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91: Migraine Update with Dr. Karly PippittIn a previous episode, Troy and Mitch both described their debilitating headaches and learned that there are treatments available to get relief. Headache specialist Dr. Karly Pippitt is back to check…
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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 |
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June 18, 2021 Interviewer: Today, we're going to talk about how you can go into your primary care physician and talk to them about headaches, so you can finally get that relief. Dr. Karly Pippitt is a primary care physician, but she's also a headache specialist at University of Utah Health, so she understands both the perspective of a primary care physician and a headache expert. So, hopefully, we'll be able to bring those perspectives together to find out how to talk, how to prepare, and other things like that. So the first question is, what kind of barriers do people run into when they're trying to talk to their doctor about headaches? Dr. Pippitt: I think probably one of the biggest barriers, when talking to primary care, is time, right? I mean, if I go to my primary care doctor, I probably have four or five things that I want sort of checked off my list to get taken care of, and this is just one in a list of a number of things. And what I have learned is that what's really important is you need to make a visit that is dedicated to your headaches. This is a problem that deserves the appropriate amount of time. So you need to go into it with that perspective if your provider doesn't guide you to that already. Interviewer: I've been fortunate. I know people that have had severe headaches. And when we talk about headaches, are we talking just about headaches in general, or are we talking about migraines? I mean, what type of headache is it generally that people seek help for? Dr. Pippitt: So most people I would say probably seek care for migraines, but I think one thing I've been very impressed by is how much people don't talk about headaches. And in my role at the Headache Clinic, I'll sometimes ask people questions about their headaches and they'll say, "No one ever asked me that before." Interviewer: Yeah. Dr. Pippitt: And it doesn't seem like a particularly earth-shattering question that I've asked them. So I think that's a pretty important thing is that if your headaches, migraines or not, are impacting something in your life, right, like it's keeping you from work, it's keeping you from school, it's keeping you from anything like that, that means you should talk about it. Interviewer: Yeah. If you kind of take an inventory and you're like, "Yeah, that is kind of an issue." Because we all get just kind of one-off headaches, a lot of people do. And that's not what we're necessarily talking about here, or is it? Dr. Pippitt: I think it can be. I think if it's not a one-off as much anymore, but like, "Hey, wait a minute, I think that's kind of been every day. And yeah, maybe I can get done what I need to do, but maybe I can't quite focus as well, or maybe I'm a little more irritable at home with my partner, with my family, and I don't really like that." Those are things you should talk to someone about. Interviewer: All right. So make that appointment with your primary care provider and just make it just about headaches if that's what you want to tackle with your primary care provider. Then what would you recommend that a patient do to start moving towards maybe managing them a little bit better? Dr. Pippitt: Yeah. So when you go in for that appointment, be ready. So most people who have headaches have more than one type of headache. This is sometimes I think if you don't have headaches or don't have frequent headaches, you don't think about this very much, but go in ready to talk about that. Maybe I have this sort of low-level headache if I don't eat enough that day or if I go a little bit late on a meal or don't stay super well hydrated, but maybe I get a really bad headache if a storm comes in or if I haven't slept very well for a couple of nights in a row. So be ready with sort of all of those different types of headaches and especially coming in with a diary. So I've seen all sorts of different diaries. There are apps for your phone that you can use. You can write these down on a calendar or just on a notepad. But you want to keep track of the frequency. So how frequent are you having headaches? How bad are they? So did you have to go home from work, or were you able to keep doing what you wanted to do that day? How did you sleep the night before? How active had you been? And then what did you take, and did it help or not? These are all important things to just sort of get a bigger picture, because we all think we remember. "Oh, I think I had a couple of headaches last month." But sometimes when you write it down, it can be pretty striking how frequent you might be having headaches. Interviewer: Yeah. So go in prepared. It's going to take a little time beforehand. How long would you recommend somebody do the diary before then they actually go and talk to their doctor? Dr. Pippitt: I'd probably say somewhere around six to eight weeks. Some of it depends on how bad your headaches are. So I think if your headaches are really pretty debilitating and you're having to miss work, then you might not want to go for quite that long. But at least a good couple of weeks of volume of extra information so that then you and your provider can look at that together to determine what might be the next appropriate step. Interviewer: Okay. And you had mentioned that there are some apps out there and they tend to ask the questions that are going to be the most useful in that appointment. Most of them are pretty good, or do you have a recommendation? Dr. Pippitt: The one that I've used the most is called My Migraine Buddy. It seems to be the most user-friendly. It actually prints out some nice, pretty charts that talk about how frequent, how intense was the pain, and things like that. That's the one I've heard the best reviews from patients. Interviewer: Yeah. And when a patient comes in with that information to you because, as you mentioned at the top, you're a primary care physician, but you have also taken extreme interest in headaches and have educated yourself to the extent that maybe the common primary care physician has not. Are you kind of struck by when they come in with that information? Does that truly make it easier for the regular primary care physician? Dr. Pippitt: Oh, absolutely. I mean I think anytime you come to me as a primary care doc and have information about when your last labs were, about your family's medical history that's really detailed, I'm never going to be upset about that. That is like a gift when you walk in the door. Interviewer: Okay. So the person brings that in, they bring you some great information, and then at that point, you would review it, and you would likely come up with a treatment plan. Are we at that point yet? Dr. Pippitt: Yeah. Absolutely. And treatment, we usually break down into two big categories. So one is rescue or acute treatment. So if you're having such intense headaches or migraines and whatever you're trying over the counter isn't working, that's sort of step number one, one thing we could treat. And then I think the second aspect of that is prevention. So if you're having really terrible migraines every week, that lasts for two or three days, well, then we should do something to try to reduce that frequency. So talking to them about what the options are, what might make the most sense based on their particular set of circumstances. Interviewer: So if I'm a person with a headache and I've gone to my primary care physician and I know maybe they've had like a day or two of training, right, and maybe they have educated themselves off and on throughout their practice, how often can a primary care physician that's kind of got that base level of headache knowledge really solve a problem? Dr. Pippitt: I think we are well equipped to solve the problem. There are a lot of good migraine medicines that have been out there for a while. And I would say before you escalate to a specialty level of care, unless there's something unusual or concerning about your headache in particular, but you should be able to try at least a couple of rescue medications with your primary care provider and at least a couple of prevention medications. I think it's important to always keep in mind there is no magic cure for any of this. There is no snap of my fingers that is going to make this go away. So patience is really important. If you come in with a migraine a week for a year, it's going to take some time to get at that. So being patient and having reasonable expectations about the outcome, I think is important going in. Interviewer: Yeah. That can be important. I know some people personally that they have headache issues and they've gone to their doctor and then they felt like they weren't able to solve it so then they just gave up. So I think kind of realizing that it sounds like it's a process, where maybe a few treatments might need to be tried would be useful. At what point then would you want to consider going to more of a specialized headache care center? Dr. Pippitt: I think if you've tried a couple of things with your primary care and you're not making any headway, if you'll pardon the pun, I think that's the time to think about talking to someone else. It's an okay thing to ask your primary care provider. Just be forthright and say, "At what point do you usually refer patients to a specialist?" I think most of us have a level of comfort with different medical conditions, like I'm clearly going to take care of a lot of things in my primary care practice that are headaches that some of my partners will not, but they'll take care of some things that I would probably send to a specialist as well. So I think asking your provider when. I think it's important that you've tried something, though. I occasionally will see patients in our Headache Clinic who've never tried anything before. They've never tried a prescription rescue medicine. They've never tried a prescription preventive medication. And while that's particularly lovely for me in the Headache Clinic, I would say it's not a good use of a pretty limited resource, because we're there to really take care of patients who've tried quite a few things and are not making any progress. Interviewer: So we talked about how to talk to your doctor, your primary care physician about headaches, make that diary. It sounds like have a little bit of patience with them as they work through a few treatment options. Are there some other keys to getting that correct diagnosis and treatment from a primary care provider? Dr. Pippitt: I think you as the patient are the one who knows your history best. So I think we worry that maybe the right questions aren't being asked. So if there's some symptom or something you're experiencing that you don't know if my hand tingling, before I get a migraine, has anything to do with it, bring it up, pay attention to those things. Really ask the questions when you go in so that you're well informed about your own condition, because that helps your provider make the correct diagnosis.
Headaches are very common, with many treatment options available. Yet, many people suffer with headache pain without ever speaking to a doctor. Don’t suffer in silence. Learn the best strategies to prepare for a discussion with your doctor about your headaches so you can get the best treatment for you. |
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Nutrition and Lifestyle Changes to Improve Your HeadachesYour lifestyle can make a significant impact on the frequency and intensity of headaches or migraines. Medications can only do so much. Dr. Karly Pippitt explains how improving habits like sleep,…
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June 04, 2021
Diet and Nutrition
Brain and Spine Interviewer: What you eat, what you don't eat, and other lifestyle factors, they play a role in the severity and frequency of migraine headaches. Dr. Karly Pippitt is a headache expert at University of Utah Health. And let's just get into how important are lifestyle and nutrition factors when it comes to migraines. Dr. Pippitt: I'll often tell patients that medications can only do so much, and so they have to be doing the things that are under their control to help us best control their migraines. And typically, people will have some awareness of some of these because they will have realized these are their triggers. The 4 Major Lifestyle Habits the Effect HedachesSo sleep is a really big one for people. You want to make sure that you're consistent in your sleep hours, so trying to go to bed around the same time, getting up around the same time, and just getting good sleep quality, if you have something like sleep apnea or another medical condition, that you're getting those treated. A lot of people will have already known that if they didn't sleep very well or if they slept too much, that they happened to get a migraine. So people usually know that that's a big trigger. Some of us don't have good control of our sleep because we're shift workers or something else has happened. And that makes your migraines a little bit worse. So to the best of your ability, if you can control your sleep, that really helps. Staying hydrated is really huge. We live in a really dry climate, and so making sure that you're drinking water, drinking things that are going to keep you hydrated throughout the day is really important. Again, sometimes people will be like, "Oh, it was a hot day and I was out hiking and then I came home and I had a bad headache." There you go. So making sure that you're staying hydrated. Being active, right, getting out, doing something. I'm not saying you need to be these crazy Utah individuals who are running ultra marathons and hiking Mount Olympus every weekend. But just go out and walk 20 minutes a couple of times a day, making sure you're doing that and not just being sort of still and sedentary. That's a really important thing with your migraines. And then you brought up nutrition. So not only what you eat, but I would also say how frequently you eat. We'll typically recommend that patients with migraines or with headaches that you're eating something probably somewhere between every two to four hours. That's something to sort of fiddle with, that works with your body best, but not going for long periods of fasting. That tends to be a trigger for a lot of people. And when you do eat a snack, making sure that you're eating something with a little bit of protein, a little bit of complex carbohydrates, something that's going to kind of sustain you and keep you going, so peanut butter, nuts, dried fruit, yogurt, cheese, something like that. And then what you eat, it does matter to a certain extent. A lot of people will say that there are certain foods that are a trigger. And you've heard me say that a couple of times now, "What is your trigger for migraines?" It's helpful to look at what you're eating and know what some common triggers are, but don't torture yourself in trying to find what you think is the cause. So some really common triggers, I would say for people, red wines or wines with sulfate. Sometimes alcohol in general, but typically red wines and beer are probably big ones. Chocolate can do it. Processed meat, so things like hot dogs, sausages, that can be a trigger for people. MSG for some people, though I would say the data is a little bit less supportive of that. And then sometimes things like fermented foods can also be a trigger. But everyone is very different. So you may have those and not bother you at all, and other people may be more sensitive. And also, maybe it's just you had a night that you didn't sleep very well, you were really busy at work and maybe you skipped breakfast. And then when you had lunch, you had a hot dog and a Coke and then later you had a headache. Was it the hot dog? Was it the skipped breakfast? Was it the poor sleep? Yes. It was really probably all of those things that did it. Interviewer: I was waiting for the answer. Dr. Pippitt: So I think that's an important thing to think about is that I've heard it described at one of our migraine conferences as the inferno of migraine. And so each of those are a little match, right? So a match that you didn't sleep very well, another little match to some dry kindling that you didn't eat breakfast, and then whatever you ate for lunch and maybe didn't stay hydrated. And all of those are really leading to that inferno that then becomes the migraine. Interviewer: I like to think of things like that in terms of the cup. So you didn't have your breakfast, you put a little water in that cup, and eventually it just gets so full it runs over. Boom, that's when you have the migraine headache. Dr. Pippitt: Absolutely. Interviewer: That's kind of my analogy. It worked for me. But I like the inferno. You had fire. I had water. So you went through a lot of kind of lifestyle things that really all of us should be trying to do to the best of our ability anyway -- staying active, eating healthy, trying to get enough sleep, controlling our alcohol consumption. Getting Good Sleep is the Best Medicine for HeadachesInterviewer:When somebody comes in, out of all of those, do you kind of have them start with one above the other? Like what's the biggest bang for my trigger buck? Dr. Pippitt: Oh, great question. I would say probably sleep. Sleep is a really big trigger for people. And not just not enough sleep, but too much sleep can also be a trigger for you. Most people, when you come in, we talk about those four. And I'll tease people that there's usually one I can pick on them about, right? Like very few of us are like good at all four of those things, so there's usually one. So if there's just one, then that's the one that I'll typically pick on. But sleep and then a close second would probably be either hydration. I don't even know that I'd give you a close second, because I feel like all of those are really common, that we get busy, we don't eat, we get busy, we don't stay hydrated, and we don't exercise. Interviewer: Yeah. We get stressed, we drink alcohol. Dr. Pippitt: Yeah. So just trying to find time to do the right thing. Interviewer: I'd like to add in too, for any of those things, it's really I think important to keep a diary, because before I got my Fitbit a couple of years ago, I thought, "Oh, I get eight hours of sleep. I go to bed at 10:00 and get up at 6:00." Well, actually, it told a little bit of a different story. I guess I didn't realize I was going to bed at 10:45 or 11:00. I thought I was going to bed at 10:00. So writing that stuff down and like what you eat is the same thing. So I think really be critical. Dr. Pippitt: Absolutely. And I love all the activity trackers, because I think a lot of us think that we're active. I have on my busiest day of clinic, I remember when I first got my Fitbit, I was like, "You got to be kidding me. I'm only doing 3,000 or 4,000 steps. Like I'm exhausted when I come home." And it's interesting how different trackers will then talk about how much you stand, how much you moved. Like maybe you didn't take that many steps, but you were up and moving around. And I was like, "Okay. Either that just made me feel better because I was actually a little more active even if it wasn't just from like a step standpoint." But I think that is useful feedback and information for you to act on. Posture Can Play a Part in HeadachesInterviewer: What about posture? Does posture trigger migraines? I know for me, if I sit all day at work, which sometimes, again, I try to get up every 10 minutes every hour. But if I sit all day, I'll start to notice headaches creeping in around 4:00 or 5:00 in the afternoon. Dr. Pippitt: Yeah. Posture can definitely lead to more headaches, maybe a little bit more tension headaches and tension headaches can then lead to migraine headaches. So you're doing the right thing by standing up every 10 minutes or so. Making sure your setup is good so that you're not hunched over. I definitely have a tendency, even though I have a pretty good setup, to hunch a little bit more, especially as I keep looking into a camera screen, that tends to curl my shoulders a little bit. So standing up, stretching, like bringing your arms above your head, sort of stretching out your pecs is really what you're looking for. So if you've got one of those exercise balls, rolling that onto your shoulders and just letting your arms fall open. We often think about, "Okay. What can I do for my neck?" But we don't realize that as we're hunching forward, you're actually shortening your pec muscles. So opening those up or going to a corner of a room and putting your hand on each of the wall and almost doing a little push-up against the wall to stretch out those areas is huge. Interviewer: Some great advice to look to try to reduce the severity. Now, do these things reduce both the severity and frequency of headaches, or do they tend to impact one or the other? Dr. Pippitt: They could do both, to be quite honest. Maybe not as much the like intensity of one that you have, but I suppose if you really filled your cup up and just like kept the hose running, that might actually make a difference with the intensity. The goal is really probably more with frequency, I would say. Interviewer: All right. And is this an alternative to taking medication, or would you recommend, if somebody has migraines, that this is in addition to? Dr. Pippitt: I would say definitely in addition to. Like I said, medications can only do so much. So even if we had a perfect medication regimen for you and you weren't sleeping, weren't eating, weren't exercising, and didn't stay hydrated, I don't know that those medicines would really do any good for you. Dr. Pippitt: I'll often tell patients that medications can only do so much, and so they have to be doing the things that are under their control to help us best control their migraines. And typically, people will have some awareness of some of these because they will have realized these are their triggers. So sleep is a really big one for people. You want to make sure that you're consistent in your sleep hours, so trying to go to bed around the same time, getting up around the same time, and just getting good sleep quality, if you have something like sleep apnea or another medical condition, that you're getting those treated. A lot of people will have already known that if they didn't sleep very well or if they slept too much, that they happened to get a migraine. So people usually know that that's a big trigger. Some of us don't have good control of our sleep because we're shift workers or something else has happened. And that makes your migraines a little bit worse. So to the best of your ability, if you can control your sleep, that really helps. Hydration and Nutrition Can Help Prevent HeadachesStaying hydrated is really huge. We live in a really dry climate, and so making sure that you're drinking water, drinking things that are going to keep you hydrated throughout the day is really important. Again, sometimes people will be like, "Oh, it was a hot day and I was out hiking and then I came home and I had a bad headache." There you go. So making sure that you're staying hydrated. Being active, right, getting out, doing something. I'm not saying you need to be these crazy Utah individuals who are running ultra marathons and hiking Mount Olympus every weekend. But just go out and walk 20 minutes a couple of times a day, making sure you're doing that and not just being sort of still and sedentary. That's a really important thing with your migraines. And then you brought up nutrition. So not only what you eat, but I would also say how frequently you eat. We'll typically recommend that patients with migraines or with headaches that you're eating something probably somewhere between every two to four hours. That's something to sort of fiddle with, that works with your body best, but not going for long periods of fasting. That tends to be a trigger for a lot of people. And when you do eat a snack, making sure that you're eating something with a little bit of protein, a little bit of complex carbohydrates, something that's going to kind of sustain you and keep you going, so peanut butter, nuts, dried fruit, yogurt, cheese, something like that. And then what you eat, it does matter to a certain extent. A lot of people will say that there are certain foods that are a trigger. And you've heard me say that a couple of times now, "What is your trigger for migraines?" It's helpful to look at what you're eating and know what some common triggers are, but don't torture yourself in trying to find what you think is the cause. So some really common triggers, I would say for people, red wines or wines with sulfate. Sometimes alcohol in general, but typically red wines and beer are probably big ones. Chocolate can do it. Processed meat, so things like hot dogs, sausages, that can be a trigger for people. MSG for some people, though I would say the data is a little bit less supportive of that. And then sometimes things like fermented foods can also be a trigger. But everyone is very different. So you may have those and not bother you at all, and other people may be more sensitive. And also, maybe it's just you had a night that you didn't sleep very well, you were really busy at work and maybe you skipped breakfast. And then when you had lunch, you had a hot dog and a Coke and then later you had a headache. Was it the hot dog? Was it the skipped breakfast? Was it the poor sleep? Yes. It was really probably all of those things that did it. Interviewer: I was waiting for the answer. Think of Your Headaches as a Constellation of FactorsDr. Pippitt: So I think that's an important thing to think about is that I've heard it described at one of our migraine conferences as the inferno of migraine. And so each of those are a little match, right? So a match that you didn't sleep very well, another little match to some dry kindling that you didn't eat breakfast, and then whatever you ate for lunch and maybe didn't stay hydrated. And all of those are really leading to that inferno that then becomes the migraine. Interviewer: I like to think of things like that in terms of the cup. So you didn't have your breakfast, you put a little water in that cup, and eventually it just gets so full it runs over. Boom, that's when you have the migraine headache. Dr. Pippitt: Absolutely. Interviewer: That's kind of my analogy. It worked for me. But I like the inferno. You had fire. I had water. So you went through a lot of kind of lifestyle things that really all of us should be trying to do to the best of our ability anyway -- staying active, eating healthy, trying to get enough sleep, controlling our alcohol consumption. When somebody comes in, out of all of those, do you kind of have them start with one above the other? Like what's the biggest bang for my trigger buck? Dr. Pippitt: Oh, great question. I would say probably sleep. Sleep is a really big trigger for people. And not just not enough sleep, but too much sleep can also be a trigger for you. Most people, when you come in, we talk about those four. And I'll tease people that there's usually one I can pick on them about, right? Like very few of us are like good at all four of those things, so there's usually one. So if there's just one, then that's the one that I'll typically pick on. But sleep and then a close second would probably be either hydration. I don't even know that I'd give you a close second, because I feel like all of those are really common, that we get busy, we don't eat, we get busy, we don't stay hydrated, and we don't exercise. Interviewer: Yeah. We get stressed, we drink alcohol. Dr. Pippitt: Yeah. So just trying to find time to do the right thing. Interviewer: I'd like to add in too, for any of those things, it's really I think important to keep a diary, because before I got my Fitbit a couple of years ago, I thought, "Oh, I get eight hours of sleep. I go to bed at 10:00 and get up at 6:00." Well, actually, it told a little bit of a different story. I guess I didn't realize I was going to bed at 10:45 or 11:00. I thought I was going to bed at 10:00. So writing that stuff down and like what you eat is the same thing. So I think really be critical. Dr. Pippitt: Absolutely. And I love all the activity trackers, because I think a lot of us think that we're active. I have on my busiest day of clinic, I remember when I first got my Fitbit, I was like, "You got to be kidding me. I'm only doing 3,000 or 4,000 steps. Like I'm exhausted when I come home." And it's interesting how different trackers will then talk about how much you stand, how much you moved. Like maybe you didn't take that many steps, but you were up and moving around. And I was like, "Okay. Either that just made me feel better because I was actually a little more active even if it wasn't just from like a step standpoint." But I think that is useful feedback and information for you to act on. Interviewer: What about posture? Does posture trigger migraines? I know for me, if I sit all day at work, which sometimes, again, I try to get up every 10 minutes every hour. But if I sit all day, I'll start to notice headaches creeping in around 4:00 or 5:00 in the afternoon. Dr. Pippitt: Yeah. Posture can definitely lead to more headaches, maybe a little bit more tension headaches and tension headaches can then lead to migraine headaches. So you're doing the right thing by standing up every 10 minutes or so. Making sure your setup is good so that you're not hunched over. I definitely have a tendency, even though I have a pretty good setup, to hunch a little bit more, especially as I keep looking into a camera screen, that tends to curl my shoulders a little bit. So standing up, stretching, like bringing your arms above your head, sort of stretching out your pecs is really what you're looking for. So if you've got one of those exercise balls, rolling that onto your shoulders and just letting your arms fall open. We often think about, "Okay. What can I do for my neck?" But we don't realize that as we're hunching forward, you're actually shortening your pec muscles. So opening those up or going to a corner of a room and putting your hand on each of the wall and almost doing a little push-up against the wall to stretch out those areas is huge. Interviewer: Some great advice to look to try to reduce the severity. Now, do these things reduce both the severity and frequency of headaches, or do they tend to impact one or the other? Dr. Pippitt: They could do both, to be quite honest. Maybe not as much the like intensity of one that you have, but I suppose if you really filled your cup up and just like kept the hose running, that might actually make a difference with the intensity. The goal is really probably more with frequency, I would say. Interviewer: All right. And is this an alternative to taking medication, or would you recommend, if somebody has migraines, that this is in addition to? Dr. Pippitt: I would say definitely in addition to. Like I said, medications can only do so much. So even if we had a perfect medication regimen for you and you weren't sleeping, weren't eating, weren't exercising, and didn't stay hydrated, I don't know that those medicines would really do any good for you.
Your lifestyle can make a significant impact on the frequency and intensity of headaches or migraines. Medications can only do so much. Improving habits like sleep, stress reduction, and nutrition can help minimize your headaches. |
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78: Migraines - Man Up and Get HelpMen get migraine headaches but aren't as likely to seek help or even realize it. Troy knows he has migraines, and by the end of the episode, Mitch realizes he probably has them too. Headache…
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May 18, 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: 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. 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 |
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