Migraines and other Headaches in Children and Adults Discussion

Migraines and other Headaches in Children and Adults Discussion

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– Hi everyone, welcome to
our Facebook Live session on migraine. I am Dr. Lauren Doyle
Strauss and I am a pediatric neurologist here at Wake
Forest Baptist Health, and I’m coming up on my
three-year anniversary. And so I’m a pediatric
neurologist with specialized training in headache medicine. I did most of my training
up in the Harvard system, in two different hospitals,
Boston Children’s Hospital and Brigham and Women’s
Hospital, and I’m very excited to be down here at Wake Forest. I lead a pediatric program,
part of the headache program at Wake Forest Baptist
Health, and what we do is, it’s an innovative program
for children and adults suffering with headaches,
providing hope and treatment options, even for the most
complex, and our ultimate goal is to help you return
to a meaningful life. I’m very excited that
they invited me to talk about migraine, especially
during this month, because June is Migraine Awareness Month. That is why I’m wearing purple. I like the color purple,
but the reason I’m wearing purple is to bring attention
to this special month, and awareness for migraine. I often get asked, what is migraine? Migraine is a neurologic
disorder that we know involves both nerve pathways
and also brain chemicals. We used to think that
migraine was only due to an abnormal blood supply or blood
pathology or blood vessel issue, because patients often
report pounding in their head that feels like a heart
beating, but we now know it’s much more complex and it
involves both nerve pathways and brain chemicals. It’s very interesting. We haven’t fully understood
all parts of how a migraine happens, because we’ve
known about migraines for a really long time. Migraines were first described
in ancient Egyptian times, written on early papyrus,
and then they’ve been written all throughout history, but
yet we’re still trying to understand why a migraine happens. What are the symptoms
that someone experiences with migraine? Well, everyone kind of
hears a little bit about the headache, but actually,
there are multiple phases to migraine. So the first one that some
patients experience is known as the prodrome, and
this is the warning phase. So a patient or migraine
sufferer may describe that they feel weak, tired,
dizzy, have neck pain. I had one patient say that
he gets a surge in energy, so it can be a lot of different
things, but it’s something that you may notice before
the headache happens. And then there is the aura phase. The aura is a neurologic symptom. The most common aura is
actually a visual aura. And this happens in about
20% of patients, and they can see very interesting things. The patients describe all sorts of things. They can see flashes of
light, sparkles, colored rainbows, and they can
even see cracked glass, or edges, or smudgings. So it’s really interesting,
it usually lasts about, it can be minutes up to
hours, and it can happen before the headache,
during the headache, after the headache, or sometimes
without a headache, so it’s pretty fascinating. Then, often, this leads on to a headache. It’s important to point
out that with migraine, it is not just a headache, okay? This is a severe, very
disabling headache associated with migraine, and it’s
usually unilateral, which means just on one side. And from headache to
headache, different headache episodes, it can switch sides. But in kids, they don’t
often have a unilateral headache, they have a
bilateral headache, which can be confusing for some people. But headache is quite severe
and that can last hours. So, how common is a migraine? It’s actually quite common. We estimate that it
affects about 15% of people around the world. To break that down into
what that means in your day-to-day life, that affects
about one in four homes. We know it’s more common in
women, it affects one in five women, and one in 16 men. A lot of people don’t realize
that this is very common in children as well. It affects one in 11 children. So who is most at risk? Anyone is at risk. We do know it’s more common
in women, especially related to times where they’re
affected by hormones. So puberty, I mentioned,
definitely the start of birth control pills,
pregnancy, and then actually headaches often improve after they’ve gone through menopause. And looking at age ranges,
we know that it’s more common at the onset of
puberty, can worsen in frequency and intensity
into their 20s and 30s, and then improves later in life. And that’s not typical for
everyone, but that’s generally most patients that are affected. In kids, although it’s most
common, we say in adults that it’s more common in
women, we know in kids, before puberty sets in,
it’s more common in boys, which can be confusing for some people. I’ll often get asked, what
are the genetic factors that lead to someone developing
migraines in their life? That is a really interesting
question, and we hope this is something we’re going
to get an answer to soon, but unfortunately it’s very complex. The reason is because it’s
most likely not just one gene. It’s most likely more than one gene. But we do know that if a parent
has a personal history of migraines, they have a 50%
chance of having a child with migraine. And then if both parents
have migraines, then you increase that chance to about 75%. So when should you seek out
care for your headaches? If the headaches are
severe, if there’s something concerning about the
headaches to you, they’re not responding to regular
over-the-counter medicines like Tylenol or Motrin,
or there is something that you think of a
neurologic symptom that is happening with your
headaches, these are reasons that you should definitely
talk about it with your primary care doctor. Your primary care doctor
is always the first place for you to go to to seek out care. And your primary care
doctor can definitely start the first steps, look into
whether or not you need more testing to look into a
cause for these headaches, can we start some treatment options? The question becomes when
do you come onto a center like ours, when should they refer? We don’t have to refer
right away, but I think that if the headaches are becoming
troublesome, bothersome, and they are not responding
to the medicines that are being prescribed by
your primary care doctor, that’s a great time to see
if referral to our center could be helpful. We are very lucky at
the headache program at Wake Forest Baptist
because we offer a lot of different treatments. We treat both children and adults. It’s important to point
out that we’ve offered treatments that are
non-narcotic options, and why do I point this out? Because in the past,
people used to think that narcotic medications were
helpful with migraine, and they do temporarily
help with migraine, the problem is, is used
chronically, they can actually worsen the intensity
of pain, it can make pain more frequent and
then they can block the effectiveness of medications. Our goal is to definitely
offer treatments that do not involve narcotics. If you’re on narcotics and you
want to come to our center, the best idea would be
to try to wean off or wean down the amount of
narcotics you’re using so that the treatments can be effective. In our program, we have a
multi-disciplinary team, so we’re very, very lucky. Our team includes several UCNS certified headache specialists. These are people that went
on for additional training in headache, and we have
a physical therapist who’s focused on the head and neck region. And we have several behavioral
medicine specialists, and we have a nutritionist. And so together we see
patients and we try to individualize treatment
to try to really help you in the best way possible. We focus on promoting a healthy lifestyle, because healthy habits,
hydration, sleeping well, reducing stress, these are
all really important in helping you cope with your
pain, but also to prevent pain. Our program is also really
unique because we offer procedural treatments for headache. A lot of people don’t realize
that there are procedural treatments for migraine. One of the ones that we use
more commonly is called botox. So botox you may have heard
of, because it is used or made popular by certain
celebrities because they’re using it to prevent wrinkles. But botox is a synthetic
purified toxin, so it temporarily paralyzes
muscles for about two to three months, and they
noticed when they were receiving cosmetic treatments
that this was helpful for headache and migraine. So there is a research trial
known as the Preempt study, that famously showed that this
treatment could be helpful in chronic migraine. Chronic migraine is one of
our worst types of migraine because migraines can, in
this case, they happen more than 15 days a month, for
more than three months, and they often don’t respond
to multiple medicines. So this is a great
treatment option available. So botox is a possibility. Then, we have another
treatment option, which are nerve blocks. One of the nerve blocks
that we offer are called occipital nerve blocks. This is really interesting,
a lot of patients haven’t heard of this, and this
is where we take numbing medicine, similar to when
you go to the dental office, and we actually inject it
in the back of your head, or sometimes in other
areas, and we numb down the scalp nerves. This allows your scalp to
go numb, put the nerves to sleep, and then the
thought is, that when they wake back up again
they’re not as irritated. And this is a very simple
procedure done in our office, you don’t need to be
sedated for it, and this can really provide relief
for patients who are in a really bad headache cycle,
someone who has a headache for a few days that doesn’t
respond to medicine. And then we’re very
excited that we’ve offered a new treatment recently,
known as SPG blocks. SPG blocks stand for
Sphenopalatine Ganglion Blocks. There’s a specialized
center located in the back of the nose, we use a
catheter and we insert it up the nose and we inject
lidocaine to be able to hit that area. We don’t fully understand
why this helps, but it has been helpful in many different
types of headache attacks to try to reduce the severity
of how long it’s going on. And then our program is also
really unique because we launched an urgent care infusion program. This is where we have a
patient who’s had headache going on for a few days. They call in to our nurse,
we know them, because they’re one of our patients,
and then we bring them in and offer then either
an injection into their thigh or the butt or we
offer an IV placement to give infusions, and this
can be the same kind of medicines that are offered
in urgent care setting, or an ED setting, or
emergency room setting. And the whole goal for
our patients is to give their lives back. To give them back control. So we want them to be able to come to us, get treatment fast and
go right back to work or back to school. That’s a great option for
a lot of our patients. We’re just so lucky at
Wake Forest Baptist Health, because being part of a
university setting like this, it really gives us the academic advantage. I really would like to
highlight a few of our ongoing clinical trials
that are targeted towards migraine, and the first
one which is currently recruiting for headache
patients who have episodic migraine is run by Dr.
Rebecca Wells, and this is a study looking at stress reduction. You take eight weekly
classes, and it is a study that is a great option
if you’re looking for an opportunity to try
something that doesn’t involve using a new medicine or
trying something that’s medicine based. This could be really helpful for you. We’re currently recruiting patients. You have to be 18 years
older, and we’ll include the link in the posting, so if
you’re interested you can contact Dr. Wells. The second study, we don’t
fully have all the details, but it’s very exciting,
we’re about to announce that we were accepted as a
clinical trial site to look at one of the new therapies
that is coming out called CGRP. CGRP is in clinical
trials across the country, this is a new target site
for migraine that has got exciting promise. It’s received a lot of national attention, and this could be the next
big treatment in headache. Really, in the early
studies that have come out, we have seen results in
refractory patients that never found response before. So this is really exciting,
and Dr. Bryson will have further details coming
out soon, but it will most likely focused on episodic
migraines, so a few headaches a month. If you’re interested in
that, I would direct you to the clinicaltrials.gov
site, because there are multiple trials ongoing for that. So at this time, we’re
going to pause for questions and see if you have anything
to pick my brain with. I can’t read it. Oh, okay. Are migraines genetic? Yeah, we kind of touched upon that. The answer to that is, yes. Nationally, everyone is
wondering this question, and if you can sort out
what the genetics are, then that would open up
lots of treatment options because if you find
where exactly to target, we would be able to treat
migraine more effectively. And in the past, most of
our medicine choices that we use in migraine treatment
have been borrowed from other fields or other
classes, so we borrow blood pressure meds, we
borrow psychiatric meds, we borrow seizure meds,
and if we could figure out where the exact genetic
cause is, it would really advance the field. So it isn’t a race to
try to understand this, the problem is it’s so
complicated because it’s multiple sites that we think are involved, and there is a movement to
create a repository where basically if you went to an
academic center like ours, part of your appointment
would be you would draw blood and then they would store
it, and eventually we could try to cumulatively understand nationally, where is the target site for migraine? Okay, so what would a child
typically experiencing migraines, what would that look like? It looks very similar to
when an adult has migraine, the problem is, children
can’t always express what they’re feeling, so we
have this international headache classification
system, and it actually says specifically for
children, that you can infer from behavior. And so during a headache,
which I didn’t mention before, you can have some associative
features, so you can be light sensitive, sound
sensitive, we use the fancy terms of photophobic or phonophobic. And so you may see a child
dive under the blankets or ask to put a pillow
over their head, or turn out the lights and close the door. And then they don’t want
their baby sister screaming because it really bothers
them, or no tv, even though they love watching tv. So there may be some extra
behaviors that you’re gonna notice. They may not come out and say. There are times that we’ll
look back and we have a four or five-year-old who
can finally express what was happening and we
realize there were times they were yelling or
holding their head and look back and say wow, they
may have even been having migraines when they were
two or three years old. Now the thing I want to
point out which is really interesting about children,
is that there are some migraine variant syndromes, which we call childhood periodic
syndromes, which happen in childhood or in
adolescence that don’t have headache part of them. And these are very different. They’re kind of a unique
group of disorders, but one is cyclic vomiting,
where you can have bouts of vomiting, sometimes
up to 15 times a day, that happen in cycles every few months. So that’s really interesting
and it definitely deserves a work up. Then there are abdominal
migraines where you can have bouts of belly pain centered
around the belly button, and sometimes get worked up
like they’re in apendicitis. And then we’ll realize with
a big workup being normal, that it might be this migraine variant. And then there’s a third,
well there’s several, but there’s another one of
interest, where you can have bouts of torticollis, which
is twisting of the neck, kind of stuck in one position
and they can have that for hours to days, and
they can do cycles where they have episodes of that. So we notice kids sometimes
don’t manifest the migraines, they sometimes have some
of these other symptoms. So any symptoms that you’re
concerned about and if they’re happening on a
regular basis, you would talk to your doctor and they
can help you sort it out. Oh, okay, this is a really
interesting question. Does the aura beforehand
have implications to migraine being more severe? The struggle is when
someone experiences their first aura, you have to
take it really seriously. You don’t want to just
say oh yeah, this might be a migraine, someone in
my family has migraine, because if it’s just a loss in your vision or even some things that can
look like a migraine aura, sometimes it can be a sign
of something more serious, and so it’s very good to
talk about your symptoms to a doctor. There are so many different
ways that someone can have an aura, sometimes
people can have tingling in an arm or leg, you don’t
want to miss a stroke. So if you have a new episode
of a neurologic symptom, even if it comes and goes, if it’s the first time
you’ve experienced that, I would definitely
mention it to your doctor. Now, once they’ve determined
that you have migraine, – [Hospital Announcer]
Your attention please, will Amanda Cooper – Sorry, we’ll pause (laughs) – [Hospital Announcer] call
security at 63305, Amanda Cooper call security at 63305, thank you. – Well, hopefully Amanda
Cooper gets in touch with them, I don’t know if you could
hear the overhead, that’s why we were pausing, but
so once they’ve determined that your symptoms are
related to migraine with aura, and they think okay,
you’ve got either episodic migraine with aura or
chronic migraine with aura, if it’s visual or sensory,
but if they’ve made that determination and
you’ve had the same sort of neurologic symptom every time, we become less and less concerned. And the type of aura, whether
or not it’s a sensory aura versus a visual aura, that
doesn’t necessarily make us more worried about your
headaches and it doesn’t necessarily change the
prognosis, meaning we can’t tell if someone has a
certain type of aura that they’re not gonna respond
to certain medicines. Oh, okay, and this is
one of the first comments that we got, so I’m glad they reminded us, there was a question
related to someone who may have migraines and who may
have sustained a brain injury of some sort and was
having issues with smell. The question was whether
or not migraines can cause loss in smell, and is there a treatment for olfactory damage? It’s very interesting
because we mentioned light sensitivity, sound sensitivity,
patients with migraine can also experience sensitivity to smell. So actually, their smells
are usually enhanced. We have to be very careful
in the headache program, we can’t wear perfume, we
don’t wear fancy shampoos, because our patients can really notice it, so the fact that the person
who sent it in their comment is having difficulties
with smell, I would suspect that’s more related to
the brain injury or what might have happened to
the olfactory bulb, rather than related to migraines. If that is a concern, I
would definitely mention it to your primary care
doctor or your rehab doctor to see if there are some
ways that you can rehab from that, or testing,
if any testing is needed. Okay, so if there are any
further questions related to that, you can always
make an appointment with us in the headache center
and see if we can help. Okay, so I think we’re
gonna be wrapping up, and I really, really appreciate your time, and coming and logging
in and listening to our session, and definitely
spread the migraine awareness. I wanted to list a few
places you can go if you want more information. One would be the American
Migraine Foundation. We call this AMF. This is a wonderful
resource, it’s on a website, and you can go and there’s
a lot of information about all different types of headache. We only spent most of the
time talking about migraine, but there’s a lot of
different types of headaches that are on that website. And AMF is very involved,
and right now, because of migraine awareness month,
they have a hashtag that you can follow on Twitter, called hashtag moveagainstmigraine, and they’ve also launched a Facebook picture that
has a purple ribbon, purple because of migraine
awareness, so you may notice some people are
doing that on Facebook. And the AMF is hosting a
tweet chat, which is on Twitter, which is gonna
be on Wednesday at 5 p.m. as part of our national
conference, and I’ll participate in it, and several other
headache specialists around the country are gonna answer
questions about migraine and other types of headache,
and what advances are coming out in headache research. So definitely check that
out if you’re on Twitter. And so I’m very involved
in the national scene as part of the American
Headache Society, and I write a monthly column looking
or trying to share what is fascinating and
new in headache research, so if that’s something
that you want to follow, you can go to the American
Headache Society webpage, Headache and then News, and
you can search under my name. And then thirdly, I want
to point out the patient organization, which is
called AHMA, it’s A-H-M-A, it’s American Headache
and Migraine Association. This is a patient run group,
and they are very active, they’re active in fundraising,
and they’re active in education and support groups. So if that’s something
that you need, I would encourage you to reach out to AHMA. They’re even organizing
now at this point national conferences for their patients. So I really want to thank you. Thank you so much, and
definitely let us know if any comments or questions come up.

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