117: Migraine Explained: Triggers, Treatment, and When to Worry for Patients

We break down migraines as a neurologic condition with a real brain-based chain reaction, not a character flaw or a one-off “bad headache.” We share practical prevention habits, how to track triggers, and how acute and preventive migraine medications fit together so you can walk into your next visit prepared. 

• what makes a migraine different from other headache types 
• common and less common migraine presentations including aura and scary look-alikes 
• the five-step migraine chain reaction including CGRP and pain amplification 
• high-yield triggers like stress, sleep changes, skipped meals, hormones, smells, and weather shifts 
• consistency as the core prevention theme across sleep, exercise, eating, and stress 
• migraine diary basics to identify patterns and improve your neurologist visit 
• when headaches warrant a call to a clinician and what red flags to take seriously 
• acute treatment options including OTC meds, triptans, CGRP blockers, and anti-nausea meds 
• medication overuse headache risk when acute meds are used too often 
• preventive options including beta blockers, anti-seizure meds, antidepressants, and Botox 

You can find us on Threads, you could send us an email, or you can send us some fan mail. We still have that voice-based fan mail still waiting for that first fateful one. 

Transcript

Welcome And Migraine Ground Rules

SPEAKER_00 0:01

Hi, welcome to your checkup. We are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine doctor in the Philadelphia area. And I'm Nicola Ruffo, I'm a nurse. And we are so excited you were able to join us here again today. So what are we going to talk about today, Nick?

SPEAKER_03 0:24

Today we're talking about migraines.

SPEAKER_00 0:27

Now, how how near and dear to your heart is this topic?

SPEAKER_03 0:32

Really near and dear. I'm sitting here looking at my Nerdek.

SPEAKER_00 0:37

Yes. All right. So we are going to this is a meaty one. We're hoping to capture, we'll see how this goes in terms of keeping your attention. But if you ever need to pause it to kind of reset, we also have a meaty banter section for you. So this will be a long one. So we'll go back and forth here. This is a very personal episode. And we're happy to go on this journey with you. So a migraine is much more than a bad headache. It actually is a whole neurological condition. It starts in the brain and the nervous system, and they cause episodes from moderate to severe head pain, often on one side of the head, along with symptoms like nausea, sensitivity to light and sound, and sometimes visual disturbances, which can be very disturbances and very disturbing to people.

SPEAKER_03 1:25

So I also think it's important to note right off the bat, I don't know if this is down here.

SPEAKER_00 1:31

No, go ahead.

SPEAKER_03 1:35

That you don't just like randomly have one migraine here and there. Or like, oh, I like once had one migraine one time. Like it's a chronic thing.

SPEAKER_01 1:46

Yeah.

SPEAKER_03 1:47

You know what I mean? It's like not just a really bad headache that you get once and then never again. It's kind of like when people say they have OCD, but they just like their house clean.

SPEAKER_00 1:56

Oh, yeah. You know? That one. Yeah. Yes. Um, because there are different types of headaches. Of course, um, we could take the approach of this episode of like looking at headache in general. Maybe at some point we'll do that. But there are tension headaches, there are cluster headaches, there are headaches of all different shapes and sizes. There's a whole medical specialty about it. So not every headache is a migraine, but that's what we're talking about here today. All right. So one important distinction that we wanted to make before we kick off too much farther is that today we are spending time talking about a migraine that comes on and offers simple pain on one side of the body and two of three nausea, sensitivity to light, or sensitivity to sound. Um, but you know, afterwards we were discussing that there are different types of migraines and complications of migraines that maybe aren't so generalizable to many people, but do happen. Yeah.

SPEAKER_03 2:56

Like we like we're talking about the I guess most common. Yeah. It might not be most common. Who knows? I think it is. But just like what you would think of of a migraine of a headache. Because not all of them cause headaches.

SPEAKER_01 3:11

Yes.

SPEAKER_03 3:12

Necessarily. You know. Yeah, like they're not abdominal migraine's a thing.

SPEAKER_00 3:18

Correct. Yep. That's a feature of this. They're abdominal migraine, vertiginous migraine, where people get dizzy and like the nervous system kind of whacks out and makes people dizzy. Um, you mentioned the name of one that can be very scary to see, a hemiplegic migraine, where someone like loses function on the side of their body.

SPEAKER_03 3:39

Yeah, like mimics a stroke, basically.

SPEAKER_00 3:41

Yeah. So like that those people go to the hospital. Um, of course. So those are those are scary things. And you know, wanted to give a little bit that like that's we're not talking about a lot of those things here today. We are spending the vast majority of our time doing the ins and outs of a more quote, like wild type in the wild, regular, degular migraine. Feel good?

SPEAKER_03 4:09

I think so.

SPEAKER_00 4:09

Cool. So

How Migraines Work In The Brain

SPEAKER_00 4:12

Nikki, how does a migraine attack happen?

SPEAKER_03 4:17

So it's kind of a chain reaction in the brain, um, which we have a simplified, more simplified step-by-step ex explanation. Um, the first step is that something sets off the brain. So people who get migraines, their brain is more sensitive to certain triggers or certain changes. So things like stress, poor sleep, skipping meals, hormonal changes, um, certain foods or smells can be triggers. Um sorry.

SPEAKER_00 4:51

I I I sprayed cologne.

SPEAKER_03 4:53

I almost had those divorce papers drawn up when you had the audacity to spray your cologne in the house.

SPEAKER_00 5:00

That you got me for a gift. I know it was a rough moment.

SPEAKER_03 5:04

So, step one, something sets it off. Step two, not every person experiences this, but it's the migraine aura, which is a wave of activity spreading across the brain. So it's a slow wave of electrical activity spreading across the surface of the brain. You can think of it like a ripple moving across a pond. And this wave temporarily disrupts the normal brain function in the areas that it passes through. So if it crosses through a vision, an area of vision, you might see flashing lights, zigzag lines. Um, some people have like full-on blind spots. So this is what causes the aura that people can experience kind of like a warning that your migraine is about to start. Although it's scary when that happens the first time.

SPEAKER_00 5:53

Yeah, it is scary. Sometimes it sends people to the hospital sometimes.

SPEAKER_03 5:57

Yeah. But it should only last like a couple minutes.

SPEAKER_00 6:01

Yeah.

SPEAKER_03 6:02

If it's like I don't know if also don't know if we talk about this, but definitely go to the hospital if it doesn't go away.

unknown 6:09

Yeah.

SPEAKER_03 6:12

Um, okay, anyway, so step three. All right, so then step three is the pain nerves around the brain get activated. So the brain itself cannot feel pain, but the surrounding the brain are tons of blood vessels and protective membranes that are rich with pain-sensing nerve fibers. So these nerves belong to the trigeminal nerve, and this is the main nerve responsible for the sensation in your face and your head. And during a migraine, those nerve fibers have become activated, and then that's what's sending the pain signals. So our pain signals are going off, and then step four, there are only five. Step four um is that inflammation and chemical release. So once activated, the nerve fibers release chemical messengers, most importantly, um, one called CGRP or calcitonin gene-related peptide. Um, so these chemicals cause the blood vessels around the brain to swell and become inflamed. And this inflammation further irritates the pain nerves, creating a cycle that intensifies the pain. So you're basically in like a circle of death in your brain. So then step five is the brain amplifies the pain. So the pain signal travels from the nerve fibers around the brain through the relay stations in the brainstem to the deep brain structure called the thalamus, and fine and finally up to the parts of the brain that process pain. So, like shooting off pain signals, looping around, your brain's processing the pain in a whole big cycle. So, along the way, these relay stations can become sensitized, meaning that they start amplifying the pain signals. So that's why during a migraine, even normal sensations like light touch on the scalp, bright light or sounds can become painful or unbearable.

SPEAKER_00 8:18

So then comes the question of after understanding why this happens, why the heck do migraines keep coming back? Well, migraine is a genetic condition. It tends to run in families. The genes involved affect how excitable the brain's nerve cells are and how blood vessels in the brain function. Because of this inherited wiring, the brain remains prone to these chain reactions throughout life. Though migraines can often improve with age. So some key takeaways so far are that migraines are a real neurologic condition, not just a headache. They involve a complex chain reaction of electrical activity, nerve activation, chemical release, inflammation, and pain amplification in the brain. And there are modern treatments, including newer medications that block what you mentioned, the CGRP pathway, target the specific chemicals and pathways related in this process. Understanding your personal triggers and working with your doctor on a treatment plan can help reduce the frequency and severity of attacks.

Triggers And Daily Prevention Habits

SPEAKER_00 9:18

So speaking of, there are certain lifestyle strategies to help prevent migraines. This, I actually talk a lot about this with people when I see them and I'm working with them on their migraines, and I tell your story quite a bit that when you like how annoying it is that when you like really did commit to these things, your migraines got so much better.

SPEAKER_03 9:40

Well, your brain, your brain likes consistency. I've learned. Also get a nod pod.

SPEAKER_00 9:47

Sponsor, hopefully. That'd be cool. I'll reach out to them. But yeah, you love that thing. Um, so living with migraines can be really challenging, right? Yeah, you're a trooper.

SPEAKER_03 9:59

So research and honestly, like uh marrying a doctor was like so clutch on my part because it's like it's taken me a year to like see a neurologist for the second time. Because the first one I went to said that I was just stressed because I just got engaged. And that was annoying. Anyway.

SPEAKER_00 10:22

Was that when you went to the hospital?

SPEAKER_03 10:24

Mm-hmm.

SPEAKER_00 10:25

Yeah, that awesome. Um, so research has shown that certain everyday habits can help reduce how often migraines happen and how severe they are. It's great. You could think of these strategies like building a strong foundation, and they work best when you try to work on other things. So you could try to remember them by living a healthy lifestyle and truly really committing to that. Sometimes people use the word seeds, sleep, exercise, eating, diary, and stress. So sleep. Keeping it consistent. Sleep problems and migraines are closely connected. Both too little and too much sleep can trigger attacks. Going to bed and waking up at the same time every day, including weekends. A consistent schedule is one of the most important things you can do. You should aim for seven to eight hours of sleep per night. Create a relaxing bedtime routine. Gosh, this is a big one. Avoid screens, phone, TV, and computer for at least 30 minutes before bed. It is this is one of them that is so annoying, but it's true.

SPEAKER_03 11:31

It is. And yeah. Honestly, get like a sleep mask or you got me a nod pod, and it has been like the best thing ever because there's something over your eyes you can't look at anything. You know? Yeah. I just lay there and do my words until I fall asleep.

SPEAKER_00 11:57

And you should only use your bed for sleep. If you can't fall asleep within about 20 minutes, get up and do something quiet until you feel sleepy. Definitely not something stimulating. So it can't be an interesting book that you're reading. It has to be something really GD boring. You have to avoid caffeine and alcohol close to bedtime. Alcohol, I probably in this situation, just toss it out the window. It's not for you if you are struggling with migraines. Try to avoid napping during the day if you have trouble at sleep. And then, as we've mentioned in previous episodes and conversations about fatigue and insomnia, the first line treatment for fatigue, or rather, the first line treatment for insomnia is cognitive behavioral therapy for insomnia. You can look into this, you can find stuff online. There are books, there are free courses. Maybe you can even find yourself a therapist. But sleep hygiene for migraine prevention is so incredibly important. In a visit, it gets like, hey, this is important, but we're really trying to bump it out here and highlight bold underline, it really matters, right?

SPEAKER_03 12:58

It does.

SPEAKER_00 12:58

Yeah. In your personal experience too. Um, any, you know, we have our like official recommendations, well, I guess or whatever recommendations. Um, do you have any thoughts or feelings in personal experience to align with people listening for for sleep? For sleep or migraine before we move on to exercise and migraine.

SPEAKER_03 13:21

No, it's like really annoying that a consistent goodnight sleep is makes you feel like a million bucks. Or like makes your head hurt a little less, you know.

SPEAKER_00 13:32

Yeah.

SPEAKER_03 13:34

But it makes sense because you like your brain needs rest and needs sleep. So if your brain is already more sensitive and you're in this like endless cycle of inflammation and pain and blah blah blah, like not getting good sleep is going to make that worse.

unknown 13:51

Yeah.

SPEAKER_00 13:52

Absolutely. So this was another one. You have always been an exercise girly, but I think you at some point started doing like you you made some change. You were like, I am doing this every single morning somewhere along the way when the headaches were really bad and you had a lot of success. So that's the next one to talk about.

SPEAKER_03 14:13

Exercise?

SPEAKER_00 14:14

Yeah. So regular physical activity has been shown to reduce migraine frequency, intensity, and duration in some studies. And it works well as in some ways, it works as well as certain preventative medications. So it's not rocket science, it's what we've been talking about all the all along. You can aim for about 30 minutes of moderate aerobic exercise, three times a week at least. This could be a brisk walk, cycling, swimming, jogging, dancing. You start slowly if you're not currently active, because jumping into intense exercises too quickly can sometimes trigger a migraine. And you should warm up and cool down before and after exercise. And there's been some evidence that shows that yoga has been shown to have benefits in migraine, especially for reducing pain intensity. Um a brother has even gotten all of us to do some yoga.

SPEAKER_03 15:03

So yeah, we did yoga as a family.

SPEAKER_00 15:06

So that was cool. Um, yoga's great. You can consider doing that. Even even you 60-year-old men listening, wherever you are, you can still do yoga too. Also, don't stay out in the heat too long. Okay.

SPEAKER_03 15:19

With your hydrochlorith oxide.

SPEAKER_00 15:21

Yeah, just probably once a time, once a once an episode in the summertime, I'm gonna try to say heat-related illness is real. Okay, great. So the next thing is about eating. Fueling your brain steadily really does matter. Skipping meals and dehydration are among the most common migraine triggers. The goal is to keep your body fueled and hydrated throughout the day. So don't skip meals. Eat at regular intervals. Aim for at least three meals a day with snacks when needed. Stay well hydrated. Get a water bottle, keep it on you. And make sure you're eating a well-balanced diet. Something like a Mediterranean style will really serve you in this situation. Be really cautious with caffeine. Small, consistent amounts of caffeine may be fine, but high intake, like three or more caffeinated drinks per day, or sudden changes in caffeine intake, can trigger migraines. Alcohol, gosh, especially red wine or beer, is a really common trigger for some people, which is also very unfortunate for the social light. Who uses these? But it's going to make your migraines worse, probably. And don't over-restrict your diet. Broad food elimination diets are generally not recommended. If you suspect a certain food triggers your migraines, you talk with your doctor before cutting it out, or at least be slow and scientific and deliberate when you're making these changes in your life. Cool. Yeah. Why don't you tell us um a little bit about tracking patterns when it comes to migraines?

Tracking Patterns And When To Get Help

SPEAKER_03 16:48

So tracking your patterns, um, keeping sort of like a diary can help you and your doctor spot ways that um or things that might trigger an attack, or maybe um when to expect one. I did download some app. I've there's like a bunch of different apps, but it can kind of tell you. It's actually similar to like the period tracking app that I use where it can tell you um I like just recently started using it, so I think it needs some like more input into it, but it can tell you like maybe when you might get a migraine or like things that might trigger it. Like the weather's a big thing for me. So I think eventually it'll kind of start to tell you like when the pressure's gonna drop, you might start to. So I forget what it's called. I don't know. There's like a million in the app store, just like download one of them.

SPEAKER_00 17:42

Wow, this is so the like barometric pressure outside affects you.

SPEAKER_03 17:47

It's like well, I think that's why I was so unwell after memorial that whole week after Memorial Day, because it rained for like four days straight.

SPEAKER_01 17:54

Yeah.

SPEAKER_03 17:54

And then I I was like about to go to the hospital for a migraine cocked, like an IV one, because we like tried one at home. Again, marrying a doctor was clutch. Would be better if you were a neurologist who's done a headache fellowship, but like I'll take what I can get, you know.

SPEAKER_00 18:13

I know that'd be fun.

SPEAKER_03 18:16

Um, anyway, so track tracking the date and time of each migraine, what you ate that day, maybe what the weather was, how you slept, your stress level, um exercise for women, where where you are in your menstrual cycle. So does this happen right before you're going to get your period, which I know is like a big one with that like hormone shift. So yeah. That's great. Super helpful. And you should do it. Okay, if you're someone who is has migraines, or maybe your head is pounding all the time and you're going to go see a doctor about it, but maybe it's taking you a whole year, like start to do these things before so that when you finally are sitting in front of a neurologist for those precious probably 20 minutes, you can present the information so they have like something to work off of.

SPEAKER_00 19:09

Yeah, you gotta be ready.

SPEAKER_03 19:10

Yeah. Or even like your regular doctor, if you're kind of starting out with that. Oh, yeah.

SPEAKER_00 19:17

If you have any regular doctor who's worth their salt, a regular degular doctor, you know. That they'll help you with this too. Um, I don't want to speak for everyone because it's definitely not the case, but um, you know. And stress is also a really important component to this as well. So it's probably one of the most common reported triggers. Um, interestingly, migraines often strike not during the most stressful more moment, but during the letdown period afterwards, like a weekend or after a hard week. So you can try to build relaxation into your daily routine, even 10 to 15 minutes a day of deep breathing, progressive muscle relaxation that's like squeezing yourself from like your head all the way down to your toes. We've talked about that before. Or sometimes meditation can really go a long way. So, a few more tips that we wanted to share with you. Um, by and large, we're gonna have like a we're gonna explore what the conversation with medications looks like by the end of this, depending on our own attention spans. Try to limit pain medication use. Using acute headache medications like ibuprofen, acetaminophen, or tryptans, like we'll introduce later, more than 10 days per month can actually cause more headaches over time, called a medication overuse headache. So you could talk to your doctor if you're finding yourself needing the medication more often. Usually speaking, like really pulling the curtain from behind the like letting you see behind the curtain rather. If there's about 15 headache days a month, one could consider the benefit of taking a medication every day to try to prevent migraines. You try to maintain a healthy body weight. People with a higher body weight tend to have a link to more severe and frequent migraines. And like Nikki mentioned earlier, being consistent. It's the single most important theme across all of these strategies is consistency. Migraines are often triggered by disruptions to your routine, irregular sleep, skipped meals, sudden changes in stress or activity. But a steady, predictable daily routine is the best defense you can have. So, sweetie, can you tell us about when you should talk to your doctor?

SPEAKER_03 21:26

Yes. Your husband. If you didn't marry a doctor, contact your doctor if it's funny because I like don't actually have a doctor now, so you're my pseudo doctor. Anyway.

SPEAKER_00 21:45

I know. I'm well aware.

SPEAKER_03 21:48

Okay, my doctor left, and then as many do it, we are like playing this game. Like, are we moving? Where are we moving to? When are we moving? So I didn't. Wanna establish new care with someone in the city if I'm just gonna leave. No, no, it's all right. It's all good. Keep going. You know, anyway. Okay, so talk to your doctor if your migraines are getting more frequent or more severe if you're using acute pain medication, so like ibuprofen, etc., and those types of things, more than two days a week. If your headaches are significantly affecting your work, school, or daily life, um, or you're experiencing new or different symptoms.

SPEAKER_00 22:36

Yeah. Great. Great. So the next part is about medications. Migraine

Acute Treatments From OTC To CGRP

SPEAKER_00 22:44

medications fall into two main categories: medications to stop an attack and medications to prevent attacks. Some people need only one type, others benefit from both. So medications that are commonly used to stop a migraine attack, the goal is really to relieve pain and other symptoms as quickly as possible. So there are several over-the-counter pain relievers that we'll mention here. These are usually the ones that people try first. Ibuprofen, which goes by brand names Advil and Motrin. Sometimes, if it's appropriate for you and your doctor, and you've talked about this, sometimes people use 400 to 600 milligrams. I am intentionally being vague and couching and like hedging a lot. Neproxin or Aleve, 500 milligrams. Sometimes people will choose to prescribe that. I see less and less people taking aspirin 325 or higher. Acetaminifin, brand name Tylenol, a thousand milligrams at one time. For many people, that's totally fine. And Exedrin migraine, like Nikki mentioned earlier, which is a combination of acetaminophen, aspirin, and caffeine. These work well for mild to moderate migraines. They are inexpensive and widely available. However, like we talked about earlier, if you use them over 10 days a month, they can actually cause more headaches over time. So then we come to the most commonly prescribed migraine medication that's uh not available over the counter. And if one of these doesn't, one of these that we just talked about doesn't help you, tryptans are usually the next step. They are prescription medications specifically designed for migraines, and they work by narrowing blood vessels around the brain and blocking pain signals. So common names include sumatriptan or brand named Imitrex. This comes as a pill, a nasal spray or injection. There's another one called rhizotryptan or maxalt, a fast-dissolving tablet, Latryptan, or RELPAX, Zomatriptan, also available as a pill or nasal spray, brandnamed Zoomig, and a few others here. There are a couple things to know about tryptans that I'd like to share with you. These are very effective when they're taken early. If one tryptan doesn't work for you, another one might. They are not all the same. Combining a tryptan with an anti-inflammatory like neproxin often works better than either alone. There are some common side effects like tightness in the chest or the throat, tingling, flushing, and fatigue. These are usually mild and temporary, and this is a big one. Tryptans should be avoided by people with heart disease, stroke, or uncontrolled high blood pressure because of the way they work, narrowing blood vessels. All right.

SPEAKER_01 25:29

So long one.

SPEAKER_00 25:32

No, that sounds good. So there are, and you know, there are certain medications that in primary care, we depending on each person's comfort, you try to like expand your reach and wrap your arms around new medications. So because access to headache neurologists are so hard, you may find yourself with a primary care doctor who is willing to entertain the conversation around these newer medicines. They are more expensive, but they're these medications are called the CGRP inhibitors. Um, one name is Gapant, but I don't want to be roasted if I mispronounced that because I haven't actually heard of Japant. I don't want to have anyone who's said in front of me before. But um there are a newer class of migraine medications that block a chemical called CGRP. Like you mentioned when we talked about like why and how migraines happen. Um, they play a huge role in how migraine pain happens. But unlike tryptans, they do not cause narrowing of blood vessels. So they make them a great option for people who cannot take tryptans due to heart or blood vessel problems. So they go by different names, and you've probably seen commercials for these. Umbrogapant or ubrelvi. Gosh, even I'm having a tough time with uh actually saying these names. That's a pill taken during an attack. Or remegapant. We're just gonna go for it. Um, called Nertec ODT. People probably have definitely seen commercials. If you listen to this, you're probably unfortunately going to get commercials now.

SPEAKER_03 26:56

It's the Clodicardashian commercial.

SPEAKER_00 26:58

Oh, is it a Cloud Kardashian commercial? This one's a dissolving tablet and interestingly, can also be used for prevention. Um, and there's another one called ZavPret, which is a nasal spray. A couple things to know about these medications. They're generally well tolerated. Common side effects include nausea and dry mouth. They are significantly more expensive than trypt tans, and they are a good alternative for people who cannot use tryptans. Um, I feel like it's totally fine to share the workaround that we found here for people who are in need and can't get a tryptan or the tryptan didn't work for them. How did you go about getting this?

SPEAKER_03 27:37

Yeah, I mean, it's not like a secret. It's we used um so Eddie had prescribed Nerdek for me. Because it was either try that or I was gonna go spend my Friday night in the hospital getting a migraine cocktail.

SPEAKER_00 27:51

God forbid, I wanted to go to the beach.

SPEAKER_03 27:53

And we wanted to go to the beach. So I stepped in. So he ordered it, and then um who makes it? Pfizer. They have a manufacturer coupon. It's only good for how many tablets come? 16 or something, 18. It's good for so like a one-month supply, theoretically, if you were someone who was taking it for prevention every other day. Um, so I used that, took it to the pharmacy, and it was free for me, those 16 tablets. And I like they like they didn't give me a dirty look, like the head honcho pharmacist in the back, because it was like over a thousand dollars, and which I like was probably going to tap the card if the coupon didn't work because I was so desperate. Um but it worked, and I like could have kissed the pharmacist on the mouth when she told me that it went through. But yeah, if you are I honestly with like any medicine that's not um generic yet, there's a coupon somewhere. Just Google it, it'll take you to the manufacturer website and then just give the pharmacist the information.

SPEAKER_01 29:08

Yeah.

SPEAKER_03 29:08

Like the bin and the PCN and everything, and they can type it in. And if you've never used it before, then it will probably work.

SPEAKER_00 29:15

It's a thing. You can do it. Don't be shy. It's not a scam. You can just like go that extra.

SPEAKER_03 29:19

Yeah, it's like not a secret, just it's on the internet.

SPEAKER_00 29:23

Yeah.

SPEAKER_03 29:23

Yeah.

SPEAKER_00 29:24

It's awesome. So since nausea and vomiting are also common during migraines, your doctor also might prescribe an anti-nausea medication. They go by names of metaclopromide or reglan, prochloroperazine or composine, or promethazine, phenergin. This can help with nausea, but may also help with migraine pain relief itself. And

Preventive Meds And Botox Options

SPEAKER_00 29:43

then there's medications that prevent migraines. So sometimes I was taught that if there's like 15 or more migraine days a month, then you might consider doing this. You can offer it can be offered to you at like even over four. Sometimes people go for it. Um, so medications for preventing migraines are usually tried for about two to three months before deciding if they are working, but they go through a couple different options. So one are common blood pressure medications, or I don't like to call them blood pressure. I actually have a huge stick against calling these things blood pressure medications, but um, beta blockers. They are the most commonly used and well-studied migraine prevention. Um, so one of them is called propranolol, brand name Endorol. That's the ones the most widely used. There's also metoprolol, brand name low pressure. Things to know about this one is that they can cause fatigue, dizziness, and low blood pressure. They may be a good choice if you have high blood pressure or anxiety. They can be really helpful. Um, and they should be avoided in people who have asthma because sometimes that can squeeze up your blood, your little bronchioles there. There are some anti-seizure medications that we have some good luck with. Originally developed for epilepsy, these medications have been found to reduce migraine frequency. So one that's commonly used is called topiramate, brand name Tobamax. This is one of the most commonly prescribed migraine prevention medications. And there are others, valproate and divalprox, or debacote. Things to know about these ones include common side effects for topiramate, including tingling in the hands and the feet, difficulty finding words. Um, basically, there's no fun way to say it. It can make you feel stupid at the right dose. So um just be careful. Um, if you feel like that's happening to you, that is probably what's going on. Um, a decreased appetite, which is why it's also used in combination with some other medications or by itself for management of obesity and appetite dysregulation. And it should not be used during pregnancy because that will mess things up. Um what to know about Valpro8? It can cause weight gain, hair thinning, and drowsiness, so be careful with that. Also can mess things up in pregnancy. So a lot of, like I feel like a lot of headache girlies are out there. Be careful. There are certain antidepressants that were older that people used by the names of amitryptyline, venlofaxine. These are all alternatives that people can reach for. And then there are like even newer, newer CGRP medications that are prevention that like they're looking at monthly injections or every three monthly injections. This is deep in the weeds neurologist stuff. So they exist. We're not gonna, I have no credentials to talk about these medications at all, but um they do exist. And interestingly, can you tell us about the more procedure-based one?

SPEAKER_03 32:30

Well, the good old Botox injections are FDA approved specifically for chronic migraine, which is classified as 15 or more headache days per month. Um, so treatment involves this says multiple, it's like a lot, I think, yeah, of injections in your head and neck every three months. Um that you go to the doctor's office. And they just take care of it.

SPEAKER_00 33:02

Yeah, they just do it right there. Lots of neurologists are doing Botox these days.

SPEAKER_03 33:05

Yeah. And if you're lucky, your insurance will cover it. Exactly that.

SPEAKER_00 33:10

The 15 days is important to have documented, though. Just saying. That's why I kept saying that.

SPEAKER_03 33:14

I feel like I'm a good candidate for Botox. We'll see. Not that I know anything, nor am I a neurologist.

SPEAKER_00 33:20

Hippa be damned for you on this show. So, important reminders as we're wrapping up here, make sure you give medications time to work. Be scientific about the process. Preventative medications often take two to three months to show their full benefit. So don't give up too soon. Avoid overusing acute medications, and then everything works in concert together. So your healthy lifestyle really takes to the front. This was a really great episode. Thank you so much for your time.

SPEAKER_03 33:47

Oh, you're so welcome.

Banter Baby Birds And Boundaries

SPEAKER_00 33:49

And now for the banter. Are you feeling very banter-y right now, or do you want to do the do you want to do this first?

SPEAKER_03 33:55

It doesn't matter.

SPEAKER_00 33:57

All right.

SPEAKER_03 33:58

We can banter-y.

SPEAKER_00 33:59

What do you want to what should we banter about?

SPEAKER_03 34:03

We can talk about our babies.

SPEAKER_00 34:05

Yeah, let's start there because then we also have a a meal we have to discuss.

SPEAKER_03 34:09

We do?

SPEAKER_00 34:10

Yeah, yesterday. Oh. Our lunch date.

SPEAKER_03 34:12

Yeah.

SPEAKER_00 34:12

How quickly they forget. Um, yeah, tell tell us about the babies.

SPEAKER_03 34:17

The babies. We did we talk about our morning dove?

SPEAKER_00 34:20

No, I don't think anyone knows about that except for us.

SPEAKER_03 34:23

We've had this. Well, first of all, you should know that Eddie really loves morning doves. It just makes him feel peaceful. So we were hearing this morning dove sound in our bathroom. And when I first heard it, I was like, oh my god, there's a bird in the walls. Or I was like looking in the vent, I'm like, where is this coming from? And then on our windowsill in our bathroom.

SPEAKER_00 34:45

Which is not very large.

SPEAKER_03 34:47

Which is not very large, was a morning dove. And she was just like sitting there all the time. Always there.

SPEAKER_00 34:56

Always.

SPEAKER_03 34:57

Always there. And then yesterday, I think, right, or the other day, a couple days ago, I we was checking on our morning dove because we regularly check on birdie and say good morning and good night to birdie. So I was checking on it. And Birdie was not there, but two little birdies were there, two little baby birds. So then I frantically, oh yeah, because you were still at work. I was like, Eddie, we have babies. And so I'm looking at the birdies and I'm like, oh my gosh, where's the mom? And then the mom comes actually quite loud, like flapping in, and like was feeding them. It was so cute. It's awesome. And then so I guess she was there and not moving because she was sitting on our babies, but they're like fluffy, and the one was like flapping his wings a little bit.

SPEAKER_00 35:47

It's so cute. Yeah, I love them. I feel so lucky that we have like we have morning doves right here at home, and I love them so much.

SPEAKER_03 35:58

We have our little babies, and we're we're naming them. Eddie wants to name, we've decided that they're twins, and one's a girl and one's a boy.

SPEAKER_00 36:04

I I retract the name I wanted to name it.

SPEAKER_03 36:06

Eddie wanted to name the boy Richard.

SPEAKER_00 36:08

No, I don't really want to name it Richard. I take it back.

SPEAKER_03 36:10

It just came at And I think we should name the girl um Abby Lee Miller.

SPEAKER_00 36:20

I'm glad that this idea just spawned from Yeah.

SPEAKER_03 36:24

So we have two baby birds. I do feel that it's a bad omen and like a sign that we're gonna have twins at some point in our life. Um time will tell. If anyone was wanting to inquire on a public platform if I am pregnant, I am not. And if I was, I wouldn't tell you. The the big you know, the hypothetical question that one might want to ask.

SPEAKER_00 36:50

Yeah, on a social media platform. Yeah.

SPEAKER_03 36:53

Yeah. Or ask me directly, Justin. Because I was not consuming any alcohol at your birthday in January. And sweet, sweet Justin asked me if I wasn't drinking because I was pregnant. Meanwhile, his wife was also there not drinking, and I decided to make him feel a little bit uncomfortable.

SPEAKER_00 37:15

You're great at doing that. Uh playfully.

SPEAKER_03 37:18

Yeah.

SPEAKER_00 37:19

Yeah. It I would never. Even if someone is nine months pregnant.

SPEAKER_03 37:30

I'm not asking. Never. I'm not talking about it unless you talk about it.

SPEAKER_00 37:35

There could be another one.

SPEAKER_03 37:36

Someone else asked you at your birthday too if I wasn't drinking because I was pregnant. It was Frank, wasn't it?

SPEAKER_00 37:40

Yeah. Well, both of us are on this like, I don't know, like, I enjoy an NA, a non-alcoholic beverage, and like you get migraines, which is funny because we talked about that today.

SPEAKER_03 37:50

Well, yeah. Like, no, I'm not drinking because I have 52 headache days a year, and it's taking me a year, or 52 headache days a month, and it's taking me a year to have an appointment with a neurologist, headache specialized neurologist.

SPEAKER_00 38:05

Yeah, it sticks.

SPEAKER_03 38:06

July 24th. Can't wait.

SPEAKER_00 38:07

It's coming up. Um, yeah, crazy. Don't worry, we we all crazy thing.

SPEAKER_03 38:12

Life lesson. Don't ask people if they're pregnant.

SPEAKER_00 38:15

Yeah, I just really think it's not the thing.

SPEAKER_03 38:18

Someone can just like be somewhere not drinking alcohol just because they don't want to.

SPEAKER_00 38:24

That's also true. So true.

SPEAKER_03 38:27

Yeah. Maybe I don't want my sleep disrupted for the next two nights.

SPEAKER_00 38:31

My gosh. What God forbid, if you just didn't want your sleep disrupted. Let's just try to get this better.

SPEAKER_03 38:41

Ollie agrees.

SPEAKER_00 38:42

Ollie agrees. Ollie might be a little excited because there are many people out and about because of we are, of course, if you Oh yeah, a host city for the World Cup.

SPEAKER_03 38:53

It seems like there's a lot of Ecuador fans here around Center City. Yes. It's cool. It is cool. If like we cared. I mean, it is cool, but like it would be cooler if we cared about soccer.

SPEAKER_00 39:06

Gosh, yeah. I can't even Or football.

SPEAKER_03 39:09

It's a shame that I can't even it's not soccer, it's only soccer here.

SPEAKER_00 39:12

Muster up the like patriotism to be interested. One like like the big game was on Friday, and I just I was like, where are the Mets? No one cares about the Mets, they're losers. I understand. Yeah. And it's a long season. So it's a long season. Um yeah, we'll see. Uh maybe I'll get into it. Uh maybe the advertising will catch my eye. I don't know. I don't really understand the sport. I never have. It doesn't mean I'm a I'm a Debbie Downer about this.

SPEAKER_03 39:41

Maybe exactly I am, but have you ever been to a professional soccer game?

SPEAKER_00 39:46

No. Oh. I've never been to a professional soccer game. Have you?

SPEAKER_03 39:50

I've been to a couple union games. Really? That's like fun. The energy is fun. I feel like going to a game like in any like city that takes the sport very seriously. Like outside of this country would be cool. Yeah. Like going to a game like in Ecuador or I don't know, like Spain or something would be cool.

SPEAKER_00 40:14

I've heard you know, people talk about it and they're like the atmosphere at these things is actually incredible. Like they get so into it, they are the most impassioned fans that exist. And there's a lot of pride. I mean, it makes a lot of sense. Um, that'd be cool. I I get it. And I think like it happened in the world baseball classic where people not to liken the two, but like people get a lot of sense of their like of patriotism about their home country. So then that element of it is really cool. I just don't care for soccer. I was the kid who was sitting in the grass picking grass when you never played soccer. I played like it's not called pee-wee soccer peanut.

SPEAKER_02 40:53

I whatever the small we were in a soccer family.

SPEAKER_00 40:56

Whatever like the smallest youngest division is when you're like flirting with a bunch of different sports. My parents put me in that, and like there's like a cute picture of me somewhere holding a soccer ball, and that's the extent of it.

SPEAKER_03 41:06

It's probably still in your parents' fridge right now.

SPEAKER_00 41:08

Probably. Place is full of memory. So um the uh yeah, so that's happening. But we also had a um you should uh the people love you by the way. I get like feedback all the time during the day, and they they love your voice. They're like, you should talk less as talking to me, and they're like, let her like her vo the the person, because I like I always think that your voice is so great, and especially listening back to it, it's so like smooth and cozy. And then like you say some like feisty stuff, like people often they tell about this, talk about the story about you like with the um the senior lady who was like poking fun at Ollie, or like oh yeah, who is and they love that story. They were like, wow, that was like a great sure I have more of them.

SPEAKER_03 41:56

Listen, if more people keep asking if I'm pregnant, I'll have a lot of fun stories.

SPEAKER_00 42:00

Well, there was that guy across the street that like you said that you would like you would fight.

SPEAKER_03 42:04

Oh

Banter Neighborhood Drama And Life Tips

SPEAKER_03 42:05

yeah. So there's a guy across the street who lives on a has like a corner house. And like we live in center city, so every house, it's like a Philadelphia row home. So he uh lives on a corner, so his property home is theoretically larger. And he has what kind of car does he have?

SPEAKER_00 42:26

I don't know.

SPEAKER_03 42:26

It's like he has some like small like midlife crisis sports car. Yep, that's a great way to put it. Probably like 50-ish, give or take, but he's kind of like I don't know, keep it PG, mean, yeah, grumpy, and he's he's giving like divorced dad, I'm having a midlife crisis because of my car. So people are walking by and with their dogs, and their dogs are like peeing sometimes on the side of a house or even on like the little patch of grass where the tree is on the sidewalk. He has like signs to like the people with signs, the people with signs, like honestly, I'm like Ollie pee here.

SPEAKER_00 43:10

Like it makes me want to have him.

SPEAKER_03 43:12

Ollie, the sign is telling you to pee here.

SPEAKER_00 43:14

It's like what this sign is saying. Go nuts.

SPEAKER_03 43:16

And he just like screams at people if your dog like pees anywhere on like his like property or sidewalk or near his home. I one time watched him, so he has like um a hose spigot on the side of his house. And it was this was probably last summer, and I think you were probably like working in 24 or something, because it was a weekend and I was walking Ollie down there um during the day and it was really hot. And this couple walking by with like their big dog turned the hose on, which I agree, like this is on someone's house. Obviously, it's like not a public water spout, but I guess he heard it turn on and he came out and like. Wrote these people to filth about turning on their water and like using his water. Oh wow. I was like, oh my God. Anyway, so we were talking about him earlier with our other neighbor when we saw her walking her dog this morning. And I just like think I would have a lot of fun.

SPEAKER_00 44:21

If you got into a confrontation with him?

SPEAKER_03 44:23

Well, like it wouldn't even be a confrontation. I think my route would be like if he was like yelling at us or like mad about Ollie or something, I would be like, Why are you yelling at a little boy like this? Or like something like that.

SPEAKER_00 44:38

Just do some weird mental gymnastics on him to make him wonder.

SPEAKER_03 44:42

Like a grown man yelling at me. This is my favorite sport.

SPEAKER_00 44:46

It is. It's how your normal work day goes usually. So basically you're practiced. You can hit him with the are you okay?

SPEAKER_03 44:55

Are you I oh my god, I love but ask I got that from you actually. Asking people, are you okay?

SPEAKER_00 45:03

It's so disarming.

SPEAKER_03 45:04

No, seriously, it can be used in any context. If someone is just like rude to you for no reason, or like, yeah, are you okay?

SPEAKER_00 45:14

Like in a like a confrontation, like you know, we I had experienced this on the phone.

SPEAKER_03 45:18

You can't yeah, if it's like on the phone or like at work and like someone says something or is rude or yelling at you for no reason, you just hit them with the concerned. Are you okay?

SPEAKER_00 45:30

Mm-hmm.

SPEAKER_03 45:32

You don't sound okay.

SPEAKER_00 45:33

Oh yeah.

SPEAKER_03 45:34

It it also And it like catches the person off guard, and then they always like nine times out of ten walk it back and they're like, oh no, I'm just uh I don't know. I was just sorry, shut up.

SPEAKER_00 45:46

It like ends it, yeah. It like it disarms them. Because especially in your situation, like no one should be yelling at you when you're at the time. Everyone yells at me, and everyone, uh many people do, probably uh 60% of the time, maybe higher.

SPEAKER_03 46:01

Depends on the day, yeah.

SPEAKER_00 46:02

Yeah, um, which like is inappropriate and the worst. And I don't know. Whatever. But yeah, hit him with the are you okay? Yeah. Then we also I mean we have life tips from your checkup. Right, exactly. Um we've got a nice this episode's gonna be what it's

Lunch Date Food Review And Wrap

SPEAKER_00 46:20

gonna be. If it's as long as it is, it is what it is. But we um got inadvertently, not inadvertently, I guess we knew that this was a Michelin recommended restaurant. Um but yesterday Is that what the category was? I asked.

SPEAKER_03 46:33

Or was it the bib gourmond or whatever?

SPEAKER_00 46:36

Um look, can you start telling them about our experience though?

SPEAKER_03 46:39

Yeah, we we've been loving a lunch date as of late, and we went to Pizzeria Badia yesterday, had ourselves a little lunch date, and that's mainly because we're geriatric and like to be inside. Keep us indoors in the evening. We turn into indoor cats.

SPEAKER_00 47:01

It got the bib gourmand. Okay, that makes sense. Yeah, but they had the Michelin sign on the city.

SPEAKER_03 47:06

And they're in the same, they did, and they're in the same group as two other restaurants. I forget what their hospitality group is. I think three. Three?

SPEAKER_00 47:14

Yeah, let me know.

SPEAKER_03 47:15

Saraya Kaleya Picnic. Oh yeah, they have picnic too.

SPEAKER_00 47:20

Let me find the name of their um I feel like they're called, like they have like a generalized name. They're called Defined Hospitality, which I'll define their hospitality for them. Amazing.

SPEAKER_03 47:35

Yeah, defined as amazing. So we got they have these are they fava beans?

SPEAKER_00 47:42

I literally got two really good appetizers.

SPEAKER_03 47:45

Yeah, the the one the beans, you gotta get the beans, and then the other appetizer we got was um well, they were both cold dishes. It was a burrata with it had cucumbers, strawberries, and then pickled green strawberries.

SPEAKER_00 48:00

Don't knock it till you try it. That was really good. That was really good.

SPEAKER_03 48:02

Yeah. And then we got one of their seasonal pizzas, which we didn't know was seasonal, but it looked good. It was a green tomato. Uh what was it? Tarragon cream. That's the piece that separated it the most.

SPEAKER_00 48:16

We like tarragon cream onions on there and green tomatoes.

SPEAKER_03 48:20

I like a green tomato.

SPEAKER_00 48:21

It was delicious.

SPEAKER_03 48:22

Did you ever read that book, Fried Green Tomatoes at the Whistle Stop Cafe?

SPEAKER_00 48:26

Seeing as though reading is a challenging thing for me. I have not read this book.

SPEAKER_03 48:30

Yeah, green tomatoes are good. Um, anyways, back to the pizza. All delicious. And then we ordered because it was our first time there, and we got you know, this like special pizza. So we were like, I wonder what their regular cheese pizza is like. So we ordered one to go.

SPEAKER_00 48:46

We did. I asked him, and I felt I was like, listen, Michael, this might be an out-of-bounds thing.

SPEAKER_03 48:54

Yeah, our server's name was Michael, and Eddie's like just like so weird sometimes.

SPEAKER_01 49:00

Here we go.

SPEAKER_03 49:02

Like the lead up. He can never just ask a question. It's always a lead up to the question. He's like, hey, Michael, so this might seem really out of bounds to ask. So then Michael like looks at me real quick.

SPEAKER_00 49:17

And I gave a pregnant pause.

SPEAKER_03 49:19

To be like, Am I safe here? And then he asks if we could get a pizza to go. And he said, people do it all the time. Oh, should we talk about Love Island?

SPEAKER_00 49:30

We could. If you save if we save a little bit of Love Island, then we can have the two full episodes done.

SPEAKER_03 49:37

Okay. Um, and then we got they also have 1-900 ice cream there. They also have 1-900 ice cream there. So we got the soft serve sweet cream, which was delicious because Eddie doesn't let us go to 1-900 ice cream anymore.

SPEAKER_00 49:54

The place ice cream is great. The vessels are despicable, especially in the heat of the summertime.

SPEAKER_03 50:03

It is a narrow-based cup. Um, they have bigger ones though, when they have their like Sundays, and I feel like or no, if you get um the scoop ice cream too, they have bigger cups. I feel like you could ask for uh in a bigger cup and the soft serve. Because they do like they like change their flavors every week, and Eddie doesn't let me go because he's mean.

SPEAKER_00 50:24

Yeah, big meanie.

SPEAKER_03 50:25

But you do take me to the candy store next door, so I guess it evens out.

SPEAKER_00 50:30

I do. You haven't um you get these waves of hankering every once in a while, and you're like, I need it.

SPEAKER_03 50:37

Ugh, I like love. Those lips are so good. The like sour lettuce.

SPEAKER_00 50:42

Look, I mean, they're so good.

SPEAKER_03 50:44

They have all like the Swedish candy. Because I like that um that like texture of candy. It's kind of like a laffy taffy, I realized when I got laffy taffies for the beach last weekend.

SPEAKER_00 50:55

I just feel like it's gonna pull a molar out, and I just like for some reason, I just can't. You're obsessed with it, credit to you. This is just one area where we differ. And they're rare when we do. But is this this is their chocolate sounds good though. The chocolate's good. All right. Let's leave a little meat on the bone.

SPEAKER_01 51:16

Okay.

SPEAKER_00 51:19

So

Find Us Then Medical Disclaimer

SPEAKER_00 51:20

thank you for coming back to another episode of Your Checkup. Hopefully, you were able to learn something for yourself, a loved one, or a neighbor with migraines. You can find us on Threads, you could send us an email, or you can send us some fan mail. We still have that voice-based fan mail still waiting for that first fateful one. Whoever will be it, whoever will be.

SPEAKER_03 51:40

I think it should be our brother.

SPEAKER_00 51:41

Hopefully.

SPEAKER_03 51:42

Do you think she's still listening?

SPEAKER_00 51:43

She would be great. Yeah, she would be great. Um, you know who you are. Um, but most importantly, stay healthy, my friends. Until next time, I'm Ed Goleschi. I'm Cole Rufo. Thank you, and goodbye.

SPEAKER_02 51:55

Bye.

SPEAKER_00 51:58

This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. I am not your nurse. And make sure you go get your own checkup with your own personal doctor.