'll get an MRI to take a look there and see what's going on.
Interviewer: So if it's something you've lived with for a while, there again, go see a physician because why should you live with that. If it's something that comes on very suddenly, for no real apparent reason, that's the trip to the ER time.
Dr. Madsen: Exactly.
Interviewer: All right. Number one on the list of three symptoms that don't seem serious but could be.
Dr. Madsen: And number one is abdominal pain. And we see lots and lots and lots of people with abdominal pain, and we see lots of people with abdominal pain who don't have anything wrong. But then we see people with abdominal pain who come in and say "I've had this pain in the right lower side of my abdomen for five days now. I just figured it was gas and it would go away." We get a CT scan and they have a ruptured appendicitis. And that's just not good.
So there are things in the abdomen that can go very wrong, and it generally happens over time. Typically in the abdomen, it's not something that's going to happen all of the sudden, but if you're having abdominal pain and it's not going away after a few hours, it's progressing, especially on the right side of your abdomen. If you're a typical young, healthy person, the right lower side is your appendix, the right upper side is your gall bladder.
Those are the most common things I see in young healthy people who are just like "I've had abdominal pain before. This will go away." They come in, they have a ruptured appendicitis, or they have a very serious case of cholecystitis, which is an infection of the gall bladder, and they have to go to the operating room to get these things repaired, which they would otherwise but often it's a much more complex case because the infection there is so advanced.
Interviewer: So it sounds like the first two, sudden symptoms. The third one, symptoms that have lasted for a while.
Dr. Madsen: Exactly. Things that came on more gradually and then progressed but people just keep thinking "This will go away" and it's not going away.
Interviewer: That's for the abdominal pain. How many days, if I kind of have a consistent abdominal thing going on, what should my line be, where I'm like "I better go see somebody"? Five days? Is that it, or sooner than that?
Dr. Madsen: I would do sooner than that. With the appendix, with the gallbladder, most things if you got a little bit of food poisoning or some gas in your stomach it's going to get better within six hours. If it's going on beyond that, if you're getting more toward 12 hours with this sort of thing, that's definitely I think a reason to at least see your doctor about it.
Interviewer: And I think it's also interesting too because I know a lot of people from some previous podcasts talk about very sudden abdominal pain like waking up in the middle of the night, sudden abdominal pain. From what you just told me, that doesn't sound like necessarily the thing to worry about. It's if it continues over time.
Dr. Madsen: Well, and again it becomes challenging because I mention that thing to you about the aortic aneurysm, like the back pain, that's also in the stomach that is a sudden thing, so it comes a little bit more challenging.
Interviewer: How do I know if something happens suddenly if I should be concerned? I mean, how do I parse this out?
Dr. Madsen: I think you have to base it on the severity of the pain, how it compares to your previous pain. But these are things where people kind of ease into it, it's like "Oh this isn't so bad. I've got a little pain in the right side of my abdomen. I'm used to having a little bit of abdominal pain." But then they gradually get worse and worse. Maybe some of these other serious things in the abdomen, they come on suddenly, and they're severe.
And so, you base it on the severity, and then those things that aren't so severe, you base it on well, what's it been doing over time, has it just been gradually getting worse, that's a sign often of something more serious.
Interviewer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.
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You are suddenly hit with a severe headache that…
Date Recorded
September 23, 2020 Transcription
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? Severe Headache and Vomiting
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. Causes of Severe Headaches
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. Thunderclap Headaches
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 MetaDescription
A sudden severe headache, sometimes described as a thunderclap headache, may be a serious cause for concern--especially when coupled with nausea or passing out.
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Migraine headaches are more common in women than…
Date Recorded
May 11, 2023 Health Topics (The Scope Radio)
Brain and Spine
Womens Health MetaDescription
Migraine headaches are more common in women than in men—about 17 percent of women will have migraine. Learn how to distinguish between women's migraines and men's migraines.
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Dr. Deanne Long discusses the symptoms of…
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