Well, hey, everybody. Welcome to the first episode
of Your Mom on Drugs, a podcast for helping people
understand what drugs are, what they are for,
how they can help, how they can hurt, and how
to know the difference. My name is Josh Klaus,
and I am joined by my mother, Jennifer Seltzer,
PharmD, who is the mom on drugs. Dr. Seltzer
worked for the UT Health System for over 30 years
as a drug information specialist, whereas I received
my bachelor's in biology, and I also have a degree
in public health. So I just wanted to take a
moment to talk about how growing up with a mom
who knew every drug in the cabinet. And I thought
that was just like mom knowledge, you know? I
was like, I have a headache. Oh, you want to
take this and this many of that? And I thought
that was just general mom knowledge. But I remember
being 15. and checking the mail one day and I
saw a letter addressed to Dr. Seltzer. I'm like,
who's Dr. Seltzer? And you're like, oh, that's
me. I'm like, you're a doctor? She goes, yeah,
I'm a doctorate in pharmacy. And I had no idea.
So I don't know why you hid that from me for
so long. I don't know either. I didn't realize
you didn't know what I did. I just thought you
were a pharmacist. I had no idea you were like
such an excellent pharmacist. I taught, you know,
I taught students. That's true. Yeah, I had no
idea you were a professor as well. She was a
professor. I had no idea. Maybe that speaks to
my lack of interest. You had a few other things
on your mind. Yes, when I was 15. So I realized
after venturing out on my own and kind of wandering
the aisles of the pharmacy looking for treatment
for a headache, stomachache, you name it, that
I was incredibly lucky to have some basic knowledge
of pharmaceuticals growing up with a mom. And
also someone I could call in the pharmacy to
ask her a question. Like I didn't have to go
to the pharmacist. I could just call you. It's
like, what should I take this? Is the generic
brand good? I mean, so I figured why not, why
keep this resource to myself? Why not share this
resource with the world? Because I'm sure there's
a lot of other people like me who walk into a
pharmacy and feel very overwhelmed. And so I
figured that we could use this time to share
our knowledge and curiosity about drugs and how
they interact with the body. And we can share
that with other people. Does that sound good
to you? That sounds great. So just some background
knowledge. There's no such thing as a panacea,
I would say. The idea that there's a one size
fits all for any disease, right? I would agree
with that, yes. Yeah. So just to let everyone
know, your body, your wonderful body, is composed
of 37 .2 trillion cells, which is an astounding
number. And each one of those cells... on average
has about 42 million proteins of different types
in them at one time, which is just insane to
think if you have 42 million ingredients inside
of one cell, when you have 37 trillion of them.
So there's a lot going on. I mean, it's imagining
like each cell is a city and it's got 42 million
residents inside of it. And then you have 37
.2 trillion cities and that just makes up your
whole body. The fact that you would have one
drug to cure an ailment that probably has a multitude
of causes is probably not out there, which is
why you need some expertise to help guide you
through this process. Here go your mom on drugs.
So your body is always in something called homeostasis.
Homeostasis is essentially a fancy word for balance.
Those 42 million proteins, they're either coming,
they're going, they're doing a job, or they're
done doing their job. They're getting built or
they're getting degraded. And most of the time
you don't notice this happening. You just notice
yourself being alive and happy in the world,
noticing the sunshine and a nice cool breeze,
or maybe it's a little too cold or a little too
hot, and you're usually fine. And when you notice
that you're out of homeostasis is when you feel
sick. Most of the time, it's when you feel that
something is wrong, something's off, and there's
usually a reason for that thing being off. And
in this moment, I like to compare the body to
a house. So your house has a lot of rooms inside
of it. It also has appliances. It also has a
structure to it. It's got frames. It's got studs.
It also has a foundation. Appliances are kind
of like organs in your body, like spleen, heart,
etc. And then you have the foundation, which
could be the bones, ligaments. Now, sometimes
things in the house can go out of whack, but
you don't notice it. Like, for example, when
my house is dirty, my mom always notices that.
But it's not going to make or break my house.
My house is going to still stand even when it's
dirty. But when something like my foundation
is cracking, that can be indicative of the house
being out of balance, out of homeostasis. And
so some things in your body can be going wrong,
like maybe a bit of indigestion or maybe a little
bit of joint pain, but it's not going to mean,
it'll probably correct itself because your body's
going to go back to homeostasis. But sometimes
things can go really wrong, like the foundation
of your body can be cracked. And I think that's
when you want to get a... you know, certified
medical professional, like a pharmacist or a
doctor or PA, NP, et cetera, to come and diagnose
you and see what's actually going on inside of
your body. So I wanted to set that as a foundation
for as we talk about these things, that your
body is an amazingly complex organism. And it's
going to take a little bit of time and a little
bit of thought and a little bit of detective
work to actually figure out what's going on,
what's right for you. You're not going to just
be able to Google it and figure it out right
away. It might be able to, you have to talk with
your primary care physician. Hopefully we can
provide some of that information as well to help
you. And we hope that this information will not
only be interesting, but also useful in your
life or somebody else in your life that might
be suffering from a certain type of condition.
So with that being said, this is your mom on
drugs with me, Josh Klaus. And Jennifer Seltzer.
Who has remained amazingly quiet. I don't know
if you want to add anything to that. No. As you
can tell, I am the one with the words. But my
mother will be having the words in this next
section when we are going to be talking about
migraines. So the first condition we wanted to
hit today was migraine headaches. And this is
something near and dear to my mom's heart because
she experiences migraines. And so I'm actually
going to just I'm fairly ignorant about migraines.
So I'm just going to ask my mom a bunch of questions
and hopefully she has the answers. And if we
don't have the answers, then we will look them
up and provide you the best information. So,
mom, what is a migraine headache? Well, migraines
are the second most common type of headache that
people experience. The first type being. a tension
type headache. But migraines, again, are the
most common headache that causes neurologic disability.
And they affect about 15 % of women and 6 % of
men in the United States over a one -year period.
And it's highest, they happen most frequently.
in people 18 to 44 years of age, but you can
have them younger or you can have them older,
but that 18 to 44 is the most common age. So
for someone who's experiencing this, it'll probably
be 18 to 44. Now I've had a headache before and
I know what that feels like. I usually take some
ibuprofen or Tylenol and that usually helps alleviate
the headache. From your personal experience,
what makes a migraine different than just a regular
tension headache, what probably most people are
used to? Okay, so a migraine headache has, it
actually has different phases. And there are...
People that have migraine headaches can have
up to four different phases that describe the
headache. The first phase is called the prodrome
or the, yes, the prodrome. And it doesn't happen
in every single patient, but it happens in about
75 % of patients that get migraines. And in the
prodrome, you can have these kind of neurologic
effects like you can have extra sensitivity to
sound or light, or you can have some difficulty
concentrating. or you can be all of a sudden
extremely sensitive to touch, so it causes pain.
You could also have some feelings of anxiety
or depression or irritability. You could even
have euphoria, you know, real light, bright happiness
and stuff. You could also have some other...
You know, physical effects to your body, like
you could have frequent urination or diarrhea
or constipation. And then you could also have
some other different kind of miscellaneous things
going on during this prodrome, like yawning or
you crave for certain types of food or you get
excessively thirsty or you may have anorexia.
Again, then it moves into what's called the headache
phase. And the thing that is characteristic of
the headache is that it's usually unilateral.
That means it's only on one side of the head.
Now, it doesn't mean that it can't switch to
the other side of the head, but usually it'll
start on one side of the head. It may generalize
at that point, but it's usually that's one of
the kind of key characteristics of a migraine
is that it happens on one side of the head. And
then it's going to it's usually a gradual and
onset pain. And, you know, interestingly, not
everybody will get an actual headache with a
migraine, which is crazy. Oh, so you can experience
prodrome symptoms. Right. And it won't develop
into a headache. Right. Now, I don't actually
have a percentage of people who don't actually
get headache pain. But you've got these other
things that are going on as well, because because.
that will characterize it as a migraine. And
I'm not a great diagnostician. So I would say
that if you've got some unique things going on
that kind of feel like a headache, but you're
not really sure whether it's a migraine or not,
I would sure have a conversation with your doctor,
you know, about that, your primary care physician.
And other things that are characteristic of that
actual headache phase is, like I said, you know,
that the headache usually is unilateral. It usually
is kind of at the front of your head or the side
of your head. Sometimes, which is different,
which is different from a usual tension type
headache, because if you've had a tension type
headache, it kind of feels like a band around
your head. Yeah, I always feel like I'm getting
squeezed. Right. And that's not the way a migraine
headache feels. It feels usually that you've
got this. throbbing pain, usually it's in the
frontal front kind of area or the side of your
head. It's like on one side. And it can increase
in intensity if you don't treat it. Usually that
kind of headache doesn't go away on its own.
Um, after you've had this headache phase and
it can last from anywhere from four to 72 hours.
So that's three days, you know, so some people
get really sick with migraines. Um, after the
migraine, after the headache phase is, is over,
then you enter what is called the post -drome
phase or the after phase. And in that phase,
you feel tired. Um, you can feel, um, Irritability
again, you feel exhausted, no energy. You can
have mood changes, depression again. Some people
will even actually feel unusually refreshed.
I know from personal experience, I feel so great
not to have that headache anymore, even if I've
had to take some medications to get rid of it.
So sometimes I'll just feel really good that
I don't have the pain anymore. Sometimes you
can have hard time concentrating after you have
a migraine and that all these after effects can
last up to one day. Yeah. So if I can summarize
and you can correct me where I'm wrong. So you
essentially have the prodrome phase where it
almost seems like certain things are just heightened.
It just seems like certain sensitivities are
just heightened. You almost feel like you're
more sensitive to the world around you. And then
that could bring on an onset of the actual migraine
headache, which usually affects one side of the
head. But it's not like a squeezing or a tension
headache. It's more of a pulsating headache or
a throbbing headache that you have. And that
could last up to 72 hours. And I don't know if
there's any reason why one would last longer
than the other if it's just random. It's just
random. And then after that, you have the post
-drome phase in which you feel almost... exhausted.
It almost sounds like a tidal wave where you
have the swelling of the wave and then the wave
crashes, which is the headache. And then you
have the leftover surf at the end of it. Kind
of. Yes. It's just that when it's over for whatever
reason, your body is just, and it's probably
due to some of the, you know, the, the, the,
the mechanism behind a migraine is not well known.
There are some genetics that could be kind of
the cause of it. Environmental factors can also
play a role. But as far as what's going on inside
your head specifically, it usually has to do
with some sort of changes in your brainstem and
specifically the trigeminal nerve, which is one
of the nerves that's in your brain that is a
major pain pathway. Trigeminal nerve. Trigeminal
nerve. That's a fun word. Yes, it is. And so
then there's going to be some other chemical
things that might be affected. I'm just going
to throw out a couple of them. And the reason
I'm throwing them out is that they come into
play when you treat a migraine headache. Yeah,
we should let everyone know here that understanding
the mechanism isn't necessary to treating the
disease. But imagine if you like working on cars,
for example, like you usually take your car to
the mechanic and you say, my AC isn't working.
And there's probably a reason why your AC isn't
working. It could be the condenser is broken.
It could be that the fan isn't blowing properly.
So you could take it to the mechanic and just
give it to them. and they could fix your car,
and you wouldn't have to know what they did.
And I've had the experience where they tell you
that long list of things that they did. I'm like,
yeah, yeah, yeah, here's my money. Thanks for
fixing my car. But if you are interested in knowing
your body like you would want to know a car,
there are certain chemicals in your body that
can go out of balance. Remember that homeostasis
thing we talked about? And so by knowing which
chemicals in which nervous systems, like the
trigeminal nervous system, is out of balance,
you then can use specific drugs to be able to
treat those symptoms because it wouldn't do you
any good to use Tums to treat a migraine because
Tums have a very different way that they interact
with the body. than something like some of the
treatments that we're going to say. So if you
are a nerd like we are, we're going to post more
detailed figures and scientific papers at the
end of this show notes, and you can click and
do your own research. But other than that, we're
just going to kind of give you the general overview
of why these treatments are appropriate. Is that
fair to say? That would be fair to say. So again,
I mentioned the body has several different...
nerves that reach into the brain and the trigeminal
nerve is just one of them. So the trigeminal
nerve is the nerve that affects your face. And
so the trigeminal nerve, it's also a major pain
pathway, which has something to do with migraine
headaches. And then there are specific chemicals
in your brain that can be unbalanced, as Josh
said, in migraines. And one of them is serotonin.
One of them can be dopamine. And one of them
is a newer peptide called calcitonin gene -related
peptide, or CGRP. And this peptide is a vasoactive,
so it's a vascular or it affects, you know, like
your vessels, you know, in your brain. And that
if it really, it's... So the trigeminal nerve
gets activated, this peptide gets released, and
it will interact with blood vessels to cause
vasodilation or your vessels in your brain get
more engorged or inflamed. Yeah, let's break
that down just so that people maybe can understand.
So if you picture a balloon, right, that's not
blown up or doesn't have water inside of it,
and you blow it up with air or you put water
inside of it, you're going to notice that balloon
expanding. Now, if you have that balloon expanding
inside of a container, for example, that's going
to put pressure upon that container. And so you
can imagine that's what vasodilation is in your
brain. And so if you have this trigeminal nerve,
basically with this CGRP simulating this vasodilation,
you're going to essentially have this pressure
that is going to be built up and could potentially
cause the throbbing. Again, this isn't a definite
mechanism, but you can see that maybe there is
some relation there. So that's kind of the basics
as far as how a migraine headache might get started.
But let's go back and let's review again. Remember,
there is a prodrome phase, a headache phase,
and a postdrome phase. But also let's not forget
that about 20 to 25 % of patients also may have
an aura. So let me tell you what an aura is.
This is exciting. It's like you got a healthy
glow about you. So yes, kind of. This aura, these
are reversible nervous system symptoms, and they
are most often visual symptoms. And but you can
also have what we call sensory motor symptoms.
So you could possibly have some numbness or weakness
or you could actually lose the ability to speak,
you know, which is a word called aphasia. But
so but that's not very common. Mostly your aura
is going to be these visual changes. And these
are things that the individual experiencing the
migraine. It's their aura, like they're experiencing
visual phenomena they wouldn't normally experience.
That's correct. And this aura usually happens
and builds up over several minutes and may last
up to 60 minutes. And the aura phase usually
occurs either before or during the migraine.
So again, remember I said that that only happens
in about 20 to 25 % of patients. And would that
happen before the headache or before the pre
-drome? It could happen before either. Is this
something that you experience? I do not. I do
not. So, but I definitely know people who do,
you know, so again, 20, so you're thinking one
in four to one in five people are going to get
the aura associated with a migraine. Of people
who have. Who have migraines. Yes. Yes. Not everybody,
but one in four or one in five people who get
who experience migraines may have an aura. There
are there is some discussion about. So people,
you know, investigators have. you know, have
researched information about migraine and characteristics
of people who get migraine. And there have been
some triggers that have been identified that
may cause people to get migraines more often.
Okay. So it's almost like there's a switch that
there's an external stimuli with a switch that
could. basically cause you to be more likely
to have a migraine. That's true. Now that doesn't
mean that if you get exposed to this particular
trigger, you're automatically going to have a
migraine and, and people who do get migraines
may have multiple triggers so that each person
kind of gets. aware of the things that may cause
them to be more susceptible to getting a migraine,
and you might want to avoid those or modify that
type of behavior. So let me give you an example
of a couple of things that might be considered
a migraine trigger. For women, it can be hormone
changes. So there are some women that just get
a migraine when they have their menses. And so
that would not be something that men had to deal
with, but so hormonal changes for sure. They
can also, women may also have changes in their
migraine headache frequency when they go through
menopause. If you drink certain... beverages
like alcohol, especially wine, and sometimes
beer. And caffeine, especially those types of
things may trigger a migraine. Although I will
offer a disclaimer in that caffeine is actually
also used to treat a migraine headache. I was
going to say that seems to be a little anecdotal.
Right. But so mostly it's things like if you
drink, especially wine is especially can be a
trigger for some patients. That's really interesting.
Is there anything special about wine? Is it just
the way that it's fermented? I think that must
be. I did not look into all the details. about
wine and why it would cause a migraine trigger,
that could be something that we could do a little
bit later on. Yeah, I think if we're going to
stop people from drinking wine, I don't think
that's going to happen on this podcast. Yeah,
I don't think so either. Just know that it could
likely induce a migraine. If you want, just be
ready for your migraine. We should also also
disclaimer about the word trigger. So trigger,
a lot of people think it's like an on -off switch,
like the trigger on a gun or the light switch
for turning your lights on in the house. It's
pretty definite that when that happens, an effect
is going to happen from the cause. But when you
think about something like the body, which has...
if not hundreds, thousands of things going on
at the same time, the smallest thing might not
push it over the edge, but it might make it more
likely. So for example, something that you might
think about is if you have an object that's in
balance, like let's imagine that you have someone
standing basically on a balance beam and you
have forces pushing them from the right and the
left. And that's keeping them upright. Now, the
smallest little nudge on the right, even though
it is pushing them to try to make them go out
of balance, they can use their abs or they can
use their body to maintain the balance. But if
you have enough things pushing them, no matter
how much they try to balance, they're going to
fall off. So the idea of a trigger doesn't necessarily
mean like it's going to definitely do it. but
it gives you a higher likelihood that this event
is going to occur. So you're always trying to
overcome some type of threshold. And we're going
to get to that when we talk about pharmaceuticals
as well, because pharmaceuticals... definitely
try to override thresholds to basically counteract
that force that's causing the migraine. And you
want to push that balance back in the other direction.
So just as a caveat there, that it's not this
on or off switch. It's very much a very nuanced
multifactorial balance situation. Okay. Thanks,
Josh, for clarifying that. A couple of other,
I think, key triggers are stress, sensory stimuli,
things like Bright lights and glare. I was driving
through Austin over this past weekend in the
evening time and a lot of bright lights. And
sure enough, when I got home, I got a migraine,
you know, and stuff. So I was like, that's just
not good. Sleep changes. So too much or too little
sleep can sometimes be a trigger. Weather changes
can be a trigger for migraines. Some foods like
aged cheeses. because they have, I believe it's
tyramine in them that can be the trigger for
migraines. If you skip a meal and you get hungry,
that can be a trigger for a migraine. And some
food additives can also cause migraines like
aspartame or monosodium glutamate. I wonder if
the thing with the aged cheese is similar to
the wine because wine is aged as well. Yes, that
there could be very much of a similarity there.
I'm just speculating. So let me just run through
that. You know, we've talked about kind of what,
you know, the phases of a migraine. We've talked
about the fact that some people can get an aura.
We've talked about triggers. Here are the common
symptoms of patients who get migraines. So usually
you're going to have some nausea, which is not
typical when you get a tension type headache.
Also, you can be sensitive to both light and
sound. So that can be part of that prodrome phase,
but that can also continue on in the migraine,
the headache phase that you just want to go into
a dark room and lie down with no noise. You can
get a little lightheaded. You can have vomiting
as well, too, if you don't treat the headache.
And you could have some visual disturbances that
are not an aura. And you can have some numbness.
So those are just some of the things that you
can have. You can have some diarrhea associated
with it. And a little bit of maybe, you know,
altered consciousness, like you just feel like
you've lost concentration and stuff. So I'd say
that. So the things that make a migraine different
than a regular headache are going to be the nausea
and vomiting that can be associated with it,
as well as that sensitivity to light and sound.
Yeah. So if someone is experiencing these symptoms,
this might be a great stepping stone to go get
diagnosed by a proper medical professional. And
whether they have these things acutely or chronically,
you know, because it could be a perpetual problem
or something that happens in the short term.
Right. And so, yes, so that's a great segue,
Josh, into kind of the key things that are looked
at to diagnose a migraine. Normally, it's not
any type of a CT scan or an MRI. You don't really
diagnose a migraine that way. But you usually
do it based on your headache frequency. So in
patients that don't have an aura, if you have
at least five attacks and the headache lasts
on each attack from four to 72 hours, whether
or not it's treated successfully or unsuccessfully.
And that it usually has, like we talked about,
that one -sided location, that it's got that
pulsating, you know, throbbing quality. It's
moderate to severe in intensity. And it can be
aggravated by movement or you want to avoid walking
around because you just don't feel good. And
that you could also have the nausea, vomiting,
and sensitivity, light and sound associated with
it. And it's not, you can't determine that any
other thing is causing any of those types of
issues. So that's going to help you get diagnosed
with a migraine without aura. If you do have
aura, then it's going to be you've got the aura
going along with it with at least two attacks
and that it's not attributed to any other condition.
Okay. Yeah, that's really interesting. I think
a common colloquialism that I hear is that if
you're in a room and upstairs you hear hooves,
you don't automatically think zebras. You automatically
think horses, right? The idea is like you want
to assume that the most common thing is happening
to you unless you rule out that the most common
thing isn't happening to you. For example, you
could be in a room in Africa on a safari in a
ranch and be like, oh, maybe there's more zebras
here than there would be horses. So what a clever
or a good doctor will do is that they will. rule
out any of the things that it's not and there's
there's techniques that you can do to diagnose
that um i would not recommend diagnosing it yourself
unless you have someone that you that you trust
or you feel like that you can analyze the literature
pretty well um because a runny nose If you have
a runny nose, just as an example, a runny nose
can be indicative of so many things. You know,
I mean, you can have a runny nose for so many
different reasons. So there's got to be other
causes associated with that runny nose that are
going to basically help you. Do you have the
common cold? Do you have the flu? You know, do
you just, you know, is it just the pollen count
high that day? So there's a lot of things to
narrow it down. And it's actually, you can have
a lot of fun just trying to narrow things down
and be a bit open -minded about the things that
are going on with you. Let's imagine that I'm
a individual who has migraines with aura or without
aura. Let's just use without aura for simplicity's
sake because that seems to be the majority of
people. And I want to get treated. And I was
looking up a stat that on average it costs about
$6 ,500 a year to treat migraines, like if you
have chronic migraines. I think that's including
doctor's visits, medication costs. etc. So I
mean, this isn't even including taking time off
of work. So because it seems like it can be a
debilitating condition. If it's pretty intense,
like the ability to not be able to focus as well
on work, so you'll just lose productivity. So
if I'm an individual who wants to treat this
disease, or this condition, I should say. You
know, where would I want to start? Okay. That
number seems a little high, you know, but I think
it might cost $6 ,500 a year, maybe for the first
year when you're actually getting diagnosed to
rule out some of those things. But I'd say as
you progress on, it shouldn't cost that much
to treat migraine headaches unless you have some
that are more difficult to control and you require
some more expensive medications. Where you start
initially in treating a migraine is that you
can use, you can try things like, let me back
up first, just to give you just a few just general
statements about treating a migraine headache.
First of all, treating a migraine headache is
individualized. No two people are probably going
to respond to the same types of treatment regimens.
And actually in the same person, The same drug
may not work every time you get a migraine. So
you kind of have a little bit of a repertoire
of medications to treat your migraine. Yeah,
I think people might have an intuition of why
that's the case, but I'll let you add upon this,
but I'm just going to give an example. So we
mentioned earlier that migraines is primarily,
it might have a genetic component, so you can
inherit conditions that might. predispose you
to have migraine headaches, for example. Now,
remember with genetics, you're inheriting your
genes, half from your mom, half from your dad,
and then they get shuffled about and then they
go inside of you and they code for the things,
not just for the outside of your body, but for
the inside of your body as well. And usually
the things that are being affected here are things
called receptors. And receptors are these proteins.
that are on the outside of cells. Remember all
those cells that you have, those wonderful cells
you have in your body. They're there to catch
things in the bloodstream that your cells need
in order to function. So for example, your brain
needs tons of hormones, molecules, proteins in
order to function. Now, because you're inheriting
those from your parents, if they're missing one
of those proteins, they don't code for it. then
you might have the possibility of missing it
as well. Therefore, I'm just speaking from personal
experience, I don't get migraine headaches. So
my mom has the genetic predisposition to have
migraines. I don't. I'm very grateful you didn't
pass that on to me, but you did give me some
stunning good looks. And I am very grateful that
I didn't get the migraine. Which is why personalized
medicine, whenever it does come into the fold,
will be amazing because you can just tailor make
molecules for your brain. We're not at that point
yet. We're almost kind of dump things into your
brain and hope for the best. But we don't want
to do it willy -nilly because that could cause
bad things, which we call side effects. And we'll
talk about side effects in a moment. But is there
anything you want to add on to that in terms
of... people being different. I think that's
true. And so, so then you're going to determine,
and it's kind of a trial and error type of experience
as far as figuring out what works for you and
what doesn't. So the other kind of key thing
is that first of all, therapy is individualized.
And then the next thing is that you want to treat
your migraine headache as quickly as possible
as it comes on. When you start feeling the, when
you experience the aura or when you start feeling
the prodrome. You start experiencing those prodrome
type symptoms because the longer you wait to
treat a migraine headache, the worse it gets.
So the first class of medications that you'll
use to try to manage your migraine headache are
going to be just your basic over -the -counter
analgesics like Aspirin or Tylenol or Ibuprofen
or everybody's probably familiar with Excedrin
Migraine, which is a combination of aspirin,
acetaminophen, which is Tylenol and caffeine.
Yeah, maybe let's slow down a little. What is
an analgesic? Oh, an analgesic. I'm so sorry.
An analgesic is a pain reliever. So it's a medication
that is used to help. kind of take away pain.
Okay. And these are over the counter analgesics.
And these drugs, they work kind of the same way,
but do they have maybe just a little bit of differences
in their mechanism? Yes. So things like aspirin
and ibuprofen, like Advil or naproxen, like Aleve,
they are, they, they. They treat pain, so they
will help to relieve pain, but they also have
an anti -inflammatory component. Whereas Tylenol
or acetaminophen or Tylenol only works on pain
relief. It doesn't really have an anti -inflammatory
component. Okay. So if I remember correctly,
there's things called nociceptors that are associated
with pain. And so maybe Tylenol. affects the
you know affinity of binding to nociceptors and
feeling pain right okay and then when you take
excedrin migraine and you've got that caffeine
component in it remember how we talked about
that migraines because of those chemicals that
get released one of the things that happens is
that you get um vasodilation or that expansion
of your your blood vessels in your head. Well,
caffeine works as a vasoconstrictor. So it's
going to help to make those vessels close back
down again. So like Josh talks about that balloon
example, the caffeine is going to help take the
air out of that balloon and make it go back down.
That's really cool. So you're just, anytime I
have a cup of coffee, I'm just taking air out
of the balloon. There you go. You're doing some
other things when you drink that coffee as well.
So now there are some medications that have aspirin
or acetaminophen and caffeine combined with it
that have some other stronger pain relievers
associated with it. Like there's a Furoset or
Furanol. They have a barbiturate in them that
kind of helps people go to sleep. And then there
are some that have codeine in them. What the
studies have shown is that these agents are really,
while they can be effective, they can set patients
up for... And something that we call medication
overuse headache, which we're going to talk about
in a little bit longer and stuff. So just keep
that term in mind. So it's not really recommended
as much to use those medications that have those
more narcotic medications in them. Yeah. And
if we can say those names again, those barbiturates.
Barbiturates. Barbiturates. And codeine. Anything.
So they're usually linked up with aspirin or
acetaminophen and maybe some caffeine and then
codeine. or barbiturate in it. Right. So if I'm
at the pharmacy and I see. Those are prescription
medications. Okay. So these are prescriptions.
Yes. If my doctor wants to prescribe these to
me, I might want to think twice because by trying
to cure my headache, I could just get another
drug -induced headache. Right. Okay. Right. So
the juice might not be worth the squeeze. Right.
Okay. Exactly. That's fair. So we talked about
the non -steroidal anti -inflammatory drugs as
well. Those are things like aspirin or ibuprofen
or naproxen. Those are Advil and Aleve. And they
are going to do something. And so the main thing
I think you remember with taking a non -steroidal
anti -inflammatory drug to treat your migraine,
if you already have some nausea. some gastrointestinal
adverse effects associated with the migraine
itself. These agents can cause some gastrointestinal
side effects, so you just need to balance out
whether or not the ibuprofen or the Aleve is
going to work for you and not make your symptoms
worse. Okay. Yeah, and just to mention gastrointestinal
things like that might be happening in your stomach.
Right. You might have an upset stomach. Upset
stomach, diarrhea, nausea, that type. Yes. And
also, too, taking Tylenol or ibuprofen, people
might think, well, that's not strong enough.
to treat my migraine. But really, I mean, the
intensity of your headache does not dictate the
success or failure of a particular treatment.
So I would say when you start feeling that migraine,
go ahead and try a Tylenol and see if it'll work.
Now, you know, you don't want to take too much
Tylenol in a particular day because it can cause
liver damage. But we're looking at four grams.
You would not take more than four grams of Tylenol
a day for that and stuff. In older patients,
it would be three grams. Okay. And just to let
everybody know, like how many, like three or
four grams is how many tablets would that be?
Yeah. So I'm saying, yeah, I'd say an extra strength
or unusual strength. Tylenol is about 500 milligrams.
So you do the math and it would be anywhere from
six to eight tablets a day. You wouldn't take
more than that. Yeah. So y 'all out there, don't
just keep popping those pills to think. that
it's just going to keep getting better, you know.
And I think what my mom was saying is that the
earlier you take them, the better. Right. And
there are some guidelines as far as if the thing
that you take first, you know, you can take a
second dose, you know, maybe in an hour if the
headache hasn't gone away. But after that second
dose, if that hasn't worked, then you may need
to, that's when you need to consider, okay, I
need to go to my regimen and pick something else
because this one doesn't happen to be working
for this particular migraine. Right. And we should
also mention that when you do take a drug or
a pharmaceutical, usually you take it orally.
And this is oral drugs. I'm making an assumption
where you're putting it in your mouth and then
it goes down into your stomach. And so it takes
time for it to metabolize. Metabolize meaning
that it breaks apart and so that it can get inside
of your bloodstream. and then actually go to
the places where it's supposed to act, which
I think, I don't know how long that normally
takes, but usually between 30 to 60 minutes,
30 minutes to an hour. So if it's not working
right away, don't panic, you know, give yourselves
30 to 60 minutes. And if you've noticed nothing
happening, then maybe take that additional dose
and then wait another 30 to 60 minutes to see
if that extra dosage, you're sending more reinforcements
to fight the battle. to go for those extra nudgings
to maybe to turn the tide so that you can at
least diminish the symptoms. I don't know if
there's any hope of them going away. I really
think it's probably just suppressing them to
a level that's manageable, correct? Right. Sometimes
if you're able to go to sleep, you know, that
you can get rid of a migraine headache, but it's,
but because you've got that pain there, it's
hard to go to sleep, you know, to get rid of
the headache and stuff. So sleep can kind of
reset the circuitry a little bit. Okay. Yeah.
That's interesting to know too. So there's the
next group of drugs that is. Now, these are prescription
drugs, so you'd need to get them from your physician
or your prescriber, you know, is going to be
what we call serotonin agonist. So remember,
we talked about serotonin being a component of,
you know, helping to cause migraine headaches.
So serotonin agonist and the thing that we know
we call them kind of as a kind of slangy name
is called triptans. So these are going to be
things like sumatriptan or your imatrex, your
zomib. your Maxalt, your Frova, your Emerge.
These are all prescription drugs. All names that
we know, just off the top of our head. Yeah,
Imatrix you may have heard of. But I think that
one of the things that I'd like to bring out
with this particular drug class is that they're
going to help to, again, help to bring that,
to help vasoconstrict the blood vessels. That's
one of the ways that they work. And they're going
to also work in that trigeminal nerve area and
help to reduce some inflammation in that area
with that activity, with that nerve. Josh mentioned
that most medications that are used to treat
migraines are oral, but there are some dosage
forms in this triptan class. There is an injectable.
There are some orally disintegrating tablets
because, think about it, if you're nauseated,
it's going to be really hard to take something
orally. So that's why there are a couple of other
dosage forms in order to be able to treat a migraine.
Some of the common side effects from this class
of agents are things like You can get some numbness
in your finger. You can feel tired. These triptans
have this syndrome called triptan sensations
where there are, in up to 25 % of patients, you
can feel chest pain or tightness. But it's not
anything to get really panicked over. But if
you do have an underlying heart condition, you
probably wouldn't want to take a triptan like
an Emetrex, you know, so. And one of the medications
in this class of drugs is also a nasal spray,
which can also cause some taste changes and stuff
if you use the nasal spray and stuff. But again,
having that variety of dosage forms for people
who have an upset stomach, but they still need
treatment for a migraine is good to know. Yeah,
I think we could go down this list and we can
talk. And I think these conversations would probably
be best with the physician and the patient just
because it's going to depend. But we should just,
as a caveat with prescription drugs and any drugs
whatsoever, even natural remedies, when you're
putting something inside of your body, even including
food, you're adding things to your body that
your body isn't used to or potentially not used
to. And most things that go inside of your body
are nonspecific. Now, what I mean by that is
there are certain receptors in your brain that
will bind to certain chemicals really, really,
really well. We call that having a high affinity,
meaning that it will just stick on there like
glue. It's super attracted to it. Now, other
things could have a low affinity, meaning they
sometimes stick to it or they sometimes don't.
That means that they could also have affinity
for other things as well. And when you put a
drug or food or natural remedy inside of you,
you could potentially have a lot of low affinity
or high affinity events that you didn't intend
for. So, for example, when mom was talking about
you could take these non -steroidal NSAIDs and
you could potentially get gastrointestinal problems.
It's because of this drug that's basically binding
to a certain area that will cause an adverse
effect because, lo and behold, drugs have multiple
binding sites because they like to be attracted
to different things because they're nonspecific.
So this is why doing good research is really
good, not just because you want to find the best
drugs for the best treatment, but you also want
to be aware of the risk. of taking a certain
type of drug. So when you are taking Tylenol,
for example, you know the benefits, but you also
know the cost, and not cost in terms of dollars,
but also the cost in terms of your potential
health. And then you say, is it worth the trade
-off? Some things aren't. Like some of these
prescription drugs, I was looking up the cost,
they can range from $600 to $2 ,000 per prescription,
because we can talk about that on another episode.
about why drugs can cost so much and what ways
to bring them down. Because if you look at like
a bottle of Tylenol, I mean, it's maybe $4. And
there's good reasons for why it's $4 now than
when it originally came out. But I just wanted
to give that as a caveat of anytime you put anything
in your body, that there could be potential changes
that happen in there. And it's good to notice
those changes and then you see if it's worth
the trade -off or not. Um, because unfortunately
nothing is a hundred percent effective. You know,
you're going to give, you're going to treat your
migraine a little bit, but then you might upset
your stomach a little bit. And unfortunately
we can't go back to being 10, uh, when everything
seemed to work perfectly. Um, and so we're trying
to basically get some type of balance as we get
older and things start kind of breaking down
and failing. Okay, and I think that Josh brought
a good point. Let me just mention a couple of
other drug classes that your healthcare provider
could prescribe for you if you have a migraine.
And if you have a migraine, you probably are
familiar with some of these. One is called ergot
derivatives, and they are kind of similar in
mechanism for the way that triptans work. So
you've got ergotamine and dihydroergotamine.
Caffeine is also a similar one as well. Yes.
The next class is, this is a newer drug class.
It's those CGRP receptor antagonists. So remember
we talked about that peptide that causes some
inflammation and vasodilation. And so these are
going to antagonize that. So you're going to
have seen some... commercials on TV for Ubrel
-V or Nertec. And those are those types of agents
that are used to abort or stop a minor. Always
with a pretty butterfly to make me feel nice
and secure so that I go ask my doctor about these
prescription drugs. There you go. And then there
is a newer, there's a newer agent. It's called
a Ditan, Ditan. It's called Rayval and it's also
available to also management migraines. Now,
if you are a person that has. recurrent migraines.
Josh kind of alluded to the fact that sometimes
they may not be very frequent or they can happen
more frequently. It may be that you and your
healthcare provider decide that you need preventive
therapy to take for a migraine. And again, that's
going to usually happen if you have more chronic
migraines, they happen more frequently. Sometimes
it's going to be, there are some more serious
migraines and that's kind of beyond. our scope
as far as diagnosing some of those things, that
would be a conversation you would have with your
healthcare provider. But so in those types of
patients, you probably would also recommend a
preventive therapy. And again, it's going to
be something that can be given so that maybe
the number of headaches that you get per month
will be reduced. And that would be a welcome.
you know, blessing. Yes. So, so some, yes, absolutely.
So I'm just going to read just kind of a, um,
a list of types of medications that have been
used for this. And again, it's not a one size
fits all and one might work sometime and might
not work later on, or something might work for
one patient that doesn't work for another. So
this is that this is a group of medications that
your physician can use to prescribe to you for
preventive therapy. One drug. classes called
beta blockers, things like propranolol or metoprolol.
These also are used to lower blood pressure,
but in this particular circumstance, you're using
them at usually a lower dose to help prevent
migraines. There are some... antidepressant medications
that have been used to have managed or to lower
migraine headache incidents. Because they can
regulate serotonin. Right. And dopamine. Yes.
And so amitriptyline and venlafaxine are the
ones that have been most, that have the most
evidence for being successfully used. There's
a couple of anesthesia medications that are used.
One is called Topamax and one is called Depakote.
And they've been prescribed. Actually, there
are some of our serotonin agonists or triptans
that can be used primarily for menstrual migraine.
So anytime you've got a migraine that has a predictable
pattern, then you can take a preventive triptan.
you know, at that particular time, you know,
to help prevent the migraines. So things like
if it's, if a woman is having her period and
then she goes, Oh, it's that time. Right. You
would start a couple of days before it's going
to start to help keep getting the migraine headache.
But the only one, the only triptans that have
been kind of looked at and investigated and found
to be effective for this are Frovo triptan, Neurotriptan
and Zolmatriptan. So. There will be a quiz at
the end. Yeah, there you go. And then that newer
class of agents, the CRGP, I'm sorry. CGRP. CGRP
receptor antagonists, excuse me for misspeaking.
How dare you. QLIPTA and NERTAC have also been
shown to be preventive agents and using that
mechanism of blocking that peptide. And then
there is also, and then you may have seen some
commercials on TV for these agents. These are
CGRP. antagonist antibodies. So these are subcutaneous
injections. So you can actually give it to yourself,
but it's under the skin. And then there's actually
one infusion, an intravenous infusion. And these
are, VIEPT is the intravenous infusion where
you'd have to go to an infusion center to get
it. And again, this is an agent that you'd only
get once every three months. And again, if you
got more serious migraines, it might be something
to consider. And that's going to be a medication
that's going to be more expensive. Antibodies
are things that are associated with your immune
system. And if they are specific to a specific
type of molecule, like the CGRPs, they're going
to go in and they're going to attach to those
CGRPs. And then the immune system essentially
going to hopefully clear them out a little bit.
So you have less of a concentration. Right. And
if that happens to be something that's causing
your migraine, then it should work. If not, then
you've eliminated a cause. There you go. There
you go. And then other agents in that particular
class are Amovig, Ajovi, and Imgality. Those,
again, are those subcutaneous injections. Again,
they're going to be more expensive, but they
may cut the number of migraine headaches that
you have in half. And again, usually these agents
are used when you have more frequent migraines.
I mean, then the last thing I want to mention,
because you see it, you definitely see it on
TV or in advertisements, is Botox. And it has
been used only, and it's only approved for use
in patients that have chronic migraines and chronic
migraines are defined as those patients who have
headaches for 15 or more days per month. And
these headaches last for four or more hours each
time. So you're talking about, you know, significant
loss of, you know, quality of life and stuff.
So Botox is going to be kind of a last resort.
And we should mention again, what Botox, first
of all, that's fascinating, but Botox is a, the.
It's a neurotoxin. Yes. From the bacteria. Yes.
Botulinum. And people figured it out long ago.
First of all, it's not good to ingest. It wouldn't
do well for you. But if given in small doses,
it promotes skin tightening, which is why people
use that to basically get a little bit tighter
skin. I remember back in the day there were Botox
parties that people would just hire physicians
and they would have people come out and just,
you know, you would just go to the corner and
you'd get an injection and then you just go on
throughout the party. So it was all the rage.
Not a smart thing to do. You know, humans have
done a lot of smart and not smart things over
our history. Yes. And we learn little bits along
the way. But anyway, so again, just I just wanted
to mention that because people might have seen
advertisements for that. And that I just want
you to know that Botox is not for everybody.
You know, it's going to be those more serious
patients. Yeah, because if you overdose on that,
that is you can get paralysis, you know, so not
a good deal. And then I just wanted to throw
out to that you you may also. There is some evidence
for some alternative medicine supplements that
can be used primarily to prevent migraines. There's
not super evidence, but there's some evidence
for their efficacy. And again, it's again going
to be that it might work in some patients, but
not in others. And one of them is vitamin B2
or riboflavin, and the other is fever. fever
few. Um, those are two examples of things that
might be used to help reduce the number of headaches
that you have. Yeah. I was reading about a systematic
review that was done as well on herbal treatments.
And, um, yeah, there was, there was some like
coriander or citron or menthol, um, that had
some positive results. But again, we'll talk
about evidence another time in another podcast,
but, um, the idea is, is like, Alternative medicine,
once proven effective, just becomes medicine.
You know, a lot of times people think, oh, it's
medicine versus alternative medicine. The thing
about alternative medicine is that usually most
of them are supplements or they're herbal remedies
and they're not regulated by the FDA. The FDA
is the Food and Drug Administration. In order
for a drug to get brought to market in the United
States, it needs to essentially be proven safe
and effective. for use basically in the treatment
that it is, and then you can sell it. But there
are things like herbs, which have obviously been
proved to be safe because we eat them all the
time. So we assume that they're safe to ingest,
but they're not going to go out and say that
this is actually going to cure the condition
that you're seeking. But again, it's not saying
that there's not because just using Tylenol or
acetaminophen as an example, that was extracted
from tree bark. You know, that was something
that was noticed in certain tribes. Sorry, that
was aspirin, not Tylenol. Oh, same. Thanks for
correcting me. Yeah. So actually it's aspirin
that was found in tree bark. And that molecule
was basically extracted out so that you can give
it in a concentrated form, which is the pill
that you see. So it started as a natural thing
in tree bark and then was extracted out to form
a pharmaceutical. So we're not saying that. no
herbs or anything doesn't have an effect we're
saying that there might be a better way to deliver
that by actually giving the active ingredient
we call it the active ingredient meaning because
it actually act is active in the condition that
you want to treat um inside of the body because
there's a lot of other stuff in plants that you
don't want in um inside of you to treat that
condition um as well like pollen for example
you don't want a lot of pollen Okay, so just
a couple of other things about preventive therapy
for migraines. Actually, preventive therapy is
effective in approximately 50 % of the time.
So it's not 100 % effective. But again, if you
change between therapies, sometimes you can find
one that's going to help at least reduce your
headache frequency to some extent. And usually
it can take a couple of months before you see
the maximum benefit from a preventive therapy.
So don't think after one dose you're going to
see an effect. And give it, like I said, give
it, you know. eight to 12 weeks, you know, of
taking it before you give up, you know, on that
particular medication. And then usually the recommended,
the recommendation is to take a preventive therapy
from anywhere from six to 12 months. And then
you can, at the end of 12 months, you could try
to taper off of it to see if actually you are
able to kind of Kind of change the frequency
of your headaches so that you don't need to take
that preventive medication for a while and stuff.
That's going to be individualized as well. You
always want to taper off your treatment, stopping
medications abruptly, especially the ones that
are prescribed to prevent migraine headaches
is not necessarily a great idea. Yeah. It's like
comparing it to like, imagine that the disease
is like a foreign invader and you're trying to
fight them with your own army, you know, quote
unquote. And if you withdraw all of your troops
at once, that's just going to give an opportunity
for the enemy to basically maintain its stronghold.
But if you strategically remove troops one at
a time, you might be able to have some type of
homeostasis or stability inside of you. Right.
And the other reason that you do taper them is
that sometimes if you abruptly discontinue a
medication, you can actually cause yourself to
have some... adverse effects. So, um, and it
just depends on the medication that you're taking.
So that again, you want to talk with your physician
to, to, to handle that appropriately. People
can relate anytime that they've gone on that
diet where they gave up coffee or they gave up
chocolate. And then the next day wasn't a good
day. You know, it's like, Oh my gosh, I need
my coffee. I need my chocolate. That's right.
The headache will speak for itself. Yes. So don't
give up. You know, keep it up. I would also strongly
recommend if you have this condition, keep a
record. Keep a record of things that have worked
and things that haven't. You know, have a little
notebook. It'll be a fun little Sherlock Holmes,
you know, detective case for you. So I think
we should, you know, close out talking about,
or did you have something else that you want
to talk about? Well, we mentioned just briefly,
we mentioned medication overuse headaches. So
let me just touch on that very shortly. So again,
if you treat a migraine acutely with a lot of
medication, you actually can set your head up
for... getting another headache as that drug
wears off. So you want to follow the guidelines
for treating migraines that your physician or
the label on the... on the bottle for a Tylenol
or an aspirin or an ibuprofen, you know, taking
it every six to eight hours or four to six hours.
You want to follow that so that you don't take
them too frequently because that can set you
up for that medication overuse headache. And
we talked about that with those combination products
that have narcotics in them, like the barbiturates
and the codeine. So again, it's really frustrating
that you could then create a headache while you're
trying to treat a headache. And so you just,
again, by not taking too much medication, that's
going to help you to prevent from having that
medication overuse headache. So maybe we should
talk about some of the misconceptions or myths
around migraines that maybe a lot of people have,
and maybe they feel like they're struggling with,
and we can kind of belay some of the fears around
some of those misconceptions. You know, they
always say knowledge, the truth will set you
free. And narrowing these things down hopefully
will eliminate a lot of variables so that you
can get to the right answer and hopefully provide
some relief for yourself, if not a loved one
who's having some issues with migraines. So I'd
say a couple of the kind of myths or maybe false
thinkings about migraines. We've probably touched
on a lot of these in our discussion, Josh. First
one is that migraine is just a headache. I think
we've kind of... If people have listened to our
conversation, we've kind of dismissed that myth
because it's not just a headache. It's not just
a tension headache. It's got a bunch of other
components. Right, because that might come with
a stigma of someone just saying, get over it.
It's just a headache, but it's not just a type
of headache because this is a really severe condition
in which it can really debilitate you. For some
patients, yes, it really can. But I think it's
more so like when you tell somebody you have
a headache. they might not really understand.
This has been so wonderful for me because I had
no idea a lot about all this stuff. I'm just
like, oh, it's just a headache. But hearing all
this today has really given me more empathy and
more compassion to be like, okay, if someone
says they have a migraine, I need to give them
a lot more grace. Right. Or if somebody says,
I have a headache, you can say, is it just a
headache or is it a migraine? You know, so because
that goes into the next kind of myth, like all
headaches are migraines. Well, we know that's
not true. You know, there's a, there's a variety
of different types of headaches and tension type
headaches and migraines are just two of them.
And there are several other types of headaches
as well. Some people might think a migraine is
their fault. And we've certainly shown that it's
not anybody's fault. It could be the way they're
made up, the environment that they live in, circumstances
that are going on. There may be some triggers
that you can kind of control to maybe help reduce
the number of headaches, but it's certainly not
somebody's fault. Yeah, but it's not your fault.
Like if you drank that glass of wine and you
got a migraine, it's not your fault that you
got a migraine. You just happen to be a person
born with the... predisposition to get migraines
on that particular day. Yep. You know, absolutely.
Right. Yes. So don't kick yourself. Right. I
think we just talked about this too, that the
more medicine I take for hip, for my, my migraine
headache, the more control I will have over my
migraine and no way, you know, we just talked
about that, that you want to take it, you want
to take it in appropriate doses, the least amount
of medication to help. To eliminate the pain.
More is not necessarily better because you could
set yourself up for that medication overuse headache.
Caffeine is the cause of my migraine. No, that's
not really true. Yes, maybe you're one of those
people who does get a migraine after drinking
a cup of coffee. But remember, caffeine is also
in a lot of therapies for treating migraine.
And it can be an effective treatment for migraine
as well. Right. So it might be a... correlation,
not causation. Like my favorite example is when
you look at a house that is, if you look at all
the houses that have ever burned down, they all
have sinks inside of them, but you wouldn't relate,
you know, the house burning down to the sink
being inside of it. Right. Right. Because we,
most of us drink tea or coffee in this, you know,
in this country. So you're, it's going to be
easy to draw that comparison. But we know from,
you know, looking at the literature that caffeine
could actually be a helpful aid. to vasoconstricting
your blood vessels in the trigeminal nerve area.
Right. The next one is that you must have an
aura for it to be a migraine. Well, we learned
that. Remember, it's only 20 to 25 % of patients
have an aura with their migraine. Here's one
that we haven't really touched on, but I think
for those that are considering having a baby
or are pregnant and you have migraines, you might
think there's nothing that you can do to manage
your migraines if you're pregnant. And that's
not true. Again, it would be a dialogue that
you would have with your physician, but there
are some medications that you can take that are
safe to use in pregnancy if your migraines do
get worse while you're pregnant. And then the
last one is that there is a diet plan that can
cure my migraine. And there might be some foods
that trigger migraine, but there's not really
a way that you can eat per se that can. get rid
of migraine headaches. So again, that's another
myth that we can dispel here. There's no real
silver bullet that is going to, um, as far as
there, there's no real silver bullet as far as
a diet that you can eat on a consistent basis.
That's going to keep you from having headaches
and stuff. So, okay. So I think, you know, to
wrap things up, you know, we talked about the
fact that a migraine is a headache that occurs
on one side, is a throbbing headache, and it
can last for up to three days. But usually in
most patients, well, it's patient specific. So
everybody's headache. uh, experience is different.
There can be triggers associated with them that
can possibly be controlled to help, you know,
reduce the number that you have in a, in a monthly
period. And thankfully there are a variety of
treatments to both treat acute episodes, as well
as to prevent the number of headaches that you
have in a migraine headaches that you have in
a particular month. And I think for. Patients
out there who are experiencing this, we are super
sorry that you're having to go through these
conditions. But one of the big things that you
want to treat it early, as soon as you start
experiencing those symptoms and you think a migraine
is coming on, almost have like a little holster,
have a little fanny pack of your medications
that have worked for you ready to go. And if
you're someone who's thinking that you might
have a migraine, I would recommend getting it
diagnosed by a physician as quickly as possible
so that you can develop a treatment plan for
you. And other than that, if you have any questions
for us, you can find us on social media, at Twitter,
Your Mom on Drugs, and we will be happy to answer
any questions that you have regarding this episode
and any future episodes. But we hope that you
learned a lot. I know I did from my wonderful
mom, who is just... Just an amazing resource
and an amazing person. So that being said, my
name is Josh Klaus. And I'm Jennifer Seltzer.
And this has been an episode of Your Mom on Drugs.
Thanks for joining.