Effective Treatments for Headaches and Migraines AM 570 ...cdn.patientpower.info/p2docs/transcripts/KVI071005.pdfEffective Treatments for Headaches and Migraines AM 570 KVI July 10,

1

KVI071005/0612/AS/jf © 2005 Patient Power, LLC All Rights Reserved

Effective Treatments for Headaches and Migraines

AM 570 KVI July 10, 2005

Sylvia Lucas, M.D.

Please remember the opinions expressed on Patient Power are not necessarily the views of Health Radio, our

sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care

from your own doctor. Please have this discussion you’re your own doctor, that’s how you’ll get care that’s

most appropriate for you.

Introduction Andrew Schorr: Good morning, Western Washington. We are on live on KVI Talk Radio 570. I'm Andrew Schorr here every Sunday to help you be a healthier person, help you and your loved ones be smarter patients. So if you're on the east side today, what have you got? You've got the 520 bridge being repaired. That gives you a headache. And if you are around the marathon that's running in Bellevue, my 15-year-old boy is helping out there with some other kids from Mercer Island, then that's good for the runners but slow for the traffic. That's a headache. But a lot of people get headaches just as part of their health. Could be what they're eating or drinking, could be, for women, their menstrual cycle, could be other reasons. Well, today on Patient Power live in the studio we have a top headache expert, not just locally but nationally, Dr. Sylvia Lucas, who is the director of the headache center at the University of Washington Medical Center. Sylvia is a neurologist and a good friend. Thank you for being with us today, Sylvia. Dr. Lucas: Thank you, Andrew. Andrew Schorr: I'm really delighted for you to be here. Now, we are going to be taking your calls live about headache, migraine. Millions of people have them or have had them during life, and this is the time for you to call in. So I want to give the phone numbers, then I want to talk about a couple other things too. But first of all, if you have questions about headache this is your chance to ask them live of a top headache expert. I know I was at an event yesterday, Sylvia, and a woman I know, ran into her, said, Oh, we're going to talk about migraine and headache on Patient Power today, and she said, Oh, I get them and my son gets them. So I want to talk about kids and migraine too. And as I said menstrual migraine where a lot of study is going on.

2


Just a couple of other things in the news. Obviously we're watching the news and listening to stories about Hurricane Dennis, which, having lived in Florida, I know how frightening it can be. My folks were evacuated from south Florida one time, so certainly that's a scare. That goes back to something we were talking about last week. Sylvia, last week we had on a doctor who is an emergency room doc, and one of the things he stressed, and I know we've had other guests on before, have a list of your medications, your allergies, etc. None of us ever know when we're going to be in an emergency situation, and that provider needs to know a lot about you really fast. Certainly folks in London knew that this last week too. So remember to make that list. Carry it in your wallet or your purse. It's very important should you need medical care quickly. Also I just wanted to mention one other thing too that was in the news this week, that was about the millions of people, particularly teenagers, but others, who are using prescription drugs improperly, really abusing them even for pain control, and that certainly relates to headaches, so we're going to talk about that. Let's start with Dr. Sylvia Lucas, who is from the University of Washington Medical Center, which I'm happy to say is now a sustaining sponsor, along with Harborview, of Patient Power, so thanks to them. And you'll hear more thanks to them as we go along. We really appreciate their help. Dr. Lucas, headache affects millions of people, right? Dr. Lucas: It certainly does, including me. But it affects probably about 28 million people in the United States, more people than who have arthritis, diabetes. So it's a big one. Typically it affects women three times as much as it affects men as well. And it really takes all ages. Usually people who have headache are between the ages of 20 to 40, but we can't forget kids. There can be kids as young as three years old who have migraine, and some people unfortunately continue to have migraines well into their 70s and 80s. Andrew Schorr: You and I were talking before the program about one of the bad actors for some people in headache and that is what we all in Western Washington imbibe a lot, and that's coffee. Caffeine can be a problem, can't it? Dr. Lucas: I hate to say it, especially in Seattle, but caffeine is a real double-edged sword because having too much caffeine can give someone headaches. Anybody will know that who drinks three, four, five cups of coffee a day and then stops, they might get a headache the next day. But caffeine, as many people note, has also been one of the ingredients in many medications for headaches such as Excedrin Migraine or some of the combination products, and it actually in small amounts can help people.

3


Andrew Schorr: So it can help people, but sometimes people take more and more and more trying to get more help or get to a threshold that they feel stops the pain, but the caffeine in the medication or other caffeine they're drinking could create more of a problem. Dr. Lucas: Exactly. Andrew Schorr: Oh, my. So it can be sort of a sticky wicket. That's why people often get to your headache center at the UW because they either have tried to self treat it, right? Dr. Lucas: Right. Andrew Schorr: Or sometimes unfortunately headache is the problem that you go to the doctor for something else and you've been getting headaches but you don't mention it. A lot of women traditionally if they were the caregiver for another family member go for little Johnny for something else, and it's the, oh, by the way that they forgot to mention when they're going back to their car, right? Dr. Lucas: Right. People tend to minimize their pain. I think if women remembered what it was like to have a baby they probably wouldn't have a second one. So I think people do the same thing with headache. Once it's over you're hoping it will never come again. But most headaches can be very, very debilitating and disabling. Andrew Schorr: And people miss work. Dr. Lucas: Absolutely. Andrew Schorr: Certainly the people with migraine miss work. They get in bed, turn off the lights, pull down the shades. Dr. Lucas: Absolutely. People with moderate to severe headache can miss an average of about five days, between five and six days of work a year. Andrew Schorr: But it doesn't have to be that way for many people, does it?

4


Dr. Lucas: No, there's treatment. Andrew Schorr: So we're going to be talking about that as we continue on the program today with Dr. Sylvia Lukas, who is the director of the headache center at the University of Washington Medical Center and a top specialist, a neurologist who specializes in the treatment of headache. The news as we continue during the program is for you or the people you love, they don't have to suffer. But it's a matter of getting the right care, whether it's a medication or other things you can do as well. So please call in at 206-421-5757. We'll be right back with a lot more of Andrew Schorr's Patient Power on KVI 570 talk radio. Treating Migraine Andrew Schorr: Welcome back to Andrew Schorr's Patient Power. Thanks for joining us. This is where we're on live every Sunday morning taking your questions and giving you our thoughts about how to be a smarter patient, whatever your health concern may be. Today we're primarily talking about headache and migraine, and certainly there are millions of sufferers out there. And we're starting to get your calls. But flood us with calls, it's fine. These hours go really fast. The number again is 206-421-5757. 206-421-5757. Or 888-312-5757. Now, how did we end up with a call from Dayton, Ohio? Ron, you are live on the air on KVI in Seattle. Are you really in Dayton, Ohio. Caller: I am definitely in Dayton Ohio. Andrew Schorr: Are you listening on the internet? Oh, good, okay. I'm an internet guy so I love it. How can we and Dr. Sylvia Lucas, all the way over here from the University of Washington but a true national headache expert, how can we help? Caller: Well, my wife and I both listen as often as we can. She's a CLL sufferer and that's how we found out about you. Andrew Schorr: And me too. Folks, that means chronic lymphocytic leukemia. And I've got my friends who have that more rare condition, certainly than migraine, but we're kind of in a little club. Well, Ron, thanks for listening. Your question about headache today. Caller: Okay. Well, my cross to bear is migraine. I've had them since I was a teenager, I'm 48 now. And I've got through periods throughout my life where they've been better and

5


worse. But I've been through a lot of treatment, to a lot of neurologists, I've been to the Diamond Headache Clinic in Chicago as recently as two years ago. But I feel like I've been through a drug roulette, like they're just picking drugs to try to prevent, and nothing really seems to address the issue. And I'm just trying to see if there's anything I'm missing, a new approach. Andrew Schorr: Okay. And tell us what drugs you've been on, just so we know. Caller: Oh, gosh. I've been through most of the beta blockers, calcium channel blockers, most of the anticonvulsants. Some of the antipsychotics. I've got a list of all of them. Andrew Schorr: The triptans, the headache medicines that you can take? Caller: Oh, the triptans for prevention, yes. And those work very well, but I end up in a situation where I'm not supposed to take triptans more than twice a week. Andrew Schorr: Okay. What I'm going to do, Ron, because it's complicated and we can't really do your healthcare on the radio or the internet, but what we're going to do is we're going to talk to Dr. Lucas now and get some guide for you and some other folks how you go through this process. So listen on the internet and we're going to talk about this for a minute. I appreciate you calling in and my best to your wife. Okay? And I'm going to be back in Cincinnati next week. We'll be broadcasting from there. So if you take a road trip we'd love to see you. Caller: Okay. Thanks. Andrew Schorr: So, Dr. Lucas, headache a complicated. Migraine is complicated. Here's Ron who is on a journey for maybe years. How do you and other headache specialists try to sort that out? And there isn't always an easy answer, is there? Dr. Lucas: There isn't, and obviously Ron has been to some expert headache experts, including the Diamonds. Ron has chronic daily headache, and about four to five percent of people with headaches, severe headaches have daily headaches, and those are much tougher to treat. I'm going to back up, though, Ron, and address some other things before we get to your problem.

6


Most people come to the doctor with three kinds of headaches. A lot of people will call them regular headaches, and that's a tension type headaches. Those are mild to moderate, and most people can go to Bartell's or Rite Aid and get some Aleve or some Tylenol Extra Strength or Excedrin and do well. These are not disabling headaches. They don't keep you from going to the theater or doing what you want. Then there are cluster headaches that men get more than women. These are very short 15-minute to three-hour headaches. They're very severe, sometimes called the suicide headache, and they're very treatable but we don't see those as often as we do the third and most common kind, which is migraine. Migraine has often been misdiagnosed because if you have the pain in your face you might think it's a sinus headache. If you have the pain in your neck you might think it's a tension headache. But migraine are true moderate to severe headaches. They can last anywhere from four hours to three days. A lot of people will have one-sided headache. They can't turn their head around without getting a lot more pain. And they can have some nausea and light and sound sensitivity. And these headaches can last as long as three days, so they can be very debilitating for some people. Many of my patients feel that just because they don't have twinkly lights in their vision or they're not vomiting that they don't have migraine, but that's not necessarily true. And there are many medications to treat these. Sometimes, however, depending on genetics, depending on your trigger factors, you can end up like Ron and get more and more and more headaches, sometimes leading to chronic daily headaches. And then you not only have to have something like the triptans --these are drugs that most people might know as Imitrex, Maxalt, Relpax, Axert, Zomig--you might not only need that but you might need a medication to take every day to prevent the headache from coming on. And typically it's not something you're doing. It's not your fault. It's not the life you pick. Sometimes I feel like it might be the city we're living in because the barometric pressure here is really awful, but migraines tend to be genetic, and most people I talk to have at least one first degree relative that has migraine, mother, grandmother, brothers, sisters, father. Andrew Schorr: So, Sylvia, there's Ron, and he's going from specialist to specialist. Any suggestions? Dr. Lucas: Well, I know he's received some excellent care, and again it's hard to treat someone over the internet. Andrew Schorr: Or the radio.

7


Dr. Lucas: As the case may be. But I think that Ron actually said something that was very important. He said that the triptans work for him, and there's a small paper out now and some physicians are saying that perhaps it might be reasonable to use the triptans on a daily basis to do prevention. And there's going to be a paper coming out using Amerge, 2.5 milligrams twice a day as preventive. So this will be published. There's also medications like the triptans, they're called the ergonovines. They're derivatives of a very old drug called an ergot alkaloid, Methergine, methylergonovine, ergonovine, that while not highly available are available, or you can get your pharmacy to compound them, and that may be very, very helpful. Andrew Schorr: Okay. I think there's a point here too, and I know it was the case for me in leukemia, Ron, and your wife, I went to more than one specialist. Because there's an art, and I think it sounds to me with complex headache problems there's not a one-size-fits-all at all. And so while you may go to top specialist A, seeing top specialist B may be in your case, maybe in Ron's case, worthwhile as well to get some consensus or to see if there's another perspective on it. Am I all wet on that, Sylvia or what do you think? Dr. Lucas: No, I think that's true. Many people have different philosophies of patient care. And the other thing about Ron is that we again have these hints of things that are going to help him. But I must say, one thing you said, Ron, that was just so amazing and that was you felt like you were a drug roulette, and I think that's a great way to describe how some people feel when we treat them. Because we don't know what your genetic process is going on to allow you to have headaches, but the genetic work that we have done shows that different people may inherit different genes that are driving the ability for your brain to carry a headache. And that's why we have to try different medications, because we just can't open up your head, pull out the brain and say, oh, that's the problem and then fix it. So we're trying to target as best we can, but a lot of times it's a trial and error process. Andrew Schorr: So neurologists don't do that, can't just take it out like fixing an engine. Dr. Lucas: Oh, I wish. Sleep Apnea and Headache Andrew Schorr: Okay. We're going to see if we can take another call before the break. Dave from Bothell has been holding. Dave, welcome to Patient Power.

8


Caller: Hi. Thanks for taking the call. Normally I don't have headache. I'm trying CPAP machine. Andrew Schorr: For a sleep problem. Caller: Right. Andrew Schorr: Sleep apnea. Caller: Sleep apnea. They are just testing it, and the other day I had headache, and I just was wondering where it came from. Could it be from the CPAP machine? Is it possible? Or was it just a fluke? Andrew Schorr: People get headaches anyway, though, too. But, Dr. Lucas, any thought about that? Dr. Lucas: Dave, did you ever have headaches before? Caller: I don't remember last. I'm 68 years old. I'm sure in my life I have, but I don't remember like a year ago or two year ago. Dr. Lucas: Okay. Well, there's an interesting relationship between sleep apnea and headache, and many people feel that sleep apnea may go hand in hand with some difficult headache problems. So the issue there is that the desaturations that you have, you know, you just don't breathe and your oxygen saturation goes down, so that can cause a headache. So it may be one of two things. Either your CPAP hasn't been put on the right pressure for you, or the second issue is that you're sleeping with this thing just strapped to your face really tight, and usually you have to sleep on your back so it might be positional as well. Caller: All my life I have slept on my side. Andrew Schorr: Now you're on your back.

9


Caller: Yeah. They say that's the best way. And as for the pressure, they did test it over at Harborview, and they determined the pressure to be seven, and that's what the machine is set for. Andrew Schorr: So be sure, first of all, to mention this headache to your sleep specialist. Be sure to mention that, and then let's see if it comes back. Caller: Okay. Andrew Schorr: Dave, I'm going to let you go, but I think it's all about communication. Thank you for calling today. You know, Dr. Lucas is a headache specialist at the University of Washington Medical Center. If it continues, that's a call to make. Otherwise certainly mention it to your sleep specialist because they want you to feel good too. Caller: Right. Thank you. Andrew Schorr: Thank you for calling, Dave. We're spending the hour with Dr. Sylvia Lucas, who is the director of the headache center at the University of Washington Medical Center and one of a select few headache specialists nationally. So this is your chance live on KVI Talk Radio to ask your questions. We'll be back with much more of Andrew Schorr's Patient Power. Stay with us. Migraine Auras Andrew Schorr: Thanks for joining us today on Andrew Schorr's Patient Power. I'm the guy, Andrew Schorr, dedicated to helping you feel better. And if you have a headache, when it happens you don't feel good at all, so we're fortunate that we have Dr. Sylvia Lucas, director of the headache center at the University of Washington Medical Center here in the studio to take your calls. We've got three waiting and I've got a couple of open lines. We're going to buzz through them as quick as we can I was trying to get a call from Tacoma. Chloe called from Federal Way. Chloe, we're going to have you on in a second, working south. Okay, Sylvia? All right. So Nancy from Mill Creek, you've been waiting so long patiently. And if you have a headache now, I hope not, it would be painful. Nancy, how are you doing and what's your question? Welcome to Patient Power.

10


Caller: Doing great. Actually, I wish I did get the headaches. I get the migraine auras without headaches, and I'm wondering is there a way to prevent that. Andrew Schorr: Do you have spots before your eyes or what happens? Caller: It's just an event like a light show type event that lasts about 20 minutes. Andrew Schorr: Some people would like that. Caller: I know. Andrew Schorr: Some college kid or something would like that. So okay. So this happens at any particular time? Caller: Yeah. It can just happen randomly. Generally not that many times per year, but it's very annoying when it does. Andrew Schorr: Now, Sylvia, as a neurologist some people would say that's not so bad because they get the aura with the terrible pain, but certainly it's disruptive to Nancy's life. Is that associated? Dr. Lucas: Oh, absolutely. And I really feel for Nancy, because, Nancy, I had to give up playing college volleyball because every time I'd look back at the lights to spike the ball I'd immediately lose my vision with the same type of thing that you're talking about. For most people, it's called scintillating scotoma, so you see these jagged maybe black and white spots. Caller: That's the one. Dr. Lucas: Yeah, and they start in the middle of your vision and they kind of work their way out over about 20, 30 minutes? Caller: Yep.

11


Dr. Lucas: Yeah. Those can be associated either before a migraine, you know, when the pain comes, or with it or after it or even, as you have, with no headache at all. And, yeah, Andy's right. Some people would kill to get a migraine like that where it doesn't hurt, but you can't drive, you can't read, you have to look all the way around a piece of paper to see what you're focusing using on. So for 20 minutes you just kind of have to sit down. But those actually are treatable. They're not treatable with the same drugs that we treat migraines with because the triptans, the drugs that probably some physicians have tried to give you, I mean, they're very powerful for migraine pain but not aura. Aura is something that's happening inside of your brain. We know the brain is hyperexcitable, and as you get that aura something in your brain, what we call a wave depolarization, is moving forward from your visual cortex at about the same rate of speed that you're seeing that going across your eye, and then it goes away. But you can treat that. Some of us treat that with a combination of calcium channel blockers, like verapamil or amlodipine and a baby aspirin, and that might help. Caller: Oh, okay. Andrew Schorr: Would that be a way to start? With a baby aspirin? Dr. Lucas: Yeah. I would certainly take the baby aspirin, but you might have to ask your doctor for a prescription of a calcium channel blocker as well. Andrew Schorr: Nancy, so this is a perfect example, and this is what Patient Power is about. Your situation is unusual. Ron's was a minute ago too. This is where you have to be smart, and thank you so much for calling. Your doctor may be familiar with this or not. Sometimes you need to go to a specialist like Dr. Lucas, but ask questions, and that's what you're doing. So I wish you well with that and thank you for calling. By the way, Sylvia calls me Andy because she's known me for a while. So it's okay. Normally it's Andrew. Okay. Thanks for calling in, Nancy. I hope that helped. Caller: Thanks.

12


Headache Pain that Affects the Rest of the Body Andrew Schorr: Okay. Let's continue now. Who's been waiting? Roger in Seattle has been there. Roger, welcome to Patient Power. Thanks for calling in. What's happening with you and headache? Caller: Well, I have a headache that hits the top of my head, the front of my head where my eyes are and of course the back of my head, my neck. And then I have pain going through my whole body, jumping around all day long. Andrew Schorr: What do you do for it? Caller: They have me on pain pills. And it doesn't do any good because I load myself up on Tylenol and pain pills, and I'm just taking so many of them. And I'm not a pill taker at all. I don't like taking pills. But anyway they had me on nasal spray for my headache, but that doesn't help at all. I mean it's been going on now for, what, three months that they've had me on all these pills, and it's just not doing a darn bit of good. And I of course have an appointment this month, again. This is the end of my third month, and I have another appointment. But it's just I'm just not sure the doctor--he claims he doesn't understand all these pains jumping around. Well, it started with my headache and now it's in my legs, my feet, everywhere, my back, my shoulders, everywhere. Andrew Schorr: Now, is the doctor you go to a neurologist? Caller: Actually I go to Harborview, and I've been to see at least four doctors, and a neurologist was one of them but he doesn't know. And he sent me back to my doctor, and my doctor sent me to see a therapist, and of course she sent me back to him. And I mean it's just not going anywhere because they say it's really a medical thing. Andrew Schorr: Roger, I don't mean to cut you short but what we'll do, let's hear from Dr. Lucas on this. We all hear the pain in your voice and how frustrating it is, and how do you get to the goal line of some relief. So we're going to talk about that. I want you to listen off the air, but thank you for calling. I hope we can give you some guidance here, okay? Caller: All right.

13


Andrew Schorr: Thank you. How frustrating. Dr. Lucas, so he's got doctors on the team and the pain is moving around. So what do you do in that sort of complicated situation? Dr. Lucas: I know Roger's been through a lot of this, so what I say he may have already tried. But typically if someone like Roger came into my office one of the things we try to do is to make sure he didn't have apples and oranges, that is, you know, headache but some other underlying reason to cause the pain all over the body. So that may involve a few tests. Blood tests, maybe imaging like a CAT scan or an MRI. The second thing is that the medicines that some of the doctors are treating Roger with could be causing pain all over his body. And one of the things that a lot of people don't appreciate is sometimes pain medications, particularly if they have narcotics in them, might actually decrease your threshold to pain. It's a very unusual idea because most of us think that taking something like codeine or hydrocodone or morphine, kind of a morphine family drug really helps you with pain. But it is not to be used long term. Because if you use it long term for something like migraine it actually decreases your threshold to pain, and you have more pain, and it doesn't take much to start the pain. So I think in Roger's case doing a thorough neurologic work-up and then finding something to treat his headaches other than Tylenol and pain pills might be the ticket. Andrew Schorr: Now, sometimes it's a question of which doctor to go to. Does this sound like a neurologist area or is it a chronic pain specialist or where does he go? Dr. Lucas: I think that either headache or chronic pain. And, you know, again the chronic pain folks are usually used to figuring out what comes from a migraine or a chronic headache point of view and what doesn't, and they might be able to point Roger in the right direction as well. Triggers Andrew Schorr: Roger, I hope you can call back in a week or a month or two months, whenever it is, and tell us you're feeling better because I know you're not now, and we feel for you. But you're doing the right thing, asking questions and trying to connect with somebody who can deal with this. Art, it really is an art of medicine and, that's the case. And we take supplements, we eat foods and we drink coffee and that all may be playing a role. We're going to be taking your calls, but I just want to ask Dr. Lucas, someone called in and said what kinds of foods can cause headaches. So let's just talk a minute about triggers. We talked about coffee. Chocolate, you've told me for some people can trigger headache.

14


Dr. Lucas: Right. Andrew Schorr: And certainly you mentioned even yeast in beer and microbrews, and I understand our sort of food allergy component can change during our life. Dr. Lucas: Absolutely, and this is a fascinating area. I think a lot of migraineurs and people who have tough other headaches can relate to this because they've all seen a list somewhere of certain food triggers or environmental triggers that can do this. And I think most of us are aware that some of us are very sensitive to coffee, let's just say a lot of coffee, chocolate, red wine, sometimes all alcohols. Andrew Schorr: MSG in Chinese food. Dr. Lucas: MSG, and they're trying to hide MSG. A lot of times you'll pick up a can in the store--and always read labels if you're sensitive to these things because they'll hide MSG because they know no one is going to buy it, so sometimes these salted foods, some other salts, like MSG is a salt, that can actually work on it too. So be aware of your triggers, although again that's not the answer for everyone. For some people also it might be altitude, flying, skipping a meal, lack of sleep, so there are a lot of things that can make your headaches worse. Andrew Schorr: Places to start. Lots more. Thank you, for Chloe and Phyllis and Mark, who are holding. We're going to get to your calls. May have time for a few more. 206-421-5757. You're listening to Andrew Schorr's Patient Power on KVI Talk Radio 570. We'll be right back. There's the Patient Power music. We're back live. Andrew Schorr on KVI Talk Radio 570 every Sunday, talking about how you can be a smarter patient. Help me. Let's all write KVI and say give Andrew a second hour, because we're getting so many calls we don't have enough time. And everybody wants to talk to Dr. Lucas. Okay. I promised Chloe from Federal Way. She's been holding forever. Chloe, we're all in a community here. We share information. You looked up something you think could be helpful. What is it? Strongyloides Caller: Yes, sir. I do think it would be helpful because I've followed her procedures on other things. Her name is Dr. Hulda Clark. She's written a book. She's a research scientist in biology and biophysics research. She's magna cum laude, and she says it's possibly the

15


parasite worm that first comes first, but even young children can suffer with migraines and Strongyloides is a microscopically small threadworm that horses are plagued with but humans and pets pick up easily. Andrew Schorr: And it leads to pain. Caller: Every migraine sufferer, one hundred percent has high levels of this tiny worm. Andrew Schorr: Does she say what to do about it? Caller: She recommends frequency generators. Andrew Schorr: Whoa. Okay. All right. Well, I'm going to let you go. Thank you for contributing. I want to get Dr. Lucas's comment on that too. We're all searching for the answer, believe me. Caller: Well, I hope you listen because I've done many things through her programs and they work. Andrew Schorr: Okay. Caller: Thank you. Andrew Schorr: Okay. We're all searching for the answer. I don't know if you've heard of that one. Dr. Lucas: Well, Strongyloides is endemic in some parts of the world, and it actually can get into the brain and get into the muscles. Luckily, it's certainly not endemic in Seattle. Of course we've got our own endemic coffee problem. But absolutely I think Chloe brings up a good point that some people may have something wrong that's in the head. Now, this happens maybe one out of every 250,000 times that someone has something that's not migraine but actually caused by something else. It could be Strongyloides, it could be an infection like a small meningioma, a noncancer brain tumor. It could be sphenoid sinusitis. Again, it's probably worth getting an imaging study if someone is not completely one hundred percent sure it's a migraine.

16


Medication Side Effects Andrew Schorr: And I thank Chloe for contributing. That's what we're about folks. If you have suggestions, you be the expert too and let's hear from you. Let's take some other calls as we round out our hour and race through as much as we can. Phyllis, you've been holding for quite a while from Shoreline. Did you have a child with migraine? Caller: Well, she's an adult, but she was diagnosed with migraine variant neurological disorder. And the headache was not the main thing. It was her heart was racing and her lungs. They first diagnosed her with having a serious heart/lung condition, but it turned out that something in her brain was triggering this. Andrew Schorr: How old is your daughter? Caller: She's 33. Andrew Schorr: And she's dealt with this now over a long period of time? Caller: No, just since December, November, December of last year. Andrew Schorr: And how are they treating that? Caller: Well, she's on some kind of a pill, and I can't remember the name. Anyway, what they gave her is taking care of the heart and lung thing, but she's having side effects from it that are numbness in her hands and feet and face. And what I'm wondering is is that a serious condition to have these side effects. Are these side effects apt to be harmful? Andrew Schorr: Okay. That's a good question. And do you know if she's been telling her doctor, about these side effects? Caller: Yeah, she thought maybe a lower dosage. She talked to the neurologist and told him this, and he said, well, just continue. But then the next time she got the prescription refilled he didn't try her on a lower dose. But we don't want the lower dose triggering the bad effects because they said she could get a heart attack from this other.

17


Andrew Schorr: Oh, my. Okay. I'm going to let you listen, Phyllis, on the air, but thank you for calling and I hope things can work out for your daughter. Let's see if Dr. Lucas has some suggestions. Caller: Thank you. Andrew Schorr: Thank you. Caller: Bye. Dr. Lucas: Hi, Phyllis. I'll try to make a comment here, but we don't know what this medication is. Some people will have a migraine variance instead of the typical migraine where you get pain and nausea and maybe lose your vision for a while. Some folks may have heart palpitations and actually feel like they're going to faint. We all think that migraine is a serotonin problem, but some people have actually dopamine hypersensitivity, and this might be one of the issues although again without talking to your daughter I can't tell. Andrew Schorr: What about the side effects issue, though? Dr. Lucas: Well, the side effect issue, not knowing the drug, I'll pick a drug out of the air that I know has numbness and tingling as a side effect, and that drug is called Topamax. And probably the number one side effect it has, seen in 50 percent of people that take it, is numbness and tingling, and that is thought to be benign. It's not a problem. It's tough when you have it and so you may have to lower the dose but it's not dangerous. Andrew Schorr: Phyllis, it's difficult for us to do this not knowing more, and it's also difficult to do it on the air. What I would encourage people to do, though, when you're having side effects be sure to speak up. And don't just gloss over, should the dose be lowered or is there another medicine in this class that possibly I could use but have an active dialogue with the nurse. And if you're not getting satisfaction there say, I really want to talk to the doctor about it. Dr. Lucas: One other thing, Andrew, too, a lot of us are able to ask our pharmacists, the people who actually hand us the drug, for a medication side effect profile, and they'll probably print you out one or two sheets on what you might expect with the medication that you take.

18


When Treatments Don’t Work Andrew Schorr: Yes. And talk to the pharmacist actively about it. They're healthcare professionals too. Pharmacists like to say, We are the most accessible healthcare professional. That's what they go to school for. Talk to them about it. Phyllis, I hope you get this resolved with your daughter and feel free to call back another time and let her know how she's doing. Okay. Let's see if we can get to Mark from Poulsbo. Mark, you've been holding for a long time. Caller: Yeah. I'm a long-term migraine sufferer from the age of 12 and I'm now in my 50s, and one of the things I have, I'm a long-term sufferer. Sometimes I last as much as 12 days. And I've taken a whole battery of drugs. I've been seeing doctors from the East Coast to the West Coast. I've tried everything from Imitrex, the beta blockers, the triptans. Right now I'm taking the Topamax. I've done Neurontin and stuff. Andrew Schorr: It's that drug roulette we were talking about. Caller: Yeah, I've been through that. I'm willing to go see a witch doctor at this point. Andrew Schorr: So your question really is, is there something else. Caller: Yeah, I've taken Vicodin and stuff, which does do some things. It makes it a little bit easier when you have the migraine but not a whole heck of a lot. Andrew Schorr: Right. And you want to be careful with pain medicines too. Caller: Yeah. You know, I'm not a real big fan of taking medications. And I do suffer from sinus headaches too, and I've had them trigger the migraines. No sooner do you get off the sinus headache and it triggers the migraine and stuff so you have a cumulative effect. Andrew Schorr: Mark, you have quite a history there. Go ahead and listen and we'll see if Dr. Lucas can talk for a minute about that kind of situation, okay? Thank you for calling in, really appreciate it.

19


Dr. Lucas: Mark, I don't have to tell you you've got one of the tougher headaches to treat. Again, we were mentioning earlier that about four to five percent of people will go on to have these chronic headaches. And some people start out when they're younger with episodic migraines, and for reason that aren't known your headaches increase in frequency and intensity, and suddenly you're waking up with a headache every day and you rarely have a headache free day. In this situation of course you want to make sure that there's no underlying problem that's treatable, checking your blood work, maybe checking an MRI. But you also want to make sure that you're not inadvertently doing it to yourself, not that you would know it. But many, many people will start taking medication for their headaches, for example let's say Vicodin, and oh, your headaches are worse, you take a little more, you take a little more, and suddenly before you know it you're using these pain pills almost on a near daily basis, then the problem arises because your solution has now become the problem. The brain does something called up regulate, which means it pops out more pain receptors that are used to seeing a drug on them practically every single day. Doesn't have to just happen with Vicodin. It can happen with Tylenol. It can happen with aspirin. It can happen with Excedrin. So if you overuse a medication more than two to three times a week on average you're really asking for it, and it could be part of the problem that you've inadvertently made your headaches into daily headaches. Andrew Schorr: My vote would be, if you can, go see Dr. Lucas personally at the UW Medical Center, the headache center to see if you can sort it out. We'll be back with a little bit more of Andrew Schorr's Patient Power when we come back on KVI Talk Radio 570. Stay with us. Visiting a Headache Center Andrew Schorr: Welcome back to the final segment of Andrew Schorr's Patient Power where we've been talking about headache and migraine today with Dr. Sylvia Lucas, who is one of the top headache specialists in the country. We're really blessed to have her at the University of Washington Medical Center, where she's the director of the headache center. Sylvia, if they want to call, you're a busy lady and you have a busy clinic, but what is the number if they want to see a headache specialist like you? Dr. Lucas: Our phone number at the clinic is area code 206-598-6950. That's the University of Washington headache clinic in the department of neurology. Andrew Schorr: Thank you. And, you know, you don't have to go to a specialist. A great place to start is with your own doctor or go to a primary care doctor. You make an appointment, I want

20


to talk to you about headache. Yes, I have a cold, yes, I have the flu, yes, I have this, but today my number one concern is the headaches I really haven't talked to you about before. Right, Sylvia? Dr. Lucas: And please do make an appointment just to talk about your headache. And take in a headache diary. I want you at least for a month to write down every day if you have a headache or not, what you took for it and what it's like. Andrew Schorr: Okay. And look at the medicines you're taking, like Excedrin and some others. See if the caffeine in it affects it. If we're drinking a lot of coffee, take a look at that. Now, if you stop drinking coffee you may well get a headache there too, right? Dr. Lucas: Oh, that's true. Andrew Schorr: So it's a little bit of you're trying this. Look at certain foods. Mentioning about Chinese foods, MSG, red wine. My dad always used to get headaches from that. So you have to stay tuned on that. By the way, I was prompting for calls from Tacoma. Fran was so good to call, and she talked to Dr. Lucas during the break. We're not going to have more time for calls, but next week we're going to be, by the way, in Cincinnati. I'm going with my daughter Ruth who was on the show a couple of weeks ago, Sylvia. Ruth, as we mentioned, has an uncommon gastrointestinal condition, eosinophilic gastroenteritis, and we're actually going to go with a couple from Woodinville, Chris and Joy, I think it is, and we're going to be seeing some specialists in that more rare condition right back there. It's the lesson of going where you need to go to connect with the care you need and deserve. So whether it's coming to you about headache or going to Cincinnati in this case to see these doctors who research that condition. So we'll be broadcasting live from there. Sound like a good idea? Dr. Lucas: That sounds great. Andrew Schorr: Sylvia, any final comment before we go for people with headache? Dr. Lucas: Thank you, everybody, for being on the show and thank you to our callers. Make sure you talk to your primary care physician about your headaches. And for any more information if you've got internet available I strongly urge you to take advantage of the American Counsel For Headache Education, that's ACHE for short, www.achenet.org.

21


Andrew Schorr: Okay. Great suggestions as you look to deal with what could be a chronic problem for you. We'll talk another time, Sylvia, about menstrual migraine and how that happens for women. I know you're doing research in that. Dr. Lucas: That's right. Andrew Schorr: Lot more to talk about. If you're out there on the east side stay away from 520, it's closed. Watch out for the marathoners. My kid's helping out there. Don't run over him. And don't let the traffic give you a headache. We'll be back with much more next week and talking about where to go to get the care you need even if you need to get on a plane or to see a subspecialist for your condition. Thanks to Ron who's listening on the internet. You can always listen on kvi.com, and pretty soon we'll have a patientpower.info website up to listen to replays of all the programs. So tell your friends. I'll let you know when it's up. If they have headache they can listen to this program. Have a great week. Thanks for joining us on Andrew Schorr's Patient Power. Talk to you next week. Bye-bye.

Please remember the opinions expressed on Patient Power are not necessarily the views of Health Radio, our

sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care

from your own doctor. Please have this discussion you’re your own doctor, that’s how you’ll get care that’s

most appropriate for you.

Documents

Effective Treatments for Headaches and Migraines AM 570 ...cdn.patientpower.info/p2docs/transcripts/KVI071005.pdfEffective Treatments for Headaches and Migraines AM 570 KVI July 10,