WEBVTT 00:00:21.460 --> 00:00:25.100 Well, hey, everybody. Welcome to the first episode 00:00:25.100 --> 00:00:28.460 of Your Mom on Drugs, a podcast for helping people 00:00:28.460 --> 00:00:31.300 understand what drugs are, what they are for, 00:00:31.850 --> 00:00:34.810 how they can help, how they can hurt, and how 00:00:34.810 --> 00:00:37.409 to know the difference. My name is Josh Klaus, 00:00:37.590 --> 00:00:40.109 and I am joined by my mother, Jennifer Seltzer, 00:00:40.250 --> 00:00:44.090 PharmD, who is the mom on drugs. Dr. Seltzer 00:00:44.090 --> 00:00:46.950 worked for the UT Health System for over 30 years 00:00:46.950 --> 00:00:50.350 as a drug information specialist, whereas I received 00:00:50.350 --> 00:00:53.250 my bachelor's in biology, and I also have a degree 00:00:53.250 --> 00:00:57.090 in public health. So I just wanted to take a 00:00:57.090 --> 00:01:00.109 moment to talk about how growing up with a mom 00:01:00.109 --> 00:01:04.090 who knew every drug in the cabinet. And I thought 00:01:04.090 --> 00:01:07.370 that was just like mom knowledge, you know? I 00:01:07.370 --> 00:01:09.769 was like, I have a headache. Oh, you want to 00:01:09.769 --> 00:01:11.329 take this and this many of that? And I thought 00:01:11.329 --> 00:01:13.329 that was just general mom knowledge. But I remember 00:01:13.329 --> 00:01:17.769 being 15. and checking the mail one day and I 00:01:17.769 --> 00:01:20.310 saw a letter addressed to Dr. Seltzer. I'm like, 00:01:20.349 --> 00:01:22.769 who's Dr. Seltzer? And you're like, oh, that's 00:01:22.769 --> 00:01:24.670 me. I'm like, you're a doctor? She goes, yeah, 00:01:24.709 --> 00:01:28.810 I'm a doctorate in pharmacy. And I had no idea. 00:01:28.969 --> 00:01:31.290 So I don't know why you hid that from me for 00:01:31.290 --> 00:01:34.269 so long. I don't know either. I didn't realize 00:01:34.269 --> 00:01:37.090 you didn't know what I did. I just thought you 00:01:37.090 --> 00:01:38.769 were a pharmacist. I had no idea you were like 00:01:38.769 --> 00:01:41.109 such an excellent pharmacist. I taught, you know, 00:01:41.170 --> 00:01:43.829 I taught students. That's true. Yeah, I had no 00:01:43.829 --> 00:01:45.469 idea you were a professor as well. She was a 00:01:45.469 --> 00:01:48.549 professor. I had no idea. Maybe that speaks to 00:01:48.549 --> 00:01:51.049 my lack of interest. You had a few other things 00:01:51.049 --> 00:01:56.209 on your mind. Yes, when I was 15. So I realized 00:01:56.209 --> 00:01:59.849 after venturing out on my own and kind of wandering 00:01:59.849 --> 00:02:02.370 the aisles of the pharmacy looking for treatment 00:02:02.370 --> 00:02:06.150 for a headache, stomachache, you name it, that 00:02:06.150 --> 00:02:08.449 I was incredibly lucky to have some basic knowledge 00:02:08.449 --> 00:02:11.310 of pharmaceuticals growing up with a mom. And 00:02:11.310 --> 00:02:13.810 also someone I could call in the pharmacy to 00:02:13.810 --> 00:02:15.590 ask her a question. Like I didn't have to go 00:02:15.590 --> 00:02:17.349 to the pharmacist. I could just call you. It's 00:02:17.349 --> 00:02:19.110 like, what should I take this? Is the generic 00:02:19.110 --> 00:02:23.629 brand good? I mean, so I figured why not, why 00:02:23.629 --> 00:02:26.530 keep this resource to myself? Why not share this 00:02:26.530 --> 00:02:28.530 resource with the world? Because I'm sure there's 00:02:28.530 --> 00:02:30.689 a lot of other people like me who walk into a 00:02:30.689 --> 00:02:33.629 pharmacy and feel very overwhelmed. And so I 00:02:33.629 --> 00:02:35.590 figured that we could use this time to share 00:02:35.590 --> 00:02:39.110 our knowledge and curiosity about drugs and how 00:02:39.110 --> 00:02:42.810 they interact with the body. And we can share 00:02:42.810 --> 00:02:44.210 that with other people. Does that sound good 00:02:44.210 --> 00:02:46.629 to you? That sounds great. So just some background 00:02:46.629 --> 00:02:51.270 knowledge. There's no such thing as a panacea, 00:02:51.270 --> 00:02:54.110 I would say. The idea that there's a one size 00:02:54.110 --> 00:02:56.689 fits all for any disease, right? I would agree 00:02:56.689 --> 00:02:59.909 with that, yes. Yeah. So just to let everyone 00:02:59.909 --> 00:03:03.770 know, your body, your wonderful body, is composed 00:03:03.770 --> 00:03:08.349 of 37 .2 trillion cells, which is an astounding 00:03:08.349 --> 00:03:11.750 number. And each one of those cells... on average 00:03:11.750 --> 00:03:15.289 has about 42 million proteins of different types 00:03:15.289 --> 00:03:18.229 in them at one time, which is just insane to 00:03:18.229 --> 00:03:21.669 think if you have 42 million ingredients inside 00:03:21.669 --> 00:03:25.930 of one cell, when you have 37 trillion of them. 00:03:25.990 --> 00:03:28.389 So there's a lot going on. I mean, it's imagining 00:03:28.389 --> 00:03:32.069 like each cell is a city and it's got 42 million 00:03:32.069 --> 00:03:35.030 residents inside of it. And then you have 37 00:03:35.030 --> 00:03:38.090 .2 trillion cities and that just makes up your 00:03:38.090 --> 00:03:40.460 whole body. The fact that you would have one 00:03:40.460 --> 00:03:44.620 drug to cure an ailment that probably has a multitude 00:03:44.620 --> 00:03:47.439 of causes is probably not out there, which is 00:03:47.439 --> 00:03:49.719 why you need some expertise to help guide you 00:03:49.719 --> 00:03:52.180 through this process. Here go your mom on drugs. 00:03:53.539 --> 00:03:57.139 So your body is always in something called homeostasis. 00:03:57.759 --> 00:04:00.259 Homeostasis is essentially a fancy word for balance. 00:04:01.530 --> 00:04:04.310 Those 42 million proteins, they're either coming, 00:04:04.409 --> 00:04:06.310 they're going, they're doing a job, or they're 00:04:06.310 --> 00:04:08.530 done doing their job. They're getting built or 00:04:08.530 --> 00:04:11.110 they're getting degraded. And most of the time 00:04:11.110 --> 00:04:13.169 you don't notice this happening. You just notice 00:04:13.169 --> 00:04:15.930 yourself being alive and happy in the world, 00:04:15.949 --> 00:04:18.350 noticing the sunshine and a nice cool breeze, 00:04:18.569 --> 00:04:20.269 or maybe it's a little too cold or a little too 00:04:20.269 --> 00:04:23.730 hot, and you're usually fine. And when you notice 00:04:23.730 --> 00:04:26.670 that you're out of homeostasis is when you feel 00:04:26.670 --> 00:04:28.920 sick. Most of the time, it's when you feel that 00:04:28.920 --> 00:04:31.000 something is wrong, something's off, and there's 00:04:31.000 --> 00:04:34.160 usually a reason for that thing being off. And 00:04:34.160 --> 00:04:37.279 in this moment, I like to compare the body to 00:04:37.279 --> 00:04:41.819 a house. So your house has a lot of rooms inside 00:04:41.819 --> 00:04:45.899 of it. It also has appliances. It also has a 00:04:45.899 --> 00:04:48.939 structure to it. It's got frames. It's got studs. 00:04:48.939 --> 00:04:52.100 It also has a foundation. Appliances are kind 00:04:52.100 --> 00:04:54.519 of like organs in your body, like spleen, heart, 00:04:54.680 --> 00:04:57.069 etc. And then you have the foundation, which 00:04:57.069 --> 00:04:59.829 could be the bones, ligaments. Now, sometimes 00:04:59.829 --> 00:05:03.430 things in the house can go out of whack, but 00:05:03.430 --> 00:05:05.470 you don't notice it. Like, for example, when 00:05:05.470 --> 00:05:08.850 my house is dirty, my mom always notices that. 00:05:09.649 --> 00:05:12.949 But it's not going to make or break my house. 00:05:12.970 --> 00:05:14.730 My house is going to still stand even when it's 00:05:14.730 --> 00:05:19.410 dirty. But when something like my foundation 00:05:19.410 --> 00:05:22.639 is cracking, that can be indicative of the house 00:05:22.639 --> 00:05:25.100 being out of balance, out of homeostasis. And 00:05:25.100 --> 00:05:28.779 so some things in your body can be going wrong, 00:05:28.800 --> 00:05:31.120 like maybe a bit of indigestion or maybe a little 00:05:31.120 --> 00:05:33.040 bit of joint pain, but it's not going to mean, 00:05:33.259 --> 00:05:35.420 it'll probably correct itself because your body's 00:05:35.420 --> 00:05:37.120 going to go back to homeostasis. But sometimes 00:05:37.120 --> 00:05:39.139 things can go really wrong, like the foundation 00:05:39.139 --> 00:05:42.100 of your body can be cracked. And I think that's 00:05:42.100 --> 00:05:44.180 when you want to get a... you know, certified 00:05:44.180 --> 00:05:46.879 medical professional, like a pharmacist or a 00:05:46.879 --> 00:05:50.759 doctor or PA, NP, et cetera, to come and diagnose 00:05:50.759 --> 00:05:53.500 you and see what's actually going on inside of 00:05:53.500 --> 00:05:57.360 your body. So I wanted to set that as a foundation 00:05:57.360 --> 00:05:59.540 for as we talk about these things, that your 00:05:59.540 --> 00:06:04.779 body is an amazingly complex organism. And it's 00:06:04.779 --> 00:06:06.819 going to take a little bit of time and a little 00:06:06.819 --> 00:06:08.519 bit of thought and a little bit of detective 00:06:08.519 --> 00:06:10.480 work to actually figure out what's going on, 00:06:10.540 --> 00:06:12.529 what's right for you. You're not going to just 00:06:12.529 --> 00:06:14.189 be able to Google it and figure it out right 00:06:14.189 --> 00:06:16.589 away. It might be able to, you have to talk with 00:06:16.589 --> 00:06:19.269 your primary care physician. Hopefully we can 00:06:19.269 --> 00:06:21.149 provide some of that information as well to help 00:06:21.149 --> 00:06:25.970 you. And we hope that this information will not 00:06:25.970 --> 00:06:28.189 only be interesting, but also useful in your 00:06:28.189 --> 00:06:30.069 life or somebody else in your life that might 00:06:30.069 --> 00:06:32.129 be suffering from a certain type of condition. 00:06:33.730 --> 00:06:36.089 So with that being said, this is your mom on 00:06:36.089 --> 00:06:40.050 drugs with me, Josh Klaus. And Jennifer Seltzer. 00:06:40.670 --> 00:06:42.730 Who has remained amazingly quiet. I don't know 00:06:42.730 --> 00:06:48.490 if you want to add anything to that. No. As you 00:06:48.490 --> 00:06:50.970 can tell, I am the one with the words. But my 00:06:50.970 --> 00:06:52.810 mother will be having the words in this next 00:06:52.810 --> 00:06:55.009 section when we are going to be talking about 00:06:55.009 --> 00:06:59.769 migraines. So the first condition we wanted to 00:06:59.769 --> 00:07:04.069 hit today was migraine headaches. And this is 00:07:04.069 --> 00:07:06.470 something near and dear to my mom's heart because 00:07:06.470 --> 00:07:10.439 she experiences migraines. And so I'm actually 00:07:10.439 --> 00:07:13.500 going to just I'm fairly ignorant about migraines. 00:07:13.560 --> 00:07:15.879 So I'm just going to ask my mom a bunch of questions 00:07:15.879 --> 00:07:17.959 and hopefully she has the answers. And if we 00:07:17.959 --> 00:07:20.720 don't have the answers, then we will look them 00:07:20.720 --> 00:07:23.199 up and provide you the best information. So, 00:07:23.199 --> 00:07:29.019 mom, what is a migraine headache? Well, migraines 00:07:29.019 --> 00:07:33.240 are the second most common type of headache that 00:07:33.240 --> 00:07:37.100 people experience. The first type being. a tension 00:07:37.100 --> 00:07:42.019 type headache. But migraines, again, are the 00:07:42.019 --> 00:07:45.959 most common headache that causes neurologic disability. 00:07:46.079 --> 00:07:52.680 And they affect about 15 % of women and 6 % of 00:07:52.680 --> 00:07:56.860 men in the United States over a one -year period. 00:07:57.360 --> 00:08:02.319 And it's highest, they happen most frequently. 00:08:03.370 --> 00:08:07.089 in people 18 to 44 years of age, but you can 00:08:07.089 --> 00:08:10.250 have them younger or you can have them older, 00:08:12.290 --> 00:08:16.069 but that 18 to 44 is the most common age. So 00:08:16.069 --> 00:08:18.230 for someone who's experiencing this, it'll probably 00:08:18.230 --> 00:08:23.250 be 18 to 44. Now I've had a headache before and 00:08:23.250 --> 00:08:25.790 I know what that feels like. I usually take some 00:08:25.790 --> 00:08:29.310 ibuprofen or Tylenol and that usually helps alleviate 00:08:29.310 --> 00:08:32.860 the headache. From your personal experience, 00:08:33.139 --> 00:08:37.600 what makes a migraine different than just a regular 00:08:37.600 --> 00:08:39.779 tension headache, what probably most people are 00:08:39.779 --> 00:08:45.860 used to? Okay, so a migraine headache has, it 00:08:45.860 --> 00:08:51.379 actually has different phases. And there are... 00:08:51.799 --> 00:08:54.039 People that have migraine headaches can have 00:08:54.039 --> 00:08:57.000 up to four different phases that describe the 00:08:57.000 --> 00:09:01.759 headache. The first phase is called the prodrome 00:09:01.759 --> 00:09:05.960 or the, yes, the prodrome. And it doesn't happen 00:09:05.960 --> 00:09:08.720 in every single patient, but it happens in about 00:09:08.720 --> 00:09:13.039 75 % of patients that get migraines. And in the 00:09:13.039 --> 00:09:17.259 prodrome, you can have these kind of neurologic 00:09:17.259 --> 00:09:21.320 effects like you can have extra sensitivity to 00:09:21.320 --> 00:09:25.759 sound or light, or you can have some difficulty 00:09:25.759 --> 00:09:32.220 concentrating. or you can be all of a sudden 00:09:32.220 --> 00:09:35.039 extremely sensitive to touch, so it causes pain. 00:09:35.840 --> 00:09:38.860 You could also have some feelings of anxiety 00:09:38.860 --> 00:09:42.500 or depression or irritability. You could even 00:09:42.500 --> 00:09:45.960 have euphoria, you know, real light, bright happiness 00:09:45.960 --> 00:09:49.340 and stuff. You could also have some other... 00:09:49.799 --> 00:09:52.840 You know, physical effects to your body, like 00:09:52.840 --> 00:09:55.740 you could have frequent urination or diarrhea 00:09:55.740 --> 00:09:59.440 or constipation. And then you could also have 00:09:59.440 --> 00:10:02.220 some other different kind of miscellaneous things 00:10:02.220 --> 00:10:06.200 going on during this prodrome, like yawning or 00:10:06.200 --> 00:10:10.019 you crave for certain types of food or you get 00:10:10.019 --> 00:10:13.720 excessively thirsty or you may have anorexia. 00:10:14.320 --> 00:10:18.080 Again, then it moves into what's called the headache 00:10:18.080 --> 00:10:21.860 phase. And the thing that is characteristic of 00:10:21.860 --> 00:10:25.419 the headache is that it's usually unilateral. 00:10:25.480 --> 00:10:27.899 That means it's only on one side of the head. 00:10:28.279 --> 00:10:30.559 Now, it doesn't mean that it can't switch to 00:10:30.559 --> 00:10:32.440 the other side of the head, but usually it'll 00:10:32.440 --> 00:10:34.899 start on one side of the head. It may generalize 00:10:34.899 --> 00:10:37.039 at that point, but it's usually that's one of 00:10:37.039 --> 00:10:41.159 the kind of key characteristics of a migraine 00:10:41.159 --> 00:10:45.190 is that it happens on one side of the head. And 00:10:45.190 --> 00:10:48.289 then it's going to it's usually a gradual and 00:10:48.289 --> 00:10:51.210 onset pain. And, you know, interestingly, not 00:10:51.210 --> 00:10:53.529 everybody will get an actual headache with a 00:10:53.529 --> 00:10:55.889 migraine, which is crazy. Oh, so you can experience 00:10:55.889 --> 00:10:59.110 prodrome symptoms. Right. And it won't develop 00:10:59.110 --> 00:11:01.529 into a headache. Right. Now, I don't actually 00:11:01.529 --> 00:11:04.169 have a percentage of people who don't actually 00:11:04.169 --> 00:11:07.210 get headache pain. But you've got these other 00:11:07.210 --> 00:11:10.669 things that are going on as well, because because. 00:11:12.600 --> 00:11:14.700 that will characterize it as a migraine. And 00:11:14.700 --> 00:11:17.700 I'm not a great diagnostician. So I would say 00:11:17.700 --> 00:11:20.120 that if you've got some unique things going on 00:11:20.120 --> 00:11:22.039 that kind of feel like a headache, but you're 00:11:22.039 --> 00:11:24.059 not really sure whether it's a migraine or not, 00:11:24.139 --> 00:11:26.740 I would sure have a conversation with your doctor, 00:11:26.820 --> 00:11:28.639 you know, about that, your primary care physician. 00:11:30.519 --> 00:11:33.019 And other things that are characteristic of that 00:11:33.019 --> 00:11:35.799 actual headache phase is, like I said, you know, 00:11:35.799 --> 00:11:39.200 that the headache usually is unilateral. It usually 00:11:39.200 --> 00:11:41.720 is kind of at the front of your head or the side 00:11:41.720 --> 00:11:44.879 of your head. Sometimes, which is different, 00:11:44.940 --> 00:11:47.659 which is different from a usual tension type 00:11:47.659 --> 00:11:50.399 headache, because if you've had a tension type 00:11:50.399 --> 00:11:52.759 headache, it kind of feels like a band around 00:11:52.759 --> 00:11:54.740 your head. Yeah, I always feel like I'm getting 00:11:54.740 --> 00:11:57.379 squeezed. Right. And that's not the way a migraine 00:11:57.379 --> 00:11:59.399 headache feels. It feels usually that you've 00:11:59.399 --> 00:12:02.139 got this. throbbing pain, usually it's in the 00:12:02.139 --> 00:12:05.039 frontal front kind of area or the side of your 00:12:05.039 --> 00:12:12.200 head. It's like on one side. And it can increase 00:12:12.200 --> 00:12:15.639 in intensity if you don't treat it. Usually that 00:12:15.639 --> 00:12:18.159 kind of headache doesn't go away on its own. 00:12:18.990 --> 00:12:21.789 Um, after you've had this headache phase and 00:12:21.789 --> 00:12:25.649 it can last from anywhere from four to 72 hours. 00:12:25.769 --> 00:12:28.470 So that's three days, you know, so some people 00:12:28.470 --> 00:12:31.529 get really sick with migraines. Um, after the 00:12:31.529 --> 00:12:34.789 migraine, after the headache phase is, is over, 00:12:34.990 --> 00:12:37.769 then you enter what is called the post -drome 00:12:37.769 --> 00:12:41.350 phase or the after phase. And in that phase, 00:12:41.429 --> 00:12:47.070 you feel tired. Um, you can feel, um, Irritability 00:12:47.070 --> 00:12:50.529 again, you feel exhausted, no energy. You can 00:12:50.529 --> 00:12:55.370 have mood changes, depression again. Some people 00:12:55.370 --> 00:12:57.909 will even actually feel unusually refreshed. 00:12:58.309 --> 00:13:02.190 I know from personal experience, I feel so great 00:13:02.190 --> 00:13:05.230 not to have that headache anymore, even if I've 00:13:05.230 --> 00:13:07.710 had to take some medications to get rid of it. 00:13:07.789 --> 00:13:09.450 So sometimes I'll just feel really good that 00:13:09.450 --> 00:13:13.419 I don't have the pain anymore. Sometimes you 00:13:13.419 --> 00:13:16.899 can have hard time concentrating after you have 00:13:16.899 --> 00:13:20.480 a migraine and that all these after effects can 00:13:20.480 --> 00:13:24.240 last up to one day. Yeah. So if I can summarize 00:13:24.240 --> 00:13:26.960 and you can correct me where I'm wrong. So you 00:13:26.960 --> 00:13:29.379 essentially have the prodrome phase where it 00:13:29.379 --> 00:13:32.720 almost seems like certain things are just heightened. 00:13:32.799 --> 00:13:35.179 It just seems like certain sensitivities are 00:13:35.179 --> 00:13:36.399 just heightened. You almost feel like you're 00:13:36.399 --> 00:13:39.659 more sensitive to the world around you. And then 00:13:39.659 --> 00:13:43.039 that could bring on an onset of the actual migraine 00:13:43.039 --> 00:13:45.759 headache, which usually affects one side of the 00:13:45.759 --> 00:13:48.299 head. But it's not like a squeezing or a tension 00:13:48.299 --> 00:13:51.279 headache. It's more of a pulsating headache or 00:13:51.279 --> 00:13:52.980 a throbbing headache that you have. And that 00:13:52.980 --> 00:13:56.679 could last up to 72 hours. And I don't know if 00:13:56.679 --> 00:13:58.639 there's any reason why one would last longer 00:13:58.639 --> 00:14:00.480 than the other if it's just random. It's just 00:14:00.480 --> 00:14:03.960 random. And then after that, you have the post 00:14:03.960 --> 00:14:08.860 -drome phase in which you feel almost... exhausted. 00:14:09.139 --> 00:14:12.360 It almost sounds like a tidal wave where you 00:14:12.360 --> 00:14:14.440 have the swelling of the wave and then the wave 00:14:14.440 --> 00:14:17.080 crashes, which is the headache. And then you 00:14:17.080 --> 00:14:19.980 have the leftover surf at the end of it. Kind 00:14:19.980 --> 00:14:22.440 of. Yes. It's just that when it's over for whatever 00:14:22.440 --> 00:14:24.659 reason, your body is just, and it's probably 00:14:24.659 --> 00:14:27.480 due to some of the, you know, the, the, the, 00:14:27.480 --> 00:14:31.259 the mechanism behind a migraine is not well known. 00:14:32.220 --> 00:14:35.539 There are some genetics that could be kind of 00:14:35.539 --> 00:14:40.039 the cause of it. Environmental factors can also 00:14:40.039 --> 00:14:43.279 play a role. But as far as what's going on inside 00:14:43.279 --> 00:14:47.259 your head specifically, it usually has to do 00:14:47.259 --> 00:14:50.399 with some sort of changes in your brainstem and 00:14:50.399 --> 00:14:53.659 specifically the trigeminal nerve, which is one 00:14:53.659 --> 00:14:55.779 of the nerves that's in your brain that is a 00:14:55.779 --> 00:14:59.789 major pain pathway. Trigeminal nerve. Trigeminal 00:14:59.789 --> 00:15:02.950 nerve. That's a fun word. Yes, it is. And so 00:15:02.950 --> 00:15:04.649 then there's going to be some other chemical 00:15:04.649 --> 00:15:08.690 things that might be affected. I'm just going 00:15:08.690 --> 00:15:11.110 to throw out a couple of them. And the reason 00:15:11.110 --> 00:15:14.289 I'm throwing them out is that they come into 00:15:14.289 --> 00:15:17.269 play when you treat a migraine headache. Yeah, 00:15:17.309 --> 00:15:20.110 we should let everyone know here that understanding 00:15:20.110 --> 00:15:22.909 the mechanism isn't necessary to treating the 00:15:22.909 --> 00:15:26.250 disease. But imagine if you like working on cars, 00:15:26.389 --> 00:15:28.750 for example, like you usually take your car to 00:15:28.750 --> 00:15:32.889 the mechanic and you say, my AC isn't working. 00:15:33.289 --> 00:15:36.809 And there's probably a reason why your AC isn't 00:15:36.809 --> 00:15:38.669 working. It could be the condenser is broken. 00:15:38.730 --> 00:15:41.090 It could be that the fan isn't blowing properly. 00:15:41.210 --> 00:15:43.870 So you could take it to the mechanic and just 00:15:43.870 --> 00:15:46.149 give it to them. and they could fix your car, 00:15:46.289 --> 00:15:48.110 and you wouldn't have to know what they did. 00:15:48.250 --> 00:15:50.389 And I've had the experience where they tell you 00:15:50.389 --> 00:15:52.009 that long list of things that they did. I'm like, 00:15:52.049 --> 00:15:53.610 yeah, yeah, yeah, here's my money. Thanks for 00:15:53.610 --> 00:15:56.870 fixing my car. But if you are interested in knowing 00:15:56.870 --> 00:15:58.929 your body like you would want to know a car, 00:15:59.110 --> 00:16:03.529 there are certain chemicals in your body that 00:16:03.529 --> 00:16:05.730 can go out of balance. Remember that homeostasis 00:16:05.730 --> 00:16:08.929 thing we talked about? And so by knowing which 00:16:08.929 --> 00:16:11.570 chemicals in which nervous systems, like the 00:16:11.570 --> 00:16:13.750 trigeminal nervous system, is out of balance, 00:16:14.299 --> 00:16:17.279 you then can use specific drugs to be able to 00:16:17.279 --> 00:16:19.620 treat those symptoms because it wouldn't do you 00:16:19.620 --> 00:16:24.240 any good to use Tums to treat a migraine because 00:16:24.240 --> 00:16:26.600 Tums have a very different way that they interact 00:16:26.600 --> 00:16:28.720 with the body. than something like some of the 00:16:28.720 --> 00:16:30.679 treatments that we're going to say. So if you 00:16:30.679 --> 00:16:32.980 are a nerd like we are, we're going to post more 00:16:32.980 --> 00:16:36.679 detailed figures and scientific papers at the 00:16:36.679 --> 00:16:38.799 end of this show notes, and you can click and 00:16:38.799 --> 00:16:41.379 do your own research. But other than that, we're 00:16:41.379 --> 00:16:43.179 just going to kind of give you the general overview 00:16:43.179 --> 00:16:46.700 of why these treatments are appropriate. Is that 00:16:46.700 --> 00:16:50.100 fair to say? That would be fair to say. So again, 00:16:51.100 --> 00:16:55.580 I mentioned the body has several different... 00:16:58.769 --> 00:17:03.950 nerves that reach into the brain and the trigeminal 00:17:03.950 --> 00:17:06.950 nerve is just one of them. So the trigeminal 00:17:06.950 --> 00:17:11.710 nerve is the nerve that affects your face. And 00:17:11.710 --> 00:17:17.890 so the trigeminal nerve, it's also a major pain 00:17:17.890 --> 00:17:20.990 pathway, which has something to do with migraine 00:17:20.990 --> 00:17:25.250 headaches. And then there are specific chemicals 00:17:25.250 --> 00:17:30.599 in your brain that can be unbalanced, as Josh 00:17:30.599 --> 00:17:34.720 said, in migraines. And one of them is serotonin. 00:17:34.839 --> 00:17:38.900 One of them can be dopamine. And one of them 00:17:38.900 --> 00:17:44.779 is a newer peptide called calcitonin gene -related 00:17:44.779 --> 00:17:53.099 peptide, or CGRP. And this peptide is a vasoactive, 00:17:53.180 --> 00:17:56.319 so it's a vascular or it affects, you know, like 00:17:56.319 --> 00:18:01.140 your vessels, you know, in your brain. And that 00:18:01.140 --> 00:18:04.420 if it really, it's... So the trigeminal nerve 00:18:04.420 --> 00:18:08.359 gets activated, this peptide gets released, and 00:18:08.359 --> 00:18:11.380 it will interact with blood vessels to cause 00:18:11.380 --> 00:18:14.480 vasodilation or your vessels in your brain get 00:18:14.480 --> 00:18:18.480 more engorged or inflamed. Yeah, let's break 00:18:18.480 --> 00:18:20.619 that down just so that people maybe can understand. 00:18:20.740 --> 00:18:24.019 So if you picture a balloon, right, that's not 00:18:24.019 --> 00:18:26.299 blown up or doesn't have water inside of it, 00:18:26.319 --> 00:18:29.799 and you blow it up with air or you put water 00:18:29.799 --> 00:18:31.559 inside of it, you're going to notice that balloon 00:18:31.559 --> 00:18:34.410 expanding. Now, if you have that balloon expanding 00:18:34.410 --> 00:18:39.730 inside of a container, for example, that's going 00:18:39.730 --> 00:18:43.430 to put pressure upon that container. And so you 00:18:43.430 --> 00:18:45.829 can imagine that's what vasodilation is in your 00:18:45.829 --> 00:18:49.150 brain. And so if you have this trigeminal nerve, 00:18:49.289 --> 00:18:54.549 basically with this CGRP simulating this vasodilation, 00:18:54.869 --> 00:18:57.829 you're going to essentially have this pressure 00:18:57.829 --> 00:19:00.630 that is going to be built up and could potentially 00:19:00.630 --> 00:19:03.559 cause the throbbing. Again, this isn't a definite 00:19:03.559 --> 00:19:06.119 mechanism, but you can see that maybe there is 00:19:06.119 --> 00:19:10.039 some relation there. So that's kind of the basics 00:19:10.039 --> 00:19:13.500 as far as how a migraine headache might get started. 00:19:14.059 --> 00:19:16.759 But let's go back and let's review again. Remember, 00:19:16.940 --> 00:19:24.839 there is a prodrome phase, a headache phase, 00:19:25.220 --> 00:19:29.400 and a postdrome phase. But also let's not forget 00:19:29.400 --> 00:19:34.160 that about 20 to 25 % of patients also may have 00:19:34.160 --> 00:19:38.619 an aura. So let me tell you what an aura is. 00:19:38.779 --> 00:19:41.380 This is exciting. It's like you got a healthy 00:19:41.380 --> 00:19:45.680 glow about you. So yes, kind of. This aura, these 00:19:45.680 --> 00:19:49.640 are reversible nervous system symptoms, and they 00:19:49.640 --> 00:19:54.700 are most often visual symptoms. And but you can 00:19:54.700 --> 00:19:57.680 also have what we call sensory motor symptoms. 00:19:57.759 --> 00:20:01.440 So you could possibly have some numbness or weakness 00:20:01.440 --> 00:20:04.920 or you could actually lose the ability to speak, 00:20:05.099 --> 00:20:08.519 you know, which is a word called aphasia. But 00:20:08.519 --> 00:20:12.779 so but that's not very common. Mostly your aura 00:20:12.779 --> 00:20:15.539 is going to be these visual changes. And these 00:20:15.539 --> 00:20:17.920 are things that the individual experiencing the 00:20:17.920 --> 00:20:21.039 migraine. It's their aura, like they're experiencing 00:20:21.039 --> 00:20:23.380 visual phenomena they wouldn't normally experience. 00:20:23.720 --> 00:20:28.319 That's correct. And this aura usually happens 00:20:28.319 --> 00:20:31.599 and builds up over several minutes and may last 00:20:31.599 --> 00:20:35.980 up to 60 minutes. And the aura phase usually 00:20:35.980 --> 00:20:40.640 occurs either before or during the migraine. 00:20:41.059 --> 00:20:44.279 So again, remember I said that that only happens 00:20:44.279 --> 00:20:48.809 in about 20 to 25 % of patients. And would that 00:20:48.809 --> 00:20:50.769 happen before the headache or before the pre 00:20:50.769 --> 00:20:53.589 -drome? It could happen before either. Is this 00:20:53.589 --> 00:20:56.410 something that you experience? I do not. I do 00:20:56.410 --> 00:20:59.849 not. So, but I definitely know people who do, 00:20:59.869 --> 00:21:02.329 you know, so again, 20, so you're thinking one 00:21:02.329 --> 00:21:05.769 in four to one in five people are going to get 00:21:05.769 --> 00:21:08.910 the aura associated with a migraine. Of people 00:21:08.910 --> 00:21:12.069 who have. Who have migraines. Yes. Yes. Not everybody, 00:21:12.150 --> 00:21:15.009 but one in four or one in five people who get 00:21:15.009 --> 00:21:18.710 who experience migraines may have an aura. There 00:21:18.710 --> 00:21:23.130 are there is some discussion about. So people, 00:21:23.250 --> 00:21:27.029 you know, investigators have. you know, have 00:21:27.029 --> 00:21:32.009 researched information about migraine and characteristics 00:21:32.009 --> 00:21:36.569 of people who get migraine. And there have been 00:21:36.569 --> 00:21:39.650 some triggers that have been identified that 00:21:39.650 --> 00:21:43.609 may cause people to get migraines more often. 00:21:44.029 --> 00:21:46.549 Okay. So it's almost like there's a switch that 00:21:46.549 --> 00:21:49.890 there's an external stimuli with a switch that 00:21:49.890 --> 00:21:52.019 could. basically cause you to be more likely 00:21:52.019 --> 00:21:54.799 to have a migraine. That's true. Now that doesn't 00:21:54.799 --> 00:21:57.859 mean that if you get exposed to this particular 00:21:57.859 --> 00:21:59.940 trigger, you're automatically going to have a 00:21:59.940 --> 00:22:03.740 migraine and, and people who do get migraines 00:22:03.740 --> 00:22:07.279 may have multiple triggers so that each person 00:22:07.279 --> 00:22:13.180 kind of gets. aware of the things that may cause 00:22:13.180 --> 00:22:17.160 them to be more susceptible to getting a migraine, 00:22:17.160 --> 00:22:20.119 and you might want to avoid those or modify that 00:22:20.119 --> 00:22:23.579 type of behavior. So let me give you an example 00:22:23.579 --> 00:22:25.920 of a couple of things that might be considered 00:22:25.920 --> 00:22:30.950 a migraine trigger. For women, it can be hormone 00:22:30.950 --> 00:22:35.029 changes. So there are some women that just get 00:22:35.029 --> 00:22:39.509 a migraine when they have their menses. And so 00:22:39.509 --> 00:22:42.150 that would not be something that men had to deal 00:22:42.150 --> 00:22:44.950 with, but so hormonal changes for sure. They 00:22:44.950 --> 00:22:49.230 can also, women may also have changes in their 00:22:49.230 --> 00:22:51.329 migraine headache frequency when they go through 00:22:51.329 --> 00:22:56.160 menopause. If you drink certain... beverages 00:22:56.160 --> 00:23:01.160 like alcohol, especially wine, and sometimes 00:23:01.160 --> 00:23:05.309 beer. And caffeine, especially those types of 00:23:05.309 --> 00:23:08.509 things may trigger a migraine. Although I will 00:23:08.509 --> 00:23:11.170 offer a disclaimer in that caffeine is actually 00:23:11.170 --> 00:23:13.490 also used to treat a migraine headache. I was 00:23:13.490 --> 00:23:15.849 going to say that seems to be a little anecdotal. 00:23:15.930 --> 00:23:18.650 Right. But so mostly it's things like if you 00:23:18.650 --> 00:23:21.750 drink, especially wine is especially can be a 00:23:21.750 --> 00:23:23.630 trigger for some patients. That's really interesting. 00:23:23.809 --> 00:23:26.269 Is there anything special about wine? Is it just 00:23:26.269 --> 00:23:28.950 the way that it's fermented? I think that must 00:23:28.950 --> 00:23:32.269 be. I did not look into all the details. about 00:23:32.269 --> 00:23:34.369 wine and why it would cause a migraine trigger, 00:23:34.609 --> 00:23:36.569 that could be something that we could do a little 00:23:36.569 --> 00:23:38.150 bit later on. Yeah, I think if we're going to 00:23:38.150 --> 00:23:39.930 stop people from drinking wine, I don't think 00:23:39.930 --> 00:23:41.369 that's going to happen on this podcast. Yeah, 00:23:41.369 --> 00:23:43.309 I don't think so either. Just know that it could 00:23:43.309 --> 00:23:45.690 likely induce a migraine. If you want, just be 00:23:45.690 --> 00:23:48.410 ready for your migraine. We should also also 00:23:48.410 --> 00:23:52.190 disclaimer about the word trigger. So trigger, 00:23:52.390 --> 00:23:55.369 a lot of people think it's like an on -off switch, 00:23:55.549 --> 00:23:58.930 like the trigger on a gun or the light switch 00:23:58.930 --> 00:24:01.170 for turning your lights on in the house. It's 00:24:01.170 --> 00:24:04.950 pretty definite that when that happens, an effect 00:24:04.950 --> 00:24:07.690 is going to happen from the cause. But when you 00:24:07.690 --> 00:24:10.150 think about something like the body, which has... 00:24:10.720 --> 00:24:13.779 if not hundreds, thousands of things going on 00:24:13.779 --> 00:24:18.460 at the same time, the smallest thing might not 00:24:18.460 --> 00:24:20.799 push it over the edge, but it might make it more 00:24:20.799 --> 00:24:24.059 likely. So for example, something that you might 00:24:24.059 --> 00:24:27.380 think about is if you have an object that's in 00:24:27.380 --> 00:24:30.500 balance, like let's imagine that you have someone 00:24:30.500 --> 00:24:35.000 standing basically on a balance beam and you 00:24:35.000 --> 00:24:38.039 have forces pushing them from the right and the 00:24:38.039 --> 00:24:41.730 left. And that's keeping them upright. Now, the 00:24:41.730 --> 00:24:45.230 smallest little nudge on the right, even though 00:24:45.230 --> 00:24:46.950 it is pushing them to try to make them go out 00:24:46.950 --> 00:24:48.809 of balance, they can use their abs or they can 00:24:48.809 --> 00:24:51.809 use their body to maintain the balance. But if 00:24:51.809 --> 00:24:53.789 you have enough things pushing them, no matter 00:24:53.789 --> 00:24:55.690 how much they try to balance, they're going to 00:24:55.690 --> 00:24:59.130 fall off. So the idea of a trigger doesn't necessarily 00:24:59.130 --> 00:25:01.589 mean like it's going to definitely do it. but 00:25:01.589 --> 00:25:04.349 it gives you a higher likelihood that this event 00:25:04.349 --> 00:25:07.250 is going to occur. So you're always trying to 00:25:07.250 --> 00:25:09.609 overcome some type of threshold. And we're going 00:25:09.609 --> 00:25:12.289 to get to that when we talk about pharmaceuticals 00:25:12.289 --> 00:25:15.599 as well, because pharmaceuticals... definitely 00:25:15.599 --> 00:25:18.700 try to override thresholds to basically counteract 00:25:18.700 --> 00:25:21.180 that force that's causing the migraine. And you 00:25:21.180 --> 00:25:23.480 want to push that balance back in the other direction. 00:25:24.059 --> 00:25:26.359 So just as a caveat there, that it's not this 00:25:26.359 --> 00:25:29.799 on or off switch. It's very much a very nuanced 00:25:29.799 --> 00:25:33.420 multifactorial balance situation. Okay. Thanks, 00:25:33.500 --> 00:25:36.720 Josh, for clarifying that. A couple of other, 00:25:36.759 --> 00:25:42.180 I think, key triggers are stress, sensory stimuli, 00:25:42.220 --> 00:25:47.190 things like Bright lights and glare. I was driving 00:25:47.190 --> 00:25:49.930 through Austin over this past weekend in the 00:25:49.930 --> 00:25:53.089 evening time and a lot of bright lights. And 00:25:53.089 --> 00:25:55.190 sure enough, when I got home, I got a migraine, 00:25:55.269 --> 00:25:56.809 you know, and stuff. So I was like, that's just 00:25:56.809 --> 00:26:00.390 not good. Sleep changes. So too much or too little 00:26:00.390 --> 00:26:05.890 sleep can sometimes be a trigger. Weather changes 00:26:05.890 --> 00:26:11.470 can be a trigger for migraines. Some foods like 00:26:11.470 --> 00:26:15.569 aged cheeses. because they have, I believe it's 00:26:15.569 --> 00:26:19.150 tyramine in them that can be the trigger for 00:26:19.150 --> 00:26:24.109 migraines. If you skip a meal and you get hungry, 00:26:24.269 --> 00:26:26.849 that can be a trigger for a migraine. And some 00:26:26.849 --> 00:26:29.430 food additives can also cause migraines like 00:26:29.430 --> 00:26:33.670 aspartame or monosodium glutamate. I wonder if 00:26:33.670 --> 00:26:35.490 the thing with the aged cheese is similar to 00:26:35.490 --> 00:26:38.269 the wine because wine is aged as well. Yes, that 00:26:38.269 --> 00:26:40.869 there could be very much of a similarity there. 00:26:41.009 --> 00:26:44.150 I'm just speculating. So let me just run through 00:26:44.150 --> 00:26:47.130 that. You know, we've talked about kind of what, 00:26:47.210 --> 00:26:52.329 you know, the phases of a migraine. We've talked 00:26:52.329 --> 00:26:54.670 about the fact that some people can get an aura. 00:26:54.869 --> 00:26:57.750 We've talked about triggers. Here are the common 00:26:57.750 --> 00:27:01.960 symptoms of patients who get migraines. So usually 00:27:01.960 --> 00:27:07.099 you're going to have some nausea, which is not 00:27:07.099 --> 00:27:09.579 typical when you get a tension type headache. 00:27:10.279 --> 00:27:14.160 Also, you can be sensitive to both light and 00:27:14.160 --> 00:27:17.319 sound. So that can be part of that prodrome phase, 00:27:17.519 --> 00:27:21.400 but that can also continue on in the migraine, 00:27:21.400 --> 00:27:24.339 the headache phase that you just want to go into 00:27:24.339 --> 00:27:28.660 a dark room and lie down with no noise. You can 00:27:28.660 --> 00:27:32.619 get a little lightheaded. You can have vomiting 00:27:32.619 --> 00:27:34.500 as well, too, if you don't treat the headache. 00:27:35.319 --> 00:27:40.200 And you could have some visual disturbances that 00:27:40.200 --> 00:27:44.319 are not an aura. And you can have some numbness. 00:27:44.559 --> 00:27:46.839 So those are just some of the things that you 00:27:46.839 --> 00:27:49.720 can have. You can have some diarrhea associated 00:27:49.720 --> 00:27:55.940 with it. And a little bit of maybe, you know, 00:27:55.960 --> 00:27:58.059 altered consciousness, like you just feel like 00:27:58.059 --> 00:28:01.019 you've lost concentration and stuff. So I'd say 00:28:01.019 --> 00:28:03.700 that. So the things that make a migraine different 00:28:03.700 --> 00:28:06.180 than a regular headache are going to be the nausea 00:28:06.180 --> 00:28:08.319 and vomiting that can be associated with it, 00:28:08.380 --> 00:28:12.059 as well as that sensitivity to light and sound. 00:28:12.539 --> 00:28:14.779 Yeah. So if someone is experiencing these symptoms, 00:28:14.859 --> 00:28:18.380 this might be a great stepping stone to go get 00:28:18.380 --> 00:28:21.309 diagnosed by a proper medical professional. And 00:28:21.309 --> 00:28:24.009 whether they have these things acutely or chronically, 00:28:24.109 --> 00:28:25.950 you know, because it could be a perpetual problem 00:28:25.950 --> 00:28:28.210 or something that happens in the short term. 00:28:28.519 --> 00:28:31.859 Right. And so, yes, so that's a great segue, 00:28:32.039 --> 00:28:34.400 Josh, into kind of the key things that are looked 00:28:34.400 --> 00:28:37.400 at to diagnose a migraine. Normally, it's not 00:28:37.400 --> 00:28:42.140 any type of a CT scan or an MRI. You don't really 00:28:42.140 --> 00:28:45.559 diagnose a migraine that way. But you usually 00:28:45.559 --> 00:28:49.059 do it based on your headache frequency. So in 00:28:49.059 --> 00:28:51.900 patients that don't have an aura, if you have 00:28:51.900 --> 00:28:55.329 at least five attacks and the headache lasts 00:28:55.329 --> 00:28:59.730 on each attack from four to 72 hours, whether 00:28:59.730 --> 00:29:03.390 or not it's treated successfully or unsuccessfully. 00:29:03.789 --> 00:29:06.789 And that it usually has, like we talked about, 00:29:06.829 --> 00:29:10.809 that one -sided location, that it's got that 00:29:10.809 --> 00:29:14.869 pulsating, you know, throbbing quality. It's 00:29:14.869 --> 00:29:18.269 moderate to severe in intensity. And it can be 00:29:18.269 --> 00:29:21.890 aggravated by movement or you want to avoid walking 00:29:21.890 --> 00:29:24.670 around because you just don't feel good. And 00:29:24.670 --> 00:29:27.009 that you could also have the nausea, vomiting, 00:29:27.150 --> 00:29:30.529 and sensitivity, light and sound associated with 00:29:30.529 --> 00:29:34.809 it. And it's not, you can't determine that any 00:29:34.809 --> 00:29:37.430 other thing is causing any of those types of 00:29:37.430 --> 00:29:40.130 issues. So that's going to help you get diagnosed 00:29:40.130 --> 00:29:43.950 with a migraine without aura. If you do have 00:29:43.950 --> 00:29:47.269 aura, then it's going to be you've got the aura 00:29:47.269 --> 00:29:50.710 going along with it with at least two attacks 00:29:50.710 --> 00:29:55.269 and that it's not attributed to any other condition. 00:29:55.930 --> 00:29:59.069 Okay. Yeah, that's really interesting. I think 00:29:59.069 --> 00:30:01.910 a common colloquialism that I hear is that if 00:30:01.910 --> 00:30:05.609 you're in a room and upstairs you hear hooves, 00:30:05.690 --> 00:30:08.970 you don't automatically think zebras. You automatically 00:30:08.970 --> 00:30:14.519 think horses, right? The idea is like you want 00:30:14.519 --> 00:30:17.279 to assume that the most common thing is happening 00:30:17.279 --> 00:30:20.019 to you unless you rule out that the most common 00:30:20.019 --> 00:30:22.259 thing isn't happening to you. For example, you 00:30:22.259 --> 00:30:26.160 could be in a room in Africa on a safari in a 00:30:26.160 --> 00:30:28.319 ranch and be like, oh, maybe there's more zebras 00:30:28.319 --> 00:30:33.079 here than there would be horses. So what a clever 00:30:33.079 --> 00:30:37.599 or a good doctor will do is that they will. rule 00:30:37.599 --> 00:30:40.160 out any of the things that it's not and there's 00:30:40.160 --> 00:30:42.160 there's techniques that you can do to diagnose 00:30:42.160 --> 00:30:45.500 that um i would not recommend diagnosing it yourself 00:30:45.500 --> 00:30:47.720 unless you have someone that you that you trust 00:30:47.720 --> 00:30:50.059 or you feel like that you can analyze the literature 00:30:50.059 --> 00:30:54.750 pretty well um because a runny nose If you have 00:30:54.750 --> 00:30:57.289 a runny nose, just as an example, a runny nose 00:30:57.289 --> 00:30:59.410 can be indicative of so many things. You know, 00:30:59.470 --> 00:31:01.130 I mean, you can have a runny nose for so many 00:31:01.130 --> 00:31:03.329 different reasons. So there's got to be other 00:31:03.329 --> 00:31:05.970 causes associated with that runny nose that are 00:31:05.970 --> 00:31:07.289 going to basically help you. Do you have the 00:31:07.289 --> 00:31:09.230 common cold? Do you have the flu? You know, do 00:31:09.230 --> 00:31:11.670 you just, you know, is it just the pollen count 00:31:11.670 --> 00:31:14.769 high that day? So there's a lot of things to 00:31:14.769 --> 00:31:16.970 narrow it down. And it's actually, you can have 00:31:16.970 --> 00:31:19.130 a lot of fun just trying to narrow things down 00:31:19.130 --> 00:31:21.589 and be a bit open -minded about the things that 00:31:21.589 --> 00:31:25.690 are going on with you. Let's imagine that I'm 00:31:25.690 --> 00:31:30.230 a individual who has migraines with aura or without 00:31:30.230 --> 00:31:33.529 aura. Let's just use without aura for simplicity's 00:31:33.529 --> 00:31:35.430 sake because that seems to be the majority of 00:31:35.430 --> 00:31:39.390 people. And I want to get treated. And I was 00:31:39.390 --> 00:31:43.049 looking up a stat that on average it costs about 00:31:43.049 --> 00:31:46.490 $6 ,500 a year to treat migraines, like if you 00:31:46.490 --> 00:31:48.829 have chronic migraines. I think that's including 00:31:48.829 --> 00:31:52.880 doctor's visits, medication costs. etc. So I 00:31:52.880 --> 00:31:55.059 mean, this isn't even including taking time off 00:31:55.059 --> 00:31:57.420 of work. So because it seems like it can be a 00:31:57.420 --> 00:32:01.519 debilitating condition. If it's pretty intense, 00:32:01.920 --> 00:32:04.339 like the ability to not be able to focus as well 00:32:04.339 --> 00:32:07.319 on work, so you'll just lose productivity. So 00:32:07.319 --> 00:32:10.680 if I'm an individual who wants to treat this 00:32:10.680 --> 00:32:14.130 disease, or this condition, I should say. You 00:32:14.130 --> 00:32:17.109 know, where would I want to start? Okay. That 00:32:17.109 --> 00:32:20.069 number seems a little high, you know, but I think 00:32:20.069 --> 00:32:24.230 it might cost $6 ,500 a year, maybe for the first 00:32:24.230 --> 00:32:26.950 year when you're actually getting diagnosed to 00:32:26.950 --> 00:32:29.750 rule out some of those things. But I'd say as 00:32:29.750 --> 00:32:32.529 you progress on, it shouldn't cost that much 00:32:32.529 --> 00:32:36.289 to treat migraine headaches unless you have some 00:32:36.289 --> 00:32:38.450 that are more difficult to control and you require 00:32:38.450 --> 00:32:42.190 some more expensive medications. Where you start 00:32:42.190 --> 00:32:45.990 initially in treating a migraine is that you 00:32:45.990 --> 00:32:50.750 can use, you can try things like, let me back 00:32:50.750 --> 00:32:54.950 up first, just to give you just a few just general 00:32:54.950 --> 00:32:56.609 statements about treating a migraine headache. 00:32:57.069 --> 00:33:00.509 First of all, treating a migraine headache is 00:33:00.509 --> 00:33:04.150 individualized. No two people are probably going 00:33:04.150 --> 00:33:07.430 to respond to the same types of treatment regimens. 00:33:07.670 --> 00:33:11.529 And actually in the same person, The same drug 00:33:11.529 --> 00:33:13.950 may not work every time you get a migraine. So 00:33:13.950 --> 00:33:17.410 you kind of have a little bit of a repertoire 00:33:17.410 --> 00:33:20.329 of medications to treat your migraine. Yeah, 00:33:20.349 --> 00:33:26.369 I think people might have an intuition of why 00:33:26.369 --> 00:33:29.250 that's the case, but I'll let you add upon this, 00:33:29.349 --> 00:33:32.230 but I'm just going to give an example. So we 00:33:32.230 --> 00:33:34.809 mentioned earlier that migraines is primarily, 00:33:34.910 --> 00:33:36.869 it might have a genetic component, so you can 00:33:36.869 --> 00:33:40.349 inherit conditions that might. predispose you 00:33:40.349 --> 00:33:43.829 to have migraine headaches, for example. Now, 00:33:43.849 --> 00:33:46.410 remember with genetics, you're inheriting your 00:33:46.410 --> 00:33:49.470 genes, half from your mom, half from your dad, 00:33:49.569 --> 00:33:52.410 and then they get shuffled about and then they 00:33:52.410 --> 00:33:55.930 go inside of you and they code for the things, 00:33:56.009 --> 00:33:57.849 not just for the outside of your body, but for 00:33:57.849 --> 00:34:00.289 the inside of your body as well. And usually 00:34:00.289 --> 00:34:03.089 the things that are being affected here are things 00:34:03.089 --> 00:34:08.030 called receptors. And receptors are these proteins. 00:34:09.159 --> 00:34:12.000 that are on the outside of cells. Remember all 00:34:12.000 --> 00:34:13.539 those cells that you have, those wonderful cells 00:34:13.539 --> 00:34:15.940 you have in your body. They're there to catch 00:34:15.940 --> 00:34:18.579 things in the bloodstream that your cells need 00:34:18.579 --> 00:34:21.420 in order to function. So for example, your brain 00:34:21.420 --> 00:34:26.260 needs tons of hormones, molecules, proteins in 00:34:26.260 --> 00:34:30.179 order to function. Now, because you're inheriting 00:34:30.179 --> 00:34:34.059 those from your parents, if they're missing one 00:34:34.059 --> 00:34:36.650 of those proteins, they don't code for it. then 00:34:36.650 --> 00:34:38.769 you might have the possibility of missing it 00:34:38.769 --> 00:34:43.210 as well. Therefore, I'm just speaking from personal 00:34:43.210 --> 00:34:45.469 experience, I don't get migraine headaches. So 00:34:45.469 --> 00:34:48.110 my mom has the genetic predisposition to have 00:34:48.110 --> 00:34:50.610 migraines. I don't. I'm very grateful you didn't 00:34:50.610 --> 00:34:52.190 pass that on to me, but you did give me some 00:34:52.190 --> 00:34:58.590 stunning good looks. And I am very grateful that 00:34:58.590 --> 00:35:01.579 I didn't get the migraine. Which is why personalized 00:35:01.579 --> 00:35:04.059 medicine, whenever it does come into the fold, 00:35:04.119 --> 00:35:06.099 will be amazing because you can just tailor make 00:35:06.099 --> 00:35:08.860 molecules for your brain. We're not at that point 00:35:08.860 --> 00:35:10.619 yet. We're almost kind of dump things into your 00:35:10.619 --> 00:35:12.960 brain and hope for the best. But we don't want 00:35:12.960 --> 00:35:14.639 to do it willy -nilly because that could cause 00:35:14.639 --> 00:35:17.300 bad things, which we call side effects. And we'll 00:35:17.300 --> 00:35:20.280 talk about side effects in a moment. But is there 00:35:20.280 --> 00:35:22.760 anything you want to add on to that in terms 00:35:22.760 --> 00:35:25.139 of... people being different. I think that's 00:35:25.139 --> 00:35:29.000 true. And so, so then you're going to determine, 00:35:29.119 --> 00:35:32.840 and it's kind of a trial and error type of experience 00:35:32.840 --> 00:35:35.619 as far as figuring out what works for you and 00:35:35.619 --> 00:35:38.920 what doesn't. So the other kind of key thing 00:35:38.920 --> 00:35:41.920 is that first of all, therapy is individualized. 00:35:42.159 --> 00:35:44.800 And then the next thing is that you want to treat 00:35:44.800 --> 00:35:47.000 your migraine headache as quickly as possible 00:35:47.000 --> 00:35:49.500 as it comes on. When you start feeling the, when 00:35:49.500 --> 00:35:52.929 you experience the aura or when you start feeling 00:35:52.929 --> 00:35:55.909 the prodrome. You start experiencing those prodrome 00:35:55.909 --> 00:35:59.550 type symptoms because the longer you wait to 00:35:59.550 --> 00:36:02.030 treat a migraine headache, the worse it gets. 00:36:02.469 --> 00:36:06.349 So the first class of medications that you'll 00:36:06.349 --> 00:36:08.909 use to try to manage your migraine headache are 00:36:08.909 --> 00:36:11.670 going to be just your basic over -the -counter 00:36:11.670 --> 00:36:18.519 analgesics like Aspirin or Tylenol or Ibuprofen 00:36:18.519 --> 00:36:21.940 or everybody's probably familiar with Excedrin 00:36:21.940 --> 00:36:25.940 Migraine, which is a combination of aspirin, 00:36:25.940 --> 00:36:29.960 acetaminophen, which is Tylenol and caffeine. 00:36:30.460 --> 00:36:33.079 Yeah, maybe let's slow down a little. What is 00:36:33.079 --> 00:36:36.960 an analgesic? Oh, an analgesic. I'm so sorry. 00:36:37.079 --> 00:36:40.820 An analgesic is a pain reliever. So it's a medication 00:36:40.820 --> 00:36:45.659 that is used to help. kind of take away pain. 00:36:45.820 --> 00:36:49.599 Okay. And these are over the counter analgesics. 00:36:49.739 --> 00:36:52.960 And these drugs, they work kind of the same way, 00:36:53.000 --> 00:36:55.380 but do they have maybe just a little bit of differences 00:36:55.380 --> 00:36:59.800 in their mechanism? Yes. So things like aspirin 00:36:59.800 --> 00:37:05.260 and ibuprofen, like Advil or naproxen, like Aleve, 00:37:05.280 --> 00:37:09.340 they are, they, they. They treat pain, so they 00:37:09.340 --> 00:37:12.239 will help to relieve pain, but they also have 00:37:12.239 --> 00:37:16.719 an anti -inflammatory component. Whereas Tylenol 00:37:16.719 --> 00:37:21.760 or acetaminophen or Tylenol only works on pain 00:37:21.760 --> 00:37:25.739 relief. It doesn't really have an anti -inflammatory 00:37:25.739 --> 00:37:29.440 component. Okay. So if I remember correctly, 00:37:29.639 --> 00:37:32.940 there's things called nociceptors that are associated 00:37:32.940 --> 00:37:36.119 with pain. And so maybe Tylenol. affects the 00:37:36.119 --> 00:37:38.800 you know affinity of binding to nociceptors and 00:37:38.800 --> 00:37:42.300 feeling pain right okay and then when you take 00:37:42.300 --> 00:37:44.480 excedrin migraine and you've got that caffeine 00:37:44.480 --> 00:37:47.679 component in it remember how we talked about 00:37:47.679 --> 00:37:51.559 that migraines because of those chemicals that 00:37:51.559 --> 00:37:54.380 get released one of the things that happens is 00:37:54.380 --> 00:37:58.460 that you get um vasodilation or that expansion 00:37:58.460 --> 00:38:02.139 of your your blood vessels in your head. Well, 00:38:02.219 --> 00:38:05.519 caffeine works as a vasoconstrictor. So it's 00:38:05.519 --> 00:38:08.380 going to help to make those vessels close back 00:38:08.380 --> 00:38:10.980 down again. So like Josh talks about that balloon 00:38:10.980 --> 00:38:13.920 example, the caffeine is going to help take the 00:38:13.920 --> 00:38:16.079 air out of that balloon and make it go back down. 00:38:16.179 --> 00:38:18.980 That's really cool. So you're just, anytime I 00:38:18.980 --> 00:38:21.059 have a cup of coffee, I'm just taking air out 00:38:21.059 --> 00:38:23.239 of the balloon. There you go. You're doing some 00:38:23.239 --> 00:38:25.199 other things when you drink that coffee as well. 00:38:26.400 --> 00:38:33.320 So now there are some medications that have aspirin 00:38:33.320 --> 00:38:36.659 or acetaminophen and caffeine combined with it 00:38:36.659 --> 00:38:40.019 that have some other stronger pain relievers 00:38:40.019 --> 00:38:43.360 associated with it. Like there's a Furoset or 00:38:43.360 --> 00:38:48.300 Furanol. They have a barbiturate in them that 00:38:48.300 --> 00:38:50.980 kind of helps people go to sleep. And then there 00:38:50.980 --> 00:38:54.800 are some that have codeine in them. What the 00:38:54.800 --> 00:38:58.199 studies have shown is that these agents are really, 00:38:58.380 --> 00:39:03.699 while they can be effective, they can set patients 00:39:03.699 --> 00:39:07.639 up for... And something that we call medication 00:39:07.639 --> 00:39:10.159 overuse headache, which we're going to talk about 00:39:10.159 --> 00:39:11.840 in a little bit longer and stuff. So just keep 00:39:11.840 --> 00:39:15.619 that term in mind. So it's not really recommended 00:39:15.619 --> 00:39:18.699 as much to use those medications that have those 00:39:18.699 --> 00:39:22.039 more narcotic medications in them. Yeah. And 00:39:22.039 --> 00:39:24.840 if we can say those names again, those barbiturates. 00:39:25.360 --> 00:39:28.179 Barbiturates. Barbiturates. And codeine. Anything. 00:39:28.219 --> 00:39:31.079 So they're usually linked up with aspirin or 00:39:31.079 --> 00:39:34.239 acetaminophen and maybe some caffeine and then 00:39:34.239 --> 00:39:36.650 codeine. or barbiturate in it. Right. So if I'm 00:39:36.650 --> 00:39:38.809 at the pharmacy and I see. Those are prescription 00:39:38.809 --> 00:39:40.969 medications. Okay. So these are prescriptions. 00:39:41.030 --> 00:39:44.659 Yes. If my doctor wants to prescribe these to 00:39:44.659 --> 00:39:47.780 me, I might want to think twice because by trying 00:39:47.780 --> 00:39:49.960 to cure my headache, I could just get another 00:39:49.960 --> 00:39:53.119 drug -induced headache. Right. Okay. Right. So 00:39:53.119 --> 00:39:55.480 the juice might not be worth the squeeze. Right. 00:39:55.480 --> 00:39:59.659 Okay. Exactly. That's fair. So we talked about 00:39:59.659 --> 00:40:03.940 the non -steroidal anti -inflammatory drugs as 00:40:03.940 --> 00:40:07.940 well. Those are things like aspirin or ibuprofen 00:40:07.940 --> 00:40:13.179 or naproxen. Those are Advil and Aleve. And they 00:40:13.179 --> 00:40:17.380 are going to do something. And so the main thing 00:40:17.380 --> 00:40:21.739 I think you remember with taking a non -steroidal 00:40:21.739 --> 00:40:24.820 anti -inflammatory drug to treat your migraine, 00:40:24.920 --> 00:40:30.719 if you already have some nausea. some gastrointestinal 00:40:30.719 --> 00:40:32.980 adverse effects associated with the migraine 00:40:32.980 --> 00:40:36.980 itself. These agents can cause some gastrointestinal 00:40:36.980 --> 00:40:39.019 side effects, so you just need to balance out 00:40:39.019 --> 00:40:44.260 whether or not the ibuprofen or the Aleve is 00:40:44.260 --> 00:40:47.460 going to work for you and not make your symptoms 00:40:47.460 --> 00:40:51.460 worse. Okay. Yeah, and just to mention gastrointestinal 00:40:51.460 --> 00:40:53.739 things like that might be happening in your stomach. 00:40:53.780 --> 00:40:55.460 Right. You might have an upset stomach. Upset 00:40:55.460 --> 00:40:59.840 stomach, diarrhea, nausea, that type. Yes. And 00:40:59.840 --> 00:41:09.920 also, too, taking Tylenol or ibuprofen, people 00:41:09.920 --> 00:41:11.659 might think, well, that's not strong enough. 00:41:12.159 --> 00:41:15.760 to treat my migraine. But really, I mean, the 00:41:15.760 --> 00:41:20.199 intensity of your headache does not dictate the 00:41:20.199 --> 00:41:23.159 success or failure of a particular treatment. 00:41:23.480 --> 00:41:26.699 So I would say when you start feeling that migraine, 00:41:26.820 --> 00:41:31.000 go ahead and try a Tylenol and see if it'll work. 00:41:31.239 --> 00:41:35.340 Now, you know, you don't want to take too much 00:41:35.340 --> 00:41:38.400 Tylenol in a particular day because it can cause 00:41:38.400 --> 00:41:41.420 liver damage. But we're looking at four grams. 00:41:42.079 --> 00:41:44.659 You would not take more than four grams of Tylenol 00:41:44.659 --> 00:41:47.139 a day for that and stuff. In older patients, 00:41:47.239 --> 00:41:49.420 it would be three grams. Okay. And just to let 00:41:49.420 --> 00:41:51.659 everybody know, like how many, like three or 00:41:51.659 --> 00:41:53.800 four grams is how many tablets would that be? 00:41:53.860 --> 00:41:57.739 Yeah. So I'm saying, yeah, I'd say an extra strength 00:41:57.739 --> 00:42:01.099 or unusual strength. Tylenol is about 500 milligrams. 00:42:01.199 --> 00:42:03.760 So you do the math and it would be anywhere from 00:42:03.760 --> 00:42:05.920 six to eight tablets a day. You wouldn't take 00:42:05.920 --> 00:42:09.079 more than that. Yeah. So y 'all out there, don't 00:42:09.079 --> 00:42:11.650 just keep popping those pills to think. that 00:42:11.650 --> 00:42:13.530 it's just going to keep getting better, you know. 00:42:13.550 --> 00:42:15.610 And I think what my mom was saying is that the 00:42:15.610 --> 00:42:17.949 earlier you take them, the better. Right. And 00:42:17.949 --> 00:42:21.030 there are some guidelines as far as if the thing 00:42:21.030 --> 00:42:24.110 that you take first, you know, you can take a 00:42:24.110 --> 00:42:26.690 second dose, you know, maybe in an hour if the 00:42:26.690 --> 00:42:29.170 headache hasn't gone away. But after that second 00:42:29.170 --> 00:42:31.750 dose, if that hasn't worked, then you may need 00:42:31.750 --> 00:42:33.730 to, that's when you need to consider, okay, I 00:42:33.730 --> 00:42:37.110 need to go to my regimen and pick something else 00:42:37.110 --> 00:42:39.429 because this one doesn't happen to be working 00:42:39.429 --> 00:42:42.219 for this particular migraine. Right. And we should 00:42:42.219 --> 00:42:46.599 also mention that when you do take a drug or 00:42:46.599 --> 00:42:49.099 a pharmaceutical, usually you take it orally. 00:42:49.099 --> 00:42:51.880 And this is oral drugs. I'm making an assumption 00:42:51.880 --> 00:42:53.440 where you're putting it in your mouth and then 00:42:53.440 --> 00:42:56.059 it goes down into your stomach. And so it takes 00:42:56.059 --> 00:42:59.579 time for it to metabolize. Metabolize meaning 00:42:59.579 --> 00:43:02.440 that it breaks apart and so that it can get inside 00:43:02.440 --> 00:43:04.849 of your bloodstream. and then actually go to 00:43:04.849 --> 00:43:07.030 the places where it's supposed to act, which 00:43:07.030 --> 00:43:08.409 I think, I don't know how long that normally 00:43:08.409 --> 00:43:11.050 takes, but usually between 30 to 60 minutes, 00:43:11.130 --> 00:43:13.789 30 minutes to an hour. So if it's not working 00:43:13.789 --> 00:43:17.110 right away, don't panic, you know, give yourselves 00:43:17.110 --> 00:43:19.789 30 to 60 minutes. And if you've noticed nothing 00:43:19.789 --> 00:43:22.269 happening, then maybe take that additional dose 00:43:22.269 --> 00:43:24.989 and then wait another 30 to 60 minutes to see 00:43:24.989 --> 00:43:27.869 if that extra dosage, you're sending more reinforcements 00:43:27.869 --> 00:43:30.989 to fight the battle. to go for those extra nudgings 00:43:30.989 --> 00:43:33.789 to maybe to turn the tide so that you can at 00:43:33.789 --> 00:43:36.610 least diminish the symptoms. I don't know if 00:43:36.610 --> 00:43:38.449 there's any hope of them going away. I really 00:43:38.449 --> 00:43:40.690 think it's probably just suppressing them to 00:43:40.690 --> 00:43:43.619 a level that's manageable, correct? Right. Sometimes 00:43:43.619 --> 00:43:46.739 if you're able to go to sleep, you know, that 00:43:46.739 --> 00:43:49.219 you can get rid of a migraine headache, but it's, 00:43:49.219 --> 00:43:50.860 but because you've got that pain there, it's 00:43:50.860 --> 00:43:52.820 hard to go to sleep, you know, to get rid of 00:43:52.820 --> 00:43:55.380 the headache and stuff. So sleep can kind of 00:43:55.380 --> 00:43:58.099 reset the circuitry a little bit. Okay. Yeah. 00:43:58.159 --> 00:44:01.880 That's interesting to know too. So there's the 00:44:01.880 --> 00:44:06.920 next group of drugs that is. Now, these are prescription 00:44:06.920 --> 00:44:09.360 drugs, so you'd need to get them from your physician 00:44:09.360 --> 00:44:13.639 or your prescriber, you know, is going to be 00:44:13.639 --> 00:44:16.940 what we call serotonin agonist. So remember, 00:44:17.159 --> 00:44:20.099 we talked about serotonin being a component of, 00:44:20.119 --> 00:44:22.219 you know, helping to cause migraine headaches. 00:44:22.320 --> 00:44:25.139 So serotonin agonist and the thing that we know 00:44:25.139 --> 00:44:28.280 we call them kind of as a kind of slangy name 00:44:28.280 --> 00:44:30.579 is called triptans. So these are going to be 00:44:30.579 --> 00:44:33.639 things like sumatriptan or your imatrex, your 00:44:33.639 --> 00:44:40.510 zomib. your Maxalt, your Frova, your Emerge. 00:44:40.510 --> 00:44:42.889 These are all prescription drugs. All names that 00:44:42.889 --> 00:44:44.909 we know, just off the top of our head. Yeah, 00:44:44.909 --> 00:44:47.670 Imatrix you may have heard of. But I think that 00:44:47.670 --> 00:44:49.449 one of the things that I'd like to bring out 00:44:49.449 --> 00:44:52.289 with this particular drug class is that they're 00:44:52.289 --> 00:44:54.900 going to help to, again, help to bring that, 00:44:54.960 --> 00:44:57.739 to help vasoconstrict the blood vessels. That's 00:44:57.739 --> 00:44:59.800 one of the ways that they work. And they're going 00:44:59.800 --> 00:45:03.400 to also work in that trigeminal nerve area and 00:45:03.400 --> 00:45:06.559 help to reduce some inflammation in that area 00:45:06.559 --> 00:45:10.900 with that activity, with that nerve. Josh mentioned 00:45:10.900 --> 00:45:13.780 that most medications that are used to treat 00:45:13.780 --> 00:45:17.320 migraines are oral, but there are some dosage 00:45:17.320 --> 00:45:21.039 forms in this triptan class. There is an injectable. 00:45:21.500 --> 00:45:24.300 There are some orally disintegrating tablets 00:45:24.300 --> 00:45:28.159 because, think about it, if you're nauseated, 00:45:28.420 --> 00:45:30.760 it's going to be really hard to take something 00:45:30.760 --> 00:45:34.260 orally. So that's why there are a couple of other 00:45:34.260 --> 00:45:38.099 dosage forms in order to be able to treat a migraine. 00:45:40.219 --> 00:45:43.820 Some of the common side effects from this class 00:45:43.820 --> 00:45:55.010 of agents are things like You can get some numbness 00:45:55.010 --> 00:45:58.849 in your finger. You can feel tired. These triptans 00:45:58.849 --> 00:46:02.150 have this syndrome called triptan sensations 00:46:02.150 --> 00:46:05.969 where there are, in up to 25 % of patients, you 00:46:05.969 --> 00:46:11.590 can feel chest pain or tightness. But it's not 00:46:11.590 --> 00:46:14.710 anything to get really panicked over. But if 00:46:14.710 --> 00:46:17.849 you do have an underlying heart condition, you 00:46:17.849 --> 00:46:20.250 probably wouldn't want to take a triptan like 00:46:20.250 --> 00:46:28.480 an Emetrex, you know, so. And one of the medications 00:46:28.480 --> 00:46:30.940 in this class of drugs is also a nasal spray, 00:46:31.079 --> 00:46:34.400 which can also cause some taste changes and stuff 00:46:34.400 --> 00:46:36.639 if you use the nasal spray and stuff. But again, 00:46:36.739 --> 00:46:39.980 having that variety of dosage forms for people 00:46:39.980 --> 00:46:43.699 who have an upset stomach, but they still need 00:46:43.699 --> 00:46:48.929 treatment for a migraine is good to know. Yeah, 00:46:48.969 --> 00:46:51.289 I think we could go down this list and we can 00:46:51.289 --> 00:46:53.530 talk. And I think these conversations would probably 00:46:53.530 --> 00:46:57.269 be best with the physician and the patient just 00:46:57.269 --> 00:46:59.570 because it's going to depend. But we should just, 00:46:59.690 --> 00:47:02.690 as a caveat with prescription drugs and any drugs 00:47:02.690 --> 00:47:06.349 whatsoever, even natural remedies, when you're 00:47:06.349 --> 00:47:09.409 putting something inside of your body, even including 00:47:09.409 --> 00:47:14.250 food, you're adding things to your body that 00:47:14.250 --> 00:47:17.710 your body isn't used to or potentially not used 00:47:17.710 --> 00:47:20.659 to. And most things that go inside of your body 00:47:20.659 --> 00:47:24.059 are nonspecific. Now, what I mean by that is 00:47:24.059 --> 00:47:29.019 there are certain receptors in your brain that 00:47:29.019 --> 00:47:31.820 will bind to certain chemicals really, really, 00:47:31.860 --> 00:47:33.940 really well. We call that having a high affinity, 00:47:34.179 --> 00:47:36.400 meaning that it will just stick on there like 00:47:36.400 --> 00:47:39.559 glue. It's super attracted to it. Now, other 00:47:39.559 --> 00:47:42.039 things could have a low affinity, meaning they 00:47:42.039 --> 00:47:44.420 sometimes stick to it or they sometimes don't. 00:47:45.400 --> 00:47:47.260 That means that they could also have affinity 00:47:47.260 --> 00:47:51.059 for other things as well. And when you put a 00:47:51.059 --> 00:47:54.039 drug or food or natural remedy inside of you, 00:47:54.119 --> 00:47:58.119 you could potentially have a lot of low affinity 00:47:58.119 --> 00:48:00.840 or high affinity events that you didn't intend 00:48:00.840 --> 00:48:04.219 for. So, for example, when mom was talking about 00:48:04.219 --> 00:48:10.099 you could take these non -steroidal NSAIDs and 00:48:10.099 --> 00:48:13.420 you could potentially get gastrointestinal problems. 00:48:14.250 --> 00:48:17.789 It's because of this drug that's basically binding 00:48:17.789 --> 00:48:21.869 to a certain area that will cause an adverse 00:48:21.869 --> 00:48:25.429 effect because, lo and behold, drugs have multiple 00:48:25.429 --> 00:48:27.289 binding sites because they like to be attracted 00:48:27.289 --> 00:48:29.210 to different things because they're nonspecific. 00:48:29.409 --> 00:48:32.989 So this is why doing good research is really 00:48:32.989 --> 00:48:36.170 good, not just because you want to find the best 00:48:36.170 --> 00:48:38.650 drugs for the best treatment, but you also want 00:48:38.650 --> 00:48:41.920 to be aware of the risk. of taking a certain 00:48:41.920 --> 00:48:44.480 type of drug. So when you are taking Tylenol, 00:48:44.539 --> 00:48:47.219 for example, you know the benefits, but you also 00:48:47.219 --> 00:48:49.780 know the cost, and not cost in terms of dollars, 00:48:49.820 --> 00:48:51.739 but also the cost in terms of your potential 00:48:51.739 --> 00:48:54.820 health. And then you say, is it worth the trade 00:48:54.820 --> 00:48:57.460 -off? Some things aren't. Like some of these 00:48:57.460 --> 00:48:59.360 prescription drugs, I was looking up the cost, 00:48:59.440 --> 00:49:04.239 they can range from $600 to $2 ,000 per prescription, 00:49:04.380 --> 00:49:08.559 because we can talk about that on another episode. 00:49:09.130 --> 00:49:15.030 about why drugs can cost so much and what ways 00:49:15.030 --> 00:49:16.650 to bring them down. Because if you look at like 00:49:16.650 --> 00:49:19.789 a bottle of Tylenol, I mean, it's maybe $4. And 00:49:19.789 --> 00:49:22.690 there's good reasons for why it's $4 now than 00:49:22.690 --> 00:49:25.349 when it originally came out. But I just wanted 00:49:25.349 --> 00:49:28.130 to give that as a caveat of anytime you put anything 00:49:28.130 --> 00:49:31.250 in your body, that there could be potential changes 00:49:31.250 --> 00:49:34.769 that happen in there. And it's good to notice 00:49:34.769 --> 00:49:36.730 those changes and then you see if it's worth 00:49:36.730 --> 00:49:39.429 the trade -off or not. Um, because unfortunately 00:49:39.429 --> 00:49:41.630 nothing is a hundred percent effective. You know, 00:49:41.670 --> 00:49:43.550 you're going to give, you're going to treat your 00:49:43.550 --> 00:49:44.989 migraine a little bit, but then you might upset 00:49:44.989 --> 00:49:46.909 your stomach a little bit. And unfortunately 00:49:46.909 --> 00:49:49.869 we can't go back to being 10, uh, when everything 00:49:49.869 --> 00:49:52.610 seemed to work perfectly. Um, and so we're trying 00:49:52.610 --> 00:49:55.429 to basically get some type of balance as we get 00:49:55.429 --> 00:49:57.250 older and things start kind of breaking down 00:49:57.250 --> 00:50:01.010 and failing. Okay, and I think that Josh brought 00:50:01.010 --> 00:50:03.010 a good point. Let me just mention a couple of 00:50:03.010 --> 00:50:05.429 other drug classes that your healthcare provider 00:50:05.429 --> 00:50:08.769 could prescribe for you if you have a migraine. 00:50:08.789 --> 00:50:10.670 And if you have a migraine, you probably are 00:50:10.670 --> 00:50:13.949 familiar with some of these. One is called ergot 00:50:13.949 --> 00:50:18.630 derivatives, and they are kind of similar in 00:50:18.630 --> 00:50:22.690 mechanism for the way that triptans work. So 00:50:22.690 --> 00:50:25.070 you've got ergotamine and dihydroergotamine. 00:50:25.070 --> 00:50:27.269 Caffeine is also a similar one as well. Yes. 00:50:28.090 --> 00:50:31.489 The next class is, this is a newer drug class. 00:50:31.570 --> 00:50:36.710 It's those CGRP receptor antagonists. So remember 00:50:36.710 --> 00:50:40.630 we talked about that peptide that causes some 00:50:40.630 --> 00:50:44.909 inflammation and vasodilation. And so these are 00:50:44.909 --> 00:50:46.750 going to antagonize that. So you're going to 00:50:46.750 --> 00:50:51.929 have seen some... commercials on TV for Ubrel 00:50:51.929 --> 00:50:56.110 -V or Nertec. And those are those types of agents 00:50:56.110 --> 00:51:01.630 that are used to abort or stop a minor. Always 00:51:01.630 --> 00:51:05.030 with a pretty butterfly to make me feel nice 00:51:05.030 --> 00:51:07.550 and secure so that I go ask my doctor about these 00:51:07.550 --> 00:51:11.039 prescription drugs. There you go. And then there 00:51:11.039 --> 00:51:13.380 is a newer, there's a newer agent. It's called 00:51:13.380 --> 00:51:17.340 a Ditan, Ditan. It's called Rayval and it's also 00:51:17.340 --> 00:51:22.699 available to also management migraines. Now, 00:51:22.719 --> 00:51:27.840 if you are a person that has. recurrent migraines. 00:51:27.980 --> 00:51:30.300 Josh kind of alluded to the fact that sometimes 00:51:30.300 --> 00:51:34.380 they may not be very frequent or they can happen 00:51:34.380 --> 00:51:38.679 more frequently. It may be that you and your 00:51:38.679 --> 00:51:41.480 healthcare provider decide that you need preventive 00:51:41.480 --> 00:51:45.320 therapy to take for a migraine. And again, that's 00:51:45.320 --> 00:51:47.519 going to usually happen if you have more chronic 00:51:47.519 --> 00:51:50.780 migraines, they happen more frequently. Sometimes 00:51:50.780 --> 00:51:53.400 it's going to be, there are some more serious 00:51:53.400 --> 00:51:56.199 migraines and that's kind of beyond. our scope 00:51:56.199 --> 00:51:58.539 as far as diagnosing some of those things, that 00:51:58.539 --> 00:52:00.639 would be a conversation you would have with your 00:52:00.639 --> 00:52:04.619 healthcare provider. But so in those types of 00:52:04.619 --> 00:52:07.159 patients, you probably would also recommend a 00:52:07.159 --> 00:52:09.760 preventive therapy. And again, it's going to 00:52:09.760 --> 00:52:11.880 be something that can be given so that maybe 00:52:11.880 --> 00:52:14.039 the number of headaches that you get per month 00:52:14.039 --> 00:52:17.420 will be reduced. And that would be a welcome. 00:52:17.840 --> 00:52:21.519 you know, blessing. Yes. So, so some, yes, absolutely. 00:52:21.820 --> 00:52:25.380 So I'm just going to read just kind of a, um, 00:52:25.420 --> 00:52:27.800 a list of types of medications that have been 00:52:27.800 --> 00:52:30.659 used for this. And again, it's not a one size 00:52:30.659 --> 00:52:34.159 fits all and one might work sometime and might 00:52:34.159 --> 00:52:36.760 not work later on, or something might work for 00:52:36.760 --> 00:52:39.260 one patient that doesn't work for another. So 00:52:39.260 --> 00:52:41.900 this is that this is a group of medications that 00:52:41.900 --> 00:52:44.780 your physician can use to prescribe to you for 00:52:44.780 --> 00:52:47.719 preventive therapy. One drug. classes called 00:52:47.719 --> 00:52:52.300 beta blockers, things like propranolol or metoprolol. 00:52:52.820 --> 00:52:56.000 These also are used to lower blood pressure, 00:52:56.039 --> 00:52:58.360 but in this particular circumstance, you're using 00:52:58.360 --> 00:53:00.920 them at usually a lower dose to help prevent 00:53:00.920 --> 00:53:04.889 migraines. There are some... antidepressant medications 00:53:04.889 --> 00:53:08.750 that have been used to have managed or to lower 00:53:08.750 --> 00:53:10.849 migraine headache incidents. Because they can 00:53:10.849 --> 00:53:13.670 regulate serotonin. Right. And dopamine. Yes. 00:53:13.730 --> 00:53:17.530 And so amitriptyline and venlafaxine are the 00:53:17.530 --> 00:53:19.829 ones that have been most, that have the most 00:53:19.829 --> 00:53:24.519 evidence for being successfully used. There's 00:53:24.519 --> 00:53:27.039 a couple of anesthesia medications that are used. 00:53:27.280 --> 00:53:31.260 One is called Topamax and one is called Depakote. 00:53:31.579 --> 00:53:36.019 And they've been prescribed. Actually, there 00:53:36.019 --> 00:53:39.099 are some of our serotonin agonists or triptans 00:53:39.099 --> 00:53:42.840 that can be used primarily for menstrual migraine. 00:53:43.119 --> 00:53:47.380 So anytime you've got a migraine that has a predictable 00:53:47.380 --> 00:53:52.800 pattern, then you can take a preventive triptan. 00:53:53.449 --> 00:53:56.369 you know, at that particular time, you know, 00:53:56.369 --> 00:53:58.449 to help prevent the migraines. So things like 00:53:58.449 --> 00:54:00.469 if it's, if a woman is having her period and 00:54:00.469 --> 00:54:02.530 then she goes, Oh, it's that time. Right. You 00:54:02.530 --> 00:54:04.130 would start a couple of days before it's going 00:54:04.130 --> 00:54:07.030 to start to help keep getting the migraine headache. 00:54:07.090 --> 00:54:09.489 But the only one, the only triptans that have 00:54:09.489 --> 00:54:13.670 been kind of looked at and investigated and found 00:54:13.670 --> 00:54:18.090 to be effective for this are Frovo triptan, Neurotriptan 00:54:18.090 --> 00:54:22.510 and Zolmatriptan. So. There will be a quiz at 00:54:22.510 --> 00:54:26.449 the end. Yeah, there you go. And then that newer 00:54:26.449 --> 00:54:33.210 class of agents, the CRGP, I'm sorry. CGRP. CGRP 00:54:33.210 --> 00:54:36.250 receptor antagonists, excuse me for misspeaking. 00:54:36.250 --> 00:54:40.170 How dare you. QLIPTA and NERTAC have also been 00:54:40.170 --> 00:54:42.650 shown to be preventive agents and using that 00:54:42.650 --> 00:54:46.349 mechanism of blocking that peptide. And then 00:54:46.349 --> 00:54:49.869 there is also, and then you may have seen some 00:54:49.869 --> 00:54:53.449 commercials on TV for these agents. These are 00:54:53.449 --> 00:55:00.500 CGRP. antagonist antibodies. So these are subcutaneous 00:55:00.500 --> 00:55:04.599 injections. So you can actually give it to yourself, 00:55:04.699 --> 00:55:07.139 but it's under the skin. And then there's actually 00:55:07.139 --> 00:55:11.280 one infusion, an intravenous infusion. And these 00:55:11.280 --> 00:55:14.320 are, VIEPT is the intravenous infusion where 00:55:14.320 --> 00:55:16.059 you'd have to go to an infusion center to get 00:55:16.059 --> 00:55:18.719 it. And again, this is an agent that you'd only 00:55:18.719 --> 00:55:21.900 get once every three months. And again, if you 00:55:21.900 --> 00:55:23.880 got more serious migraines, it might be something 00:55:23.880 --> 00:55:26.050 to consider. And that's going to be a medication 00:55:26.050 --> 00:55:28.550 that's going to be more expensive. Antibodies 00:55:28.550 --> 00:55:30.489 are things that are associated with your immune 00:55:30.489 --> 00:55:33.710 system. And if they are specific to a specific 00:55:33.710 --> 00:55:36.809 type of molecule, like the CGRPs, they're going 00:55:36.809 --> 00:55:38.889 to go in and they're going to attach to those 00:55:38.889 --> 00:55:41.210 CGRPs. And then the immune system essentially 00:55:41.210 --> 00:55:43.289 going to hopefully clear them out a little bit. 00:55:43.309 --> 00:55:45.929 So you have less of a concentration. Right. And 00:55:45.929 --> 00:55:49.190 if that happens to be something that's causing 00:55:49.190 --> 00:55:52.570 your migraine, then it should work. If not, then 00:55:52.570 --> 00:55:54.710 you've eliminated a cause. There you go. There 00:55:54.710 --> 00:55:58.309 you go. And then other agents in that particular 00:55:58.309 --> 00:56:02.389 class are Amovig, Ajovi, and Imgality. Those, 00:56:02.510 --> 00:56:04.670 again, are those subcutaneous injections. Again, 00:56:04.769 --> 00:56:06.869 they're going to be more expensive, but they 00:56:06.869 --> 00:56:09.449 may cut the number of migraine headaches that 00:56:09.449 --> 00:56:13.909 you have in half. And again, usually these agents 00:56:13.909 --> 00:56:16.949 are used when you have more frequent migraines. 00:56:17.559 --> 00:56:19.300 I mean, then the last thing I want to mention, 00:56:19.360 --> 00:56:21.320 because you see it, you definitely see it on 00:56:21.320 --> 00:56:26.880 TV or in advertisements, is Botox. And it has 00:56:26.880 --> 00:56:30.840 been used only, and it's only approved for use 00:56:30.840 --> 00:56:34.920 in patients that have chronic migraines and chronic 00:56:34.920 --> 00:56:37.880 migraines are defined as those patients who have 00:56:37.880 --> 00:56:41.840 headaches for 15 or more days per month. And 00:56:41.840 --> 00:56:44.179 these headaches last for four or more hours each 00:56:44.179 --> 00:56:47.519 time. So you're talking about, you know, significant 00:56:47.519 --> 00:56:50.920 loss of, you know, quality of life and stuff. 00:56:50.980 --> 00:56:53.940 So Botox is going to be kind of a last resort. 00:56:54.079 --> 00:56:56.460 And we should mention again, what Botox, first 00:56:56.460 --> 00:56:59.559 of all, that's fascinating, but Botox is a, the. 00:57:00.450 --> 00:57:03.829 It's a neurotoxin. Yes. From the bacteria. Yes. 00:57:04.110 --> 00:57:07.510 Botulinum. And people figured it out long ago. 00:57:07.570 --> 00:57:11.150 First of all, it's not good to ingest. It wouldn't 00:57:11.150 --> 00:57:13.429 do well for you. But if given in small doses, 00:57:13.650 --> 00:57:17.170 it promotes skin tightening, which is why people 00:57:17.170 --> 00:57:20.190 use that to basically get a little bit tighter 00:57:20.190 --> 00:57:23.570 skin. I remember back in the day there were Botox 00:57:23.570 --> 00:57:26.989 parties that people would just hire physicians 00:57:26.989 --> 00:57:29.550 and they would have people come out and just, 00:57:29.630 --> 00:57:31.349 you know, you would just go to the corner and 00:57:31.349 --> 00:57:32.989 you'd get an injection and then you just go on 00:57:32.989 --> 00:57:36.030 throughout the party. So it was all the rage. 00:57:36.050 --> 00:57:39.409 Not a smart thing to do. You know, humans have 00:57:39.409 --> 00:57:41.750 done a lot of smart and not smart things over 00:57:41.750 --> 00:57:44.190 our history. Yes. And we learn little bits along 00:57:44.190 --> 00:57:47.380 the way. But anyway, so again, just I just wanted 00:57:47.380 --> 00:57:49.940 to mention that because people might have seen 00:57:49.940 --> 00:57:52.679 advertisements for that. And that I just want 00:57:52.679 --> 00:57:54.679 you to know that Botox is not for everybody. 00:57:54.780 --> 00:57:56.900 You know, it's going to be those more serious 00:57:56.900 --> 00:57:59.699 patients. Yeah, because if you overdose on that, 00:57:59.760 --> 00:58:02.679 that is you can get paralysis, you know, so not 00:58:02.679 --> 00:58:05.739 a good deal. And then I just wanted to throw 00:58:05.739 --> 00:58:10.840 out to that you you may also. There is some evidence 00:58:10.840 --> 00:58:14.300 for some alternative medicine supplements that 00:58:14.300 --> 00:58:17.980 can be used primarily to prevent migraines. There's 00:58:17.980 --> 00:58:22.320 not super evidence, but there's some evidence 00:58:22.320 --> 00:58:24.260 for their efficacy. And again, it's again going 00:58:24.260 --> 00:58:26.440 to be that it might work in some patients, but 00:58:26.440 --> 00:58:31.500 not in others. And one of them is vitamin B2 00:58:31.500 --> 00:58:35.800 or riboflavin, and the other is fever. fever 00:58:35.800 --> 00:58:39.079 few. Um, those are two examples of things that 00:58:39.079 --> 00:58:41.639 might be used to help reduce the number of headaches 00:58:41.639 --> 00:58:44.460 that you have. Yeah. I was reading about a systematic 00:58:44.460 --> 00:58:47.559 review that was done as well on herbal treatments. 00:58:47.820 --> 00:58:50.559 And, um, yeah, there was, there was some like 00:58:50.559 --> 00:58:54.639 coriander or citron or menthol, um, that had 00:58:54.639 --> 00:58:59.000 some positive results. But again, we'll talk 00:58:59.000 --> 00:59:01.340 about evidence another time in another podcast, 00:59:01.380 --> 00:59:05.679 but, um, the idea is, is like, Alternative medicine, 00:59:05.880 --> 00:59:09.260 once proven effective, just becomes medicine. 00:59:09.559 --> 00:59:11.159 You know, a lot of times people think, oh, it's 00:59:11.159 --> 00:59:13.760 medicine versus alternative medicine. The thing 00:59:13.760 --> 00:59:16.300 about alternative medicine is that usually most 00:59:16.300 --> 00:59:18.679 of them are supplements or they're herbal remedies 00:59:18.679 --> 00:59:22.019 and they're not regulated by the FDA. The FDA 00:59:22.019 --> 00:59:25.079 is the Food and Drug Administration. In order 00:59:25.079 --> 00:59:27.519 for a drug to get brought to market in the United 00:59:27.519 --> 00:59:31.559 States, it needs to essentially be proven safe 00:59:31.559 --> 00:59:35.989 and effective. for use basically in the treatment 00:59:35.989 --> 00:59:39.949 that it is, and then you can sell it. But there 00:59:39.949 --> 00:59:42.690 are things like herbs, which have obviously been 00:59:42.690 --> 00:59:44.909 proved to be safe because we eat them all the 00:59:44.909 --> 00:59:48.889 time. So we assume that they're safe to ingest, 00:59:48.889 --> 00:59:50.250 but they're not going to go out and say that 00:59:50.250 --> 00:59:51.929 this is actually going to cure the condition 00:59:51.929 --> 00:59:55.170 that you're seeking. But again, it's not saying 00:59:55.170 --> 00:59:57.989 that there's not because just using Tylenol or 00:59:57.989 --> 01:00:00.849 acetaminophen as an example, that was extracted 01:00:00.849 --> 01:00:02.920 from tree bark. You know, that was something 01:00:02.920 --> 01:00:05.780 that was noticed in certain tribes. Sorry, that 01:00:05.780 --> 01:00:08.559 was aspirin, not Tylenol. Oh, same. Thanks for 01:00:08.559 --> 01:00:11.440 correcting me. Yeah. So actually it's aspirin 01:00:11.440 --> 01:00:15.199 that was found in tree bark. And that molecule 01:00:15.199 --> 01:00:18.820 was basically extracted out so that you can give 01:00:18.820 --> 01:00:21.400 it in a concentrated form, which is the pill 01:00:21.400 --> 01:00:24.380 that you see. So it started as a natural thing 01:00:24.380 --> 01:00:27.199 in tree bark and then was extracted out to form 01:00:27.199 --> 01:00:30.320 a pharmaceutical. So we're not saying that. no 01:00:30.320 --> 01:00:33.420 herbs or anything doesn't have an effect we're 01:00:33.420 --> 01:00:35.179 saying that there might be a better way to deliver 01:00:35.179 --> 01:00:37.460 that by actually giving the active ingredient 01:00:37.460 --> 01:00:39.340 we call it the active ingredient meaning because 01:00:39.340 --> 01:00:42.739 it actually act is active in the condition that 01:00:42.739 --> 01:00:45.619 you want to treat um inside of the body because 01:00:45.619 --> 01:00:47.500 there's a lot of other stuff in plants that you 01:00:47.500 --> 01:00:50.860 don't want in um inside of you to treat that 01:00:50.860 --> 01:00:53.539 condition um as well like pollen for example 01:00:53.539 --> 01:00:56.210 you don't want a lot of pollen Okay, so just 01:00:56.210 --> 01:00:58.210 a couple of other things about preventive therapy 01:00:58.210 --> 01:01:01.610 for migraines. Actually, preventive therapy is 01:01:01.610 --> 01:01:04.690 effective in approximately 50 % of the time. 01:01:05.380 --> 01:01:09.440 So it's not 100 % effective. But again, if you 01:01:09.440 --> 01:01:11.860 change between therapies, sometimes you can find 01:01:11.860 --> 01:01:13.780 one that's going to help at least reduce your 01:01:13.780 --> 01:01:17.920 headache frequency to some extent. And usually 01:01:17.920 --> 01:01:20.099 it can take a couple of months before you see 01:01:20.099 --> 01:01:22.280 the maximum benefit from a preventive therapy. 01:01:22.400 --> 01:01:25.119 So don't think after one dose you're going to 01:01:25.119 --> 01:01:27.840 see an effect. And give it, like I said, give 01:01:27.840 --> 01:01:32.489 it, you know. eight to 12 weeks, you know, of 01:01:32.489 --> 01:01:35.489 taking it before you give up, you know, on that 01:01:35.489 --> 01:01:38.929 particular medication. And then usually the recommended, 01:01:39.050 --> 01:01:43.510 the recommendation is to take a preventive therapy 01:01:43.510 --> 01:01:46.730 from anywhere from six to 12 months. And then 01:01:46.730 --> 01:01:49.409 you can, at the end of 12 months, you could try 01:01:49.409 --> 01:01:52.730 to taper off of it to see if actually you are 01:01:52.730 --> 01:01:55.599 able to kind of Kind of change the frequency 01:01:55.599 --> 01:01:57.619 of your headaches so that you don't need to take 01:01:57.619 --> 01:02:00.440 that preventive medication for a while and stuff. 01:02:00.480 --> 01:02:03.420 That's going to be individualized as well. You 01:02:03.420 --> 01:02:06.820 always want to taper off your treatment, stopping 01:02:06.820 --> 01:02:09.440 medications abruptly, especially the ones that 01:02:09.440 --> 01:02:11.800 are prescribed to prevent migraine headaches 01:02:11.800 --> 01:02:14.880 is not necessarily a great idea. Yeah. It's like 01:02:14.880 --> 01:02:17.920 comparing it to like, imagine that the disease 01:02:17.920 --> 01:02:21.360 is like a foreign invader and you're trying to 01:02:21.360 --> 01:02:23.260 fight them with your own army, you know, quote 01:02:23.260 --> 01:02:25.920 unquote. And if you withdraw all of your troops 01:02:25.920 --> 01:02:28.360 at once, that's just going to give an opportunity 01:02:28.360 --> 01:02:32.539 for the enemy to basically maintain its stronghold. 01:02:32.619 --> 01:02:35.480 But if you strategically remove troops one at 01:02:35.480 --> 01:02:37.760 a time, you might be able to have some type of 01:02:37.760 --> 01:02:40.980 homeostasis or stability inside of you. Right. 01:02:41.019 --> 01:02:43.719 And the other reason that you do taper them is 01:02:43.719 --> 01:02:46.500 that sometimes if you abruptly discontinue a 01:02:46.500 --> 01:02:48.840 medication, you can actually cause yourself to 01:02:48.840 --> 01:02:52.690 have some... adverse effects. So, um, and it 01:02:52.690 --> 01:02:54.530 just depends on the medication that you're taking. 01:02:54.590 --> 01:02:57.210 So that again, you want to talk with your physician 01:02:57.210 --> 01:02:59.610 to, to, to handle that appropriately. People 01:02:59.610 --> 01:03:01.489 can relate anytime that they've gone on that 01:03:01.489 --> 01:03:03.869 diet where they gave up coffee or they gave up 01:03:03.869 --> 01:03:06.050 chocolate. And then the next day wasn't a good 01:03:06.050 --> 01:03:08.130 day. You know, it's like, Oh my gosh, I need 01:03:08.130 --> 01:03:11.110 my coffee. I need my chocolate. That's right. 01:03:11.269 --> 01:03:14.730 The headache will speak for itself. Yes. So don't 01:03:14.730 --> 01:03:17.300 give up. You know, keep it up. I would also strongly 01:03:17.300 --> 01:03:19.239 recommend if you have this condition, keep a 01:03:19.239 --> 01:03:21.139 record. Keep a record of things that have worked 01:03:21.139 --> 01:03:22.940 and things that haven't. You know, have a little 01:03:22.940 --> 01:03:25.900 notebook. It'll be a fun little Sherlock Holmes, 01:03:26.000 --> 01:03:30.000 you know, detective case for you. So I think 01:03:30.000 --> 01:03:33.760 we should, you know, close out talking about, 01:03:34.039 --> 01:03:36.119 or did you have something else that you want 01:03:36.119 --> 01:03:38.409 to talk about? Well, we mentioned just briefly, 01:03:38.469 --> 01:03:41.670 we mentioned medication overuse headaches. So 01:03:41.670 --> 01:03:44.949 let me just touch on that very shortly. So again, 01:03:45.150 --> 01:03:54.010 if you treat a migraine acutely with a lot of 01:03:54.010 --> 01:03:57.449 medication, you actually can set your head up 01:03:57.449 --> 01:04:01.869 for... getting another headache as that drug 01:04:01.869 --> 01:04:05.369 wears off. So you want to follow the guidelines 01:04:05.369 --> 01:04:09.650 for treating migraines that your physician or 01:04:09.650 --> 01:04:14.489 the label on the... on the bottle for a Tylenol 01:04:14.489 --> 01:04:17.510 or an aspirin or an ibuprofen, you know, taking 01:04:17.510 --> 01:04:19.849 it every six to eight hours or four to six hours. 01:04:19.889 --> 01:04:22.289 You want to follow that so that you don't take 01:04:22.289 --> 01:04:24.489 them too frequently because that can set you 01:04:24.489 --> 01:04:27.449 up for that medication overuse headache. And 01:04:27.449 --> 01:04:29.909 we talked about that with those combination products 01:04:29.909 --> 01:04:32.590 that have narcotics in them, like the barbiturates 01:04:32.590 --> 01:04:36.550 and the codeine. So again, it's really frustrating 01:04:36.550 --> 01:04:39.610 that you could then create a headache while you're 01:04:39.610 --> 01:04:41.829 trying to treat a headache. And so you just, 01:04:41.889 --> 01:04:44.750 again, by not taking too much medication, that's 01:04:44.750 --> 01:04:46.889 going to help you to prevent from having that 01:04:46.889 --> 01:04:49.730 medication overuse headache. So maybe we should 01:04:49.730 --> 01:04:53.409 talk about some of the misconceptions or myths 01:04:53.409 --> 01:04:57.010 around migraines that maybe a lot of people have, 01:04:57.110 --> 01:04:59.449 and maybe they feel like they're struggling with, 01:04:59.590 --> 01:05:02.809 and we can kind of belay some of the fears around 01:05:02.809 --> 01:05:05.170 some of those misconceptions. You know, they 01:05:05.170 --> 01:05:07.630 always say knowledge, the truth will set you 01:05:07.630 --> 01:05:11.400 free. And narrowing these things down hopefully 01:05:11.400 --> 01:05:13.599 will eliminate a lot of variables so that you 01:05:13.599 --> 01:05:15.460 can get to the right answer and hopefully provide 01:05:15.460 --> 01:05:18.139 some relief for yourself, if not a loved one 01:05:18.139 --> 01:05:21.880 who's having some issues with migraines. So I'd 01:05:21.880 --> 01:05:24.960 say a couple of the kind of myths or maybe false 01:05:24.960 --> 01:05:28.280 thinkings about migraines. We've probably touched 01:05:28.280 --> 01:05:31.500 on a lot of these in our discussion, Josh. First 01:05:31.500 --> 01:05:35.460 one is that migraine is just a headache. I think 01:05:35.460 --> 01:05:39.059 we've kind of... If people have listened to our 01:05:39.059 --> 01:05:44.239 conversation, we've kind of dismissed that myth 01:05:44.239 --> 01:05:47.159 because it's not just a headache. It's not just 01:05:47.159 --> 01:05:48.940 a tension headache. It's got a bunch of other 01:05:48.940 --> 01:05:50.199 components. Right, because that might come with 01:05:50.199 --> 01:05:52.420 a stigma of someone just saying, get over it. 01:05:52.460 --> 01:05:54.659 It's just a headache, but it's not just a type 01:05:54.659 --> 01:05:57.599 of headache because this is a really severe condition 01:05:57.599 --> 01:06:00.380 in which it can really debilitate you. For some 01:06:00.380 --> 01:06:02.280 patients, yes, it really can. But I think it's 01:06:02.280 --> 01:06:04.800 more so like when you tell somebody you have 01:06:04.800 --> 01:06:07.210 a headache. they might not really understand. 01:06:07.570 --> 01:06:11.989 This has been so wonderful for me because I had 01:06:11.989 --> 01:06:13.590 no idea a lot about all this stuff. I'm just 01:06:13.590 --> 01:06:16.530 like, oh, it's just a headache. But hearing all 01:06:16.530 --> 01:06:19.389 this today has really given me more empathy and 01:06:19.389 --> 01:06:21.690 more compassion to be like, okay, if someone 01:06:21.690 --> 01:06:23.690 says they have a migraine, I need to give them 01:06:23.690 --> 01:06:26.369 a lot more grace. Right. Or if somebody says, 01:06:26.449 --> 01:06:29.820 I have a headache, you can say, is it just a 01:06:29.820 --> 01:06:32.739 headache or is it a migraine? You know, so because 01:06:32.739 --> 01:06:36.099 that goes into the next kind of myth, like all 01:06:36.099 --> 01:06:37.960 headaches are migraines. Well, we know that's 01:06:37.960 --> 01:06:40.000 not true. You know, there's a, there's a variety 01:06:40.000 --> 01:06:42.579 of different types of headaches and tension type 01:06:42.579 --> 01:06:44.320 headaches and migraines are just two of them. 01:06:44.340 --> 01:06:45.840 And there are several other types of headaches 01:06:45.840 --> 01:06:49.980 as well. Some people might think a migraine is 01:06:49.980 --> 01:06:53.320 their fault. And we've certainly shown that it's 01:06:53.320 --> 01:06:55.340 not anybody's fault. It could be the way they're 01:06:55.340 --> 01:06:58.300 made up, the environment that they live in, circumstances 01:06:58.300 --> 01:07:01.780 that are going on. There may be some triggers 01:07:01.780 --> 01:07:05.000 that you can kind of control to maybe help reduce 01:07:05.000 --> 01:07:07.360 the number of headaches, but it's certainly not 01:07:07.360 --> 01:07:08.880 somebody's fault. Yeah, but it's not your fault. 01:07:08.920 --> 01:07:10.559 Like if you drank that glass of wine and you 01:07:10.559 --> 01:07:12.239 got a migraine, it's not your fault that you 01:07:12.239 --> 01:07:14.159 got a migraine. You just happen to be a person 01:07:14.159 --> 01:07:17.349 born with the... predisposition to get migraines 01:07:17.349 --> 01:07:19.590 on that particular day. Yep. You know, absolutely. 01:07:19.710 --> 01:07:22.710 Right. Yes. So don't kick yourself. Right. I 01:07:22.710 --> 01:07:24.829 think we just talked about this too, that the 01:07:24.829 --> 01:07:28.530 more medicine I take for hip, for my, my migraine 01:07:28.530 --> 01:07:30.530 headache, the more control I will have over my 01:07:30.530 --> 01:07:33.349 migraine and no way, you know, we just talked 01:07:33.349 --> 01:07:35.250 about that, that you want to take it, you want 01:07:35.250 --> 01:07:37.849 to take it in appropriate doses, the least amount 01:07:37.849 --> 01:07:40.989 of medication to help. To eliminate the pain. 01:07:41.309 --> 01:07:44.329 More is not necessarily better because you could 01:07:44.329 --> 01:07:46.809 set yourself up for that medication overuse headache. 01:07:50.389 --> 01:07:53.650 Caffeine is the cause of my migraine. No, that's 01:07:53.650 --> 01:07:56.489 not really true. Yes, maybe you're one of those 01:07:56.489 --> 01:07:59.269 people who does get a migraine after drinking 01:07:59.269 --> 01:08:02.210 a cup of coffee. But remember, caffeine is also 01:08:02.210 --> 01:08:04.710 in a lot of therapies for treating migraine. 01:08:04.769 --> 01:08:07.150 And it can be an effective treatment for migraine 01:08:07.150 --> 01:08:10.179 as well. Right. So it might be a... correlation, 01:08:10.420 --> 01:08:13.780 not causation. Like my favorite example is when 01:08:13.780 --> 01:08:17.380 you look at a house that is, if you look at all 01:08:17.380 --> 01:08:20.100 the houses that have ever burned down, they all 01:08:20.100 --> 01:08:22.659 have sinks inside of them, but you wouldn't relate, 01:08:22.800 --> 01:08:24.880 you know, the house burning down to the sink 01:08:24.880 --> 01:08:27.239 being inside of it. Right. Right. Because we, 01:08:27.300 --> 01:08:29.979 most of us drink tea or coffee in this, you know, 01:08:29.979 --> 01:08:32.359 in this country. So you're, it's going to be 01:08:32.359 --> 01:08:35.000 easy to draw that comparison. But we know from, 01:08:35.060 --> 01:08:37.020 you know, looking at the literature that caffeine 01:08:37.020 --> 01:08:40.600 could actually be a helpful aid. to vasoconstricting 01:08:40.600 --> 01:08:43.359 your blood vessels in the trigeminal nerve area. 01:08:43.520 --> 01:08:47.699 Right. The next one is that you must have an 01:08:47.699 --> 01:08:50.060 aura for it to be a migraine. Well, we learned 01:08:50.060 --> 01:08:52.899 that. Remember, it's only 20 to 25 % of patients 01:08:52.899 --> 01:08:56.340 have an aura with their migraine. Here's one 01:08:56.340 --> 01:08:58.159 that we haven't really touched on, but I think 01:08:58.159 --> 01:09:02.819 for those that are considering having a baby 01:09:02.819 --> 01:09:06.659 or are pregnant and you have migraines, you might 01:09:06.659 --> 01:09:09.199 think there's nothing that you can do to manage 01:09:09.199 --> 01:09:10.779 your migraines if you're pregnant. And that's 01:09:10.779 --> 01:09:13.840 not true. Again, it would be a dialogue that 01:09:13.840 --> 01:09:15.939 you would have with your physician, but there 01:09:15.939 --> 01:09:18.520 are some medications that you can take that are 01:09:18.520 --> 01:09:22.359 safe to use in pregnancy if your migraines do 01:09:22.359 --> 01:09:26.420 get worse while you're pregnant. And then the 01:09:26.420 --> 01:09:29.359 last one is that there is a diet plan that can 01:09:29.359 --> 01:09:33.039 cure my migraine. And there might be some foods 01:09:33.039 --> 01:09:35.479 that trigger migraine, but there's not really 01:09:35.479 --> 01:09:39.479 a way that you can eat per se that can. get rid 01:09:39.479 --> 01:09:41.579 of migraine headaches. So again, that's another 01:09:41.579 --> 01:09:44.520 myth that we can dispel here. There's no real 01:09:44.520 --> 01:09:48.380 silver bullet that is going to, um, as far as 01:09:48.380 --> 01:09:50.920 there, there's no real silver bullet as far as 01:09:50.920 --> 01:09:53.859 a diet that you can eat on a consistent basis. 01:09:53.920 --> 01:09:55.500 That's going to keep you from having headaches 01:09:55.500 --> 01:09:58.460 and stuff. So, okay. So I think, you know, to 01:09:58.460 --> 01:10:00.359 wrap things up, you know, we talked about the 01:10:00.359 --> 01:10:03.720 fact that a migraine is a headache that occurs 01:10:03.720 --> 01:10:08.539 on one side, is a throbbing headache, and it 01:10:08.539 --> 01:10:12.739 can last for up to three days. But usually in 01:10:12.739 --> 01:10:15.939 most patients, well, it's patient specific. So 01:10:15.939 --> 01:10:21.920 everybody's headache. uh, experience is different. 01:10:22.119 --> 01:10:25.659 There can be triggers associated with them that 01:10:25.659 --> 01:10:27.920 can possibly be controlled to help, you know, 01:10:27.920 --> 01:10:30.399 reduce the number that you have in a, in a monthly 01:10:30.399 --> 01:10:33.479 period. And thankfully there are a variety of 01:10:33.479 --> 01:10:37.159 treatments to both treat acute episodes, as well 01:10:37.159 --> 01:10:39.720 as to prevent the number of headaches that you 01:10:39.720 --> 01:10:42.100 have in a migraine headaches that you have in 01:10:42.100 --> 01:10:46.399 a particular month. And I think for. Patients 01:10:46.399 --> 01:10:49.479 out there who are experiencing this, we are super 01:10:49.479 --> 01:10:51.420 sorry that you're having to go through these 01:10:51.420 --> 01:10:54.739 conditions. But one of the big things that you 01:10:54.739 --> 01:10:56.840 want to treat it early, as soon as you start 01:10:56.840 --> 01:10:59.180 experiencing those symptoms and you think a migraine 01:10:59.180 --> 01:11:01.100 is coming on, almost have like a little holster, 01:11:01.140 --> 01:11:04.680 have a little fanny pack of your medications 01:11:04.680 --> 01:11:08.199 that have worked for you ready to go. And if 01:11:08.199 --> 01:11:09.779 you're someone who's thinking that you might 01:11:09.779 --> 01:11:12.760 have a migraine, I would recommend getting it 01:11:12.760 --> 01:11:16.460 diagnosed by a physician as quickly as possible 01:11:16.460 --> 01:11:18.359 so that you can develop a treatment plan for 01:11:18.359 --> 01:11:22.000 you. And other than that, if you have any questions 01:11:22.000 --> 01:11:25.380 for us, you can find us on social media, at Twitter, 01:11:25.500 --> 01:11:28.899 Your Mom on Drugs, and we will be happy to answer 01:11:28.899 --> 01:11:31.359 any questions that you have regarding this episode 01:11:31.359 --> 01:11:34.539 and any future episodes. But we hope that you 01:11:34.539 --> 01:11:37.500 learned a lot. I know I did from my wonderful 01:11:37.500 --> 01:11:41.159 mom, who is just... Just an amazing resource 01:11:41.159 --> 01:11:44.739 and an amazing person. So that being said, my 01:11:44.739 --> 01:11:47.760 name is Josh Klaus. And I'm Jennifer Seltzer. 01:11:47.920 --> 01:11:50.239 And this has been an episode of Your Mom on Drugs. 01:11:50.619 --> 01:11:51.539 Thanks for joining.