October 15, 2024 • 40 mins
Today’s episode is all about migraines, a debilitating condition that affects millions of people worldwide, including our very own Britt. Britt has struggled with migraines her entire life. We’re joined by Dr. Kaitlyn Parratt, a neurologist who specialises in headache disorders and epilepsy.
We speak about:
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Why women experience migraines more than men
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Periods of our lives when you might experience them more
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How hormones and other triggers affect migraines
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The genetic component of migraines
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The physical and psychological toll they take
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Treatment options, first and second line therapies
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The process of qualifying for migraine ‘botox’
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Chicken or the egg? Anxiety, OCD, depression and migraines
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Do orgasms help relieve migraine pain?
You can find information and neurologists at Sharp Neurology
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Life on Cut acknowledges the traditional custodians of country whose
lands were never seated. We pay our respects to their
elders past and present.
Speaker 2 (00:07):
Always was, always will be Aboriginal Land. This episode was
recorded on Cameragle Land.
Speaker 1 (00:22):
Hi guys, and welcome back to another episode of Life
on Cut. I'm Brittany and I'm Laura, and today we
have a bit of.
Speaker 3 (00:27):
A different episode for you. If you've been following along
for a little while my story or.
Speaker 1 (00:33):
My personal instagrams, it's something I've spoken about a lot,
and that is migraines. Like I have been a migraine
headache sufferer for as long as I can remember, since
like probably my early teens. I think, like you know
when you sort of hit puberty.
Speaker 2 (00:46):
I mean, I've known you for what almost six years now, Britt,
and it has been something that has been such a
frequent occurrence for you, Like I mean the amount of
times where old message and You're like, sorry, I'm in
the depths of a migraine and then I don't hear
from you for a couple of.
Speaker 3 (01:00):
Well, that's just my excusee. I'm just in home in Hawaii.
Speaker 4 (01:03):
I'm like, can't contact me.
Speaker 5 (01:05):
And do not just stand.
Speaker 1 (01:06):
It's an unusual one because we talk about these unseen
diseases that women experience, you know Enjimy triosis, hey pcos
pain that can be debilitating, and it's so hard to
explain to another person because you can't see it and
you're like, oh, I've got a headache. You're like, okay, cool,
take a tablet and get over it. Migraines are not
like that, and you feel really guilty. You feel like
you're making it up or someone doesn't believe you. And
(01:29):
I can unequivocally say when I post stories on Instagram
about migraines, it's probably the thing over the years that
I get the most responses for. People want to know
the most about it. There's so many questions, There's so
many people saying, I suffer this too, thanks for talking
about it, this is what I do for relief? Or
did you find this worked? And I thought, wow, this
affects so many more people than we realize, So we
(01:51):
decided to do an episode all around this. I managed
to find an amazing neurologist, doctor Caitlin Parrott, who I
have somehow managed to convince to come in and talk
to us today. She's been treating me for probably sixty
nine months, majority of this year.
Speaker 4 (02:07):
I think we dragged her in here kicking and screaming.
Speaker 5 (02:10):
We dragged we did.
Speaker 1 (02:12):
And she is a specialist in epilepsy and migraines and
sort of other headache related issues.
Speaker 3 (02:18):
So Caitlin welcome.
Speaker 5 (02:19):
Thank you very much, Brittany and Laura, thanks for having me.
Speaker 2 (02:21):
Can I ask because apart from britt the only other
person I have had experience with having migraines was my mum.
But I grew up with my mum having them so
frequently that I knew that she would just be blackout
in her room and it was a fend for yourself
kind of day as a kid. How common is it
for people to get migraines and is there a time
in life where it becomes more prevalent or is it
more prevalent when it's like gendered Yeah, what are the
(02:42):
numbers that we're looking at?
Speaker 5 (02:43):
Yeah, So migraine is incredibly common and that's part of
the problem. So it affects up to fifteen percent of
the population in total, but it affects women more than men.
So between the age of say twenty and forty, which
is probably when your mum was suffering most when you
were a kid. Up to twenty five percent of women
will be getting migraine, so it's a huge number of
people that are potentially disabled by it. And from the
(03:05):
point of view of what stage of life does this occur,
particularly for women, there's two peaks, and that's when you've
got fluctuations in your sex hormones, so estrogen and progesterone
around puberty and heading into young adulthood, and then again
at the perimenopause. But really it can occur all throughout
that lifespan. Tends to drop off after the menopause, and
it does affect men as well, and I think we
(03:26):
can't forget that often it is kind of considered to
be a woman's disease, but I look after a good
number of men who suffer with migraine as well. So
there's obviously mechanisms other than just hormones going into the
cause of the problem.
Speaker 3 (03:41):
So is there actual data that is linked directly to
the hormone headache?
Speaker 5 (03:45):
Yeah, there is. So sex steroid hormones, of which estrogen, progesterone,
and testosterone are the big ones. We know that they
act on organs in our body. But they're also neurosteroids,
so they actually act on neurons and have an effect,
and that's how we think that they promite migraine. So
there's scientific evidence that estrogen is excitatory that increases the
production of some of the substances that drive migraine. So
(04:07):
we know that it's involved to some extent.
Speaker 3 (04:09):
Women just get the short straw and everything, don't they.
Speaker 1 (04:12):
It's like and the more when we're finally putting money
into the research behind things that affect women, which we
haven't done for a very long time, we just keep
finding all these links that we can't escape, like, and
I guess this is the problem. Sometimes you can't escape it.
And I have spent my entire life like this is
the first time in my life at thirty five. Sorry,
I'm thirty six.
Speaker 3 (04:32):
I am thirty seven.
Speaker 5 (04:33):
Fuck shoulder than you.
Speaker 1 (04:36):
Do that really hard, really snuck.
Speaker 5 (04:38):
Up on me.
Speaker 3 (04:39):
Also, you know you're getting old if you can't remember
how old.
Speaker 2 (04:42):
No, you know that you're getting old when you've been
lying about it, so you continuous to get the age wrong.
Speaker 4 (04:46):
You're like thirty five three? How old did I say
I was last week?
Speaker 1 (04:50):
No? So at thirty six was when I got my relief.
Like I'm thirty seven now, but I finally found that
really at thirty six, and it got to the point
where I didn't think there was anything left for me.
I I've accepted, and I used to say to people,
it's okay, it's just how it is.
Speaker 3 (05:03):
If it's okay. It's been like that my whole life.
I've tried what I've tried. But it did peak for me,
now that you say it.
Speaker 1 (05:09):
Fifteen sixteen, when I was getting my little boobies and
I was coming into that age, and all the doctors
at the time just used to say, to me, deal
with it.
Speaker 3 (05:18):
It's hormones. You're coming into puberty. It'll pass. And the
fact is it never passed, and.
Speaker 5 (05:23):
The hormones play a role. But the underlying cause of
migraine is almost certainly genetic. You know, some people have
forms of migraine. We know the gene, we can identify it.
But most people it will be a genetic basis. But
it's complex and it's a complex combination of genes. And
so I say to people I see with migraine all
the time, I probably said it to you, We're probably
never going to cure this. You're always going to be
(05:45):
at risk of having an attack, but what we want
is for you to have less attacks and have a
really good plan to deal with them, so you're not
walking around anxious about when the next one's going to hit.
Speaker 2 (05:53):
What is the difference though, So, I mean most people
get headaches and it's kind of I always look in
it too, you know how when people get the cold
and they're like, I've got the flu, and I'm like,
you don't have the.
Speaker 4 (06:02):
Flu, because if you wouldn't be here.
Speaker 2 (06:05):
So what is the difference between a headache and having
a migraine?
Speaker 5 (06:09):
So headache is a big specialty area. There's lots of
different sorts of headaches from commonplace. You get a bit
dehydrated you're out in the sun. Obviously your vessels in
your brain dilate, stretch your pain receptors, and you get
a bit of a headache. You have to rehydrate and
lie down. Migrains a very specific type of headache. We
refer to it as a primary headache disorder, which basically
means that there's not any underlying lump or bump or
(06:31):
problem with your blood vessels in your brain or anything.
Your brain structurally looks normal, but intermittently and episodically there's
some sort of dysfunction that drives this very typical type
of attack. So a migraine, we think now, starts in
the neurons and a process is activated by where you
get this spread of activity through the brain we call
cortical spreading depression, which then activates areas specifically in your
(06:55):
trigeminal nerve and your upper ceviacal area in the spine,
which then results in the relief of all of these substances,
which causes inflammation in the blood vessels and the meninga's
which is like the glad wrap around your brain, which
causes the throbbing, very sort of recognizable migrantous headache. So
the nature of the headache is different. The way the
headache evolves from the brain signals to that inflammatory process
(07:18):
is different to you know, your run of the mill
tension headache or dehydration headache.
Speaker 2 (07:22):
What are the symptoms and the signs that well, I
guess the signs more so that if someone's experiencing it,
they can go okay, this is what characterizes a migraine,
and I know that that's what that is.
Speaker 5 (07:32):
Now so if you can broadly divide migraines into classic
migraine without aura, classic migraine with aura ache, caphalgic migraine,
which is where you get the aura but no headache,
and then there's the menstrually associated one. So a typical
classic migraine, someone will often get a prodrome fatigue, agetation, hunger,
and then the onset of a headache. And the headache
(07:54):
is often on one side of the head, it might
change sides in between attacks. It's throbbing, it's really quite severe,
and then it's followed by nausea some people vomit uncontrollably
at times, and photosensitivity. So don't want to be around light,
don't want to be around noise sometimes smells can drive
you crazy, and really just want to be very still
because every movement, bending, what have you exacerbates that headache
(08:16):
pain and that's quite different to you know you say,
you know, tightness around the front of your head with
at tension type headache, et cetera. So you can really
make a diagnosis of migraine just talking to someone about
their history without any auxiliary tests.
Speaker 1 (08:30):
Mine have always been the same side, so mine's always
the same spot, which is really interesting.
Speaker 3 (08:36):
That's why I thought I had a brain tumor or something.
Speaker 1 (08:38):
I was like, how can this just be a migraine
every day like in the same area. So it's interesting
because that's I think that was one of the things
for me that differentiated too. I don't want to scoot
over something you just said. You just said that there's
literally a gene for hormone.
Speaker 5 (08:51):
So now there's there's a gene for some forms of migraine, right,
So there's a particular type of migraine called for mid
little hemiplegic migraine where the aura, which haven't talked about yet,
but that's the neurological phenomena that can go along with it,
is where the person gets a terrible headache and actually
can't move one side of their body. And they've identified
the gene that causes that.
Speaker 2 (09:09):
Well, yeah, so, brit when you get migraines, what are
the things that trigger it for you?
Speaker 1 (09:14):
I cannot pinpoint a trigger, which is annoying because it
means I can't actively avoid something, but I know they're coming.
I'll feel it, and I feel a very particular way,
and I don't know how to explain it.
Speaker 3 (09:24):
You feel a bit nauseous.
Speaker 1 (09:26):
You start and you start to get the throbbing pain.
It just you can just tell when you've experienced it
that it's different from a normal headache. And I now,
thanks to Caitlin, have a bunch of different medications for
different things.
Speaker 3 (09:37):
So I have medication that I can.
Speaker 1 (09:38):
Take straight away that will hopefully stop it before it
gets that far. But most people that suffer them feel
them coming for quite a long time. Like you get that,
you get that nauseous feeling and I need to just
lay down straight away, I need to turn lights off.
I have only ever once, like part of my symptoms
are I vomit quite a bit from them when they're extreme,
(09:58):
But only once have I had vertigo, where I have
never experienced anything like it. I could not turn over
onto my side in my bed without vomiting. You cannot move.
It is the craziest thing I've ever had. And that's
the only time I have personally had that. So for me,
it's light sensitivity, noise sensitivity, which is hard, exactly what
Caitlin said.
Speaker 3 (10:19):
I don't want to move. I don't even want to
walk to.
Speaker 1 (10:22):
The fridge to get a drink, Like every step feels
like you are being electric, like a shock through your body.
And then yeah, the vomiting is not every single time
for me, probably every three to four times I'll get
like a vomiting migraine. But for me they've always been
unavoidable and I could take as much medication as I wanted.
Speaker 3 (10:39):
It did nothing like you have to have.
Speaker 1 (10:41):
What I have found for me is I had to
have this really special specific migraine medication for it to
have helped, and I had to go down the track
of getting these botox treatments, which we will get into.
Speaker 2 (10:51):
Well, I would love to know that's your specific experience.
What are the general triggers for most people?
Speaker 5 (10:56):
Yes, So, as Brittany said, some people don't have triggers.
We always look for something because if you find something
that you can fix, then maybe you'll avoid the attack.
Many people don't. But the common things that people do
describe are variable. So foods and particularly things like chocolate, cheese,
all the good stuff in line, alcohol including red wine.
I do sad.
Speaker 3 (11:14):
I have a lot of the above.
Speaker 5 (11:15):
Yeah, And then there's lifestyle things and not getting enough sleep,
increased stress, dehydration, poor nutrition, and then there's sort of
more odd things. I guess that are more specific to
unique people. But some people say it's this change in season,
change in weather, certain odors they smell, light exposure could
trigger the attack, And as Brittany was saying, the warning
can be that sort of odd. I can't quite describe this,
(11:38):
but I know it's coming, or it can just be
the pain, but it can also be this aura that
I was talking about, And that's the neurological manifestations people have,
and that can range from visual disturbance where you could
maybe see bright lights, feel like you're looking through water,
can get tingling up one side of the body. Some
people aren't able to speak or create language at the
time of a migraine, and the dizziness and vertigo is
(12:00):
and that's the stibular aura. The aura sensation may be
different for different people as well, so.
Speaker 1 (12:05):
People that have those like, is an aura migraine any
different to a normal migraine with someone that doesn't get
the aura.
Speaker 5 (12:11):
No, It's thought to be the same process within the
brain that thing I talked about, where the electrical activity
spreads through the brain before you activate. All the pain
pathways may travel across an area of your brain that
you're conscious of, like your sensory area or your vision
or your speech, but it may also cross over a
part of the brain that you don't have conscious awareness of,
(12:32):
so maybe your balance center or your gut. And so
in that case, you're not going to get a neurological sensation.
You're just going to go from prodrome to pain.
Speaker 4 (12:41):
That's so interesting, isn't it.
Speaker 2 (12:42):
And also, I mean, considering that people and some people
deal with this so frequently, my next thought is if
someone doesn't seek any sort of medication or management for this,
can being a migraine sufferer cause long term health effects?
Can there be long term problems of being a micrain sufferer.
Speaker 5 (13:01):
Yeah, I mean absolutely, and in two ways, physical and psychological,
because you know, having pain all the time is hard,
it's hard to do normal things. You expend more energy.
Can absolutely be associated with depression and increased levels of anxiety.
From a physical perspective, yes, as well just from a
normal lifestyle perspective, because you're not going to be able
to do all those things to look after yourself as
(13:21):
you would. Migraine is associated with a number of other
medical conditions, including cardiovascular disease rarely stroke. These sorts of things.
So yes is the answer, both physically and from a
psychological and life perspective.
Speaker 1 (13:37):
Yeah, what way is the association when you say it's
associated to other health conditions?
Speaker 3 (13:42):
Like what comes first? The chicken or the egg?
Speaker 1 (13:43):
Does the migraine come as a byproduct of cardiovascular disease
or does the cardiovascular disease come as the byproduct of
the migraine.
Speaker 5 (13:49):
And that's a very good question and a question we
don't know the answer to. So those sort of associations
are based upon looking at big data about this person
has migraine and what else do they have? Andred of
people things like anxiety and depression. Again, it still is
chicken or eggs, So more people with migraine probably have,
you know, a variety of anxious personality trays. We always
(14:11):
joke huge amounts of neurologists have migraine, and we joke
that it's because we're all a bit obsessive, compulsive and
mildly anxious, and you know helper bees who can't say no.
But that does associate. But also, as you would have experienced,
you become anxious because you're like, my god, I've got
to go out today, I've got to do this. I've
got all these things. What if I get a migraine.
Speaker 3 (14:30):
I would and let's talk about the anxiety side for
a while.
Speaker 1 (14:33):
I would get really anxious if I didn't have and
I have it in my back now, If I don't
have painkillers in my bag and I took the wrong
bag and I didn't have them, it would give me
anxiety because I thought, if I'm not nearest somewhere that
can stop this.
Speaker 3 (14:45):
It used to really worry me. But a big part
of the.
Speaker 1 (14:49):
Psychological side that I have experienced, and I believe we
spoke about it maybe our first console, and I probably
got upset about it. But a huge part of me
not knowing if I want to have kids. And this
might sound over the top to a lot of people,
but was my migraines. I every single time I got
a migraine, I was like, I couldn't have I physically
(15:10):
could not have a child right now. And I always
think what if I had a baby or a kid,
because it is properly debilitating, and I still think about
that every day. Like I had a migraine just a
couple of weeks ago, which was the first one I've
had in a while, and I just thought, in my
situation with Ben, my partner who lives overseas, I thought,
if I had a child right now and I was
(15:30):
living alone, what would I do? I was trying to
run through my options. I was like, would I have
been able to call Keisha and say, I'm so unwell?
Now can you come? And I'm like, but you can't
rely on It's no one else's issue, right Like, you
can't be relying on those people. And a big part
of the fact that I'm thirty seven and haven't had
a child is because I don't think I could have
done it with this condition.
Speaker 4 (15:52):
What's the normal length of time that someone might suffer.
Speaker 5 (15:55):
For I meant in the headache classification thing, you know,
it's a headache lasting between four and seven into your
two hours. So once it goes beyond seventy two hours,
we call it status migronosis, which is continuous migraine and
have to implement a whole new management plan. But they
can go for a long time, And you're right. And
I look after a lot of women with epilepsy as well,
and they have very similar concerns and worries about what
(16:16):
if I have a seizure when I'm looking after my baby.
So these things are faced by many people with particularly
these disorders which are characterized by recurrent episodic events. You're
totally normally in between and then you're pretty much completely
not able to function when you're having the attack. So
it is tricky, and I think planning, optimizing your treatment,
(16:39):
having action plans not just to treat you but to
manage your life are the sort of things that you
have to become creative with when you start to have
your kids.
Speaker 4 (16:47):
What does that look like?
Speaker 2 (16:48):
So what for a lot of people, what are the
treatments that are available, the treatment plans. I know you've
spoken heats on the podcast around botox for migraines.
Speaker 3 (16:57):
Yes, but that's not an easy place to get to.
Speaker 5 (16:59):
No, I know.
Speaker 2 (16:59):
And I also so we're not promoting because we can't.
We're just talking about different treatment options. But I think
it's really interesting to know, like what does that look
like for someone because I think a lot of people
live with this type of stuff thinking that there's nothing
that can be done or it's just a byproduct of
you know, just.
Speaker 4 (17:13):
Being a woman and being alive.
Speaker 2 (17:14):
What would be the first steps and how does one
kind of go down that treatment path.
Speaker 5 (17:18):
Yeah, you absolutely spot on. I always think of this
woman I saw and she'd had migraine for thirty years.
We can do this, we can do that.
Speaker 4 (17:24):
She's like, really, well, that was me too.
Speaker 1 (17:26):
I was like, I can't believe there was something that
could be done. Seventeen years I've had it. My dad
has had them. Talk about the genetical link. My dad
has had them his entire life, and I don't think
he's ever gone and gotten proper heir.
Speaker 4 (17:38):
But that's interesting to me, ber it.
Speaker 2 (17:39):
Does that mean that you've never really brought up with
a GP before or does that mean that a GP
didn't give you solutions for it? Like, because it's to
me quite unusual. That's something that's a medical problem that
you've dealt with so frequently you wouldn't have just at
least mentioned it to a GP.
Speaker 3 (17:53):
It's a bit of A and a bit of B.
Speaker 1 (17:55):
So in the early days, I guess the treatments maybe
weren't as known. And I said the early days we
are literally talking when I was fifteen years old, right,
So there was a big period there where I went
and got the MRI scans. I went and got the
scans of people like let's investigate this and this and this.
Let's se if you've got an allergy, your brain's fine.
So it was sort of like you're on your way,
like it's just something that you'll either grow out of.
Speaker 3 (18:16):
Actually, I remember a.
Speaker 1 (18:17):
Doctor at fifteen saying you'll probably grow out of it.
It's a hormonal thing. So when you're told that, for
about five years, I just got into this train of
this is how it is. Like there's no you know,
I didn't ever think to go back to a doctor
and say, hey, I'm still getting my headaches. Like I
just in my head, I was like, why would I
waste my time? There's nothing that you can be done.
Speaker 5 (18:36):
And it's funny, more often than not, when I'm taking
a history from a patient about some other problem, I
will say, you know, what are you past medical history
and write it all down, and then halfway through the
consultation they go, oh, yeah, I get migraine, but it
hasn't been put on their radar to be a real
priority from the perspective of their care. Yeah, the treatment wise,
there's lots of things we can do. So you know,
when I see someone with migraine for the first time,
(18:56):
we talk about acute therapies, which is to try and
try to eat that attack, reduce its severity, shorten its length,
get you up and going as quickly as possible. And
the other treatments are preventative. And that's if you're getting
you know, at least one a fortnight, they're starting to
interfere with your life, make you anxious, then you need
preventive therapies which will reduce the frequency of attacks and
hopefully the severity as well. And I always think about
(19:19):
management of any medical problem as we've got medications that
we can use, but you've also got to look at
the lifestyle side of things, sleep, stress, nutrition, and your
psychological well being because they all feed into one another.
But medication wise, the trick with migrain is treating as
early as humanly possible. So when you get that warning,
that's when you take your medication. You don't wait because
we all tend to go, oh, it's not too bad,
(19:40):
I'll just put up with it a bit longer. Whereas
early treatment is we know is advantageous, and we use
a combination of aspirin. Sounds ridiculous, but it's an anti
inflammatory painkiller paracetamol, which is a central painkiller and then
a trip down which is a specific type of migrain painkiller.
Speaker 4 (19:56):
And what does that do.
Speaker 5 (19:57):
So it promotes the release of serah toomee which acts
upon those blood vessels and the miningjis in the brain
to reduce the sensation of pain.
Speaker 1 (20:07):
So what does it take then? For this was a
question I was getting a lot for the general person.
Everyone was like, Oh my god, what is your neurologist name?
Where does she work? I'm going to book in, But
it's not as easy as just like going and calling
up in EUROLGIS and booking in.
Speaker 3 (20:20):
You have to go through a process. So can you
talk us through that?
Speaker 5 (20:22):
Correct? So you know, acute therapy like that. If you
go and see your local doctor, tell them your symptoms,
they recognize its migraine. You can start on that sort
of treatment program and if you've attacks become more minor,
you just use aspird and panetal and save your trip
down for later. There's a new acute medication which I
can tell you about later as well. But from the
point of view of getting to what am I going
to do to prevent these medications? As I said, if
(20:44):
you're getting one a fortnite it's interfering with you getting
to work, looking after your kids, enjoying your life, then
prevention is warranted. And at the moment we have first
line therapies and then second line therapies. You need to
have tried three first line therapies before you're eligible for
second line therapies. You gp can initiate those and then
refer you on too a neurologist. If they don't work,
then you've got all of these options to discuss. And
(21:06):
those medications are really all repurposed, so none of them
are specific to migraine. They've all been repurposed for migraine
prevention when used for other conditions. So includes things like
riberflav and vitamin B six amitriptolene, which is an old
fashioned antidepressant but again has an impact on the transmitters
in the central nervous system. To reduce migraine, there's a
(21:27):
bunch of blood pressure lowering agents which can be used
as long as you don't have low resting blood pressure,
and the use of them is based upon both theory
of how migraines evolve and noticing. Say, for example, a
group of people were treated with X medication, they also
had migraine and that's settled down, So sometimes it's just serendipity.
And then there's a number of anti seizure medications which
(21:48):
can be used as preventatives as well, and your choice
there depends upon what other medical problems people have. As
I said, they're blood pressure, whether they're of childbearing age,
because we might not want to use the anti seazure
medications for headache prevention.
Speaker 2 (22:01):
Why is it that a person who gets migraines has
to go through these three sort of like milestones first,
these three sort of entry options before they can go
through to a neurologist.
Speaker 5 (22:11):
Well, look, they could go straight to a neurologist to
discuss these And I certainly get people who've literally seen
their GP, they've got migraine, they've been given a trip
down and they come and see us. It's more the
process of a prescribing because those first line therapies are
you know, they're easily available, they're inexpensive, and for a
significant proportion of people, they're perfectly adequate and they'll control
(22:34):
the migraine attacks. Yeah, second line therapies, you know, we
would love to be able to give more people second
line therapies. First up, because we know they've got higher efficacy,
but they're obviously more expensive. For the botul anemtoxin, you
need a procedure done. And the CGRP antagonists, which are
the newest group, we've only really had them available to
us in the recent past. So part of it's I guess,
(22:57):
choosing the least complicated financially access correct which will work
for a lot of people, and then escalating, which is
the same sort of process you'll see with regards to
prescribing in lots of specialties, you know, ecology, neurology, all
those sorts of things.
Speaker 1 (23:12):
It does seem strange that from our point of view,
like from a plebs point of view, we're not a neurologist.
You can go and just book in tomorrow to get botox,
right if you want to wrinkle for esthetic reasons, if
you want to clear your wrinkles.
Speaker 3 (23:24):
But what I found so strange is I was like, Wow, I.
Speaker 1 (23:28):
Can get botox for a wrinkle like that, But to
get something that is going to literally change my life
was just so many more steps and so many more
hoops to jump through. But apart from that, I didn't
know it was available, And that's why, I guess we're
having these discussions so people know there are other options.
Speaker 4 (23:44):
Is the reason for that though?
Speaker 2 (23:45):
Because of the volume, Like are you getting like massive
doses when it's in your neck and your head and
everywhere else.
Speaker 5 (23:51):
Or is it you are getting a decent volume, So
you need two viyls per patient. So the cost of
that is significant and the government subsidize it. So if
you qualify for second line therapies, you know there are criteria.
You have to have fifteen head eight days a month,
eight of which are classic migraine. You've tried three therapies.
Then the Pharmaceutical Benefit Scheme says, look, this is a
good investment here because if we use this efficacious therapy,
(24:14):
this person's going to get back on their feet. So
that's going to be working and paying tax dollars exactly. Yes,
you get them wrinkle free and ready to get back
to work. You know, it does seem ridiculous. And as
healthcare providers, I mean, we're all, you know, at the
end of the day, most of us are altruists and
wish we could just use the very best, brand new,
best tolerated medication for everything we do. But health economics,
(24:37):
as you indicate it does intervene. So that's the process
and that's why it does take time. But people not
knowing about it is a tragedy.
Speaker 4 (24:44):
How does botox work though?
Speaker 5 (24:46):
For it?
Speaker 2 (24:46):
So saying that it's been something that's I guess newly
discovered as being very efficacious, what is it about it
that is so beneficial and how does it work?
Speaker 5 (24:54):
So no one really knows, but it works.
Speaker 2 (24:59):
So that's however somebody there we discover this. I think like,
who's the first person that thought that's a good idea.
I'll shove two vals of that in my deck.
Speaker 5 (25:07):
So one of the major theories is the other thing
that drives a migraine is this thing called sensitization, so
pain sensitization, which refers to this process where your neurons
become more responsive to a certain pain or noxious stimuli,
and then your threshold for having those symptoms lowers, Your
response to that magnifies, and it spreads, so it perpetuates things.
(25:29):
So botchylineum toxin pretty much switches off one of those
sensory receptors in the proofery, so then their feedback into
your brain is altered. It's down regulated, and we think
that desensitizes those areas of your brain that are responsible
for experiencing the migraine attack.
Speaker 1 (25:46):
So I think I'm going to get this wrong, but
I remember you telling me one of our consults. You
said that there is a chance that if I do
this for a little while and it works and I
go migraine free, there's a chair ancept it almost tricks
your body, and that when you wean yourself off it,
you don't get as many migraines.
Speaker 5 (26:04):
Is that right correct? So a person with migraine can
have different phases of migraine in their lifetime, just as
you have, you know, high frequency episodic, low frequency episodic,
or chronic. So when you were in your puberty years,
you were probably getting low to high frequency episodic attacks,
which is the only reason you could tolerate it. And
then as that sensitization process escalates, it becomes the more
(26:27):
of a chronic situation. That doesn't mean that we can't
de escalate that and get people back to being low
frequency migrants.
Speaker 1 (26:34):
So can you get them more frequently because your body
expects them? Like, is that why when they're coming more frequently?
Is that your body being like, oh, I know, what
that pain is. Let's go to straight to migraine because
it's like a learned tradition, do.
Speaker 3 (26:47):
You well, what's it like a learned Yeah.
Speaker 5 (26:49):
Like in a way that's kind of like the sensitization
thing we're talking about. So yes, you with time, with
that whole sensitization process, it can require far less for
you to experience that much migrain than what it would
have when you weren't sensitized.
Speaker 3 (27:02):
A better way to say it. What I was trying
to get it, And I.
Speaker 4 (27:07):
Know who the neurologist is in the room.
Speaker 2 (27:09):
Hey, are there lifestyle factors that people can change that
help to either minimize the severity or minimize the number
of migraines people are receiving?
Speaker 5 (27:19):
Yeah, I think so. And as I said, I'm the
threefold neurologist, medications, lifestyle, and psychological well beings my sort
of mantra. So lifestyle things that we know can be
triggers for people are poor hydration, so we need people
to stay well hydrated, eat regularly, so often starving yourself
for long periods can trigger things. Good sleep, so sleep
deprivations are classic, which is why I got my first
(27:42):
migraine when I was postparted.
Speaker 2 (27:43):
So fun for all the new mums out that, which
comes back to the anxiety.
Speaker 5 (27:47):
Yeah, and stress. You know, stress is not just a
psychological thing, it's a physiological response, and we throw out
all of our stress hormones that bathes our brain and
again that makes us more prone to migraine, a seizures,
all of these sorts of things that affect the nervous system.
So actually really proactively dealing with that can help.
Speaker 2 (28:06):
Can migraine be a byproduct of other illnesses? That can
it be a symptom that something else is going on
in your body that needs to be addressed.
Speaker 5 (28:14):
Not in the sense that it is a primary headache disorder,
so there isn't an underlying cause for it.
Speaker 2 (28:18):
Like it's not like you're going to be cancer here,
that's why you've got a migraine.
Speaker 5 (28:21):
Correct night, right. So it's a primary problem, it's a
dysfunction of the nervous system, but it can absolutely be
exacerbated by other illnesses. And I went through a period
during the COVID pandemic when my migraine patients had come
back and said it's not working, and it was just
that they'd had COVID and that was an absolute trigger
for people with migraines, and that was solid migraines for
a period of time.
Speaker 1 (28:41):
Right. Yeah, So talking about the botox treatment, because that
was obviously what I ended up having and what was
of a lot of interest to people.
Speaker 3 (28:50):
Is that protocol that you get that I get.
Speaker 1 (28:53):
Is that the same migraine protocol botox protocol that anyone
would get with a migraine or is it more specific
to my kind of migraines?
Speaker 5 (29:00):
So yours is more specific now because we've tweaked it
to you. There's a standard protocol called the preempt protocol
with a series of injections in the forehead, the sides
of your head, the back, neck, and your shoulders. It
traps and that's kind of what we do the first time,
the first couple of times. Then we can be spoke
it to the individual.
Speaker 3 (29:18):
So now I get my forehead and I'm my crosby and.
Speaker 4 (29:24):
You deserve it.
Speaker 5 (29:26):
So there's a sort of saying in migraine therapy where
you chase the pain. So if someone's having more pain
in a particular region, you can put more toxin there
to try to switch off that process in that region
less in other places. I adjust the protocol, often in
the forehead, because when I started doing it, people said
to me, I love this. My migraines have gone, but
I look funny. So it did cosmetic training so that
(29:47):
you know a lot of people are young women, so
that you can inject in the same muscle get the
same effect, but not have people having esthetic side effects,
which you know they're not the main priority, but they
do matter to people.
Speaker 3 (29:58):
You don't want to drop an eye lid on some
eye on somebody.
Speaker 5 (30:00):
Correct, I've got to have that in mind.
Speaker 2 (30:03):
You also don't want someone to forego treatment and suffer
with the migraine because they're worried about how it's going
to impact the way they look.
Speaker 5 (30:10):
Correct, And we can always wiggle things around. If people
don't want anything to affect their appearance, then we can
just slightly move it, say muscles, just different areas. And
definitely if people have a focus of pain, say in
one side of their neck or one shoulder, we can
move the injections around a little bit, but pretty much
just stayed to the same dose in the same region.
Speaker 1 (30:29):
Speaking about tweaking the treatments, I don't know, Caitlin. If
you have seen my video, I posted on Instagram that
my fiance and I'm Bana. We're learning this first dance.
If you haven't seen it, please go and watch it.
Speaker 3 (30:40):
It is hilarious.
Speaker 5 (30:41):
We bring back memories of my own attempt.
Speaker 1 (30:43):
Well, no, because I so my last treatment with doctor Parrott.
We had to tweak it more to me because my
migraines were really good. They weren't coming, but I was
getting a lot of other pain that was still problematic,
and a lot of that was coming down the front
of my neck from the side of my skull. So
we decided to do some injections in the front of
my neck and in a muscle there, and some extra
(31:04):
injections that we hadn't done before down the side. Ah amazing,
right Like in terms of how I feel, I want
it to be known, and I haven't told you this yet.
Speaker 3 (31:12):
I could not hold my neck up. It was like
a fool.
Speaker 4 (31:15):
I couldn't turn my neck. I had to turn like
a robot.
Speaker 1 (31:18):
All the muscles were so relaxed, which was brilliant for headaches,
but hilariously, I couldn't do anything with my neck and
just this week I feel like I've got more movements
because it must be slowly wearing off. But Ben would
dip me in this dance we're practicing, and I couldn't
get back up.
Speaker 5 (31:32):
My hand was just like flat.
Speaker 1 (31:37):
Stop talking about it, because I want people to know
as well. I don't want people to just be like,
oh cool, you just go get your botox and there's
there's no repercussions.
Speaker 3 (31:44):
Obviously it's dependent on everyone.
Speaker 1 (31:46):
But at the end of the day, the front and
the back of my neck have been relaxed, and they
were very relaxed, but to the point that like, even
if I wanted to lay up out of bed, I
had to get my hand behind my head and pull
myself up.
Speaker 3 (31:58):
I couldn't just sit up anymore. And if for me
it's what's more important.
Speaker 5 (32:02):
It's important to talk about though, because you know, and
when we discuss doing the procedure, we say the main
potential side offict is weakness. So to weaken muscles, we
might weaken them too much, and so it's important to
know that. I've had a number of people come and
say I love it, but I'm having trouble at pilates
for same reason. And then we just omit those neck extenses,
you know, for a cycle or two until you feel
(32:23):
like things are back to normal. The beauty of the
treatment is it wears off, as you say, but it's
really important to make that known because it's not a
sort of This is magical and there's no potential issues
with it, just like any medical therapy.
Speaker 2 (32:36):
What would you say to people who are listening to this,
Because I think the vast number of people who are
going to click on this episode and really want to
listen to it are either going to be people who
have migraines themselves or they have someone who they love
dearly who is absolutely in the depths of suffering from it.
What is your first piece of advice to someone who
hasn't started any sort of treatment process for their migraine
but is really really suffering.
Speaker 5 (32:57):
First thing to do is to go and talk to
your local doctor. Talk to your local doctor, say I
think I've got migraine and see if that is exactly
what you've got, so get a diagnosis made. If there's
red flags, you know it's a new on set headache
and an older person or other things that we look for,
you might need imaging to confirm that and then they
can start you. As I said, on an acute treatment plan,
they can begin the first line preventatives and if it's
(33:19):
been going on for that long, get a referral at
that point to see a neurologists because there will be
wait times to be seen, and then they can cycle
through various preventatives, see if there's a response, and then
talk about the second line therapies if those haven't been successful.
Speaker 1 (33:33):
Generally speaking, what happens to a migraine sufferer when they
fall pregnant?
Speaker 3 (33:38):
Does it increase? Does it decrease? Are they still treatments
you can take?
Speaker 5 (33:41):
Look thankfully, most of the time it decreases, which is
kind of odd because your estrogen levels go up, but
so levels of other hormones as well. It's problematic in
pregnancy because we can't use a lot of the therapies
that we use when people are not pregnant. So we
can't use aspirin except in the second trimester. We try
to avoid trip dans though if it's significant and we
(34:02):
talk to the obstetrician about risks. Sometimes people use them,
but generally they're not indicated in pregnancy, so it does
become an issue, and so we often have to utilize
slightly more creative things, you know, fluids, magnesium. Sometimes people
need to have short doses of steroids, so there are options.
But thankfully often it kind of gets better during that period,
(34:22):
and then when you've got your baby and you're horribly
sleep deprived and stress, you can take all the drugs again.
Speaker 1 (34:27):
So basically, once I commit to pregnancy, I've got to
commit for life.
Speaker 3 (34:30):
I've got to be pregnant like NonStop.
Speaker 4 (34:33):
No, no, please don't do that. Trust me that I'll
give you a few migraines as well.
Speaker 1 (34:38):
But the last thing that I wanted to ask you
was what are the some of the newer and more
progressive treatments that have come out.
Speaker 5 (34:44):
So the newest treatment we have available to us are
a class of drugs called CGRP antagonists. CGRPs like a protein.
It's one of those substances that I said was released
from that trigeminal region when the migraine is activated. We
know that that's involved in a cascade causes a migraine,
and that was identified because they found higher levels of
it in people suffering migraine. And these medications are either antibodies,
(35:07):
so just like we'd make to a virus, you inject
them into yourself. They float around your bloodstream connect to
the CGRP as though it was a virus in your
immune system destroys it. So then even though you may
still have that predisposition to start the migraine, once it
gets to needing that protein to cause all the inflammation,
it stops. So people have a lot less attacks.
Speaker 1 (35:27):
Well, knowing that it's so hormone related, does that mean
as we age and you know, maybe our forties or fifties,
maybe when perimenopause starts, do they decrease or the idea
of perimenopause and menopause because your hormones are changing so rapidly. Again,
is that when we get another influx of migraine it's.
Speaker 5 (35:46):
The second one sat so that the two peaks are
in that you know puberty bit where you've got fluctuations
in estrogen progesterone and then in the perimenopause, but it
falls off after the menopause. So there is potential and
get relief at sixty. Maybe it doesn't happen to everyone.
Not every migraine sufferer has the same patterns. Some people
(36:07):
will have an upshot in perimenopause, some people won't. So
I think it's just being aware of it and having
it on your radar and not suffering through it if
you are one of those people that it happens to.
And again, you know, there's all sorts of different approaches
we can take in those sorts of circumstances.
Speaker 3 (36:23):
Is this a myth or maybe Ben just told me this.
Speaker 4 (36:27):
I'm not sure if his person, I'll be taking medical advice.
Speaker 1 (36:30):
Well, you'll laugh on youre do orgasms help relieve pain
and medicate and like migraine that kind of a thing.
Speaker 2 (36:37):
Imagine if you went to a neurologist and they were like,
you know what, you need more orgasms.
Speaker 5 (36:41):
I've sort of this one happened.
Speaker 1 (36:43):
Imagine if Ben's like, baby, I've been doing some research.
Speaker 4 (36:45):
Apparently, Yeah, get on your way.
Speaker 5 (36:51):
Look, there's two answers to that question. One is no
and one is yes. So the no answer is that,
in fact, sometimes sexual activity and orgasm can trigger headaches,
whether they're migraine headaches or there is a specific type
of headache called benign sex headache, where people have sex
climax and then they develop a horrible headache.
Speaker 4 (37:09):
That's a headache.
Speaker 3 (37:10):
Benign sex headaches.
Speaker 5 (37:11):
A headache, benign sex headache exactly every day is a
school day here in the classification.
Speaker 4 (37:16):
Wow, there's all sorts of.
Speaker 5 (37:17):
Weird and wonderful things. But to the contra of that,
an orgasm would result in release of endorphins, and they
are natural opioids. So look, maybe, but probably not really,
So risk it for the biscuit.
Speaker 3 (37:32):
Give it a whirl, see.
Speaker 5 (37:33):
What have Don't avoid it entirely, I guess is the thing.
Don't avoid it, but I'm not sure that it's not
gonna hell. It's not a recognized therapy, but it could
be analgesic.
Speaker 1 (37:42):
It might help well, to be honest, like you would
have to do it when you feel the migraine coming,
because no one's in the depths of the migraine is
having sex, like no one's being pounded.
Speaker 2 (37:51):
Yeah, imagine your partner trying to convince you that's not
like you're not being like pain pound me. I've got
something that's going to make you feel better, sweetie, go in.
Speaker 5 (38:01):
When you say like that. Yeah. I actually asked my daughter.
We've talked about myths and misconceptions when we were thinking
about this podcast, and I said, what do you think?
And she gets migraine and she said, you know, the
biggest misconception mum is people think it's just a headache
and it's actually so bad. And so I think that's
the thing, is to give people the empathy that they
(38:22):
need and power people with migraine to say, well, what
are we going to do about it?
Speaker 1 (38:25):
Do you prefer people to when they have reached you,
to have already had, say an MRI scan or a
CT scan.
Speaker 3 (38:32):
Is that sort of a prerequisite for you? Are you
going to send them there anyway?
Speaker 5 (38:35):
Look, it's not a prerequisite, it's I think most people
in twenty twenty four who present with headache will end
up having a scan. As I said, it's a clinical diagnosis.
But you know, we've got access to imaging every now
and then you get a surprise. So yes, you know
imaging of your brain, including your blood vessels is helpful.
But if you haven't had it, and you're a typical
migraine sufferer, you know you don't necessarily need it.
Speaker 3 (38:55):
Did you get my back scan this week?
Speaker 4 (38:57):
Have you looked at that yet?
Speaker 1 (38:58):
I have a look, kay, I was going to get
I was going to the results. Yeah, I got my
MRI I sent to you, So we'll talk about later.
Speaker 5 (39:06):
This is a much nicer place in the consultation room.
Speaker 1 (39:08):
Though.
Speaker 4 (39:10):
I'm not sure if I need to be privy to
all the information, but I'll sit through it. It's fine, No,
it's fine.
Speaker 3 (39:14):
Thank you so much for coming on. I really appreciate it.
I know this might seem like.
Speaker 1 (39:18):
Maybe a little bit left field for Lifelung Cut podcast,
but it was something that I just had an overwhelming
response for. And I know that there are so many
people out there like me that are suffering. And if
they're not suffering, I know that there are people that
they know that are suffering, a family member or a
partner or a child.
Speaker 3 (39:35):
I just guess it doesn't discriminate.
Speaker 5 (39:36):
No, it absolutely doesn't.
Speaker 1 (39:38):
We will put the link to your practice. We obviously
are based in Sydney for anyone that's listening. I'm sorry
if you're outside of Sydney. But there are so many
great neurologists. There is like a whole website of where
you can find neurologists. So we will put that link
in as long as you keep space for me if
people feel like scale, and.
Speaker 5 (39:55):
That's my prerequisite always.
Speaker 4 (39:57):
Brittany Al, thanks so much for having a being part
of the podcast.
Speaker 5 (40:01):
Oh that's a pleasure. Thanks for having me, M.
Life on Cut acknowledges the traditional custodians of country whose
lands were never seated. We pay our respects to their
elders past and present.
Speaker 2 (00:07):
Always was, always will be Aboriginal Land. This episode was
recorded on Cameragle Land.
Speaker 1 (00:22):
Hi guys, and welcome back to another episode of Life
on Cut. I'm Brittany and I'm Laura, and today we
have a bit of.
Speaker 3 (00:27):
A different episode for you. If you've been following along
for a little while my story or.
Speaker 1 (00:33):
My personal instagrams, it's something I've spoken about a lot,
and that is migraines. Like I have been a migraine
headache sufferer for as long as I can remember, since
like probably my early teens. I think, like you know
when you sort of hit puberty.
Speaker 2 (00:46):
I mean, I've known you for what almost six years now, Britt,
and it has been something that has been such a
frequent occurrence for you, Like I mean the amount of
times where old message and You're like, sorry, I'm in
the depths of a migraine and then I don't hear
from you for a couple of.
Speaker 3 (01:00):
Well, that's just my excusee. I'm just in home in Hawaii.
Speaker 4 (01:03):
I'm like, can't contact me.
Speaker 5 (01:05):
And do not just stand.
Speaker 1 (01:06):
It's an unusual one because we talk about these unseen
diseases that women experience, you know Enjimy triosis, hey pcos
pain that can be debilitating, and it's so hard to
explain to another person because you can't see it and
you're like, oh, I've got a headache. You're like, okay, cool,
take a tablet and get over it. Migraines are not
like that, and you feel really guilty. You feel like
you're making it up or someone doesn't believe you. And
(01:29):
I can unequivocally say when I post stories on Instagram
about migraines, it's probably the thing over the years that
I get the most responses for. People want to know
the most about it. There's so many questions, There's so
many people saying, I suffer this too, thanks for talking
about it, this is what I do for relief? Or
did you find this worked? And I thought, wow, this
affects so many more people than we realize, So we
(01:51):
decided to do an episode all around this. I managed
to find an amazing neurologist, doctor Caitlin Parrott, who I
have somehow managed to convince to come in and talk
to us today. She's been treating me for probably sixty
nine months, majority of this year.
Speaker 4 (02:07):
I think we dragged her in here kicking and screaming.
Speaker 5 (02:10):
We dragged we did.
Speaker 1 (02:12):
And she is a specialist in epilepsy and migraines and
sort of other headache related issues.
Speaker 3 (02:18):
So Caitlin welcome.
Speaker 5 (02:19):
Thank you very much, Brittany and Laura, thanks for having me.
Speaker 2 (02:21):
Can I ask because apart from britt the only other
person I have had experience with having migraines was my mum.
But I grew up with my mum having them so
frequently that I knew that she would just be blackout
in her room and it was a fend for yourself
kind of day as a kid. How common is it
for people to get migraines and is there a time
in life where it becomes more prevalent or is it
more prevalent when it's like gendered Yeah, what are the
(02:42):
numbers that we're looking at?
Speaker 5 (02:43):
Yeah, So migraine is incredibly common and that's part of
the problem. So it affects up to fifteen percent of
the population in total, but it affects women more than men.
So between the age of say twenty and forty, which
is probably when your mum was suffering most when you
were a kid. Up to twenty five percent of women
will be getting migraine, so it's a huge number of
people that are potentially disabled by it. And from the
(03:05):
point of view of what stage of life does this occur,
particularly for women, there's two peaks, and that's when you've
got fluctuations in your sex hormones, so estrogen and progesterone
around puberty and heading into young adulthood, and then again
at the perimenopause. But really it can occur all throughout
that lifespan. Tends to drop off after the menopause, and
it does affect men as well, and I think we
(03:26):
can't forget that often it is kind of considered to
be a woman's disease, but I look after a good
number of men who suffer with migraine as well. So
there's obviously mechanisms other than just hormones going into the
cause of the problem.
Speaker 3 (03:41):
So is there actual data that is linked directly to
the hormone headache?
Speaker 5 (03:45):
Yeah, there is. So sex steroid hormones, of which estrogen, progesterone,
and testosterone are the big ones. We know that they
act on organs in our body. But they're also neurosteroids,
so they actually act on neurons and have an effect,
and that's how we think that they promite migraine. So
there's scientific evidence that estrogen is excitatory that increases the
production of some of the substances that drive migraine. So
(04:07):
we know that it's involved to some extent.
Speaker 3 (04:09):
Women just get the short straw and everything, don't they.
Speaker 1 (04:12):
It's like and the more when we're finally putting money
into the research behind things that affect women, which we
haven't done for a very long time, we just keep
finding all these links that we can't escape, like, and
I guess this is the problem. Sometimes you can't escape it.
And I have spent my entire life like this is
the first time in my life at thirty five. Sorry,
I'm thirty six.
Speaker 3 (04:32):
I am thirty seven.
Speaker 5 (04:33):
Fuck shoulder than you.
Speaker 1 (04:36):
Do that really hard, really snuck.
Speaker 5 (04:38):
Up on me.
Speaker 3 (04:39):
Also, you know you're getting old if you can't remember
how old.
Speaker 2 (04:42):
No, you know that you're getting old when you've been
lying about it, so you continuous to get the age wrong.
Speaker 4 (04:46):
You're like thirty five three? How old did I say
I was last week?
Speaker 1 (04:50):
No? So at thirty six was when I got my relief.
Like I'm thirty seven now, but I finally found that
really at thirty six, and it got to the point
where I didn't think there was anything left for me.
I I've accepted, and I used to say to people,
it's okay, it's just how it is.
Speaker 3 (05:03):
If it's okay. It's been like that my whole life.
I've tried what I've tried. But it did peak for me,
now that you say it.
Speaker 1 (05:09):
Fifteen sixteen, when I was getting my little boobies and
I was coming into that age, and all the doctors
at the time just used to say, to me, deal
with it.
Speaker 3 (05:18):
It's hormones. You're coming into puberty. It'll pass. And the
fact is it never passed, and.
Speaker 5 (05:23):
The hormones play a role. But the underlying cause of
migraine is almost certainly genetic. You know, some people have
forms of migraine. We know the gene, we can identify it.
But most people it will be a genetic basis. But
it's complex and it's a complex combination of genes. And
so I say to people I see with migraine all
the time, I probably said it to you, We're probably
never going to cure this. You're always going to be
(05:45):
at risk of having an attack, but what we want
is for you to have less attacks and have a
really good plan to deal with them, so you're not
walking around anxious about when the next one's going to hit.
Speaker 2 (05:53):
What is the difference though, So, I mean most people
get headaches and it's kind of I always look in
it too, you know how when people get the cold
and they're like, I've got the flu, and I'm like,
you don't have the.
Speaker 4 (06:02):
Flu, because if you wouldn't be here.
Speaker 2 (06:05):
So what is the difference between a headache and having
a migraine?
Speaker 5 (06:09):
So headache is a big specialty area. There's lots of
different sorts of headaches from commonplace. You get a bit
dehydrated you're out in the sun. Obviously your vessels in
your brain dilate, stretch your pain receptors, and you get
a bit of a headache. You have to rehydrate and
lie down. Migrains a very specific type of headache. We
refer to it as a primary headache disorder, which basically
means that there's not any underlying lump or bump or
(06:31):
problem with your blood vessels in your brain or anything.
Your brain structurally looks normal, but intermittently and episodically there's
some sort of dysfunction that drives this very typical type
of attack. So a migraine, we think now, starts in
the neurons and a process is activated by where you
get this spread of activity through the brain we call
cortical spreading depression, which then activates areas specifically in your
(06:55):
trigeminal nerve and your upper ceviacal area in the spine,
which then results in the relief of all of these substances,
which causes inflammation in the blood vessels and the meninga's
which is like the glad wrap around your brain, which
causes the throbbing, very sort of recognizable migrantous headache. So
the nature of the headache is different. The way the
headache evolves from the brain signals to that inflammatory process
(07:18):
is different to you know, your run of the mill
tension headache or dehydration headache.
Speaker 2 (07:22):
What are the symptoms and the signs that well, I
guess the signs more so that if someone's experiencing it,
they can go okay, this is what characterizes a migraine,
and I know that that's what that is.
Speaker 5 (07:32):
Now so if you can broadly divide migraines into classic
migraine without aura, classic migraine with aura ache, caphalgic migraine,
which is where you get the aura but no headache,
and then there's the menstrually associated one. So a typical
classic migraine, someone will often get a prodrome fatigue, agetation, hunger,
and then the onset of a headache. And the headache
(07:54):
is often on one side of the head, it might
change sides in between attacks. It's throbbing, it's really quite severe,
and then it's followed by nausea some people vomit uncontrollably
at times, and photosensitivity. So don't want to be around light,
don't want to be around noise sometimes smells can drive
you crazy, and really just want to be very still
because every movement, bending, what have you exacerbates that headache
(08:16):
pain and that's quite different to you know you say,
you know, tightness around the front of your head with
at tension type headache, et cetera. So you can really
make a diagnosis of migraine just talking to someone about
their history without any auxiliary tests.
Speaker 1 (08:30):
Mine have always been the same side, so mine's always
the same spot, which is really interesting.
Speaker 3 (08:36):
That's why I thought I had a brain tumor or something.
Speaker 1 (08:38):
I was like, how can this just be a migraine
every day like in the same area. So it's interesting
because that's I think that was one of the things
for me that differentiated too. I don't want to scoot
over something you just said. You just said that there's
literally a gene for hormone.
Speaker 5 (08:51):
So now there's there's a gene for some forms of migraine, right,
So there's a particular type of migraine called for mid
little hemiplegic migraine where the aura, which haven't talked about yet,
but that's the neurological phenomena that can go along with it,
is where the person gets a terrible headache and actually
can't move one side of their body. And they've identified
the gene that causes that.
Speaker 2 (09:09):
Well, yeah, so, brit when you get migraines, what are
the things that trigger it for you?
Speaker 1 (09:14):
I cannot pinpoint a trigger, which is annoying because it
means I can't actively avoid something, but I know they're coming.
I'll feel it, and I feel a very particular way,
and I don't know how to explain it.
Speaker 3 (09:24):
You feel a bit nauseous.
Speaker 1 (09:26):
You start and you start to get the throbbing pain.
It just you can just tell when you've experienced it
that it's different from a normal headache. And I now,
thanks to Caitlin, have a bunch of different medications for
different things.
Speaker 3 (09:37):
So I have medication that I can.
Speaker 1 (09:38):
Take straight away that will hopefully stop it before it
gets that far. But most people that suffer them feel
them coming for quite a long time. Like you get that,
you get that nauseous feeling and I need to just
lay down straight away, I need to turn lights off.
I have only ever once, like part of my symptoms
are I vomit quite a bit from them when they're extreme,
(09:58):
But only once have I had vertigo, where I have
never experienced anything like it. I could not turn over
onto my side in my bed without vomiting. You cannot move.
It is the craziest thing I've ever had. And that's
the only time I have personally had that. So for me,
it's light sensitivity, noise sensitivity, which is hard, exactly what
Caitlin said.
Speaker 3 (10:19):
I don't want to move. I don't even want to
walk to.
Speaker 1 (10:22):
The fridge to get a drink, Like every step feels
like you are being electric, like a shock through your body.
And then yeah, the vomiting is not every single time
for me, probably every three to four times I'll get
like a vomiting migraine. But for me they've always been
unavoidable and I could take as much medication as I wanted.
Speaker 3 (10:39):
It did nothing like you have to have.
Speaker 1 (10:41):
What I have found for me is I had to
have this really special specific migraine medication for it to
have helped, and I had to go down the track
of getting these botox treatments, which we will get into.
Speaker 2 (10:51):
Well, I would love to know that's your specific experience.
What are the general triggers for most people?
Speaker 5 (10:56):
Yes, So, as Brittany said, some people don't have triggers.
We always look for something because if you find something
that you can fix, then maybe you'll avoid the attack.
Many people don't. But the common things that people do
describe are variable. So foods and particularly things like chocolate, cheese,
all the good stuff in line, alcohol including red wine.
I do sad.
Speaker 3 (11:14):
I have a lot of the above.
Speaker 5 (11:15):
Yeah, And then there's lifestyle things and not getting enough sleep,
increased stress, dehydration, poor nutrition, and then there's sort of
more odd things. I guess that are more specific to
unique people. But some people say it's this change in season,
change in weather, certain odors they smell, light exposure could
trigger the attack, And as Brittany was saying, the warning
can be that sort of odd. I can't quite describe this,
(11:38):
but I know it's coming, or it can just be
the pain, but it can also be this aura that
I was talking about, And that's the neurological manifestations people have,
and that can range from visual disturbance where you could
maybe see bright lights, feel like you're looking through water,
can get tingling up one side of the body. Some
people aren't able to speak or create language at the
time of a migraine, and the dizziness and vertigo is
(12:00):
and that's the stibular aura. The aura sensation may be
different for different people as well, so.
Speaker 1 (12:05):
People that have those like, is an aura migraine any
different to a normal migraine with someone that doesn't get
the aura.
Speaker 5 (12:11):
No, It's thought to be the same process within the
brain that thing I talked about, where the electrical activity
spreads through the brain before you activate. All the pain
pathways may travel across an area of your brain that
you're conscious of, like your sensory area or your vision
or your speech, but it may also cross over a
part of the brain that you don't have conscious awareness of,
(12:32):
so maybe your balance center or your gut. And so
in that case, you're not going to get a neurological sensation.
You're just going to go from prodrome to pain.
Speaker 4 (12:41):
That's so interesting, isn't it.
Speaker 2 (12:42):
And also, I mean, considering that people and some people
deal with this so frequently, my next thought is if
someone doesn't seek any sort of medication or management for this,
can being a migraine sufferer cause long term health effects?
Can there be long term problems of being a micrain sufferer.
Speaker 5 (13:01):
Yeah, I mean absolutely, and in two ways, physical and psychological,
because you know, having pain all the time is hard,
it's hard to do normal things. You expend more energy.
Can absolutely be associated with depression and increased levels of anxiety.
From a physical perspective, yes, as well just from a
normal lifestyle perspective, because you're not going to be able
to do all those things to look after yourself as
(13:21):
you would. Migraine is associated with a number of other
medical conditions, including cardiovascular disease rarely stroke. These sorts of things.
So yes is the answer, both physically and from a
psychological and life perspective.
Speaker 1 (13:37):
Yeah, what way is the association when you say it's
associated to other health conditions?
Speaker 3 (13:42):
Like what comes first? The chicken or the egg?
Speaker 1 (13:43):
Does the migraine come as a byproduct of cardiovascular disease
or does the cardiovascular disease come as the byproduct of
the migraine.
Speaker 5 (13:49):
And that's a very good question and a question we
don't know the answer to. So those sort of associations
are based upon looking at big data about this person
has migraine and what else do they have? Andred of
people things like anxiety and depression. Again, it still is
chicken or eggs, So more people with migraine probably have,
you know, a variety of anxious personality trays. We always
(14:11):
joke huge amounts of neurologists have migraine, and we joke
that it's because we're all a bit obsessive, compulsive and
mildly anxious, and you know helper bees who can't say no.
But that does associate. But also, as you would have experienced,
you become anxious because you're like, my god, I've got
to go out today, I've got to do this. I've
got all these things. What if I get a migraine.
Speaker 3 (14:30):
I would and let's talk about the anxiety side for
a while.
Speaker 1 (14:33):
I would get really anxious if I didn't have and
I have it in my back now, If I don't
have painkillers in my bag and I took the wrong
bag and I didn't have them, it would give me
anxiety because I thought, if I'm not nearest somewhere that
can stop this.
Speaker 3 (14:45):
It used to really worry me. But a big part
of the.
Speaker 1 (14:49):
Psychological side that I have experienced, and I believe we
spoke about it maybe our first console, and I probably
got upset about it. But a huge part of me
not knowing if I want to have kids. And this
might sound over the top to a lot of people,
but was my migraines. I every single time I got
a migraine, I was like, I couldn't have I physically
(15:10):
could not have a child right now. And I always
think what if I had a baby or a kid,
because it is properly debilitating, and I still think about
that every day. Like I had a migraine just a
couple of weeks ago, which was the first one I've
had in a while, and I just thought, in my
situation with Ben, my partner who lives overseas, I thought,
if I had a child right now and I was
(15:30):
living alone, what would I do? I was trying to
run through my options. I was like, would I have
been able to call Keisha and say, I'm so unwell?
Now can you come? And I'm like, but you can't
rely on It's no one else's issue, right Like, you
can't be relying on those people. And a big part
of the fact that I'm thirty seven and haven't had
a child is because I don't think I could have
done it with this condition.
Speaker 4 (15:52):
What's the normal length of time that someone might suffer.
Speaker 5 (15:55):
For I meant in the headache classification thing, you know,
it's a headache lasting between four and seven into your
two hours. So once it goes beyond seventy two hours,
we call it status migronosis, which is continuous migraine and
have to implement a whole new management plan. But they
can go for a long time, And you're right. And
I look after a lot of women with epilepsy as well,
and they have very similar concerns and worries about what
(16:16):
if I have a seizure when I'm looking after my baby.
So these things are faced by many people with particularly
these disorders which are characterized by recurrent episodic events. You're
totally normally in between and then you're pretty much completely
not able to function when you're having the attack. So
it is tricky, and I think planning, optimizing your treatment,
(16:39):
having action plans not just to treat you but to
manage your life are the sort of things that you
have to become creative with when you start to have
your kids.
Speaker 4 (16:47):
What does that look like?
Speaker 2 (16:48):
So what for a lot of people, what are the
treatments that are available, the treatment plans. I know you've
spoken heats on the podcast around botox for migraines.
Speaker 3 (16:57):
Yes, but that's not an easy place to get to.
Speaker 5 (16:59):
No, I know.
Speaker 2 (16:59):
And I also so we're not promoting because we can't.
We're just talking about different treatment options. But I think
it's really interesting to know, like what does that look
like for someone because I think a lot of people
live with this type of stuff thinking that there's nothing
that can be done or it's just a byproduct of
you know, just.
Speaker 4 (17:13):
Being a woman and being alive.
Speaker 2 (17:14):
What would be the first steps and how does one
kind of go down that treatment path.
Speaker 5 (17:18):
Yeah, you absolutely spot on. I always think of this
woman I saw and she'd had migraine for thirty years.
We can do this, we can do that.
Speaker 4 (17:24):
She's like, really, well, that was me too.
Speaker 1 (17:26):
I was like, I can't believe there was something that
could be done. Seventeen years I've had it. My dad
has had them. Talk about the genetical link. My dad
has had them his entire life, and I don't think
he's ever gone and gotten proper heir.
Speaker 4 (17:38):
But that's interesting to me, ber it.
Speaker 2 (17:39):
Does that mean that you've never really brought up with
a GP before or does that mean that a GP
didn't give you solutions for it? Like, because it's to
me quite unusual. That's something that's a medical problem that
you've dealt with so frequently you wouldn't have just at
least mentioned it to a GP.
Speaker 3 (17:53):
It's a bit of A and a bit of B.
Speaker 1 (17:55):
So in the early days, I guess the treatments maybe
weren't as known. And I said the early days we
are literally talking when I was fifteen years old, right,
So there was a big period there where I went
and got the MRI scans. I went and got the
scans of people like let's investigate this and this and this.
Let's se if you've got an allergy, your brain's fine.
So it was sort of like you're on your way,
like it's just something that you'll either grow out of.
Speaker 3 (18:16):
Actually, I remember a.
Speaker 1 (18:17):
Doctor at fifteen saying you'll probably grow out of it.
It's a hormonal thing. So when you're told that, for
about five years, I just got into this train of
this is how it is. Like there's no you know,
I didn't ever think to go back to a doctor
and say, hey, I'm still getting my headaches. Like I
just in my head, I was like, why would I
waste my time? There's nothing that you can be done.
Speaker 5 (18:36):
And it's funny, more often than not, when I'm taking
a history from a patient about some other problem, I
will say, you know, what are you past medical history
and write it all down, and then halfway through the
consultation they go, oh, yeah, I get migraine, but it
hasn't been put on their radar to be a real
priority from the perspective of their care. Yeah, the treatment wise,
there's lots of things we can do. So you know,
when I see someone with migraine for the first time,
(18:56):
we talk about acute therapies, which is to try and
try to eat that attack, reduce its severity, shorten its length,
get you up and going as quickly as possible. And
the other treatments are preventative. And that's if you're getting
you know, at least one a fortnight, they're starting to
interfere with your life, make you anxious, then you need
preventive therapies which will reduce the frequency of attacks and
hopefully the severity as well. And I always think about
(19:19):
management of any medical problem as we've got medications that
we can use, but you've also got to look at
the lifestyle side of things, sleep, stress, nutrition, and your
psychological well being because they all feed into one another.
But medication wise, the trick with migrain is treating as
early as humanly possible. So when you get that warning,
that's when you take your medication. You don't wait because
we all tend to go, oh, it's not too bad,
(19:40):
I'll just put up with it a bit longer. Whereas
early treatment is we know is advantageous, and we use
a combination of aspirin. Sounds ridiculous, but it's an anti
inflammatory painkiller paracetamol, which is a central painkiller and then
a trip down which is a specific type of migrain painkiller.
Speaker 4 (19:56):
And what does that do.
Speaker 5 (19:57):
So it promotes the release of serah toomee which acts
upon those blood vessels and the miningjis in the brain
to reduce the sensation of pain.
Speaker 1 (20:07):
So what does it take then? For this was a
question I was getting a lot for the general person.
Everyone was like, Oh my god, what is your neurologist name?
Where does she work? I'm going to book in, But
it's not as easy as just like going and calling
up in EUROLGIS and booking in.
Speaker 3 (20:20):
You have to go through a process. So can you
talk us through that?
Speaker 5 (20:22):
Correct? So you know, acute therapy like that. If you
go and see your local doctor, tell them your symptoms,
they recognize its migraine. You can start on that sort
of treatment program and if you've attacks become more minor,
you just use aspird and panetal and save your trip
down for later. There's a new acute medication which I
can tell you about later as well. But from the
point of view of getting to what am I going
to do to prevent these medications? As I said, if
(20:44):
you're getting one a fortnite it's interfering with you getting
to work, looking after your kids, enjoying your life, then
prevention is warranted. And at the moment we have first
line therapies and then second line therapies. You need to
have tried three first line therapies before you're eligible for
second line therapies. You gp can initiate those and then
refer you on too a neurologist. If they don't work,
then you've got all of these options to discuss. And
(21:06):
those medications are really all repurposed, so none of them
are specific to migraine. They've all been repurposed for migraine
prevention when used for other conditions. So includes things like
riberflav and vitamin B six amitriptolene, which is an old
fashioned antidepressant but again has an impact on the transmitters
in the central nervous system. To reduce migraine, there's a
(21:27):
bunch of blood pressure lowering agents which can be used
as long as you don't have low resting blood pressure,
and the use of them is based upon both theory
of how migraines evolve and noticing. Say, for example, a
group of people were treated with X medication, they also
had migraine and that's settled down, So sometimes it's just serendipity.
And then there's a number of anti seizure medications which
(21:48):
can be used as preventatives as well, and your choice
there depends upon what other medical problems people have. As
I said, they're blood pressure, whether they're of childbearing age,
because we might not want to use the anti seazure
medications for headache prevention.
Speaker 2 (22:01):
Why is it that a person who gets migraines has
to go through these three sort of like milestones first,
these three sort of entry options before they can go
through to a neurologist.
Speaker 5 (22:11):
Well, look, they could go straight to a neurologist to
discuss these And I certainly get people who've literally seen
their GP, they've got migraine, they've been given a trip
down and they come and see us. It's more the
process of a prescribing because those first line therapies are
you know, they're easily available, they're inexpensive, and for a
significant proportion of people, they're perfectly adequate and they'll control
(22:34):
the migraine attacks. Yeah, second line therapies, you know, we
would love to be able to give more people second
line therapies. First up, because we know they've got higher efficacy,
but they're obviously more expensive. For the botul anemtoxin, you
need a procedure done. And the CGRP antagonists, which are
the newest group, we've only really had them available to
us in the recent past. So part of it's I guess,
(22:57):
choosing the least complicated financially access correct which will work
for a lot of people, and then escalating, which is
the same sort of process you'll see with regards to
prescribing in lots of specialties, you know, ecology, neurology, all
those sorts of things.
Speaker 1 (23:12):
It does seem strange that from our point of view,
like from a plebs point of view, we're not a neurologist.
You can go and just book in tomorrow to get botox,
right if you want to wrinkle for esthetic reasons, if
you want to clear your wrinkles.
Speaker 3 (23:24):
But what I found so strange is I was like, Wow, I.
Speaker 1 (23:28):
Can get botox for a wrinkle like that, But to
get something that is going to literally change my life
was just so many more steps and so many more
hoops to jump through. But apart from that, I didn't
know it was available, And that's why, I guess we're
having these discussions so people know there are other options.
Speaker 4 (23:44):
Is the reason for that though?
Speaker 2 (23:45):
Because of the volume, Like are you getting like massive
doses when it's in your neck and your head and
everywhere else.
Speaker 5 (23:51):
Or is it you are getting a decent volume, So
you need two viyls per patient. So the cost of
that is significant and the government subsidize it. So if
you qualify for second line therapies, you know there are criteria.
You have to have fifteen head eight days a month,
eight of which are classic migraine. You've tried three therapies.
Then the Pharmaceutical Benefit Scheme says, look, this is a
good investment here because if we use this efficacious therapy,
(24:14):
this person's going to get back on their feet. So
that's going to be working and paying tax dollars exactly. Yes,
you get them wrinkle free and ready to get back
to work. You know, it does seem ridiculous. And as
healthcare providers, I mean, we're all, you know, at the
end of the day, most of us are altruists and
wish we could just use the very best, brand new,
best tolerated medication for everything we do. But health economics,
(24:37):
as you indicate it does intervene. So that's the process
and that's why it does take time. But people not
knowing about it is a tragedy.
Speaker 4 (24:44):
How does botox work though?
Speaker 5 (24:46):
For it?
Speaker 2 (24:46):
So saying that it's been something that's I guess newly
discovered as being very efficacious, what is it about it
that is so beneficial and how does it work?
Speaker 5 (24:54):
So no one really knows, but it works.
Speaker 2 (24:59):
So that's however somebody there we discover this. I think like,
who's the first person that thought that's a good idea.
I'll shove two vals of that in my deck.
Speaker 5 (25:07):
So one of the major theories is the other thing
that drives a migraine is this thing called sensitization, so
pain sensitization, which refers to this process where your neurons
become more responsive to a certain pain or noxious stimuli,
and then your threshold for having those symptoms lowers, Your
response to that magnifies, and it spreads, so it perpetuates things.
(25:29):
So botchylineum toxin pretty much switches off one of those
sensory receptors in the proofery, so then their feedback into
your brain is altered. It's down regulated, and we think
that desensitizes those areas of your brain that are responsible
for experiencing the migraine attack.
Speaker 1 (25:46):
So I think I'm going to get this wrong, but
I remember you telling me one of our consults. You
said that there is a chance that if I do
this for a little while and it works and I
go migraine free, there's a chair ancept it almost tricks
your body, and that when you wean yourself off it,
you don't get as many migraines.
Speaker 5 (26:04):
Is that right correct? So a person with migraine can
have different phases of migraine in their lifetime, just as
you have, you know, high frequency episodic, low frequency episodic,
or chronic. So when you were in your puberty years,
you were probably getting low to high frequency episodic attacks,
which is the only reason you could tolerate it. And
then as that sensitization process escalates, it becomes the more
(26:27):
of a chronic situation. That doesn't mean that we can't
de escalate that and get people back to being low
frequency migrants.
Speaker 1 (26:34):
So can you get them more frequently because your body
expects them? Like, is that why when they're coming more frequently?
Is that your body being like, oh, I know, what
that pain is. Let's go to straight to migraine because
it's like a learned tradition, do.
Speaker 3 (26:47):
You well, what's it like a learned Yeah.
Speaker 5 (26:49):
Like in a way that's kind of like the sensitization
thing we're talking about. So yes, you with time, with
that whole sensitization process, it can require far less for
you to experience that much migrain than what it would
have when you weren't sensitized.
Speaker 3 (27:02):
A better way to say it. What I was trying
to get it, And I.
Speaker 4 (27:07):
Know who the neurologist is in the room.
Speaker 2 (27:09):
Hey, are there lifestyle factors that people can change that
help to either minimize the severity or minimize the number
of migraines people are receiving?
Speaker 5 (27:19):
Yeah, I think so. And as I said, I'm the
threefold neurologist, medications, lifestyle, and psychological well beings my sort
of mantra. So lifestyle things that we know can be
triggers for people are poor hydration, so we need people
to stay well hydrated, eat regularly, so often starving yourself
for long periods can trigger things. Good sleep, so sleep
deprivations are classic, which is why I got my first
(27:42):
migraine when I was postparted.
Speaker 2 (27:43):
So fun for all the new mums out that, which
comes back to the anxiety.
Speaker 5 (27:47):
Yeah, and stress. You know, stress is not just a
psychological thing, it's a physiological response, and we throw out
all of our stress hormones that bathes our brain and
again that makes us more prone to migraine, a seizures,
all of these sorts of things that affect the nervous system.
So actually really proactively dealing with that can help.
Speaker 2 (28:06):
Can migraine be a byproduct of other illnesses? That can
it be a symptom that something else is going on
in your body that needs to be addressed.
Speaker 5 (28:14):
Not in the sense that it is a primary headache disorder,
so there isn't an underlying cause for it.
Speaker 2 (28:18):
Like it's not like you're going to be cancer here,
that's why you've got a migraine.
Speaker 5 (28:21):
Correct night, right. So it's a primary problem, it's a
dysfunction of the nervous system, but it can absolutely be
exacerbated by other illnesses. And I went through a period
during the COVID pandemic when my migraine patients had come
back and said it's not working, and it was just
that they'd had COVID and that was an absolute trigger
for people with migraines, and that was solid migraines for
a period of time.
Speaker 1 (28:41):
Right. Yeah, So talking about the botox treatment, because that
was obviously what I ended up having and what was
of a lot of interest to people.
Speaker 3 (28:50):
Is that protocol that you get that I get.
Speaker 1 (28:53):
Is that the same migraine protocol botox protocol that anyone
would get with a migraine or is it more specific
to my kind of migraines?
Speaker 5 (29:00):
So yours is more specific now because we've tweaked it
to you. There's a standard protocol called the preempt protocol
with a series of injections in the forehead, the sides
of your head, the back, neck, and your shoulders. It
traps and that's kind of what we do the first time,
the first couple of times. Then we can be spoke
it to the individual.
Speaker 3 (29:18):
So now I get my forehead and I'm my crosby and.
Speaker 4 (29:24):
You deserve it.
Speaker 5 (29:26):
So there's a sort of saying in migraine therapy where
you chase the pain. So if someone's having more pain
in a particular region, you can put more toxin there
to try to switch off that process in that region
less in other places. I adjust the protocol, often in
the forehead, because when I started doing it, people said
to me, I love this. My migraines have gone, but
I look funny. So it did cosmetic training so that
(29:47):
you know a lot of people are young women, so
that you can inject in the same muscle get the
same effect, but not have people having esthetic side effects,
which you know they're not the main priority, but they
do matter to people.
Speaker 3 (29:58):
You don't want to drop an eye lid on some
eye on somebody.
Speaker 5 (30:00):
Correct, I've got to have that in mind.
Speaker 2 (30:03):
You also don't want someone to forego treatment and suffer
with the migraine because they're worried about how it's going
to impact the way they look.
Speaker 5 (30:10):
Correct, And we can always wiggle things around. If people
don't want anything to affect their appearance, then we can
just slightly move it, say muscles, just different areas. And
definitely if people have a focus of pain, say in
one side of their neck or one shoulder, we can
move the injections around a little bit, but pretty much
just stayed to the same dose in the same region.
Speaker 1 (30:29):
Speaking about tweaking the treatments, I don't know, Caitlin. If
you have seen my video, I posted on Instagram that
my fiance and I'm Bana. We're learning this first dance.
If you haven't seen it, please go and watch it.
Speaker 3 (30:40):
It is hilarious.
Speaker 5 (30:41):
We bring back memories of my own attempt.
Speaker 1 (30:43):
Well, no, because I so my last treatment with doctor Parrott.
We had to tweak it more to me because my
migraines were really good. They weren't coming, but I was
getting a lot of other pain that was still problematic,
and a lot of that was coming down the front
of my neck from the side of my skull. So
we decided to do some injections in the front of
my neck and in a muscle there, and some extra
(31:04):
injections that we hadn't done before down the side. Ah amazing,
right Like in terms of how I feel, I want
it to be known, and I haven't told you this yet.
Speaker 3 (31:12):
I could not hold my neck up. It was like
a fool.
Speaker 4 (31:15):
I couldn't turn my neck. I had to turn like
a robot.
Speaker 1 (31:18):
All the muscles were so relaxed, which was brilliant for headaches,
but hilariously, I couldn't do anything with my neck and
just this week I feel like I've got more movements
because it must be slowly wearing off. But Ben would
dip me in this dance we're practicing, and I couldn't
get back up.
Speaker 5 (31:32):
My hand was just like flat.
Speaker 1 (31:37):
Stop talking about it, because I want people to know
as well. I don't want people to just be like,
oh cool, you just go get your botox and there's
there's no repercussions.
Speaker 3 (31:44):
Obviously it's dependent on everyone.
Speaker 1 (31:46):
But at the end of the day, the front and
the back of my neck have been relaxed, and they
were very relaxed, but to the point that like, even
if I wanted to lay up out of bed, I
had to get my hand behind my head and pull
myself up.
Speaker 3 (31:58):
I couldn't just sit up anymore. And if for me
it's what's more important.
Speaker 5 (32:02):
It's important to talk about though, because you know, and
when we discuss doing the procedure, we say the main
potential side offict is weakness. So to weaken muscles, we
might weaken them too much, and so it's important to
know that. I've had a number of people come and
say I love it, but I'm having trouble at pilates
for same reason. And then we just omit those neck extenses,
you know, for a cycle or two until you feel
(32:23):
like things are back to normal. The beauty of the
treatment is it wears off, as you say, but it's
really important to make that known because it's not a
sort of This is magical and there's no potential issues
with it, just like any medical therapy.
Speaker 2 (32:36):
What would you say to people who are listening to this,
Because I think the vast number of people who are
going to click on this episode and really want to
listen to it are either going to be people who
have migraines themselves or they have someone who they love
dearly who is absolutely in the depths of suffering from it.
What is your first piece of advice to someone who
hasn't started any sort of treatment process for their migraine
but is really really suffering.
Speaker 5 (32:57):
First thing to do is to go and talk to
your local doctor. Talk to your local doctor, say I
think I've got migraine and see if that is exactly
what you've got, so get a diagnosis made. If there's
red flags, you know it's a new on set headache
and an older person or other things that we look for,
you might need imaging to confirm that and then they
can start you. As I said, on an acute treatment plan,
they can begin the first line preventatives and if it's
(33:19):
been going on for that long, get a referral at
that point to see a neurologists because there will be
wait times to be seen, and then they can cycle
through various preventatives, see if there's a response, and then
talk about the second line therapies if those haven't been successful.
Speaker 1 (33:33):
Generally speaking, what happens to a migraine sufferer when they
fall pregnant?
Speaker 3 (33:38):
Does it increase? Does it decrease? Are they still treatments
you can take?
Speaker 5 (33:41):
Look thankfully, most of the time it decreases, which is
kind of odd because your estrogen levels go up, but
so levels of other hormones as well. It's problematic in
pregnancy because we can't use a lot of the therapies
that we use when people are not pregnant. So we
can't use aspirin except in the second trimester. We try
to avoid trip dans though if it's significant and we
(34:02):
talk to the obstetrician about risks. Sometimes people use them,
but generally they're not indicated in pregnancy, so it does
become an issue, and so we often have to utilize
slightly more creative things, you know, fluids, magnesium. Sometimes people
need to have short doses of steroids, so there are options.
But thankfully often it kind of gets better during that period,
(34:22):
and then when you've got your baby and you're horribly
sleep deprived and stress, you can take all the drugs again.
Speaker 1 (34:27):
So basically, once I commit to pregnancy, I've got to
commit for life.
Speaker 3 (34:30):
I've got to be pregnant like NonStop.
Speaker 4 (34:33):
No, no, please don't do that. Trust me that I'll
give you a few migraines as well.
Speaker 1 (34:38):
But the last thing that I wanted to ask you
was what are the some of the newer and more
progressive treatments that have come out.
Speaker 5 (34:44):
So the newest treatment we have available to us are
a class of drugs called CGRP antagonists. CGRPs like a protein.
It's one of those substances that I said was released
from that trigeminal region when the migraine is activated. We
know that that's involved in a cascade causes a migraine,
and that was identified because they found higher levels of
it in people suffering migraine. And these medications are either antibodies,
(35:07):
so just like we'd make to a virus, you inject
them into yourself. They float around your bloodstream connect to
the CGRP as though it was a virus in your
immune system destroys it. So then even though you may
still have that predisposition to start the migraine, once it
gets to needing that protein to cause all the inflammation,
it stops. So people have a lot less attacks.
Speaker 1 (35:27):
Well, knowing that it's so hormone related, does that mean
as we age and you know, maybe our forties or fifties,
maybe when perimenopause starts, do they decrease or the idea
of perimenopause and menopause because your hormones are changing so rapidly. Again,
is that when we get another influx of migraine it's.
Speaker 5 (35:46):
The second one sat so that the two peaks are
in that you know puberty bit where you've got fluctuations
in estrogen progesterone and then in the perimenopause, but it
falls off after the menopause. So there is potential and
get relief at sixty. Maybe it doesn't happen to everyone.
Not every migraine sufferer has the same patterns. Some people
(36:07):
will have an upshot in perimenopause, some people won't. So
I think it's just being aware of it and having
it on your radar and not suffering through it if
you are one of those people that it happens to.
And again, you know, there's all sorts of different approaches
we can take in those sorts of circumstances.
Speaker 3 (36:23):
Is this a myth or maybe Ben just told me this.
Speaker 4 (36:27):
I'm not sure if his person, I'll be taking medical advice.
Speaker 1 (36:30):
Well, you'll laugh on youre do orgasms help relieve pain
and medicate and like migraine that kind of a thing.
Speaker 2 (36:37):
Imagine if you went to a neurologist and they were like,
you know what, you need more orgasms.
Speaker 5 (36:41):
I've sort of this one happened.
Speaker 1 (36:43):
Imagine if Ben's like, baby, I've been doing some research.
Speaker 4 (36:45):
Apparently, Yeah, get on your way.
Speaker 5 (36:51):
Look, there's two answers to that question. One is no
and one is yes. So the no answer is that,
in fact, sometimes sexual activity and orgasm can trigger headaches,
whether they're migraine headaches or there is a specific type
of headache called benign sex headache, where people have sex
climax and then they develop a horrible headache.
Speaker 4 (37:09):
That's a headache.
Speaker 3 (37:10):
Benign sex headaches.
Speaker 5 (37:11):
A headache, benign sex headache exactly every day is a
school day here in the classification.
Speaker 4 (37:16):
Wow, there's all sorts of.
Speaker 5 (37:17):
Weird and wonderful things. But to the contra of that,
an orgasm would result in release of endorphins, and they
are natural opioids. So look, maybe, but probably not really,
So risk it for the biscuit.
Speaker 3 (37:32):
Give it a whirl, see.
Speaker 5 (37:33):
What have Don't avoid it entirely, I guess is the thing.
Don't avoid it, but I'm not sure that it's not
gonna hell. It's not a recognized therapy, but it could
be analgesic.
Speaker 1 (37:42):
It might help well, to be honest, like you would
have to do it when you feel the migraine coming,
because no one's in the depths of the migraine is
having sex, like no one's being pounded.
Speaker 2 (37:51):
Yeah, imagine your partner trying to convince you that's not
like you're not being like pain pound me. I've got
something that's going to make you feel better, sweetie, go in.
Speaker 5 (38:01):
When you say like that. Yeah. I actually asked my daughter.
We've talked about myths and misconceptions when we were thinking
about this podcast, and I said, what do you think?
And she gets migraine and she said, you know, the
biggest misconception mum is people think it's just a headache
and it's actually so bad. And so I think that's
the thing, is to give people the empathy that they
(38:22):
need and power people with migraine to say, well, what
are we going to do about it?
Speaker 1 (38:25):
Do you prefer people to when they have reached you,
to have already had, say an MRI scan or a
CT scan.
Speaker 3 (38:32):
Is that sort of a prerequisite for you? Are you
going to send them there anyway?
Speaker 5 (38:35):
Look, it's not a prerequisite, it's I think most people
in twenty twenty four who present with headache will end
up having a scan. As I said, it's a clinical diagnosis.
But you know, we've got access to imaging every now
and then you get a surprise. So yes, you know
imaging of your brain, including your blood vessels is helpful.
But if you haven't had it, and you're a typical
migraine sufferer, you know you don't necessarily need it.
Speaker 3 (38:55):
Did you get my back scan this week?
Speaker 4 (38:57):
Have you looked at that yet?
Speaker 1 (38:58):
I have a look, kay, I was going to get
I was going to the results. Yeah, I got my
MRI I sent to you, So we'll talk about later.
Speaker 5 (39:06):
This is a much nicer place in the consultation room.
Speaker 1 (39:08):
Though.
Speaker 4 (39:10):
I'm not sure if I need to be privy to
all the information, but I'll sit through it. It's fine, No,
it's fine.
Speaker 3 (39:14):
Thank you so much for coming on. I really appreciate it.
I know this might seem like.
Speaker 1 (39:18):
Maybe a little bit left field for Lifelung Cut podcast,
but it was something that I just had an overwhelming
response for. And I know that there are so many
people out there like me that are suffering. And if
they're not suffering, I know that there are people that
they know that are suffering, a family member or a
partner or a child.
Speaker 3 (39:35):
I just guess it doesn't discriminate.
Speaker 5 (39:36):
No, it absolutely doesn't.
Speaker 1 (39:38):
We will put the link to your practice. We obviously
are based in Sydney for anyone that's listening. I'm sorry
if you're outside of Sydney. But there are so many
great neurologists. There is like a whole website of where
you can find neurologists. So we will put that link
in as long as you keep space for me if
people feel like scale, and.
Speaker 5 (39:55):
That's my prerequisite always.
Speaker 4 (39:57):
Brittany Al, thanks so much for having a being part
of the podcast.
Speaker 5 (40:01):
Oh that's a pleasure. Thanks for having me, M.
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