Search for tag: "u6024458"

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Interviewer: Really? Wow.

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

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

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

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

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

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

Interviewer: So foods from our modern society.

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

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

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

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

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

Interviewer: Yeah, like a stroke.

Dr. Bartel: Exactly.

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

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

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

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

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