PODCAST: Is Your Headache a Migraine?

ZACH MOORE: Welcome to On Health with Houston Methodist. I’m Zach Moore. I’m a photographer and editor here, and I’m also a long-time podcaster.

KATIE MCCALLUM: I’m Katie McCallum. Former researcher, turned health writer, mostly writing for our blogs.

TODD ACKERMAN: I’m Todd Ackerman. I’m a former medical reporter, turned editor here at Houston Methodist.

KIM RIVERA HUSTON-WEBER: I’m Kim Rivera Huston-Weber and I’m a copywriter here at Houston Methodist.

ZACH: Hey Kim, do you get migraines?

KIM: I do. Ever since my late teen years, it’s just been something that has been kind of part of my life. They’re not fun.

ZACH: No, I wouldn’t imagine so.

KATIE: When you’re getting ‘em, like how often are you getting migraines?

KIM: I would have them as often as often as maybe like 17, 18 times a month and then…

ZACH: Woah!

KIM: I have them as few as, like, a few times a month.

ZACH: Wow, I got a feeling you’re gonna say like, “Eighteen times ever.”

KATIE: Right, per year. Which would be my…

KIM: Yeah, and you know I think that’s an experience that a lot of women have because I think migraine predominantly affects women. So, I have lots of friends who actually experience migraine too and they’re kind of similar where some of them have a lot every month and then some of them just, you know, once a month usually around their lady time.

KATIE: So, have you, like, picked out any triggers or anything? ‘Cause I think a lot of what I’ve heard is that, like, you know, people are like, “Oh, you know, it’s because of this.” But like -- then you’re always -- like, you do so many things, like have you -- have you narrowed down any triggers of anything? Is that real? I don’t know if I’m making that up.

KIM: No. No. I think it’s really -- it’s really true that there are certain things. One of the times most recently that I got one, I was actually taking -- I was doing a ride share and the driver had very -- it seemed like he was swimming in cologne, and I stepped in, and I was like, “This is gonna be a problem.”

[Laughter]

The window is up. It’s Houston in the summer.

ZACH: No escape.

KIM: No escape on the highways too. It was terrible. Sometimes if it’s too bright certain places. The weather is a big trigger for me. So, now that I live here in Houston and it’s just hot all the time, I have those less, but those have been some of the big triggers for me.

KATIE: Yeah, and I mean like -- so I have another question for you, because, you know, I don’t think I’ve gotten migraines really, but I -- you know, everyone’s had headaches. So, like on a scale of one to ten, where would you rate migraine in terms of like everyday headache, maybe hangover headache? ‘Cause I think that’s the one I think of. It’s like the worst. Like, you tell me, is it the worst?

KIM: I would say hangover is probably on the spectrum too. Like, I would think about the worst hangover you’ve ever had where if you were vomiting or having something like that, I think that’s more on the migraine spectrum.

KATIE: Okay.

KIM: Because I do get them where I get sick, I have to have blackout curtains. Like --

KATIE: Yeah, go in a dark place, lay down, experience nothing sensory except for your body physically existing.

KIM: Exactly.

[Laughter]

ZACH: Now Todd, you’re quiet over there. Have you had a migraine in your time?

TODD: I think so.

ZACH: Well, if you think so you probably have it, right.

TODD: No, I’ve always thought if you had a migraine, you know it.

ZACH: Well, there you go.

TODD: This very notion of this podcast seems to call that into question.

KATIE: Okay, I see. I see.

TODD: I don’t get migraines generally, but there’s one I suffered I believe I’m pretty sure I suffered 30 years ago that’s still distinct in my memory because it was so intense.

KATIE: Wow. Thirty years. That is an intense headache.

TODD: Yeah. And it seems like a migraine. Even though I thought one of the definitions of migraines was you get them regularly, but it -- this one time seemed like a migraine because of the sheer intensity of it. The fact that I was nauseous during it, and that light was so bothersome that I had to do the whole sensory deprivation thing.

KATIE: And it was out of the blue?

TODD: I had traveled to high altitude.

KATIE: Okay.

TODD: Which I think people where I was thought that that was a common trigger.

KATIE: Okay.

TODD: I may have had other migraines in my life but that’s the one that really stood out and ge -- you know, I generally suffer from occasional sinus headaches. To me, those seem easy to distinguish from that migraine I had.

KIM: Yeah, well in people that experience migraine, their brains are just -- they have the ability to tip into that migraine so they’re just more prone to it. So, it seems like there’s a lot of lifestyle factors that can help you lessen how migraine affects you. So, I don’t know Todd, maybe your brain does have the propensity to tip into that migraine and -- but you’ve got that clean living going on that’s --

[Laughing]

That’s keeping you, keeping you.

TODD: Perhaps. My mother had suffered from migraines or with headaches anyway. I don’t know if they were migraines probably. She took a lot of aspirin I remember.

KIM: Yeah. And you know, I think that’s one thing. It’s hereditary. So, if your mother did indeed experience migraine, you probably do, or at least have the propensity to do so.

TODD: That’s interesting. Just because it seems so weird to me.

KIM: Yeah.

ZACH: But Kim, who did we talk to today about migraines and headaches?

KIM: We talked to Dr. Julia Jones, a neurologist here at Houston Methodist.

[Sound effect signaling beginning of interview]

KIM: We’re here with Dr. Julia Jones, neurologist with Houston Methodist. Dr. Jones, thank you so much for being with us today.

DR. JULIA JONES: Thank you for having me.

KIM: So, in my experience I’ve heard people use the word migraine when they actually mean severe headache, or bad headache, or, “My head’s killing me.” And as a person who experiences migraine, I know there’s a distinction, but I also know that headache can be as painful to the person that’s experiencing them. And even though they might not have the right words to express what’s happening to them. So, I’d like to start by asking some definitions. What is a headache, and what is a migraine, and where is there overlap?

DR. JONES: So, a migraine is a primary type of headache, and we define a migraine by certain criteria. You have to have at least five headaches. They usually have moderate intensity, interfere with activities. When you walk around, cough, or sneeze, aggravates the headache. You have to have some degree of light or noise sensitivity or nausea. So, we define migraine by those criteria, and they are genetic. Now a headache could mean many different things. It could be whamo! The frying pan hit my head. Worst headache of life, and that would be suspicious for a subarachnoid hemorrhage related to a cerebral aneurysm rupture. So, there are different headaches. But the primary headaches: cluster, migraine, tension type headaches, or -- are defined by those criteria. But there are -- headaches have ominous features sudden onset, severe, progressive, and obviously have other causes.

KIM: That leads me to my next question. What causes migraines, and do the causes seem to differ from other types of headaches?

DR. JONES: Well, as far as a migraine headache we know they’re genetic. The mom or dad had it, you got a good of chance of getting them. We know that migraine brains are basically hard wired to tip into that headache. So, more prevalent your 30s and 40s, often start in your teenage years. But they’ve done cerebral blood flow studies given someone nitroglycerin and looking at migraine patients and they have stronger connection between that hypothalamus and autonomic and pain centers. So, we know they’re kind hardwired as I say, they sort of tip into that headache. As far as tension type headaches, cervicogenic headache, they may relate to more muscle spasm, muscular skeletal issues with the shoulder, neck, or jaw.

KIM: Which headache types most often get confused with migraine?

DR. JONES: I think sinus headache would be one of them. And that people will have a headache, they have pressure in their face that go see their ear, nose and throat doc, and lo and behold, their sinuses are totally clear. And in fact, they probably have migraines. Some of these patients may have dizziness which we can see as a feature of migraines. But they may have frontal pressure, or pressure in the cheek, because a migraine can be anywhere above the shoulders as far as the pain. And sometimes will have activation of nasal congestion, even flushing or tearing with a migraine headache. But now, if you have a sinus infection, a headache is a minor feature. You’re sick, you’ve got green stuff coming out the back of your throat or your nose. A headache is a minor feature. The sinus infection will not go away with Tylenol or a migraine medicine. It goes away with an antibiotic. So, I think that’s maybe where I see my -- most of my patients coming from an ENT. They don’t have sinusitis, or sinus headaches, they have migraines.

KIM: And kind of to that point, I always like to say that my husband can predict the weather because whenever there’s a drop in barometric pressure, he gets a headache. Is that more sinus headache? Is that more migraine? What would you say that is?

DR. JONES: I would say that’s pretty typical of a migraine if they meet those criteria with the features. So, a lot of patients will tell me, “I know the weather change is coming before the weather guys does on TV.” And so, there have been studying it, and I think it does correlate. It’s, you know, there are many triggers for migraine patients and, you know, the hypothalamus is what kind of controls our homeostasis, when we’re tired, we’re hungry, et cetera. And so, when, you know, emotional stressors, hormonal change, odors, et cetera. All these things can alter homeostasis. And weather change is listed as not an uncommon migraine trigger. And I’ve had lot of patients who were really happy this summer, because there’s been no weather change.

KIM: Oh yeah. I’ve been pretty excited. That’s has been the only exciting thing about the weather just been blazing hot. Now I know, definitively, that weather can be a trigger, but what are some of the most common migraine triggers that exist, and what are some of the not so common ones you may have seen in your practice?

DR. JONES: So, you know, as I mentioned, we’re kind of hardwired to tip into those headaches when your hypothalamus is not happy. So, ideally, make it happy by normalizing your meals, your sleep, your exercise. Probably the number one trigger would be stress. Sometimes we don’t know we’re under that stress until it’s kind of behind us. People having headache, headache, headache with their job and their boss making them crazy. They go away when they change jobs. Stress let down. Yay! Finals are over. I’m on vacation. Yay! Boom there’s a headache. So, stress, stress, let down. Hormonal for women, ovulation, menses, very common. Usually, it’s that withdrawal of estrogen once a month where you will get menstrual migraines day two or three of your period, that can actually be more severe than headaches outside of that. We’ll also see it with being off with your meals, such as you were late for breakfast, you waited for the breakfast tacos at work, or you skipped a meal. And then sleep pattern variability, different time zone. My shift workers, nurses, bus drivers, police officers. Or you just decided to sleep in on your Sunday. Those can all be migraine triggers. Also, people will note triggers such as odors, smoke, incense, candles. I know there are certain stores I do not like to go into because they smell. And also 26% will find a food trigger, so only 26%. But it’s nice if you can find that out because you can avoid that trigger. Meaning, chocolate, aged cheeses, smoked meats, nuts, additives and seasonings like in marinades. We can see it with the processed meats, the nitrites, salami, baloney, hot dog, bacon. The tyramine foods. Also, the other ones I’ve mentioned. So -- and they’ve also done studies. “Okay, let’s see if we give you a headache. Here’s your chocolate bar. Well, you didn’t have a headache, but three months ago, horrible headache.” Well, three months ago maybe you hadn't slept, it was your period. Didn’t feel so hot, boom, chocolate. You got a migraine. So, identical triggers may not always trigger headache. Go figure.

KIM: Yeah. It’s wild sometimes when you experience something and it’s not one of your usual triggers. Are there other conditions that may lead someone to believe that they have migraine or maybe chronic headache when they might not?

DR. JONES: Well, I think if someone has a new onset severe headache they might think of a migraine. We know that less than 5% after the age of 55 will have the onset of migraines. They’re usually younger, 20s, 30s, 40s. So, if you’re having a late onset severe headache, they need an investigation into other causes. Is there are stroke, a tumor, hydrocephalus, or what we call water on the brain. You know, something else that’s not so good.

KIM: Before we talk treatments and prevention and you kind of spoke to it there. Can you share when someone should seek care for either chronic headache or migraine?

DR. JONES: So, migraine headaches are, you know, are pre -- like I said, fairly prevalent in your 30s and 40s. A lot of people will get relief with Tylenol, Advil, so they’re probably not the people who need to come in and be seen, if they can get rid of their headache and they can function well. I think it’s someone who’s having more frequent headaches that are not responding to over-the-counter medicines, that they need treatment either with their primary care physician or seeing a neurologist. For instance, no matter how perfect your day is, and how happy your hypothalamus, about a third of patients with migraines will need a prevention, something to turn them down and make them less frequent and/or severe. So, it’s important that they get in with their doctor because we have a lot of new treatments that are out there that target treating the migraine.

KIM: Managing migraine or headaches can be somewhat of a personal affair. I’ve talked with several people who experience migraine and asked what various natural or homeopathic methods they’ve used to deal with pain, whether it be a warm bath, peppermint oil on the temple, warm rag on the neck and a cool rag on the forehead. I’ve heard everything. Someone even told me that when they experienced migraines as a child that their grandmother told them to submerge their feet in really hot water to pull the blood away from your brain. I’m sure you’ve heard it all when it comes to migraine pain management technique. So, when it comes to home remedies, what actually works versus what might be a placebo or just something that is self-soothing.

DR. JONES: So, I think with a migraine patient a lot of them have light and noise sensitivity. Typically, they’ll go into a dark room where it’s quiet and it’s cool. And no one bothers them. Hopefully, they can take an anti-inflammatory or Tylenol that works for them. If we’re, you know, doing at home treatment some patients will get the frozen peas and put it on their head and hopefully that that will work for them. Often sleep will relieve a migraine headache. If they can get some sleep, knock out, a little Benadryl they may wake up without a headache, but, you know, not always. As far as homeopathic sort of preventatives there is magnesium oxide. Some will take about 420 milligrams at bedtime. They can help ‘em sleep and it does have class B efficacy for migraine prevention. In addition to vitamin B2 are riboflavin, about 200 milligrams daily. So, if someone is potentially planning pregnancy those are obviously very safe mag oxide and that vitamin B2. There’s some data also class B, for coQ10, Feverfew. So, we have some other ones that are over the counter but if, you know, someone’s disabled they’re laying in bed, I would recommend they get on medicine that treats their headache so they can not have to do that and just function and go about their day.

[Sound effect signaling break in interview]

ZACH: The American Migraine Foundation says the one in every four households in the U.S. has someone who experiences migraine. It’s also considered the third most common condition in the world affecting one out of every seven people globally. But unfortunately, migraine can be under-diagnosed and under treated. The American Migraine Foundation says a fewer than 5% have been seen by a heath care provider, receive an accurate diagnosis, and obtain appropriate care. People may believe they’re having sinus or extreme tension headaches and taking over the counter medicines too much, leading to even more migraines.

[Sound effect signaling resumption of interview]

KIM: Let’s talk migraine treatment types, both those that can help ease migraine attack symptoms and the preventive medications that exist.

DR. JONES: So, acutely with a migraine patient it -- let’s assume they’re coming to see the doctor and they haven’t responded to Tylenol, Advil. They may be taking a frequent amount of Excedrin, BC powders. And unfortunately, besides those being able to give you an ulcer they also can give you rebound headaches, or withdrawal headaches, when you’re not taking the Excedrin or BC powder. So that can also contribute to transforming that headache that’s on occasion now to almost every day. So, we need to get off the over the counters as much as possible. Tylenol probably is the least offensive one to take but it more than likely doesn’t work. So, seeing the physician, the acute treatment, we usually go with the Triptans. And these are a group of drugs that came out in the 90’s. Actually, a Glaxo scientist discovered Imitrex in 1984, came on the market as a shot in 1992. Then all the pills rolled out the Triptans: Imitrex, Maxol, Relpax, et cetera. All generic now and very affordable and they work for two-thirds. They are helping out being an agonist at some of the serotonin receptors in our brain. Some of these are on the heart. Also, some of the contraindications with these other drugs would be coronary artery disease or uncontrolled high blood pressure. But the Triptans work for two-thirds of folks who take them. They work in about 20 minutes, most of the pills Imitrex, Maxol, Relpax, Zomig. There also is a spray and a shot as I mentioned, but they are pretty effective. Now some other contraindications besides uncontrolled high blood pressure, heart disease would be -- well if you don’t tolerate it, some of the side effects can include tightness in your muscles, dry mouth, dizziness, fatigue. I’ve had some patients who just have to lay down with these, so that’s not really acceptable. You don’t wanna take something then have to go lay down, you wanna take something that works, and you can keep going. So, the Triptans now are still present and available. And now we have some newer drugs that you see advertised on television, Nurtec, Ubrelvy, and these are a new class of drug called the Gepants. So, these work a little slower but have less side effects. So, these drugs are working by blocking something called CGRP, Calcitonin gene-related peptide. So, this is neuropeptide in our brain, it’s also in the peripheral nervous system, it’s in our skin, it’s in our gut. But we know, CGRP plays a role in causing release of the pain factors that give us our headache. For instance, CGRP is increased in the jugular venous blood when patients have a migraine, injection or intravenously of CGRP causes a horrible headache in migraine patients. And then now these newer medicines, these Gepants, Nurtec, Ubrelvy are very effective in aborting a migraine headache. And then we also have larger molecule blockers of CGRP, Aimovig, Ajovy, and Emgality that work very effectively as a preventative. So, acutely we’ve got Triptans, we’ve got Nurtec, Ubrelvy. There’s another one called Reyvow that’s out, that’s new. It’s a Ditan. It works by agonizing another serotonin receptor. So, the last ones I’ve mentioned, the newer ones, Nurtec, Ubrelvy, Reyvow. They are actually stroke and are high blood and stroke patients, whereas the Triptans can be problematic. So, we have a lot of new acute medicinesthat are out there. There are even some devices that are used, Nerivio arm band. That’s approved for ages 12 and up. So, it’s a little band that goes on your biceps, looks like a little, I don’t know. Just a wrap around gizmo. And it stimulates the muscular cutaneous nerve or the nerve for the biceps. You put this on, acutely within 20 minutes of the headache, leave it on for 45 minutes. You’ll feel a little warmth on your arm. You control it with your smart phone. And this is working by what’s called remote electrical neuromodulation. It’s sending inhibitory impulses to your brain stem that guess what? Blocks the release of CGRP. So, these are kind of neat. And it did just get approved for prevention to be used every other day. Now going on to prophylactics, we have a lot of drugs that have been around for many years. And in fact, most of the migraine preventatives were borrowed, for instance, Amitriptyline, Depakote, Topamax, Endural. These are drugs that were approved for other primary purposes and then they were used for prevention of migraine. So, we have class A data for some of the old school ones. Amitriptyline is a B. Magnesium I mentioned is a B. Vitamin B2. As far as other prescriptions class A we’ve got Topamax, a seizure drug, been approved for migraines. Depakote, seizure drug approved for migraines in 1995. And beta blockers metoprolol, these are class A. The other class preventatives include Nurtec, that’s the one I mentioned that we can use acutely. It’s a Gepant. Another one that just came out, that’s also another Gepant is Qulipta, class A data. And then we have the large molecule, monoclonal antibodies against CGRP. Aimovig, Ajovy, Emgality and an infusion called Vyepti. And so, these are basically binding CGRP directly or blocking the CGRP receptor and the periphery of the brain. So, these large molecule injections are very low side effects, they’re all class A. They did not study pregnancy and breast feeding so if someone was to say, “Hey, I wanna have babies, you wanna get the injection or get that out of their system for five half-lives, about five months. These medicines are cool in that they’re not going through your kidney or liver. I have a lung transplant patient who takes Ajovy. There’s no drug interactions. It’s broken down at the cellular level, that’s why it has such a long half-life. And the side effects are pretty low. In other words, you can have an allergic reaction of course. It's a little injection you do on the side of your leg, on your stomach, so you can have an injection sight reaction a little red-hot spot. We have some GI issues with Aimovig up to 3% could have some constipation. It could be severe. Although Aimovig is the one that actually is approved in Germany as well, and beat out Topamax, and has five-year safety data. So, I -- all of these are very usable medications. Vyepti the infusion is the same sort of thing, and you have to go to an infusion center every three months. It lasts about 30 minutes, then you repeat it. Those are some of our newer preventatives and you’ve probably heard of Botox. Botox got approved in October of 2010. And so, it’s 31 injections in the face, scalp, and neck region. Botox, you know, was used for cosmetics back in 2002 when it was approved. And they found that patients were having less migraines so lo and behold, what does Botox do? Well, it blocks the citicoline so you don’t wrinkle, but it also blocks, guess what? Release of CGRP. So that’s why we have a certain protocol sort of wanna call it shot gunned. But you do that every three months.

KIM: So, this is something that I’ve witnessed in my friends, and my family and I’ve experienced it somewhat that there’s just this treatment journey that you go on to find what works and what doesn’t. And it’s a lot of trial and error when it comes to getting relief from a migraine. Can you speak to working with a neurologist to figure out what the right treatment options are?

DR. JONES: Yes, I think most of my patients are going to have episodic migraines, less than 15 headache days in a month. And I mentioned, usually if you’re hitting six to eight headache days in the month that’s the group I recommend getting on a preventative. ‘Cause we know we can get rebound from certain over the counter medicines. We can get rebound from Imitrexial Triptans. No, we don’t get rebound from our new ones, Ubrelvy or Nurtec. But about a third of folks will need a preventative. Now, what if you’re having more than 15 headaches days? We’d call that chronic migraines. So, I mentioned Botox already, that’s actually only approved for chronic migraine, not episodic.  And usually something has to be a treatment failure with a couple of older drugs or a -- or newer drugs. But if, you know, all the patients that need prevention, which I said is a third -- about a third of those are chronic migraines. Now, certain medicines are approved for both prevention of episodic and chronic that would include Qulipta, the daily pill, Atogepant. And Botox is only for chronic. Now the injectables: Emgality, Ajovy, Vyepti, Aimovig. Those can be used with episodic or chronic migraines. So, a lot of times when I see patients, they’ve been on old amitriptyline or a beta blocker, maybe Topamax. And we’re gonna, you know, get them on something that’s more effective and has less side effects. So usually, we kind of go through the process, you know, are you planning pregnancy? They’re certain questions you have to know because we wouldn’t give the injectables. Something like a Nurtec every other day or Qulipta daily, could be stopped pretty quickly and out of your system in a week if you wanted to conceive. Meanwhile those shots, we say get it -- get out of your system for five months because -- and we don’t know what it -- what it does.

KIM: Aside from the preventive medications that exist, are there things people can do to help prevent their migraines?

DR. JONES: So, I think going back to a happy hypothalamus or kind of being chill, meaning you’re normalizing your meals. You’re waking up at 6:00 on the weekdays and the weekends, not sleeping in. And if you can do cardio three times a week for 35 minutes or even, you know, four days a week, but good de-stressor. You sleep better, you feel better. So, taking care of you goes a long way. You know, you’re skipping meals, you’re stressed out, you’re not sleeping. That’s gonna stir it up.

KIM: And is there any such thing as being cured of migraine? Can they go away on their own?

DR. JONES: Often women about 60% after menopause, which average age is about 51, will have less headaches or they may get rid of them. Men obviously don’t have that. So, I think it varies on the individual. I see a lot of patients who, you know, they had headaches when they were kids. They went away in their 20s, after they had their baby in their 30s. Here they are again, they’re back. So, I don’t know how to predict that, but we know looking back at those triggers like stressors, or variability in routine certainly can be problematic for folks. So, I don’t -- I don’t typically see someone going completely in remission. For instance, I remember seeing a lady who her cardiologist sent her to me because she’d seen a rainbow in her vision. And she didn’t really remember, but she had migraines when she was a kid. But what she had was a migraine aura, the cardiologist was afraid she had a stroke. But in fact, she had a migraine aura which is -- which is very characteristic. So, you know, and she was in her 80s. But, you know, she hadn’t had anything for years.

KIM: I’m hoping it’ll happen for me, they’ll go away. You’ve mentioned rebound headaches, and do you hear from patients about migraine hangover? So maybe the next day after a headache being somewhat as bad as the headache or is that what you would consider a rebound headache?

DR. JONES: So, I think when we have a migraine, if you can best treat it acutely with what works for you, you have the best bet of not having that. But some people do have the postdrome where they feel a bit fatigued, or wiped out, or what you said, “Hangover.” And some people have a little bit of a sensitization. What that means is, if we didn’t get that headache treated acutely the scalp gets tender. It hurts to put on your glasses, brush your hair. So, we can certainly see that. We need a better acute treatment hopefully that knocks it out. But sometimes it’s menstrual migraine time and you’re having a headache every day for a few days and you may need to have some medicine, you know, repeated short term during that time period. 

KIM: So, when you talk about each person’s migraine triggers are probably going to be unique to them, and I’m sure in your practice you’re seeing people and they might be new to their migraine journey, and they might not know what their triggers are, how do you help them figure out what’s causing their migraines?

DR. JONES: So, we mentioned, we know the triggers, the stress, et cetera. And what I ask patients to do is to keep a headache diary. There are a couple of apps that are available. A migraine buddy, Iheadache, Allergan has one with Botox. So, you can kind of get a feel from maybe what might be triggering your headaches ‘cause sometimes it’s unclear. But we know a migraine can actually be cooking up to three days before the pain so that, you know, Friday night glass of Rosé might give you your Monday headache. So, it’s kind of a long ways to look back. Most people think, “Oh, I drank red wine. I should -- it should give me a headache right away.” No, not necessarily. So, it’s helpful to keep that headache diary and sort of see what’s off. And then usually I give my patients some information, what I call migraine FYI. You know, looking at the new medicines, you know, going over that. Talking about rebound, trying to avoid a lot of over the counters. Let’s not take what doesn’t work. And, you know, when they’re seeing me, it’s not working, let’s switch gears. Steer away from narcotics, butalbital if you are, and keeping the diary I think is very helpful for them. Because a lot of people will go, “Hey, when I got to the Astros game and have peanuts, I get a headache. Then I went to that fish fry, peanut oil.” I had a patient who told me that. I’m like, “Okay, good. Avoid peanuts.” Unfortunately, peanuts are in a lot of things. But if you can figure out a trigger. It’s good.

KIM: It’s very interesting because I feel that especially as the newer medications have come out, it just feels like it’s really opened up for a lot of people who experience migraine. Because I have a friend that it took a really long time, she’s doing Botox now, but she had a really hard time with the Triptans and…

DR. JONES: ‘Cause we got better stuff.

KIM: Yeah, it’s really a whole new world out there.

DR. JONES: Yeah, ‘cause I started practicing in '92. We had the Ergots, Cafergot Ergostat. And then, you know, Imitrex came out ‘92, you know.

KIM: Well, thank you so much for sitting down with us today.

DR. JONES: Sure, thank you.

[Sound effect signaling the end of the interview]

ZACH: So, Kim migraines are a big part of your life. And did you find, when talking to Dr. Jones here, did you find validation, reassurance, some maybe new strategies you could try? Like, what was your big take away from this?

KIM: The conversation was very reaffirming of my experience. And the one thing that I have really latched on to was when she discussed lifestyle factors. I wouldn’t say -- I’m no Todd, I haven’t taken care of myself, you know, for the entirety of my life, I would say. I’ve definitely gone through some, like, dirtbag phases where, you know, I’m not sleeping well. I’m, you know, not eating well. Like, all of the things and surprise, those were the periods in my life where…

ZACH: Who would have thought?

KIM: Tons of migraines.

TODD: Just for the record I was young once.

[Laughter]

ZACH: Did you have a dirtbag phase as well?

[Laughter]

TODD: That’s the exact term -- way I’d put it but…

KATIE: Todd, what’s the craziest snack you’ve ever eaten?

[Laughter]

Pretzels?

ZACH: Ritz crackers.

TODD: When I was a kid, you know, we gotta remember the times here. My mom gave me a dollar to get dinner at a baseball -- like a local baseball game.

KIM: Well, that’s depressing to think about.

TODD: Where the idea was to get a hotdog or something. I got ten ice cream sandwiches.

ZACH: Ten ice cream sandwiches?

KIM: That’s a lot to unpack there.

[Laughter]

ZACH: That’s a lot of ice cream sandwiches, don’t you think? For one.

KATIE: Did you eat all ten?

TODD: Yeah.

KATIE: Did you have a migraine after?

TODD: No.

KIM: Alright, well.

ZACH: Well, brain freeze is a totally different situation.

TODD: Yeah. I had that.

[Laughter]

ZACH: But no, that’s a good take away though. Right? I mean, like we’re always talking about on -- I feel like every conversation we have about this, you know, take care of yourself and your body will, you know, take care of you. Right?

KIM: Yeah, for sure. And, you know, the recommendation for working out, and I’ve been doing more --semi recently and, you know, I’ve had less headaches. I mean, I still have headaches every month.

ZACH: Migraines.

KIM: Migraines, yeah. See, I did the thing, you know.

ZACH: You kind of lessen it for your…

KIM: Well, you know, I think it’s because sometimes some of them will be -- I’m getting sick and there’s no way of getting out of it, and then there’s, you know. I’m not feeling well and is it a migraine or did I just not have enough water today?

KATIE: Well, and to your point too, she -- I liked how she talked about it’s additive and the sense of maybe this one trigger that’s random. Well, it doesn’t really bother you unless you’re also not sleeping well or, you’re also, you know, you have all these other triggers that kind of start piling on and then things like sleep, you know, exercise helps you sleep. So yeah, I don’t know. It gets back to this thing where it’s all sort of this big circle of like, you just have to be healthy which is hard, right? It’s hard.

KIM: Yeah, ‘cause being a dirtbag is a little fun sometimes.

[Laughter]

KATIE: That’s true.

ZACH: So, for people out there who are listening, who are on the fence if they’re having migraines or not, as someone who has experienced a lot of them what would you tell them?

KIM: I would say If you’re having a lot of headaches in a month and you can’t really pinpoint why, I would probably get checked out. Especially if you’re light sensitive. If you’re -- nothing is really bringing you relief for them because I think that’s another important thing. Like, if you’re over using over the counter medications you’re just gonna give yourself more headache and I think that might be the vicious loop that people find themselves in.

KATIE: Yeah, and I liked one of the telling signs that you mentioned where your husband can tell he’s getting a migraine when the weather changes. I think that’s weird too, right? That should be kind of like a red flag. It’s like, “Hmmm if I can start predicting the weather just with a headache, maybe it’s a little more than a headache.”

TODD: Yeah.

KIM: Exactly.

TODD: I like that Houston’s weather is actually good for your headaches. That’s the first real good testimonial in favor of Houston weather.

KATIE: I was just about to say, “Good for something.”

KIM: Yeah.

ZACH: Alright, that’s gonna do it for this episode of On Health with Houston Methodist. We drop new episodes every Tuesday morning, so be sure to share, like, and subscribe wherever you get your podcasts. And until then, stay tuned, and stay healthy.

[Music ends signaling end of episode]