The Paid Leave Podcast

There is Hope Managing Headaches and Migraines

• The Connecticut Paid Leave Authority • Season 3 • Episode 39

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In this episode of The Paid Leave Podcast, we are talking about headaches and migraines.  June is Headache and Migraine Awareness Month. Gretchen Michaelson, the founder of the Headache Care Center in South Windsor, she is an Adult Nurse Practitioner specializing in headache medicine. She explains the difference between headaches and migraines, the various treatments available, including prescription medications, neuromodulation, and lifestyle changes. She highlights the importance of addressing migraines promptly to prevent chronic conditions and improve quality of life. Michaelson also discusses the impact of migraines on mental health and the advancements in treatment since 2018, emphasizing the need for awareness and proper diagnosis. Michaelson also talks about the importance of CT Paid Leave in that it allows for intermittent leave or when the episodic headaches or migraines may flare up.

 

To get in touch with Gretchen Michaelson: go to their website: Treatment Team - Headache Care Center News

Or call The Headache Care Center in South Windsor (860) 263-3603

 

For information or to apply for benefits please go to: ctpaidleave.org

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Nancy Barrow:

Hello Connecticut, and welcome to The Paid Leave Podcast. The title basically says it all. I'm Nancy Barrow, and I will be delving into this new state program and how it can help you and your family. This podcast will give you information you should know about Connecticut Paid Leave and maybe just a little bit more. Connecticut Paid Leave brings peace of mind to your home, family and workplace. Welcome to The Paid Leave Podcast. June is National Migraine and Headache Awareness Month, and it's aimed at increasing awareness and trying to reduce the stigma. Here to help in this discussion, is the founder and director of the headache Care Center in South Windsor Gretchen Michaelson. Gretchen is an Adult Nurse Practitioner specializing in headache medicine, and her career has focused on neurological conditions since 2000. She has dedicated her practice to improving quality of life for patients with various headaches, and she is a certified headache specialist through the National Headache Foundation. And Gretchen's practice philosophy, centers on providing specialized care for individuals with headache conditions and guiding them towards improved quality of life through evidence based treatment approaches and in her spare time, she's a wife and a mom of six children. Welcome to The Paid Leave podcast, Gretchen.

Gretchen Michaelson:

Thank you very much.

Nancy Barrow:

So Thanks for lending your expertise to this topic in June, especially since it's Migraine and Headache Awareness Month. So have you ever suffered personally from headaches or migraines?

Gretchen Michaelson:

I do not have migraines. It's a question I get from patients all the time. I do have two children with migraine stuff so.

Nancy Barrow:

You do?

Gretchen Michaelson:

I do

Nancy Barrow:

Let's start with the headache Care Center in South Windsor, and how you got started in this line of work with headaches and migraines.

Gretchen Michaelson:

So I've always been in neurology, 25 years now, which is crazy. And I said it was the one field I never wanted to do. I was never going to do neurology.

Nancy Barrow:

Why would that be?

Gretchen Michaelson:

You know, it all came down to it just, it just seemed too much, too complicated. I was more into the cardiothoracic world, and that's what I was going to do, but my husband and I, we were looking to be living in the same location, and the job that made itself self as evident in the ICU was only in neurology. So I thought, I'll just do that for a couple years, and then I'll transition to what I really want to do, and I fell in love, and have never left it.

Nancy Barrow:

Wow. And that's amazing. That story is amazing. So tell me about headaches and migraines, and how are they different?

Gretchen Michaelson:

You have to think of headache as a description of what's going on. So it's a head pain. So you can have all kinds of different headaches. You can have headaches because you had the flu. You can have a headache because you had hit your head on the cabinet. Or you can have migraine headache, which is an entirely different pathophysiology.

Nancy Barrow:

What are some of the treatments? Can they be over the counter, like Advil?

Gretchen Michaelson:

The certainly can be, I think, for people who have very episodic, you know, infrequent type headaches, those that certainly can be helpful. You know, the patients that we're seeing, especially with migraine, were usually using multiple modalities, from prescription medication to neuromodulation to lifestyle modifications and all of those different things combined.

Nancy Barrow:

So what's neuromodulation?

Gretchen Michaelson:

So neuromodulation is where we have various types of external stimulus. They have various devices, some that go on your arm, some that actually stick to your head and that actually try and they all work by different mechanisms, but some of them simulate your own neural pathways to try and help control headache or prevent headache. Everyone needs what we call, you know, when we're talking specifically with migraine, everyone needs an abortive plan. This is what you take when you get a headache, but when the headaches become too frequent, it's really not great for the brain. It's an inflammatory process, and there can actually be radiographic changes like on MRI that would be related to those inflammatory processes. So when we're seeing patients who are at, you know, four headaches a month, you know, one a week, we say, you know, at that point in time, we probably should be considering putting on preventative medication.

Nancy Barrow:

Let's talk about migraines, because they are a different animal. My dad and I both had migraines, and we both had kind of the same thing. We needed dark, we needed quiet, I needed cold, and I think I got my first migraine as a teenager, and my dad was taking Caffergot and I know it's, it's old school, but it, he said, take one, and if it doesn't work in 30 minutes, then you take another one. And it really helped. So I think that what, and I may be wrong, but I thought that we had like, a vascular headache, vascular migraines. And I don't know if that's correct the terminology, but I think it was something, you know, obviously with caffeine helped.

Gretchen Michaelson:

Right, well, that was something that I think we've made great strides in pathophysiology over the years, and so we used to describe them as and relate pathophysiology more to a vascular problem. Now we've kind of transitioned into a trigeminal vascular Situation. So the pathophysiology is a little bit different, and we're not so concerned, I suppose, related to specifically a vascular headache.

Nancy Barrow:

Yeah, well, let's talk about migraines in general. There are obviously a bunch of different types of migraines. Can you kind of talk about the different types of migraines?

Gretchen Michaelson:

Yes so we like to categorize migraine first migraine. How frequently does it occur? So is the migraine episodic, meaning you're having less than 15 headache days per month, or is it chronic? Are we having more than 15 migraine days per month? And then in addition to that, we separate migraine with aura and migraine without aura. So notice that, yes. So for some individuals, they they can have and again, it's a small percentage of individuals, maybe a third of individuals with migraine that will develop prior to the headache developing, can develop a number of different types of symptoms, whether it be, you know, shapes that move through their field of vision, sparkly lights, zigzags. You can have speech involvement. I know you can certainly watch YouTube videos of seeing people actively in a migraine, where their speech becomes garbled, they can have, you know, tingling since sensory type symptoms and that, that's what we consider aura, that would only and it usually lasts about five to 60 minutes, and then the headache follows.

Nancy Barrow:

Wow, so then they suffer from a headache for how long after?

Gretchen Michaelson:

So migraine, per diagnostic criteria, lasts anywhere between four to 72 hours.

Nancy Barrow:

What are some of the different treatments that you have for the various migraines?

Gretchen Michaelson:

So I do have to say there have been such great strides in what's available now. So 2018 was a big year in the headache world. We had the addition of various types of treatment options that play with a molecule called CGRP or calcitonin gene related peptide, which is a neuropeptide, which during migraine, we see those neuropeptides rise, and as a migraine dissipates, we see those dissipate. So we now have targeted treatment that plays with this molecule, and the outcome from using these treatments has just been something we have never seen before. Wow, which is great. We call it like the golden age of migraine treatments and patients really, truly have been able to be given their lives back.

Nancy Barrow:

Do you use alternative kind of therapies like Botox or acupuncture or even, like cupping,for situations where it can be really severe?

Gretchen Michaelson:

Yeah, so Botox is actually an FDA approved medication for the treatment of chronic migraine, so that's headaches that are more than 15 days per month. So we wouldn't even consider that like an alternative treatment that's definitely on label when we talk about massage or acupuncture, sometimes it depends on what we're targeting. So for some individuals who have a lot of spasticity that then seems to trigger their headaches, those are patients that I, you know, will send for acupuncture, which can be very helpful for that, you know, minimizing that spasticity.

Nancy Barrow:

Kiind of that of that relief. How much time do people need away from work? Like it sounds like it's a long process to kind of figure out what they have and what the treatment might be.

Gretchen Michaelson:

Yeah, there with migraine, a lot of it is more of episodic, you know, unpredictable times where they may not be able to function. Because, again, headaches can last four to 72 hours, and we, I would love to say that we get the first treatment right out of, you know, the gates. But unfortunately, sometimes it's trying of different things to find the right combination so that that patient can have success. The gold standard of treatment for us, and I tell this to all of my patients that come to see us, is that you would have complete relief of that migraine within two hours, and it doesn't return in 24 so that's what we're striving for. But it may take a couple of, you know, or layering of medications before we find that right fit.

Nancy Barrow:

An do you try to find out triggers? And are there always triggers? Because I couldn't figure out what triggered mine.

Gretchen Michaelson:

Right? Triggers are, they're a hot topic these days because, yeah, we have years of talking about triggers and food triggers and alcohol triggers or, you know, dehydration, lack of sleep, too much sleep, all of those over stimulation, stimulation, all of those different things. I think some of those that trigger, you know, sometimes patients will come and say, Oh, I ate the wrong thing. I had chocolate, and that's what, what triggered my migraine. And we actually have some more recent data to suggest that actually with migraine, we have activation of the hypothalamus, and that that actually causes food craving. So you actually might be craving the chocolate, for which then you eat the chocolate, and then you blame your migraine on your chocolate, when, in reality, the pathophysiology was already preceding that.

Nancy Barrow:

Well let's go back and talk about cluster headaches, because I know we had discussed this before, but I know that they affect more men than women, correct?

Gretchen Michaelson:

So cluster headache is a unique, you know, subset of headache. It's. Not a huge population in general, but when it occurs, it's profoundly debilitating. So we see it more often in men. These are headaches that last anywhere from 15 to 90 minutes. We call them a sidelocked headache. So they're only ever on the right side of the head or the left side of the head tends to feel like they're being it's like a hot poker in their eye, and that pain will last for again, it's a short duration, 15 to 90 minutes, but they can have up to eight attacks a day. Wow. And how long usually a cycle can last four to eight or six to eight weeks would be more typical.

Nancy Barrow:

And so if you have one of these cluster headaches once, are you more susceptible to getting them?

Gretchen Michaelson:

So men, they usually tend to cycle. Spring and Fall is the more typical times that we see clusters. Can't we kind of call it cluster season. And you know, suddenly your phone starts to ring and, oh, I'm starting back in cycle again. Thankfully, these headaches, because they're so disabling, we have some great treatments that now are starting to really make a difference for these individuals, because without treatment, there's a extremely high suicide rate with these types of headaches.

Nancy Barrow:

Wow, wow. That is frightening. Do you also think about mental health for people who are who are going through these cluster headaches, do you, or even someone who's going through migraines? I mean, it's, it is really debilitating when you get like, a diagnosis of that and you know that it's a chronic situation for you, do you suggest that they have, like, mental health or go talk to someone?

Gretchen Michaelson:

Yeah mental health is a big part of what we do in neurology anyway, because, you know, there's that comorbid condition between anxiety, depression and some of these pain conditions, partly because it's unpredictable. So what happens is, is they don't know when they're going to get a headache, and so they try and plan activities, then they're not able to participate in those activities. And as time goes on, you know, friends are like, Oh, maybe I don't want to invite that person or part, you know, include them, just because they end up canceling all the time. And then that can send people, you know, kind of down that road. And by the time they come to see us at the Headache Center, they may have very high frequent headaches, and then also be struggling with all kinds of anxiety, depression, that anticipation of, when is that neck attack going to occur, right? I think that also goes to how important treatment is, because when you have a treatment where you know you can have complete relief in that two hours and it's not going to return in 24 it empowers patients to go, you know what? I have a plan. I know if it occurs, I'm not going to be derailed. I'm going to take my whatever my treatment is, and I'll be good to go. And that is so empowering to patients, and allows them to feel like they can participate and do things in life. Yeah? Why I do what I do.

Nancy Barrow:

Yeah, I mean, you want them to be you want to be successful in the treatment, right? So, so they can go to work, they can be a mother, father, sister, brother, whatever they're trying to do in life, and have some quality of life, because it can be so debilitating. I just know from my mine that I've had they're so debilitating, there's no way I could work through a migraine for me.

Gretchen Michaelson:

Yeah no. And I mean, it would be very difficult if you didn't have the if you didn't have the appropriate treatment, which is why, you know, we really work for we work through that process to try and get there.

Nancy Barrow:

And since 2018 there's these great new meds.

Gretchen Michaelson:

Great new treatment options yes.

Nancy Barrow:

That's so amazing.

Gretchen Michaelson:

So we've seen, not only better efficacy in treating the actual headache, but also for preventative medication, so that patients now, hey, I used to get, you know, 18 a month, and now I'm down to one or two a month, and I take my medication and I'm good to go.

Nancy Barrow:

What kind of therapies do you use? Do you use, like biofeedback? Or do you use different types of therapies for people who have headaches?

Gretchen Michaelson:

So there's all kinds of different things that we use. So obviously, medications are a big portion of what we use, depending on frequency. We have even, you know, IV therapies that we do. We have Botox that we use for those only with chronic migraine. That's the only indication related to migraine. With Botox, we have, sometimes even just therapy, various types of, you know, cognitive therapy. We some patients use acupuncture. Some people use massage. We also talk a lot about lifestyle changes. You know, migraineurs are have very sensitive brains, so they we like to keep everything very homeostatic, so everything that's the same. So going to bed at the same time, getting up at the same time, which is hard for your adolescents, who, you know, they go to school and on, you know, during the school week, they have to get up at ridiculous times in the morning, and so on the weekend, they're not going to get up at six o'clock in the morning. And yet, they really shouldn't deviate more than an hour.

Nancy Barrow:

Oh my gosh!

Gretchen Michaelson:

wake up time that brain really likes to have everything very much the same, eating at regular intervals. All of those components will play into headache.

Nancy Barrow:

So being a mom and having two kids who've had had headaches and migraines, how did you look at them differently?

Gretchen Michaelson:

There wasn't a question in terms of diagnosis. And I think that's a big barrier for a lot of individuals, and I think unfortunately, our medical model right now doesn't play well with that, because. Such a limited time. And so I'll have, you'll have individuals who have seen multiple people before, they've come to see a headache specialist, and, you know, seen or, or maybe even not, felt like they were, heard that their migraines were as debilitating as they as they are. And so they say, Well, no, I mentioned it to, you know, my doctor or to my specialist, and they were like, oh, you know, if you take over the counter medication and it helps some, okay, that's, that's good enough. And I think then they interpret that to mean that's, I mentioned it, they didn't offer anything else, and so there must not be anything else available. And that's just not the case. It's not the case, thankfully nowadays, but I think it allows people to function at very high levels of headache, and, you know, potentially miss out on like job promotions and all of those things, because then they miss work when, when there are treatments that are available that really do change lives.

Nancy Barrow:

And how young Are people that you've treated, are there really young children that get these?

Gretchen Michaelson:

So we at our center, we treat down to the age of 13, but and for a lot of women, you know that time period in their lives hormonal changes that we start to see, that that's when those headaches will start to kind of pick up and kind of rear their ugly head. That is a genetic predisposition. So it's not uncommon for us to see the grandmother, the mother and then the child.

Nancy Barrow:

Connecticut Paid Leave, as you know, can help with many aspects of migraines and headaches. You can get up to 12 weeks of income replacement a year to take care of your own serious health condition, like a headache or a migraine, or to take care of a loved one who is suffering from these and you can take intermittent leave, or you can take a reduced schedule leave, or you can take that whole block leave, like say you're really having cluster headaches and you need to take two months off to really deal with this, or three months off. How valuable are resources like this for your patients?

Gretchen Michaelson:

I think it certainly is a valuable resource that they can have as some income replacement, I think especially that that episodic component, because migraine tends to be episodic, so it's not it's not typically that block of time, but to know that they have some time that they can treat and try various treatments, so that we can get them to a place where they need to be, with the goal of them being able to say, hey, now I actually am able to use my PTO to do fun things like vacation.

Nancy Barrow:

So it is headache and migraine Awareness Month. What are you hoping happens during this month?

Gretchen Michaelson:

I'm hoping number one, that patients realize that having headaches and frequent headaches is not normal. And so if you're having frequent headaches, number one, ask questions, whether it be for your primary care provider, or, you know, reach out to us or somebody to say, Hey, I'm having these headaches. I'm guessing maybe this, I should have it looked at, and then have an evaluation, because I think we normalize, especially with migraine, it's such a high percentage of women that we tend to normalize it and say, Oh, this is just how I live, and it just doesn't have to be that way.

Nancy Barrow:

And what is the percentage of women that get migraines?

Gretchen Michaelson:

So it's about across the United States. It's about 20% of individuals. Well, it can have 15 to 20% of patients. So one in five.

Nancy Barrow:

One in five have migraines?

Gretchen Michaelson:

It's grossly underdiagnosed, unfortunately.

Nancy Barrow:

And why is that? Is there a stigma still attached to that?

Gretchen Michaelson:

There is a huge stigma associated with it. And actually, there's some newer data coming out now as we're trying to address stigma associated with migraine. And I think it goes back to even some of those original questions, is it a headache or migraine? I mean, the reality is that most of us, over the course of our lifetime, will experience a headache at some point in time. But we have to understand that migraine is a different pathophysiology.

Nancy Barrow:

And it can be a chronic health condition, which is another thing that we cover.

Gretchen Michaelson:

Yes, it is a chronic health condition. We say once a migraineur are always a migraneur.

Nancy Barrow:

Migraineur. Oh, yeah. So that's that's me right there. What would you like people to take away from this podcast, Gretchen?

Gretchen Michaelson:

Let's see if I had to choose something just that there's hope that there is so many options available. I hear it over and over again from patients, especially in these last couple of years, to say, I have my life back, and I had no idea it would be possible. And I think again, it goes back to combination of stigmatization and not knowing resources were available. So just being able to say, Hey, I'm going to look into it and see what I can do, and then be able to enjoy life to the fullest. Now it's a repeated thing to have patients come back to say, I mean, I hear it all. I hear I have I get to do more hobbies that I've never been able to do. I've been able to go to my kids events, for patients, to be able to come back and say I went to my daughter's wedding and I wasn't even concerned about not being able to enjoy it to its fullest. And I think those are those moments that we don't think about as sometimes, as clinicians. Those are the moments that are important to patients, and to be able to have them come back and really be able to live life, it's great. Or patients coming back and saying, Hey, I got a promotion at work, because now I'm not, you know, missing all of this work or not, that they're missing work, but they're not functioning to their full capacity, because they're trying to struggle through going to work while while having a migraine, that they can really advance and do the things that they want to do. And it's exciting to see them come back and be excited about it.

Nancy Barrow:

Is that the best part of your job you think?

Gretchen Michaelson:

For sure, that's the only reason why I

Nancy Barrow:

With six kids.(laughter) stay in it! (laughter)

Gretchen Michaelson:

For sure!

Nancy Barrow:

I want to thank my guest, Gretchen Michaelson, the founder and director of the Headache Care Center in South Windsor, for being on The Paid Leave Podcast. Thank you so much for being here.

Gretchen Michaelson:

Thank you so much for having me!

Nancy Barrow:

And I got a real education about headaches and migraines. So thank you so much for that.

Gretchen Michaelson:

You're very welcome!

Nancy Barrow:

For more information or to apply for benefits, please go to ctpaidleave.org. This has been another edition of The Paid Leave Podcast. Please like and subscribe so you'll be notified about new podcasts that become available. Connecticut Paid Leave is a public act with a personal purpose. I'm Nancy Barrow, and thanks for listening.

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