Migraine Relief: What Helps, What Doesn’t and What’s New

Migraines are often dismissed as “just a bad headache,” but they can be much more serious and disruptive. So what actually causes migraines, and when should someone stop trying to push through the pain?

In this episode of Baptist Health Talk, host Sandra Peebles speaks with Dr. Maria Vera Silva, neurologist at Baptist Health Miami Neuroscience Institute, and Dr. Andrew Forster, internal medicine physician at Baptist Health Primary Care, about what migraines are, how they affect the brain, and why treatment is not one size fits all.

In this conversation, they discuss:

•  Why migraines are considered a neurologic disease 
•  How migraines differ from regular headaches 
•  Common triggers, including stress, hormones, sleep changes, foods and weather 
•  The connection between migraines and mental health 
•  Treatment options, including anti inflammatories, triptans, CGRP inhibitors and Botox 
•  What to know about viral migraine “hacks” on social media 
•  When migraine symptoms should prompt a visit to a doctor 

Migraines can interfere with work, school, family life and everyday activities. Understanding the signs, triggers and treatment options can help patients get the right care sooner.

For more health and wellness information, visit Baptist Health South Florida’s resource blog: baptisthealth.net/news

Host:
Sandra Peebles
Award-Winning Journalist

Guest:
Maria Andreina Vera Silva, M.D.
Neurologist
Baptist Health Miami Neuroscience Institute

Andrew Forster, M.D.
Internal Medicine Physician 
Baptist Health Primary Care

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A 'Heads Up' on Migraine & Headache Disorders

Transcript

SPEAKER_00 0:00

Once women go through menopause, generally they they grow out of the migraines. So that's one good thing about getting older is the migraines will go away at some point during their life.

SPEAKER_02 0:09

Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for health care prevention and wellness.

SPEAKER_03 0:19

Hi everyone, I'm your host, Sandra Peebles. Welcome back to a new episode of Baptist Health Talk, where we answer your most searched questions on trending health topics. Today we're talking about migraines, what they really are, why they happen, and why they're so much more than just a headache. We're breaking down the myths, the triggers, and the treatments that actually work with expert insight and real life perspective. We're joined by Dr. Maria Verasilva, neurologist at Baptist Health Miami Neuroscience Institute, and Dr. Andrew Forster, internal medicine physician at Baptist Health Primary Care. Thank you both for being here. Thank you. Dr. Verasilva, let's talk about what migraines actually are and how they differ from a regular headache. Does that distinction affect treatment?

SPEAKER_01 1:07

Migraine is a neurologic disease. It's not just a headache. Unlike sinus or tension type of headache, the migraine is going to be associated with other symptoms, including light sensitivity, sound sensitivity, and limitations of the daily activities. These differences are very important because the migraine treatment target specific brain pathways. And for example, the simple painkillers don't help with the headaches when it's specifically migraine and actually can increase the frequency when we overuse them.

SPEAKER_03 1:44

Many think that because many think it's just a bad headache, you could just push through it. Is there any truth to that?

SPEAKER_01 1:50

No, this is a myth. Migraine can be disabling, affecting your memory, your thinking, your vision, your balance, and also your speech. Trying to push through is not the best way because actually you can prolong the episodes and have more frequent migraines. Actually, migraines are considered one of the leading causes of disability worldwide.

SPEAKER_03 2:14

Wow, really. Dr. Forster, uh, how do migraine migraines actually impact humans' daily life, whether it's their work life, their family life, their mental health? And when should people start trying to not when should people stop trying to go at it alone and seek professional help?

SPEAKER_00 2:35

Yeah, so as we mentioned, it's really, really common. It's probably the number one disability for people under 50. Not that they're rendered disabled all the time, but they miss work, they miss school, they miss social events, so it's really, really common. So about 30, something like 30% of women in the in their 30s have migraines. So I'm sure somebody here on the office staff have has migraines. It's really common. And, you know, people should seek attention early. If it's if it's relief with over-the-counter pain meds, fine. But anything more than that, they really should get a medical opinion and be seen and not try and push through it themselves.

SPEAKER_03 3:13

Really, this is news to me. The fact that people are, that's like the number one reason for disability is migraine, which seems something so common. So, Dr. Vera Silva, what's actually happening in the brain when someone is experiencing a migraine?

SPEAKER_01 3:25

So during migraines, the brain becomes more sensitive. Basically, we have like a pain pathway activating specific nerve that we have, including the trigeminal nerve. It causes the activation and release of specific chemicals called CGRP, which amplified the pain signal. And also we can have activation in other parts of the brain which are associated with other symptoms that patients with migraine can present, like visual disturbances, speech problems, and also sensory disturbances as well.

SPEAKER_03 4:01

So is the pain actually in the brain? Because I've heard that the brain doesn't really feel pain, that it's outside of the actual brain itself.

SPEAKER_01 4:08

Yeah, we can say that it's in the structures surrounding the brain, is uh everything is coming from the trigerminal nerve activation and releasing a specific substance that are gonna amplify the pain signal.

SPEAKER_03 4:21

Dr. Forster, what are the triggers? Because a lot of times we think it may be this, it may be that. Are there any uh triggers that might be surprising to patients?

SPEAKER_00 4:28

Yeah, so there's a really long list. Probably number one is stress, probably number two is hormonal. So that's why it's much more common in women than men. Uh, it can be certain odors, cigarette smoke, certain foods, red wine, anything that's fermented, change in weather, lack of sleep, lack of eating. So classic story, you know, college student pulling in all nighter, not eating, not getting sleep. They have a test the next day, they're stressed, they get a migraine the day of the test. So it's really uh triggered by multiple, multiple things.

SPEAKER_03 4:58

And they can last how long?

SPEAKER_00 5:00

Well, the definition is four to 72 hours, but most people, it's a day or two without medication. There's also a genetic basis, so a lot of people, it runs in their family for migraines.

SPEAKER_03 5:12

Dr. Vedasilva, there's an assumption that migraines are all stress related, um, but there are neurological reasons that might be driving that pain. Uh, could you tell us what they might be, even if there's no stress?

SPEAKER_01 5:24

Well, as he mentioned, the stress can be one of the triggers, but it's not the only one. As I mentioned before, the brain is going to be hypersensitive to specific stimuli, including light hormonal changes, sleep changes, and all of these can be represent, and also food actually, and all of them can represent a trigger. That's why it's very important that every single patient try to identify their own triggers and try to avoid them.

SPEAKER_03 5:51

Uh so the migraines don't only affect the head, they actually affect um your mental health of the patient's mental health. How important is it, Dr. Forster, to treat both aspects of the mental health and the physical.

SPEAKER_00 6:04

Right. So there's a there's a really big association with low socioeconomic status and other behavioral health problems. So just treating anxiety and depression often relieves a lot of the migraine burden that people have. So there are there's pretty good evidence showing that behavioral modification, behavioral therapy really helps with reducing migraines.

SPEAKER_03 6:24

Um, when we talk about treatment, Dr. Vera Silva, uh, some people respond to certain treatments, and yet that same treatment that could be so effective for one patient has no effect on another. Why does that happen?

SPEAKER_01 6:36

Well, because the migraines are biologically uh diverse. People differ in genetics, in hormonal status, in brain uh chemistry, and also in the triggers. That's why no one medication is gonna be the perfect solution for every single uh patient. The migraine care is more about like a personalized try and error instead of like a one-size-fit-all approach.

SPEAKER_03 7:03

And how do anti-inflammatories or steroids fit into uh the treatment for a migraine and what should people know about these?

SPEAKER_00 7:12

So anti-inflammatories like ibuprofen are generally considered first-line therapy. If that doesn't work, we can go on to what are called the tryptins, something like imitrex as a trade name. If that doesn't work, there are some newer drugs, uh what we call the CRGP antagonists. Steroids don't really have a role unless it's somebody's in the emergency room and they're given intravenous steroids, but we we really don't ever give people steroids by mouth to take on a regular basis for migraines. Those really aren't part of the treatment algorithm.

SPEAKER_03 7:44

One new treatment that I've been seeing on TV is Botox for migraines. But how does that work? Number one, how do they apply it? Do you uh do you get a two-for-one where you get, you know, the the beauty, the cosmetic part?

SPEAKER_01 7:54

Really, it's not the cosmetic, but how how does it function for well yes, the Botox is gonna help with the pain signaling and the level of the sensory nerve. We have like a protocol where we have to place the injections, and this is a therapy approved for patients with chronic migraines, meaning headache on 15 or more days in one month. And it works best as a preventive therapy, know when you already have the migraine.

SPEAKER_03 8:22

So we spoke about hormonal, the hormonal effect of these migraines. How does it show up when it's hormonal uh for the patient?

SPEAKER_00 8:29

Well, typically it's so as we talked about, it's more common. And women typically they will get, if they have migraines, they'll get it at the beginning or just before their menstrual period.

SPEAKER_03 8:39

And so is that indicative of which hormone is be is fluctuating?

SPEAKER_00 8:44

Um no, I mean it's just the the migraines are more common at that time of the month, so to speak. So once women go through menopause, generally they they grow out of the migraines. So that's one good thing about getting older is the migraines will go away at some point during their life.

SPEAKER_03 8:59

There's a few things that are relieved by that menopause that we hate to speak about. The truth is. There's a lot of buzz, and I heard you speaking about the CGRP inhibitors and stem therapy stem cell therapy. How much of this is experimental as opposed to um promising? How do we see these new treatments?

SPEAKER_01 9:19

Well, as a new treatment, we have the CGRP antagonists that we mentioned before, and they come in several presentations, including pills and also injectables. They're very effective and well tolerated by patients. Nowadays, we have neuromodulation devices that are promising, and we have the stem cell therapy. However, this is something that they are investigating. We don't have any specific guidelines, and so far, this is not included as a part of the treatment for migraines, maybe in the future.

SPEAKER_03 9:49

Okay, so social media is an entire world in and of itself for journalists. Obviously, there's a lot of alternative news. And I know for you doctors, you've dealt with Dr. Google, where people are just out there. Um, there are a lot of hacks and a lot of biohacks that people are looking at on social media. So I want to go through some of them and I'll ask you each, uh, and and you tell me what you think uh about these particular trends. So one viral trend was using a hair clip, and it's one of those, you know, clips like this that you put on your eyebrow. Is there any truth to that?

SPEAKER_00 10:18

Yeah, so I wouldn't recommend that. I think there's a risk of eye injury, and that's not generally accepted as as treatment. So I probably would not do that.

SPEAKER_03 10:27

Um what they say on social media is that it kind of interrupts the nerve and it kind of distracts you from the pain. Do you think there's any value in that?

SPEAKER_00 10:34

Uh I mean there may be some mild physiologic reason that it works, but it's not an accepted form of treatment.

SPEAKER_03 10:41

That's not gonna happen then. Okay, another one that people um speak about, Dr. Vera Silva, is Diet Coke and French fries from McDonald's. So is this really about the nutrition or is it maybe the sweet and the salt? Could there be something on that?

SPEAKER_01 10:56

Basically, I think it's a combination of the caffeine and that is gonna cause it's part of the treatment for migraines and maybe the carbs, the carbs which can stabilize a little bit the glucose, but for sure this is something that I'm not gonna recommend. We have to try to keep a healthy diet.

SPEAKER_03 11:13

But then maybe there is that other conversation we were having where some treatments work for some people. So maybe there is something in that carb that would work for this person. Exactly. Maybe, right? So when they tried it, it worked, and they said, I found the cure. It's at McDonald's. Um, we've seen people soaking their feet in warm water, and um, and and supposedly that relieves migraines. Is that just a psychological side effect?

SPEAKER_00 11:34

It doesn't make sense to me physiologically, so I'd I would have to say there are better treatments than soaking your feet in hot water. But there's nothing.

SPEAKER_03 11:42

But if you have a migraine and you soak your feet, I guess it's okay.

SPEAKER_00 11:45

Yeah, it's all right as long as you don't burn yourself. Well, not that hot.

SPEAKER_03 11:48

Um, ear piercings and pressure point techniques are often mentioned as possible cures for migraine. Um, should people set expectations on that kind of treatment? I can't imagine how many piercings you'd have to get every time you have.

SPEAKER_01 12:03

So we don't have any strong scientific uh evidence supporting that this is something that we have to use uh regarding the acupuncture. Well, basically we can modulate a little bit the pain signal, but we have to be, you know, realistic. And this is something that we can try in addition to a proper medical treatment.

SPEAKER_03 12:22

Okay, and that's been a lot of fun, obviously, speaking about these alternative treatments, because it's always interesting to see what people come up with. And like we said, some things have an effect for someone, and it, you know, it could be that one day that you got uh a relief and then thought you found um the cure. But on a more serious note, Dr. Forster, when should someone really take this seriously and try to find treatment? Because a lot of times we think, no, it's just a headache. Sometimes it's cultural, sometimes it might be women, sometimes it might be because um they're during their menstrual period and they're like brushing it off. When what's the point where you should say, okay, time to see the doctor?

SPEAKER_00 12:54

I mean, I I would I would definitely get medical attention if they're if the headaches are very frequent, if they're disabling, like you're missing work, you're missing school, you're missing your kids' piano recital, something like that, where they're really interrupting your life. If it's something that happens once in a while, it's relieved with over-the-counter painkillers. Fine, you probably don't need immediate medical attention. But certainly if it's interfering with your activities of normal life, you need to get checked out because we do have really good treatments that work very effectively.

unknown 13:25

Dr.

SPEAKER_03 13:26

Vedasilva, any thoughts on that when the person should really seek medical attention?

SPEAKER_01 13:30

I completely uh agree with the doctor. I think the main thing is you see any changes in your pattern because maybe you are you're having headaches for a long time, but now it's more frequent, or the localization of the headache is different, or if they are associated with other symptoms, I think is a good time to seek medical attention.

SPEAKER_03 13:50

Okay, thank you so much. This has been so interesting and eye-opening. I really never realized that um it's one of the leading causes of disability for human beings. So thank you so much for opening our eyes to this important topic that affects so many people. It's been an amazing conversation. So thank you for sharing your insight with our audience. And remember, viewers, be sure to hit that subscribe button on our channel here to keep up with the latest health and wellness information and of course tips from our experts.

SPEAKER_02 14:15

Thank you for watching. Find additional valuable health and wellness information on our resource blog at baptisthealth.net slash news. And be sure to interact with us on our social media channels for live and upcoming events. Baptist Health Talk is brought to you by Baptist Health, the warmer side of care.