Episode Transcript
[00:00:00] Speaker A: From Riverside Health System. This is the Healthy youy Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
Welcome to the Healthy youy the podcast where you explore conditions, treatments and ways to stay well.
I'm your host, Frankie Myers and today we are diving into a topic that affects millions every day.
Headaches.
From the occasional tension to chronic migraines. Understanding the root causes and treatment options can dramatically improve quality of life.
Joining me today is Dr. Ben Othman, a neurologist with Riverside Neurology Specialist who brings expert insight into this often misunderstood condition.
Dr. Ben Othman, thank you for joining us. It's great to have you here with me in the Healthy U studio.
[00:01:09] Speaker B: Thank you Frankie. It is a pleasure to be here. Headaches are something that almost everyone will experience at some point. However, for many they are more than just an occasional annoyance.
They can interfere with work, social life, relationships and overall well being.
[00:01:30] Speaker A: Absolutely.
[00:01:31] Speaker B: I am really glad that we are having this conversation today because there are so many things we can do to help patients better understand, manage and even prevent their headaches.
[00:01:41] Speaker A: Absolutely. Very insightful. Before we dive into the types of headaches and what causes them, let's take a step back and look at the big picture.
Did you know that more than 39 million Americans suffer from migraines and globally over 1 billion people are affected?
Those are staggering numbers to me and yet so many people don't seek help or think there's anything they can do about it.
What are your thoughts, Dr. Ben Hoffman? Does this line up with what you see in your current practice and are these numbers reflected in what you're seeing as far as your patient and your patient population?
[00:02:27] Speaker B: Yeah, absolutely. Absolutely, Frankie. The headaches, migraines, chronic headaches are exceedingly common and yet they are under diagnosed and undertreated.
I often meet patients who have been experiencing headaches for many years and yet they never get a proper diagnosis or even realize that what they're experiencing are actually migraines, not just bad headaches.
And what is so striking is how much these headaches can affect people's lives.
We're talking about missed work days, skipped social events, trouble sleeping, difficulty concentrating. They can be incredibly disruptive and people will try to push through or self medicate with over the counter analgesics, which actually can backfire the good news is that there are so many treatment options and strategies, but the first step is to recognize that help is available and to seek it out.
[00:03:28] Speaker A: Absolutely. I'm glad we're talking about this. I've actually had headaches, so I'm really excited about this episode and learning more. So let's start with the basics.
What exactly is a headache from a neurologist perspective?
[00:03:42] Speaker B: Yeah. So headaches are broadly divided into two types.
Primary headaches and secondary headaches. Primary headaches are headaches that are not caused by another condition. They are the condition themselves.
And thinking about the pathophysiology of migraine, it is not completely understood, but genetic plays a big role in it. An easy way to think of it is a network problem. It is an alteration of the way pain centers in the brain interact with each other. Now, among primary headaches, you have tension type headaches. Those are the most common. They are often described as a tight bend or pressure around the head.
Then you have migraine headaches. They're more complex, characterized by throbbing pain, often associated with nausea, light and noise sensitivity. Some patient will experience visual changes at the onset of some of their headaches. We call them auras. And then you have the cluster headaches. These are very severe headaches, fortunately not as common. They affect one side of the head. They are often associated with nasal congestion or tearing in one eye.
Some people become restless during the headache episodes and they come in clusters.
Now these are some of the primary headaches, but there are many more. These are the more common. Then you have the secondary headaches.
These are headaches that are caused by something else, like a brain infection, a head trauma, high blood pressure, or even brain bleed or tumor. That's why it's important to get checked out if the headache changes in features or if there are associated warning signs.
[00:05:33] Speaker A: Yes. Good. You mentioned auras. I remember that term being used for seizure activity. Things that you may experience prior to having a seizure.
[00:05:43] Speaker B: Correct.
[00:05:43] Speaker A: Would you talk a little bit more about what an aura is for our listeners?
[00:05:47] Speaker B: Right, absolutely. So an aura is an aura of a migraine, is there?
It can be visual, sensory, speech, motor, but the most common is visual. And people that have this can see these scintillating scotomas, jagged lines that precede their headaches. And they progress gradually over minutes, usually five, 20 minutes. And then the headache start. Okay. Some people will experience the aura without the headache. We call it asaphalgic migraine.
[00:06:18] Speaker A: Okay. Okay. Good stuff.
Many people self diagnose themselves and their headaches. What are some of the signs of a headache may be coming or may be very serious and require evaluation. You mentioned a little bit, right?
[00:06:37] Speaker B: Yeah. So most headaches are not dangerous, but there are certainly red flags that will signal that someone needs to be checked out.
There's one condition in particular that we worry about. It's a sudden headache that is very severe that we call thunderclap headache. And that is when the patient complain of the worst headache in their lives and the headache comes on instantly. That can be a sign of something serious brain bleed that needs to be evaluated immediately.
Another situation is when the headache is associated with other neurologic symptoms such as blurred vision, slurred speech, weakness or numbness on one side of the body, or confusion or difficulty speaking.
[00:07:25] Speaker A: Right.
[00:07:25] Speaker B: Those could be signs of stroke or something else focal in the brain and needs to be evaluated.
Now, we also pay attention to a change in the headache features. The headaches increase in frequency, intensity, pattern. For example, if someone was experiencing a headache, mild headache once a week, and all of a sudden is having daily severe headaches, that's something that needs to be checked out. And finally, if a headache wakes you up from sleep or gets worse when lying down, that raises concern about increased pressure the brain and needs to be evaluated.
[00:08:02] Speaker A: Absolutely.
[00:08:02] Speaker B: Now the bottom, so the bottom line is that if a headache changes in feature or there are associated symptoms, don't ignore it. It's better to be safe and get it checked out.
[00:08:12] Speaker A: Yes, yes. When in doubt, check it out.
[00:08:14] Speaker B: Absolutely.
[00:08:15] Speaker A: Absolutely. That, that's great information. I know I've, I've had headaches and I can identify maybe what's causing them for myself. I know if I eat a lot of salt, I get a, I get a headache and it's probably because my blood pressure's up. So sometimes you can tell knowing your body. And I think it's also important for our viewers to have those relationships with their primary care that you're having those annual checkups and you have those relationships that if something needs to be evaluated, they can link you to the appropriate resource. And what would you say about that is, do you see a lot of your patient population coming from primary care?
[00:08:54] Speaker B: Well, so you know when someone has and ongoing headaches or worsening headaches, they should definitely check in with their primary care physician. They know your medical history and they're well equipped to start an evaluation, particularly when the headaches are infrequent or mild.
The primary care physician can evaluate the patient's symptoms, explore potential triggers and initiate basic treatment strategies. Now, if the headaches become more Complex, more chronic, not responding to usual treatments. That's usually, usually when your primary care physician will refer you to a specialist like a neurologist like myself. We can dig deeper into the diagnosis, explore treatment options and design a long term treatment plan.
[00:09:42] Speaker A: Absolutely, absolutely.
Let's talk about, we've already talked a little bit about some of the triggers and what are the common lifestyle or environmental triggers for headaches?
[00:09:52] Speaker B: Yeah, the triggers play a huge role and you know, for migraines, but also for tension type headaches.
And what's tricky is that they can vary from one person to the other.
Some of the common triggers include stress. That's probably the most common. And what's interesting is that some patients actually will experience headaches when the stress has let up. We call them weekend headaches.
[00:10:17] Speaker A: Absolutely.
[00:10:18] Speaker B: Sleep, not enough sleep, too much sleep, or even irregular sleep schedule, all problematic diet, skipping meals, caffeine withdrawal, and certain foods. It's a long list of food triggers. The most common food triggers are artificial sweetness in sodas, aged cheese, cured meat, red wine, msg, dehydration, even mild dehydration can be a trigger for some patients hormones, but this applies particularly in women.
Fluctuation in estrogen levels, such as during menstruation, pregnancy, menopause, can affect migraines, environmental factors, bright light, loud noises, strong smells, all changes in barometric pressure can be triggered. And then you have computer screen and.
[00:11:14] Speaker A: Posture and TVs, right?
[00:11:16] Speaker B: Exactly.
[00:11:16] Speaker A: Close positioning.
[00:11:17] Speaker B: Exactly. So spending too much time in front of the TV or front of computer screen, poor ergonomics, looking down at the phone for hours, all can be triggered. So that's why it's important to keep a headache log, because then that can potentially help you identify your own triggers.
[00:11:36] Speaker A: That's good, that's good stuff there. Very good. Is there a connection between mental health and headaches?
[00:11:41] Speaker B: Absolutely. Franke headaches and mental health are deeply interconnected and we see that in our patients on a daily basis.
So conditions like depression, anxiety, mood disorder, ptsd, chronic stress can definitely increase the frequency and the intensity of headaches. The brain pain and emotional centers are closely linked and so if someone is under emotional strain, their pain sensitivity is heightened and their headaches are more likely to become more persistent and difficult to treat.
Now, at the same time, if someone is living with frequent headaches, that is bound to affect their mental health. It's not just one way street.
[00:12:30] Speaker A: Yeah, the quality of life and everything.
[00:12:32] Speaker B: Exactly. So people will feel frustrated, isolated and anxious about when the next attack is going to hit, particularly when the headaches affect Their social life, their work, their sleep, and you end up with this vicious circle where mental stress and headaches feed into each other.
That's why the holistic approach to treatment is very important. So treating the physical symptoms of migraines is one piece of the puzzle, but supporting emotional well being is just as critical. And for some patients, that may mean working with a therapist or practicing mindfulness or incorporating stress management techniques into their daily routine. Routine.
[00:13:17] Speaker A: That's good stuff there. Thank you.
Let's talk about what happens when someone seeks help for ongoing headaches. Many people may not know that the first step should be talking with the primary care, as we mentioned, and you've already walked us through this process. Anything else you want to add as it relates to that?
[00:13:35] Speaker B: No, absolutely. I think primary care physician should be your first stop for most patients.
[00:13:40] Speaker A: All right, Very, very good, good stuff, stuff.
All right. So moving right along, all of that makes a lot of sense, especially as it relates to, you know, escalating care.
Once someone is referred to you, walk us through what that looks like, you know, what, what, what does that patient experience look like?
[00:14:02] Speaker B: So when, when, when somebody is referred to us for headaches, our first, first goal is to absolutely get to the root of what's causing their headaches. So we start with the history and we ask a lot of questions, A lot of questions.
The headache features, the associated symptoms, what medication they've tried, what doses, for what duration. We also ask about lifestyle, habit, their sleep, the stress level, any potential triggers. We ask about family history and then comes the neurologic exam, and that is to rule out anything serious. We want to make sure there is no signs of increased pressure in the brain, no nerve dysfunction. Now, for most patients with primary headaches, like migraines or tension type headaches, that exam is usually normal.
But if there are any red flags, whether it's from the history, the feature of the headaches, or abnormalities on the examination, then we will order some testing or the CT or mri.
Now, for most patients with a thorough history and exam, we are able to secure a solid diagnosis without having to do much testing. And then that allows us to move rapidly towards designing a treatment plan that is focused both on relief and prevention.
[00:15:23] Speaker A: Good, good, good.
Once diagnosed, what are some of the treatment pathways or treatment modalities, especially for conditions like migraines? Right.
[00:15:33] Speaker B: So the treatment is divided into two categories. You have acute treatment and preventive treatment. Acute treatment is something you take as needed when you get a headache to stop the headache that day to relieve the symptoms. Preventive treatment Goal is for you not to have the headaches to begin with or at least that's not always possible. To at least make them a lot less frequent, less severe, more responsive to treatment. So that's how the now the acute treatment some patient will respond to. Simple analgesic may respond to acetaminophen or anti inflammatory like ibuprofen or combination medications like Excedrin. Those are fine, particularly when the headaches are mild, but people should not overuse them.
[00:16:17] Speaker A: Okay.
[00:16:18] Speaker B: Now for mild to, for moderate to severe headaches we might prescribe triptans or one of the newer medications like ditins or gpens. These are medications that work more specifically on the migraine process.
[00:16:31] Speaker A: Okay.
[00:16:32] Speaker B: For preventive treatments we have a lot of options and they are chosen based on the patient's own characteristics. We might use daily oral medications like blood pressure medications, antidepressants or anti seizure medications that have been shown to reduce the frequency of the of the migraines.
We might use CGRP inhibitors. Now CGRP is a molecule that is made by the nerve endings that when someone has a headache the CGRP level goes up and when the headache resolves or is treated, the CGRP levels goes down. If you take CGRP and inject it to somebody, they'll get a headache. So it works on the mechanism of the migraine.
And so these medications can be given once a month as an injection or quarterly or some of them are given by mouth daily or every other day.
Now the CGRP inhibitors started coming to the market in 2018 and they really have been a game changer for a lot of patients and they don't have a lot of side effects.
[00:17:41] Speaker A: That's good.
[00:17:42] Speaker B: Botox given every 12 weeks can be very effective. For patients with chronic migraines, we also use nerve blocks.
Now medication is only part of the picture. We also use neuromodulation. These are devices that deliver small electrical or magnetic pulses that aim to change the way the nerves involved in migraine behave.
They're very good non medication option and they essentially have no side effects.
[00:18:13] Speaker A: That's good.
[00:18:13] Speaker B: We also work with patients on lifestyle modifications to help them manage their sleep, their stress, staying hydrated and identifying their triggers. We also can use non therapeutic options such as physical therapy, acupuncture or biofeedback.
The key is that treatment is not one size fits all.
We work with each patient individually to.
[00:18:41] Speaker A: Find there's some troubleshooting going on there. Right.
[00:18:43] Speaker B: And you end up finding the combination of strategies that will give the Patient the best quality of life with the fewest side effects.
[00:18:52] Speaker A: Absolutely. Absolutely. Great information.
Wow. A lot of stuff to unpack there.
[00:18:59] Speaker B: That's right.
[00:18:59] Speaker A: Great stuff.
Migraines are just sometimes termed misconception as just a bad headache and medication is the only solution. So you've talked a little bit about that.
I've heard people say, just drink some coffee, have a cup of coffee. Caffeine causes it or caffeine may help it. I don't know which one is right or which one is wrong. What are your thoughts about it?
[00:19:28] Speaker B: Right.
So, yeah, so caffeine, some of the head medications have caffeine in them.
[00:19:34] Speaker A: Okay.
[00:19:35] Speaker B: Because, you know, when you have a headache, caffeine can be helpful.
[00:19:38] Speaker A: Okay.
[00:19:38] Speaker B: However, if you drink several caffeinated beverages per day, you end up causing problems down the road. Yes, actually there are. You know, since you brought this point, there are a lot of misconceptions out there about headaches and migraine. One of the. And they can actually delay patients from getting the right treatment. And, and the diagnostic diagnosis.
[00:19:59] Speaker A: Yes.
[00:19:59] Speaker B: One of the most common misconception in my experience is that the headaches are caused by sinus problems.
In reality, the vast majority of what people think are sinus headaches are actually migraines.
[00:20:14] Speaker A: Really?
[00:20:15] Speaker B: You know, migraine can cause sinus pressure, nasal congestions, and even tearing, which leads people to think that their headaches are sinus related.
Actually, studies have shown that about 90% of those headaches are actually migraines.
So if you're having recurrent sinus headaches that are not improving with allergy medications or antibiotics, you definitely should get checked for migraines.
[00:20:44] Speaker A: Yeah, that's good.
[00:20:45] Speaker B: Another common myth out there is that headaches are caused by neck problems.
So, you know, migraine patients very often have neck pain. And the reason for that is that neck pain is part of the migraine syndrome. And so the neck pain can start before the headache starts. It can happen with the headache, or people can have a headache migraine and then at the end get the neck pain, which leads people to think that their headaches are caused by a neck problem.
As a consequence, I see a lot of patients undergo unnecessary testing and treatment focused entirely on the neck while in, you know, like physical therapy or repeat imaging and even procedures. While in fact, their head, their neck pain is just part of that broader migraine spectrum.
And finally, like you said, there is this idea that headaches are part of life, that you have to live with headaches, that it's, it's not serious enough to bring it up. With a doctor.
[00:21:53] Speaker A: That's a good point.
[00:21:54] Speaker B: Yeah. That is simply not true. If your headaches are affecting your daily life, your work, your social life, that is reason enough to get it checked out, to get help. There are so many treatment options nowadays that nobody should feel like they have to push through it.
[00:22:12] Speaker A: Absolutely. You have to advocate for yourself. Because to your point, sometimes people think it's something you can just brush off. It's not as serious as other things.
Such great information.
Do you have any memorable patient stories? We always have those things that stick with us.
Do you have any of those testimonials that you'd like to share?
[00:22:31] Speaker B: Yes, Frankie. There is one patient in particular that comes to mind. This is a man who has been experiencing headaches for more than 20 years.
He has severe, unrelenting, constant headaches for many, many years.
He sometimes experienced congenital congestion in one nostril tearing in the eye. With his headaches, he has seen numerous providers, has tried countless medications and even procedures. Nothing helped. So when we saw him in our clinic, his presentation immediately raised a red flag for a rare but treatable condition called hemicrania continua. This is a type of headache that is often mistaken for migraines or sinus disease, but it has a defining feature. It responds completely to a specific medication called indomethacin.
And so, you know, we started him on a treatment trial and within days his headaches were completely gone.
After decades, it honestly changed his life.
He told us that he does not remember the last time he was headache free.
So it's cases like this that remind us to dig deeper when the headaches don't respond to usual treatment.
[00:23:56] Speaker A: Yes, yes, yes. Thank you for sharing. That's a great story for our listeners who deal with frequent headaches. What practice tips can you give them to reduce frequency and severity?
[00:24:10] Speaker B: Yeah. So I'll tell you what I tell my patients.
Very easy to remember.
Keep everything steady and regular.
[00:24:18] Speaker A: I like that. Steady and regular.
[00:24:19] Speaker B: Migraine doesn't like changes. So regular sleep, go to bed, wake up at the same time every day. Yes. Eat regular meals. Skipping meals can cause hypoglycemia. Drop your blood sugar, which can cause headaches. Eat healthy, you know, whole foods, not processed food. You eat an ice cream, your blood sugar will peak, you know, an hour later, insulin kicks in, blood sugar drops, you get hypoglycemia, you get a headache. But if you eat an apple, it's absorbed slowly, you don't get that. And good hydration, very, very important.
[00:24:51] Speaker A: That's key.
[00:24:52] Speaker B: It really is key. Patients come into the emergency room with a bad migraine. What's the first thing we do? We give them IB fluids because it's so important.
And you know, pay attention to your trigger. You know, keep a headache lock. It can help you identify your own triggers.
[00:25:12] Speaker A: Yes.
[00:25:13] Speaker B: And finally, don't forget about medication overuse headaches. So you get a headache, you take something for it. The next day you have another headache, you take something else and before you know it, you are taking these medications, analgesics, four to five times a week.
And what happened that causes medication overuse headaches? It causes your headaches to become more frequent, eventually daily and more severe, more difficult to treat.
[00:25:39] Speaker A: Wow, good stuff there.
When should someone seek special specialist care from someone like yourself as we wrap up this episode?
[00:25:48] Speaker B: So, you know, many headaches can be treated by the primary care physician, but there are definitely instances where it is appropriate or even necessary to see a neurologist. So you should see, you know, you could consider seeing a neurologist if your headaches are not responding to treatment or if they are becoming disabling, affecting your daily life, affecting work, school, home.
Also, if they are associated this neurologic symptoms with your headaches, difficulty with vision, speech confusion, or if they change in feature because more frequent, more intense, or the pattern changes. We already talked about Thunderclap headache. It's that headache that goes from 0 to 10 in seconds. It's less than a minute and it's very severe. With that we worry about brain bleed. And for that you actually really don't want to see a neurologist. You want to head to the emergency room.
[00:26:49] Speaker A: Yes. Thank you for taking time out of your busy schedule to come and talk with us. This episode is definitely going to help make a difference in just conveying all that key information to help our viewers.
Dr. Ben Othman, thank you so much for taking time out of your busy schedule to come and talk with us today. I appreciate you so much and thank you for your commitment and all that you're doing to serve.
[00:27:14] Speaker B: Thank you. Thank you. Frankly, thank you for having me.
It's been great talking about headaches and migraines. They are really more common and more complex than most people realize. And so having conversations like this really help. I hope it sheds some light on what people are going through and what we can do to support them.
[00:27:34] Speaker A: Yes, I know it will make a difference. So thank you again and to our listeners, thank you so much for tuning in to the Healthy youy. If this episode helped you, please do share with a friend or someone else that you can help. And thank you for tuning in.
Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline. Com.
