Search for tag: "migraines"

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Scot: Back in May, we did an episode about migraines, and we learned that men who have migraines aren't likely to seek help or even know that they have them. It's Episode 78 with Dr. Karly Pippitt, if you want to check that out.

And just as I get done recording, I hit the stop . . . We know Troy has migraines. That was really the whole purpose. He hasn't really been doing anything for them. But Mitch was on the show as well, and just as I hit stop, Mitch goes, "Gosh, Troy . . ." Actually, do you want to play the part of Mitch, Mitch?

Mitch: No. I would like to see you play the part of Mitch.

Scot: You're like, "Gosh, Troy, I couldn't imagine what it'd be like having migraines for three days. I just have headaches that I have to go in a dark room for four hours, and can't interact with anybody, and have to close the blinds and roll up into a little small ball."

Dr. Pippitt: Totally normal. It happens to everybody.

Scot: And at that point . . . Dr. Pippitt, do you want to play the part of Dr. Pippitt?

Dr. Pippitt: I don't know. You're doing pretty good. I think you can keep going.

Troy: That was a pretty good impression.

Scot: Dr. Pippitt was like, "Mitch, you have migraines," after the whole episode about men having migraines that they don't even know that they have them sometimes, and they're less likely to seek help. So why didn't you think you had migraines, Mitch?

Mitch: A very almost meta situation of happening in the episode is the same as what was talked about before. I just assumed that it must not be that bad. I assumed that some men out there that are like, "Nah. I'm okay. This is just what happens," not realizing that having a headache for more than an hour or two is not okay, especially if it's bad enough you have to go curl up in a corner and just shut your eyes and whatever, then . . .

So that was the thing that was the most shocking listening back to the episode when I was editing it, is just like, "Man, am I dumb? Or am I just . . ."

Scot: You just sat through a whole episode of us talking about it and didn't realize until the end, until you were told.

Mitch: Right. And I guess that's just it. It's like, guys, if you are listening to this right now, and anything that we say sounds like it, just go talk to your doctor.

Scot: Yeah. They can help you.

Dr. Pippitt: Don't torture yourself.

Scot: Right. There's no need. You're not winning any awards by doing that. The bragging rights aren't worth it. Get bragging rights doing something else, doing something cool. I don't know.

Dr. Pippitt: And probably not just making yourself miserable, but potentially everyone around you miserable as well too.

Troy: Yeah, that's true.

Scot: When you don't do anything about them. So this is the update episode. We're going to have an update episode to find out if Troy went actually to his doctor and was diagnosed with migraines, and if he got any help, and then Mitch, as well, was going to make an appointment. So that's where we're at right now. Who wants to start?

Troy: I'll start off first since I was the first one that put myself out on a limb there on the episode since Mitch left me hanging until the end.

Scot, I was experiencing headaches about every month or so. They would come on usually after night shifts, like a day or two later, left side of my face, head. It would just feel miserable for, like, 48 hours. I'd feel sick to my stomach. I would just want to lie down and sleep. Light bothered me.

And this had been something I'd dealt with for years, and was just trying to treat it with Tylenol. I had read some stuff about ginger helping, and it did kind of help as well with the nausea, and I just tried to power through it.

So we did the episode, talked about it, and I resolved I was going to talk to my doctor.

So I did talk to my doctor. Went in there, told him everything, told him about the symptoms, told him about the podcast, told him about this discussion. He said, "Yep. It sure sounds like you have migraines." And so he prescribed medication for me. Since that time, I have had multiple opportunities to use that medication.

And it's funny, it was just this last weekend, I had three evening shifts in a row when I was getting to bed at 2:00 or 3:00 in the morning. And the first evening shift, everything was fine, and then the next evening shift, I got about halfway through it and it hit me.

Karly, I made the mistake of not taking medication then at work. I just didn't take it. I was just like, "Oh, I'm just tired. It's just a painful shift." And I think it was one of those things where my mentality was, "Just power through. Get through it in general, with the shift," and not getting as much sleep. Ugh, it hurt.

And the next day, I really felt it that morning. So I finally took medication that morning. Had to take it again a few hours later. Got through the next shift that evening, the third in a row of those late shifts, and then had to take medication the next day.

It was bad, but I was so glad I had the medication, because, otherwise, trying to get through those shifts, if I were just trying to power through that migraine those three shifts in a row, it would have been absolutely miserable. So it was a lifesaver.

The other times, I've caught it early. Took one dose the medication and I was good. No issues at all after that. But this was definitely a lesson in taking medication early.

Dr. Pippitt: I think it's okay, especially for that first time you take it, when you're at . . . It's a scary thing. You're at work. You have to think a lot for your job. It's pretty important that you're "on." And you don't know what the side effects of the medication are going to be. That's not to say that maybe you're not your best self when you have a migraine either, but still, I'm not going to chastise you too much because I can totally understand that. You're just a little worried about maybe "What will the response be?"

But you did do it the next day, and more importantly, you repeated your dose. I think sometimes people think, "Oh, well, if this didn't do the trick, then it's just not going to work." And you're absolutely right, it's unlikely to be as effective the longer you get into the headache, which is exactly what you experienced, right? In later headaches, you took it early and magic.

Troy: Exactly. But you can chastise me a bit because I had already had three migraines prior to this when I was at home, and I took it. And so I kind of knew how it felt. When I took the medication, I knew any side effects. So this was more just me being at work and being like, "I'm fine. I don't need anything." Even though I'd taken your advice and I had it in my bag, I had it there in my backpack, I just didn't take it. And I paid the price.

But that being said, it was a good lesson in taking it early. And even though I didn't take it as early as I should have, it was still effective even though I had to take a couple more doses.

Again, so glad . . . it's hard to say anything is a life changer. You don't want to just throw that term out here and there, but this truly has affected my outlook.

So often, I have looked at my calendar, and I have said, "Okay, I'm working a night shift. That's about when I'm due for a migraine. It's going to hit me two days later. What's scheduled that day? Okay, get ready for it. Brace yourself. Be ready for it. Be ready to take a bunch of Tylenol. Be ready to take ginger. Be ready just to feel miserable and get through it." And this has totally changed that, and it's a great feeling. It really has made a big difference.

Scot: Wow, that's awesome.

Dr. Pippitt: I couldn't be happier. I mean, baby steps. You got the medication on your person. You've done this. I mean, to be fair, how many years did it take you to finally talk to someone about this? So I'll give you that extra 12-hour cushion when you should have taken it sooner, given the time it's taken to get here in the first place.

Troy: Thank you. I have to add one other thing in this whole migraine story. Scot, we talk about genetics on our podcast as our "one more," our core four plus one more.

So my cousin listened to our podcast, happened to listen to the migraine episode. She sent me a text. She said, "I was listening to your podcast on migraines. Did you know we have a strong family history of migraine headaches?"

She said, "My grandmother's mother and grandmother both suffered from them." My grandmother told my cousin stories about how her mother and her mother's mother used to talk about needing to go lie down in a dark room because they were having a "sick headache." I mean, we're talking back in the 1800s.

Scot: Wow.

Troy: This goes back many generations. She said she's dealt with migraines from a young age, her sister, her brother, all my cousins there. So it would have been nice if I'd maybe gotten into my family history a little bit more with this issue, but clearly there's a pattern here. Interesting, though. It was great to hear from her. Great that she's listening, and really interesting to hear that from her and what she's had to deal with too. And obviously, she's been getting treatment for years.

Dr. Pippitt: And I think an important reminder to talk to each other about this. I mean, I don't know about your guys' family. Mine doesn't really sit down and share details at the dinner table, or holidays, or anything like that. But there are things that can make a difference in everyone else's lives, and maybe isn't as personal as other healthcare information, that would really make a difference in your family's lives too.

Troy: It really would. Yeah. Next time I get together with my family for anything, I'm talking about my migraines. So it'll be a fun Christmas dinner conversation.

Dr. Pippitt: Party at Troy's house.

Troy: Party at my house. Everyone, come on over. Let's talk about migraines.

Scot: And then, Mitch, did you go and see somebody about your headaches?

Mitch: I did, and I think it's kind of embarrassing in hindsight. Karly, love you, you're so great, but when I went to the doctor, the first thing . . .

Scot: Where's this going?

Mitch: Right. The first thing out of my mouth is like, "I'm on this dumb podcast or whatever, and I think I might have migraines." I don't know what man part of me took over to be like, "Sorry, I know better. Someone has been telling . . ." No. It's so dumb.

But I sat, and my lovely general . . . my PCP, she looked at me for a good . . . She's like, "Well, can you describe your symptoms?" And she just gave me this dead stare, and she's just like, "It sounds like you have migraines." And it was just like, "Yeah. Of course, I do." And she gave me some drugs.

Troy: You got the drugs.

Scot: You mean medication?

Troy: Medication. Yeah. That's what we prefer to call them, but yeah.

Dr. Pippitt: Potato, potahto.

Troy: Exactly.

Mitch: She just got me the rescue medication that you were talking about the last episode that we talked about this, and I have had . . . So she gave me two things. One, she wanted me do the rescue medication, and two, to start tracking. Like the diary of pain, this idea of, "What is causing these migraines?"

The good news, bad news. Good news is I've only had one since we talked. The medication worked spectacularly.

Dr. Pippitt: Awesome.

Mitch: I knew that I get this little bit of pain in the back of my head. It feels like a tension headache, but just keeps on cranking up. Took one of these pills, was fine. I felt a little oogie for, like, an hour, but it wasn't an all-afternoon event. And then I haven't had any since.

So my little pain diary, I've got nothing. I've got nothing over the last couple of months, so . . . I don't know.

Dr. Pippitt: I hope you haven't jinxed yourself now, right? Go knock on some wood or something.

Mitch: Sure.

Dr. Pippitt: Pull out the rabbit's foot.

Scot: How often would you have them before that?

Mitch: Once or twice a month.

Scot: Oh, wow. And we recorded back in May. So you've only had one since then?

Mitch: Yeah.

Scot: When it used to be once or twice a month.

Mitch: It's also when I stopped working my second job. I'm almost wondering if that was a big part of it.

Dr. Pippitt: I do love how often people come back and follow up, and they're like, "Oh, yeah. My migraines are totally better." And I'm like, "What happened?" And it's something exactly like that, like, "Left my spouse. Quit my second job," things that I can't generally recommend as treatment advice.

Troy: So did you have any side effects, Mitch?

Mitch: I was a little dizzy, to be honest. I just had a little bit of dizziness when I took it, but a little bit of dizziness for 15, 20 minutes is tons better than curled up in the corner, feeling like I'm going to die for a couple hours.

Troy: Interesting.

Dr. Pippitt: That's a good point, though, Troy, because if you . . . I will tell you the first rescue migraine medication I had, I didn't actually like how it made me feel. And so then I wouldn't take it, because I was like, "Well, is it worse to feel the side effects of the medication or the headache? I don't think the headache is quite that bad, so I'm just going to hold out," which then didn't really help anything either.

So it's important, if you do have side effects from it, that you tell your doc, because there are other things that you can take in that same class of drugs that often don't have those same side effects.

Troy: Yeah. And I haven't had any major issues. I find about 30 minutes in, my face will feel kind of tingly, and then the migraine just starts to dissipate, and it just feels like the medication is just there working its way into my brain, and making my face tingly, and making the migraine disappear. It's kind of a cool feeling. I kind of like it.

Dr. Pippitt: It is kind of weird when you're like, "Oh, my God." I mean, it's not even . . . I don't want to say a vise, like a tension headache, but you just start to feel it slip away as the medicine starts working. It's a really wonderful thing, especially when you're feeling really crappy.

Troy: It really is. It is a wonderful feeling. And I think for anyone who hasn't experienced migraines, it's hard to describe that sensation, but it's kind of consuming. It's just there, and it's just like you can't focus. You can't concentrate. You just feel sick. I feel like I have an illness, like I'm coming down with something. And just to feel that melt away, it's great. It really is a game changer, and so glad that you talked to us about this, and really convinced us to do something about it. So I'm very happy about that.

Dr. Pippitt: I'm just glad you guys did something. I mean, truthfully, this is the thing. People just think it's not that bad and they don't do anything about it. It sucks because it could be so much better for you guys.

Mitch: Well, that's the thing I wanted to mention. I thought I just had casual headaches, like no big deal. They're just something that happens when you get older. They're just something that happens when you're a person. And if you're listening to this episode right now, if you're out there and you're like, "I get headaches but they're not that bad," maybe you should just mention that you have headaches to someone. Mention it to your doctor, mention it to someone, because these drugs are kind of magical.

Dr. Pippitt: And mention it with some details. Maybe not this casual, "Hey, I think, maybe, I don't know." Just giving you a hard time, Mitch.

Mitch: It's okay.

Scot: And mention it to family members too. That might help you with your detective work.

Hey, Dr. Pippitt, do triggers . . . So triggers are the things that trigger people's headaches. They could be various things. Troy knows his triggers. Mitch hasn't figured out his yet. Are those hereditary as well? Do they tend to run in families?

Dr. Pippitt: That's a really great question. I think it would stand to reason that they probably do, but I don't know that I've ever had anyone specifically come up with that. I mean, I think the triggers are pretty . . . the common ones are common for most people, so hard to say. Is that just because it's a common trigger, or because it's the hereditary aspect of it?

Scot: Yeah. I thought that might be helpful with detective work. If somebody in Mitch's family is like, "Oh, I have them too, and these are my triggers," if that would shed some light. But you're saying it's common triggers.

I would encourage anybody to go back and listen to Episode 78 on May 18, 2021. But quickly, just mention some of those common triggers.

Dr. Pippitt: So Troy gave a really good example of one, when your sleep schedule is disrupted. So if you're not getting good sleep, you're staying up late, or you're sleeping in too much, or just too many hours of sleep, all of that is probably . . . That's one of the biggest triggers for people.

Alcohol. So particularly red wine, beer. Aged cheeses, or cured meats. So things like sausage, bacon, all the delicious stuff. Chocolate, unfortunately, can be a trigger for some people.

Scot: So Mitch mentioned that his diary, he really hasn't had . . . He hasn't had migraines, so he hasn't really been able to track down those triggers. And I know keeping a diary is pretty important. Explain how somebody might do that so then when they finally do decide to go in, like Troy and Mitch, that they've got all the information they need to provide to their doctor.

Dr. Pippitt: So, Mitch, did your doctor tell you to just mark down when you had headaches, or what other things are you supposed to note in your diary?

Mitch: One of the things that I was supposed to look for is when do I have headaches, what my general mood was around those headaches, what I had eaten that day on a day with a headache. And then they kept talking . . . I don't get it, but they kept talking about the aura, or the haziness, or the ooginess. I don't know what the word is. Like, "Do you have that pre-migraine feeling? And if you do, do the same sort of thing. What's going on in your sleep, your food, your mood?" I think that's it.

Dr. Pippitt: Yeah. Some things that I'll add to that would be things like how much physical activity have you had that day. On the diary that we print out, we talk about a couple of different triggers, so foods. We talk about other psychological stressors. So have you just had something really stressful happen in your life? Did someone die? Were you just sick? Do you have a big deadline at work? Things like that.

Weather, I don't actually put that down as something in the diary, but some people will notice that when a storm is coming in . . . In fact, the day that I had a migraine, I had had headache clinic the day before, and I ended up emailing the patient so we could connect virtually. And she was like, "Yeah, I think we're going to have a storm tomorrow." She messaged me the next day because it rained and was like, "I'm better than the weatherman. I'm telling you."

Troy: Wow.

Dr. Pippitt: And that's one that I think people sometimes feel a little like, "Am I nuts that I think that I can predict the weather, that it always happens with a storm?" But that's another really common trigger, just a change in the barometric pressure. So something else to think about watching for.

So to talk briefly about that aura that you're asked about, this is mostly . . . So the technical definition of an aura is a reversible neurologic symptom. So the vast majority of auras tend to be visual, and so people will describe this as either like a black dot or spot in their eye, that regardless of when you turn your head, you still see.

So all of us have done this when you've accidentally looked at something really bright, or looked at the sun, and then you look away. So it's just this like black dot that persists.

The other fancy medical one is something called a scintillating scotoma, which basically is like a zigzag line across your vision, or even sometimes like a shimmer, like a heat wave, that just sort of persists in your vision the whole time.

You can get other aura. So some people get numbness. We sometimes talk about the march of migraine. So that numbness starts in your hand, moves up your hand into your neck and your face, and then the numbness will happen there. It's typically neurologic symptoms, pause, then headache follows, but doesn't have to be that way.

Mitch: What about sparkles, sparkles in your vision?

Dr. Pippitt: Tell me more about your sparkles.

Mitch: Little diamond-y, shimmery. And it goes away after a couple of seconds.

Dr. Pippitt: I want to say that . . . I'm trying to remember the time frame. I think it needs to last a little bit longer than that. Where does it happen in relation to the headache?

Mitch: I've never connected the two. But I'm afraid that I'll be doing the same thing I did on the last episode where we'll turn it off and I'll be like, "Oh, yeah. No. Totally. I've been getting auras all my life."

Dr. Pippitt: I mean, the issues with aura tend to be more around . . . So people with aura have a slightly higher risk of stroke, and it matters in particular for female-identifying persons who want to use birth control for some sort of contraception, just because we know estrogen also puts you at higher risk of stroke. So the two together, if you're someone who identifies as female and you have migraine with aura, you should not be using an estrogen-containing birth control.

Troy: Talking about this and just my experience personally with migraines and seeing people in the emergency department with migraines, migraines are just weird. They are just weird. Do you know what causes them?

Dr. Pippitt: I mean, definitely our understanding of many of these things has changed over time. These new drugs are targeted towards something called the calcitonin gene-related peptide. So we've known about that since the '80s as being implicated in migraines. So it comes from this trigeminal ganglia, and then that's also in the sensory nerve fibers in the meninges. So it is a potent vasodilator. See this is what I'm talking about. This is why you don't know that you want this in there.

Troy: I'm sorry I asked.

Dr. Pippitt: It's what causes the transmission of the pain signals from the meninges to the brain.

So I don't know that we know what it is that activates that trigeminal ganglion that then makes the CGRP get released. But if any of us . . . not you, Scot, but the rest of us, if we got an infusion of the CGRP, we would actually get a migraine. So that's what these new drugs are. They actually are a receptor antagonist or blocker from that.

Troy: Oh, okay. So people who don't have migraines don't have that receptor?

Dr. Pippitt: I think they have the receptor. I just don't know that . . . do you not respond to it?

Troy: Just not so sensitive.

Dr. Pippitt: Is there something else? Yeah.

Troy: Interesting.

Dr. Pippitt: Exactly.

Troy: It's great to hear because, yeah, that's always been my understanding, is migraines are a mystery. But it sounds like there's more and more understanding of what's causing it and treatments targeted specifically at that. So that's great to hear.

Dr. Pippitt: Absolutely. I always tell people it's a good time to have migraine because this is really the first time in a long time we've had any very specific medications for it.

Troy: Right. Yeah, that's great.

Scot: Just want to point out you said 12 sentences in a row before I finally understood one. I was just waiting to see how many of those sentences you could string along with those words.

Troy: Did you not pick up on CGRP, Scot? We've talked about it before.

Scot: Oh, have we? Okay.

Troy: I'm just kidding. Yeah.

Dr. Pippitt: I could have read the next line that was something about being a multimore of a G protein coupled receptor. I mean, this is why I had to pull it up. This is not stuff I talk about to people.

Troy: That would have brought it all together. If you'd only said that, then really that would have brought it home.

Dr. Pippitt: Yeah, it would have been like, "Oh, Karly, you're holding out on me. Geez."

Troy: Exactly.

Scot: You can leave out the most . . . you're burying the headline here.

Troy: "Now I get it."

Dr. Pippitt: Mitch, about your sparkles, though, the other thing I was thinking is we often think about . . . So migraine has very distinct phases. So there's the prodrome, or what happens before you get a migraine, when you get it, and then the postdrome. And so there are some symptoms that people get that can be seen as precursor signs or sort of a premonitory sign.

One of those is yawning. That's actually a really common thing that people have happen. Sometimes you have to go to the bathroom a lot, like just urinate more.

It's a funny question to ask people sometimes, like, "Hey, have you ever noticed that these things happen, or you have cravings for certain foods, and then the next day you get a headache?" And you probably wouldn't notice it. But then someone says it to you, and you're like, "Oh, my goodness. You're absolutely right." And those are different than aura.

That was the only thing I wanted to point out. And it might be something you guys watch for now if you see anything like that.

Scot: Dr. Pippitt, thank you for making both Mitch's life and Troy's life so much better. We appreciate that.

Dr. Pippitt: And yours, I hope, too, right?

Scot: Well, I mean, Troy actually . . . I never knew he had migraines because I don't know if . . . I never . . .

Troy: Yeah, I didn't talk about it.

Scot: Yeah, I didn't know if I just never interacted with him on those days. I knew Mitch did once in a while. But they never really impacted me directly, I guess, that I noticed.

So if you get a chance, go back to Episode 78 because it really is good. You can learn a little bit more about your migraines.

Dr. Pippitt, before we go, though, if somebody does not go back to that episode, how should we wrap this up? What's your message of hope?

Dr. Pippitt: I think the message is there is treatment for this. And don't think that you have to be . . . We keep teasing and joking about curled up in the corner of a dark room. If your pain is significant enough that it interferes with your life activity, it's worth getting checked out.

Scot: Or you just think about it, right?

Dr. Pippitt: Yeah.

Scot: That is interfering with your normal activity, I would think.

Dr. Pippitt: Absolutely.

Scot: And then I think one other thing I do want to try to tease out here before we go is, obviously, Troy is an ER physician, so he tried the medication beforehand because he didn't want it impacting his work. People that drive trucks, heavy machinery operators, people that are in those sorts of things, they might hesitate to get this medication because they don't want to be on medication when they're working. Is it safe for those types of environments generally? Can you generally find an option for somebody?

Dr. Pippitt: Yeah, generally. I would say most of these medications don't cause drowsiness. It's not uncommon for people to say that they feel drowsy, but it's hard to know, "Is that actually a medication side effect, or is it what the postdrome is?" I think most of us would actually say you feel a little bit wrung out after a migraine, and that could be why too.

Scot: Dr. Pippitt, as always, just so wonderful having you on the show. And I went to the U of U Health headache webpage, and there's a link to something called a questionnaire, a new patient's questionnaire. Does that include the diary, all that sort of stuff? Would that be a good resource for somebody to start?

Dr. Pippitt: This would be a great resource. I wouldn't say that it includes a diary, but does a really detailed history of what symptoms you experience, what medications you've tried. In addition to family history, there's a question about what medications have worked best for your family.

It's about 17 pages. It's pretty long. One thing I do like about it is it gives me the most detailed version of your history, and it really forces you to go back and look at . . . Especially people who've seen other providers and had lots of medications tried, it helps you know, "Okay, I think I've tried a lot of stuff, but look at all these other things on this list. There's still a lot of stuff on there."

Scot: And this could be a barrier in and of itself. I could see somebody going, "Oh, I'd rather deal with my migraines than do 17 pages." I mean, can you get away with coming to your doctor with a little bit less?

Dr. Pippitt: To your primary care doctor, absolutely. I will tell you it's a prerequisite for a headache clinic to get people in to do it, but for primary care, yeah. I mean, it'd be a reasonable thing to take a look at. And then bring a diary. You don't have to do anything fancy. There are apps. I just have it on the notes tab on my phone. That's what I do, is just put a little . . . I just mark the date when I have a headache.

Scot: All right. All in favor that Dr. Pippitt rocks, say aye.

Troy: Aye.

Mitch: Aye.

Dr. Pippitt: Aye. Do I get to agree too?

Troy: Yes, you do.

Scot: Aye. Dr. Pippitt, thank you for being on the podcast, and thank you for caring about men's health.

Dr. Pippitt: Absolutely. Thank you, guys. This is always such a pleasure.

Scot: Hey, it's Scot from "Who Cares About Men's Health." Thank you so much for making it all the way to the end. By the way, if there's somebody in your life that you think would find this episode, or any of our episodes, or this podcast useful, do us a big favor and let them know about it, whether it's online, sharing it on your social media platforms, or even if it's a face-to-face conversation or an email. That would be great. That would help us tremendously make sure that more men hear our podcast.

If you'd like to reach out, if you've got a migraine story you'd like to tell us, or a question, you can do so a lot of different ways. You can email us, hello@thescoperadio.com. You can send a Facebook message, facebook.com/whocaresmenshealth. You can even leave a voicemail at our listener line, which is 601-55SCOPE. That's 601-55SCOPE.

Thank you very much for listening, and thanks for caring about men's health.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Troy: We're here.

Scot: Welcome to the "Who Cares About Men's Health Sideshow." We're all here.

Mitch: Yeah.

Troy: We're here.

Scot: Are you here, Mitch? You're here. Good.

Troy: Mitch is here.

Scot: All right.

Troy: Scot is here.

Scot: All right. My name's Scot. His name's Troy, he's an emergency room doctor. He brings the MD, I bring the BS, and then Mitch brings the microphones. He's our producer.

Mitch: Hello.

Scot: Just in case you're tuning in for the first time "Who Cares About Men's Health?" we have three different types of shows that we do, so you can pick the one that's most interesting to you. We talk about the "Core Four," which is nutrition, exercise, sleep, and mental health and we have episodes that focus just on the Core Four. So if that's of interest to you, you might want to check those out. We have our "Men's Health Essentials" episodes. Those are the issues that affect men like men's health conditions.

And then we have the "Sideshow." It's a little loose but we do talk about health things, it's just more of a personal slant. So if you're into that, you're in the right place. So a few episodes back, we had a headache expert on. Her name was Karly Pippitt, and we talked about men and migraines. And that's a great episode to listen to. The interesting discovery that we made during Karly Pippitt's show is we knew Troy had them, but Mitch learned that he had them too. And this episode of the "Sideshow" is to see if either one of you two went in to get treatment to do something about them because Troy self-diagnosed, he's never seen anybody about them. Mitch didn't realize he had them until after the episode. So give us an update. Let's start with Troy.

Troy: It's funny because we talked about it on the show and I said, "Yes, I'm going to go talk to my doctor." And then I kind of wavered a little bit, but then I worked the next two days shifts in the emergency department, with just this horrible migraine. And at the end of that, I just thought, "I've got to do something about this. This is ridiculous." So I saw my primary care physician and I made sure beforehand when I filled out the stuff, like a week ahead online, I said, "Migraines, I got to talk about migraines," so that I did not back out. So it was on there. And I was committed. Then I talked to him and I said, you know, "I record the podcast," and he's an avid listener. Just kidding. He's not. He's not an avid listener.

But I said, "We had Karly Pippitt on there. We talked about migraines." He knows Dr. Pippitt. And I said, "I kind of self-diagnosed this. This is what I have." He says, "Yeah, I think you're right on. It sounds like you have migraines and here's what I'd recommend." So he prescribed some medication for me. I have not, fortunately, yet had the opportunity to use it, but I have a night shift coming up in about three days. And I expect . . . Usually the pattern is two days after that I've got a migraine so I've got the medication and I sure hope it works. So that's where I am.

Scot: And when we talked to Dr. Pippitt, there's a few different types of medications. One is, like, a recovery, isn't it? To help you recover?

Troy: A rescue.

Scot: A rescue.

Troy: Rescue. So it's when you're having the migraine, you take it, or as soon as you know, you're going to have it.

Scot: And then there's other medications that you would take more consistently that would help prevent them. What kind did you get?

Troy: I got the rescue medication. And that's exactly the discussion I had with him too. He said, "Well, it sounds like you're having these about once a month, which has been the pattern. So that's not frequently enough where you would need to be on a preventive medication." And that's what Dr. Pippitt talked about as well. Like if it's frequent enough, you know, more than, like, every two weeks I think was the cutoff, she said, or at least every two weeks, they'll do a preventative.

He said, "I don't think you need to do that." He said, "Let's try this, see how it goes, and then we'll circle back and see if we need to do something differently." So I hope it works. I've got the medication, ready to use it. Hopefully, I don't get a migraine coming up in the next week. But if previous experience holds true, I probably will. And again, hoping this does the trick.

Scot: All right. And Mitch, you went. What'd you discover?

Mitch: Well, first I realized that I still have some toxic masculinity I need to work through because I, like, bust in there. And it's just the . . . it's just my annual checkup that I started doing and I'm like, "Oh, and by the way, there's this thing. I'm on this podcast, whatever, like, it's probably nothing." No, she gave me a side-eye and she's like, "That sounds like migraines," you know? It was just . . . that was just it, is it was like, "Oh, well, I get these headaches every so . . ." Same thing that happened on the episode, you know?

And she's like, well, "Do sound and light really bother you?" I'm like, "Yeah. But, like, you know, that happens with headaches." She's like, "No, like, and how long do these last?" I'm like, "Oh, just a couple hours. I just, you know, curl up in a ball in a corner of a room and, you know, I just do that." And she's like, "That sounds pretty terrible. We should probably fix that," you know? And so sure enough, she diagnosed me with migraines, and I got the rescue agent as well. She got me on Imitrex or sumatriptan, I guess, is the generic.

Scot: Same sort of thing.

Mitch: Sumatriptan.

Troy: Same med for me, Mitch. So it's, you know . . . I was hoping you got something different so we could just, kind of, swap meds and see which works. I'm just kidding. I would never recommend swapping meds.

Scot: Do not do that.

Troy: Just for . . . Make sure I'm clear. I would not recommend swapping meds. We joked about it.

Mitch: The interesting thing that I think I'm different than Troy is Troy, you've been having these long enough and recognizing them and diagnosing them that you kind of know your triggers. I have no idea what causes mine. And so she's like, just add it to my diary of pain that I work on. So now, I'm tracking both my ankle pain and any time I have headaches. So I have not had a migraine since, so I can't tell how effective it was or whatever, but I'm oddly, like, looking forward to the next one.

Troy: You're really excited about it.

Mitch: I'm like, "Oh my God. I have some emergency meds in a cabinet I can use to make this better," so . . .

Troy: I'm kind of feeling the same way, Mitch. I don't want another migraine, but I know it'll hit so I'm kind of like, "Bring it on. I'm ready."

Mitch: Let me try this.

Troy: I'm kind of excited, too. I'm like, "Bring it on," because I want to try it and see if it works. Just because it has been such a frustrating thing that I've just dealt with. And, you know, I've tried different treatments and we'll talk a little bit more about one of those treatments I've tried that there is some evidence to support, but hopefully, this works and hopefully, it does the trick.

Scot: I hope so too. I mean, talking about this, I'm getting all nervous for you guys that, you know, they'll hit and then it won't . . . and there'll be disappointment. I hate disappointment.

Troy: I know.

Scot: Like, you'll take your medication . . .

Troy: That's kind of how I'm feeling too. Like, I don't want to take it and . . . yeah.

Scot: . . . and it doesn't work. I'm going to feel terrible. I mean, but I guess, you know, if it doesn't work, when we talked to Dr. Pippitt, sometimes it takes time to figure out what's going to work for you, right? There's a lot of different medications out there so, you know, maybe it not working would be good because we could play that out, and not that I wish a migraine upon you, but we could play that out in real-time and see what that process looks like so . . .

Troy: Right. And, and that's kind of how I look at it. I've got something to try. I'll try it for six months. That probably means, you know, six migraines over the course of those six months. See if it works, see what the best approach is. If it doesn't work, then I can circle back with my primary care physician and look into some other options. So it's good to know there are a lot of other options out there, like she said. You know, it's great. It's a great time to have a migraine. There are multiple treatment options.

Scot: And you know, they are associated a lot of times more with women than men, but men absolutely do get them. A lot of times we deny that we get them or we blow them off or we don't acknowledge them.

Troy: Or we self-diagnose and self-treat.

Scot: So if you, you know, do suffer, check out that episode 78, migraines. We called it "Man Up and Get Help." I don't know, maybe that's a little too much.

Troy: Those were her words. Not ours.

Scot: It's true. That would be a good next step if you want to learn more about, you know, getting relief from your migraines or if you think you might have migraines. There's just no point in suffering. There really isn't. All right. So yeah, this week, then on the Sideshow Troy's article is going to focus on migraines, all right? What did I call this segment again? "Checking Out Troy's Articles?" "Troy presents his articles?"

Troy: Can we do a better . . .

Mitch: It's "Troy Is Presenting His Articles."

Scot: All right. It's time for "Check It Out, Troy's Articles." He's going to talk about perhaps something that you could use for your migraines that the research supports. So go ahead. Let's check out Troy's article.

Troy: Let's check it out. So we're not giving you choices today, Scot. You get one choice and the choice is "The effect of ginger for the treatment of migraine, a meta-analysis of randomized controlled studies." The question is, do you choose to hear more about my article or not?

Scot: Yeah, I will.

Troy: You don't get to pick. Usually, we'll give you a series of articles you can choose from, but . . .

Scot: No, we do.

Troy: . . . we're keeping it focused today.

Scot: I find it fascinating, the concept that ginger could help migraines. I mean, probably . . .

Troy: You know . . .

Scot: Yeah.

Troy: I do too. And this is something . . . We're talking about this because we talked about a little bit with Dr. Pippitt and it's something I have used for several months now after reading this article. This article appeared in November of 2020 in the "American Journal of Emergency Medicine." And they did a meta-analysis, which means they found several studies that were done, they combine these studies and then look to see, does ginger help people who have migraines? They found that ginger, when they gave people ginger supplements, so ginger is just an over-the-counter medication. You can buy it anywhere. It's just a supplement. You know, granted the formulation's probably going to differ from one to the other. Usually buy it as ginger root, comes in these capsules.

So they just treated people with ginger who came into the emergency department for treatment with migraines, and they found that people at two hours had a significant improvement than those who said they had zero pain. And those who didn't have zero pain, but still had pain, still had much less pain than those who didn't get ginger who got the placebo. So the placebo just being, you know, being, like, a sugar pill. And they found that there was no significant worsening in, like, adverse events, and those who had ginger, it's not like they were having a lot of side effects, which you wouldn't expect. This is just . . . it's ginger. It's, you know, like, ginger ale, ginger, you know, people take ginger for nausea when they fly. It's not, like, a big deal taking this stuff.

They also found that people who took ginger had much less nausea and vomiting. So their takeaway from this was that in the emergency department setting, it's probably something you could use to help treat people with migraines. The way I use this was I, you know, after I read this article, I thought, "Well, that's a great idea." Like, ginger is something that you often use for just saying, "Hey, you can try this when you fly." That's why ginger ale is such a popular drink on flights. The ginger kind of settles your stomach, helps with nausea, maybe a little bit of vomiting. So I thought, well, "Try it with the migraines," and what I've done, I've just gotten these ginger capsules, just, you know, standard sort of supplement and taken that, like, every four to six hours when I've had migraines.

And it has absolutely made things better for me. One takeaway, though, I think from our discussion with Dr. Pippitt last time is if it is something where it's debilitating, where it's very distracting, it may be worth just saying, "Don't do the ginger. Just talk to your doctor, try getting on a prescription medication." That's the conclusion I came to after trying, even with ginger and Tylenol and all this over-the-counter stuff, you know, which I've been trying to self-treat for years. The conclusion I came to is, "Hey, I probably just need something else."

Scot: So, for some people, it might work?

Troy: Yeah. For some people, it might work. And, you know, if your migraines are something where you do fine with Tylenol, you feel fine and maybe a little bit of nausea, try some ginger with it too. It probably will help.

Mitch: So are these like tablets? Like, what's the dosage? Or were you just gnawing on a chunk of ginger?

Scot: That would be a cool new trend. I love it.

Troy: I love it.

Scot: I love it. Just . . . Guys . . .

Troy: Just getting ginger root?

Scot: Yeah. Gnawing some ginger root.

Troy: Ginger.

Scot: Like, instead of cigars, when you got to invite the guys over for poker, you're all gnawing on ginger root.

Troy: "Hey, guys."

Mitch: And spitting it out.

Troy: "Here's some ginger." No, these are ginger capsules. The formulation, it differs, it differed across these studies. If you go online or you go to a store and you just buy the ginger, it will tell you how much of that they recommend taking, how often. Again, that's part of the challenge is this is not an exact science. I think you can try it. You could try, like, one capsule and see if it makes a difference. And then if it says you could take two capsules every six hours, you could try that. And there's not a lot of downside to taking a lot of ginger. I wouldn't take more than it recommends, but ginger is a pretty safe thing to take. And so it's again one of those things you can, kind of, try it out and see what seems to work for you and adjust that dose based on your experience.

Scot: All right. That was the Sideshow, guys.

Troy: That was the Sideshow. I know.

Scot: It's done.

Troy: Hopefully, you like it. Hopefully, people like it. I don't know. It's pretty loose.

Scot: If you want to learn more about the "Core Four," you know, go ahead and go back through our . . . We're trying to get them labeled so you can, kind of, very quickly at a glance see if it's a "Sideshow" or if it's a "Men's Health Essential" or if it's a "Core Four." You might find that more interesting than Sideshow. It's a little bit more straightforward information and advice. Thanks for listening to "Who Cares About Men's Health?" Blah. You guys have a sign-off noise you'd like to make?

Mitch: Like a "Woo?"

Scot: Well, I just went "Blah." I guess that's my sign-off noise.

Troy: Womp womp. That's my sign-off noise.

Scot: That's great.

Troy: Sorry. What other noises should I make? I mean I don't know. We got to have a better one than that.

Mitch: Fun noises with the boys.

Troy: Exactly. We're just like an acapella group.

Scot: We haven't heard your noise, Mitch.

Mitch: Like a "Cuckakachoo."

Troy: What was that?

Mitch: I don't know.

Troy: Is that a bird? Sounds like a bird.

Mitch: I think so. It was like a . . . Yeah, it was definitely a bird.

Scot: I'm going to stop recording now. This is a waste of bits.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: What would you say to any man listening that's suffering from migraines? What would be your one or two sentences?

Dr. Pippitt: Man up and go see your doctor.

Scot: It's a different kind of man-up.

Troy: I like it. I like it.

Scot: Instead of don't be a wuss, just deal with it. It's man up and see your doctor. Get something done about it.

Dr. Pippitt: Yeah, absolutely. You don't have to live this way. There are things to be done about it. And like, this is real. I mean, you know, sometimes I'll tease patients like, yeah, this is all in your head, but there is something we can do about it.

Scot: Dr. Pippitt, thank you very much for joining us today to talk about men and migraine headaches. I want to get into migraines in general, and then also talk about if there are any special considerations for men. Have you met Dr. Troy Madsen, one of our emergency room physicians and cohost of this fine show?

Dr. Pippitt: We have met I think in meetings, but probably never face-to-face.

Scot: Troy, I know you said . . . I didn't know this about Troy, Troy said he suffers from migraines, and I never knew that.

Troy: Yeah. As is often the case on our podcast, I am aiding an example of what not to do. I'm often a bad example. I am a self-diagnosed sufferer of migraines, and it's been, I mean, I had headaches as a child and it's been at least 20 years and it took me forever even being a physician to say these are migraines. And I finally concluded, well, they're probably migraines, so we can talk more about that.

Dr. Pippitt: Well, I think you're going to get at what is exactly the issue is that migraines are traditionally thought of as very much a female disease or a disease that afflicts women, but men really do get migraine as well.

But I think there's . . . you sort of brought up the two things that happen. One, men don't often go to the doctor as much as women do necessarily and so you may not seek treatment. And then, because I think the classic teaching is so often that men don't really get migraines as much as women, you don't get the diagnosis of migraine when in fact you actually meet all the criteria to have a migraine.

Scot: Is that a problem? Is it a problem that Troy's self-diagnosed, or is it a problem that men don't get that diagnosis?

Dr. Pippitt: I would say the biggest issue is that because men don't get a diagnosis and often don't get an accurate diagnosis, then they don't get the correct treatment. So that's really the biggest issue is we're delaying treatment and the best care possible because we're not getting the right diagnosis.

Scot: And then, as a result, men just get these terrible headaches and it just impacts their life and their work and their home relationships. Is that usually what ends up migraines end up impacting, or what is bad about migraines? Luckily, I've never had them.

Dr. Pippitt: I think what's the worst, I mean, as someone else who suffers migraine is, you know, the number of, you know, the time away from work, the time away from activities that you enjoy. Those are really important parameters.

Some people think, "Oh, it's not a migraine if my level of pain isn't severe enough. If I'm not like my aunt or my mom who was, you know, down in bed in a dark room with the lights off. And I can function with my migraine, it just hurts and I can't concentrate super well and I kind of feel like I want to barf." Well, you still have a migraine. It's not a matter of intensity of pain. And I think that's an important thing for people to understand.

Troy: Well, here's where fortune has smiled upon us. As good luck would have it, I have a migraine right now.

Scot: What?

Dr. Pippitt: Perfect.

Troy: I am not joking. It started this morning. I was like, wow, isn't that fortuitous. It started yesterday. I just felt kind of tired yesterday. And I don't know that I really saw it coming on because I had a lot of meetings. I was like, "Oh, I'm just tired because I've had a lot of meetings," and, you know, doing lectures, etc., etc. And then today I started to feel it.

And I typically will feel it. It comes on about once a month. It's kind of like my left side of my face and kind of like the back of my nostril on my left side and then I'll feel it up into my forehead. I feel it really around my left eye, I have trouble focusing and, you know, then I just feel very tired while I'm experiencing this with some nausea. It usually lasts about 48 hours. So I'm looking, I've got a shift tomorrow. I've got a shift on Friday. So maybe by the end of my ER shift on Friday, I'll feel better.

So I guess my question for you, Karly, is number one, am I mistaken in thinking these are migraines and then number two, you know, if yes or no, how do you typically diagnose these, and how does someone know if they're having migraines?

Dr. Pippitt: I would say I think you're spot on, Troy. I think you do have migraines. There's a really great three-item questionnaire that's been validated that if two out of three are positive, your chances are pretty good that you've got a migraine.

So one is, do you have nausea or do you feel sick to your stomach when you have a headache? The other is question two is, do you have sensitivity to light or sound? And then question three is, does the level of pain sort of impact what you need to do? Did it impact did you have to skip work? Did you skip activities for fun? Did it alter your activities because the pain was so bad?

I loved what you said about yesterday maybe it was coming on and you felt a little tired. And headaches definitely and migraines definitely have a prodrome, and if you can recognize some of those symptoms, you can actually sometimes catch your migraine before you even get to the pain level.

I often tell people with, you know, the aura that happens before a migraine, which for most people is visual that they get, you know, something that looks like a heat wave or some shimmers or squiggles in their vision. I tell them they're kind of lucky because they know. Whereas some of us who don't have aura, I think to myself, some days, is this just a headache or is this a migraine?

And I'll tell my patients, that's the answer to your question right there. If you're questioning is this just a regular headache or is this a migraine? Should I go take my migraine-specific medicine? That's the answer to your question. You should just go do it because you're probably right. If you're already thinking that, it probably is going to be a worse headache.

Troy: And I wonder too how often you see this, how many men are out there where maybe they're not sure that it's a migraine. They've just dealt with headaches for years. They just said I've had headaches. I went through a process. I remember during med school thinking, "Wow, I need to go to the dentist because this pain came on and it just hurt in my teeth, but I could feel it like up into my sinuses."

And then later I thought, "Well, I'm getting these recurrent sinus infections." It hurts on the left side of my nose and around my sinuses and my face, and maybe I just get these sinus infections and they go away after a couple of days.

How often do you see people that have just struggled either trying to self-diagnose or maybe even going to, you know, specialists who aren't headache specialists and have not had the appropriate diagnosis of migraines?

Dr. Pippitt: Yeah. I think this goes back to that training we got in medical school really like presenting migraines as a disease of women that, you know, when someone comes into the ER, when someone goes into your clinic, this might not be the first thing that you think about. Like, sure, it might be on your differential, but you're not going to move it up the list in one way or another as much as maybe you should.

This is where getting some of the other key features of a migraine history so in particular things like family history. I was talking to a patient of mine the other day. She's got migraines, her mom has migraines, her kiddo, you know, we were talking and she's like, "I don't know. He's kind of been complaining, he had bumped his head. Should I worry?" And we started talking about migraines.

I said, you know, he's only like 9 or 10, but knowing your family history, that may be something that's going to come his way so we should start thinking about it and should start talking about it so that the treatment is there sooner.

I think some of the people we see in the headache clinic have not had anyone ask them those questions about migraine or not had anyone ask questions about a family history for both sexes of patients, men and women. So these are questions we should be asking that is additional helpful information to help you decide is this migraine or is this just a headache?

Scot: If there's somebody listening like Troy that gets them about once a month, but it doesn't seem to like, he seems to just work through it. I mean, should that person seek help or should they just work through it? Would you consider Troy a candidate for some sort of medication or something?

Dr. Pippitt: Help.

Scot: Help. Yeah, that's a good word, "help." I'm a man. I'm going to have a hard time saying that word "help."

Troy: Troy would need to reach out first, which I have not done.

Scot: Do you find that guys just won't admit it? They don't want to admit it. We're tougher than that. We don't get it.

Troy: Maybe that's part of it. And I'm curious that maybe for me, that's been part of it. I've just tried to self-treat with, I'll take, you know, Tylenol every four to six hours and caffeine and that's kind of how I get through it, but yeah, I'm curious if that's what you see, Karly.

Dr. Pippitt: I think what's really hard is that you know, headaches, there's usually nothing that if we were actually meeting each other face to face, Troy, and I looked at you, I couldn't look at you and say like, "Oh, I think you have a headache or it looks like you have a migraine," as opposed to, "Hey, I can see that you have this huge laceration on your arm that needs, you know, stitched up."

So there's I think that's one big problem is that, you know, my level of pain, your level of pain, pain is just such a subjective thing that it's hard for people to say, "Oh, this is bad enough to need something or maybe I'm just not tough enough." So since no one else can see, there is no like definitive blood test or something that it really does come down to the history and asking the questions.

So I think that's one reason that some people don't necessarily get a diagnosis because the questions aren't being asked. They're not thinking sort of more broadly or thinking they're even, this is something that could happen to them.

I would say, Troy though, you definitely could get treatment. You're totally a candidate for it. And when we talk about treatment, we talk about two sort of different arms. One is rescue, which for you, someone who's maybe just getting one migraine a month, I think that would be a very reasonable thing to think about.

So something you'd take, you know, ideally yesterday when you're like, "Oh, I don't know. I feel kind of tired. This might be a migraine," then you would take it then, and hopefully, that could actually minimize your symptoms to more like 24 or even 24 hours or even less time than that.

Now there's nothing wrong with over-the-counter. I just want to be clear about that first of all. So what you're doing isn't incorrect, but I think the question is could something be better?

Troy: And what about for the person who's say experiencing headaches on a weekly basis, or, you know, it's keeping them out of work, say several days a month, what do you recommend for them?

Dr. Pippitt: Yeah, absolutely. That's when we start talking about preventive treatment or something that you take every day to try to prevent migraines. And even then, I mean, you're hitting kind of right at that mark where I'll start to talk to people about it where if it's more than once a week or sometimes, you know, you said your migraines will usually last about 48 hours.

Well, if you were having two of those and you know, those were each two days, that's about four days a month where we'll start to talk about, "Hey, what do you think? Do you think you want to take something every day that might help you prevent it?" It would be a different conversation if you had a medicine that you took for rescue and then you never got a migraine. Then you're probably like, well, I don't really want to take something every day because I already have something when I think it's coming that I take it and I don't ever have symptoms after that.

Scot: What about men and the triggers? So, you know, when migraines I hear triggers mentioned, does it apply to men as well as it does to women, and are there things that somebody could do in their life that could reduce the severity or the longevity of their migraines?

Dr. Pippitt: Absolutely. I mean, I think that's a good question for Troy. You said like, hey, you thought maybe you were just in a bunch of meetings yesterday. Have you ever thought about what some of your triggers might be?

Scot: It's meetings.

Troy: Meetings. Can I get a doctor's note? I want a doctor's note for meeting and night shifts. Night shifts and meetings. I know what my triggers are. It's lack of sleep. It's often, you know, stress, those sorts of things. Yeah, so you're right.

I mean, it does seem to follow a pattern that once a month thing, but then I know if I have a night shift coming up about when it's due, I know that within about, you know, 36 hours of that night shift, I'm going to have a migraine. So I imagine others are in that same boat where it's a similar sort of thing.

Dr. Pippitt: Yes. Sleep is a really big trigger, either not enough or too much or even just what you're describing sort of changing your sleep schedule. That's a huge trigger for most people to get that and to get a migraine.

And then other things, you know, are you staying hydrated? I mean, I know like a call shift was sort of a classic day after for me to get a migraine. Like you've disrupted my sleep, I probably didn't eat very regularly and I didn't stay very well hydrated. That's, you know, sort of like the trifecta there of badness going to happen the next day.

Troy: Well, what's the outlook, you know, for let's say someone like me where you say, "Well, I've got this." Do I just expect this is something I will just continue to have the rest of my life? Can I expect it's going to get worse? It's going to get more frequent or is it going to go away someday?

Dr. Pippitt: The natural course of migraines is they're usually with you for your lifetime, and they will wax and wane in intensity sometimes for reasons that make sense. So if you're in a particularly stressful period of your life like in residency training or something where you don't have as much control of your schedule, well, yeah, I think you would obviously think they would get worse.

For some people, as they, you know, as their career changes, some people they move so there might've been something in the environment that was really making them worse for them. For a lot of women once they go through menopause, sometimes that will make it a little bit better.

So we think about like puberty and menopause in women as sort of being a trigger and then sometimes a bit of a release valve. Men don't necessarily go through menopause unless we want to go down a whole other rabbit hole of manopause but maybe we shouldn't talk about that.

Troy: I was just going to say it. Yeah, we won't go there.

Scot: There's no such thing, right? Please tell them there's no such thing.

Dr. Pippitt: Podcast for another day, but you know, there isn't maybe as much of an off-ramp in that sense that we think about for, you know, people who are men but I think some of it is just your life sort of changes. As we get towards that age, maybe you're not quite as busy, you're not doing as many night shifts, you've hopefully gotten a little bit wiser and, you know, don't do the things that give you a migraine in the first place if you can help it.

Scot: I have a question about triggers. So alcohol use in men, you know, it can be problematic at time because we have episodes that you can go back and listen to if that's something you're struggling with, but alcohol is a trigger, isn't it? Or is it just wine? So then, of course, you know, the stereotypical men drink beer, women drink wine, alcohol wouldn't be a trigger, or is it?

Dr. Pippitt: Yeah, I would say alcohol definitely is the trigger. Red wine is sort of the classic trigger for a lot of people. And it's either the sulfates or the sulfites I have to double-check, but it's one of those that really tends to be the trigger in red wine. And you can find some red wine that doesn't have that in it, but beer can do it too for people. Other like common foods are things like MSG or chocolate for some people, preserved meats. So things like, you know, salamis, hot dogs.

Scot: Don't say beef jerky, don't say beef jerky.

Dr. Pippitt: Preserved meat. I'll just say preserved meat.

Troy: There's nothing unpreserved about that.

Dr. Pippitt: But if you don't have migraines, then that's not necessarily it. And I'll tell people, you know, sure. Look for your triggers. That can be a helpful thing. Like a headache diary can be a helpful thing for like, you know, just what Troy said. He's clearly figured that out. "Oh, the day after I do a night shift, I'm pretty much guaranteed to get a migraine."

So he already knows kind of where that trigger is, but I also tell people don't torture yourself because you can look at every single thing in your lifetime and you know, in a day or in your headache diary and not come up with a single answer for what is it that gave it to you and that's okay. There may not be one perfect, one little thing.

An analogy I heard at a headache conference was think of it like, you know, you had the one match of you had a night shift and then you had another match that you got dehydrated and then you had another match that maybe there was a whole bunch of smoke in the air and all of those make the inferno that is migraine. So it's not usually if X then Y or sort of one thing and then another

Scot: What about hard liquor? Is that a contributor as well? Is that a possible trigger? Does hard liquor have sulfates in it or is that just really wine?

Dr. Pippitt: I think it's mostly just wine. And I think, again, some of this is just you. If you were going to drink liquor, then maybe you weren't as likely to be drinking water that day, or maybe you're outside with a bunch of friends where it's, you know, you're camping and it's warm and so you get a little dehydrated. So it's kind of that whole picture that goes together.

Troy: Knowing now that maybe I should try a medication like I said, I just try and self-treat. I've found that I just take Tylenol like every four to six hours, I take caffeine. I've tried ginger as well. I've read some stuff about ginger. So I'm kind of trying to max out the over-the-counter stuff without a prescription.

How effective would a prescription be if someone has a migraine, you know, whether they're in my shoes or more frequently whatever the case may be?

Dr. Pippitt: I mean, I would hope that the prescription treatment because it's more targeted is going to be more effective. The key with any rescue medication in migraine is that you take it early. So back to that earlier statement of like, well, do I think this is a migraine or do I think this is just a headache? And just taking it, you can often like ward off something from there.

And with any medicine, you know, like you said, Troy, you've tried a bunch of different over-the-counter medicines. Yeah. You may find one that works better. Like Tylenol may work better for you. Excedrin may work better for Scot if he suddenly got diagnosed with migraines or any of those things. So you have to decide what's going to work best for you and it probably is going to be a matter of trial and error before we find the right one.

Even in prescription medicines, there's a whole bunch that are in the same class that we use for rescue. Typically, the triptans is the first place we start, but sometimes, you know, I personally went through a couple of triptans before I found the one that seems to work the best for my migraine rescue treatment.

Scot: Other than the treatments Troy mentioned, are there other over-the-counter things or more natural things that a person could do?

Dr. Pippitt: I liked that you brought up ginger, Troy. Like I said, in the criteria for, you know, if you have a migraine, one of them is nausea. We know that people who have migraine have gut stasis, meaning that your things just aren't moving through your GI tract like they're supposed to, which is why most people feel nausea with migraine. So treating the nausea can be a really important component.

And for some people, if you can treat the nausea alone and ginger has some pretty good data about helping with nausea, that can sometimes be enough to get you over the hump that maybe you don't need your caffeine or, you know, your Tylenol, your Excedrin, your whatever else you need to do.

Scot: So Troy, are you going to go get a prescription? You're going to get a diagnosis and a prescription or you're going to just . . .

Troy: You're going to get me to commit, aren't you?

Scot: Well, no, I'm just wondering, like, you know, are you?

Troy: I struggle with it. Like I feel, and maybe that's maybe that's my problem because I feel like, "Hey, I'm able to function." I get by. Like I said, I've been dealing with this now for about eight hours today and I think I've found a combination that seems to work for me, that I'm able to get through shifts and I'm able to kind of get by.

But again, you know, maybe I do need to look into that and having something more definitive and that's more effective. So it's not like when this hits, I'm like, wait, okay, here we go. Forty-eight hours, power through it. So I'm not dealing with that. So it's a good discussion for me to have for sure.

Dr. Pippitt: I think that's what makes it hard when you feel like you can work through it. You're doing okay. You're maybe not doing the best that you could be, but when it's been this way for so long, sometimes it's hard to realize how bad it actually is.

Troy: That's true.

Dr. Pippitt: Because it's still two days that you're taking medicines for two days, you know, and that just sort of gets you to like limp along to get there. But, you know, don't be afraid to bring it up because I think what we found is that if men aren't really getting the diagnosis, so if you go in and you feel sort of silly because they're like, "Well, dude you have a headache. Why are you coming in to see me?" And then I think you can very much ask the question. Well, could this be a migraine?

Troy: And where's the best place to go? I've got my primary care physician. I actually have an appointment with him coming up in I think a few weeks. Is that the best person to talk to about this? Or should I, you know, come and see you or see a headache specialist or what do you typically recommend to people?

Dr. Pippitt: I would say absolutely start with your primary care. This is a bread-and-butter diagnosis of migraine. So it's making that diagnosis initially. So if they can make that diagnosis, then you can get better treatment.

Some of this too is like you said, people just don't really bring it up. Like if this podcast hadn't have happened, you might not have brought it up next week at your appointment even though you had a migraine just the week before, because you know, it's not happening every day. It's just once a month, you can get through it. It doesn't seem that important.

So make sure you bring it up with your primary care and then they can help you decide, you know, do we need to have another appointment to discuss this further because maybe you went in for your physical and other things where they're like, hey, this is really important. Let's make another appointment to talk about your headaches. Because I think headaches too often get put on the back burner and we don't give it the due, the time that it really needs to give it the proper treatment.

Troy: Okay. I think, you know, Scot and Karly, I think, you got me committed. I'm going to do it.

Scot: All right.

Troy: I will bring it up when I talk to my primary care physician. Karly, it is just a routine sort of thing and it does make sense to say, "Hey yeah, sure. I can power through this." But if you don't need to just power through it, if there are other options, it's worth exploring. And it makes sense to me to, you know, and hopefully, others out there as well who are just in the same boat I'm in to at least bring it up with your primary care physician and look into some other options.

Scot: Hey, Mitch. Did you have anything that you wanted to ask?

Mitch: No. I just, I guess for me, I'm kind of on Karly's side. I don't have migraines, but like the fact that people are like, "Oh, I'll just work through 48 hours of nausea or whatever," that is so bizarre to me. Why are you not going to a doctor? That sounds miserable. Or am I just a baby? Like, I don't know. Maybe I'm just like . . .

Scot: The nausea part to me sounds more miserable than the headache almost, but, you know, there again, I'm a guy who's never had them.

Troy: It is miserable. There's no doubt. It is. I think, you know, for me and probably others, you just have to learn to get by and you kind of just deal with it. And you accept that it's part of your life and you find that it happens in a certain pattern and but yeah, it is miserable.

Dr. Pippitt: So seriously, Troy. I'd love to hear the follow-up on this, that you talk about it, that you get a diagnosis, and that you get treatment. This is the primary care provider in me. I have to know what happens. I like to know the, it's not really the end of the story that makes it sound like something terrible happened but I want to know that you get the right diagnosis and treatment.

Scot: So is the hope that I mean, are you fairly confident, Dr. Pippitt, that he's going to feel better having the recovery medication?

Dr. Pippitt: Yeah. Absolutely. I think it might be a little bit of trial and error to find the right one. I think I probably tried like three with my own provider before I finally found the one that worked best for me, but I'm definitely confident we can . . . Especially this 48 hours nonsense, if we can knock that down, I think that would be huge.

Troy: That would be. Yeah, no, if I can knock that down even if it's, you know, down to 24 hours or something, that's a lot better than looking ahead at the next 48 hours and thinking, "Wow, I've just got to deal with this." So that would be a significant improvement.

Scot: And I can't imagine a world with 100% functioning Troy. I mean, I have a hard enough time keeping up with him when he's got migraines apparently.

Troy: Thanks, Scot.

Dr. Pippitt: Have I just changed the whole podcast now? Oh my goodness. We're not even going to know.

Troy: There's just going to be so much energy, you're not going to know what to do. This is me with a migraine. Without it, it's just going to be like overwhelming. Get ready.

Dr. Pippitt: I see the numbers climbing already.

Troy: Exactly.

Scot: All right. Well, Dr. Pippitt, thank you very much for talking to migraines with us today. We'll follow up with, Troy, here and see how his treatment ends up going. And if you're listening and you suffer from migraines, know that there is help. Dr. Pippitt, thanks for being on the show and thanks for caring about men's health.

All right. So we had to pop the mics back on because after we turned the microphones off talking to the headache expert, Mitch who was quiet the whole time and not only was he quiet the whole time, I actually asked him if he had anything to add and he said then starts talking about, "Oh, I can't believe, Troy, that you're able to function and do this podcast with your headaches because when I get a headache, I tell my partner like shut all the curtains. I'm going to go curl up in a ball." You didn't bring up the fact that you had headaches when we had the headache expert on.

Troy: Thanks, Mitch.

Mitch: I know. I know.

Scot: What's up with . . .

Troy: He just left me out there alone like I'm the weirdo here that gets migraines.

Mitch: I did.

Troy: And you've got headaches too.

Scot: Explain to me your thought process please behind why you didn't jump in.

Mitch: Yeah, no, it totally didn't dawn on me while we were talking because it was just, you know, "Oh, well I get headaches, but they're probably not as bad as Troy's are because he's talking about nausea, he's talking about whatever."

And even as we're talking about how men undervalue their own headaches or that they have to power through, I just, it's the same thing. If I miss sleep or something like that, I'm just . . . I do. I get really bad headaches and I have to like shut my eyes and like disappear for a couple hours. It's not 48 hours, but at the very least, it probably is something I probably should talk to my doctor about at least for Karly . . .

Scot: You think?

Mitch: Yeah, probably.

Troy: And then she made the point too. Again, we didn't have that on there. Like when you look at those criteria she listed, you meet at least a couple of those.

Mitch: I do.

Troy: Yeah. I mean, it's interesting because again, I'm not blaming you because I do the same thing. I see the really bad, bad cases in the ER, people who have severe migraines that come in and they have to get IV medications and they are just completely disabled.

And so that's where I'm coming from. I'm like, "Well, I'm not like that. I'm fine. Look, I have a migraine now and I'm taking care of them so what's my problem? I don't need to get treatment." So I think we all kind of do that where we do hear really bad stories, but maybe, you know, others are out there with headaches that are in your boat as well, that maybe there's some benefit to getting some treatment. I don't know.

Scot: Yeah. I love the fact that you sat there through the whole thing and it wasn't until after the fact that you finally have [inaudible 00:25:42]. It's exactly as Dr. Pippitt was talking about.

Mitch: What were her three things? Nausea, sensitivity to light, and the . . .

Troy: And it affects . . . It gets disabling. Like it affects the sensitivity light or sound, and then it somehow affects your ability to function. Because I mean, it sounds like there you're closing the curtains, you're turning the lights off. I don't know if you have sensitive. Well, it sounds like you do have sensitivity to light if you're closing the curtains.

Mitch: That would be it.

Troy: That would be it.

Scot: It sounds like it's impacting your ability to function.

Mitch: It sure does.

Scot: You have to remove yourself from the world.

Troy: Yeah, it sure does.

Scot: Wow.

Troy: Sure appreciate you letting me fly solo there, Mitch, through that whole thing.

Mitch: All right. You're good.

Troy: Thanks, man.

Scot: I think it's a good lesson though. I think it's a good lesson that even though you were engaged in this show, you know, in a way that a regular listener might not be completely engaged, it still took you a while at the end of the conversation to realize that, you know, maybe this is something I should talk to my primary care provider about. Are you going to do that?

Mitch: Yeah, I'll talk to him next time. I kind of have to now.

Scot: Begrudgingly, he says it. All right. Good episode.

Troy: Good. Well, we can all follow up in a few months. Sounds like, Scot, you still are in the clear, but maybe two of us. One of us for sure has migraines, maybe two of us. Who knows? But we can follow up in a couple months and see how things are going with us.

Scot: Hey, thanks for checking out the podcast. We'll follow up with Troy and Mitch and their journey with migraines. If you suffer from migraines or know somebody that does that would benefit from hearing this episode, please think about who that one person might be and share this episode with them.

Also, another great way to help out the podcast is to join our Facebook group, become an active community in the Who Cares about Men's Health group at facebook.com/whocaresmenshealth. And thanks for listening and thanks for caring about men's health.

Recording: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Chronic migraines are a mysterious and debilitating illness that affects an estimated 36 million people in the United States. That's a large number of patients who have a chronic illness for which there is no known treatment or cure.
Dr. K.C. Brennan is an assistant professor of neurology at the University of Utah School of Medicine. He's an expert in treating and researching migraines and he's here today to talk to us about migraines. Dr. Brennan, welcome.

Dr. K.C. Brennan: Thank you for having me.

Interviewer: Would you just quickly explain what a migraine is.

Dr. K.C. Brennan: Imagine a pounding headache, throbbing pain, then imagine that normal light hurts your eyes, sound hurts your ears, normal smells and tastes make you feel nauseous, you're completely incapacitated, that's what a migraine is.

Interviewer: What are the common migraine treatments right now and how well do they work?

Dr. K.C. Brennan: The best medications we have are called the triptan drugs, Imitrex, Maxalt, those are the names of these drugs and you see them advertised. There's been no single medication developed to prevent migraine.

Interviewer: How much do we know about these migraines right now, in terms of what causes them?

Dr. K.C. Brennan: We know that migraine is a pain disorder; it's a disorder where your pain system is activated when it shouldn't be activated. But we also know that migraine is an excitable disorder of the brain, it's the brain firing when it shouldn't be firing.
Migraine is also a disorder of plasticity, plasticity is the ability of the brain to change itself and it's what the brain does when it learns. When you see a chronic migraine patient you realize that their brain has learned to produce pain when it's not supposed to. I think that's a very important way of framing the question of migraine.

Interviewer: At the moment though we really don't know why the brain is doing this.

Dr. K.C. Brennan: We know that your genetics contribute a lot, there is your environment, you know, light and sound can trigger migraines, they sort of set the process off. Stress is a huge trigger of migraines, and release from stress, so not just a kid going into exams but that kid after they're done with exams suddenly stress releases and that's when they get their migraines.
Hormones are a very big part of it so two-thirds of people with migraine are women, only one-third are men, why is that? Well we think it's because of female sex hormones. So there's a lot of factors that can trigger or modulate, they can turn the volume knob up or down or start things off. We do not know the ultimate cause and that's probably because there are many ultimate causes.

Interviewer: Do migraines tend to run in families?

Dr. K.C. Brennan: They do tend to run in families.

Interviewer: What's the current state of research in migraines? How much are we learning and what are the big questions that people are looking at?

Dr. K.C. Brennan: I think there's been a real infusion of strength into the migraine field from two fronts, one is that we're now doing imaging in humans with migraine, so we're able to actually look at the brains of people with migraine. The other area where we've really had an infusion of strength is we're looking at migraine as a pain disorder, how pain works in the brain in general and then what makes migraine unique.

Interviewer: Can you just give us a little bit more in depth detail about what you've discovered and what you're hoping eventually to accomplish.

Dr. K.C. Brennan: What we've done recently is try and look at what this event, cortical spreading depression, which is the event that underlies the aura, what it does to the brain that might contribute to the migraine attack because the aura is something painless.

Interviewer: Yeah, and to be clear, when you talk about a spreading depression, the cortical spreading depression, define that if you would, that's a massive firing of?

Dr. K.C. Brennan: Right, it's got an unfortunate name, spreading depression is a massive wave of activity, it's like a tidal wave in the brain and it spreads out and it doesn't respect boundaries in the brain, it just moves out like a ripple in a pond.

Interviewer: And this itself, the aura itself is not, is it the migraine or is it what pre-stages the migraine?

Dr. K.C. Brennan: It's considered part of a migraine attack for people who have migraine with aura. Now there are people who have migraine without aura and there's fertile debate in our field about whether these are different kinds of migraine or whether they're all the same thing.

Interviewer: Where do you see research going and how much more do you think we will know about migraines 10 years from now?

Dr. K.C. Brennan: I'm optimistic we're going to know a huge amount more and I'm optimistic for a number of reasons. We've got tools to study migraine, in the lab and in the clinic that are just wondrous.

Interviewer: Is there some evolutionary reason that this volume knob might have been turned up?

Dr. K.C. Brennan: One line of thought goes, what goes on in migraine is essentially the sickness response. A person with migraine is very much like a person with a bad flu. When you have a bad flu or when you have meningitis or something like that, you know, all the senses hurt. And this is known as the sickness response that there's an inflammatory everything hurts reaction that goes on that incentivizes the person to get somewhere where they can get better, go to a dark room, lie down, heal up.
It seems like that sickness response gets switched on, that sickness volume knob gets turned up in migraine for reasons that don't make sense. The circuitry that creates migraine exists for a reason but it gets overused in migraine and then it entrains itself it becomes this daily miserable thing.

Recording: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.