November 7, 2025 • 34 mins
In this episode of The Eye-Q Podcast, I speak with neurologist and headache specialist Dr. Huma Sheikh about what really causes migraine—and why it’s far more than “just a headache.” We unpack the difference between migraine and tension pain, common triggers like hormones and stress, and simple, effective lifestyle shifts that can help bring your body back into balance.
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Dr. Sheikh is a highly trained and well-experienced headache specialist who provides a comprehensive and holistic approach to the diagnosis and management of chronic headaches.
In addition to migraine, she is highly experienced in the treatment of other headache and facial pain disorders, including cluster, hemicrania, and trigeminal neuralgia.
Dr. Sheikh takes pride in being knowledgeable about the latest evidence-based medications as well as incorporating the latest in herbal and complementary lifestyle approaches to managing headaches.
Services include a one-time comprehensive consultation for diagnosis as well as ongoing management, education, and support for chronic headaches.
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Huma Sheik, MD
Website: https://www.headachesnyc.com/
Instagram: https://www.instagram.com/headachesnyc/
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
And for me, it's thinking about it as trying to put your body
into homeostasis. And it's like you said, you
know, if you're not getting enough sleep, if you're stressed
out, if you're not eating right,your body will warn you and your
body will give you signals that something is out of balance.
And when I started to think about it that way and when I
started to explain it to patients that way, I think
(00:22):
that's when we said, you know, we have to focus more on what is
triggering the migraine, what isout of balance and what can I
change my lifestyle to try to bring everything back to
homeostasis. Welcome to the IQ Podcast.
I'm Doctor Ronnie Banik, here tohelp you boost your IQ with
powerful insights that connect your eyes, your brain, and your
(00:44):
whole body Wellness. Hello everyone, and welcome to
another episode of the IQ Podcast.
I rear host Doctor Ronnie Manik,and in this podcast, you will
gain insights into your vision health, your brain health, and
your overall Wellness to help you raise your IQ today.
I'm so excited for our topic because it is something very
(01:06):
near and dear to my heart, whichis migraine.
And I've invited one of my colleagues who's really an
expert in headache and migraine,Dr. Huma Sheikh.
Thank you so much, Doctor Sheikhfor joining us on the IQ
Podcast. Of course.
Thank you so much for having me here.
I'm excited to have a really good educational talk and it's
exciting to be here. Thank you.
(01:28):
Yeah, thank you for taking the time out of your busy day and to
introduce you to the audience. Dr. Sheikh is a highly trained
and well experienced headache specialist who provides A
comprehensive and holistic approach to the diagnosis and
management of chronic headaches.In addition to migraine, she's
also highly experienced in the treatment of other headache and
(01:48):
facial pain disorders, includingcluster headache, hemicrania,
and trigeminal neuralgia. Doctor Sheikh takes pride in
being knowledgeable about the latest evidence based
medications as well as incorporating the latest in
herbal and complementary lifestyle approaches to managing
headaches. So again, you, your, your
(02:08):
mission really resonates with mebecause I found for I'm, I'm a
headache sufferer myself, migraine sufferer.
And in my journey, I had tried many of the traditional
medications that really didn't do much for me.
And it was really when I startedto address the nutrition aspect
of things, the lifestyle aspect of things, the mindset.
(02:28):
That's when I started to get better.
And now I like to share that. But could you share with our
audience how you became interested in headache and what
drew you to this particular subspecialty of neurology?
Sure. So I think I had a similar
journeyed as yourself. I started getting migraine
headaches when I was in medical school.
And it was so interesting that, you know, I remember, I mean,
(02:52):
obviously medical school, you have to study long hours.
The week of our exams, all you're doing is sitting in the
library. And it was actually like the
first time that I started drinking a lot of coffee.
So it's like a huge cup of coffee sitting in the library,
just 12 hours straight. And sometimes I'd have to cut
those short, go home and just lay down because I'd have such a
bad headache and such a bad migraine.
(03:14):
And I didn't realize that I had migraine until I was actually
doing my neurology residency. And I looked back and I was
like, wow, these are migraine attacks that I'm having.
I'm having the nausea with it. I'm having the sensitivity to
light sound, and I just need to go to bed.
And I was hearing the same stories from the patients that
we would see in clinic. And that's where I made the
(03:35):
first connection. And essentially what I was doing
was trying to just sleep them off or take something over the
counter once in a while. And it really wasn't until I
started my own practice in New York City that I realized that a
lot of my patients are dealing with these migraine attacks the
same way. They're just dealing with them
on their own and not realizing that they have actual
(03:57):
neurological condition where their nervous system is
overexcited, oversensitive. And a lot of them, they were in
the reproductive years. They were thinking about
conceiving or they were pregnant.
And that's the time when I thinkmost women are the most hesitant
about putting products into their body, right?
Because now they have someone else to think about.
(04:20):
And so that's when I really started to focus on moving away
from, like you said, just takingmore medications with more side
effects and really try to figureout what is migraine and how can
I treat it in a way that's actually trying to get at the
underlying issue. And for me, it's thinking about
it as trying to put your body into homeostasis.
(04:42):
And it's like you said, you know, if you're not getting
enough sleep, if you're stressedout, if you're not eating right,
your body will warn you and yourbody will give you signals that
something is out of balance. And when I started to think
about it that way and when I started to explain it to
patients that way, I think that's when we said, you know,
we have to focus more on what istriggering the migraine, what is
(05:04):
out of balance and what can I change my lifestyle to try to
bring everything back to homeostasis.
So not that's not to say that wedon't use medications and I'm
not open to them. I use a lot of the especially
more newer specific medications that are made after we found
something that is one of the involved in the pathophysiology
(05:25):
for migraines, CGRP. But it's really important to
think about migraine as a genetic predisposition that is
affected by your environment, whether it's your external
environment or your internal environment.
Well, thank you for sharing that.
And you know, it's kind of uncanny because I also going
back to what you said earlier, you started to develop migraine.
(05:46):
And during medical school, my very first migraine, my very
first one was I was a second year medical student.
I was studying in the science library and I had an aura and I
had no idea what that was back then.
And then later on I realized, OK, this is my first migraine.
So I, I wonder if they've ever done a study of medical school
students to see how many of themactually have migraine or, or
(06:08):
just seeing people studying intensely late at night.
It'll be interesting to know. But before we go on to talk
about some of those therapies that you mentioned, you
mentioned that, you know, a lot of people don't know that they
have migraine. They just think it's a headache.
So can you explain to our listeners what makes migraine
different from a regular headache?
(06:30):
And you said it's in neurologic condition, so how is it
different? And I know that there are
criteria. So what are some of those
criteria? You know, there's a simple way
to think about it. There's three questions that a
lot of times primary doctors. I've given this information to
them because it can be an easy way to pick up whether a
headache could be a migraine. So you ask yourself three
(06:50):
questions. Do I get nausea sometimes with
my headache? Do I get sensitive to light or
sound during my headache? And has the headache kept me
from doing a social activity, either school or work, at least
one day greater than a day in the last three months?
So in order, if you have said yes to two out of three of those
(07:12):
questions, there's a 93% chance that your headache is actually a
migraine. So.
Wow, 93% by doing that? Check.
Yeah, it's. So it's an easy way to think, to
be able to say, oh, wow, I don'thave just a headache.
I'm not drinking enough water orI don't have a headache because
I didn't sleep well. This is actually a migraine.
(07:34):
And the reason we want to think about it that way is distinguish
a headache from a migraine is because then you do start to
think about yourself as having acondition that you can take
control of. You know, if we think about a
headache, then it's like, I don't know what's going to cause
it. I don't know what brought it on,
so I don't know when it's going to happen, but a migraine really
(07:56):
is a condition where you know, you can start to pick up your
patterns, your triggers, and really start to develop some
control around when it happens or what you do if it does
happen. So the the official criteria is
that you have to have at least 5episodes of a headache that
lasts for at least four hours. And we really go off of the
(08:18):
characteristic of the headache, which it tends to be on one
side. It can change sides every time
you have the migraine attack andthe character of the headache is
pulsating or throbbing, and thenyou have to have those symptoms
along with it. What we call migrainous features
like nausea, vomiting, sensitivity to light to sound.
(08:38):
A lot of patients can have othersensitivities to to smells.
They can have sensitivity to touch.
That's called allodynia. But the criteria really ask for
nausea, sensitivity to light andsound.
And it's an easy criteria. If it happens more than five
times, lasts more than this amount of time, you know you
probably have migraine. I see.
(08:58):
And and we'll definitely includethose criteria in the show notes
under the episode so people can refer to that.
Now, is it enough? I have some patients who have
their very, very first migraine and usually they have, they come
in because they've had visual aura, so they think it's an eye
problem. So they come in and, you know,
we do their eye exam, their eyesare totally normal and it ends
(09:19):
up being migraine. So if somebody hasn't had, let's
say, just a single episode or maybe 2, does that mean that
they meet this criteria for migraine?
Or is there kind of a minimum number of episodes that they
have to have to have this diagnosis?
Yeah. So we do say 5 and typically,
you know, by the time they have come to see somebody, if it's
just for migraine without the aura, they kind of had these
(09:41):
headaches now for a while. So we usually end up meeting
that criteria. What's interesting is, like you
mentioned, if someone is coming to you for their first aura,
even though it might sound like a classic visual aura, I'm sure
you do the work up for other causes.
So if they come in and they've had the stereotype aura for
years and years, then we're morecomfortable saying, yeah, this
(10:02):
is migraine, this is their aura.But I think the first time, like
you said, if you out of nowhere are sitting there and you
develop a visual aura the first time, I mean, that's very scary.
Those are neurological symptoms.That could be a stroke or could
be something else. So it is important to rule out
other things you know the first or second time that it's
happening. Absolutely.
(10:24):
And I just want to touch upon this as well because I see quite
a few younger people in my practice.
I see children. Are children vulnerable to
migraine? And if so, like how do you know
if a child is having a migraine?Because sometimes they can't
tell you. Yeah, that's actually a really
good question. It is about one in 11 children
do have migraine and we considerthat below the age of like
(10:47):
adolescence, so before the age of their teen years.
It becomes much more common as women develop menarche and start
to become teenagers and adolescents.
But children definitely can get migraine and it's like you said,
in children it can be a little bit more difficult because it
can be actually different symptoms.
There is something called abdominal migraine where a
(11:10):
child's migraine is more centered in their gut.
And we know that migraine is an oversensitivity of your nervous
system or your nerves, and your gut actually has almost as many
nerves as your brain. So in children, it can sometimes
come across as abdominal pain, trouble eating, nausea.
(11:30):
And a lot of these patients get missed because no one thinks
about the GI as being involved in migraine.
And that's why I tell patients all the time, migraine is more
than a headache. It's not just a headache, so it
can be missed a lot, but if it is a stereotype pattern and if
they do get a headache along with it, that sometimes can be a
clue. If children are very young and
(11:51):
they're not able to really tell you 5-6 years old that they're
having head pain, sometimes they'll point to their head or
sometimes they'll want to kind of be out of the light.
That can sometimes be a clue. As they start to get older, 7-8
years old, I think they can start to tell you, you know, my
head hurts or it hurts here, or I don't want to eat or I want to
throw up. So hopefully that is a clue.
(12:14):
And that starts to clue people in that, you know, something
might be going on. But yeah, it's definitely missed
a lot. And it can be very difficult.
It's hard to tell sometimes if, you know, they don't want to go
to school and they're just saying my stomach hurts or my
head hurts. So I think a lot of times it
probably gets missed a lot more than we, you know, think about
it. Yeah.
And I think just being aware of those types of symptoms because
(12:36):
it's not something you think of as a headache, right, Like it's
or you don't link it to being a migraine headache.
And so just being aware of the complexity and the various types
of organ systems that can get involved in a migraine.
Now going back to the, you know,you mentioned earlier it's a
complex neurologic disorder. What do we think is actually
(12:57):
happening in the brain? I know that there's lots of
theories about this, but what's kind of the predominant theory
right now? Like what is triggering these
neurologic symptoms and and non neurologic symptoms as well?
Yeah. So that's a really great
question. And the vast theory right now is
that it's a combination of what we call neurovascular.
(13:18):
So if there is involvement of the nerves and the brain itself
as well as the blood vessels that are surrounding the brain,
and we don't know exactly what that first kind of drop is, but
then it's like a domino effect, then every domino just starts to
fall. So that first domino that falls
(13:39):
we think is some type of hyper excitability in the brain that
causes the nerves in the brain, in the cortex to become hyper
excitable. And because of that, that then
affects the trigeminal vascular system, the trigeminal nerve,
which is peripheral in some areas, it's under your sinuses,
(14:00):
It goes into your face. And that's why a lot of people
notice a lot of pain sometimes in their sinuses, in their jaw,
in their teeth and. And there's also some branches
that go to the eye socket, right?
So they can have eye. Oh yeah.
I have a lot of medicines that come in with eye pain and it
ends up being migraine. Yeah, so that's actually
probably the most common. I'm, I thank you for mentioning
(14:22):
that. And that most of the time
they're able to tell that this is a headache and not an eye
issue. But sometimes they're not sure
if it's an eye issue or a headache, but sometimes if it's
in their sinuses. A lot of these patients think
that they have sinusitis or sinus allergies and it can take
a while for them to be diagnosedwith migraine.
So once the trigeminal nerves are activated, then this
(14:44):
activates some of the blood vessels that surround your
meninges. That's the next domino to fall.
And that releases a lot of inflammatory factors, something
called VIP, something called CGRP, which is an inflammatory
peptide that causes the blood vessels to dilate and release
even more inflammatory markers. So and then essentially you
(15:08):
develop inflammation. So it's like a cycle.
It's like one thing happens and it's just kind of like all the
dominoes fall. So it is very complex.
And some of the medications try to stop, you know, the beginning
where there's hyper excitability.
Some of the medications focus onCGRP and some are just a little
bit more general and they try tostop the inflammation that is
(15:29):
happening. So it really does affect your
entire body because then once the blood vessels are dilated
that can, you know, give you things like some people feel
fatigue or brain fog, you can have GI issues like we mentioned
so. Thank you for that elegant
explanation because it's so hardto explain, but you really with
(15:49):
the analogy of the domino effect, it really makes a lot of
sense because yes, there are electrical changes and then
there's blood vessel changes andthen the nerves get it, you
know, triggered and then there'spain that you know, comes and
neurotransmitter. So it's really complex.
We don't fully understand it, but it does.
You know, when you explain it that way, it does make sense why
(16:11):
it's so complex. You know, when you're talking
about, you know, we don't understand what may be the very
first thing to happen, like what's causing that irritation
that is triggering this whole domino effect?
What are some common triggers that many people have control
over that they may not know thatthis is a trigger?
Sure, so the biggest one in migraine I'm sure everyone
(16:35):
already knows, but is much more common in women than men.
So all the studies and a lot of the information that we have
about migraine is in women, and in women particularly, hormones
play a big role, and especially estrogen and estradiol.
So we know that when your estrogen changes, when it falls
or drops, especially around ovulation, there's a small
(16:58):
change. And then right before you start
bleeding, but there's a bigger change.
That drop in estrogen is a big trigger for a lot of women to
develop a migraine attack. So we think that estrogen and
estradiol, the receptors are on a lot of the blood vessels.
And so we think that has something to do with that.
It picks up that there is less estrogen or less estradiol, and
(17:22):
that's also involved in pain pathways.
To I've also read that there arereceptors, estrogen receptors.
I could think they're alpha and beta in the brainstem, which is
very close to the center of the trigem nerve.
So I think there is a central mechanism maybe and also a
peripheral mechanism where the brain is very sensitive to
estrogen changes. Yes, exactly.
(17:43):
And so, you know, we can't necessarily control that.
You know, obviously women are going to have their monthly
cycle, but there may be ways to intervene if you know that
that's a big trigger for you. There are ways to preemptively
treat, especially before your menstrual cycle.
It's called mini prophylaxis. You can take something a day or
(18:04):
two before you know you're goingto get your period.
For some women, with some caveats, it might be a good idea
to go on a long term birth control so that they don't get a
period and don't have the drops in the estrogen.
There's some caveats that come with that, especially if you
have aura. So that that's something that
you definitely want to speak to your physician about before
deciding to do. And then other big triggers that
(18:26):
can happen are stress and sleep are the other two biggest
triggers. You know, there are studies done
that 80% even more for them. Stress is the biggest trigger.
And so that's why I love to tellmy patients.
I tell every one of my patients,if you can do mindfulness and
yoga, put that into your routine.
It doesn't have to be something you have to go home today and
(18:48):
start doing an hour every day. It needs to, you know, it should
be small, but it could be. It needs to be consistent.
Yeah, I can tell you from personal experience, like stress
is such a major factor for my myattacks, you know, guarantee.
Like, if I track it, I can tell exactly when I can predict when
it's going to happen. So Doctor Sheikh, this has been
(19:08):
such an enlightening discussion about migraine.
I have so many other questions Iwould love to ask you.
We're going to take a very shortbreak to hear from one of our
sponsors, and then we'll be right back with more on the IQ
Podcast. Stay tuned.
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Welcome back everyone to the IQ Podcast.
Today we're talking about one ofmy favorite topics, which is
migraine and we're speaking withDoctor Sheikh.
And Dr. Sheikh, you mentioned earlier that with a lot of your
patients, you talked to them about their lifestyle and other
(20:37):
things that they have control over and you really integrate in
these complementary therapies. So can you share with us, let's
say, the top three pillars when it comes to some of the
complementary therapies that yourecommend for your migraine
patients? We talked a little bit about
this, but the top three things that I tell patients to focus on
is movement, food, and their stress.
(20:59):
So we talked a little bit about stress and I have them integrate
mindfulness or yoga into their life slowly because it has been
shown to actually change how ourbody responds to stress.
So you can't get rid of stress, that's going to happen no matter
what, but you can start to trainyour brain on how it responds.
Instead of releasing stress hormones, it actually gets you
(21:22):
out of fight or flight mode. So stress, trying to incorporate
mindfulness or cognitive behavioral therapy, breathing
exercises. There's something called box
breathing that I will go throughwith them in the office.
That's simple to do, but it makes such a difference if
you're doing it consistently. And then food is a huge part of
(21:43):
migraine care. You know, unfortunately, we live
in a society where everything isfast food and we don't know
what's in our food. So I really try to tell our
patients to try to cook yourselfso you know what's in your food
and to use Whole Foods that are not processed.
And you're eating the rainbow, you're eating different
vegetables that are different colors, and you're getting all
(22:04):
the different nutrients that youneed, as well as making sure
that you're using high quality oils and nuts.
Nuts and berries are very good for your brain.
We talk about foods that have Omega threes like salmon and
healthy fats like avocado. So really talking about eating
healthy Whole Foods. And unfortunately that does
(22:25):
require you to cook more at homebecause that's the way that
you're going to get healthy foods.
But I think patients start to notice a difference in how
they're feeling overall, their energy levels.
And so they, you know, very quickly realize that it is
something that also really helpstheir migraine attacks.
You know, when it comes to food,like I had the worst diet ever
(22:46):
all through my, you know, teenage years, young adulthood
into, you know. Into residency, yeah, Residency
especially. All I did was chips and snap.
Yeah, exactly. Caffeine and sugar and pizza and
ice cream. Fast food basically.
And then when I made those shifts, it was difficult.
(23:08):
But when I was starting to eat more fruits and vegetables, you
know, just organic fresh, I think that's what made the big
difference is switching over. And one thing I don't know if
you, if you recommend this to your to your patients, Doctor
Sheikh is doing maybe a smoothieor juicing.
What's been your experience withthat or what have your patients
(23:28):
told you? You know, for a lot of patients,
especially a lot of women who are working and they have, you
know, so many responsibilities, it's a fast, easy way for them
to feel like they've done a nutritious breakfast.
Mostly is when they do it, you know, either a protein smoothie
or a quick smoothie in the morning is that they can take to
go because it's like you said, it is very difficult and you
(23:48):
have to give patients ways that they can make it easier for
themselves. So yeah, I love doing smoothies
in the morning. Putting in different chia seeds
or flax seeds can be very helpful because then you're
getting in protein, you're feeling full, and then you're
not running to snacks, you know,until lunchtime.
So yeah. And the other aspect of food is
also hydration, right, Doctor Shane?
(24:11):
Yeah. So I always ask medications, how
much are you drinking? And the vast majority of them
will say I'm just not. I, I don't drink.
I don't drink water. And that's a such a simple,
actionable thing that people cando that can really turn, you
know, turn things around tremendously.
Yeah, I'll give you a story too.Yeah, it's so interesting.
You know, during residency, likeI said, I would just live off of
(24:33):
coffee and chips and just because you're running around
all day, but I wouldn't drink a lot of water because then you
have to stop to go to the bathroom.
I mean, that's how you know, if you're on call and you're seeing
all these patients even that much felt like.
And so and then you fall into these routines where for a long
time my only hydration was my coffee.
And then, you know, whatever I drank with a little bit of my
(24:56):
lunch or dinner, but you have tobe drinking in between as well.
And I think what's also important with hydration is
making sure that you're getting the electrolytes with it.
Sometimes we tell patients, you know, drink lots of water and
they have a whole big, you know,jug of water, but they need to
put in a little bit of electrolytes either with some of
the things that are on the market that are OK.
(25:16):
Just be careful of the sugar content.
Or you could do it yourself. Coconut water with lemon, lime
and a little bit of Celtic salt is everything that you need but
you just have to be mindful to do.
That and I've had so many patients who, you know, they try
to be healthy, they're working out and they do an intense
workout and all of a sudden theystart getting their visual aura
and then it becomes a migraine attack.
(25:38):
And they were probably dehydrated, so they just weren't
drinking enough before their activity.
So yes, activity is good, but try to prepare and stabilize
things before you do something that may be a potential trigger.
Yeah. What's the third?
I sorry I interrupted you, Doctor.
Shaker not as well. This is great.
So the third is what I like to call movement, and that's
(25:59):
exercise, but also stretching. So for a lot of people who have
migraine, they keep all their stress in their head and neck
and shoulders. Or if you're sitting at the
computer all day, which is a lotof people nowadays, you know,
you're keeping all your tension in the head, head and neck.
So it's very, very important to make sure that you are
(26:19):
stretching your head and neck, your upper back, your mid back,
you know, with something like yoga or just specific stretching
for those areas. And then like you said, exercise
and moving exercise, even just low cardio has been shown to be
helpful in decreasing migraine and it's helpful for your
overall metabolism. It's the way that you're able to
(26:40):
take toxins out of your body. It's the way that you're able to
keep, you know, your connective tissue loose and hydrated.
So all these things, movement, food and your stress levels are
the three big ones. If they've done all of that and
they're doing great, then we move on to making sure your
sleep is good, you know, and some of these other things, but
(27:01):
that can make a big difference. Just those three things to try
to focus on. And we do one at a time because
it can be very overwhelming to say, hey, change your stress
levels, go start exercising, change your entire food.
You know, it can feel like a lot.
So we start on one and we, you know, kind of come up with a
plan for one thing at a time andjust give each thing a few
(27:23):
months at a time and then, you know, slowly build other
healthier habits. Yeah, I wanted to go back to the
topic of movement and exercise. I have definitely patients who
have chronic migraines, so more than 15 days a month where
they're suffering from their migraine symptoms and they just
can't move. You know, they feel like they're
paralyzed because of their pain.So how do you introduce
(27:47):
movement? Like how?
Because some patients are very resistant, right?
Because they they just say, well, if I start to do
something, I feel worse, so why would I do that?
But how do you kind of get them into some routine where they're
incorporating that in a regular basis?
So if they're open to it, I sendthem to physical therapy.
There are a lot of physical therapy rehab places where they
(28:09):
actually specialize in migraine.They might do something called
craniosacral therapy, which is initially very passive, so they
are not moving, but the person is kind of somewhat like massage
and somewhat of stretching. So it's helping them to stretch
out and the the rehab therapist can see, the physical therapist
(28:29):
can see where they're the most tight, where they have the most
issue and slowly start to build up their tolerance to movement.
But yeah, I see that a lot. And what also could be helpful
is if a lot of the tightness andstiffness is in their head and
neck and shoulders, doing trigger point injections or
nerve blocks can give them some temporary relief.
(28:51):
So then they're able to kind of,you know, not be in so much pain
and start the physical therapy. And the combination could be
very helpful because now they'removing more, so they're not as
tight. And then the trigger point
injections also helps them alongthe way.
But yeah, I think going to physical therapy, having someone
guide them initially can be very, very helpful.
No, I love that idea and I've definitely, I've been to
(29:13):
physical therapist myself and it's made a big difference with
my neck tightness. Yeah, good.
Good. Yeah.
So I wanted to ask you or just mention two things, like,
finally, just a few more thoughts about movement.
Sometimes, you know, people get overwhelmed, but even just deep
breathing or even walking can make a difference.
Like whatever you feel comfortable with, just get
(29:34):
moving, right? That's what I tell my patients,
like just get out of bed or get off the couch and move in some
way. And then the second thing I
wanted to ask you about was as acomplementary therapy, we're
talking about massage. What about, what are your
thoughts about acupressure, selfacupressure?
Do you have any experience with that?
Yes. So acupressure and then even
(29:55):
acupuncture, but acupressure, there are very good studies that
it can be actually helpful as anacute therapy for some of the
things that come with migraine. So for nausea, there's an
acupressure point on your wrist that I've done in the past
that's very helpful for the pain.
There's an acupressure point in the occipital nerve in the
occipital notch in the back. So I have noticed that you know
(30:18):
if I'm not able to take right? Behind where the bone, Where the
bone knee structure is just underneath.
Yes. And a lot of people, it will be
tender in that moment. But what they will notice is,
and sometimes you can use a little bit of like an essential
oil, but if you massage that area for 5-6 minutes while
they're pressing, it's going to hurt a little bit more.
But when they let go, there's some temporary relief, and it
(30:41):
can be very helpful acutely if they're waiting for their
abortive to kick in or if they happen to be somewhere where
they don't have their abortives on hand, or if they're trying to
avoid taking something for whatever reason.
So yeah, definitely that area can be very helpful.
There's a acupressure point in your temple right here and right
above your eyebrow. Yeah, I found that so effective
(31:02):
because a lot of my migraines are in my eye socket.
They actually like right here and then right here.
So there are two nerves here andsuper trochlear, super orbital.
So if you do that acupressure technique, it can really
sometimes even abort the migraine.
Yeah. So what I've noticed is when I
don't want to take an abortive, I trust that there or if I have
like somebody do it for me and then I stretch my neck in that
(31:25):
area, stretch it out. It's very intense and painful.
But if I can do it for at least a minute, when I let go, it
feels so much better. It feels like a release,
attention and a release. So it's almost like you're
redirecting the, OR you're, you're stopping that pain
pathway, right? And with the physical pressure.
Wow, so many great tips. Doctor Sheikh, I really
(31:46):
appreciate your sharing all these because these are things
that people can do. They, they should obviously be
under the care of a provider, but these are things they can do
at home. And these techniques are so
empowering and they can really improve one's quality of life.
We are just about out of time and there are so many more
questions I would love to ask you, especially about other
therapies, complementary and then also medications and some
(32:09):
of the other headache syndromes.I think we'll have to have you
come back on the, I would love to, of this topic because
there's, again, it's just a wealth of things that you're, I
would love for you to share withthe audience.
But in the meantime, if someone wanted to learn more about you,
about your work, or perhaps evenbecome a patient, how could they
reach out and find you? Yeah, sure.
So my website is Headaches NYC. So HEADACHES nyc.com.
(32:37):
I have an Instagram page with the same name as well as a
TikTok with the same name. So my website has all the
information on how to contact us.
You can text us or call us. All that information is there
and you can learn about all the different ways that we treat
migraine and other headaches as well.
And wonderful, and we will shareall of Doctor Sheikh's links in
the show notes. So you can reach out and
(32:57):
definitely follow her on Instagram.
She's got a great Instagram page, very educational.
So there's always lots to learn from Doctor Sheikh.
But thank you again for spendingsome time with us today in the
IQ Podcast. If there's one last message
you'd like to leave our audiencewith about this topic of
migraine and headaches, what would that be?
I think it would just be to knowthat there's a lot of people who
(33:19):
have this disease and it's not just a headache and, you know,
find a provider that can really help and guide you and really
understands what's. Going on yeah, absolutely.
And and I always tell my patients that is if you're not
comfortable with a provider, youcan always seek out another one.
Find someone who aligns with you, whether that be you want to
just use medications or you wantto use a device or you want to
(33:41):
use just the complimentary therapies.
Find a provider who will supportyou in what works best for you
and your yeah, your, your journey.
So again, Doctor Sheikh, thank you so much.
I know you have a very busy day ahead, but we really appreciate
your time and thank you all for listening, tuning in to the IQ
podcast. I hope you've enjoyed this
episode. Please remember to subscribe so
(34:04):
you don't miss any announcementsof future episodes.
And also please leave us a review so that others can also
be interested and also learn from the IQ podcast.
So thank you so much and I look forward to seeing you next time.
Thank you. Take care.
Bye. Bye bye.
Thank you for tuning in to the IQ Podcast.
I hope you enjoyed today's episode and learn something new
(34:27):
to help you boost your IQ. Leave us a review and share the
podcast with your family and friends.
Stay connected with me for more eye opening insights on ihealth,
nutrition and lifestyle. Until next time, keep your
vision clear and your IQ sharp.
And for me, it's thinking about it as trying to put your body
into homeostasis. And it's like you said, you
know, if you're not getting enough sleep, if you're stressed
out, if you're not eating right,your body will warn you and your
body will give you signals that something is out of balance.
And when I started to think about it that way and when I
started to explain it to patients that way, I think
(00:22):
that's when we said, you know, we have to focus more on what is
triggering the migraine, what isout of balance and what can I
change my lifestyle to try to bring everything back to
homeostasis. Welcome to the IQ Podcast.
I'm Doctor Ronnie Banik, here tohelp you boost your IQ with
powerful insights that connect your eyes, your brain, and your
(00:44):
whole body Wellness. Hello everyone, and welcome to
another episode of the IQ Podcast.
I rear host Doctor Ronnie Manik,and in this podcast, you will
gain insights into your vision health, your brain health, and
your overall Wellness to help you raise your IQ today.
I'm so excited for our topic because it is something very
(01:06):
near and dear to my heart, whichis migraine.
And I've invited one of my colleagues who's really an
expert in headache and migraine,Dr. Huma Sheikh.
Thank you so much, Doctor Sheikhfor joining us on the IQ
Podcast. Of course.
Thank you so much for having me here.
I'm excited to have a really good educational talk and it's
exciting to be here. Thank you.
(01:28):
Yeah, thank you for taking the time out of your busy day and to
introduce you to the audience. Dr. Sheikh is a highly trained
and well experienced headache specialist who provides A
comprehensive and holistic approach to the diagnosis and
management of chronic headaches.In addition to migraine, she's
also highly experienced in the treatment of other headache and
(01:48):
facial pain disorders, includingcluster headache, hemicrania,
and trigeminal neuralgia. Doctor Sheikh takes pride in
being knowledgeable about the latest evidence based
medications as well as incorporating the latest in
herbal and complementary lifestyle approaches to managing
headaches. So again, you, your, your
(02:08):
mission really resonates with mebecause I found for I'm, I'm a
headache sufferer myself, migraine sufferer.
And in my journey, I had tried many of the traditional
medications that really didn't do much for me.
And it was really when I startedto address the nutrition aspect
of things, the lifestyle aspect of things, the mindset.
(02:28):
That's when I started to get better.
And now I like to share that. But could you share with our
audience how you became interested in headache and what
drew you to this particular subspecialty of neurology?
Sure. So I think I had a similar
journeyed as yourself. I started getting migraine
headaches when I was in medical school.
And it was so interesting that, you know, I remember, I mean,
(02:52):
obviously medical school, you have to study long hours.
The week of our exams, all you're doing is sitting in the
library. And it was actually like the
first time that I started drinking a lot of coffee.
So it's like a huge cup of coffee sitting in the library,
just 12 hours straight. And sometimes I'd have to cut
those short, go home and just lay down because I'd have such a
bad headache and such a bad migraine.
(03:14):
And I didn't realize that I had migraine until I was actually
doing my neurology residency. And I looked back and I was
like, wow, these are migraine attacks that I'm having.
I'm having the nausea with it. I'm having the sensitivity to
light sound, and I just need to go to bed.
And I was hearing the same stories from the patients that
we would see in clinic. And that's where I made the
(03:35):
first connection. And essentially what I was doing
was trying to just sleep them off or take something over the
counter once in a while. And it really wasn't until I
started my own practice in New York City that I realized that a
lot of my patients are dealing with these migraine attacks the
same way. They're just dealing with them
on their own and not realizing that they have actual
(03:57):
neurological condition where their nervous system is
overexcited, oversensitive. And a lot of them, they were in
the reproductive years. They were thinking about
conceiving or they were pregnant.
And that's the time when I thinkmost women are the most hesitant
about putting products into their body, right?
Because now they have someone else to think about.
(04:20):
And so that's when I really started to focus on moving away
from, like you said, just takingmore medications with more side
effects and really try to figureout what is migraine and how can
I treat it in a way that's actually trying to get at the
underlying issue. And for me, it's thinking about
it as trying to put your body into homeostasis.
(04:42):
And it's like you said, you know, if you're not getting
enough sleep, if you're stressedout, if you're not eating right,
your body will warn you and yourbody will give you signals that
something is out of balance. And when I started to think
about it that way and when I started to explain it to
patients that way, I think that's when we said, you know,
we have to focus more on what istriggering the migraine, what is
(05:04):
out of balance and what can I change my lifestyle to try to
bring everything back to homeostasis.
So not that's not to say that wedon't use medications and I'm
not open to them. I use a lot of the especially
more newer specific medications that are made after we found
something that is one of the involved in the pathophysiology
(05:25):
for migraines, CGRP. But it's really important to
think about migraine as a genetic predisposition that is
affected by your environment, whether it's your external
environment or your internal environment.
Well, thank you for sharing that.
And you know, it's kind of uncanny because I also going
back to what you said earlier, you started to develop migraine.
(05:46):
And during medical school, my very first migraine, my very
first one was I was a second year medical student.
I was studying in the science library and I had an aura and I
had no idea what that was back then.
And then later on I realized, OK, this is my first migraine.
So I, I wonder if they've ever done a study of medical school
students to see how many of themactually have migraine or, or
(06:08):
just seeing people studying intensely late at night.
It'll be interesting to know. But before we go on to talk
about some of those therapies that you mentioned, you
mentioned that, you know, a lot of people don't know that they
have migraine. They just think it's a headache.
So can you explain to our listeners what makes migraine
different from a regular headache?
(06:30):
And you said it's in neurologic condition, so how is it
different? And I know that there are
criteria. So what are some of those
criteria? You know, there's a simple way
to think about it. There's three questions that a
lot of times primary doctors. I've given this information to
them because it can be an easy way to pick up whether a
headache could be a migraine. So you ask yourself three
(06:50):
questions. Do I get nausea sometimes with
my headache? Do I get sensitive to light or
sound during my headache? And has the headache kept me
from doing a social activity, either school or work, at least
one day greater than a day in the last three months?
So in order, if you have said yes to two out of three of those
(07:12):
questions, there's a 93% chance that your headache is actually a
migraine. So.
Wow, 93% by doing that? Check.
Yeah, it's. So it's an easy way to think, to
be able to say, oh, wow, I don'thave just a headache.
I'm not drinking enough water orI don't have a headache because
I didn't sleep well. This is actually a migraine.
(07:34):
And the reason we want to think about it that way is distinguish
a headache from a migraine is because then you do start to
think about yourself as having acondition that you can take
control of. You know, if we think about a
headache, then it's like, I don't know what's going to cause
it. I don't know what brought it on,
so I don't know when it's going to happen, but a migraine really
(07:56):
is a condition where you know, you can start to pick up your
patterns, your triggers, and really start to develop some
control around when it happens or what you do if it does
happen. So the the official criteria is
that you have to have at least 5episodes of a headache that
lasts for at least four hours. And we really go off of the
(08:18):
characteristic of the headache, which it tends to be on one
side. It can change sides every time
you have the migraine attack andthe character of the headache is
pulsating or throbbing, and thenyou have to have those symptoms
along with it. What we call migrainous features
like nausea, vomiting, sensitivity to light to sound.
(08:38):
A lot of patients can have othersensitivities to to smells.
They can have sensitivity to touch.
That's called allodynia. But the criteria really ask for
nausea, sensitivity to light andsound.
And it's an easy criteria. If it happens more than five
times, lasts more than this amount of time, you know you
probably have migraine. I see.
(08:58):
And and we'll definitely includethose criteria in the show notes
under the episode so people can refer to that.
Now, is it enough? I have some patients who have
their very, very first migraine and usually they have, they come
in because they've had visual aura, so they think it's an eye
problem. So they come in and, you know,
we do their eye exam, their eyesare totally normal and it ends
(09:19):
up being migraine. So if somebody hasn't had, let's
say, just a single episode or maybe 2, does that mean that
they meet this criteria for migraine?
Or is there kind of a minimum number of episodes that they
have to have to have this diagnosis?
Yeah. So we do say 5 and typically,
you know, by the time they have come to see somebody, if it's
just for migraine without the aura, they kind of had these
(09:41):
headaches now for a while. So we usually end up meeting
that criteria. What's interesting is, like you
mentioned, if someone is coming to you for their first aura,
even though it might sound like a classic visual aura, I'm sure
you do the work up for other causes.
So if they come in and they've had the stereotype aura for
years and years, then we're morecomfortable saying, yeah, this
(10:02):
is migraine, this is their aura.But I think the first time, like
you said, if you out of nowhere are sitting there and you
develop a visual aura the first time, I mean, that's very scary.
Those are neurological symptoms.That could be a stroke or could
be something else. So it is important to rule out
other things you know the first or second time that it's
happening. Absolutely.
(10:24):
And I just want to touch upon this as well because I see quite
a few younger people in my practice.
I see children. Are children vulnerable to
migraine? And if so, like how do you know
if a child is having a migraine?Because sometimes they can't
tell you. Yeah, that's actually a really
good question. It is about one in 11 children
do have migraine and we considerthat below the age of like
(10:47):
adolescence, so before the age of their teen years.
It becomes much more common as women develop menarche and start
to become teenagers and adolescents.
But children definitely can get migraine and it's like you said,
in children it can be a little bit more difficult because it
can be actually different symptoms.
There is something called abdominal migraine where a
(11:10):
child's migraine is more centered in their gut.
And we know that migraine is an oversensitivity of your nervous
system or your nerves, and your gut actually has almost as many
nerves as your brain. So in children, it can sometimes
come across as abdominal pain, trouble eating, nausea.
(11:30):
And a lot of these patients get missed because no one thinks
about the GI as being involved in migraine.
And that's why I tell patients all the time, migraine is more
than a headache. It's not just a headache, so it
can be missed a lot, but if it is a stereotype pattern and if
they do get a headache along with it, that sometimes can be a
clue. If children are very young and
(11:51):
they're not able to really tell you 5-6 years old that they're
having head pain, sometimes they'll point to their head or
sometimes they'll want to kind of be out of the light.
That can sometimes be a clue. As they start to get older, 7-8
years old, I think they can start to tell you, you know, my
head hurts or it hurts here, or I don't want to eat or I want to
throw up. So hopefully that is a clue.
(12:14):
And that starts to clue people in that, you know, something
might be going on. But yeah, it's definitely missed
a lot. And it can be very difficult.
It's hard to tell sometimes if, you know, they don't want to go
to school and they're just saying my stomach hurts or my
head hurts. So I think a lot of times it
probably gets missed a lot more than we, you know, think about
it. Yeah.
And I think just being aware of those types of symptoms because
(12:36):
it's not something you think of as a headache, right, Like it's
or you don't link it to being a migraine headache.
And so just being aware of the complexity and the various types
of organ systems that can get involved in a migraine.
Now going back to the, you know,you mentioned earlier it's a
complex neurologic disorder. What do we think is actually
(12:57):
happening in the brain? I know that there's lots of
theories about this, but what's kind of the predominant theory
right now? Like what is triggering these
neurologic symptoms and and non neurologic symptoms as well?
Yeah. So that's a really great
question. And the vast theory right now is
that it's a combination of what we call neurovascular.
(13:18):
So if there is involvement of the nerves and the brain itself
as well as the blood vessels that are surrounding the brain,
and we don't know exactly what that first kind of drop is, but
then it's like a domino effect, then every domino just starts to
fall. So that first domino that falls
(13:39):
we think is some type of hyper excitability in the brain that
causes the nerves in the brain, in the cortex to become hyper
excitable. And because of that, that then
affects the trigeminal vascular system, the trigeminal nerve,
which is peripheral in some areas, it's under your sinuses,
(14:00):
It goes into your face. And that's why a lot of people
notice a lot of pain sometimes in their sinuses, in their jaw,
in their teeth and. And there's also some branches
that go to the eye socket, right?
So they can have eye. Oh yeah.
I have a lot of medicines that come in with eye pain and it
ends up being migraine. Yeah, so that's actually
probably the most common. I'm, I thank you for mentioning
(14:22):
that. And that most of the time
they're able to tell that this is a headache and not an eye
issue. But sometimes they're not sure
if it's an eye issue or a headache, but sometimes if it's
in their sinuses. A lot of these patients think
that they have sinusitis or sinus allergies and it can take
a while for them to be diagnosedwith migraine.
So once the trigeminal nerves are activated, then this
(14:44):
activates some of the blood vessels that surround your
meninges. That's the next domino to fall.
And that releases a lot of inflammatory factors, something
called VIP, something called CGRP, which is an inflammatory
peptide that causes the blood vessels to dilate and release
even more inflammatory markers. So and then essentially you
(15:08):
develop inflammation. So it's like a cycle.
It's like one thing happens and it's just kind of like all the
dominoes fall. So it is very complex.
And some of the medications try to stop, you know, the beginning
where there's hyper excitability.
Some of the medications focus onCGRP and some are just a little
bit more general and they try tostop the inflammation that is
(15:29):
happening. So it really does affect your
entire body because then once the blood vessels are dilated
that can, you know, give you things like some people feel
fatigue or brain fog, you can have GI issues like we mentioned
so. Thank you for that elegant
explanation because it's so hardto explain, but you really with
(15:49):
the analogy of the domino effect, it really makes a lot of
sense because yes, there are electrical changes and then
there's blood vessel changes andthen the nerves get it, you
know, triggered and then there'spain that you know, comes and
neurotransmitter. So it's really complex.
We don't fully understand it, but it does.
You know, when you explain it that way, it does make sense why
(16:11):
it's so complex. You know, when you're talking
about, you know, we don't understand what may be the very
first thing to happen, like what's causing that irritation
that is triggering this whole domino effect?
What are some common triggers that many people have control
over that they may not know thatthis is a trigger?
Sure, so the biggest one in migraine I'm sure everyone
(16:35):
already knows, but is much more common in women than men.
So all the studies and a lot of the information that we have
about migraine is in women, and in women particularly, hormones
play a big role, and especially estrogen and estradiol.
So we know that when your estrogen changes, when it falls
or drops, especially around ovulation, there's a small
(16:58):
change. And then right before you start
bleeding, but there's a bigger change.
That drop in estrogen is a big trigger for a lot of women to
develop a migraine attack. So we think that estrogen and
estradiol, the receptors are on a lot of the blood vessels.
And so we think that has something to do with that.
It picks up that there is less estrogen or less estradiol, and
(17:22):
that's also involved in pain pathways.
To I've also read that there arereceptors, estrogen receptors.
I could think they're alpha and beta in the brainstem, which is
very close to the center of the trigem nerve.
So I think there is a central mechanism maybe and also a
peripheral mechanism where the brain is very sensitive to
estrogen changes. Yes, exactly.
(17:43):
And so, you know, we can't necessarily control that.
You know, obviously women are going to have their monthly
cycle, but there may be ways to intervene if you know that
that's a big trigger for you. There are ways to preemptively
treat, especially before your menstrual cycle.
It's called mini prophylaxis. You can take something a day or
(18:04):
two before you know you're goingto get your period.
For some women, with some caveats, it might be a good idea
to go on a long term birth control so that they don't get a
period and don't have the drops in the estrogen.
There's some caveats that come with that, especially if you
have aura. So that that's something that
you definitely want to speak to your physician about before
deciding to do. And then other big triggers that
(18:26):
can happen are stress and sleep are the other two biggest
triggers. You know, there are studies done
that 80% even more for them. Stress is the biggest trigger.
And so that's why I love to tellmy patients.
I tell every one of my patients,if you can do mindfulness and
yoga, put that into your routine.
It doesn't have to be something you have to go home today and
(18:48):
start doing an hour every day. It needs to, you know, it should
be small, but it could be. It needs to be consistent.
Yeah, I can tell you from personal experience, like stress
is such a major factor for my myattacks, you know, guarantee.
Like, if I track it, I can tell exactly when I can predict when
it's going to happen. So Doctor Sheikh, this has been
(19:08):
such an enlightening discussion about migraine.
I have so many other questions Iwould love to ask you.
We're going to take a very shortbreak to hear from one of our
sponsors, and then we'll be right back with more on the IQ
Podcast. Stay tuned.
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Welcome back everyone to the IQ Podcast.
Today we're talking about one ofmy favorite topics, which is
migraine and we're speaking withDoctor Sheikh.
And Dr. Sheikh, you mentioned earlier that with a lot of your
patients, you talked to them about their lifestyle and other
(20:37):
things that they have control over and you really integrate in
these complementary therapies. So can you share with us, let's
say, the top three pillars when it comes to some of the
complementary therapies that yourecommend for your migraine
patients? We talked a little bit about
this, but the top three things that I tell patients to focus on
is movement, food, and their stress.
(20:59):
So we talked a little bit about stress and I have them integrate
mindfulness or yoga into their life slowly because it has been
shown to actually change how ourbody responds to stress.
So you can't get rid of stress, that's going to happen no matter
what, but you can start to trainyour brain on how it responds.
Instead of releasing stress hormones, it actually gets you
(21:22):
out of fight or flight mode. So stress, trying to incorporate
mindfulness or cognitive behavioral therapy, breathing
exercises. There's something called box
breathing that I will go throughwith them in the office.
That's simple to do, but it makes such a difference if
you're doing it consistently. And then food is a huge part of
(21:43):
migraine care. You know, unfortunately, we live
in a society where everything isfast food and we don't know
what's in our food. So I really try to tell our
patients to try to cook yourselfso you know what's in your food
and to use Whole Foods that are not processed.
And you're eating the rainbow, you're eating different
vegetables that are different colors, and you're getting all
(22:04):
the different nutrients that youneed, as well as making sure
that you're using high quality oils and nuts.
Nuts and berries are very good for your brain.
We talk about foods that have Omega threes like salmon and
healthy fats like avocado. So really talking about eating
healthy Whole Foods. And unfortunately that does
(22:25):
require you to cook more at homebecause that's the way that
you're going to get healthy foods.
But I think patients start to notice a difference in how
they're feeling overall, their energy levels.
And so they, you know, very quickly realize that it is
something that also really helpstheir migraine attacks.
You know, when it comes to food,like I had the worst diet ever
(22:46):
all through my, you know, teenage years, young adulthood
into, you know. Into residency, yeah, Residency
especially. All I did was chips and snap.
Yeah, exactly. Caffeine and sugar and pizza and
ice cream. Fast food basically.
And then when I made those shifts, it was difficult.
(23:08):
But when I was starting to eat more fruits and vegetables, you
know, just organic fresh, I think that's what made the big
difference is switching over. And one thing I don't know if
you, if you recommend this to your to your patients, Doctor
Sheikh is doing maybe a smoothieor juicing.
What's been your experience withthat or what have your patients
(23:28):
told you? You know, for a lot of patients,
especially a lot of women who are working and they have, you
know, so many responsibilities, it's a fast, easy way for them
to feel like they've done a nutritious breakfast.
Mostly is when they do it, you know, either a protein smoothie
or a quick smoothie in the morning is that they can take to
go because it's like you said, it is very difficult and you
(23:48):
have to give patients ways that they can make it easier for
themselves. So yeah, I love doing smoothies
in the morning. Putting in different chia seeds
or flax seeds can be very helpful because then you're
getting in protein, you're feeling full, and then you're
not running to snacks, you know,until lunchtime.
So yeah. And the other aspect of food is
also hydration, right, Doctor Shane?
(24:11):
Yeah. So I always ask medications, how
much are you drinking? And the vast majority of them
will say I'm just not. I, I don't drink.
I don't drink water. And that's a such a simple,
actionable thing that people cando that can really turn, you
know, turn things around tremendously.
Yeah, I'll give you a story too.Yeah, it's so interesting.
You know, during residency, likeI said, I would just live off of
(24:33):
coffee and chips and just because you're running around
all day, but I wouldn't drink a lot of water because then you
have to stop to go to the bathroom.
I mean, that's how you know, if you're on call and you're seeing
all these patients even that much felt like.
And so and then you fall into these routines where for a long
time my only hydration was my coffee.
And then, you know, whatever I drank with a little bit of my
(24:56):
lunch or dinner, but you have tobe drinking in between as well.
And I think what's also important with hydration is
making sure that you're getting the electrolytes with it.
Sometimes we tell patients, you know, drink lots of water and
they have a whole big, you know,jug of water, but they need to
put in a little bit of electrolytes either with some of
the things that are on the market that are OK.
(25:16):
Just be careful of the sugar content.
Or you could do it yourself. Coconut water with lemon, lime
and a little bit of Celtic salt is everything that you need but
you just have to be mindful to do.
That and I've had so many patients who, you know, they try
to be healthy, they're working out and they do an intense
workout and all of a sudden theystart getting their visual aura
and then it becomes a migraine attack.
(25:38):
And they were probably dehydrated, so they just weren't
drinking enough before their activity.
So yes, activity is good, but try to prepare and stabilize
things before you do something that may be a potential trigger.
Yeah. What's the third?
I sorry I interrupted you, Doctor.
Shaker not as well. This is great.
So the third is what I like to call movement, and that's
(25:59):
exercise, but also stretching. So for a lot of people who have
migraine, they keep all their stress in their head and neck
and shoulders. Or if you're sitting at the
computer all day, which is a lotof people nowadays, you know,
you're keeping all your tension in the head, head and neck.
So it's very, very important to make sure that you are
(26:19):
stretching your head and neck, your upper back, your mid back,
you know, with something like yoga or just specific stretching
for those areas. And then like you said, exercise
and moving exercise, even just low cardio has been shown to be
helpful in decreasing migraine and it's helpful for your
overall metabolism. It's the way that you're able to
(26:40):
take toxins out of your body. It's the way that you're able to
keep, you know, your connective tissue loose and hydrated.
So all these things, movement, food and your stress levels are
the three big ones. If they've done all of that and
they're doing great, then we move on to making sure your
sleep is good, you know, and some of these other things, but
(27:01):
that can make a big difference. Just those three things to try
to focus on. And we do one at a time because
it can be very overwhelming to say, hey, change your stress
levels, go start exercising, change your entire food.
You know, it can feel like a lot.
So we start on one and we, you know, kind of come up with a
plan for one thing at a time andjust give each thing a few
(27:23):
months at a time and then, you know, slowly build other
healthier habits. Yeah, I wanted to go back to the
topic of movement and exercise. I have definitely patients who
have chronic migraines, so more than 15 days a month where
they're suffering from their migraine symptoms and they just
can't move. You know, they feel like they're
paralyzed because of their pain.So how do you introduce
(27:47):
movement? Like how?
Because some patients are very resistant, right?
Because they they just say, well, if I start to do
something, I feel worse, so why would I do that?
But how do you kind of get them into some routine where they're
incorporating that in a regular basis?
So if they're open to it, I sendthem to physical therapy.
There are a lot of physical therapy rehab places where they
(28:09):
actually specialize in migraine.They might do something called
craniosacral therapy, which is initially very passive, so they
are not moving, but the person is kind of somewhat like massage
and somewhat of stretching. So it's helping them to stretch
out and the the rehab therapist can see, the physical therapist
(28:29):
can see where they're the most tight, where they have the most
issue and slowly start to build up their tolerance to movement.
But yeah, I see that a lot. And what also could be helpful
is if a lot of the tightness andstiffness is in their head and
neck and shoulders, doing trigger point injections or
nerve blocks can give them some temporary relief.
(28:51):
So then they're able to kind of,you know, not be in so much pain
and start the physical therapy. And the combination could be
very helpful because now they'removing more, so they're not as
tight. And then the trigger point
injections also helps them alongthe way.
But yeah, I think going to physical therapy, having someone
guide them initially can be very, very helpful.
No, I love that idea and I've definitely, I've been to
(29:13):
physical therapist myself and it's made a big difference with
my neck tightness. Yeah, good.
Good. Yeah.
So I wanted to ask you or just mention two things, like,
finally, just a few more thoughts about movement.
Sometimes, you know, people get overwhelmed, but even just deep
breathing or even walking can make a difference.
Like whatever you feel comfortable with, just get
(29:34):
moving, right? That's what I tell my patients,
like just get out of bed or get off the couch and move in some
way. And then the second thing I
wanted to ask you about was as acomplementary therapy, we're
talking about massage. What about, what are your
thoughts about acupressure, selfacupressure?
Do you have any experience with that?
Yes. So acupressure and then even
(29:55):
acupuncture, but acupressure, there are very good studies that
it can be actually helpful as anacute therapy for some of the
things that come with migraine. So for nausea, there's an
acupressure point on your wrist that I've done in the past
that's very helpful for the pain.
There's an acupressure point in the occipital nerve in the
occipital notch in the back. So I have noticed that you know
(30:18):
if I'm not able to take right? Behind where the bone, Where the
bone knee structure is just underneath.
Yes. And a lot of people, it will be
tender in that moment. But what they will notice is,
and sometimes you can use a little bit of like an essential
oil, but if you massage that area for 5-6 minutes while
they're pressing, it's going to hurt a little bit more.
But when they let go, there's some temporary relief, and it
(30:41):
can be very helpful acutely if they're waiting for their
abortive to kick in or if they happen to be somewhere where
they don't have their abortives on hand, or if they're trying to
avoid taking something for whatever reason.
So yeah, definitely that area can be very helpful.
There's a acupressure point in your temple right here and right
above your eyebrow. Yeah, I found that so effective
(31:02):
because a lot of my migraines are in my eye socket.
They actually like right here and then right here.
So there are two nerves here andsuper trochlear, super orbital.
So if you do that acupressure technique, it can really
sometimes even abort the migraine.
Yeah. So what I've noticed is when I
don't want to take an abortive, I trust that there or if I have
like somebody do it for me and then I stretch my neck in that
(31:25):
area, stretch it out. It's very intense and painful.
But if I can do it for at least a minute, when I let go, it
feels so much better. It feels like a release,
attention and a release. So it's almost like you're
redirecting the, OR you're, you're stopping that pain
pathway, right? And with the physical pressure.
Wow, so many great tips. Doctor Sheikh, I really
(31:46):
appreciate your sharing all these because these are things
that people can do. They, they should obviously be
under the care of a provider, but these are things they can do
at home. And these techniques are so
empowering and they can really improve one's quality of life.
We are just about out of time and there are so many more
questions I would love to ask you, especially about other
therapies, complementary and then also medications and some
(32:09):
of the other headache syndromes.I think we'll have to have you
come back on the, I would love to, of this topic because
there's, again, it's just a wealth of things that you're, I
would love for you to share withthe audience.
But in the meantime, if someone wanted to learn more about you,
about your work, or perhaps evenbecome a patient, how could they
reach out and find you? Yeah, sure.
So my website is Headaches NYC. So HEADACHES nyc.com.
(32:37):
I have an Instagram page with the same name as well as a
TikTok with the same name. So my website has all the
information on how to contact us.
You can text us or call us. All that information is there
and you can learn about all the different ways that we treat
migraine and other headaches as well.
And wonderful, and we will shareall of Doctor Sheikh's links in
the show notes. So you can reach out and
(32:57):
definitely follow her on Instagram.
She's got a great Instagram page, very educational.
So there's always lots to learn from Doctor Sheikh.
But thank you again for spendingsome time with us today in the
IQ Podcast. If there's one last message
you'd like to leave our audiencewith about this topic of
migraine and headaches, what would that be?
I think it would just be to knowthat there's a lot of people who
(33:19):
have this disease and it's not just a headache and, you know,
find a provider that can really help and guide you and really
understands what's. Going on yeah, absolutely.
And and I always tell my patients that is if you're not
comfortable with a provider, youcan always seek out another one.
Find someone who aligns with you, whether that be you want to
just use medications or you wantto use a device or you want to
(33:41):
use just the complimentary therapies.
Find a provider who will supportyou in what works best for you
and your yeah, your, your journey.
So again, Doctor Sheikh, thank you so much.
I know you have a very busy day ahead, but we really appreciate
your time and thank you all for listening, tuning in to the IQ
podcast. I hope you've enjoyed this
episode. Please remember to subscribe so
(34:04):
you don't miss any announcementsof future episodes.
And also please leave us a review so that others can also
be interested and also learn from the IQ podcast.
So thank you so much and I look forward to seeing you next time.
Thank you. Take care.
Bye. Bye bye.
Thank you for tuning in to the IQ Podcast.
I hope you enjoyed today's episode and learn something new
(34:27):
to help you boost your IQ. Leave us a review and share the
podcast with your family and friends.
Stay connected with me for more eye opening insights on ihealth,
nutrition and lifestyle. Until next time, keep your
vision clear and your IQ sharp.
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