Search for tag: "migraines"
91: Migraine Update with Dr. Karly PippittIn a previous episode, Troy and Mitch both… +1 More
November 02, 2021
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: 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.
Relevant Links:
Contact: hello@thescoperadio.com
Listener Line: 601-55-SCOPE
The Scope Radio: https://thescoperadio.com
Who Cares About Men’s Health?: https://whocaresmenshealth.com
Facebook: https://www.facebook.com/whocaresmenshealth |
|
Sideshow: Ginger for MigrainesMitch and Troy are back from speaking with their… +1 More
June 15, 2021
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.
Relevant Links:
Contact: hello@thescoperadio.com
Listener Line: 601-55-SCOPE
The Scope Radio: https://thescoperadio.com
Who Cares About Men’s Health?: https://whocaresmenshealth.com
Facebook: https://www.facebook.com/whocaresmenshealth |
|
Chronic Migraines: A Tidal Wave of Activity in the BrainAn estimated 36 million people in the U.S. suffer… +3 More
February 24, 2014
Brain and Spine
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. Chronic Migraines
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. What Causes a 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. Latest Migraine Research
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. What Triggers Migraines?
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. What is the Aura of a Migraine?
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. The Future of Migraine Research
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.
The latest research on migraines has been focused on what causes a migraine in order to better understand how pain works in the brain and what contributes to a migraine attack. |
|
How Women's Migraines Differ from Men'sMigraine headaches are more common in women than… +3 More
|