How to Prevent Severe Headaches

Dr. Sal [00:00:00]:

These are people that can have a migraine that's associated with dizzy spells, or they can have a migraine that eventually results in slurred speech, which in most cases, people get really scared with that because they believe that they're having a stroke. Welcome to the Health QUEST Podcast, your guide to God's will for good health. Hello. My name is doctor Sal, and I've been a practicing surgeon for well over 30 years. And my goal for each episode is that it'll be able to have you transform your mind to God's design for good health and in a way to affect the way you eat in the way you live. If you're new here, we release a new episode every week. And if you enjoy the content, would you please leave us a good review? It really helps our ratings and allows our show to reach more people, and in turn, we can help them as well. Thank you for your support.

Dr. Sal [00:01:06]:

And on today's episode, we're gonna be talking about migraine headaches. So let's dive right in on today's health podcast. Migraine headaches are neurologic disorders that could cause debilitating pain that could leave you in bed for days. Such things such as light, sound, movement, and other triggers may exacerbate these symptoms. It affects about 12% of Americans. It is a genetic disorder, and it is the 6th most disabling disease in the world. There's a 150 types of headaches, And these could be divided into 2 categories, primary and secondary. Primary being one where the the pain actually starts in the head and causes the headache.

Dr. Sal [00:01:56]:

And the secondary is where you may have some other physical ailment occurring elsewhere in the body that eventually ends up causing a headache too as well. It is a clinical diagnosis. Now what that means is is that there isn't any kind of imaging study, whether it's an MRI or a CAT scan or any kind of blood test that you could do that actually confirms that you have a migraine headache. A clinical diagnosis is based on the symptoms that you present with to your physician. And over time, it starts to fit into these categories or prototypes that eventually indicates that you're having the migraine. But What are the different types of migraines, for instance? We have migraine with aura, which is the complicated migraine. And then we have the migraine without the aura, which is your common migraine. Sometimes these migraines can present with a sense of paralysis or a sensory change on one side of the body.

Dr. Sal [00:02:56]:

Yes. Sometimes people can have a weakness or even paralysis on one side of their body while they're experiencing these headaches, or they just feel a funny sensation on, the one side of the body. And this is called hemiplegic migraines. These are usually the neurological changes that occur to one side, and one in particular is called the ocular migraine in or retinal migraine, which is really a migraine that starts with pain in the eye and then over time starts to radiate to other areas of the body. A chronic migraine usually occurs when you've had at least 15 headaches or migraines per month. And these symptoms can fluctuate. In other words, it could start off with a dull headache and then eventually intensified to this throbbing headache where it makes you or it you become debilitated, and you get at least 15 of these in a month. These are the ones since they become debilitating and sometimes require hospitalization, and we'll get it we'll talk about that shortly.

Dr. Sal [00:04:03]:

But we could also have migraines with brainstem auras. Now the brainstem is an area a brain that eventually controls your balance, your speech, your vision. So these are people that can have a migraine that's aided with dizzy spells, or they can have a migraine that eventually results in slurred speech, which in most cases, people get really scared with that because they believe that they're having in a stroke. It could also affect your vision where you start getting double vision. And this is the area where if there's no evidence of a tumor or or some type of hemorrhagic stroke, then we can assume that it is based on the area which is the brainstem, on the back of the brain and then the base of the brain that's causing you to have these other symptoms associated with the so called headache. A status migrainosis status migrainosis is rare. And what that is, it is a headache that lasts for longer than 70 to hours. I am talking about a debilitating headache where you are bedridden for at least 3 days.

Dr. Sal [00:05:17]:

And these are individuals that do require hospitalization and require a certain therapy with IV or ergotamines, and we're gonna talk about that shortly. Late. But let's talk about the 4 stages or the phases of a migraine. Well, The first stage is known as the prodome, symptoms, and these are people that get, like, a pre headache that last for a few hours or a couple days. It's usually just a little bit of a dull headache. They have sometimes a problem concentrating. They become irritable, oftentimes depressed, especially if it starts to come on more frequently. Because as they start feeling it coming on.

Dr. Sal [00:05:58]:

They start believing that, okay. I'm gonna get this headache. I'm gonna be debilitated for the day. I've got stuff that I have to do. And And so they can get depressed. They can have difficulty reading or speaking, therefore, debilitating their capabilities working and doing their daily chores. They could also have difficulty sleeping. Now if you don't get a good night to sleep, then it results in fatigue, which can then exacerbate or worsen the headaches.

Dr. Sal [00:06:27]:

That's another form of anxiety that people develop because sleeping actually settles the migraine down. And if you can't sleep well and and have this continuing headache, then eventually results in in fatigue and your inability to function in in your daily routine. These are individuals that are very sensitive to light and sound. And As a result, they have to go into a dark room, which is completely quiet because any form of sound or sensitivity to light can make the headache in worse. And what is the aura phase? Well, that usually lasts for about 5 to 60 minutes. There's a numbness, a tingling, a sense of in weakness, some visual disturbance where you get some visual kaleidoscope like blurred blurred spots or fornications, these flashing lights. It seems like you've got, like, these explosions that are occurring in your eyes, or you may see things in a kaleidoscope where things are moving. And occasionally, you get some blind spots or blurry spots that occur with that.

Dr. Sal [00:07:33]:

You could have the headache, which is the 3rd phase, which is throbbing, or you could have pressure. People describe it as being migratory where it starts to move back or starts from the back and moves towards the front. You can have a sense where you feel your ahead as a drilling sensation or an ice pick sensation into your head. This could be associated with neck pain and stiffness, depression and anxieties we talked about and, of course, again, the sensitivity to light and sound and also even smell. These are people that can have once they get these headaches, they can have associated nausea and vomiting. And as a result, they don't sleep. Without sleep, you can't get that headache to settle down. And this goes from hours, and the headache can last for up to days.

Dr. Sal [00:08:26]:

But let's say you get over the headache. Now we go into the 4th phase or the postdrome phase of the headache. And you could be in a sense as if you had this feeling of a hangover, or you're just completely out of it. You don't have the ability to concentrate. You could be in a depressed mode. Again, These are people where they gotta get up and they've gotta go to work. They don't feel like it. They just lost all motivation.

Dr. Sal [00:08:55]:

They have fatigue. They have a lack of comprehension. And again, as I said, it's kinda like that hangover feeling that you have if you had too much to drink the night before. So we understand now the phases of it, the symptoms that go along with it. But what actually causes a migraine? And the migraine is believed to be caused by a mixture of environmental and genetic factors that influence the excitation inhibition of nerve cells in the brain. In other words, what causes the nerve cells or the nerve fibers to to be excited and send other signals and what causes them to shut down in the brain. Now the older vascular hypothesis. And this is what I learned back in medical school back in the eighties.

Dr. Sal [00:09:43]:

It was due to and it was postulated that the headaches of a migraine were produced by the blood vessels dilating in the aura by the constriction of the blood vessels. But this mechanism has been disproven now, and now the accepted hypothesis suggests that there's multiple primary neuronal impairments. So there's a lot of abnormal neurotransmitters being sent throughout the nervous system, them and it leads to a series of intracranial and extracranial changes that triggers this physiologic cascade that eventually and leads to migraine symptomatology. Of course, there is an underlying inflammatory process that goes along with that as well. So we start to see that really a migraine is like a short circuiting of the brain. But what can trigger this? Well, there's a variety of different factors. Emotional stress. People that go through stress and are genetically susceptible to it.

Dr. Sal [00:10:45]:

Poor diet. There we go again with by it because you could have sensitivity to specific chemicals and preservatives that are in the foods itself. Alcohol, chocolate, Food additives such as nitrates that are in the foods that we talked about, especially with these cold cuts that you get in these sandwiches, contain a lot of nitrates. These can trigger that. Excessive use of pain relieving medications. And And the reason why I say that is you say, well, shouldn't you take pain medications for a migraine? Yes. I mean, it's what you do to for any kind of pain is to take something to relieve it. But there is the, the effect of a rebound that could take place.

Dr. Sal [00:11:30]:

So we get this rebound effect if You take too many of these pain medications, and all of a sudden, you get over the headache and it rebounds. You take the pain medication and it rebounds. And over time, the pain medication becomes less and less effective. There can be hormonal changes, and this is one of the reasons why migraines are more common in women than they are in men. But I've seen it happen in men that I almost think it's about a 5050, racial, men to women, but the literature states that it's more women having these migraines. We believe that it's due to the hormonal changes. Light, that especially, flashing lights can trigger these migraines, fluorescent lights, TVs, and computers, and the lighting that the Blue light that comes from these, particular modes eventually can trigger a migraine too. Excessive sunlight.

Dr. Sal [00:12:27]:

If you're out in the sun, that's why it's good to wear a good pair of sunglasses. Other possible triggers such as changing weather, barometric changes, humidity changes, temperature changes, overexertion. Just getting exhausted can trigger this dehydration from not drinking enough water, disruption of sleep patterns, of course, loud noises, exposure to cigarette smoke, of perfumes and even pungent odors. So we now know the triggers. We know some of the symptoms. The question is is how do we treat migraines? Now migraines that are chronic, they can't be cured, but they could be managed and possibly improved. There are 2 main treatment in approaches that use medications either for abortive reasons or preventative. So let's talk about abortive medications, and these are most defective when you use them at first sign of a migraine.

Dr. Sal [00:13:21]:

So you start feeling, hey. I think a migraine is coming on. People that have had them for so many years No one is coming on. They you know, the symptoms become very apparent to them because they've had so much experience with it. And when they start getting a mild, headache. They start to take some type of prophylactic or preventative medication, that eventually reduces the severity of it. If it occurs, you really shouldn't be taking more than 3 or 4 times the pain medication per month because it could significantly interfere with normal activities. So what medications are used to relieve migraine pain? Well, it's recommended that you to start taking something over the counter, such as a Excedrin for migraine.

Dr. Sal [00:14:14]:

Those are, aspirin with caffeine in it. Usually, anything that's treated for migraines over the counter or will have some form of caffeine. Caffeine does help settle a migraine down. And this is for people that have a mild to moderate, pain. And, again, we were talking about the Ibuprofen, the Aspirin, acetaminophen, which is your Tylenol, naproxen. Again, these contain caffeine, and these are the over the counter products, that were approved by the Food and Drug Administration for migraine headaches. Be cautious when taking over the counter pain medication because overusing it, eventually causes the rebound effects that we talked about earlier. It also can you could also develop a dependency on this.

Dr. Sal [00:15:02]:

Now believe it or not, I've seen people become dependent or addicted to just Motrin. Now whether it's physiologic or psychological, it doesn't matter. Some people feel that I feel something. I gotta take this right away. I recall bodybuilders back many, many years ago from, you know, working out hard the next day. They didn't wanna feel the soreness the muscles, so they started taking Motrin, and they took an excessive amount of it too as well. If you're taking pain medications more than 2 to 3 times a week, you may wanna go see your physician who may prescribe some form of prescriptive medication that could be more effective. And some of these prescriptive medications are, these are the ones that are more abortive.

Dr. Sal [00:15:50]:

Imitrex as a commonly known one. And these are fancy names like sumatriptan, zolmitriptan, in niratriptan. These are the ones that are usually abortive. There are calcium channel blockers that we use for blood pressure medications such as verapamil that can help reduce these headaches. Now there's these new sides or what they're called monoclonal antibodies. And these are calcitonin gene related, peptides which help to prevent these headaches from coming on. It's a shot that you get once a month, and it helps to prevent them. Sometimes you have to do it in combination.

Dr. Sal [00:16:34]:

There are other beta blockers. Again, just like your calcium channel blockers, these are, blood pressure medications that and help lower the blood pressure and reduce some of the strain on the nerve endings inside the brain. In the past, they've used antidepressants. I've talked about this before. Antidepressants have been tolerated fairly well and used very well for the treatment of chronic pain. As a result of that, however, people that have taken these antidepressants for a number of years over time starts to alter the neural networks. One of the most famous one that was used many, many years ago, I'm talking 40 years ago was amitriptyline. It worked very, very well.

Dr. Sal [00:17:18]:

However, we're starting to see that these people that are in their fifties now that we're taking them in their early teens because migraines can affect teenagers just as well, are now starting to, I believe, to have a rebound from that and getting it to the point where these antidepressants aren't working as well anymore. They're using anti seizure medications that have been helpful. It doesn't work all the time, but by the same token, We feel that when there's a a short circuiting within the brain that's causing these migraines, it could almost mimic that of what we call a petit mal seizure where you could lose concentration on something. And so some of these anti seizure medications are useful for the prevention of migraines. Some of the other medications that they've used are corticosteroids to reduce inflammation. Phenothiazines are also anti inflammatory. Your health care provider may recommend also some in vitamins. And this is what I always try to advise, anybody that has this.

Dr. Sal [00:18:21]:

There are a number of minerals, particularly magnesium. And we've talked about this where Americans are almost close to 70% magnesium deficient. So I treated my patients with magnesium in supplements and help reduce a lot of their symptoms. There's a number of herbs that you could take too as well. Rosemary, basil, sage have been helpful. There's vitamins like, vitamin b 2, which is, riboflavin. But you should really take a a multivitamin or at least a multi complex b vitamin daily. Other herbs, are like feverfew, butterburp.

Dr. Sal [00:19:03]:

Coenzyme q ten, so important now. The only way you Can actually get that is by eating beef hearts. And I don't see too many Americans eating beef hearts. So, co q ten not only helps reduce some of the in inflammation that could cause some of these headaches. But it's also a good way to take that particular coenzyme when you're taking the statin because statins have a tendency to lower coenzyme q ten, and that's why you'll hear on those commercials that it causes muscle cramping because it does weaken the muscles. There are drugs or medications that can help relieve, the nausea such as Zofran. When taking something over the counter, I always recommend taking Benadryl. Now if you mix Benadryl with a corticosteroid, one of the best antiemetics that you could take or anti nausea medication.

Dr. Sal [00:19:53]:

All all of these medications, of course, should be under the direction of a specialist or a health care a provider with that that really specialize in in migraine therapy. Some of the things that when you get a migraine, some of the ways to kind of help reduce it is, resting in the dark and quiet room. And apply a cold compress or washcloth to your to forehead 2 as well or even to the back of the neck. You could put a heating pad, massaging the scalp, doing yoga. These are some of the other home remedies that you you do to help reduce these migraines or make you feel better. Meditating is also important. In keeping yourself in a calm state. Kinda difficult in our modern day society where it's always constantly running, meditating, and prayer.

Dr. Sal [00:20:41]:

Biofeedback has been shown to be very helpful with this. And I'm gonna make this very clear because You really have to develop a good relationship with your neurologist. Some neurologists are here. Take your medications. I'll see you in 2 weeks. But then some of these people end up on a Friday with these severe headaches that they become bedridden. And You have to have a neurologist that has to have an office or at least send you to a place where you can get IV infusions, where they can give you magnesium in some steroids and other, medications or even supplements that help to diffuse that headache or reduce the severity of it. There's nerve blocks that can be done externally.

Dr. Sal [00:21:28]:

I've done them, for patients just for surgical reasons, hitting nerve blocks which have been have worked. And now there's a doctor out of Cleveland that actually does surgeries to open up those foramen or the the openings so that those nerves aren't pinched. Dihydoroergotamine, needs to be done over 70 to our period, usually intravenously, and it's done in a hospital setting. You have to have, again, that relationship with ologist that has to be affiliated with a hospital that does that kind of therapy. That way, they can admit you and get it started without having to wait in an ER for 6, 8, sometimes times even up to 13 hours before you even get some kind of attention. The health care is really starting to decline, and, It it's not to me, I think it's not fair for somebody with a migraine that can be treated, or already have a treatment plan but has to wait almost a full all day before they can actually get any kind of attention. So there has to be active participation between the doctor and the patient. And with that, I hope you enjoy our show.

Dr. Sal [00:22:35]:

Thank you so much for watching us today. If you enjoyed this episode, be sure to leave us a review and visit our website in social media accounts to connect with us more. If you happen to have any questions about your health regarding this episode, my email will be in the description below, and I'll be happy to answer your any of your questions. And if you would like to see any of the sources of research in this episode, out, they will be available to you in the show notes in the description. Until next time. I'm doctor Sal. Have a great day, and god bless.