December 20, 2022 • 24 mins
An insightful and informative conversation with a renowned Neurologist, who has since retired from his private practice in New York City about when is it a headache or is it a migraine? Or, is it something else?
Please note that this interview is based own the experiences and knowledge of the many cases seen by Dr. G throughout the years. Please see your own physician for any medical issues or concerns.
For any questions or comments for this episode, please do so at the email address below. Thanks!
This is a podcast for those who love to talk common sense about everyday issues. You will listen to a variety of guests that share common sense ideas through their life experiences by sharing what they learned. For any comments, questions or suggestions for future topics, please contact the show at: stand4commonsense@outlook.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
MizzyM (00:24):
Hi.
Welcome to another episode ofPodcast From the Edge Talking
Common Sense.
This is Manju, your host,otherwise known as MizzyM.
And in today's episode, I willbe speaking to someone special,
a man who was a neurologist(nowretired) for many, many years
(00:48):
practicing in the city of NewYork.
And he was gracious enough tospend some of his time with us
to share his knowledge andexpertise on the basic question,
am I having a headache or is ita migraine, or is it really
something else?
So I hope you enjoy the show,and I thank you so much once
(01:11):
again for tuning in.
So let's get started.
Okay.
So why don't you first describewhat is a headache and then what
is a migraine?
Dr. G (01:23):
Headache is one of the most common symptoms people
have.
Uh, you can get a headache fromjust a fever.
Or you can get a headache fromnot sleeping and so many reasons
one could get a headache.
So how do you distinguish aheadache, common garden variety
headache and migraine headache.
The most important feature ofmigraine headache is it is
(01:46):
unilateral, meaning one-sided.
Very, very rarely is migraineheadache on both sides.
That's one.
And number two, most of the timewhen you get the migraine
headache, there are somepremonitory signs or precaution
signs.
Uh, you may have blurry vision.
(02:08):
You may see flashing coloredzigzag lines in front of one eye
or both eyes both.
You may get a bad smell, badtaste, or sometimes funny
sensations in the skin, likecrawling insects, crawling or
burning, um, feeling bad andvery strange, unusual skin
(02:29):
sensation.
And, uh, migraine is a kind ofheadache, which is triggered by
something usually.
This could be from anyone of thefive senses, it could be a bad
smell.
Like you walk around New YorkCity, you go through certain
states, there is this verystrong a smell of Indian food,
(02:52):
for example, and lot of peoplewho have migraine prone.
They will, that will trigger theheadache and, uh, not only smell
bright light, uh, any, any kindof loud noise, sometimes
MizzyM (03:07):
caffeine or chocolate.
Dr. G (03:08):
Caffeine.
Chocolate and all five senses,uh, can trigger a migraine
headache.
MizzyM (03:14):
And what about, um, like a woman's menstrual cycle?
Dr. G (03:20):
Women with migraine do get bad migraine during their
periods.
Not every month, but most of thetime they get the headache
during their periods.
So the point I'm making is thereis always some kind of trigger
that, uh, uh, triggers thismigraine.
Let me just, I know I don't haveany blackboard or anything to
(03:40):
draw, but I'm trying to explainit to you.
The sensory input, which comesfrom all five sensory modes,
vision, hearing, touch, taste,and smell.
When it hits a part of thebrain, we call the brain stem.
Brainstem is, if you can imaginethe brain sitting on top of a
(04:03):
stem and the brain, the stempart is the brainstem.
What we are calling now, and themost important part of the
brainstem in regards to migraineis pons, PONS.
So brainstem is mid brain.
Pons and medulla oblongata.
So pons is the key part of themigraine syndrome.
(04:28):
The nucleus of the trigeminalnerve, trigeminal nerve is in
the pons.
That is where all these sensoryinput from the five sensations
come in and connects with thenucleus.
In the pons trigeminal nucleus.
(04:51):
From the nucleus,the secondaryneuron starts the second
connection, which goes all theway up the brain, one side, and
both sides eventually.
So if I get a bad smell, thatsmell sensation hits the
trigeminal nucleus there.
It connects with the secondaryneuron that carries it all the
(05:14):
way up to the brain, and now thebrain starts secreting chemical
substances, which causedilatation of the blood vessels
in the covering of the brain,which is the basis of the
headache.
The headache is due to thedilatation of the blood vessels
in the covering of the braincalled the meninges, which is
(05:36):
typically one-sided, but rarelyit could get also bilateral.
So the migraine headache isone-sided.
It throbbing in nature.
It could start in the front ofthe brain or in the back of the
brain occipital area, you callit, and then it can spread to
various parts into the ear orinto the neck and, uh, very
(06:00):
early you can even have painfulsensation going into your upper
arm.
It is all part of the migraine.
Very rarely it can becomebilateral.
It's extremely rare, uh, tobecome bilateral, and as I told
you, the headache is pulsating,throbbing nature.
It could be felt behind the eyeas if the eyeball is exploding
(06:24):
and many times disassociatedwith lacrimation, runny nose and
uh, funny sensation inside theear and inside the throat.
And the headache can lastanywhere from, uh, half an hour,
one hour.
Sometimes it can linger aroundfor days, and once the migraine
is full blown, it's verydifficult to get it under
(06:47):
control.
Most of the pain medicationslike Ibuprofen or Naproxen will
help, but for a short period,then it comes back.
So it runs the course of itsown, which is luckily few hours
and then it goes away.
But rarely, migraine can go onand on for days, needing
(07:09):
sometimes hospitalization andinjecting intravenous,
intravenous pain medications, itcan be so bad, certain cases.
MizzyM (07:18):
Well, um, what about, uh, you know, when I used to
have headaches, it, I used toget something, um, the day
before a migraine and you usedto tell me it was an aura.
Dr. G (07:30):
Yeah.
That is what you call the wordis aura.
A u r a.
The aura could be, as it said,visual or seeing flashing
lights.
It could be bad smell.
It could be also hearing ringingnoise or funny, painful noises
in the ear or in the skinsensations of various kinds that
(07:51):
can happen on one side of thebody.
Uh, typically it is on one sideof the body and this, this kinda
symptoms are warning premonitory symptom symptoms could
be sensory.
Or sometimes motor, which, whichI mean, uh, giving you an
example, uh, a British womancame to JFK airport, collected
(08:14):
her bag and was ready to get outand get a cab to come to my
office.
While she was walking to thecab, she felt this funny
sensation on her face.
Then by the time she's in thecab, her right hand was numb and
in the cab she felt weakness ofboth right arm and right leg.
(08:38):
So she had difficulty gettingout of the cab when she reached
the Hilton(Hotel).
And from there, the hotel senther to the emergency room.
That is where I saw her in theemergency room.
By the time she was not onlyhaving sensations- she had
difficulty moving the right armand right leg, the whole thing
cleared.
By the time I came to the ER tosee her from my office, barely
(09:02):
45 minutes or maybe 50 minutes,she was okay.
She was sitting up and takingher breakfast and, and coffee.
The whole thing disappeared bythe time.
This, is what we call hemiplegicmigraine-hemiplegic means
one-sided paralysis.
It can last from minutes tohours, sometimes up to a day or
(09:22):
even a day and a half.
It can take that long.
So migraine by no means is justa headache.
It is a symptom complex.
Many things can happen duringthe migraine phenomenon.
And, uh, to put it in a, what,what can I say?
In a electro physiologicalcontext, a group of cells.
(09:44):
In one part of the brain, maybein the front or in the back of
the brain, gets irritated, getsstimulated, gets stimulated by
the migraine process.
It generates electricalimpulses.
If it starts in the back of thebrain called the occipital area,
this electrical activity canspread forward coming to the
(10:05):
front of the brain, which canaffect your speech.
Which can affect your motorfunction, which can affect your
sensory function and make yousometimes act like a, what do
you call, a someone who lo losthis mind like a schizophrenic
patient.
If it hits the front part of thebrain, it is nothing but an
(10:25):
electrical wave starting at onepoint in the brain and spreading
forward, and it can also crossover.
and come on the other side, thenit becomes bilateral.
You can also lose consciousnessin some cases.
There are many instances,especially in children in
(10:46):
including me when I was seven oreight years old.
You certainly pass out for noreason and.
Wake up very quickly, and whenyou wake up, you feel sick,
nauseous, and then thisthrobbing headache comes.
It, it, it's very common inchildren, very common.
And many times this faintingspell is the only warning sign
(11:08):
for several months or yearsbefore the child develops, a
full blown, migraine.
A lot of times, uh, parentsbecome so upset when children
pass out for no reason and theygo to the doctor.
MRI is normal.
EKG is normal.
Everything is normal and nobodyknows why the child fainted.
(11:28):
It is migraine, so always beaware of that.
Unexplained fainting in childrenwhen, and they wake up within a
few minutes or maybe within thehalf an hour will could very
well be the beginning ofmigraine.
It may not be anything else.
Okay.
MizzyM (11:42):
What about if you vomit or you have nausea?
Yes.
Is that part of a migraine?
Dr. G (11:47):
Common warning, one of the flashing lights, nausea,
vomiting, tearing from the eye,noise in the ear.
All these things involving allthe five sensory modes can
happen as a warning or a premmonitory, signs of migraine.
MizzyM (12:04):
So do you recommend anything to prevent migraines?
Dr. G (12:10):
There is truly nothing much to prevent migraine.
Uh, very difficult to preventit, but what I used to do, or
what made me very famous in NewYork and all over the country
is, you could prevent thismigraine, uh, in the long term
by addressing the basicphysiological events that happen
(12:35):
in the brain.
As I told you, the brain cellshave to generate abnormal
electrical activity, and thatelectrical activity is what?
From back to the front or fromfront to the back of the brain
and causing all these problemswith migraine.
So the initial starting point isdestabilization of the cell
(13:01):
membrane, which causes anelectrical impulse to be
generated.
So preventing migraine basicallymeans you have to stabilize the
brain cell membranes, which willnot depolarize or which will not
generate an electrical activity.
So one thing I very successfullyused in many, many of my
(13:23):
patients are, which made me verypopular in, in, in, in this
area, is what, how do youcontrol the destabilization of
the, of the cell membrane in thebrain?
One is magnesium.
Magnesium has a very stabilizingeffect on the cell membrane
without proper, uh, uh, what doyou call it, concentration of
(13:48):
magnesium in the cell membrane.
Uh, you cannot prevent the cellbecoming destabilized and
creating an electrical impulse.
So I recommend taking two 50milligrams of magnesium oxide or
magnesium citrate.
Once or twice a day.
Lot of people cannot tolerate ittwice a day, but at least once a
(14:09):
day they could tolerate.
That's number one.
And number two is, uh, coq 10,coenzyme Q 10, which is a
intracellular.
Uh, chemical, uh, in themitochondrial, uh, influencing
the mitochondrial function inthe brain and stabilizes the
brain.
(14:30):
So between the CoQ10 and themagnesium, you truly stabilize
the cell membrane withoutgetting electrical activity
generated.
It helps been very useful and inyoung people, especially young
women who develop migraine.
Each episode of migrainedepletes the serotonin level in
(14:53):
the brain.
And how do we know that?
There used to be a, a scientistat Merck.
Uh, he was the main scientistwho ran the migraine lab at
Merck.
He had done lots of studies, ofwomen in part after a bad
migraine episode, if you collectthe urine- 24 hour collection of
(15:16):
urine in patients who havemigraine, you will notice that
there is a huge increase in thelevel of serotonin metabolites
or breakdown products ofserotonin in the urine, which
tells you that during a migrainethe brain depletes serotonin.
The brain does not produce ahell of a lot of serotonin.
(15:39):
It's very difficult to produceserotonin in the brain.
So if you are getting migrainefrequently every week, every
two, two times a week and thingslike that, you are depleting the
serotonin levels in the brain,which predisposes you to more.
And the low levels of serotoninmakes you irritable, uh,
(16:00):
cantankerous in your behaviorand eventually you'll get
depression cause you need enoughserotonin in the brain to keep
your normal functioning of yourpsyche and your uh, and your,
uh, emotional attitudes.
So that is one reason why lot ofpeople with frequent migraine
(16:20):
become very irritable anddifficult to deal with.
You know, people, it is nottheir fault because, They don't
know that they're lackingserotonin in the brain.
So part of the treatment of, uh,migraine, especially chronic
migraine sufferers is depletingor replacing the serotonin by
(16:40):
giving small doses, you don'thave to give them big doses,
small doses of, uh, serotoninenhancing drugs that are a whole
variety of them.
Most of the women tolerate itvery well without any side
effects.
But very rarely if small dosesof uh, uh, Lexapro and things
like that, the drugs like thatcan cause sexual dysfunction in
(17:03):
women.
So patients usually don't liketo take it.
It's becomes a big problem.
Uh uh, they is no food oranything that actually can
increase the serotonin level inthe brain.
It's difficult to do that.
You have to hold the hands ofthe patients, and I usually
convince them to take it for ashort time.
When the levels goes up, Imaintain it and then take it
(17:25):
off.
That's what I do.
MizzyM (17:27):
Okay, so then now since we discussed headaches and
migraines, How does, how arethey both different from, let's
say, having a cerebral vascularattack or an aneurysm or like a
subdural hematoma, somethingwhere there's bleeding in the
brain?
How can you tell if any of thosethings are going on?
Dr. G (17:49):
Most of the time those kind of headaches due to a
bleeding or due to inflammationor any other cause, uh, headache
is bilateral.
There is no subduralsubarachnoid hemorrhage or
aneurysm hemorrhage causingone-sided headaches.
There is nothing like that.
(18:10):
All those headaches arebilateral, so one headache is
unilateral, especially.
Associated aura, like seeingflashing lights or hearing
strange noise.
Bad taste.
Bad smell.
This is migraine.
Cannot be anything else.
If it, the headache is one-sidedand in most cases it is
(18:31):
one-sided.
Uh, it's not difficult todistinguish migraine headache
from other headaches because ofthat one nature.
Unilateral headache, unilateralthrobbing, very painful
headache.
Along with either visual,auditory, or gustatory, meaning
taste, aura, that clenches, thatdiagnosis is clinched.
(18:55):
There is nothing else that givesyou that kind symptom.
So before I leave that, uh,headache part of the migraine,
um, lot, where I, I became veryfamous in New York, for example,
is because of what I'm going totell you.
Not every patient with migrainehas a headache.
There is something calledmigraine without headache,
(19:17):
sorry.
We call it transformed migrainehere.
The patients don't get aheadache at all.
Now, since I mentioned it to youto make sense so that you won't
get confused and you don't feelthat I am telling you something
very strange.
I just have to tell you for oneminute a little bit of anatomy.
Once the pain impulses from allthe five sensorium, skin,
(19:42):
tongue, ear, taste, the.
The brain, it is coming to thetrigeminal nucleus.
In from there, it connects andthe secondary fibers go up to
the brain on one side or even onboth sides.
And when these, uh, painfulimpulses hit the serotonin
(20:04):
receptors inside the bloodvessels of the brain, it causes
dilatation of the blood vesselsin the covering of the brain,
which causes the real headachein this is what everybody knows.
Every patient knows every doctorknow, but not many people don't
understand, including doctorswho are not neurologists.
(20:26):
The pain impulses need notalways go up to the brain.
Trigeminal nucleus in the ponshas what we call a descending
tract of the trigeminal nerve,meaning one part of that nucleus
goes down like a tail all theway to the upper cervical spinal
(20:47):
cord.
So it from the pons, it goesthrough the medulla and from the
medulla it enters the upper partof the spinal cord.
There are instances where themigraine impulse hits the
trigeminal nucleus but does notgo up to the brain causing the
headache, but it goes downthrough the descending tract of
(21:08):
the trigeminal nerve, and thenthe symptoms are entirely
different.
They get vertigo with vomitingand all that, and that is when
it hits the vestibular nucleusin the lower part of the pons.
When it comes to the medulla itcauses a whole variety of vagal
or vagus nerve mediated symptomslike explosive vomiting, painful
(21:32):
cramping of the abdomen,diarrhea, and uh, going down
further.
They get burning painfulsensation in the upper thighs
and around the umbilicus.
These people will not make anyconnection to migraine unless
you really take a very goodhistory and they establish the
fact that this patient.
(21:53):
Typical migraine in the past andnow this is what we call
modification or a, uh,transformation of migraine
transformed migraine.
MizzyM (22:03):
Okay.
You, so you mentioned a burningsensation in the thigh and the
umbilicus.
So what is the umbilicus, justin case if people don't know?
Dr. G (22:11):
I had a woman from New Jersey who came, her main
complaint was for the lastcouple of weeks.
She couldn't wear her.
Because the skirt, when sheties, it irritates her skin
around the umbilicus so bad.
MizzyM (22:26):
Which is the belly button?
Dr. G (22:27):
Yeah, the belly button.
Okay.
So she had to take it out.
She, she can't wear it.
She had to take it out.
It was so painful for her andnobody made the connection.
That she was a chronic migrainesufferer and uh, I put her on
what I told you earlier, themagnesium CoQ10 and the small
dose of serotonin enhancing drugLexapro within three to four
(22:47):
months.
She was completely symptom free.
These kinda things can happenonce you understand what I said
earlier.
The trigeminal nerve nucleusdescends down into the middle
and the upper spinal cord.
You can understand all thesesymptoms happening without a
headache; there's no headachebecause the impulses did not go
(23:08):
to the upper brain and connectwith the, with the brain cells.
That is the reason why theydon't have any brain symptoms.
Uh, I hope I made it clear toyou that these patients have
symptoms connected to the lowerbrain stem symptoms, the nausea,
vomiting, diarrhea, abdominalcramping, painful sensation
around the umbilicus, and evenup to the thigh-muscle cramping
(23:32):
up to the thigh, and all those.
You don't establish from thehistory that this patient mostly
a woman had migraine and she's achronic migraine sufferer.
You completely miss this and youwill send them to
gastroenterologist, toproctologist, you name it, and
nobody can find out what shehas.
MizzyM (23:49):
Right.
Well that was a very, veryfascinating conversation and I
hope we can, you know, you cancome back again to talk about
other things that youencountered in your practice.
Thank you very much.
Dr. G (24:05):
Thank you.
Hi.
Welcome to another episode ofPodcast From the Edge Talking
Common Sense.
This is Manju, your host,otherwise known as MizzyM.
And in today's episode, I willbe speaking to someone special,
a man who was a neurologist(nowretired) for many, many years
(00:48):
practicing in the city of NewYork.
And he was gracious enough tospend some of his time with us
to share his knowledge andexpertise on the basic question,
am I having a headache or is ita migraine, or is it really
something else?
So I hope you enjoy the show,and I thank you so much once
(01:11):
again for tuning in.
So let's get started.
Okay.
So why don't you first describewhat is a headache and then what
is a migraine?
Dr. G (01:23):
Headache is one of the most common symptoms people
have.
Uh, you can get a headache fromjust a fever.
Or you can get a headache fromnot sleeping and so many reasons
one could get a headache.
So how do you distinguish aheadache, common garden variety
headache and migraine headache.
The most important feature ofmigraine headache is it is
(01:46):
unilateral, meaning one-sided.
Very, very rarely is migraineheadache on both sides.
That's one.
And number two, most of the timewhen you get the migraine
headache, there are somepremonitory signs or precaution
signs.
Uh, you may have blurry vision.
(02:08):
You may see flashing coloredzigzag lines in front of one eye
or both eyes both.
You may get a bad smell, badtaste, or sometimes funny
sensations in the skin, likecrawling insects, crawling or
burning, um, feeling bad andvery strange, unusual skin
(02:29):
sensation.
And, uh, migraine is a kind ofheadache, which is triggered by
something usually.
This could be from anyone of thefive senses, it could be a bad
smell.
Like you walk around New YorkCity, you go through certain
states, there is this verystrong a smell of Indian food,
(02:52):
for example, and lot of peoplewho have migraine prone.
They will, that will trigger theheadache and, uh, not only smell
bright light, uh, any, any kindof loud noise, sometimes
MizzyM (03:07):
caffeine or chocolate.
Dr. G (03:08):
Caffeine.
Chocolate and all five senses,uh, can trigger a migraine
headache.
MizzyM (03:14):
And what about, um, like a woman's menstrual cycle?
Dr. G (03:20):
Women with migraine do get bad migraine during their
periods.
Not every month, but most of thetime they get the headache
during their periods.
So the point I'm making is thereis always some kind of trigger
that, uh, uh, triggers thismigraine.
Let me just, I know I don't haveany blackboard or anything to
(03:40):
draw, but I'm trying to explainit to you.
The sensory input, which comesfrom all five sensory modes,
vision, hearing, touch, taste,and smell.
When it hits a part of thebrain, we call the brain stem.
Brainstem is, if you can imaginethe brain sitting on top of a
(04:03):
stem and the brain, the stempart is the brainstem.
What we are calling now, and themost important part of the
brainstem in regards to migraineis pons, PONS.
So brainstem is mid brain.
Pons and medulla oblongata.
So pons is the key part of themigraine syndrome.
(04:28):
The nucleus of the trigeminalnerve, trigeminal nerve is in
the pons.
That is where all these sensoryinput from the five sensations
come in and connects with thenucleus.
In the pons trigeminal nucleus.
(04:51):
From the nucleus,the secondaryneuron starts the second
connection, which goes all theway up the brain, one side, and
both sides eventually.
So if I get a bad smell, thatsmell sensation hits the
trigeminal nucleus there.
It connects with the secondaryneuron that carries it all the
(05:14):
way up to the brain, and now thebrain starts secreting chemical
substances, which causedilatation of the blood vessels
in the covering of the brain,which is the basis of the
headache.
The headache is due to thedilatation of the blood vessels
in the covering of the braincalled the meninges, which is
(05:36):
typically one-sided, but rarelyit could get also bilateral.
So the migraine headache isone-sided.
It throbbing in nature.
It could start in the front ofthe brain or in the back of the
brain occipital area, you callit, and then it can spread to
various parts into the ear orinto the neck and, uh, very
(06:00):
early you can even have painfulsensation going into your upper
arm.
It is all part of the migraine.
Very rarely it can becomebilateral.
It's extremely rare, uh, tobecome bilateral, and as I told
you, the headache is pulsating,throbbing nature.
It could be felt behind the eyeas if the eyeball is exploding
(06:24):
and many times disassociatedwith lacrimation, runny nose and
uh, funny sensation inside theear and inside the throat.
And the headache can lastanywhere from, uh, half an hour,
one hour.
Sometimes it can linger aroundfor days, and once the migraine
is full blown, it's verydifficult to get it under
(06:47):
control.
Most of the pain medicationslike Ibuprofen or Naproxen will
help, but for a short period,then it comes back.
So it runs the course of itsown, which is luckily few hours
and then it goes away.
But rarely, migraine can go onand on for days, needing
(07:09):
sometimes hospitalization andinjecting intravenous,
intravenous pain medications, itcan be so bad, certain cases.
MizzyM (07:18):
Well, um, what about, uh, you know, when I used to
have headaches, it, I used toget something, um, the day
before a migraine and you usedto tell me it was an aura.
Dr. G (07:30):
Yeah.
That is what you call the wordis aura.
A u r a.
The aura could be, as it said,visual or seeing flashing
lights.
It could be bad smell.
It could be also hearing ringingnoise or funny, painful noises
in the ear or in the skinsensations of various kinds that
(07:51):
can happen on one side of thebody.
Uh, typically it is on one sideof the body and this, this kinda
symptoms are warning premonitory symptom symptoms could
be sensory.
Or sometimes motor, which, whichI mean, uh, giving you an
example, uh, a British womancame to JFK airport, collected
(08:14):
her bag and was ready to get outand get a cab to come to my
office.
While she was walking to thecab, she felt this funny
sensation on her face.
Then by the time she's in thecab, her right hand was numb and
in the cab she felt weakness ofboth right arm and right leg.
(08:38):
So she had difficulty gettingout of the cab when she reached
the Hilton(Hotel).
And from there, the hotel senther to the emergency room.
That is where I saw her in theemergency room.
By the time she was not onlyhaving sensations- she had
difficulty moving the right armand right leg, the whole thing
cleared.
By the time I came to the ER tosee her from my office, barely
(09:02):
45 minutes or maybe 50 minutes,she was okay.
She was sitting up and takingher breakfast and, and coffee.
The whole thing disappeared bythe time.
This, is what we call hemiplegicmigraine-hemiplegic means
one-sided paralysis.
It can last from minutes tohours, sometimes up to a day or
(09:22):
even a day and a half.
It can take that long.
So migraine by no means is justa headache.
It is a symptom complex.
Many things can happen duringthe migraine phenomenon.
And, uh, to put it in a, what,what can I say?
In a electro physiologicalcontext, a group of cells.
(09:44):
In one part of the brain, maybein the front or in the back of
the brain, gets irritated, getsstimulated, gets stimulated by
the migraine process.
It generates electricalimpulses.
If it starts in the back of thebrain called the occipital area,
this electrical activity canspread forward coming to the
(10:05):
front of the brain, which canaffect your speech.
Which can affect your motorfunction, which can affect your
sensory function and make yousometimes act like a, what do
you call, a someone who lo losthis mind like a schizophrenic
patient.
If it hits the front part of thebrain, it is nothing but an
(10:25):
electrical wave starting at onepoint in the brain and spreading
forward, and it can also crossover.
and come on the other side, thenit becomes bilateral.
You can also lose consciousnessin some cases.
There are many instances,especially in children in
(10:46):
including me when I was seven oreight years old.
You certainly pass out for noreason and.
Wake up very quickly, and whenyou wake up, you feel sick,
nauseous, and then thisthrobbing headache comes.
It, it, it's very common inchildren, very common.
And many times this faintingspell is the only warning sign
(11:08):
for several months or yearsbefore the child develops, a
full blown, migraine.
A lot of times, uh, parentsbecome so upset when children
pass out for no reason and theygo to the doctor.
MRI is normal.
EKG is normal.
Everything is normal and nobodyknows why the child fainted.
(11:28):
It is migraine, so always beaware of that.
Unexplained fainting in childrenwhen, and they wake up within a
few minutes or maybe within thehalf an hour will could very
well be the beginning ofmigraine.
It may not be anything else.
Okay.
MizzyM (11:42):
What about if you vomit or you have nausea?
Yes.
Is that part of a migraine?
Dr. G (11:47):
Common warning, one of the flashing lights, nausea,
vomiting, tearing from the eye,noise in the ear.
All these things involving allthe five sensory modes can
happen as a warning or a premmonitory, signs of migraine.
MizzyM (12:04):
So do you recommend anything to prevent migraines?
Dr. G (12:10):
There is truly nothing much to prevent migraine.
Uh, very difficult to preventit, but what I used to do, or
what made me very famous in NewYork and all over the country
is, you could prevent thismigraine, uh, in the long term
by addressing the basicphysiological events that happen
(12:35):
in the brain.
As I told you, the brain cellshave to generate abnormal
electrical activity, and thatelectrical activity is what?
From back to the front or fromfront to the back of the brain
and causing all these problemswith migraine.
So the initial starting point isdestabilization of the cell
(13:01):
membrane, which causes anelectrical impulse to be
generated.
So preventing migraine basicallymeans you have to stabilize the
brain cell membranes, which willnot depolarize or which will not
generate an electrical activity.
So one thing I very successfullyused in many, many of my
(13:23):
patients are, which made me verypopular in, in, in, in this
area, is what, how do youcontrol the destabilization of
the, of the cell membrane in thebrain?
One is magnesium.
Magnesium has a very stabilizingeffect on the cell membrane
without proper, uh, uh, what doyou call it, concentration of
(13:48):
magnesium in the cell membrane.
Uh, you cannot prevent the cellbecoming destabilized and
creating an electrical impulse.
So I recommend taking two 50milligrams of magnesium oxide or
magnesium citrate.
Once or twice a day.
Lot of people cannot tolerate ittwice a day, but at least once a
(14:09):
day they could tolerate.
That's number one.
And number two is, uh, coq 10,coenzyme Q 10, which is a
intracellular.
Uh, chemical, uh, in themitochondrial, uh, influencing
the mitochondrial function inthe brain and stabilizes the
brain.
(14:30):
So between the CoQ10 and themagnesium, you truly stabilize
the cell membrane withoutgetting electrical activity
generated.
It helps been very useful and inyoung people, especially young
women who develop migraine.
Each episode of migrainedepletes the serotonin level in
(14:53):
the brain.
And how do we know that?
There used to be a, a scientistat Merck.
Uh, he was the main scientistwho ran the migraine lab at
Merck.
He had done lots of studies, ofwomen in part after a bad
migraine episode, if you collectthe urine- 24 hour collection of
(15:16):
urine in patients who havemigraine, you will notice that
there is a huge increase in thelevel of serotonin metabolites
or breakdown products ofserotonin in the urine, which
tells you that during a migrainethe brain depletes serotonin.
The brain does not produce ahell of a lot of serotonin.
(15:39):
It's very difficult to produceserotonin in the brain.
So if you are getting migrainefrequently every week, every
two, two times a week and thingslike that, you are depleting the
serotonin levels in the brain,which predisposes you to more.
And the low levels of serotoninmakes you irritable, uh,
(16:00):
cantankerous in your behaviorand eventually you'll get
depression cause you need enoughserotonin in the brain to keep
your normal functioning of yourpsyche and your uh, and your,
uh, emotional attitudes.
So that is one reason why lot ofpeople with frequent migraine
(16:20):
become very irritable anddifficult to deal with.
You know, people, it is nottheir fault because, They don't
know that they're lackingserotonin in the brain.
So part of the treatment of, uh,migraine, especially chronic
migraine sufferers is depletingor replacing the serotonin by
(16:40):
giving small doses, you don'thave to give them big doses,
small doses of, uh, serotoninenhancing drugs that are a whole
variety of them.
Most of the women tolerate itvery well without any side
effects.
But very rarely if small dosesof uh, uh, Lexapro and things
like that, the drugs like thatcan cause sexual dysfunction in
(17:03):
women.
So patients usually don't liketo take it.
It's becomes a big problem.
Uh uh, they is no food oranything that actually can
increase the serotonin level inthe brain.
It's difficult to do that.
You have to hold the hands ofthe patients, and I usually
convince them to take it for ashort time.
When the levels goes up, Imaintain it and then take it
(17:25):
off.
That's what I do.
MizzyM (17:27):
Okay, so then now since we discussed headaches and
migraines, How does, how arethey both different from, let's
say, having a cerebral vascularattack or an aneurysm or like a
subdural hematoma, somethingwhere there's bleeding in the
brain?
How can you tell if any of thosethings are going on?
Dr. G (17:49):
Most of the time those kind of headaches due to a
bleeding or due to inflammationor any other cause, uh, headache
is bilateral.
There is no subduralsubarachnoid hemorrhage or
aneurysm hemorrhage causingone-sided headaches.
There is nothing like that.
(18:10):
All those headaches arebilateral, so one headache is
unilateral, especially.
Associated aura, like seeingflashing lights or hearing
strange noise.
Bad taste.
Bad smell.
This is migraine.
Cannot be anything else.
If it, the headache is one-sidedand in most cases it is
(18:31):
one-sided.
Uh, it's not difficult todistinguish migraine headache
from other headaches because ofthat one nature.
Unilateral headache, unilateralthrobbing, very painful
headache.
Along with either visual,auditory, or gustatory, meaning
taste, aura, that clenches, thatdiagnosis is clinched.
(18:55):
There is nothing else that givesyou that kind symptom.
So before I leave that, uh,headache part of the migraine,
um, lot, where I, I became veryfamous in New York, for example,
is because of what I'm going totell you.
Not every patient with migrainehas a headache.
There is something calledmigraine without headache,
(19:17):
sorry.
We call it transformed migrainehere.
The patients don't get aheadache at all.
Now, since I mentioned it to youto make sense so that you won't
get confused and you don't feelthat I am telling you something
very strange.
I just have to tell you for oneminute a little bit of anatomy.
Once the pain impulses from allthe five sensorium, skin,
(19:42):
tongue, ear, taste, the.
The brain, it is coming to thetrigeminal nucleus.
In from there, it connects andthe secondary fibers go up to
the brain on one side or even onboth sides.
And when these, uh, painfulimpulses hit the serotonin
(20:04):
receptors inside the bloodvessels of the brain, it causes
dilatation of the blood vesselsin the covering of the brain,
which causes the real headachein this is what everybody knows.
Every patient knows every doctorknow, but not many people don't
understand, including doctorswho are not neurologists.
(20:26):
The pain impulses need notalways go up to the brain.
Trigeminal nucleus in the ponshas what we call a descending
tract of the trigeminal nerve,meaning one part of that nucleus
goes down like a tail all theway to the upper cervical spinal
(20:47):
cord.
So it from the pons, it goesthrough the medulla and from the
medulla it enters the upper partof the spinal cord.
There are instances where themigraine impulse hits the
trigeminal nucleus but does notgo up to the brain causing the
headache, but it goes downthrough the descending tract of
(21:08):
the trigeminal nerve, and thenthe symptoms are entirely
different.
They get vertigo with vomitingand all that, and that is when
it hits the vestibular nucleusin the lower part of the pons.
When it comes to the medulla itcauses a whole variety of vagal
or vagus nerve mediated symptomslike explosive vomiting, painful
(21:32):
cramping of the abdomen,diarrhea, and uh, going down
further.
They get burning painfulsensation in the upper thighs
and around the umbilicus.
These people will not make anyconnection to migraine unless
you really take a very goodhistory and they establish the
fact that this patient.
(21:53):
Typical migraine in the past andnow this is what we call
modification or a, uh,transformation of migraine
transformed migraine.
MizzyM (22:03):
Okay.
You, so you mentioned a burningsensation in the thigh and the
umbilicus.
So what is the umbilicus, justin case if people don't know?
Dr. G (22:11):
I had a woman from New Jersey who came, her main
complaint was for the lastcouple of weeks.
She couldn't wear her.
Because the skirt, when sheties, it irritates her skin
around the umbilicus so bad.
MizzyM (22:26):
Which is the belly button?
Dr. G (22:27):
Yeah, the belly button.
Okay.
So she had to take it out.
She, she can't wear it.
She had to take it out.
It was so painful for her andnobody made the connection.
That she was a chronic migrainesufferer and uh, I put her on
what I told you earlier, themagnesium CoQ10 and the small
dose of serotonin enhancing drugLexapro within three to four
(22:47):
months.
She was completely symptom free.
These kinda things can happenonce you understand what I said
earlier.
The trigeminal nerve nucleusdescends down into the middle
and the upper spinal cord.
You can understand all thesesymptoms happening without a
headache; there's no headachebecause the impulses did not go
(23:08):
to the upper brain and connectwith the, with the brain cells.
That is the reason why theydon't have any brain symptoms.
Uh, I hope I made it clear toyou that these patients have
symptoms connected to the lowerbrain stem symptoms, the nausea,
vomiting, diarrhea, abdominalcramping, painful sensation
around the umbilicus, and evenup to the thigh-muscle cramping
(23:32):
up to the thigh, and all those.
You don't establish from thehistory that this patient mostly
a woman had migraine and she's achronic migraine sufferer.
You completely miss this and youwill send them to
gastroenterologist, toproctologist, you name it, and
nobody can find out what shehas.
MizzyM (23:49):
Right.
Well that was a very, veryfascinating conversation and I
hope we can, you know, you cancome back again to talk about
other things that youencountered in your practice.
Thank you very much.
Dr. G (24:05):
Thank you.
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