January 27, 2025 • 48 mins
This podcast dives deep into the complexities of post-traumatic headaches and migraines, exploring the differences in symptoms, triggers, and treatment options. Insights introduce listeners to medication overuse headaches and emphasize the importance of accurate diagnosis and holistic approaches for recovery after a concussion.
• Exploring common types of post-traumatic headaches
• Migraines as a risk factor for poor outcomes
• Defining migraines and associated symptoms
• Migraine "triggers"
• Understanding the neurological basis of migraines
• Examining the interplay of hormones and diet
• Discussing medication overuse headaches and their impact
• Emphasizing the value of a multidisciplinary approach to treatment
• Discussing alternative therapies and lifestyle modifications
• Encouraging patients to advocate for appropriate care
Research papers discussed in this podcast:
Sufrinko, A., McAllister-Deitrick, J., Elbin, R. J., Collins, M. W., & Kontos, A. P. (2018). Family History of Migraine Associated With Posttraumatic Migraine Symptoms Following Sport-Related Concussion. J Head Trauma Rehabil, 33(1), 7-14. doi:10.1097/HTR.0000000000000315
Leung, A. (2020). Addressing chronic persistent headaches after MTBI as a neuropathic pain state. J Headache Pain, 21(1), 77. doi:10.1186/s10194-020-01133-2
Gosalia, H., Moreno-Ajona, D., & Goadsby, P. J. (2024). Medication-overuse headache: a narrative review. J Headache Pain, 25(1), 89. doi:10.1186/s10194-024-01755-w
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Disclaimer:
This podcast is separate and unaffiliated from Sophia Bouwen's work and employment at the Health Partners Neuroscience Center.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ayla Wolf (00:00):
Most of the patients that I see are people that are
(00:04):
coming to me because they've hadthese horrible headaches they
can't get rid of after theirconcussion. And the headaches
are usually a combination ofsome kind of tension type,
pressure headache, along withmoments or episodes of these
throbbing headaches that aresometimes unilateral, sometimes
bilateral, but they can't answeryes to those four questions that
(00:27):
we just talked about.
Sophia Bouwens (00:28):
Welcome to the life after impact podcast where
we do a deep dive into allthings concussion and brain
injury related. We talk aboutall the different symptoms that
can follow brain injury,different testing methods,
conventional and functional, anddifferent types of specialists
out there, as well as differenttherapies available. I'm Sophia
(00:50):
Bowens, and I'm here with DrAyla Wolf, and we will be your
guides to living your best lifeafter impact.
Ayla Wolf (00:59):
Well, Sophia, episode number three. We've made it this
far.
Sophia Bouwens (01:02):
Here we go.
We're gonna keep going too.
We're just getting started.
That's right. How are you doingtoday? I'm great, good. I'm
excited for our discussiontoday. We're gonna dive into
post traumatic headache,migraines, migraine like,
headaches, medication overuseand kind of deciphering those
things with post traumaticheadache after an injury,
Ayla Wolf (01:25):
let's just dive right in. Great. There was a paper
that was published in 2018 thatwas looking at athletes with
concussions, and it had someinteresting findings
differentiating people that hada post traumatic migraine versus
people who didn't. And one ofthe things they found was that
(01:48):
the concussed athletes with posttraumatic migraines were seven
times more likely to have alonger recovery time than those
without headaches at all, andtwo times more likely to have a
longer recovery than other typesof post traumatic headaches.
Sophia Bouwens (02:03):
So is that saying that if you had migraines
before an injury, that you'regoing to have a more complicated
recovery, or what they'refinding?
Ayla Wolf (02:11):
So the literature says that people that have a
history of migraines beforetheir concussion, it's a risk
factor for poor outcomes or amore prolonged recovery, and so
I think that is important torecognize, and that presence of
migraines before the concussionis also a key differentiating
(02:32):
factor between trying to figureout whether people are indeed
having true migraines or ifthey're having a post traumatic
headache That is migraine-likein nature, it resembles a
migraine, but it's actually not.
Sophia Bouwens (02:44):
Sounds complex.
Ayla Wolf (02:45):
We'll get into that because there's kind of four
simple questions that can get tothe bottom of that for a lot of
people.
Sophia Bouwens (02:51):
I'd like to ask you or find out more about those
questions, but first, I want toknow what is a migraine?
Ayla Wolf (02:59):
Yeah, so I think right out of the gate, a lot of
people who have never had amigraine don't have a good sense
of just how awful they are.
Sophia Bouwens (03:09):
I can attest to that.
Ayla Wolf (03:11):
Yeah, and I currently do not have migraines, but there
was a brief period of time thatwere definitely hormonally
triggered. So I had migrainesprobably between the ages of 13
and 15, and I'll never forgetthe very first migraine I ever
had. I went to my best friend'shouse. This is somebody I've
been friends with since theywere three years old, and I was
(03:32):
at Elsa's house, and her mom hadmade chocolate chip pancakes for
breakfast, and my mom was, ofcourse, like this crazy health
nut. So we never got, nevergetting chocolate chip pancakes
at my house.
Sophia Bouwens (03:46):
No, that was that was unheard of my house,
either.
Ayla Wolf (03:49):
Yeah, my mom literally made me bring green
beans to McDonald's, and I hadto eat the green beans before I
could have a happy meal. I had amom child abuse. It was
terrible.
Sophia Bouwens (03:59):
I thought my mom was abusive when my most exotic
cereal I was allowed to havewas, like, Raisin Bran.
Ayla Wolf (04:05):
Oh, that is bad.
Sophia Bouwens (04:06):
Not Raisin Bran crunch. That was too much sugar.
It was awful.
Ayla Wolf (04:10):
Oh, man, okay, so more with more things we have in
common. Yeah. So anyway, I'llnever forget I ate the chocolate
chip pancakes, and then all of asudden I started to get the
migraine aura. And if you'venever had that before, it can be
frightening, because you have noclue what's happening. And all
of a sudden the whole worldturns into a kaleidoscope, and
(04:31):
you have like tunnel vision, andthere's bright colors moving
around. And I got very nauseous,and then I started vomiting, and
then I had the horriblethrobbing headache, and all I
could do was just lay in bed andfeel miserable and feel like I
was gonna puke for, you know,four hours straight, and then
you have the hangover afterthat, where you just feel like
crap, awful. So I migraines areterrible.
Sophia Bouwens (04:54):
I got migraines for a while when I was younger,
too, and they would always startwith this, like taste of. Mouth
and the aura that was hard todescribe, kind of Kaleidoscope
like, but also, just like, theworld was different, kind of
looked smaller, was fuzzy aroundthe edges, and when those would
come on, all I could do would belike, go in a dark room and
sleep. Nothing else would help,no medication, because I'd get
(05:18):
nauseous, I'd get lightsensitive. I didn't want to
smell anything. It was horrible.
Ayla Wolf (05:22):
Yeah, did you have food triggers for your
migraines?
Sophia Bouwens (05:25):
I did.Cilantro would always trigger migraines
for me, and then, like greasyfoods would be not good.
Caffeine would sometimes help.
Sometimes it would make itworse. So it was always hit or
miss with that,
Ayla Wolf (05:38):
my trigger was chocolate. I, you know, I
finally figured it out that if Iever Well, here's the weird
thing, if I ever ate chocolatebefore lunch, I it would trigger
a migraine for me. And so Ilearned from the age of 13 on.
And you know me, I'm addicted tochocolate.
Sophia Bouwens (05:52):
You love chocolate!
Ayla Wolf (05:55):
I am addicted to chocolate, but chocolate before
lunch, it's like someone'strying to hand me poison. I do
not want to even look atchocolate before lunch, even to
this day and again, I don't haveI haven't had migraines for a
very long time, but to this day,chocolate before lunch. I will
not touch it.
Sophia Bouwens (06:13):
I'll never give you chocolate before lunch. Now
I know this. I'm learning thisthing. So migraines can be
really debilitating and havethis aura, like component
sensitivity, components well.
Ayla Wolf (06:25):
And actually, the research says only about 30% of
migraine sufferers have theaura, okay? And so even though
we both have had this strongaura, 70% of people that get
migraines don't actually havethe aura. But so when you going
back to your initial question oflike, what is a migraine? So
there's something called CGRP,calcitonin gene related peptide.
(06:47):
And when CGRP is released inlarge amounts, all of a sudden,
it causes vasodilation and bloodvessels dilate, and then all of
a sudden, people can get thisthrobbing headache. Originally,
they thought that that was justthat, that was kind of like the
simplistic mechanism of just,oh, blood vessels dilate, and
(07:09):
now all of a sudden the migrainehappens. But now they're
recognizing that there's thiswhole neural component to that
it's not just blood vesselsdilate, and because if that was
the case, if you justconstricted the blood vessels,
then that would basically fix itin, you know, 100% of cases. And
that's not true. We do know thatfor some people, they can take
(07:29):
caffeine, it can constrict theblood vessels, and it for some
people that can help, but it'snot like a 100% of the time, all
I need to do is take a caffeinepill and my headache goes away,
right? So there's thisneurological component to it.
There's a neurovascularcomponent. It's the interaction
of the nerves with the bloodvessels that are part of this
(07:50):
migraine pathophysiology. Allhead pain involves the
trigeminal system. And I use theword system intentionally,
because we have cranial nervefive is our trigeminal nerve,
and that has three mainbranches, and those essentially
cover the whole face, all theway up until the top of the
(08:11):
head, so it goes into the scalpand even the ear. But all of
that information goes intodifferent parts of the brain, so
we've got different nuclei inthe midbrain and the lower brain
stem that all take thatinformation and then converge
that information with kind ofother nerves from the back of
the head. And so there's a veryspecific part of the lower brain
(08:34):
stem and even into the spinalcord, called the trigeminal
cervical complex, and that isjust a hub of sensory
information about the face andthe head that is transferring
pain information to the brain.
And so what happens withmigraines is that this very
specific part of the brain canbecome hyperactive, and that's
where a lot of therapies aretargeted in terms of
(08:58):
neuromodulation is, can we dosome kind of neuromodulatory
therapy on the trigeminal nerveon the face, in order to kind of
modulate that information goinginto that trigeminal cervical
complex in the brain stem, tothen change this pain perception
happening at these highercortical levels?
Sophia Bouwens (09:18):
Or for me, I would always get pain kind of at
the back of my head, the base ofit almost like it would feel
like kind of throbbing, and Iwould know, like, this is where
this headache is kind of comingfrom, and working that area
would be helpful. And for awhile, I thought, Oh, it's on my
neck. But it's not just the neckthat's involved there. It comes
(09:39):
across more systemic,
Ayla Wolf (09:42):
yeah. And in the back of the head, we've got the
greater occipital nerve and thelesser occipital nerve and the
third occipital nerve. And soall of the nerves in the back of
the head also have kind ofpathways that go into that
trigeminal cervical complex. Andso the. That's where it's like,
wherever the pain is in yourhead, it's all still kind of
(10:04):
going to that same hub. Andbecause that hub of information
is in the lower brain stem andthe upper spinal cord, that's
why different types of, say,like chiropractic adjustments or
manual manipulation, of say, c1and c2 can have a big impact on
these types of headaches,because if those are subluxated
(10:27):
or there's nerve impingementhappening, that can just be a
trigger for all of this.
Sophia Bouwens (10:31):
I think Atlas orthogonal or this upper
cervical work for me has beenhelpful. I also noticed hormone
changes would trigger them forme. So I think that there's a
metabolic component withhormones and diet and food. Do
you find that?
Ayla Wolf (10:47):
All the time? And that's where I think that when
people have migraines, we haveto look at it as we can't just
approach it from one angle. Wehave to approach it from like,
12 different angles. And right,
Sophia Bouwens (11:00):
like, your initial question of, like, Did
you have food triggers? Like, itdives right into that,
Ayla Wolf (11:04):
yeah. And the food trigger thing is interesting,
because it kind of goes back tomore of this bucket theory of,
if your bucket is already full,the food trigger is just like
that one extra drop that kind oftips you into the migraine. And
so when it comes to kind ofneuromodulation and neuro
rehabilitation for people withmigraines, what you're really
(11:26):
trying to do is get that bucketa lot emptier so that the
triggers aren't so triggering.
Sophia Bouwens (11:34):
So do you find different diets or different
foods are better for people whosuffer with migraines, like
should they follow a specifictype of thinking around eating
and food.
Ayla Wolf (11:45):
A lot of times, you can make faster progress with
people if they are willing togive up dairy and gluten and
sugar and alcohol and caffeine.
So a lot of people, you know youcan't use caffeine
therapeutically to abort amigraine, if you're drinking a
lot of it every single day,sure, and so for a lot of
(12:05):
people, when we're talking aboutpeople that have migraines, like
more than 15 days out of themonth, like when people have
lots of chronic migraines,that's when you have to really
kind of pull all the stops andkind of remove a lot of things
from the diet and the lifestyleand approach this from all the
different angles. But if peoplecan actually go caffeine free,
they're going to have three tofive days of horrible caffeine
(12:29):
withdrawal headaches. Butusually, if they can get through
those five days, you know, thenthey are through the worst of
it. And in many cases, goingcaffeine free is actually an
important part of addressing themigraines.
Sophia Bouwens (12:47):
I found that for me, hormones and food were
important, movement and activitywas important. I love caffeine,
so I have withdrawn from itbefore and had it out of my
system for a while, and that didhelp, but after I kind of
cleaned up things, I noticed themigraines also got much better
and didn't come back so much. Sowhen you live with migraines in
(13:10):
a debilitating way, changingyour food, sometimes it's the
comfort, like all I can have isthe food that I like. But if you
know that freedom is on theother side, it can really be
life changing for that.
Ayla Wolf (13:24):
Yeah, I mean, when I took a course, it was 150 hour
course on migraines, taught byDr Adam Harcourt, who has a
clinic specifically in SantaBarbara, where he specializes in
people who have serious,debilitating migraines. People
from all over the world flythere to his clinic to get
treated. And if I hope I'msaying this correctly, but I
(13:47):
thought that he said that manytimes before he even has people
come and do like, a week longintensive with him, he will ask
them to basically cut out glutenand caffeine and a lot of foods
out of their diet completelybefore they even show up to work
with him, so that he's notfighting against some of these
inflammatory things that arekeeping them in that
(14:14):
state,right? what he's doing ishe's setting himself and the
patient up for success.
Sophia Bouwens (14:24):
Absolutely. How do you see hormones playing a
role in migraines?
Ayla Wolf (14:30):
A lot of times, excessive amounts of estrogen
can be a trigger for migraines,and there is very often a
hormonal component to them,especially with women, but even
with men to hormonal imbalancescan cause migraines, and I like
for any migraine sufferer,patient that I work with to do a
Dutch test, or some kind ofhormone test where we can really
(14:52):
look at the breakdown betweenthe different types of estrogen
and how that relates to theirprogesterone levels, their
testosterone levels. Is theirDHEA, their cortisol, and just
get all that information to say,Okay, what hormonal imbalances
might be driving theseheadaches? I had a woman who was
in her 60s who developedmigraines, and when we got her
(15:17):
Dutch test results back, she waslow across the board. So I mean,
I mean below the post menopausalrange of where she should be,
and by and because she was lowacross the board in everything
by simply just having her takeDHEA and pregnenolone, which are
kind of the building blocks forcreating testosterone and
(15:37):
progesterone and estrogen, wegot rid of her migraines just by
actually getting her hormonesinto the correct post menopausal
level. Whereas many people whoare still cycling, many women
that have excessive amounts ofestrogen, by getting those
levels down into a normal,healthy range, you can reduce
the frequency of migraines too.
Sophia Bouwens (15:58):
I remember, Dutch test is your favorite
hormone panel to do that kind ofanalysis. Why is it your
favorite?
Ayla Wolf (16:04):
Because it gives you all of that information. Whereas
many people, if they just go inand have their blood drawn, all
you get is just basic numbersfor where their levels were at
in terms of their e2 but itdoesn't give, oftentimes, it
doesn't give the breakdown of e1e2 and e3 and so what I like
(16:24):
about the Dutch test is it givesyou the ratios between the e1
two and three, to see if they'rein the correct ratios. And then
you can also really easily seeif the metabolites of
progesterone are approximatelythe same as the metabolites of
testosterone. And so you canlook at how the body is breaking
down different hormones andtheir metabolites, because that
(16:46):
highlights very specificenzymatic pathways that might
not be functioning or befunctioning too high. And so the
Dutch test just gives you somuch more information than a
general blood test does. Thatcan help to figure out okay, if
this one enzymatic pathway isout of balance, I know the
different kind of naturaltherapies that can help to bring
(17:06):
it back in balance.
Sophia Bouwens (17:07):
And what's it?
What do you do for a Dutch test?
What's it? How is it different?
Where do you find it, or whatkind of provider would you go to
to get a Dutch test?
Ayla Wolf (17:16):
Usually a naturopathic doctor, a
functional medicinepractitioner, an integrative
medicine doctor or differentacupuncturist based on kind of
where they're practicing, orwhat their backgrounds are. And
chiropractors, too. A lot ofchiropractors order the Dutch
test. So a lot of kind ofholistic practitioners and
people practicing FunctionalMedicine and integrative
(17:37):
medicine tend to rely more ontests like the Dutch test, and
one similar to that, and it's acombination of taking some
saliva samples for measuringcortisol throughout the day, as
well as taking urine samples.
And so it's actually measuringthese hormone metabolites that
are in the urine, to give you asense of kind of the levels in
the body.
Sophia Bouwens (17:59):
And different parts of the system and how
they're being utilized ordisposed of too. Yeah?
Ayla Wolf (18:05):
What do you mean by that?
Sophia Bouwens (18:06):
Like, if you're catching what's in the urine
you're catching, kind of likethe waste products of things,
and how much is there, and thenin the saliva? Is that more
active in the system?
Ayla Wolf (18:17):
They are pulling different information from the
saliva versus the urine, and sothey're pulling different
cortisol levels from the saliva,but then they're looking at
cortisol metabolites in theurine, sure, and so they're kind
of getting two differentpictures. Exactly.
Sophia Bouwens (18:32):
Cool. So what about stress? Can stress play an
impact on the I know stress canimpact hormone regulation. It
can impact cortisol inparticular. What do you see for
stress and migraines?
Ayla Wolf (18:45):
Well, quite simply, Stress makes everything worse!
Sophia Bouwens (18:48):
Oh, really!
Ayla Wolf (18:50):
yes. And you know, it's so easy to say to somebody,
oh, you just need to reduce yourstress levels, but it's so much
harder, in reality, to to makethat change. Because the I think
the truth is that we have somethings that we have control
over, and we have many, manythings that we don't have
control over in our lives. Andso our stress, you know, can
(19:11):
come from both places. Sometimespeople's mindset, you know, is
set up so that they'reperceiving many things to be
stressful, right
Sophia Bouwens (19:19):
Way of thinking, right!
Ayla Wolf (19:20):
Sometimes it's a process of just being more aware
of your own thoughts and yourown thought patterns and how you
might actually be creatingstress in your life by how you
choose to react to things,versus, you know, being really
aware of what you have theability to control and then
letting go of the things thatyou don't. And so, you know,
(19:40):
when it comes to stressmanagement, I think that
counseling can play a huge rolein helping people to just be
more aware of their habits andtheir thinking patterns and the
role that they may be playing inthe stress in their lives.
Sophia Bouwens (19:56):
Perception is everything. So much of it is,
yeah.
Ayla Wolf (19:59):
And I think that, you know, we live in a we live in a
world now where there's so manyinternet trolls and so many
people making hateful, meancomments on social media, and
so, I mean, there's a reason whyI don't like social media and
why I don't like being on it isbecause I just don't,
(20:20):
personally, don't like beingattacked, and I don't like
people who don't know me makingthese weird statements about
like that don't even make sense,but they're just clearly trying
to be negative or hateful ormean, and I just don't
understand it. It's like, I, youknow, I feel like I have to be
on social media because I owndifferent companies and
businesses, but I don't want tobecause of all the strange stuff
(20:43):
that goes on that I just don'twant to be part of.
Sophia Bouwens (20:45):
It's not even a real world. It's all electronic,
which is so some something somind blowing to think about in
our generation has grown up nowwith, like, pre social media,
and now social media, and thenthese kids out there who are
inheriting a world that hasalways had social media, and
(21:05):
it's a lot so there's a lot ofthings about how you're
structuring your life, or whatyou're engaging with that could
impact this as well. Migrainesare complex, as we are learning
headaches altogether arecomplex. What about headaches
that are similar to migraines,but not true migraines,
migraine-like headache. Maybeyou could talk about the
questions you would ask if youwere trying to have a clarity
(21:28):
with experiencing a truemigraine. You said there was
four questions,
Ayla Wolf (21:32):
yeah, and again this, I like to give credit where
credit's due. So this came outof the teachings that Dr
Harcourt taught in his course onon migraines that was offered
through the Carrick Institute,which offers kind of post
doctoral training in appliedclinical neuroscience. And so he
taught a 150 hour course onmigraines, and did a great job
(21:56):
of getting into migrainepathophysiology, as well as
addressing all these differentlifestyle factors, the stress,
the hormones, the diet, thesleep, I mean, all of that is
Sophia Bouwens (22:07):
150 hours of that yes, yes. So much That's
important.
amazing.
Ayla Wolf (22:13):
Yeah, so there are three questions that, if people
answer yes to all, sorry, fourquestions, where, if people
answer yes to all fourquestions, then it's highly
likely that what they'reexperiencing is a true migraine.
And the first question is, areyour headaches on only one side
of the head? Or at least at theonset of these headaches, were
(22:37):
they one sided? Because that isa, what a kind of classic
migraine presentation is? It isa, you know, throbbing, one
sided headache. When people dodevelop migraines that go on to
just become kind of theseintractable headaches that are
there all the time, then theycan start to kind of be
bilateral, but at least in thebeginning, traditionally,
(22:59):
classically, these migraines areone sided, right? So are your
headaches on only one side ofthe head? So if people answer
yes to that, you know that'skind of one clue. The second one
is, do you have a history ofmigraines? So if we're talking
specifically about people whohave had a concussion and then
go on to develop headaches, didthey have a history of
(23:21):
migraines, because usuallymigraines come on when people
are, you know, teenager or earlyadult. And so it is much less
likely for somebody to justsuddenly develop migraines in
their 50s, 60s, 70s, after ahead injury. Yeah. And so if you
answer yes to that that you youyourself have a history of
(23:41):
migraines, and then you get aconcussion, and now these
throbbing headaches are worse,right? That can be an
indication, yes, this is indeeda migraine. And then also, is
there a family history ofmigraines? Because migraines are
there's a genetic component toit. They do run in families.
Over 70% of migraine sufferersare women, and so it's usually
(24:03):
if somebody's suffering frommigraines they also have a
sister, a mother, an aunt, agrandma, other people in their
family that likely also havemigraines. And then the fourth
question is, if you takemigraine aboard of medications,
do they help? And so somebodysays yes. Then again, it's very
(24:24):
likely that what they're dealingwith is a true migraine.
Sophia Bouwens (24:28):
So, if, after a head injury, you have a history
of migraines, you have a familyhistory of migraines, it
responds well to migrainemedication, and it is only on
one side, or at least at theonset, then it's likely you're
having a true migraine.
Ayla Wolf (24:44):
A true migraine, yes.
Sophia Bouwens (24:45):
And what about the other group of people who
might say no to one of thosequestions, or all four of those
questions, but they're stilldiagnosed with migraines. What
do those headaches look like? Orwhat might decipher that? Yeah.
Ayla Wolf (24:56):
So that brings us to, I think, a very important. One
group of people who have hadconcussions, they develop post
traumatic headaches after theconcussion, and those headaches
are often throbbing. They'repulsing and you know, they're a
throbbing, pulsing headache.
They often have lightsensitivity, sound sensitivity,
nausea, but many times in thatcase, if it's not a cervicogenic
(25:21):
headache, if it's not comingfrom the neck, if it is more of
just a migraine like headache,then it is often bilateral. And
that's most of the patients thatI see. Are people that are
coming to me because they've hadthese horrible headaches they
can't get rid of after theirconcussion. And the headaches
(25:41):
are usually a combination ofsome kind of tension type,
pressure headache, along withmoments or episodes of these
throbbing headaches that aresometimes unilateral, sometimes
bilateral, but they can't answeryes to those four questions that
we just talked about they didn'thave a history of migraines
before their concussion. Theydon't have a family history of
(26:04):
migraines. And many times whenthese people have been given
migraine medications, they aretelling me that they don't work.
Sophia Bouwens (26:15):
So let's talk about that, because that's
interesting. Oftentimes I havepatients that come in that have
tried different migrainemedications and have been on
them for a long time, ordifferent ones in different
periods, and they're not superhelpful. They can actually get
headaches from the medicationuse even, yeah,
Ayla Wolf (26:35):
so there's it is a whole other ball of wax, and I
think it is happening morefrequently than people realize,
because people can get amedication overuse headache from
not that much medication. And soI think it would be probably
helpful for our listeners if wedive we, if we did a deep dive
(26:58):
into this idea of medicationoveruse headaches, because they
can happen not only from certainprescription medications, but
also from over the countermedications, sure.
Sophia Bouwens (27:07):
So let's talk about the windows of time like
and what are some of themedications that are commonly
used prescriptions? I know lotsof triptans are used. What are
some drug names that peoplemight recognize with this class,
the triptan class?
Ayla Wolf (27:20):
So I would say most of my patients that have been
prescribed triptans are eitheron Imitrex, that's probably the
most popular Maxalt, Relpax andZomig.
Sophia Bouwens (27:31):
Something like that. And how many days a month
do you use those to beconsidered kind of that overuse
time?
Ayla Wolf (27:39):
Yeah. So if people are taking a triptan more than
10 days a month for more thanthree months, they can develop a
medication overuse headache. Andbecause doctors know this a lot
of times, they only give peoplea 10 day supply per month of
triptans. But then what happensis that people run out of their
(28:01):
triptans, and so then they starttaking either ibuprofen or Aleve
or these other things. And whatthe research is also showing is
that if you take, say, likeTylenol, more than 15 days per
month for more than threemonths, or ibuprofen or some of
these non steroidal, antiinflammatory drugs 15 days per
(28:23):
month for three months. Or ifyou take a combination analgesic
like Excedrin migraine, whichhas caffeine in it as well, if
you take that for greater than10 days per month for more than
three months. Or if you takemultiple drug classes, right? So
if you're now mixing andmatching different drugs for
(28:45):
more than 10 days per month formore than three months, you can
develop medication overuseheadaches, or what people call
rebound headaches.
Sophia Bouwens (28:53):
That's so amazing that the headache
medication can cause headachesand adds another level of
complexity there. And thosewindows aren't always that
large, right? 10 days for manyof them, right?
Ayla Wolf (29:09):
Yeah. And so once I read this paper, which, you
know, let me back up. So when Idid the 150 hours of studying
migraines, the first 25 hours ofthat program, we read a 70-page
paper. The lead author was aresearcher named Peter Goadsby
(29:30):
who is a expert on migraines.
And so this paper was thedefinitive paper on migraine
pathophysiology. We spent thefirst 25 hours of the course
reading line by line, the 70page research paper, because it
was so important. And it was thedefinitive paper on migraines.
And so when he then published apaper on medication overuse
(29:53):
headaches in 2024 as soon as Isaw his name on that paper, I
paid attention. Because thisisn't just some random person
publishing a paper on medicationoveruse headaches. This is Peter
Goadsby that is writing a paperon medication overuse headaches,
and he is the expert onmigraines.
Sophia Bouwens (30:12):
One thing I saw that was really interesting
about that paper is that they'dsee brain changes in relation to
these medications, and if peoplewould stop taking them, they saw
a reversal in those brainchanges. So this is not
something that once it's done,you're stuck with it. It's
something that if you work withthe right provider to come off
of them, you can actually havehealing in a bigger way from
(30:36):
this too.
Ayla Wolf (30:37):
Yeah. I mean, they talked about different clinics
that would take people off ofthese medications and have
really significant improvementsin people's headaches. And then
they also talked about, like yousaid, the fact that, when they
were doing brain imagingresearch, people that had
medication overuse headaches hadwhat they were calling
(30:58):
hypometabolism in differentparts of the brain, and hypo
metabolism is also one of thethings when it's in, when you
have hypo metabolism ordecreased neuronal firing in,
say, the prefrontal cortex,that's what people with ADHD
suffer from, and that's why theADHD medications are stimulants,
(31:20):
and why? You take someone who'shyperactive and you give them a
stimulant, and all of a suddenthey're calmer. They're
hyperactive because of actuallya Hypo-metabolism that's
preventing them from actuallyhaving focused concentration.
And so you give them astimulant, you increase the
metabolism in the prefrontalcortex, and all of a sudden they
(31:41):
can do life better. They canfunction better. And so when
you've got hypo-metabolismhappening in the prefrontal
cortex that can cause all kindsof cognitive symptoms, and after
a concussion, people can alsohave hypo metabolism. So then,
if you're giving themmedications that create further
hypo-metabolism, you can createfurther cognitive issues, maybe
(32:03):
even depression and things withdifficulty focusing and
attention and brain fog and allof that. And so that's another
reason why these medicationsshould really be used with
caution, and should, andespecially with say, like the
triptans, should not be kind ofaccidentally given to people
that maybe look like they havemigraines but aren't actually
(32:24):
suffering from true migraines,
Sophia Bouwens (32:27):
and then having the headaches from overusing
that medication because it's notworking for them, because it's
not the right medication. Thisdiagnosis component continues to
be so important.
Ayla Wolf (32:40):
and I know I mentioned this in the previous
episode, but I had, you know, apatient who was in a very bad
car accident, and she had atraumatic brain injury and a lot
of headaches, and she had brokeher jaws. She'll have facial
pain, jaw pain, and as I workedwith her, a lot of things were
(33:00):
getting better, but herheadaches were not getting
better. And I kept asking herabout her use of ibuprofen,
because she would kind ofmention it casually, and I think
she always kind of downplayedit, because finally, when this
paper came out, and it reallyhighlighted to me the importance
of this idea that if you'reoverusing even something like
ibuprofen that it can actuallycause headaches. I finally took
(33:24):
a different tactic, and Ibasically started talking about
the paper and saying, like, hey,this isn't just me, in my
opinion. This is, you know,people who are experts that are
publishing papers on this, thatare saying, if you're taking
ibuprofen more than 15 days amonth for three months in a row,
that can actually triggerheadaches. And so she finally
took my advice and she stoppedtaking the ibuprofen, after
(33:46):
admitting to me that she took italmost every single day, wow.
And so she stopped taking it andI saw her at that point. I was
only seeing her, I think, once amonth, because everything else
was really a lot better. It wasjust these headaches that were
the most stubborn thing that shewas dealing with. And so when I
saw her month later, she said,Oh yeah, my headaches are, like,
practically gone. And it wasjust, you know, such a stark
(34:11):
proof to me that, wow, like, youknow, ibuprofen, as innocuous as
it may seem, had actually beencausing her headaches. And for
over a year, she had headachesevery single day,
Sophia Bouwens (34:23):
and I'm sure she was probably taking ibuprofen to
help with them, not knowing theywere driving them. Thank
goodness for researchers, nerdsthat just like, sit up there and
do all these investigations,then publish it out there for
patients to glean from, becauseproviders and practitioners like
yourself are doing the research,reading the research, and what.
Ayla Wolf (34:42):
And the reality is that doctors are so busy,
they're many of them are veryburnt out, and so most doctors
are not going home and readingall of the research at night.
You know, I mean, they often sayit can take the 20 to 40 years
for research to make its wayinto clinical practice, and
that's too long, like we don'thave time to wait 20 to 40
(35:05):
years. People are suffering now.
And so that's, you know, a oneof the reasons why I wrote my
book as well is, if you look atthe dates of a lot of the
research papers that I referencein my book, they are literally
coming from papers that werepublished in 2023, 2024 -
really up to date. And so welive in, we live in a day and
age where you can actuallypublish a book in 2025 that is
(35:26):
based on research that waspublished in 2024 and I think
you know, Never have we lived ina time period where you could do
that?
Sophia Bouwens (35:36):
No. They are not always updated or you have to go
to libraries and archives andread them and pull them out.
Ayla Wolf (35:43):
So that's I think, another reason why I'm so
excited is that my book isreally representative of the
most kind of recent researchthat we have, the most cutting
edge research that ultimatelyhasn't fully made its way into
mainstream medicine and into theforefront of people's minds yet.
Sophia Bouwens (36:02):
So what guidance would you give a migraine
sufferer, post traumaticheadache, migraine sufferer, or
migraine like suffer, if theysuspect these things, what do
you think they should do orcould do?
Ayla Wolf (36:13):
Yeah, I think the first step is if people answered
no to all four of thosequestions at the beginning of
the podcast, and they've beendiagnosed with migraines, they
should probably go back to theirprescribing physician or doctor
and have a conversation aroundwhether or not that's the right
diagnosis for them, because we,you know, we definitely don't
(36:34):
want people to be misdiagnosedor on medications that are for
the wrong thing, especially ifthose medications aren't
working. And a lot of people,you know, really do put so much
faith into into medicine. And soa lot of people take medications
even if they're not helping. Imean, I see that all the time is
(36:55):
that people have been onmedications for six months to
two years, and they are stillhighly symptomatic, and they
haven't gotten any better, andthey're not getting relief. And
a lot of times, what happens isthey're just put on one migraine
medication, and if that doesn'twork, they're put on a different
one. If that doesn't work,they're put on a different one,
and it's just, again, taxing tothe liver, and if it's the wrong
(37:16):
diagnosis to begin with, they'vegot to try a different approach.
So for the people who don't havetrue migraines and they have,
quote, "migraine-like posttraumatic headaches", the
migraine medications are likelynot going to help them. And so
there are other medications,like amitriptyline, we talked
(37:36):
about that before, where somepeople get some relief from
that, but obviously with usbeing, you know, acupuncturists
and always trying other naturaltherapies that are non
pharmaceutical, you know, we'veseen great results with things
like acupuncture and even, youknow, upper cervical
(37:57):
chiropractic care, Massagetherapy to help address neck
tension. Craniosacral therapyfor that, yep, craniosacral
therapy, osteopathicmanipulation from DOS,
peripheral nerve stimulationdevices to help modulate the
trigeminal nerve and that lesserand greater occipital nerves. So
there's a lot of other therapiesthat I think can do a lot for
(38:21):
those people?
Sophia Bouwens (38:22):
Yeah, exercise, dietary changes, like the diet,
I can't, I don't think it can beunder emphasized, but you have
to make sure that the diagnosisis right so you're working with
the right set of information.
Ayla Wolf (38:34):
Yeah, absolutely.
Sophia Bouwens (38:36):
Well is there anything else you'd like anyone
to know about migraine andmigraine, like headache for now,
or medication overuse and itscomplexities?
Ayla Wolf (38:44):
Man, I mean, I feel like we potentially maybe
overwhelmed people a lot ofinformation.
Sophia Bouwens (38:50):
Well it wasn't a 150 hour course, but it was a
touch into the complexity there,and hopefully people come away
with some better clarity aroundwhat a migraine is and what can
be done for it effectively, orif it's not effective, maybe
(39:10):
what other alternatives mightbe?
Ayla Wolf (39:12):
I guess I will say, you know, one thing for people
who are suffering from truemigraines, that research paper
that we've been referencing withPeter Goadsby that came out in
2024 what they did say is thatthere are two classes of medic
of migraine medications, thoseCGRP receptor antagonists and
(39:33):
then the CGRP antibodies. So theCGRP receptor antagonists are
things like Ubrelvy and then theCGRP antibodies are things like
Emgality and Ajovi. And many ofthese are a once a month
injectable medication. And whatthey were saying is that for
people that have true migraines,that are dealing with medication
(39:55):
overuse headaches, that thoseare safer medications and that
they don't cause. Thosemedication overuse headaches and
so as part of the process ofweaning people off of the other
medications, whether it's thetriptans or the Aleve or the
ibuprofen or Tylenol, in theprocess of helping people
withdraw off those medications,these two classes of migraine
(40:16):
medications are actually saferand one of the kind of bridge
therapies that people can use tostill get relief from their
migraines while they're gettingoff of those other medications.
So again, that's something thatI think people could go to their
doctors and ask them about. Sothat's, I think, important to
recognize.
Sophia Bouwens (40:34):
And I think it's also important just to recognize
that these migraine medicationsaren't something you can stop
abruptly. You have to useguidance to come off of them in
different ways.
Ayla Wolf (40:44):
Yeah, absolutely, because there's, there's a lot
going on when you just suddenlystop taking medication. And so
obviously, we're not givingpeople pharmaceutical advice,
but recommending they do workwith their doctors to make sure
that they're doing the rightthing for their situation, yeah,
Sophia Bouwens (41:01):
and doing that in a safe way. Because I think
that paper that you referencedearlier, too even talked about
how an abrupt finish tomedications can be helpful
compared to slow withdrawal, butthat that abrupt finish isn't
just cutting it out completely.
You have to do that in a safeway that should be managed well
with a prescribing provider aswell.
Ayla Wolf (41:21):
Yeah, excellent advice. There was also another
research paper. It was a metaanalysis looking at all the
different research papers hadbeen published on omega three
essential fatty acids. And whatthey found is that when people
were taking high doses of Omegathree essential fatty acids, and
we're talking like 1800milligrams to 2000 milligrams a
(41:44):
day consistently, that thatactually was effective in
helping people reduce thefrequency of their migraines.
And I often find that people aretaking omega three, essential
fatty acid supplements, fishoils, things like that, but that
they're not taking them at thosehigher doses. And so the
(42:05):
research is really saying thatthose things can be helpful, but
you have to take a high enoughdose. And because high quality
fish oils are expensive, I thinka lot of people are either, you
know, for the purpose of savingmoney, or just because they
don't know any better they'rethey're taking lower doses that
aren't actually moving theneedle or helping them, as far
(42:27):
as reducing the amount ofheadaches that they're actually
experiencing.
Sophia Bouwens (42:31):
And we could get into a whole conversation about
the importance of safety aroundsupplements and things you find
in health food stores or on theshelves at random stores, and
how they're not necessarilyregulated. So there's a lot of
evidence out there that unlesstheir company is really doing
extra work to put forward good,high quality stuff with what it
(42:52):
says is in there, in what you'rebuying, there's a lot of
companies that produce thingsthat don't even have the
ingredients they say are inthere, or they're not in a
formula body can use, or theycome with all these other toxic
components that aren't wellprocessed.
Ayla Wolf (43:07):
And that's especially the case when you're talking
about fish oils or any kind ofOmega three, essential fatty
acid, because if you're taking alow quality, Poor fish oil
supplement, A, it might bereally high in mercury, which
nobody needs in their body. B,it could actually have a rancid
oil that's been, you know,oxidized. And you also don't
want to take oxidized oils thatcause free radical damage in
(43:30):
your brain either. And so you doneed to know, like, which
companies are safe, whichcompanies are reputable. I often
recommend that people you know,get their supplements from like
healthcare providers who workwith companies that only sell to
healthcare providersprofessional brands. Those
professional brands usually arereally focused on healthcare,
(43:51):
and sadly, what's happened is alot of the pharmaceutical
companies have been buying up alot of the supplement companies
only because they want theprofits of the supplement
companies. They just want acorner of the supplement market,
which is, you know, probably inthe trillions of dollars at this
point, and so they don't careabout the quality. And, you
(44:12):
know, not to name names, butwhenever I see now a supplement
company that has a commercial onTV, in my mind, I'm like, Okay,
well, if they have enough moneyto have a commercial on national
TV, it probably means thatthey're owned by a
pharmaceutical company that hasthe budget to do that.
Sophia Bouwens (44:27):
And doing less investment in their product
quality than they are theproduct name brand, yeah.
Ayla Wolf (44:33):
So potentially, the quality is a huge important
issue.
Sophia Bouwens (44:38):
For sure, very important. Okay, well, that's
awesome. We learned some newthings about exactly what is a
migraine. Some questions to askyourself around how to know
you're actually having amigraine, and then some
resources to consider things youcould do in your lifestyle to
help with migraines, avoidingthose medication overuses and
(44:58):
headaches and. Ways to talk toyour providers around migraine
and migraine like headaches andoptions for that. I think that
was pretty robust,
Ayla Wolf (45:09):
agreed. And then in our next episode on neuropathic
pain, we'll also do a furtherdiscussion on some of these
natural therapies that peoplecan try to help with migraines
and migraine like post traumaticheadaches. And then in the
episode after that, we'llactually get into our own
research study that was justpublished in the Journal of
(45:31):
Neurotrauma on acupuncture forpost-traumatic headaches. So
that's gonna be a super funepisode where we actually get to
talk about our own process ofdoing clinical research.
Sophia Bouwens (45:41):
What a process that was too, and going back,
looking at doing it again, or itwas a pilot study, so designing
something different, reallylearning and using this
information to frame a betterquestion, or maybe a different
way of intervening to see if wecan even get better results. So
that's exciting. I'm excited forthat too. Yeah. Thank you
(46:02):
listeners for listening. I hopeyou glean something. Feel free
to share this with somebody ifyou found it valuable, or you
think they might find itvaluable, share it with your
providers and tune into our nextepisode on neuropathic pain and
how that can cause a lot ofheadaches and be really similar
to post concussion symptoms,excellent.
Ayla Wolf (46:22):
Thanks for listening.
Medical disclaimer, this videoor podcast is for general
informational purposes only anddoes not constitute the practice
of medicine or otherprofessional health care
services, including the givingof medical advice, no doctor
patient relationship is formed.
(46:45):
The use of this information andmaterials included is at the
user's own risk. The content ofthis video or podcast is not
intended to be a substitute formedical advice, diagnosis or
treatment. Consumers of thisinformation should seek the
advice of a medical professionalfor any and all health related
issues. A link to our fullmedical disclaimer is available
(47:08):
in the notes you.
Most of the patients that I see are people that are
(00:04):
coming to me because they've hadthese horrible headaches they
can't get rid of after theirconcussion. And the headaches
are usually a combination ofsome kind of tension type,
pressure headache, along withmoments or episodes of these
throbbing headaches that aresometimes unilateral, sometimes
bilateral, but they can't answeryes to those four questions that
(00:27):
we just talked about.
Sophia Bouwens (00:28):
Welcome to the life after impact podcast where
we do a deep dive into allthings concussion and brain
injury related. We talk aboutall the different symptoms that
can follow brain injury,different testing methods,
conventional and functional, anddifferent types of specialists
out there, as well as differenttherapies available. I'm Sophia
(00:50):
Bowens, and I'm here with DrAyla Wolf, and we will be your
guides to living your best lifeafter impact.
Ayla Wolf (00:59):
Well, Sophia, episode number three. We've made it this
far.
Sophia Bouwens (01:02):
Here we go.
We're gonna keep going too.
We're just getting started.
That's right. How are you doingtoday? I'm great, good. I'm
excited for our discussiontoday. We're gonna dive into
post traumatic headache,migraines, migraine like,
headaches, medication overuseand kind of deciphering those
things with post traumaticheadache after an injury,
Ayla Wolf (01:25):
let's just dive right in. Great. There was a paper
that was published in 2018 thatwas looking at athletes with
concussions, and it had someinteresting findings
differentiating people that hada post traumatic migraine versus
people who didn't. And one ofthe things they found was that
(01:48):
the concussed athletes with posttraumatic migraines were seven
times more likely to have alonger recovery time than those
without headaches at all, andtwo times more likely to have a
longer recovery than other typesof post traumatic headaches.
Sophia Bouwens (02:03):
So is that saying that if you had migraines
before an injury, that you'regoing to have a more complicated
recovery, or what they'refinding?
Ayla Wolf (02:11):
So the literature says that people that have a
history of migraines beforetheir concussion, it's a risk
factor for poor outcomes or amore prolonged recovery, and so
I think that is important torecognize, and that presence of
migraines before the concussionis also a key differentiating
(02:32):
factor between trying to figureout whether people are indeed
having true migraines or ifthey're having a post traumatic
headache That is migraine-likein nature, it resembles a
migraine, but it's actually not.
Sophia Bouwens (02:44):
Sounds complex.
Ayla Wolf (02:45):
We'll get into that because there's kind of four
simple questions that can get tothe bottom of that for a lot of
people.
Sophia Bouwens (02:51):
I'd like to ask you or find out more about those
questions, but first, I want toknow what is a migraine?
Ayla Wolf (02:59):
Yeah, so I think right out of the gate, a lot of
people who have never had amigraine don't have a good sense
of just how awful they are.
Sophia Bouwens (03:09):
I can attest to that.
Ayla Wolf (03:11):
Yeah, and I currently do not have migraines, but there
was a brief period of time thatwere definitely hormonally
triggered. So I had migrainesprobably between the ages of 13
and 15, and I'll never forgetthe very first migraine I ever
had. I went to my best friend'shouse. This is somebody I've
been friends with since theywere three years old, and I was
(03:32):
at Elsa's house, and her mom hadmade chocolate chip pancakes for
breakfast, and my mom was, ofcourse, like this crazy health
nut. So we never got, nevergetting chocolate chip pancakes
at my house.
Sophia Bouwens (03:46):
No, that was that was unheard of my house,
either.
Ayla Wolf (03:49):
Yeah, my mom literally made me bring green
beans to McDonald's, and I hadto eat the green beans before I
could have a happy meal. I had amom child abuse. It was
terrible.
Sophia Bouwens (03:59):
I thought my mom was abusive when my most exotic
cereal I was allowed to havewas, like, Raisin Bran.
Ayla Wolf (04:05):
Oh, that is bad.
Sophia Bouwens (04:06):
Not Raisin Bran crunch. That was too much sugar.
It was awful.
Ayla Wolf (04:10):
Oh, man, okay, so more with more things we have in
common. Yeah. So anyway, I'llnever forget I ate the chocolate
chip pancakes, and then all of asudden I started to get the
migraine aura. And if you'venever had that before, it can be
frightening, because you have noclue what's happening. And all
of a sudden the whole worldturns into a kaleidoscope, and
(04:31):
you have like tunnel vision, andthere's bright colors moving
around. And I got very nauseous,and then I started vomiting, and
then I had the horriblethrobbing headache, and all I
could do was just lay in bed andfeel miserable and feel like I
was gonna puke for, you know,four hours straight, and then
you have the hangover afterthat, where you just feel like
crap, awful. So I migraines areterrible.
Sophia Bouwens (04:54):
I got migraines for a while when I was younger,
too, and they would always startwith this, like taste of. Mouth
and the aura that was hard todescribe, kind of Kaleidoscope
like, but also, just like, theworld was different, kind of
looked smaller, was fuzzy aroundthe edges, and when those would
come on, all I could do would belike, go in a dark room and
sleep. Nothing else would help,no medication, because I'd get
(05:18):
nauseous, I'd get lightsensitive. I didn't want to
smell anything. It was horrible.
Ayla Wolf (05:22):
Yeah, did you have food triggers for your
migraines?
Sophia Bouwens (05:25):
I did.Cilantro would always trigger migraines
for me, and then, like greasyfoods would be not good.
Caffeine would sometimes help.
Sometimes it would make itworse. So it was always hit or
miss with that,
Ayla Wolf (05:38):
my trigger was chocolate. I, you know, I
finally figured it out that if Iever Well, here's the weird
thing, if I ever ate chocolatebefore lunch, I it would trigger
a migraine for me. And so Ilearned from the age of 13 on.
And you know me, I'm addicted tochocolate.
Sophia Bouwens (05:52):
You love chocolate!
Ayla Wolf (05:55):
I am addicted to chocolate, but chocolate before
lunch, it's like someone'strying to hand me poison. I do
not want to even look atchocolate before lunch, even to
this day and again, I don't haveI haven't had migraines for a
very long time, but to this day,chocolate before lunch. I will
not touch it.
Sophia Bouwens (06:13):
I'll never give you chocolate before lunch. Now
I know this. I'm learning thisthing. So migraines can be
really debilitating and havethis aura, like component
sensitivity, components well.
Ayla Wolf (06:25):
And actually, the research says only about 30% of
migraine sufferers have theaura, okay? And so even though
we both have had this strongaura, 70% of people that get
migraines don't actually havethe aura. But so when you going
back to your initial question oflike, what is a migraine? So
there's something called CGRP,calcitonin gene related peptide.
(06:47):
And when CGRP is released inlarge amounts, all of a sudden,
it causes vasodilation and bloodvessels dilate, and then all of
a sudden, people can get thisthrobbing headache. Originally,
they thought that that was justthat, that was kind of like the
simplistic mechanism of just,oh, blood vessels dilate, and
(07:09):
now all of a sudden the migrainehappens. But now they're
recognizing that there's thiswhole neural component to that
it's not just blood vesselsdilate, and because if that was
the case, if you justconstricted the blood vessels,
then that would basically fix itin, you know, 100% of cases. And
that's not true. We do know thatfor some people, they can take
(07:29):
caffeine, it can constrict theblood vessels, and it for some
people that can help, but it'snot like a 100% of the time, all
I need to do is take a caffeinepill and my headache goes away,
right? So there's thisneurological component to it.
There's a neurovascularcomponent. It's the interaction
of the nerves with the bloodvessels that are part of this
(07:50):
migraine pathophysiology. Allhead pain involves the
trigeminal system. And I use theword system intentionally,
because we have cranial nervefive is our trigeminal nerve,
and that has three mainbranches, and those essentially
cover the whole face, all theway up until the top of the
(08:11):
head, so it goes into the scalpand even the ear. But all of
that information goes intodifferent parts of the brain, so
we've got different nuclei inthe midbrain and the lower brain
stem that all take thatinformation and then converge
that information with kind ofother nerves from the back of
the head. And so there's a veryspecific part of the lower brain
(08:34):
stem and even into the spinalcord, called the trigeminal
cervical complex, and that isjust a hub of sensory
information about the face andthe head that is transferring
pain information to the brain.
And so what happens withmigraines is that this very
specific part of the brain canbecome hyperactive, and that's
where a lot of therapies aretargeted in terms of
(08:58):
neuromodulation is, can we dosome kind of neuromodulatory
therapy on the trigeminal nerveon the face, in order to kind of
modulate that information goinginto that trigeminal cervical
complex in the brain stem, tothen change this pain perception
happening at these highercortical levels?
Sophia Bouwens (09:18):
Or for me, I would always get pain kind of at
the back of my head, the base ofit almost like it would feel
like kind of throbbing, and Iwould know, like, this is where
this headache is kind of comingfrom, and working that area
would be helpful. And for awhile, I thought, Oh, it's on my
neck. But it's not just the neckthat's involved there. It comes
(09:39):
across more systemic,
Ayla Wolf (09:42):
yeah. And in the back of the head, we've got the
greater occipital nerve and thelesser occipital nerve and the
third occipital nerve. And soall of the nerves in the back of
the head also have kind ofpathways that go into that
trigeminal cervical complex. Andso the. That's where it's like,
wherever the pain is in yourhead, it's all still kind of
(10:04):
going to that same hub. Andbecause that hub of information
is in the lower brain stem andthe upper spinal cord, that's
why different types of, say,like chiropractic adjustments or
manual manipulation, of say, c1and c2 can have a big impact on
these types of headaches,because if those are subluxated
(10:27):
or there's nerve impingementhappening, that can just be a
trigger for all of this.
Sophia Bouwens (10:31):
I think Atlas orthogonal or this upper
cervical work for me has beenhelpful. I also noticed hormone
changes would trigger them forme. So I think that there's a
metabolic component withhormones and diet and food. Do
you find that?
Ayla Wolf (10:47):
All the time? And that's where I think that when
people have migraines, we haveto look at it as we can't just
approach it from one angle. Wehave to approach it from like,
12 different angles. And right,
Sophia Bouwens (11:00):
like, your initial question of, like, Did
you have food triggers? Like, itdives right into that,
Ayla Wolf (11:04):
yeah. And the food trigger thing is interesting,
because it kind of goes back tomore of this bucket theory of,
if your bucket is already full,the food trigger is just like
that one extra drop that kind oftips you into the migraine. And
so when it comes to kind ofneuromodulation and neuro
rehabilitation for people withmigraines, what you're really
(11:26):
trying to do is get that bucketa lot emptier so that the
triggers aren't so triggering.
Sophia Bouwens (11:34):
So do you find different diets or different
foods are better for people whosuffer with migraines, like
should they follow a specifictype of thinking around eating
and food.
Ayla Wolf (11:45):
A lot of times, you can make faster progress with
people if they are willing togive up dairy and gluten and
sugar and alcohol and caffeine.
So a lot of people, you know youcan't use caffeine
therapeutically to abort amigraine, if you're drinking a
lot of it every single day,sure, and so for a lot of
(12:05):
people, when we're talking aboutpeople that have migraines, like
more than 15 days out of themonth, like when people have
lots of chronic migraines,that's when you have to really
kind of pull all the stops andkind of remove a lot of things
from the diet and the lifestyleand approach this from all the
different angles. But if peoplecan actually go caffeine free,
they're going to have three tofive days of horrible caffeine
(12:29):
withdrawal headaches. Butusually, if they can get through
those five days, you know, thenthey are through the worst of
it. And in many cases, goingcaffeine free is actually an
important part of addressing themigraines.
Sophia Bouwens (12:47):
I found that for me, hormones and food were
important, movement and activitywas important. I love caffeine,
so I have withdrawn from itbefore and had it out of my
system for a while, and that didhelp, but after I kind of
cleaned up things, I noticed themigraines also got much better
and didn't come back so much. Sowhen you live with migraines in
(13:10):
a debilitating way, changingyour food, sometimes it's the
comfort, like all I can have isthe food that I like. But if you
know that freedom is on theother side, it can really be
life changing for that.
Ayla Wolf (13:24):
Yeah, I mean, when I took a course, it was 150 hour
course on migraines, taught byDr Adam Harcourt, who has a
clinic specifically in SantaBarbara, where he specializes in
people who have serious,debilitating migraines. People
from all over the world flythere to his clinic to get
treated. And if I hope I'msaying this correctly, but I
(13:47):
thought that he said that manytimes before he even has people
come and do like, a week longintensive with him, he will ask
them to basically cut out glutenand caffeine and a lot of foods
out of their diet completelybefore they even show up to work
with him, so that he's notfighting against some of these
inflammatory things that arekeeping them in that
(14:14):
state,right? what he's doing ishe's setting himself and the
patient up for success.
Sophia Bouwens (14:24):
Absolutely. How do you see hormones playing a
role in migraines?
Ayla Wolf (14:30):
A lot of times, excessive amounts of estrogen
can be a trigger for migraines,and there is very often a
hormonal component to them,especially with women, but even
with men to hormonal imbalancescan cause migraines, and I like
for any migraine sufferer,patient that I work with to do a
Dutch test, or some kind ofhormone test where we can really
(14:52):
look at the breakdown betweenthe different types of estrogen
and how that relates to theirprogesterone levels, their
testosterone levels. Is theirDHEA, their cortisol, and just
get all that information to say,Okay, what hormonal imbalances
might be driving theseheadaches? I had a woman who was
in her 60s who developedmigraines, and when we got her
(15:17):
Dutch test results back, she waslow across the board. So I mean,
I mean below the post menopausalrange of where she should be,
and by and because she was lowacross the board in everything
by simply just having her takeDHEA and pregnenolone, which are
kind of the building blocks forcreating testosterone and
(15:37):
progesterone and estrogen, wegot rid of her migraines just by
actually getting her hormonesinto the correct post menopausal
level. Whereas many people whoare still cycling, many women
that have excessive amounts ofestrogen, by getting those
levels down into a normal,healthy range, you can reduce
the frequency of migraines too.
Sophia Bouwens (15:58):
I remember, Dutch test is your favorite
hormone panel to do that kind ofanalysis. Why is it your
favorite?
Ayla Wolf (16:04):
Because it gives you all of that information. Whereas
many people, if they just go inand have their blood drawn, all
you get is just basic numbersfor where their levels were at
in terms of their e2 but itdoesn't give, oftentimes, it
doesn't give the breakdown of e1e2 and e3 and so what I like
(16:24):
about the Dutch test is it givesyou the ratios between the e1
two and three, to see if they'rein the correct ratios. And then
you can also really easily seeif the metabolites of
progesterone are approximatelythe same as the metabolites of
testosterone. And so you canlook at how the body is breaking
down different hormones andtheir metabolites, because that
(16:46):
highlights very specificenzymatic pathways that might
not be functioning or befunctioning too high. And so the
Dutch test just gives you somuch more information than a
general blood test does. Thatcan help to figure out okay, if
this one enzymatic pathway isout of balance, I know the
different kind of naturaltherapies that can help to bring
(17:06):
it back in balance.
Sophia Bouwens (17:07):
And what's it?
What do you do for a Dutch test?
What's it? How is it different?
Where do you find it, or whatkind of provider would you go to
to get a Dutch test?
Ayla Wolf (17:16):
Usually a naturopathic doctor, a
functional medicinepractitioner, an integrative
medicine doctor or differentacupuncturist based on kind of
where they're practicing, orwhat their backgrounds are. And
chiropractors, too. A lot ofchiropractors order the Dutch
test. So a lot of kind ofholistic practitioners and
people practicing FunctionalMedicine and integrative
(17:37):
medicine tend to rely more ontests like the Dutch test, and
one similar to that, and it's acombination of taking some
saliva samples for measuringcortisol throughout the day, as
well as taking urine samples.
And so it's actually measuringthese hormone metabolites that
are in the urine, to give you asense of kind of the levels in
the body.
Sophia Bouwens (17:59):
And different parts of the system and how
they're being utilized ordisposed of too. Yeah?
Ayla Wolf (18:05):
What do you mean by that?
Sophia Bouwens (18:06):
Like, if you're catching what's in the urine
you're catching, kind of likethe waste products of things,
and how much is there, and thenin the saliva? Is that more
active in the system?
Ayla Wolf (18:17):
They are pulling different information from the
saliva versus the urine, and sothey're pulling different
cortisol levels from the saliva,but then they're looking at
cortisol metabolites in theurine, sure, and so they're kind
of getting two differentpictures. Exactly.
Sophia Bouwens (18:32):
Cool. So what about stress? Can stress play an
impact on the I know stress canimpact hormone regulation. It
can impact cortisol inparticular. What do you see for
stress and migraines?
Ayla Wolf (18:45):
Well, quite simply, Stress makes everything worse!
Sophia Bouwens (18:48):
Oh, really!
Ayla Wolf (18:50):
yes. And you know, it's so easy to say to somebody,
oh, you just need to reduce yourstress levels, but it's so much
harder, in reality, to to makethat change. Because the I think
the truth is that we have somethings that we have control
over, and we have many, manythings that we don't have
control over in our lives. Andso our stress, you know, can
(19:11):
come from both places. Sometimespeople's mindset, you know, is
set up so that they'reperceiving many things to be
stressful, right
Sophia Bouwens (19:19):
Way of thinking, right!
Ayla Wolf (19:20):
Sometimes it's a process of just being more aware
of your own thoughts and yourown thought patterns and how you
might actually be creatingstress in your life by how you
choose to react to things,versus, you know, being really
aware of what you have theability to control and then
letting go of the things thatyou don't. And so, you know,
(19:40):
when it comes to stressmanagement, I think that
counseling can play a huge rolein helping people to just be
more aware of their habits andtheir thinking patterns and the
role that they may be playing inthe stress in their lives.
Sophia Bouwens (19:56):
Perception is everything. So much of it is,
yeah.
Ayla Wolf (19:59):
And I think that, you know, we live in a we live in a
world now where there's so manyinternet trolls and so many
people making hateful, meancomments on social media, and
so, I mean, there's a reason whyI don't like social media and
why I don't like being on it isbecause I just don't,
(20:20):
personally, don't like beingattacked, and I don't like
people who don't know me makingthese weird statements about
like that don't even make sense,but they're just clearly trying
to be negative or hateful ormean, and I just don't
understand it. It's like, I, youknow, I feel like I have to be
on social media because I owndifferent companies and
businesses, but I don't want tobecause of all the strange stuff
(20:43):
that goes on that I just don'twant to be part of.
Sophia Bouwens (20:45):
It's not even a real world. It's all electronic,
which is so some something somind blowing to think about in
our generation has grown up nowwith, like, pre social media,
and now social media, and thenthese kids out there who are
inheriting a world that hasalways had social media, and
(21:05):
it's a lot so there's a lot ofthings about how you're
structuring your life, or whatyou're engaging with that could
impact this as well. Migrainesare complex, as we are learning
headaches altogether arecomplex. What about headaches
that are similar to migraines,but not true migraines,
migraine-like headache. Maybeyou could talk about the
questions you would ask if youwere trying to have a clarity
(21:28):
with experiencing a truemigraine. You said there was
four questions,
Ayla Wolf (21:32):
yeah, and again this, I like to give credit where
credit's due. So this came outof the teachings that Dr
Harcourt taught in his course onon migraines that was offered
through the Carrick Institute,which offers kind of post
doctoral training in appliedclinical neuroscience. And so he
taught a 150 hour course onmigraines, and did a great job
(21:56):
of getting into migrainepathophysiology, as well as
addressing all these differentlifestyle factors, the stress,
the hormones, the diet, thesleep, I mean, all of that is
Sophia Bouwens (22:07):
150 hours of that yes, yes. So much That's
important.
amazing.
Ayla Wolf (22:13):
Yeah, so there are three questions that, if people
answer yes to all, sorry, fourquestions, where, if people
answer yes to all fourquestions, then it's highly
likely that what they'reexperiencing is a true migraine.
And the first question is, areyour headaches on only one side
of the head? Or at least at theonset of these headaches, were
(22:37):
they one sided? Because that isa, what a kind of classic
migraine presentation is? It isa, you know, throbbing, one
sided headache. When people dodevelop migraines that go on to
just become kind of theseintractable headaches that are
there all the time, then theycan start to kind of be
bilateral, but at least in thebeginning, traditionally,
(22:59):
classically, these migraines areone sided, right? So are your
headaches on only one side ofthe head? So if people answer
yes to that, you know that'skind of one clue. The second one
is, do you have a history ofmigraines? So if we're talking
specifically about people whohave had a concussion and then
go on to develop headaches, didthey have a history of
(23:21):
migraines, because usuallymigraines come on when people
are, you know, teenager or earlyadult. And so it is much less
likely for somebody to justsuddenly develop migraines in
their 50s, 60s, 70s, after ahead injury. Yeah. And so if you
answer yes to that that you youyourself have a history of
(23:41):
migraines, and then you get aconcussion, and now these
throbbing headaches are worse,right? That can be an
indication, yes, this is indeeda migraine. And then also, is
there a family history ofmigraines? Because migraines are
there's a genetic component toit. They do run in families.
Over 70% of migraine sufferersare women, and so it's usually
(24:03):
if somebody's suffering frommigraines they also have a
sister, a mother, an aunt, agrandma, other people in their
family that likely also havemigraines. And then the fourth
question is, if you takemigraine aboard of medications,
do they help? And so somebodysays yes. Then again, it's very
(24:24):
likely that what they're dealingwith is a true migraine.
Sophia Bouwens (24:28):
So, if, after a head injury, you have a history
of migraines, you have a familyhistory of migraines, it
responds well to migrainemedication, and it is only on
one side, or at least at theonset, then it's likely you're
having a true migraine.
Ayla Wolf (24:44):
A true migraine, yes.
Sophia Bouwens (24:45):
And what about the other group of people who
might say no to one of thosequestions, or all four of those
questions, but they're stilldiagnosed with migraines. What
do those headaches look like? Orwhat might decipher that? Yeah.
Ayla Wolf (24:56):
So that brings us to, I think, a very important. One
group of people who have hadconcussions, they develop post
traumatic headaches after theconcussion, and those headaches
are often throbbing. They'repulsing and you know, they're a
throbbing, pulsing headache.
They often have lightsensitivity, sound sensitivity,
nausea, but many times in thatcase, if it's not a cervicogenic
(25:21):
headache, if it's not comingfrom the neck, if it is more of
just a migraine like headache,then it is often bilateral. And
that's most of the patients thatI see. Are people that are
coming to me because they've hadthese horrible headaches they
can't get rid of after theirconcussion. And the headaches
(25:41):
are usually a combination ofsome kind of tension type,
pressure headache, along withmoments or episodes of these
throbbing headaches that aresometimes unilateral, sometimes
bilateral, but they can't answeryes to those four questions that
we just talked about they didn'thave a history of migraines
before their concussion. Theydon't have a family history of
(26:04):
migraines. And many times whenthese people have been given
migraine medications, they aretelling me that they don't work.
Sophia Bouwens (26:15):
So let's talk about that, because that's
interesting. Oftentimes I havepatients that come in that have
tried different migrainemedications and have been on
them for a long time, ordifferent ones in different
periods, and they're not superhelpful. They can actually get
headaches from the medicationuse even, yeah,
Ayla Wolf (26:35):
so there's it is a whole other ball of wax, and I
think it is happening morefrequently than people realize,
because people can get amedication overuse headache from
not that much medication. And soI think it would be probably
helpful for our listeners if wedive we, if we did a deep dive
(26:58):
into this idea of medicationoveruse headaches, because they
can happen not only from certainprescription medications, but
also from over the countermedications, sure.
Sophia Bouwens (27:07):
So let's talk about the windows of time like
and what are some of themedications that are commonly
used prescriptions? I know lotsof triptans are used. What are
some drug names that peoplemight recognize with this class,
the triptan class?
Ayla Wolf (27:20):
So I would say most of my patients that have been
prescribed triptans are eitheron Imitrex, that's probably the
most popular Maxalt, Relpax andZomig.
Sophia Bouwens (27:31):
Something like that. And how many days a month
do you use those to beconsidered kind of that overuse
time?
Ayla Wolf (27:39):
Yeah. So if people are taking a triptan more than
10 days a month for more thanthree months, they can develop a
medication overuse headache. Andbecause doctors know this a lot
of times, they only give peoplea 10 day supply per month of
triptans. But then what happensis that people run out of their
(28:01):
triptans, and so then they starttaking either ibuprofen or Aleve
or these other things. And whatthe research is also showing is
that if you take, say, likeTylenol, more than 15 days per
month for more than threemonths, or ibuprofen or some of
these non steroidal, antiinflammatory drugs 15 days per
(28:23):
month for three months. Or ifyou take a combination analgesic
like Excedrin migraine, whichhas caffeine in it as well, if
you take that for greater than10 days per month for more than
three months. Or if you takemultiple drug classes, right? So
if you're now mixing andmatching different drugs for
(28:45):
more than 10 days per month formore than three months, you can
develop medication overuseheadaches, or what people call
rebound headaches.
Sophia Bouwens (28:53):
That's so amazing that the headache
medication can cause headachesand adds another level of
complexity there. And thosewindows aren't always that
large, right? 10 days for manyof them, right?
Ayla Wolf (29:09):
Yeah. And so once I read this paper, which, you
know, let me back up. So when Idid the 150 hours of studying
migraines, the first 25 hours ofthat program, we read a 70-page
paper. The lead author was aresearcher named Peter Goadsby
(29:30):
who is a expert on migraines.
And so this paper was thedefinitive paper on migraine
pathophysiology. We spent thefirst 25 hours of the course
reading line by line, the 70page research paper, because it
was so important. And it was thedefinitive paper on migraines.
And so when he then published apaper on medication overuse
(29:53):
headaches in 2024 as soon as Isaw his name on that paper, I
paid attention. Because thisisn't just some random person
publishing a paper on medicationoveruse headaches. This is Peter
Goadsby that is writing a paperon medication overuse headaches,
and he is the expert onmigraines.
Sophia Bouwens (30:12):
One thing I saw that was really interesting
about that paper is that they'dsee brain changes in relation to
these medications, and if peoplewould stop taking them, they saw
a reversal in those brainchanges. So this is not
something that once it's done,you're stuck with it. It's
something that if you work withthe right provider to come off
of them, you can actually havehealing in a bigger way from
(30:36):
this too.
Ayla Wolf (30:37):
Yeah. I mean, they talked about different clinics
that would take people off ofthese medications and have
really significant improvementsin people's headaches. And then
they also talked about, like yousaid, the fact that, when they
were doing brain imagingresearch, people that had
medication overuse headaches hadwhat they were calling
(30:58):
hypometabolism in differentparts of the brain, and hypo
metabolism is also one of thethings when it's in, when you
have hypo metabolism ordecreased neuronal firing in,
say, the prefrontal cortex,that's what people with ADHD
suffer from, and that's why theADHD medications are stimulants,
(31:20):
and why? You take someone who'shyperactive and you give them a
stimulant, and all of a suddenthey're calmer. They're
hyperactive because of actuallya Hypo-metabolism that's
preventing them from actuallyhaving focused concentration.
And so you give them astimulant, you increase the
metabolism in the prefrontalcortex, and all of a sudden they
(31:41):
can do life better. They canfunction better. And so when
you've got hypo-metabolismhappening in the prefrontal
cortex that can cause all kindsof cognitive symptoms, and after
a concussion, people can alsohave hypo metabolism. So then,
if you're giving themmedications that create further
hypo-metabolism, you can createfurther cognitive issues, maybe
(32:03):
even depression and things withdifficulty focusing and
attention and brain fog and allof that. And so that's another
reason why these medicationsshould really be used with
caution, and should, andespecially with say, like the
triptans, should not be kind ofaccidentally given to people
that maybe look like they havemigraines but aren't actually
(32:24):
suffering from true migraines,
Sophia Bouwens (32:27):
and then having the headaches from overusing
that medication because it's notworking for them, because it's
not the right medication. Thisdiagnosis component continues to
be so important.
Ayla Wolf (32:40):
and I know I mentioned this in the previous
episode, but I had, you know, apatient who was in a very bad
car accident, and she had atraumatic brain injury and a lot
of headaches, and she had brokeher jaws. She'll have facial
pain, jaw pain, and as I workedwith her, a lot of things were
(33:00):
getting better, but herheadaches were not getting
better. And I kept asking herabout her use of ibuprofen,
because she would kind ofmention it casually, and I think
she always kind of downplayedit, because finally, when this
paper came out, and it reallyhighlighted to me the importance
of this idea that if you'reoverusing even something like
ibuprofen that it can actuallycause headaches. I finally took
(33:24):
a different tactic, and Ibasically started talking about
the paper and saying, like, hey,this isn't just me, in my
opinion. This is, you know,people who are experts that are
publishing papers on this, thatare saying, if you're taking
ibuprofen more than 15 days amonth for three months in a row,
that can actually triggerheadaches. And so she finally
took my advice and she stoppedtaking the ibuprofen, after
(33:46):
admitting to me that she took italmost every single day, wow.
And so she stopped taking it andI saw her at that point. I was
only seeing her, I think, once amonth, because everything else
was really a lot better. It wasjust these headaches that were
the most stubborn thing that shewas dealing with. And so when I
saw her month later, she said,Oh yeah, my headaches are, like,
practically gone. And it wasjust, you know, such a stark
(34:11):
proof to me that, wow, like, youknow, ibuprofen, as innocuous as
it may seem, had actually beencausing her headaches. And for
over a year, she had headachesevery single day,
Sophia Bouwens (34:23):
and I'm sure she was probably taking ibuprofen to
help with them, not knowing theywere driving them. Thank
goodness for researchers, nerdsthat just like, sit up there and
do all these investigations,then publish it out there for
patients to glean from, becauseproviders and practitioners like
yourself are doing the research,reading the research, and what.
Ayla Wolf (34:42):
And the reality is that doctors are so busy,
they're many of them are veryburnt out, and so most doctors
are not going home and readingall of the research at night.
You know, I mean, they often sayit can take the 20 to 40 years
for research to make its wayinto clinical practice, and
that's too long, like we don'thave time to wait 20 to 40
(35:05):
years. People are suffering now.
And so that's, you know, a oneof the reasons why I wrote my
book as well is, if you look atthe dates of a lot of the
research papers that I referencein my book, they are literally
coming from papers that werepublished in 2023, 2024 -
really up to date. And so welive in, we live in a day and
age where you can actuallypublish a book in 2025 that is
(35:26):
based on research that waspublished in 2024 and I think
you know, Never have we lived ina time period where you could do
that?
Sophia Bouwens (35:36):
No. They are not always updated or you have to go
to libraries and archives andread them and pull them out.
Ayla Wolf (35:43):
So that's I think, another reason why I'm so
excited is that my book isreally representative of the
most kind of recent researchthat we have, the most cutting
edge research that ultimatelyhasn't fully made its way into
mainstream medicine and into theforefront of people's minds yet.
Sophia Bouwens (36:02):
So what guidance would you give a migraine
sufferer, post traumaticheadache, migraine sufferer, or
migraine like suffer, if theysuspect these things, what do
you think they should do orcould do?
Ayla Wolf (36:13):
Yeah, I think the first step is if people answered
no to all four of thosequestions at the beginning of
the podcast, and they've beendiagnosed with migraines, they
should probably go back to theirprescribing physician or doctor
and have a conversation aroundwhether or not that's the right
diagnosis for them, because we,you know, we definitely don't
(36:34):
want people to be misdiagnosedor on medications that are for
the wrong thing, especially ifthose medications aren't
working. And a lot of people,you know, really do put so much
faith into into medicine. And soa lot of people take medications
even if they're not helping. Imean, I see that all the time is
(36:55):
that people have been onmedications for six months to
two years, and they are stillhighly symptomatic, and they
haven't gotten any better, andthey're not getting relief. And
a lot of times, what happens isthey're just put on one migraine
medication, and if that doesn'twork, they're put on a different
one. If that doesn't work,they're put on a different one,
and it's just, again, taxing tothe liver, and if it's the wrong
(37:16):
diagnosis to begin with, they'vegot to try a different approach.
So for the people who don't havetrue migraines and they have,
quote, "migraine-like posttraumatic headaches", the
migraine medications are likelynot going to help them. And so
there are other medications,like amitriptyline, we talked
(37:36):
about that before, where somepeople get some relief from
that, but obviously with usbeing, you know, acupuncturists
and always trying other naturaltherapies that are non
pharmaceutical, you know, we'veseen great results with things
like acupuncture and even, youknow, upper cervical
(37:57):
chiropractic care, Massagetherapy to help address neck
tension. Craniosacral therapyfor that, yep, craniosacral
therapy, osteopathicmanipulation from DOS,
peripheral nerve stimulationdevices to help modulate the
trigeminal nerve and that lesserand greater occipital nerves. So
there's a lot of other therapiesthat I think can do a lot for
(38:21):
those people?
Sophia Bouwens (38:22):
Yeah, exercise, dietary changes, like the diet,
I can't, I don't think it can beunder emphasized, but you have
to make sure that the diagnosisis right so you're working with
the right set of information.
Ayla Wolf (38:34):
Yeah, absolutely.
Sophia Bouwens (38:36):
Well is there anything else you'd like anyone
to know about migraine andmigraine, like headache for now,
or medication overuse and itscomplexities?
Ayla Wolf (38:44):
Man, I mean, I feel like we potentially maybe
overwhelmed people a lot ofinformation.
Sophia Bouwens (38:50):
Well it wasn't a 150 hour course, but it was a
touch into the complexity there,and hopefully people come away
with some better clarity aroundwhat a migraine is and what can
be done for it effectively, orif it's not effective, maybe
(39:10):
what other alternatives mightbe?
Ayla Wolf (39:12):
I guess I will say, you know, one thing for people
who are suffering from truemigraines, that research paper
that we've been referencing withPeter Goadsby that came out in
2024 what they did say is thatthere are two classes of medic
of migraine medications, thoseCGRP receptor antagonists and
(39:33):
then the CGRP antibodies. So theCGRP receptor antagonists are
things like Ubrelvy and then theCGRP antibodies are things like
Emgality and Ajovi. And many ofthese are a once a month
injectable medication. And whatthey were saying is that for
people that have true migraines,that are dealing with medication
(39:55):
overuse headaches, that thoseare safer medications and that
they don't cause. Thosemedication overuse headaches and
so as part of the process ofweaning people off of the other
medications, whether it's thetriptans or the Aleve or the
ibuprofen or Tylenol, in theprocess of helping people
withdraw off those medications,these two classes of migraine
(40:16):
medications are actually saferand one of the kind of bridge
therapies that people can use tostill get relief from their
migraines while they're gettingoff of those other medications.
So again, that's something thatI think people could go to their
doctors and ask them about. Sothat's, I think, important to
recognize.
Sophia Bouwens (40:34):
And I think it's also important just to recognize
that these migraine medicationsaren't something you can stop
abruptly. You have to useguidance to come off of them in
different ways.
Ayla Wolf (40:44):
Yeah, absolutely, because there's, there's a lot
going on when you just suddenlystop taking medication. And so
obviously, we're not givingpeople pharmaceutical advice,
but recommending they do workwith their doctors to make sure
that they're doing the rightthing for their situation, yeah,
Sophia Bouwens (41:01):
and doing that in a safe way. Because I think
that paper that you referencedearlier, too even talked about
how an abrupt finish tomedications can be helpful
compared to slow withdrawal, butthat that abrupt finish isn't
just cutting it out completely.
You have to do that in a safeway that should be managed well
with a prescribing provider aswell.
Ayla Wolf (41:21):
Yeah, excellent advice. There was also another
research paper. It was a metaanalysis looking at all the
different research papers hadbeen published on omega three
essential fatty acids. And whatthey found is that when people
were taking high doses of Omegathree essential fatty acids, and
we're talking like 1800milligrams to 2000 milligrams a
(41:44):
day consistently, that thatactually was effective in
helping people reduce thefrequency of their migraines.
And I often find that people aretaking omega three, essential
fatty acid supplements, fishoils, things like that, but that
they're not taking them at thosehigher doses. And so the
(42:05):
research is really saying thatthose things can be helpful, but
you have to take a high enoughdose. And because high quality
fish oils are expensive, I thinka lot of people are either, you
know, for the purpose of savingmoney, or just because they
don't know any better they'rethey're taking lower doses that
aren't actually moving theneedle or helping them, as far
(42:27):
as reducing the amount ofheadaches that they're actually
experiencing.
Sophia Bouwens (42:31):
And we could get into a whole conversation about
the importance of safety aroundsupplements and things you find
in health food stores or on theshelves at random stores, and
how they're not necessarilyregulated. So there's a lot of
evidence out there that unlesstheir company is really doing
extra work to put forward good,high quality stuff with what it
(42:52):
says is in there, in what you'rebuying, there's a lot of
companies that produce thingsthat don't even have the
ingredients they say are inthere, or they're not in a
formula body can use, or theycome with all these other toxic
components that aren't wellprocessed.
Ayla Wolf (43:07):
And that's especially the case when you're talking
about fish oils or any kind ofOmega three, essential fatty
acid, because if you're taking alow quality, Poor fish oil
supplement, A, it might bereally high in mercury, which
nobody needs in their body. B,it could actually have a rancid
oil that's been, you know,oxidized. And you also don't
want to take oxidized oils thatcause free radical damage in
(43:30):
your brain either. And so you doneed to know, like, which
companies are safe, whichcompanies are reputable. I often
recommend that people you know,get their supplements from like
healthcare providers who workwith companies that only sell to
healthcare providersprofessional brands. Those
professional brands usually arereally focused on healthcare,
(43:51):
and sadly, what's happened is alot of the pharmaceutical
companies have been buying up alot of the supplement companies
only because they want theprofits of the supplement
companies. They just want acorner of the supplement market,
which is, you know, probably inthe trillions of dollars at this
point, and so they don't careabout the quality. And, you
(44:12):
know, not to name names, butwhenever I see now a supplement
company that has a commercial onTV, in my mind, I'm like, Okay,
well, if they have enough moneyto have a commercial on national
TV, it probably means thatthey're owned by a
pharmaceutical company that hasthe budget to do that.
Sophia Bouwens (44:27):
And doing less investment in their product
quality than they are theproduct name brand, yeah.
Ayla Wolf (44:33):
So potentially, the quality is a huge important
issue.
Sophia Bouwens (44:38):
For sure, very important. Okay, well, that's
awesome. We learned some newthings about exactly what is a
migraine. Some questions to askyourself around how to know
you're actually having amigraine, and then some
resources to consider things youcould do in your lifestyle to
help with migraines, avoidingthose medication overuses and
(44:58):
headaches and. Ways to talk toyour providers around migraine
and migraine like headaches andoptions for that. I think that
was pretty robust,
Ayla Wolf (45:09):
agreed. And then in our next episode on neuropathic
pain, we'll also do a furtherdiscussion on some of these
natural therapies that peoplecan try to help with migraines
and migraine like post traumaticheadaches. And then in the
episode after that, we'llactually get into our own
research study that was justpublished in the Journal of
(45:31):
Neurotrauma on acupuncture forpost-traumatic headaches. So
that's gonna be a super funepisode where we actually get to
talk about our own process ofdoing clinical research.
Sophia Bouwens (45:41):
What a process that was too, and going back,
looking at doing it again, or itwas a pilot study, so designing
something different, reallylearning and using this
information to frame a betterquestion, or maybe a different
way of intervening to see if wecan even get better results. So
that's exciting. I'm excited forthat too. Yeah. Thank you
(46:02):
listeners for listening. I hopeyou glean something. Feel free
to share this with somebody ifyou found it valuable, or you
think they might find itvaluable, share it with your
providers and tune into our nextepisode on neuropathic pain and
how that can cause a lot ofheadaches and be really similar
to post concussion symptoms,excellent.
Ayla Wolf (46:22):
Thanks for listening.
Medical disclaimer, this videoor podcast is for general
informational purposes only anddoes not constitute the practice
of medicine or otherprofessional health care
services, including the givingof medical advice, no doctor
patient relationship is formed.
(46:45):
The use of this information andmaterials included is at the
user's own risk. The content ofthis video or podcast is not
intended to be a substitute formedical advice, diagnosis or
treatment. Consumers of thisinformation should seek the
advice of a medical professionalfor any and all health related
issues. A link to our fullmedical disclaimer is available
(47:08):
in the notes you.
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