>> OVERINDULGENCE, STRESS OR THE COMMON COLD, THERE ARE
MANY CAUSES AND A VARIETY OF "CURES."
HEADACHES - CAUSES, EFFECTS AND TREATMENTS - TONIGHT "ON CALL WITH THE PRAIRIE DOC."
>> GOOD EVENING, AND WELCOME TO "ON CALL WITH THE PRAIRIE DOC."
DR. HOLM IS OFF TONIGHT. I AM DR. DEBRA JOHNSTON WITH
AVERA MEDICAL GROUP - BROOKINGS. ACCORDING TO THE WORLD HEALTH
ORGANIZATION, HEADACHES ARE EXTREMELY COMMON. NEARLY EVERYONE HAS A HEADACHE OCCASIONALLY.
WHEN THEY OCCUR REPEATEDLY, THEY ARE A SYMPTOM OF A HEADACHE DISORDER.
THE MOST COMMON HEADACHE DISORDER IS TENSION-TYPE HEADACHE.
BUT, FIRST, LET'S TAKE A LOOK AT THIS WEEK'S PRAIRIE DOC QUIZ QUESTION.
TRUE OR FALSE? HEADACHES CAN BE TRIGGERED BY STRONG PERFUMES.
TRUE OR FALSE? VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED
INTO A DRAWING TO WIN A SIGNED COPY OF OUR BOOK, "THE PICTURE OF HEALTH."
EACH OF DR. HOLM'S ESSAYS, ORIGINALLY WRITTEN FOR THIS SHOW, COMES WITH A WONDERFUL
ACCOMPANYING PHOTOGRAPH BY DR. JUDITH PETERSON.
WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW.
REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN! WE ANSWER YOUR MEDICAL
QUESTIONS ABOUT HEADACHES AS THEY ARE CALLED IN OR SENT TO US VIA FACEBOOK OR EMAIL.
CALL IN QUESTIONS TO 1-888-376-6225 OR SEND US AN EMAIL TO THE ADDRESS ON THE SCREEN.
JOINING US TONIGHT IS DR. CAROL NELSON WITH AVERA MEDICAL GROUP,
NEUROLOGY, SIOUX FALLS. WELCOME, CAROL. IT'S GREAT TO HAVE YOU HERE.
>> THANK YOU. I'M HAPPY TO BE HERE.
>> TELL US A LITTLE BIT ABOUT YOUR BACKGROUND.
>> WELL, I'M ORIGINALLY FROM VIBORG, SOUTH DAKOTA, SO A VERY SMALL TOWN.
MY FATHER WAS A PHYSICIAN, AND, SO, I WATCHED HIM AND I
ALWAYS THOUGHT THAT WAS WHAT I WANTED TO BE AND THEN AS I GOT
OLDER, I THOUGHT, GOSH, MAYBE I BETTER SEE IF THAT'S WHAT I
REALLY WANT TO DO OR IF I'M JUST WANTING TO BE WHAT MY DAD WAS.
SO I STARTED WORKING AS A NURSE'S AIDE, WENT TO COLLEGE, MEDICAL SCHOOL, RESIDENCY, AND
I DID MY MEDICAL SCHOOL IN VERMILLION, AT THE TIME IT WAS THE UNIVERSITY OF SOUTH DAKOTA
SCHOOL OF MEDICINE, IT WAS CALLED THEN.
AND THEN I DID MY RESIDENCY IN VERMONT. AND THEN I CAME BACK TO SIOUX
FALLS IN 1995, AND I'VE BEEN HERE SINCE THEN.
>> AND HOW DID YOU DECIDE ON NEUROLOGY?
>> WELL, I DID THAT BY KIND OF FINDING 'THE COMMON THREAD IN
ALL OF MY PRECEPTORSHIPS THAT I LIKED THE BEST. WHICH WAS ALWAYS NEUROLOGY.
I ALWAYS CAME BACK TO NEUROLOGY. I DID LOVE NEUROANATOMY, THAT
WAS MY FAVORITE CLASS, BUT THEN AS I WENT THROUGH ALL MY
DIFFERENT PRECEPTORSHIPS, I DECIDED THAT IS WHAT I WANTED
TO DO, I'M REALLY HAPPY WITH MY CHOICE I REALLY DO LOVE NEUROLOGY.
>> AND NOW YOU'VE SPECIALIZED EVEN A LITTLE BIT FURTHER IN
NEUROLOGY, BEYOND JUST NEUROLOGY AS OPPOSED TO GENERAL PRACTICE.
>> RIGHT. WELL, IN MY RESIDENCY, I WAS GENERAL NEUROLOGY.
I DIDN'T DO A FELLOWSHIP AFTER THAT, BUT WHEN I CAME HERE, I
WAS THE ONLY FEMALE NEUROLOGIST IN SIOUX FALLS, ACTUALLY, IN THE AREA.
AND I SORT OF NATURALLY STARTED GETTING MORE FEMALES.
HEADACHE IS A LITTLE BIT MORE COMMON IN FEMALES.
SO, MY PRACTICE JUST KIND OF GRADUALLY MORPHED OVER INTO
BEING MORE AND MORE HEADACHE. THE MORE I DID, THE MORE I
LIKED IT, THE MORE I LIKED IT, THE MORE I DID. AND, SO, IT JUST EVENTUALLY
BECAME THE MAJORITY OF MY PRACTICE AND I'VE BEEN DOING IT FOR A LONG TIME NOW.
>> AND YOU MENTIONED SOMETHING A FEW MINUTES AGO THAT I THINK
IS A REALLY PERTINENT BIT OF INFORMATION THAT HEADACHES
ARE MORE COMMON IN WOMEN. WHY IS THAT?
>> WELL, IT'S PROBABLY A FEW DIFFERENT INFLUENTIAL FACTORS.
BUT IT'S PROBABLY PRIMARILY HORMONES. SO, BOYS AND GIRLS HAVE ABOUT
THE SAME INCIDENCE OF MIGRAINE UNTIL THEY HIT PUBERTY.
AND THEN THE FEMALES GO TO ABOUT THREE TIMES MORE COMMON THAN THE MALES.
SO THE MALES KIND OF KEEP THAT PLATEAU NUMBER OR PERCENTAGE,
BUT THE FEMALES SORT OF SHOOT OFF THE CHARTS AT THAT POINT.
SO, IT'S PROBABLY PRIMARILY HORMONAL.
>> OKAY. YEAH. AND DOES THAT HAVE IMPLICATIONS FOR YOUR TREATMENT OPTIONS?
>> I DON'T REALLY TREAT THE MALES AND THE FEMALES TOO DIFFERENTLY.
DURING THE REPRODUCTIVE YEARS, YOU'VE GOT TO BE CAREFUL,
THERE'S A POTENTIAL BABY, YOU HAVE TO JUST BE REALLY CAREFUL
ABOUT WHICH MEDICATIONS YOU'RE CHOOSING. BUT OTHERWISE, NO, THE
TREATMENTS WOULD REALLY BE THE SAME.
>> OKAY. LET'S TALK A LITTLE BIT ABOUT DIFFERENT TYPES OF HEADACHES,
BECAUSE I THINK THAT THERE'S A MISCONCEPTION OUT THERE THAT
ANY BAD HEADACHE IS A MIGRAINE OR THAT SOMEBODY MIGHT NOT
HAVE A MIGRAINE WHEN I REALLY START TALKING WITH THEM AND
DECIDE, YOU KNOW WHAT, I THINK YOU REALLY DO.
SO LET'S TALK A LITTLE ABOUT THOSE DIFFERENT TYPES OF HEADACHES.
>> YEAH. YOU KNOW WHAT? I THINK I T'S SURPRISING WHEN
YOU REALLY VISIT WITH PEOPLE THAT COME IN WITH A HEADACHE
HOW OFTEN IT IS REALLY A MIGRAINE-TYPE HEADACHE.PEOPLE IN THE GENERAL PUBLIC
TEND TO THINK OF A MIGRAINE IS REALLY A SEVERE HEADACHE, BUT
SOME OF THEM AREN'T THAT SEVERE. SO, IN GENERAL, THEY SHOULD BE
THROBBING, ONE-SIDED, NAUSEA, VOMITING, LIGHT SENSITIVE,
SOUND SENSITIVE, WORSE WITH ACTIVITY. BUT YOU DON'T HAVE TO HAVE ALL THOSE CRITERIA.
SO SOMETIMES PEOPLE WILL HAVE A MODERATE HEADACHE AND IT'S
ON BOTH SIDES BUT, YET, THEY'RE GETTING LIGHT SENSITIVE AND SOUND SENSITIVE
AND NAUSEOUS, IT STILL FULFILLS THE CRITERIA.
AND IT'S IMPORTANT TO KIND OF DIFFERENTIATE WHAT HEADACHE TYPE YOU'RE DEALING WITH
BECAUSE, OF COURSE, THAT'S GOING TO DIRECT WHAT YOUR TREATMENT'S GOING TO BE.
WHEREAS, -- SO THE MIGRAINES TEND TO BE MORE THE MORE SEVERE ONES.
TENSION HEADACHES TEND TO BE PROBABLY A LITTLE LESS SEVERE,
BUT THEY CAN HANG IN FOR A LONG PERIOD OF TIME.
SO IT SORT OF WEARS YOU DOWN AND, THEREFORE, PROBABLY STARTS TO FEEL WORSE OVER TIME.
AND THEN THERE'S SOME OTHER HEADACHES THAT ARE LESS
COMMON, LIKE A CLUSTER HEADACHE, THAT THOSE ARE LIKE
OFF THE CHARTS SEVERE HEADACHES. RIGHT.
YOU CAN GET HEADACHES WITH A BRAIN TUMOR. IT'S LESS COMMON.
THAT'S WHAT IT IS. MORE TYPICALLY WITH A TUMOR YOU'RE GOING TO SEE OTHER
THINGS, LIKE MAYBE NUMBNESS ON ONE SIDE OF THE BODY OR WEAKNESS OR SOME ELSE --
>> SEIZURES.
>> -- SEIZURES, SO IT'S PRETTY UNCOMMON FOR
THE PRESENTING FEATURE TO BE A HEADACHE. AND THEN THERE'S ALWAYS, YOU
KNOW, DIFFERENT BLEEDS THAT PEOPLE COULD HAVE, LIKE A SUB
ARACHNOID HEMORRHAGE OR SOMETHING AND THAT'S A
HEADACHE THAT YOU DON'T HAVE AND THEN ALL OF A SUDDEN IT'S A 10 OUT OF 10, RIGHT.
>> PROBABLY THE THING THAT I SEE IN MY OFFICE MOST OFTEN
ARE PEOPLE WHO COME IN AND THEY SAY, OH, I'VE GOT A SINUS
INFECTION BECAUSE I HAVE A HEADACHE RIGHT HERE. AND I TALK TO THEM FOR A
LITTLE WHILE, AND, NO, I DON'T THINK YOU HAVE A SINUS
INFECTION, I THINK YOU HAVE A MIGRAINE OR SOME OTHER KIND OF HEADACHE.
>> YEAH.
>> AND I THINK THAT'S A VERY COMMON MISCONCEPTION.
>> IT'S ACTUALLY -- I READ THAT ABOUT 60 TO 80% OF SINUS
HEADACHES IN THE GENERAL POPULATION, SOMEBODY CALLING
IT A SINUS HEADACHE, NOT NECESSARILY A PHYSICIAN, ARE ACTUALLY MIGRAINES.
AND THE REASON IS THAT THE NERVE THAT CAUSES MIGRAINES IS
ALSO -- ALSO INNOVATES THE SINUSES. SO NOT ONLY IS A SINUS
HEADACHE AND A MIGRAINE IN THE SAME PLACE, WHICH IS KIND OF
RIGHT AROUND THE AREA OF THE EYE, BUT YOU CAN ALSO GET NASAL STUFFINESS AND DRAINAGE
AS PART OF THE MIGRAINE SYNDROME, WHICH MAKES YOU THINK, OH, IT'S MY ALLERGIES,
IT'S MY SINUSES. I GET A LOT OF REFERRALS FROM THE EAR, NOSE AND THROAT ONCE
THEY SAID, OKAY, THE SINUSES LOOK GOOD, BUT YOU'VE STILL
GOT THESE SEVERE HEADACHES AND, SO, A LOT OF SINUS
HEADACHES I REDIAGNOSE AND IT'S REALLY COMMONLY
MIGRAINES. I THINK THAT'S A REALLY GOOD POINT.
>> YEAH. I THINK THAT'S PROBABLY SOMETHING THAT I SEE A LOT AS
A PRIMARY CARE PROVIDER BECAUSE THEY DON'T USUALLY GO
RIGHT TO THE NEUROLOGIST WHEN THEY THINK THEY'VE GOT A SINUS PROBLEM.
>> YEAH. I DOUBT THEY PROBABLY EVER DO.
>> NO, NO. THAT'S NOT USUALLY WHERE THEY GO.
>> YEAH.
>> WE DO HAVE A QUESTION. AND I THINK THIS IS A GOOD ONE.
IT REFERS TO SOMETHING YOU AND I WERE TALKING ABOUT A LITTLE EARLIER.
AN INDIVIDUAL FROM SIOUX FALLS WHO WANTS TO KNOW ABOUT BOTOX AND IF IT'S SAFE?
>> SO, BOTOX IS ONE OF THE PROVEN TREATMENTS, ACTUALLY, FOR MIGRAINE.
IT'S ONE OF THE FEW DRUGS THAT'S ACTUALLY INDICATED AS A
DIRECT TREATMENT. FOR MIGRAINE, RIGHT.
>> AND THAT'S AN IMPORTANT THING TO RECOGNIZE, LIKE IN SO
MANY THINGS IN MEDICINE, A LOT OF WHAT WE DO AREN'T FORMALLY
APPROVED TO TREAT WHATEVER PROBLEM IT IS THAT WE'RE TREATING.
>> WE USE THEM OFF LABEL.
>> WE USE THEM OFF LABEL, RIGHT BUT BOTOX IS ACTUALLY APPROVED.
>> IS APPROVED. AND I'VE BEEN INJECTING BOTOX SINCE -- ABOUT SINCE WE
STARTED USING IT THERAPEUTICALLY FOR MIGRAINE BECAUSE THAT WAS RIGHT ABOUT
THE TIME I WAS GETTING OUT OF RESIDENCY. SO, I STARTED INJECTING IN
ABOUT -- ACTUALLY, I STARTED IN 1998 USING BOTOX.
AND, SO -- AND IT CHANGED OVER TIME.
WE STARTED WITH A REALLY LOW DOSE. WE STARTED WITH ABOUT 50 UNITS.
NOW WE START WITH 155. IT GOES BY UNITS RATHER THAN
MILLIGRAMS BECAUSE IT'S A REALLY SMALL DOSE.
BECAUSE IT IS BOTULISM. IT'S THE TOXIN. AND THERE'S A SET SERIES THAT
HAS BEEN PROVEN AND STUDIED. IT IS -- IT'S VERY SAFE.
YOU KNOW, EVERY DRUG HAS SIDE EFFECTS.
AND, AGAIN, AS WE KNOW FROM THE WORD, IT'S A TOXIN.
>> RIGHT.
>> SO, I DO SEE PEOPLE VERY RARELY GETTING SOME PAIN AT
THE BACK OF THEIR HEAD. AND I THINK THAT'S PRIMARILY
BECAUSE I LOOSEN SOME OF THE MUSCLES BACK THERE AND OTHER
MUSCLES HAVE TO KIND OF WAKE UP AND, YOU KNOW, WORK A LITTLE BIT HARDER.
>> COMPENSATE FOR THAT.
>> IF THEY GET THAT, THEY'LL HAVE THAT FOR USUALLY JUST A
FEW DAYS. THERE'S BEEN REPORTS OF KIND
OF SOME GENERAL ILLNESS, LIKE A FLU-LIKE SYMPTOM.
AS FAR AS I KNOW, MY PATIENTS HAVEN'T HAD THAT.
THEY MIGHT NOT NECESSARILY TELL ME, AS LONG AS IT'S MILD.
BUT FOR THE MOST PART, I DON'T HEAR SIDE EFFECTS.
AND THERE'S SIDE EFFECTS TO A LOT OF THE MEDICATIONS THAT WE USE FOR PREVENTION.
>> ABSOLUTELY.
>> SO, IF I WAS GOING TO PICK JUST PURELY AS FAR AS SIDE
EFFECTS, I WOULD PROBABLY, IF IT WAS ME THAT WAS GETTING IT,I WOULD PROBABLY CHOOSE BOTOX.
>> HOW OFTEN DO YOU SEE SKIN IRRITATION OR SKIN INFECTIONS?
>> NOT VERY OFTEN. I DO GET SOME BRUISING, YOU
KNOW, IF I HAPPEN TO HIT ONE OF THOSE LITTLE VEINS THAT I CAN'T SEE.
YOU CAN GET SOME BRUISING. YOU'RE NOT SUPPOSED TO GIVE IT
IF THERE'S SIGNS OF INFECTION IN THAT AREA.
BUT YOU CAN USUALLY GO AROUND ANY LITTLE INFECTED AREA.
>> RIGHT.
>> SO, NO, I DON'T REALLY SEE THAT AS A PROBLEM.
>> DEFINITELY SOMETHING WORTH
THINKING ABOUT FOR THOSE CHRONIC MIGRAINE SUFFERERS.
>> RIGHT.
>> IT IS SELDOM THAT THERE IS JUST ONE CAUSE FOR A HEADACHE.
LIKE MUCH OF LIFE, IT'S COMPLICATED.
>> YOU KNOW, IT'S PROBABLY BEEN ABOUT SEVEN OR EIGHT
YEARS SINCE I STARTED GETTING, YOU KNOW, FREQUENT HEADACHES.
AND AT FIRST I THOUGHT IT WAS JUST BAD SINUS INFECTION.
SO I WAS ACTUALLY SEEKING SOME TREATMENT FOR THAT.
BUT IT WAS WEIRD BECAUSE I'D HAVE THEM A COUPLE DAYS AND THEN IT WOULD GO AWAY.
THEN IT WOULD COME BACK AGAIN. AND LUCKILY, MY DOCTOR, DEB
JOHNSTON, INVESTIGATED A LITTLE FURTHER, AND CONNECTED DIFFERENT HORMONAL CHANGES AS
I AGE, AS A FEMALE, THAT, YOU KNOW, IS CONNECTED TO THE
FREQUENCY AND SEVERITY OF THE HEADACHES. SO, STARTED THE ROAD OF
TREATMENT THAT WAY. I GET THIS PAIN LIKE YOU WOULD
THINK OF SINUS INFECTION WOULD FEEL LIKE, GET THIS PAIN, IT
STARTS IN THE MIDDLE, KIND OF, OF MY NOSE, AND SOMETIMES IT'S
WORSE ON ONE SIDE THAN THE OTHER. AND I REALLY NEED TO JUST TAKE
ONE OF THE PILLS RIGHT AWAY IF I CAN BEFORE IT GETS WORSE
BECAUSE IT'S REALLY HARD, I THINK MOST HEADACHE SUFFERERS
WILL TELL YOU IT'S REALLY HARD ONCE YOU HAVE A FULL-BLOWN
MIGRAINE TO GET ON TOP OF IT. SO IT'S A MIXTURE OF SOME DIFFERENT MEDICATIONS.
RIGHT NOW I TAKE RELPAX WHICH WORKS REALLY WELL WHEN I DO
HAVE A HEADACHE SO I TAKE THAT AS NEEDED.
I HAVE ABOUT SIX TO SEVEN EPISODES -- OR HEADACHE DAYS A
MONTH, WHICH IS LESS THAN IT USED TO BE.
AND THEN THERE'S JUST SOME DIFFERENT HORMONAL-TYPE THINGS
THAT MY DOCTOR HAS WORKED WITH ME TO HELP DECREASE THE
FREQUENCY OF THE HEADACHE AND THE SEVERITY THAT CAN BE
RELATED TO HORMONAL CHANGES AS WOMEN AGE.
BEFORE I GOT SOME RELIEF AND SOME DIFFERENT THINGS THAT
WOULD WORK, I JUST WOULD HAVE SEVEN OR EIGHT REALLY BAD DAYS.
AND IT WASN'T JUST THE BAD DAY YOU HAVE THE HEADACHE, YOU
KNOW, YOU USUALLY FEEL PRETTY WIPED OUT THE DAY AFTER, AND,
YOU KNOW, THAT CAN MAKE IT HARD TO WORK. I DON'T SKIP WORK BECAUSE OF MY HEADACHES.
I PLOW THROUGH THEM. I'M LUCKY TO BE ABLE TO DO THAT.
THERE'S DIFFERENT, YOU KNOW, SOCIAL THINGS OR EVENTS AND
THINGS THAT IF I'VE HAD A MIGRAINE THAT DAY, I JUST
DON'T GO TO, JUST NOT UP TO IT. SO, I DO KNOW, THOUGH, THAT IF
ONE IS STARTING, YOU CAN KIND OF FEEL IT, IT'S LIKE YOU JUST
FEEL WHERE IT'S GOING TO START, THAT IF I CAN, YOU KNOW, GET ON TOP OF IT AND
TAKE SOMETHING, THEN I CAN PROBABLY DECREASE THE SEVERITY
OR THE LENGTH OF THE SUFFERING THAT DAY TO A FEW HOURS
COMPARED TO, YOU KNOW, A FULL 24 HOURS. I THINK JOURNALING THINGS OUT
AND KEEPING TRACK OF WHAT'S GOING ON OR, YOU KNOW, EVEN
KEEPING A FOOD AND DRINK DIARY, MAYBE YOU'RE TRIGGERED
BY SOME OF THOSE TYPES OF THINGS, YOU KNOW, MAYBE IT'S STRESS IN YOUR LIFE OR
WHATEVER, BUT TRY TO DO SOMETHING FOR IT.
YOU KNOW? YOU DON'T NEED TO SUFFER UNNECESSARILY FOR LONG PERIODS OF TIME.
SOMETIMES THERE'S NOT A LOT THAT CAN BE DONE, BUT I DO
KNOW THAT OUR DOCTORS CAN REFER YOU TO OTHER PLACES TO
SEEK EVEN FURTHER TREATMENT FOR THE HEADACHES.
>> SO WE HAD A QUESTION COME IN WHILE WE WERE LISTENING TO BECKY'S TALK THERE.
A WOMAN FROM HARRISBURG, WHO WANTED TO TALK ABOUT SOME HOME REMEDIES FOR HEADACHES,
AND I THINK THAT'S A GREAT QUESTION. SO, WHAT ARE SOME OPTIONS FOR PEOPLE WITH HEADACHES?
>> WELL, WHAT I ALWAYS LIKE TO EDUCATE PEOPLE IS THE THINGS
THEY CAN DO TO HELP AVOID A HEADACHE, THINGS THEY CAN DO JUST IN THEIR LIFE.
SO YOU WANT TO EAT ON A REGULAR SCHEDULE. DON'T SKIP BREAKFAST.
SLEEP ON A REGULAR SCHEDULE. SO IT'S NOT JUST HAVING, YOU
KNOW, SEVEN OR EIGHT HOURS OF SLEEP, IT'S ACTUALLY GETTING
TO BED AT THE SAME TIME AND GETTING UP AT THE SAME TIME.
>> AND NOT OVERSLEEPING.
>> OVERSLEEPING.
>> THAT'S AN IMPORTANT ONE.
>> OVERSLEEPING OR UNDERSLEEPING, BOTH ARE BAD. SO KEEP A REGULAR SLEEPING
SCHEDULE, REGULAR EATING SCHEDULE, AVOID FOODS WITH
PRESERVATIVES, MINIMIZE YOUR CAFFEINE, EXERCISE REGULARLY.
AND THAT DOESN'T MEAN LIKE YOU NEED TO GO CRAZY OR ANYTHING.
IF YOU'RE GOING TO A 20-MINUTE WALK THREE TIMES A WEEK,
THAT'S A REALLY GOOD PLACE TO START.
MORE IS BETTER. SO ALL OF THOSE THINGS CAN HELP AVOID HEADACHES.
>> STAYING WELL HYDRATED.
>> STAYING HYDRATED IS REALLY IMPORTANT, EXACTLY.
I DON'T KNOW WHAT THEY MEAN BY HOME REMEDIES EXACTLY, BUT THERE ARE, OF COURSE, SOME
OVER-THE-COUNTER MEDICATIONS THAT YOU CAN USE.
THERE'S ALSO A LOT OF TALK RECENTLY ABOUT, LIKE, THE
ESSENTIAL OILS, AND ONE OF THOSE THAT'S ACTUALLY BEEN
STUDIED AND PROVEN IS FRANKINCENSE.
>> REALLY?
>> YEAH. SO THAT'S ONE THAT I HAVE
LEARNED ABOUT RECENTLY. SO I THINK, YOU KNOW, THOSE KIND OF THINGS CAN BE --
>> AEROSOLIZED.
>> THEY DIDN'T SAY. THIS IS AT THE AMERICAN
HEADACHE SOCIETY MEETING. BUT I KNOW MY PATIENTS HAVE
DONE IT, USUALLY THEY'LL RUB IT ON THEIR FOREHEAD.
>> I DON'T KNOW WHAT IT TASTES LIKE. I DON'T KNOW IF THEY CAN DRINK
IT OR EAT IT. I DON'T KNOW. I DON'T KNOW WHAT THAT SMELLS LIKE.
>> I DON'T THINK I'D DO ANY ESSENTIAL OILS INTERNALLY.
>> YEAH. SO THAT IS ONE THAT'S -- THAT'S BEEN PROVEN.
AND, IN GENERAL, YOU WANT TO AVOID CERTAIN SMELLS.
YOU KNOW, SO IF YOU CAN AVOID PERFUMES OR POTPOURRIS OR CANDLES, YOU KNOW, KIND OF
KEEP YOUR ENVIRONMENT AS CLEAN AS YOU CAN IN THE HOME, YOU
KNOW, AS FAR AS SCENTS AND SMELLS, THAT'S BETTER AS WELL.
>> I THINK ONE THING THAT'S IMPORTANT TO POINT OUT IS WITH
THE OVER-THE-COUNTER REMEDIES, YOU DON'T WANT TO OVERDO THOSE.
>> RIGHT.
>> BECAUSE YOU CAN GET INTO THAT MEDICATION OVERUSE
HEADACHE SITUATION AND IF YOU'RE GETTING HEADACHES, IF
YOU'RE USING YOUR MEDICATION MORE THAN A FEW TIMES A WEEK,
THEN YOU REALLY NEED TO BE COMING IN AND TALKING WITH
YOUR DOCTOR BECAUSE YOU'RE RUNNING THE RISK OF HAVING THE
MEDICATION ACTUALLY CAUSING THE HEADACHE.
>> EXACTLY. AND THAT USED TO BE CALLED -- THAT USED TO BE CALLED
WITHDRAWAL HEADACHES, SO CAFFEINE WAS KIND OF THE
FAMOUS ONE AT THAT TIME. AND THEN THEY CHANGED IT TO
REBOUND HEADACHES. ACTUALLY, THEY CHANGED THE
NAME TO MEDICATION OVERUSE HEADACHES, SO THAT PEOPLE KNOW WHAT THEY'RE DOING.
SO JUST TO KIND OF LABEL IT AND LET PEOPLE KNOW THAT --
>> REINFORCE THAT. RIGHT.
>> SO ANY TIME YOU'RE TAKING A MEDICATION THAT YOU TAKE AT
THE TIME OF THE HEADACHE, WHAT WE CALL A SYMPTOMATIC
MEDICATION, IF YOU'RE TAKING THAT MORE THAN TWO TO THREE
TIMES EVERY WEEK, THEN YOU'RE AT RISK OF THE REBOUND OR MEDICATION OVERUSE.
IT'S A DULL HEADACHE THAT THAT'S THERE WHEN YOU GET UP,
IT WAXES AND WANES THROUGH THE DAY, DEPENDING ON WHEN YOU'RE TAKING YOUR MEDICATIONS.
BUT EVENTUALLY YOU CAN HAVE NO HEADACHE-FREE TIME.
IF YOU DO THAT. SO, IT'S REALLY IMPORTANT IF YOU'RE USING THEM ON A REGULAR
BASIS THAT YOU GO IN TO YOUR PHYSICIAN AND SEE WHAT ARE YOU
DOING, ARE THERE TRIGGERS, DO YOU NEED A PREVENTIVE MEDICATION.
>> WHAT TYPE OF HEADACHE IS THIS, IS THIS SOMETHING ELSE THAT YOU SHOULD BE DOING.
>> EXACTLY.
>> ONE TREATMENT THAT I FIND IS OFTEN UNDERAPPRECIATED IS ICE.
ICE OR HEAT. THOSE PHYSICAL MODALITIES. THERE ARE A FEW SITUATIONS
WHERE THAT MIGHT NOT BE SAFE FOR SOMEBODY, BUT IT'S PRETTY RARE FOR THAT NOT --
>> IT'S A REALLY GOOD PLACE TO START, THOUGH, RIGHT.
>> FOR A HOME REMEDY. I WANT TO POINT OUT TO
EVERYBODY, THIS IS YOUR SHOW, YOUR QUESTIONS ARE KEY TO OUR DISCUSSION.
CALL IN YOUR QUESTIONS ABOUT HEADACHES TO 1-888-376-6225 OR
SEND US AN EMAIL TO ASK@PRAIRIEDOC.ORG. SO THAT'S A QUESTION ABOUT HOME REMEDIES.
YOU KNOW, I THINK EVERYBODY WHO HAS HEADACHES IS PROBABLY
FAMILIAR WITH IMITREX, WHICH WAS REALLY REVOLUTIONARY WHEN IT CAME OUT.
>> RIGHT.
>> WHAT IS IT, 25 YEARS AGO NOW?
>> ACTUALLY, THAT WAS IN ABOUT 1994.
>> OKAY.
>> I WAS IN RESIDENCY AT THE TIME SO I REMEMBER WHEN THAT CAME OUT.
AND IT REALLY CHANGED HOW WE TREATED HEADACHES.
>> YES. IT CHANGED PEOPLE'S LIVES.
>> RIGHT.
>> IN A MAJOR WAY. AND NOW, OF COURSE, IT'S GOT
SEVERAL SIBLING DRUGS THAT ARE AVAILABLE OUT THERE.
>> RIGHT.
>> ARE THERE ANY NEWER THINGS OUT THERE FOR HEADACHE?
>> WELL, BOTOX IS PROBABLY THE NEWEST THING THAT HAS COME OUT.
AND THAT WAS ACTUALLY QUITE A FEW YEARS AGO.
THERE'S ANOTHER DRUG THAT IS JUST RIGHT ON THE CUSP, WE'RE
JUST WAITING FOR IT, IT'S GOT A TOTALLY DIFFERENT MECHANISM OF ACTION.
I DON'T KNOW TOO MUCH ABOUT IT YET.
BECAUSE WE DON'T KNOW A NAME, WE DON'T KNOW HOW IT'S GIVEN,
WE DON'T KNOW A DOSE. WE'LL FIND THAT OUT WITH
EVERYBODY ELSE ON THE "TODAY" SHOW.
BUT THERE IS SOME REALLY EXCITING HEADACHE RESEARCH.
THERE'S ALSO SOME RESEARCH THAT WE'VE DONE THROUGH OUR
OFFICE THAT I KNOW YOU'RE FAMILIAR WITH ON HEADACHES
CALLED EYEGRAINES THAT HAVE TO DO WITH HOW YOUR EYES WORK TOGETHER.
AN OPTOMETRIST IN MITCHELL HAS DEVELOPED SOME PATENTED LENSES
TO HELP YOUR EYES WORK TOGETHER AND AVOID THAT
PARTICULAR HEADACHE TYPE. SO THAT'S SOME EXCITING RESEARCH, TOO.
AND THAT'S SOMETHING THAT'S NOT A MEDICATION, WHICH IS
NICE, TO HAVE SOMETHING THAT'S NOT A MEDICATION OPTION.
>> SPEAKING OF NONMEDICATION OPTIONS, WHAT IS YOUR
EXPERIENCE BEEN WITH, WHAT IS IT CALLED, CEPHALY, THE LITTLE TENS UNIT.
>> THAT'S THE CEPHALY DEVICE. IT IS A TENSE UNIT, IT'S PUT
ON YOUR FOREHEAD, THE END POINTS OF THE MIGRAINE, PUT ON
THAT NERVE, THE TRIGEMINAL NERVE, IT LOOKS LIKE YOU TOOK
SOME CLASSES AND PUT THEM UP UP ON YOUR FOREHEAD. SORT OF LIKE A HEAD BAND.
IT'S A STICKER, IT STICKS THERE. THERE'S A NEW UNIT THAT CAME
OUT, THAT'S VERY SMALL, LIKE THE SIZE OF A 50 CENT PIECE OR
A LITTLE BIT SMALLER, WITH THE STICKER, IT GOES JUST RIGHT ON YOUR HEAD.
AND I HAD KIND OF MIXED RESULTS WITH IT.
I THINK THAT'S A LITTLE BIT OF A MILDER MIGRAINE.
IT'S FOR PREVENTIVE THERAPY SO, YOU PUT IT -- YOU USE IT FOR 20 MINUTES EACH DAY.
SO I'VE HAD -- I'VE HAD A FEW PATIENTS USE IT.
AGAIN, SOMETHING THAT'S NOT A MEDICATION.
GOOD FOR PEOPLE THAT ARE INTOLERANT TO MEDICATIONS,
GOOD FOR PEOPLE THAT ARE PREGNANT, SOMEBODY THAT CAN'T
TAKE -- MAYBE EVEN SOMEBODY YOUNGER THAT CAN'T TOLERATE
MEDICATIONS AS WELL, POTENTIALLY.
>> INTERESTING. INTERESTING.
>> THERE'S ACTUALLY SOME OTHER NEWER ONES.
THAT ONE GOES AT THE FRONT OF YOUR HEAD.
BUT THERE'S SOMETHING CALLED AN SPMS DEVICE THAT IS -- IT'S
LIKE A LITTLE -- A LITTLE POP OF -- IT'S NOT REALLY LIKE AN
ELECTRICAL SHOCK, BUT IT'S THIS THING THAT YOU HOLD ON
THE BACK OF YOUR HEAD AND IT GIVES YOU THESE LITTLE PULSES.
AND IT SOUNDS KIND OF QUIRKY, BUT THAT'S ACTUALLY PROVEN, TOO.
AND, SO, THAT'S SOMETHING THAT'S JUST COME OUT.
WE'LL SEE HOW THAT WORKS, THE STUDIES LOOK GOOD, IT'S FAIRLY
EXPENSIVE BECAUSE IT'S NEW. SO I THINK THAT MIGHT BE A LIMITER.
BUT THERE ARE A FEW THINGS THAT ARE COMING DOWN THE PIKE,
WHICH IS NICE, BECAUSE WE HAVEN'T HAD ANYTHING NEW FOR A WHILE.
>> TALK TO ME ABOUT MASSAGE AND HEADACHES. WHAT DO YOU SEE THE ROLE OF
GETTING MASSAGES FOR PEOPLE WITH HEADACHES?
>> WELL, I THINK MASSAGE IS GOOD FOR A COUPLE OF REASONS.
IT DOES CAUSE SOME STRESS RELIEF, WHICH IS HELPFUL
BECAUSE I MENTIONED THAT'S A TRIGGER. BUT WHEN PEOPLE GET MIGRAINES,
BECAUSE OF THIS TRIGEMINAL NERVE BEING INVOLVED AND WHERE
THAT COMES FROM IN THE BRAIN STEM, IT ACTUALLY ACTIVATES
INTO YOUR NECK SO A LOT OF PEOPLE WITH MIGRAINES, ABOUT
80%, BEFORE, DURING OR AFTER A HEADACHE, A MIGRAINE ARE GOING
TO HAVE NECK PAIN AS PART OF THEIR SYNDROME. SO WHEN THAT -- WHEN THAT
MIGRAINE IS ACTIVATED, IT ACTIVATES YOUR BRAIN STEM AND
INTO YOUR NECK AND CAUSES THAT TIGHTNESS IN YOUR NECK AND
SHOULDERS, GETTING THE MASSAGE CAN LOOSEN THAT UP.
NOW, IT DOESN'T GET TO THE UNDERLYING MECHANISM OF THE
HEADACHE, BUT IT GETS TO KIND
OF THE END POINT WHERE YOU CAN RELAX YOUR MUSCLES AND, YOU
KNOW, JUST KIND OF MORE FORSYMPTOMATIC RELIEF. SO THAT'S A GOOD OPTION.
>> GOOD. A QUESTION CAME IN ABOUT SOME
DIFFERENT TYPES OF HEADACHES THAT PEOPLE MIGHT EXPERIENCE
BESIDES WE SPENT A LOT OF TIME TALKING ABOUT MIGRAINES, WHICH
ARE CERTAINLY ONE OF THE MOST COMMON TYPE OF HEADACHES THAT
PEOPLE COME TO CARE FOR, BUT THIS QUESTION WAS ABOUT A POST CONCUSSIVE HEADACHE.
SO, THE QUESTION HAD TO DO WITH HOW LONG PEOPLE COULD
EXPECT TO EXPERIENCE HEADACHE AFTER A CONCUSSION?
AND SPECIFICALLY AN ELDERLY LADY WHO HADN'T HAD HEADACHES
BEFORE HER CONCUSSION AND NOW AFTER A FALL AND A CONCUSSION,
SHE'S GETTING HEADACHES.
>> WELL, THERE'S A FEW PIECES TO THAT. SO, WHEN -- LIKE IF A PERSON
WITH MIGRAINES HAS A CONCUSSION, IT CAN OFTEN
EXACERBATE THEIR HEADACHE. NOW, SOMEBODY WHO HASN'T HAD
MIGRAINES BY THIS POINT, CERTAINLY NOT A MIGRAINE
PERSON, SO, WHEN YOU GET A CONCUSSION, YOU TEND TO GET
MORE OF A GENERALIZED HEADACHE, OR IT HURTS RIGHT
WHERE YOU HIT YOUR HEAD. SO IT TENDS TO BE A SLIGHTLY
DULLER PAIN, THAN, SAY, A MIGRAINE WOULD BE POTENTIALLY
SHARP AND THROBBING, BUT THEY CAN REALLY HANG IN THERE.
IF YOU READ ABOUT IT, THEY'RE GOING TO TALK MOSTLY ABOUT A TWO-WEEK HEADACHE.
I SEE IT A LOT LONGER THAN THAT. AND IT HAS TO DO WITH A FEW FACTORS.
ONE IS THAT, YOU KNOW, IT CAUSES THE HEADACHE JUST FROM
THAT JARRING OF THE BRAIN AND THE CHANGE IN THE NEUROCHEMICALS IN YOUR BRAIN.
BUT ESPECIALLY SOMEBODY THAT'S OLDER, YOU KNOW, THEY HURT FOR OTHER REASONS.
YOU KNOW, AS THEY'RE FALLING, THEY CAN TIGHTEN UP, WHEN THEY HIT, THEY TIGHTEN UP.
SO THERE'S A LOT OF MUSCULAR COMPONENT TO IT AND PROBABLY
SOME BONE COMPONENT TO IT. SO THE PAIN'S COMING FROM DIFFERENT SOURCES.
SO, TO SAY A DEFINITE TIME THAT IT WOULD LAST IS REALLY
HARD, WITHOUT KNOWING THE WHOLE STORY, BECAUSE IT DEPENDS ON SO MANY FACTORS.
BUT IF YOU JUST LOOKED IT UP, YOU'RE GOING TO SEE TWO WEEKS
BUT I SEE IT A LOT, LASTING MUCH LONGER THAN THAT.
>> MUCH LONGER, I DO, TOO. AND OBVIOUSLY MY PATIENT
POPULATION IS NOT USUALLY AS INTRACTABLE AS YOURS.
>> RIGHT.
>> ONE OTHER QUESTION THAT REFERS BACK A LITTLE BIT TO
WHAT YOU HAD MENTIONED ALITTLE BIT BEFORE, A MAN FROM
SIOUX FALLS, WHO HAD SOME QUESTIONS ABOUT GLASSES OR NOT
HAVING GLASSES AND WHETHER THIS COULD CAUSE MIGRAINES AND
IN HIS INDIVIDUAL CASE, HIS HEADACHE WAS LOCALIZED BEHIND
HIS LEFT EYE AND WOULD GLASSES OR CONTACTS HELP ALLEVIATE HIS HEADACHES?
>> SO, I ALWAYS LIKE MY PATIENTS TO GET THEIR EYES CHECKED EVERY YEAR.
IF YOU'RE STRUGGLING TO SEE CLOSE OR AT A DISTANCE,
THERE'S GOING TO BE EYE STRAIN. THERE'S SO MUCH CONNECTION
BETWEEN YOUR EYES AND HOW THEY MOVE TOGETHER AND HOW THEY
SEE, YOUR VISUAL ACUITY OR CLARITY, AND YOUR BRAIN, THAT
YOU REALLY WANT TO BE ABLE TO SEE WELL AND GET YOUR GLASSES ADJUSTED TO THE RIGHT
PRESCRIPTION TO MAKE SURE THAT YOU'RE NOT PUTTING MORE STRAIN
ON YOUR EYES AND YOUR BRAIN. THE MIGRAINES TEND TO BE RIGHT BEHIND ONE EYE.
SO THE FACT THAT HE HAS PAIN BEHIND ONE EYE. IT'S PROBABLY A MIGRAINE.
SO YOU PROBABLY NEED MORE THAN GLASSES ALONE. BUT I -- I REALLY TRY TO
PREACH TO MY PATIENTS TO GET INTO THEIR EYE DOCTOR AND MAKE
SURE THAT THEY'RE TAKING AWAY THAT COMPONENT, THAT EYE STRAIN COMPONENT OF IT.
BUT SOMEBODY WITH HEADACHES BEHIND ONE EYE, IT'S MORE
LIKELY A MIGRAINE AND THAT'S PROBABLY NOT GOING TO BE THE SORT OF EASIER OPTION.
>> AND THAT'S A FAIRLY CLASSIC THING, IS THAT HEADACHE THERE
OR THERE IN THE TEETH, THE TEETH HURTING.
>> RIGHT.
>> SUCH A COMMON COMPLAINT FOR PEOPLE.
>> RIGHT.
>> TELL US A LITTLE BIT ABOUT THE AURA THAT SOME PEOPLE
EXPERIENCE WITH MIGRAINE BECAUSE I THINK THAT'S
SOMETHING THAT A LOT OF PEOPLE IN THE GENERAL PUBLIC UNDERAPPRECIATE.
>> SO AN AURA IS ACTUALLY PRESENT ONLY IN ABOUT 20% OF MIGRAINE PATIENTS.
SO, THAT'S WHY IT USED TO BE CALLED THE CLASSIC MIGRAINE.
NOW WE CALL IT MIGRAINE WITH AURA BECAUSE IT WAS KIND OF
SORT OF CONSIDERED THAT'S WHAT A MIGRAINE IS.
SO, THERE'S DIFFERENT TYPE OF AURA. SO THERE'S THE VISUAL AURA,
WHICH TENDS TO -- IT CAN BE THE SHIMMERING LIGHT, TEND TO
BE ON THE OUTSIDE, IT CAN BE BLACK SPOTS THAT MOVE AROUND,
ACTUALLY CAN BE VERY DISABLING WHEN SOMEBODY IS TRYING TO
WORK, SOMEBODY'S GOT THIS BLACK SPOT THEY'RE TRYING TO READ AROUND.
SO THERE'S THE DIFFERENT VISUAL AURA.
IT MIGHT BE A REALLY BRIGHT FLASHING LIGHT.
IT'S REALLY COMMON FOR THE PERSON'S VISUAL AURA TO BE THE SAME EVERY TIME.
SO YOU MIGHT HAVE A VISUAL AURA.
YOU MIGHT HAVE NUMBNESS ON ONE SIDE OF THE BODY OR THE OTHER.
SOME PEOPLE, MUCH LESS COMMONLY WILL HAVE TROUBLE WITH THEIR SPEECH.
LIKE NOT JUST A LITTLE BIT OF CONCENTRATION TROUBLE AND
TROUBLE COMING UP WITH THE WORDS, MAYBE CAN'T REMEMBER
THAT NAME, BUT MUCH MORE PRONOUNCED THAN THAT.
AND REALLY QUITE RARE HEADACHE IS A HEMIPLEGIC MIGRAINE, BUT
THE HEADACHE IS WITH A WEAKNESS LIKE THEY HAD A STROKE ON ONE SIDE.
IMPORTANT TO DIFFERENTIATE THAT TYPE. THAT PERSON DEFINITELY NEEDS A
MRI AND A WORKUP, MAKE SURE THEY DON'T HAVE STROKE RISK FACTORS.
THOSE ARE ALL AURAS. THEY TEND TO LAST ABOUT 20 OR 30 MINUTES.
IF THEY'RE LASTING MORE THAN TWO HOURS IT STARTS TO GET A LITTLE WORRISOME.
IT DOESN'T MEAN THE VISUAL AURA THAT COMES AND GOES OVER
THE WHOLE DAY, BUT EACH TIME YOU HAVE IT, IT SHOULD BE LESS THAN TWO HOURS.
>> VERY INTERESTING.
>> YEAH.
>> INTERESTING WHAT THE BRAIN CAN DO.
>> IT IS AMAZING.
>> SOMETIMES IT IS HARD TO TELL IF A NEW PAIN PRESENTS
ITSELF IF IT IS ACUTE OR CHRONIC, BUT IT IS AN
IMPORTANT DISTINCTION FOR THE PATIENT.
>> CHRONIC PAIN IS DEFINED AS PAIN OF GREATER THAN SIX MONTHS' DURATION.
AND ACUTE PAIN IS PAIN LESS THAN SIX MONTHS' DURATION THAT
WE ASSUME WILL HAVE AN END POINT AND WILL GO AWAY. WHEN IT DOESN'T, ACUTE PAIN
CAN THEN BECOME CHRONIC PAIN. ACUTE AND CHRONIC PAIN ARE, IF
UNDIAGNOSED, ARE TREATED THE SAME.
PAIN IS A PROTECTIVE MECHANISM OF THE BODY.
WHEN THE BODY'S INJURED OR THERE'S SOMETHING WRONG, AND
YOU SHOULD ALWAYS FIRST EVALUATE FOR POTENTIAL SERIOUS
CAUSES, FRACTURES OR TUMORS OR BLOOD VESSELS THAT AREN'T GROWING IN THE CORRECT PLACE.
RULE OUT THOSE KIND OF TRAGIC OR CATASTROPHIC POSSIBILITIES
BEFORE YOU START TO TREAT THE PAIN.
CHRONIC PAIN HAS A LOT OF DIFFERENT CAUSES.
IT ALSO HAS A DIFFERENT IMPACT ON EACH PATIENT'S LIFE.
WE SEE A SIGNIFICANT AMOUNT OF ANXIETY AND DEPRESSION THAT GOES ALONG WITH CHRONIC PAIN.
WE ALSO SEE A LOT OF CHRONIC PAIN IN PATIENTS WITH PRIMARY ANXIETY AND DEPRESSION.
SO, MAKING SURE THAT WE ADDRESS THE BEHAVIORAL HEALTH
SIDE OF CHRONIC PAIN MANAGEMENT IS VERY IMPORTANT
AND SOMETIMES THOSE PEOPLE WILL NEED A LITTLE MORE ACCESS
TO THE HEALTH CARE SYSTEM THAN OTHERS.
TREATMENTS FOR PAIN THAT RANGE FROM A NEW EXERCISE REGIMEN TO
A SHORT-TERM PRESCRIPTION REGIMEN TO A SURGICAL
PROCEDURE DEPENDING ON THE CAUSE.
AND THAT'S WHERE THE DIAGNOSTIC PART OF IT IS VERY
IMPORTANT TO ISOLATE THE SPECIFIC CAUSE.
AND WHEN THERE'S NO CAUSE IDENTIFIED, THAT'S PROBABLY
WHEN WE STRUGGLE THE MOST IN OVERALL TREATMENT. BE PATIENT.
THE MEDICAL WORLD RIGHT NOW IS GOING THROUGH A HUGE CHANGE IN
THEIR PHILOSOPHICAL APPROACH TO PAIN MANAGEMENT.
SO, IN THIS DAY AND AGE WE'RE TRYING TO FIND CAUSES TO THE
PAIN, WE'RE TRYING TO FIND NONMEDICATION MANAGEMENT
STRATEGIES TO DEAL WITH IT, AND AS FAR AS NONCANCER PAIN
GOES, WE'VE REALLY CHANGED OUR APPROACH WITH THE NARCOTIC
MEDICATIONS THAT WE'RE LIMITING THEM. AND THAT MAY BE THEIR PRIMARY
CARE PROVIDER, PHYSICAL THERAPIST, CHIROPRACTORS,
PSYCHOLOGISTS, NUTRITIONIST, THERE'S A WIDE VARIETY OF
PEOPLE THAT CAN CONTRIBUTE TO TREATMENT OF CHRONIC PAIN.
>> WE HAD A VERY INTERESTING QUESTION COME IN HERE.
AND THIS IS SOMETHING I HADN'T CONSIDERED BEFORE.
BUT HAS MIGRAINE EVER BEEN CONSIDERED AN AUTOIMMUNE DISEASE?
>> HUM. THAT'S A GOOD QUESTION. I'VE NEVER HEARD THAT IT IS.
THERE'S A LOT OF DIFFERENT THEORIES, THOUGH.
THE MECHANISM OF MIGRAINE HAS CHANGED OVER -- SINCE MY CAREER AND PROBABLY YOURS.
>> YEAH.
>> YOU'RE YOUNGER THAN ME.
>> NOT MUCH.
>> BUT PROBABLY OVER YOURS AS WELL.
BUT I'VE NEVER -- WELL, I THINK THAT'S A REALLY
INTERESTING QUESTION. AN INTERESTING THOUGHT.
BUT TO DATE, THERE'S NOTHING REALLY REVOLVING AROUND THE AUTOIMMUNE COMPONENT OF IT.
>> IT IS INTERESTING BECAUSE WE SEE MIGRAINES MORE COMMONLY
IN WOMEN, WE SEE AUTOIMMUNE DISEASES MORE COMMONLY IN WOMEN.
MAYBE IN 20 YEARS OUR SUCCESSORS WILL BE SITTING
HERE TALKING ABOUT HOW IT IS AN AUTOIMMUNE DISEASE. WHO KNOWS.
INTERESTING QUESTION. AND HERE'S ANOTHER ONE THAT I THINK IS ALSO INTERESTING, I
THINK THIS IS A GOOD THING TO TALK ABOUT BECAUSE I THINK IT
PLAYS INTO SOME OF THOSE OTHER TYPES OF HEADACHES THAT WE
HAVEN'T TALKED VERY MUCH ABOUT, BUT THIS INDIVIDUAL GETS A HEADACHE EVERY WEEK
THAT'S A VERY INSTANT HEADACHE, LASTS ONLY A FEW MINUTES.
THEY HAD AN X-RAY DONE, BUT NOTHING WAS FOUND.
AND WHAT WOULD SOME POTENTIAL CAUSES FOR THAT HEADACHE BE?
>> SO THAT TYPE OF HEADACHE, IT'S PROBABLY -- THERE'S DIFFERENT NAMES OF IT.
IT CAN BE CALLED AN EXERTIONAL HEADACHE, A THUNDER CLAP HEADACHE.
THOSE HEADACHES COME ON REALLY SUDDENLY.
THEY PEAK REALLY QUICKLY AND THEN THEY'RE GONE REALLY QUICKLY.
AND THEN THEY CAN LINGER WITH A LITTLE BIT OF A DULL PAIN, THOUGH.
SO, THOSE -- THE FIRST THING YOU WANT TO DO IS RULE OUT AN ANEURYSM.
NOW, PEOPLE THAT HAVE HAD SEVERAL OF THESE, IT'S PROBABLY NOT AN ANEURYSM.
BUT I ALWAYS LIKE TO GET THAT JUST TO KIND OF RULE THAT OUT,
SO THAT I CAN CONCENTRATE ON THE TREATMENT.
>> PARTICULARLY IF IT'S NOT SOMETHING THEY'VE BEEN GETTING FOR 20 YEARS OR FIVE YEARS.
>> EXACTLY, YEAH.
>> YEAH.
>> SO THAT HEADACHE TYPE IS A LITTLE BIT LESS COMMON, BUT IT'S NOT THAT RARE.
WE DO SEE IT A FAIR AMOUNT. ANOTHER HEADACHE IN THAT SAME
CATEGORY IS CALLED A PRIMARY STABBING HEADACHE, WHICH USED TO BE CALLED AN ICE PICK
HEADACHE, WHICH I LIKE THAT NAME BETTER BECAUSE IT'S VERY DESCRIPTIVE.
SO THAT TENDS TO BE A HEADACHE THAT'S IN A VERY -- KIND OF A
SMALL AREA BUT IT'S JUST REALLY SHARP AND JUST -- WILL
LAST A FEW SECONDS AND ALMOST DROP YOU TO YOUR KNEES-TYPE
PAIN AND YOU THINK, GOSH, IF THAT WAS ANY LONGER, I REALLY
WOULDN'T BE ABLE TO STAND THAT. SO THAT -- THAT HEADACHE TYPE
IS ONE THAT DOESN'T NECESSARILY RESPOND TO OVER-THE-COUNTERS, AND THEY'RE
SO SHORT, BY THE TIME YOU FIND YOUR MEDICINE, IT'S GONE ANYWAY.
BUT IT'S COMMON FOR YOU TO GET MORE THAN ONE IN A DAY.
SO, I USUALLY HAVE PEOPLE TREAT WITH, LIKE, AN OVER-THE-COUNTER IBUPROFEN,
ALEVE, ONE OF THOSE, BECAUSE THEY'RE MORE LIKELY TO GET
SOME LATER IN THAT DAY AS WELL. NOW, SOMETIMES THEY WON'T
RESPOND TO THOSE, AND YOU NEED INDOCIN, INDOMETHACIN, THEY
RESPOND TO THAT PARTICULAR MEDICATION. SO INDOMETHACIN, NONSTEROIDAL
ANTI-INFLAMMATORY DRUG, SO IN THE SAME CATEGORY AS IBUPROFEN
AND ALEVE, BUT THE SPECIFIC HEADACHE TYPE IS MORE SPECIFIC
IN THAT IT REALLY LIKES THAT ONE.
>> THE ONLY ONE WE REALLY USE THAT FOR VERY FREQUENTLY IS GOUT.
>> RIGHT, EXACTLY. YUP.
>> NOT SOMETHING YOU USUALLY TREAT.
>> NO. NEVER. BUT IT'S HARD TO TAKE THAT MEDICINE.
>> IT'S HARD ON YOUR STOMACH. YEAH, IT IS VERY HARD ON THE STOMACH.
THE OTHER THING I THINK OF WHEN I READ THAT QUESTION IS
OCCIPITAL NEURALGIA OR TRIGEMINAL NEURALGIA OR THOSE
KIND OF SHORT, STABBING, DOESN'T LAST VERY LONG, BUT
REALLY INTENSE KINDS OF HEADACHES.
>> YEAH. SO TRIGEMINAL NEURALGIA, YOU'VE HEARD ME SAY THE
TRIGEMINAL NERVE A FEW TIMES BEFORE AS MIGRAINE BUT THAT
USUALLY INVOLVES THE TOP COUPLE OF DIVISIONS.
THE TRIGEMINAL NEURALGIA IS MORE COMMON, LIKE, THROUGH THE
CHEEK AREA, OR DOWN INTO THE CHIN AND THAT IS A VERY --
THAT'S A ELECTRIC, SHARP, SEVERE PAIN.
SO IF IT'S MORE IN YOUR FACE, THAN IN YOUR HEAD, THEN I
WOULD DEFINITELY BE THINKING ABOUT TRIGEMINAL NEURALGIA.
>> YEAH. SO, -- AND THIS WAS A QUESTION
THAT I THOUGHT WAS KIND OF PLAYS INTO A LITTLE BIT OF
WHAT WE WERE TALKING ABOUT, I DON'T KNOW IF THIS INDIVIDUAL
HAD CALLED IN BEFORE OR AFTER, BUT THIS INDIVIDUAL'S
26-YEAR-OLD DAUGHTER HAD HAD A HISTORY OF TERRIBLE MIGRAINES
AND GOT THOSE NEUROLENSES, THE EYEGRAINE LENSES, THAT WE WERE TALKING ABOUT.
FOUND SIGNIFICANT MIGRAINE RELIEF AND THEY WERE ASKING
WHAT YOUR OPINION OF THOSE LENSES WAS.
>> WELL, I HAVE A GOOD OPINION OF THOSE BECAUSE I'M PART OF THAT RESEARCH.
[ Laughter ]
I'VE SEEN A LOT OF REALLY JUST MIRACULOUS ASSISTANCE IN THE
HEADACHES FROM THE NEUROLENSES. SO THAT'S NOT ACTUALLY A
MIGRAINE SO, IT'S A LITTLE BIT DIFFERENT.
SO THE EYEGRAINE HAS TO DO WITH HOW YOUR EYES WORK
TOGETHER AND SINCE EACH EYE CAN SEE, WHEN YOU OPEN BOTH OF
YOUR EYES, THE IMAGES HAVE TO MATCH UP PERFECTLY.
I MEAN, LIKE A MIRROR IMAGE OF EACH OTHER OR YOUR BRAIN
DOESN'T LIKE IT TO BE OFF SLIGHTLY.
SO, THEN ALL DAY, NO MATTER WHERE YOU'RE LOOKING, YOUR
BRAIN IS TRYING TO KEEP THOSE IMAGES MATCHED UP.
AND, SO, YOU SEE OKAY, BUT YOUR BRAIN IS BASICALLY IN OVERDRIVE.
>> RIGHT.
>> AND, SO, THERE'S A MEASUREMENT THAT WE DO WITH A
SIGHT SYNC TEST THAT MEASURES HOW YOUR EYES WORK TOGETHER.
AND IT'S NOT LIKE THEY'RE WAY OFF. LIKE, YOU AND I WOULD SEE
PATIENTS THAT HAVE DOUBLE VISION, THEY'RE PRETTY FAR OFF.
THIS IS NOT SOMETHING THAT YOU CAN JUST SEE BY LOOKING AT SOMEBODY.
AND OUT OF THAT SIGHT SYNC MEASUREMENT YOU GET A PRESCRIPTION FOR THE
NEUROLENSES SO IT'S A PATENTED PROGRESSIVE PRISM LENS SO
YOU'VE GOT THE RIGHT AMOUNT OF PRISM NO MATTER WHERE YOU'RE LOOKING.
YOU KNOW, WHETHER YOU'RE LOOKING AT A DISTANCE OR CLOSE.
AND IT BASICALLY KEEPS YOUR EYES IN SYNC.
SO THAT YOU'RE NOT PUTTING THAT TRIGEMINAL NERVE INTO OVERDRIVE.
SO, EYEGRAINES ARE A LITTLE BIT DIFFERENT.
THEY'RE MORE OF A BILATERAL HEADACHE, VERY COMMONLY AT THE
BACK AS OPPOSED TO THE FRONT. THEY'RE WORSE WITH READING AND
WORKING ON THE COMPUTER, AND WHEN YOU HAVE THAT, YOU ALSO
TEND TO GET SLEEPY WHEN YOU'RE READING OR WORKING ON THE
COMPUTER AND SOMETIMES DRY EYES. SO, YOU GET THIS MEASUREMENT,
YOU WEAR THE NEUROLENSES, YOU WEAR THOSE FOR THE MOST PART,
YOU WEAR THEM ALL THE TIME, SOME PEOPLE CAN GET AWAY WITH
WEARING THEM WITH JUST WITH READING AND WORKING ON THE COMPUTER.
AND IT BASICALLY TAKES THAT STRAIN OR THAT STRESSOR OFF
YOUR BRAIN NEEDING TO COORDINATE THOSE EYE
MOVEMENTS, AND WHEN IT DOES THAT, AND BACKING OFF,
BASICALLY, FROM THAT TRIGEMINAL NERVE, IT CAN
ACTUALLY HELP YOUR MIGRAINES AS WELL.
IT'S NOT INDICATED FOR MIGRAINE, BUT WHEN YOU GET RID
OF THE EYEGRAINE COMPONENT, YOU DON'T HAVE THAT FEED RIGHT
INTO YOUR MIGRAINE AS WELL.
>> IT'S LOWERING THAT HIGH JUMP BAR AGAIN.
>> RIGHT.
>> OR RAISING IT. HOWEVER YOU WANT TO SAY IT.
>> EXACTLY. YUP.
>> WITH SOMETHING LIKE WEARING A PATCH GIVE SOMEBODY AN IDEA
IF THAT MIGHT BE SOMETHING THAT WOULD BE HELPFUL TO THEM?
>> THAT'S A GREAT QUESTION. AND THAT'S ACTUALLY ONE OF THE WAYS WE TEST FOR IT.
IT'S HARD TO DO BECAUSE YOU WOULD NEED TO WEAR THE PATCH
FOR A WHILE, OF COURSE, YOU LOSE YOUR DEPTH PERCEPTION.
>> RIGHT.
>> SO, -- BUT IF YOU WANTED TO TRY IT AND SEE IF YOU POTENTIALLY HAVE THAT, SINCE
IT HAS TO DO WITH HOW YOUR EYES COORDINATE TOGETHER, YOU
CAN PATCH ONE EYE. AND THEN IF YOUR HEADACHES GO AWAY, THAT'S WHAT IT IS.
>> HOW LONG WOULD YOU NEED TO DO THAT TO MAKE IT A FAIR TRIAL?
>> YOU HAD WANT TO DO IT FOR SEVERAL HOURS, WE RECOMMEND
PEOPLE DO IT FOR THREE DAYS. THAT'S WHY IT GETS 0 SO TRICKY.
IF YOU COULD DO IT THE WHOLE WEEKEND, THAT'S IDEAL.
SOME PEOPLE CAN TELL RIGHT AWAY, THEY CAN TELL AFTER A COUPLE OF HOURS.
THEY TAKE THE PATCH OFF, THEY FEEL THE PULL OR THE STRAIN COME BACK.
>> INTERESTING.
>> YOU CAN DO THAT OR YOU CAN GET THE SIGHT SYNC TESTING. THAT'S AN EASIER WAY TO DO IT.
>> YEAH.
>> BUT MAYBE A LITTLE MORE TIME INVOLVED THAN JUST
PATCHING YOUR EYE FOR A WEEKEND.
>> EXACTLY.
>> THEN YOU'D KNOW THAT, GEE, THIS IS PROBABLY GOING TO BE REALLY HELPFUL.
>> RIGHT.
>> HERE'S A QUESTION THAT I THINK IS, AGAIN, REFERS BACK
TO HOW THINGS HAVE CHANGED SINCE YOU AND I WENT THROUGH MEDICAL SCHOOL.
IS MIGRAINE MOSTLY VASCULAR OR NEUROLOGICAL?
AND DOES A HOT OR COLD SHOWER HELP?
>> WELL, RIGHT. WE USED TO THINK THAT MIGRAINE WAS VASCULAR.
THAT WAS BASED ON WHAT WE WERE TAUGHT.
>> THE THEORY.
>> RIGHT. THAT'S BASED ON A THEORY FROM DR. WOLF, WHO WAS A FAMOUS
HEADACHE SPECIALIST. AND THAT THEORY WAS THAT YOU
WOULD GET SOME CONSTRICTION OF YOUR VESSELS AND THEN
DILATION, AND THAT DILATION WAS THAT THROBBING-TYPE PAIN.
WHAT WE'VE LEARNED OVER THE YEARS AS IN MEDICINE ALL THE
TIME, YOUR THEORIES KIND OF MORPH OVER TIME AS WE HAVE MORE RESEARCH.
>> LEARN MORE.
>> RIGHT. AND HAVE BETTER TESTING. THAT IT ACTUALLY HAS TO DO
WITH THE CHANGE IN THE CHEMICALS OF YOUR BRAIN AND SEVERAL OF THEM.
IT HAS TO DO WITH DOPAMINE AND SEROTONIN WHICH ARE PROBABLY
THE MOST COMMONLY DISCUSSED IN THE HEADACHE REALM.
BUT ALSO SOMEWHAT EPINEPHRINE AND NOREPINEPHRINE.
NOW THERE'S SOMETHING CALLED CGRP, WHICH IS ANOTHER
RECEPTOR THAT IS RESPONSIBLE FOR HEADACHES.
AND THAT'S ACTUALLY WHAT THAT NEW DRUG IS TARGETING THAT WE WERE TALKING ABOUT EARLIER.
>> AND THESE ARE CHEMICAL MESSENGERS, BASICALLY.
>> RIGHT.
>> THE WAY I DESCRIBE THEM TO PEOPLE, YOUR BRAIN CELLS USE THESE TO TALK TO EACH OTHER.
>> EXACTLY. AND, SO, I THINK WITH THAT QUESTION, ASKING IF IT'S
NEUROLOGIC, I THINK THAT'S PROBABLY WHAT THEY MEAN BY THAT.
I WOULD SAY, INSTEAD OF BEING A VASCULAR THING, IT'S MORE OF A BIOCHEMICAL THING.
AND WHEN THOSE CHEMICALS CHANGE IN YOUR BRAIN, IT
ACTUALLY CAUSES YOUR VESSELS TO CHANGE A LITTLE BIT BUT
THAT'S ACTUALLY NOT WHAT'S CAUSING THE PAIN. IT'S A PART OF THE --
>> SIDE EFFECT.
>> EXACTLY, IT'S JUST PART OF THE WHOLE SYNDROME.
>> AND DO YOU USUALLY FIND COLD OR HOT MORE EFFECTIVE? OR IS IT PERSON DEPENDENT?
>> I'VE SEEN BOTH. IT'S VERY PERSON DEPENDENT. BACK ON THAT WOLF THEORY, WHEN
YOU WOULD GET THE VASODILATION OF YOUR VESSELS AS THE
PRESUMED THEORY, PART OF THAT CAME FROM PEOPLE GETTING IN HOT TUBS.
YOU KNOW, YOUR VESSELS DILATE SO YOU CAN GET MORE BLOOD OUT
TO YOUR EXTREMITIES TO KIND OF DISSIPATE THAT HEAT.
AND THAT WOULD SET OFF MIGRAINES FOR PEOPLE.
SO, THAT'S KIND OF ONE OF THE WAYS THAT THEORY CAME TO BE.
SO, IN SOME PATIENTS, YES, IT WILL GET WORSE IF YOU TAKE A
HOT BATH, BUT IN SOME PATIENTS, FROM THE RELAXATION AND WHATEVER, THEY DO BETTER.
SO YOU HAVE TO FIND WHAT WORKS FOR YOU. >> THIS IS, I THINK, A VERY
RELATED, VERY IMPORTANT, INTERESTING QUESTION.
A WOMAN FROM RAPID CITY WHO WANTS TO KNOW IF G.I. SYMPTOMS, LIKE IBS OR NAUSEA
AND VOMITING ARE COMMON WITH MIGRAINES?
>> THOSE ARE COMMON. IT'S ACTUALLY PART OF THE
DIAGNOSIS, IS TO HAVE THE NAUSEA AND VOMITING.
AND IT'S REALLY -- WHEN WE'RE TALKING ABOUT THESE CHEMICALS
OR THESE NEUROTRANSMITTERS, ONE OF THE NEUROTRANSMITTERS
RESPONSIBLE FOR MIGRAINE IS SEROTONIN. THAT'S THE NEUROTRANSMITTER
RESPONSIBLE FOR HOW THINGS HAPPEN IN THE GUT.
AND, SO, THERE'S A REALLY STRONG CONNECTION BETWEEN THE
GUT AND THE HEAD. AND, SO, THERE'S A STRONG CORRELATION BETWEEN HEADACHE
PROBLEMS AND STOMACH PROBLEMS. I DON'T KNOW IF IT'S
DEFINITELY, YOU KNOW, SOMETHING WITH THE MIGRAINE
MAKES THEM MORE PRONE TO IBS. I DO SEE MORE PATIENTS THAT
HAVE THE IRRITABLE BOWEL SYNDROME THAT ALSO HAVE
HEADACHE BUT I DON'T KNOW IF IT'S TWO COMMON THINGS THAT ARE BOTH COMING TOGETHER --
>> HAPPENING COMMONLY.
>> BUT THERE'S CERTAINLY A CONNECTION WITH THE BRAIN AND
THE NEUROTRANSMITTERS AND THE GUT AND WHAT HAPPENS THERE.
>> YEAH. AND, OF COURSE, THE VOMITING
IS SUCH A COMMON PROBLEM WITH THE MIGRAINE.
>> EXACTLY. THE VOMITING CAN BE A DISABLING PART BECAUSE IT'S
HARD TO STAY AT WORK, IF THE NAUSEA AND VOMITING IS THAT BAD.
>> RIGHT. EVEN IF YOU CAN CONCENTRATE THROUGH THE HEADACHE.
>> EXACTLY.
>> YEAH. I'M NOT QUITE SURE EXACTLY WHAT THEY MEAN WITH THIS NEXT QUESTION.
WHAT ARE THE CAUSES AND TREATMENTS OF OCULAR MIGRAINE WITH RUPTURED VISION?
I SUSPECT IT MIGHT HAVE TO DO WITH THE LIMITED, THE MIGRAINE
WITH JUST THE AURA WHERE YOU DON'T GET THE HEADACHE AFTER.
>> SO THE OCULAR MIGRAINE IS
ALSO ONE OF THOSE OLDER TERMS THAT WE NOW WE CALL MIGRAINE WITH AURA.
SO, SOME PEOPLE WILL GET IT, WILL GET THE OCULAR MIGRAINE
OR THE AURA BUT NOT GET THE HEADACHE. THEY MIGHT GET THE SHIMMERING
LIGHTS OR THE BLACK SPOTS OR COLORED FLASHING LIGHTS OR
SOMETIMES THEY'LL LOSE HALF OF THEIR VISION IN EACH EYE.
SOMETIMES THEY WON'T GET THE HEADACHE. SO, I'M NOT SURE IF THAT'S
MAYBE EVEN WHAT THEY'RE TALKING ABOUT.
BUT THE MECHANISM OF THAT IS STILL THE CHANGE IN THE
NEUROTRANSMITTERS AND, THEREFORE, THE TREATMENT IS REALLY THE SAME.
NOW, THE TRICKY PART, IF YOU JUST HAVE THE AURA IS IT
OFTENTIMES IS GOING TO BE GONE IN 20 MINUTES.
AND, SO, IT'S HARD TO TREAT IT, BY THE TIME YOU FIND YOUR
MEDICINE, TAKE IT, IT GETS ABSORBED, THE AURA IS GOING TO BE GONE ALREADY.
SO IF SOMEBODY IS HAVING A REALLY FREQUENT AURA AND IT'S
GETTING IN THE WAY OF THEIR WORK OR THEY'RE DRIVING,
SOMETIMES I'LL ADD A PREVENTION MEDICINE BECAUSE
YOU JUST CAN'T TREAT IT AT THE TIME, IT'S TOO SHORT.
>> AS A PRIMARY CARE PERSON, I THINK IT'S ALSO REALLY
IMPORTANT TO SAY, THAT IF YOU'RE GETTING THESE SYMPTOMS,
YOU NEED TO GET TO THE EYE DOCTOR AND MAKE SURE THAT IT'S
NOT SOMETHING GOING ON IN YOUR RETINA THAT YOU'RE NOT HAVING
A DETACHED RETINA OR SOME OTHER INJURY TO THE EYE.
>> RIGHT.
>> SO, HERE'S ANOTHER QUESTION. I THINK GETS INTO SOME OF
THOSE NONMEDICINE TREATMENT OPTIONS. A WOMAN FROM ABERDEEN WANTING
TO KNOW IF HYPNOSIS MIGHT BE HELPFUL IN MIGRAINE TREATMENT?
AND IF YOU'RE AWARE OF ANYBODY IN THE AREA WHO MIGHT DO THAT?
>> I DON'T KNOW OF ANYBODY IN THE AREA THAT'S DOING THAT.
I THINK ALL OF THOSE THINGS HAVE TO DO, REALLY, WITH HOW
YOU'RE COPING OR MANAGING YOUR MIGRAINES.
AND I THINK ANYTHING THAT IS GOING TO WORK FOR YOU,
ESPECIALLY THINGS THAT ARE NOT A MEDICINE, ARE GOOD.
BECAUSE THE MORE YOU CAN BRING YOUR HEADACHES DOWN IN NUMBER,
YOU'RE GOING TO HAVE TO USE FEWER HEADACHE MEDICATIONS AT THE TIME.
AND, SO, THAT'S GOING TO HELP YOU AVOID REBOUND HEADACHES.
SO I'M NOT AWARE OF ANY SPECIFIC RESEARCH WITH
HYPNOSIS, AND I HAVEN'T HAD A LOT OF PATIENTS TELL ME THAT
THEY'VE DONE IT, SO, I DON'T KNOW THAT I CAN GIVE A GREAT
ANSWER ON THAT, BUT ANYTHING THAT'S GOING TO BRING YOUR
HEADACHES DOWN, I'M ALL FOR IT.
>> I ALSO THINK THAT IT KIND OF PLAYS INTO SOME OF THE
BIOFEEDBACK, THE COGNITIVE BEHAVIORAL THERAPY.
>> RIGHT.
>> I MEAN, I THINK THAT THERE'S A LOT OF NONPRESCRIPTION,
NONMEDICATION, NONDRUG THINGS THAT YOU CAN DO TO MANAGE YOUR
HEADACHES AND A LOT OF THE CHRONIC PAIN PROGRAMS
AVAILABLE THAT ARE GOOD FOR ALL KINDS OF DIFFERENT PAIN,
NOT JUST HEADACHES, BUT FIBROMYALGIA AND RHEUMATOID
ARTHRITIS AND ALL OF THOSE THINGS CAN REALLY INVOLVE THAT
AND IN A WAY, HYPNOSIS PLAYS INTO THAT KIND OF THING.
>> I THINK SO, TOO. I THINK, ALONG THAT SAME LINE, ACUPUNCTURE.
>> YES.
>> I'VE HAD A LOT OF PATIENTS HAVE REALLY GOOD LUCK WITH ACUPUNCTURE.
BUT I THINK ANY PATIENT THAT'S GOING TO GO TO A COUNSELOR,
GET SOME STRESS MANAGEMENT TECHNIQUES, ANYTHING THEY CAN
DO TO HELP WITH THE COPING DURING A HEADACHE, BECAUSE
WHEN YOU START TO GET A HEADACHE, EVERYTHING KIND OF RAMPS UP.
YOUR HEART RATE GOES UP, YOU KIND OF GET IN THAT FIGHT OR
FLIGHT MODE, WHICH MAKES YOU MORE RESPONSIVE TO PAIN IN A BAD WAY.
>> THAT'S RIGHT.
>> SO, IF SOMEBODY CAN HELP YOU, LIKE, WHEN THE HEADACHE
COMES ON, KEEP ALL OF THOSE THINGS TO A MINIMUM, IT'S
GOING TO DECREASE THE PAIN FROM REALLY RAMPING UP.
SO, ANY OF THOSE THINGS ARE REALLY GREAT OPTIONS.
>> DEFINITELY WORTH PURSUING. HERE'S A QUESTION THAT DOESN'T
QUITE RELATE TO HEADACHES, BUTA QUESTION ABOUT MORE GENERAL NEUROLOGY.
IF YOU HAD A CONCUSSION AND A MINOR BLEED, HOW LONG SHOULD YOU WAIT BEFORE YOU FLY?
>> OOH, THAT'S A QUESTION FOR A NEUROSURGEON.
NEUROLOGISTS DON'T ACTUALLY DO A LOT WITH THE BLEEDS, UNLESS
IT'S A REAL SMALL ONES FROM HIGH BLOOD PRESSURE.
I'M NOT GOING TO ANSWER THAT.
>> NOT GOING TO ANSWER THAT.
>> I DON'T WANT TO ACCIDENTALLY GIVE THE WRONG ANSWER.
>> THAT'S A FAIR RESPONSE.
>> TOO FAR OUT OF MY FIELD. YEAH.
>> WE'LL KICK IT TO THE NEUROSURGEON, WAS PROBABLY CONSULTED.
>> EXACTLY.
>> AND AN INDIVIDUAL WANTING TO KNOW, INTRIGUED BY THE NEUROLENSES,
WHERE CAN THEY GET THEM?
>> SO, THERE'S A COUPLE OF PLACES -- WELL, THERE'S A FEW
PLACES NOW THAT YOU CAN GET THEM. SIOUX FALLS FAMILY VISION YOU CAN.
THERE'S -- ONE OF THE DOCTORS, AN OPTOMETRIST, DR. OCKERMAN,
THAT DOES THEM, HE'S A GREAT WAY TO LOOK UP, THOSE ARE BOTH IN SIOUX FALLS.
THERE'S DR. JEFF CRAWL AND DR. JOE CRAWL, IN MITCHELL.
AND DR. JEFF KRAUL WAS ACTUALLY THE INVENTOR.
HIS FATHER SORT OF STARTED IT ORIGINALLY, AND DR. JEFF KRAUL
INVENTED THE SIGHT SYNC MACHINE AND PATENTED THOSE
LENSES SO IF YOU'RE CLOSE BY MITCHELL, THAT'S A GREAT PLACE TO GO.
BUT DR. KRAUL AND DR. OCKERMAN HAVE A HUGE AMOUNT OF EXPERIENCE.
SIOUX FALLS FAMILY VISION DOES IT AS WELL.
>> AND HOW IS THE INSURANCE COVERAGE FOR THAT?
>> INSURANCE DOESN'T COVER IT. LIKE YOUR EYE EXAM COULD
POTENTIALLY BE COVERED IF YOU HAVE EYE INSURANCE AND
POTENTIALLY THE FRAMES. BUT WHEN THIS FIRST CAME OUT,
IT WAS A PRETTY EXPENSIVE TREATMENT. IT WAS IN THE THOUSANDS.
WITH THE NEW RESEARCH AND THE DEVELOPMENT OF THE MACHINE.
>> RIGHT.
>> AND THE STUDIES AND STUFF. SO, THAT HAS COME WAY DOWN.
AND IT'S A LITTLE BIT DIFFERENT DEPENDING UPON WHERE YOU GO.
BUT IT'S ANYWHERE BETWEEN ABOUT 600 AND PROBABLY I THINK
AROUND $900, DEPENDING UPON IF YOU NEED, YOU KNOW,
PROGRESSIVE PRISM OR HOW BAD YOUR PRESCRIPTION IS, BUT THE
PRICE HAS COME WAY DOWN, REALLY MUCH DOWN INTO WHERE
PEOPLE CAN, YOU KNOW, MORE REASONABLY TRIAL THEM.
>> AND NOW FOR THE WINNER OF TONIGHT'S PRAIRIE DOC QUIZ QUESTION.
TRUE OR FALSE? HEADACHES CAN BE TRIGGERED BY STRONG PERFUMES.
TRUE OR FALSE? THE ANSWER IS TRUE! IT WAS LARRY WARD FROM PIERRE,
SOUTH DAKOTA, WHO ANSWERED THE QUESTION CORRECTLY.
THANK YOU, LARRY, FOR PARTICIPATING AND A BOOK WILL
BE IN THE MAIL TO YOU SOON. WE'LL BE RIGHT BACK AFTER THIS.
>> ALL AROUND TOWN, FROM STORES TO PLAYGROUND, BABIES ARE ON THE MOVE.
AND THERE ARE DISEASES THAT ARE ON THE MOVE, TOO.
AND SOME OF THESE SPREAD EASILY. TO BEST PROTECT HIM FROM 14
SERIOUS DISEASES BY THE TIME HE TURNS 2 YEARS OLD,
VACCINATE HIM ACCORDING TO THE RECOMMENDED SCHEDULE.
SO HE CAN GO ON ABOUT HIS BUSINESS AND YOU CAN HAVE PEACE OF MIND.
FOR MORE REASONS TO VACCINATE, TALK TO YOUR CHILD'S DOCTOR OR GO TO CDC.GOV/VACCINE.
>> HEADACHES ARE AN AGE-OLD AILMENT. IN FACT, WRITTEN DESCRIPTIONS
DATE BACK TO THE ANCIENT MESOPOTAMIANS AND EGYPTIANS,
WHERE THEY WERE ATTRIBUTED TO CURSES FROM DEMONS, OR TO
IMBALANCES IN THE BODY'S DIGESTIVE SYSTEM. SUGGESTED REMEDIES RANGED FROM
INCANTATIONS MEANT TO ENLIST THE AID OF THE GODS, TO
TOPICAL POULTICES MADE FROM A VARIETY OF OFTEN UNSAVORY SUBSTANCES.
IN LATER CENTURIES, ATTEMPTS TO OBTAIN RELIEF MIGHT INVOLVE
SHOCKS FROM ELECTRIC RAY FISH, OR EVEN INFLICTING PHYSICAL DAMAGE TO THE SCALP AND SKULL.
HEADACHES MAY BE GENERALLY INVISIBLE TO THE OUTSIDE
OBSERVER, BUT THE SUFFERING THEY INFLICT IS NEVERTHELESS VERY REAL.
PEOPLE CALL IN SICK, OR SHOW UP TO WORK UNABLE TO
CONCENTRATE, OR STAY HOME FROM SOCIAL AND FAMILY EVENTS THEY WANT TO ATTEND.
THE ANNUAL FINANCIAL BURDEN IS IN THE BILLIONS OF DOLLARS,
AND HOW CAN YOU QUANTIFY THE PERSONAL COST TO INDIVIDUALS AND FAMILIES?
ALMOST UNIVERSALLY, WHEN PATIENTS SHOW UP IN MY OFFICE
SUFFERING HEADACHES, THEY WANT TWO THINGS.
FIRST, RELIEF FROM THEIR SUFFERING. SECOND, RELIEF FROM THE FEAR
THAT THE PAIN THEY ARE EXPERIENCING MAY REPRESENT SOME TERRIBLE DISEASE THAT
WILL THREATEN THEIR FUTURE, SUCH AS CANCER OR A STROKE.
HAPPILY, ONLY A MINORITY OF HEADACHES ARE A SYMPTOM OF
SOME OMINOUS UNDERLYING PROBLEM. IN MOST INSTANCES, THE KEY TO
UNDERSTANDING A PERSON'S HEADACHE LIES IN UNDERSTANDING ITS PATTERN.
WHEN DOES IT STRIKE, HOW DOES IT DEVELOP, WHAT INFLUENCES
THE PAIN, FOR BETTER, OR FOR WORSE.
ONLY RARELY DO C.T. SCANS OR MRIS OR LAB WORK CONTRIBUTE TO
THE DIAGNOSIS. AS WITH SO MANY THINGS IN
MEDICINE, HAVING THE TIME TO ASK THE RIGHT QUESTIONS AND TO
LISTEN CAREFULLY TO THE ANSWERS IS IRREPLACEABLE.
HEADACHES CAN'T YET BE CAPTURED BY TECHNOLOGY.
OUR OPTIONS FOR BRINGING RELIEF, THOUGH, HAVE COME A
LONG WAY FROM THE DAYS OF OUR ANCESTORS. WE HAVE PREVENTATIVE
TREATMENTS TO REDUCE THE FREQUENCY OF ATTACKS, AND
TARGETED THERAPIES TO INTERRUPT THEM ONCE THEY START.
THIS OFTEN INCORPORATES MEDICATIONS ORIGINALLY
INTENDED TO TREAT OTHER AILMENTS, AND SOME DESIGNED
SPECIFICALLY TO TREAT HEADACHE. IT MIGHT INCLUDE BIOFEEDBACK,
OR COGNITIVE BEHAVIORAL THERAPY, OR PHYSICAL THERAPY,
OR ACUPUNCTURE, OR MASSAGE. WE OFTEN RECOMMEND CHANGES IN
DIET, EXERCISE AND SLEEP HABITS.
SOMETIMES WE EVEN USE ELECTRICITY, ALTHOUGH TODAY'S
DELIVERY SYSTEM IS A BIT MORE SOPHISTICATED THAN WHAT THE
ANCIENT ROMANS HAD AVAILABLE. AFTER 6,000 YEARS, WE ARE
GETTING CLOSER TO CONQUERING HEADACHES.
MODERN MEDICINE CAN OFFER HOPE FOR AN IMPROVED QUALITY OF LIFE.
>> A BIG THANK YOU TO OUR GUEST CAROL NELSON. HER EXPERIENCE BROUGHT GREAT
INSIGHT TO OUR DISCUSSION TONIGHT.
>> THANKS FOR HAVING ME.
>> THAT DOES IT FOR TONIGHT. FROM ALL OF US HERE AT "ON
CALL WITH THE PRAIRIE DOC," UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE.
>> WE OPEN OUR PHONE LINES AND E-MAIL TO ANY MEDICAL QUESTION YOU MAY HAVE.
IT IS OUR FIRST "ASK ANYTHING" OF THE SEASON,
NEXT TIME "ON CALL WITH THE PRAIRIE DOC."
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