June 9, 2025 • 21 mins
In this episode of The Paid Leave Podcast, we are talking about headaches and migraines. June is Headache and Migraine Awareness Month. Gretchen Michaelson, the founder of the Headache Care Center in South Windsor, she is an Adult Nurse Practitioner specializing in headache medicine. She explains the difference between headaches and migraines, the various treatments available, including prescription medications, neuromodulation, and lifestyle changes. She highlights the importance of addressing migraines promptly to prevent chronic conditions and improve quality of life. Michaelson also discusses the impact of migraines on mental health and the advancements in treatment since 2018, emphasizing the need for awareness and proper diagnosis. Michaelson also talks about the importance of CT Paid Leave in that it allows for intermittent leave or when the episodic headaches or migraines may flare up.
To get in touch with Gretchen Michaelson: go to their website: Treatment Team - Headache Care Center News
Or call The Headache Care Center in South Windsor (860) 263-3603
For information or to apply for benefits please go to: ctpaidleave.org
https://ctpaidleave.org/s/?language=en_US
https://www.facebook.com/CTPaidLeave
https://www.instagram.com/ctpaidleave/
https://twitter.com/CTPaidLeave
https://www.youtube.com/results?search_query=ct+paid+leave
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Nancy Barrow (00:01):
Hello Connecticut, and welcome to The Paid Leave
Podcast. The title basicallysays it all. I'm Nancy Barrow,
and I will be delving into thisnew state program and how it can
help you and your family. Thispodcast will give you
information you should knowabout Connecticut Paid Leave and
maybe just a little bit more.
Connecticut Paid Leave bringspeace of mind to your home,
(00:22):
family and workplace. Welcome toThe Paid Leave Podcast.
June is National Migraine andHeadache Awareness Month, and
it's aimed at increasingawareness and trying to reduce
the stigma. Here to help in thisdiscussion, is the founder and
director of the headache CareCenter in South Windsor Gretchen
(00:43):
Michaelson. Gretchen is an AdultNurse Practitioner specializing
in headache medicine, and hercareer has focused on
neurological conditions since2000. She has dedicated her
practice to improving quality oflife for patients with various
headaches, and she is acertified headache specialist
through the National HeadacheFoundation. And Gretchen's
practice philosophy, centers onproviding specialized care for
(01:06):
individuals with headacheconditions and guiding them
towards improved quality of lifethrough evidence based treatment
approaches and in her sparetime, she's a wife and a mom of
six children. Welcome to ThePaid Leave podcast, Gretchen.
Gretchen Michaelson (01:19):
Thank you very much.
Nancy Barrow (01:21):
So Thanks for lending your expertise to this
topic in June, especially sinceit's Migraine and Headache
Awareness Month. So have youever suffered personally from
headaches or migraines?
Gretchen Michaelson (01:31):
I do not have migraines. It's a question
I get from patients all thetime. I do have two children
with migraine stuff so.
Nancy Barrow (01:37):
You do?
Gretchen Michaelson (01:37):
I do
Nancy Barrow (01:38):
Let's start with the headache Care Center in
South Windsor, and how you gotstarted in this line of work
with headaches and migraines.
Gretchen Michaelson (01:44):
So I've always been in neurology, 25
years now, which is crazy. And Isaid it was the one field I
never wanted to do. I was nevergoing to do neurology.
Nancy Barrow (01:55):
Why would that be?
Gretchen Michaelson (01:56):
You know, it all came down to it just, it
just seemed too much, toocomplicated. I was more into the
cardiothoracic world, and that'swhat I was going to do, but my
husband and I, we were lookingto be living in the same
location, and the job that madeitself self as evident in the
ICU was only in neurology. So Ithought, I'll just do that for a
(02:19):
couple years, and then I'lltransition to what I really want
to do, and I fell in love, andhave never left it.
Nancy Barrow (02:24):
Wow. And that's amazing. That story is amazing.
So tell me about headaches andmigraines, and how are they
different?
Gretchen Michaelson (02:28):
You have to think of headache as a
description of what's going on.
So it's a head pain. So you canhave all kinds of different
headaches. You can haveheadaches because you had the
flu. You can have a headachebecause you had hit your head on
the cabinet. Or you can havemigraine headache, which is an
entirely differentpathophysiology.
Nancy Barrow (02:49):
What are some of the treatments? Can they be over
the counter, like Advil?
Gretchen Michaelson (02:52):
The certainly can be, I think, for
people who have very episodic,you know, infrequent type
headaches, those that certainlycan be helpful. You know, the
patients that we're seeing,especially with migraine, were
usually using multiplemodalities, from prescription
medication to neuromodulation tolifestyle modifications and all
of those different thingscombined.
Nancy Barrow (03:13):
So what's neuromodulation?
Gretchen Michaelson (03:14):
So neuromodulation is where we have
various types of externalstimulus. They have various
devices, some that go on yourarm, some that actually stick to
your head and that actually tryand they all work by different
mechanisms, but some of themsimulate your own neural
pathways to try and help controlheadache or prevent headache.
(03:34):
Everyone needs what we call, youknow, when we're talking
specifically with migraine,everyone needs an abortive plan.
This is what you take when youget a headache, but when the
headaches become too frequent,it's really not great for the
brain. It's an inflammatoryprocess, and there can actually
be radiographic changes like onMRI that would be related to
those inflammatory processes. Sowhen we're seeing patients who
(03:55):
are at, you know, four headachesa month, you know, one a week,
we say, you know, at that pointin time, we probably should be
considering putting onpreventative medication.
Nancy Barrow (04:01):
Let's talk about migraines, because they are a
different animal. My dad and Iboth had migraines, and we both
had kind of the same thing. Weneeded dark, we needed quiet, I
needed cold, and I think I gotmy first migraine as a teenager,
and my dad was taking Caffergotand I know it's, it's old
(04:21):
school, but it, he said, takeone, and if it doesn't work in
30 minutes, then you takeanother one. And it really
helped. So I think that what,and I may be wrong, but I
thought that we had like, avascular headache, vascular
migraines. And I don't know ifthat's correct the terminology,
but I think it was something,you know, obviously with
(04:41):
caffeine helped.
Gretchen Michaelson (04:42):
Right, well, that was something that I
think we've made great stridesin pathophysiology over the
years, and so we used todescribe them as and relate
pathophysiology more to avascular problem. Now we've kind
of transitioned into atrigeminal vascular Situation.
So the pathophysiology is alittle bit different, and we're
(05:04):
not so concerned, I suppose,related to specifically a
vascular headache.
Nancy Barrow (05:08):
Yeah, well, let's talk about migraines in general.
There are obviously a bunch ofdifferent types of migraines.
Can you kind of talk about thedifferent types of migraines?
Gretchen Michaelson (05:17):
Yes so we like to categorize migraine
first migraine. How frequentlydoes it occur? So is the
migraine episodic, meaningyou're having less than 15
headache days per month, or isit chronic? Are we having more
than 15 migraine days per month?
And then in addition to that, weseparate migraine with aura and
migraine without aura. So noticethat, yes. So for some
individuals, they they can haveand again, it's a small
(05:39):
percentage of individuals, maybea third of individuals with
migraine that will develop priorto the headache developing, can
develop a number of differenttypes of symptoms, whether it
be, you know, shapes that movethrough their field of vision,
sparkly lights, zigzags. You canhave speech involvement. I know
you can certainly watch YouTubevideos of seeing people actively
in a migraine, where theirspeech becomes garbled, they can
(06:01):
have, you know, tingling sincesensory type symptoms and that,
that's what we consider aura,that would only and it usually
lasts about five to 60 minutes,and then the headache follows.
Nancy Barrow (06:16):
Wow, so then they suffer from a headache for how
long after?
Gretchen Michaelson (06:19):
So migraine, per diagnostic
criteria, lasts anywhere betweenfour to 72 hours.
Nancy Barrow (06:24):
What are some of the different treatments that
you have for the variousmigraines?
Gretchen Michaelson (06:29):
So I do have to say there have been such
great strides in what'savailable now. So 2018 was a big
year in the headache world. Wehad the addition of various
types of treatment options thatplay with a molecule called CGRP
or calcitonin gene relatedpeptide, which is a
neuropeptide, which duringmigraine, we see those
(06:49):
neuropeptides rise, and as amigraine dissipates, we see
those dissipate. So we now havetargeted treatment that plays
with this molecule, and theoutcome from using these
treatments has just beensomething we have never seen
before. Wow, which is great. Wecall it like the golden age of
migraine treatments and patientsreally, truly have been able to
(07:12):
be given their lives back.
Nancy Barrow (07:14):
Do you use alternative kind of therapies
like Botox or acupuncture oreven, like cupping,for
situations where it can bereally severe?
Gretchen Michaelson (07:27):
Yeah, so Botox is actually an FDA
approved medication for thetreatment of chronic migraine,
so that's headaches that aremore than 15 days per month. So
we wouldn't even consider thatlike an alternative treatment
that's definitely on label whenwe talk about massage or
acupuncture, sometimes itdepends on what we're targeting.
So for some individuals who havea lot of spasticity that then
(07:51):
seems to trigger theirheadaches, those are patients
that I, you know, will send foracupuncture, which can be very
helpful for that, you know,minimizing that spasticity.
Nancy Barrow (08:00):
Kiind of that of that relief. How much time do
people need away from work? Likeit sounds like it's a long
process to kind of figure outwhat they have and what the
treatment might be.
Gretchen Michaelson (08:12):
Yeah, there with migraine, a lot of it is
more of episodic, you know,unpredictable times where they
may not be able to function.
Because, again, headaches canlast four to 72 hours, and we, I
would love to say that we getthe first treatment right out
of, you know, the gates. Butunfortunately, sometimes it's
trying of different things tofind the right combination so
(08:33):
that that patient can havesuccess. The gold standard of
treatment for us, and I tellthis to all of my patients that
come to see us, is that youwould have complete relief of
that migraine within two hours,and it doesn't return in 24 so
that's what we're striving for.
But it may take a couple of, youknow, or layering of medications
before we find that right fit.
Nancy Barrow (08:53):
An do you try to find out triggers? And are there
always triggers? Because Icouldn't figure out what
triggered mine.
Gretchen Michaelson (09:00):
Right?
Triggers are, they're a hottopic these days because, yeah,
we have years of talking abouttriggers and food triggers and
alcohol triggers or, you know,dehydration, lack of sleep, too
much sleep, all of those overstimulation, stimulation, all of
those different things. I thinksome of those that trigger, you
know, sometimes patients willcome and say, Oh, I ate the
(09:22):
wrong thing. I had chocolate,and that's what, what triggered
my migraine. And we actuallyhave some more recent data to
suggest that actually withmigraine, we have activation of
the hypothalamus, and that thatactually causes food craving. So
you actually might be cravingthe chocolate, for which then
you eat the chocolate, and thenyou blame your migraine on your
chocolate, when, in reality, thepathophysiology was already
(09:42):
preceding that.
Nancy Barrow (09:45):
Well let's go back and talk about cluster
headaches, because I know we haddiscussed this before, but I
know that they affect more menthan women, correct?
Gretchen Michaelson (09:54):
So cluster headache is a unique, you know,
subset of headache. It's. Not ahuge population in general, but
when it occurs, it's profoundlydebilitating. So we see it more
often in men. These areheadaches that last anywhere
from 15 to 90 minutes. We callthem a sidelocked headache. So
they're only ever on the rightside of the head or the left
(10:16):
side of the head tends to feellike they're being it's like a
hot poker in their eye, and thatpain will last for again, it's a
short duration, 15 to 90minutes, but they can have up to
eight attacks a day. Wow. Andhow long usually a cycle can
last four to eight or six toeight weeks would be more
typical.
Nancy Barrow (10:36):
And so if you have one of these cluster headaches
once, are you more susceptibleto getting them?
Gretchen Michaelson (10:41):
So men, they usually tend to cycle.
Spring and Fall is the moretypical times that we see
clusters. Can't we kind of callit cluster season. And you know,
suddenly your phone starts toring and, oh, I'm starting back
in cycle again. Thankfully,these headaches, because they're
so disabling, we have some greattreatments that now are starting
(11:01):
to really make a difference forthese individuals, because
without treatment, there's aextremely high suicide rate with
these types of headaches.
Nancy Barrow (11:07):
Wow, wow. That is frightening. Do you also think
about mental health for peoplewho are who are going through
these cluster headaches, do you,or even someone who's going
through migraines? I mean, it's,it is really debilitating when
you get like, a diagnosis ofthat and you know that it's a
chronic situation for you, doyou suggest that they have,
(11:28):
like, mental health or go talkto someone?
Gretchen Michaelson (11:29):
Yeah mental health is a big part of what we
do in neurology anyway, because,you know, there's that comorbid
condition between anxiety,depression and some of these
pain conditions, partly becauseit's unpredictable. So what
happens is, is they don't knowwhen they're going to get a
headache, and so they try andplan activities, then they're
not able to participate in thoseactivities. And as time goes on,
(11:49):
you know, friends are like, Oh,maybe I don't want to invite
that person or part, you know,include them, just because they
end up canceling all the time.
And then that can send people,you know, kind of down that
road. And by the time they cometo see us at the Headache
Center, they may have very highfrequent headaches, and then
also be struggling with allkinds of anxiety, depression,
that anticipation of, when isthat neck attack going to occur,
(12:09):
right? I think that also goes tohow important treatment is,
because when you have atreatment where you know you can
have complete relief in that twohours and it's not going to
return in 24 it empowerspatients to go, you know what? I
have a plan. I know if itoccurs, I'm not going to be
derailed. I'm going to take mywhatever my treatment is, and
(12:29):
I'll be good to go. And that isso empowering to patients, and
allows them to feel like theycan participate and do things in
life. Yeah? Why I do what I do.
Nancy Barrow (12:39):
Yeah, I mean, you want them to be you want to be
successful in the treatment,right? So, so they can go to
work, they can be a mother,father, sister, brother,
whatever they're trying to do inlife, and have some quality of
life, because it can be sodebilitating. I just know from
my mine that I've had they're sodebilitating, there's no way I
(13:00):
could work through a migrainefor me.
Gretchen Michaelson (13:04):
Yeah no.
And I mean, it would be verydifficult if you didn't have the
if you didn't have theappropriate treatment, which is
why, you know, we really workfor we work through that process
to try and get there.
Nancy Barrow (13:14):
And since 2018 there's these great new meds.
Gretchen Michaelson (13:16):
Great new treatment options yes.
Nancy Barrow (13:18):
That's so amazing.
Gretchen Michaelson (13:19):
So we've seen, not only better efficacy
in treating the actual headache,but also for preventative
medication, so that patientsnow, hey, I used to get, you
know, 18 a month, and now I'mdown to one or two a month, and
I take my medication and I'mgood to go.
Nancy Barrow (13:33):
What kind of therapies do you use? Do you
use, like biofeedback? Or do youuse different types of therapies
for people who have headaches?
Gretchen Michaelson (13:40):
So there's all kinds of different things
that we use. So obviously,medications are a big portion of
what we use, depending onfrequency. We have even, you
know, IV therapies that we do.
We have Botox that we use forthose only with chronic
migraine. That's the onlyindication related to migraine.
With Botox, we have, sometimeseven just therapy, various types
of, you know, cognitive therapy.
(14:06):
We some patients useacupuncture. Some people use
massage. We also talk a lotabout lifestyle changes. You
know, migraineurs are have verysensitive brains, so they we
like to keep everything veryhomeostatic, so everything
that's the same. So going to bedat the same time, getting up at
the same time, which is hard foryour adolescents, who, you know,
they go to school and on, youknow, during the school week,
(14:27):
they have to get up atridiculous times in the morning,
and so on the weekend, they'renot going to get up at six
o'clock in the morning. And yet,they really shouldn't deviate
more than an hour.
Nancy Barrow (14:34):
Oh my gosh!
Gretchen Michaelson (14:36):
wake up time that brain really likes to
have everything very much thesame, eating at regular
intervals. All of thosecomponents will play into
headache.
Nancy Barrow (14:42):
So being a mom and having two kids who've had had
headaches and migraines, how didyou look at them differently?
Gretchen Michaelson (14:50):
There wasn't a question in terms of
diagnosis. And I think that's abig barrier for a lot of
individuals, and I thinkunfortunately, our medical model
right now doesn't play well withthat, because. Such a limited
time. And so I'll have, you'llhave individuals who have seen
multiple people before, they'vecome to see a headache
specialist, and, you know, seenor, or maybe even not, felt like
(15:13):
they were, heard that theirmigraines were as debilitating
as they as they are. And so theysay, Well, no, I mentioned it
to, you know, my doctor or to myspecialist, and they were like,
oh, you know, if you take overthe counter medication and it
helps some, okay, that's, that'sgood enough. And I think then
they interpret that to meanthat's, I mentioned it, they
didn't offer anything else, andso there must not be anything
(15:35):
else available. And that's justnot the case. It's not the case,
thankfully nowadays, but I thinkit allows people to function at
very high levels of headache,and, you know, potentially miss
out on like job promotions andall of those things, because
then they miss work when, whenthere are treatments that are
(15:56):
available that really do changelives.
Nancy Barrow (15:58):
And how young Are people that you've treated, are
there really young children thatget these?
Gretchen Michaelson (16:03):
So we at our center, we treat down to the
age of 13, but and for a lot ofwomen, you know that time period
in their lives hormonal changesthat we start to see, that
that's when those headaches willstart to kind of pick up and
kind of rear their ugly head.
That is a geneticpredisposition. So it's not
uncommon for us to see thegrandmother, the mother and then
the child.
Nancy Barrow (16:23):
Connecticut Paid Leave, as you know, can help
with many aspects of migrainesand headaches. You can get up to
12 weeks of income replacement ayear to take care of your own
serious health condition, like aheadache or a migraine, or to
take care of a loved one who issuffering from these and you can
take intermittent leave, or youcan take a reduced schedule
(16:45):
leave, or you can take thatwhole block leave, like say
you're really having clusterheadaches and you need to take
two months off to really dealwith this, or three months off.
How valuable are resources likethis for your patients?
Gretchen Michaelson (16:59):
I think it certainly is a valuable resource
that they can have as someincome replacement, I think
especially that that episodiccomponent, because migraine
tends to be episodic, so it'snot it's not typically that
block of time, but to know thatthey have some time that they
can treat and try varioustreatments, so that we can get
(17:21):
them to a place where they needto be, with the goal of them
being able to say, hey, now Iactually am able to use my PTO
to do fun things like vacation.
Nancy Barrow (17:29):
So it is headache and migraine Awareness Month.
What are you hoping happensduring this month?
Gretchen Michaelson (17:35):
I'm hoping number one, that patients
realize that having headachesand frequent headaches is not
normal. And so if you're havingfrequent headaches, number one,
ask questions, whether it be foryour primary care provider, or,
you know, reach out to us orsomebody to say, Hey, I'm having
these headaches. I'm guessingmaybe this, I should have it
(17:56):
looked at, and then have anevaluation, because I think we
normalize, especially withmigraine, it's such a high
percentage of women that we tendto normalize it and say, Oh,
this is just how I live, and itjust doesn't have to be that
way.
Nancy Barrow (18:09):
And what is the percentage of women that get
migraines?
Gretchen Michaelson (18:13):
So it's about across the United States.
It's about 20% of individuals.
Well, it can have 15 to 20% ofpatients. So one in five.
Nancy Barrow (18:21):
One in five have migraines?
Gretchen Michaelson (18:23):
It's grossly underdiagnosed,
unfortunately.
Nancy Barrow (18:25):
And why is that?
Is there a stigma still attachedto that?
Gretchen Michaelson (18:28):
There is a huge stigma associated with it.
And actually, there's some newerdata coming out now as we're
trying to address stigmaassociated with migraine. And I
think it goes back to even someof those original questions, is
it a headache or migraine? Imean, the reality is that most
of us, over the course of ourlifetime, will experience a
headache at some point in time.
But we have to understand thatmigraine is a different
(18:49):
pathophysiology.
Nancy Barrow (18:51):
And it can be a chronic health condition, which
is another thing that we cover.
Gretchen Michaelson (18:56):
Yes, it is a chronic health condition. We
say once a migraineur are alwaysa migraneur.
Nancy Barrow (18:59):
Migraineur. Oh, yeah. So that's that's me right
there. What would you likepeople to take away from this
podcast, Gretchen?
Gretchen Michaelson (19:06):
Let's see if I had to choose something
just that there's hope thatthere is so many options
available. I hear it over andover again from patients,
especially in these last coupleof years, to say, I have my life
back, and I had no idea it wouldbe possible. And I think again,
it goes back to combination ofstigmatization and not knowing
(19:29):
resources were available. Sojust being able to say, Hey, I'm
going to look into it and seewhat I can do, and then be able
to enjoy life to the fullest.
Now it's a repeated thing tohave patients come back to say,
I mean, I hear it all. I hear Ihave I get to do more hobbies
that I've never been able to do.
I've been able to go to my kidsevents, for patients, to be able
to come back and say I went tomy daughter's wedding and I
(19:49):
wasn't even concerned about notbeing able to enjoy it to its
fullest. And I think those arethose moments that we don't
think about as sometimes, asclinicians. Those are the
moments that are important topatients, and to be able to have
them come back and really beable to live life, it's great.
Or patients coming back andsaying, Hey, I got a promotion
at work, because now I'm not,you know, missing all of this
(20:11):
work or not, that they'remissing work, but they're not
functioning to their fullcapacity, because they're trying
to struggle through going towork while while having a
migraine, that they can reallyadvance and do the things that
they want to do. And it'sexciting to see them come back
and be excited about it.
Nancy Barrow (20:27):
Is that the best part of your job you think?
Gretchen Michaelson (20:29):
For sure, that's the only reason why I
Nancy Barrow (20:30):
With six kids.
(laughter)stay in it! (laughter)
Gretchen Michaelson (20:33):
For sure!
Nancy Barrow (20:34):
I want to thank my guest, Gretchen Michaelson, the
founder and director of theHeadache Care Center in South
Windsor, for being on The PaidLeave Podcast. Thank you so much
for being here.
Gretchen Michaelson (20:43):
Thank you so much for having me!
Nancy Barrow (20:44):
And I got a real education about headaches and
migraines. So thank you so muchfor that.
Gretchen Michaelson (20:49):
You're very welcome!
Nancy Barrow (20:50):
For more information or to apply for
benefits, please go toctpaidleave.org. This has been
another edition of The PaidLeave Podcast. Please like and
subscribe so you'll be notifiedabout new podcasts that become
available. Connecticut PaidLeave is a public act with a
personal purpose. I'm NancyBarrow, and thanks for
(21:10):
listening.
Hello Connecticut, and welcome to The Paid Leave
Podcast. The title basicallysays it all. I'm Nancy Barrow,
and I will be delving into thisnew state program and how it can
help you and your family. Thispodcast will give you
information you should knowabout Connecticut Paid Leave and
maybe just a little bit more.
Connecticut Paid Leave bringspeace of mind to your home,
(00:22):
family and workplace. Welcome toThe Paid Leave Podcast.
June is National Migraine andHeadache Awareness Month, and
it's aimed at increasingawareness and trying to reduce
the stigma. Here to help in thisdiscussion, is the founder and
director of the headache CareCenter in South Windsor Gretchen
(00:43):
Michaelson. Gretchen is an AdultNurse Practitioner specializing
in headache medicine, and hercareer has focused on
neurological conditions since2000. She has dedicated her
practice to improving quality oflife for patients with various
headaches, and she is acertified headache specialist
through the National HeadacheFoundation. And Gretchen's
practice philosophy, centers onproviding specialized care for
(01:06):
individuals with headacheconditions and guiding them
towards improved quality of lifethrough evidence based treatment
approaches and in her sparetime, she's a wife and a mom of
six children. Welcome to ThePaid Leave podcast, Gretchen.
Gretchen Michaelson (01:19):
Thank you very much.
Nancy Barrow (01:21):
So Thanks for lending your expertise to this
topic in June, especially sinceit's Migraine and Headache
Awareness Month. So have youever suffered personally from
headaches or migraines?
Gretchen Michaelson (01:31):
I do not have migraines. It's a question
I get from patients all thetime. I do have two children
with migraine stuff so.
Nancy Barrow (01:37):
You do?
Gretchen Michaelson (01:37):
I do
Nancy Barrow (01:38):
Let's start with the headache Care Center in
South Windsor, and how you gotstarted in this line of work
with headaches and migraines.
Gretchen Michaelson (01:44):
So I've always been in neurology, 25
years now, which is crazy. And Isaid it was the one field I
never wanted to do. I was nevergoing to do neurology.
Nancy Barrow (01:55):
Why would that be?
Gretchen Michaelson (01:56):
You know, it all came down to it just, it
just seemed too much, toocomplicated. I was more into the
cardiothoracic world, and that'swhat I was going to do, but my
husband and I, we were lookingto be living in the same
location, and the job that madeitself self as evident in the
ICU was only in neurology. So Ithought, I'll just do that for a
(02:19):
couple years, and then I'lltransition to what I really want
to do, and I fell in love, andhave never left it.
Nancy Barrow (02:24):
Wow. And that's amazing. That story is amazing.
So tell me about headaches andmigraines, and how are they
different?
Gretchen Michaelson (02:28):
You have to think of headache as a
description of what's going on.
So it's a head pain. So you canhave all kinds of different
headaches. You can haveheadaches because you had the
flu. You can have a headachebecause you had hit your head on
the cabinet. Or you can havemigraine headache, which is an
entirely differentpathophysiology.
Nancy Barrow (02:49):
What are some of the treatments? Can they be over
the counter, like Advil?
Gretchen Michaelson (02:52):
The certainly can be, I think, for
people who have very episodic,you know, infrequent type
headaches, those that certainlycan be helpful. You know, the
patients that we're seeing,especially with migraine, were
usually using multiplemodalities, from prescription
medication to neuromodulation tolifestyle modifications and all
of those different thingscombined.
Nancy Barrow (03:13):
So what's neuromodulation?
Gretchen Michaelson (03:14):
So neuromodulation is where we have
various types of externalstimulus. They have various
devices, some that go on yourarm, some that actually stick to
your head and that actually tryand they all work by different
mechanisms, but some of themsimulate your own neural
pathways to try and help controlheadache or prevent headache.
(03:34):
Everyone needs what we call, youknow, when we're talking
specifically with migraine,everyone needs an abortive plan.
This is what you take when youget a headache, but when the
headaches become too frequent,it's really not great for the
brain. It's an inflammatoryprocess, and there can actually
be radiographic changes like onMRI that would be related to
those inflammatory processes. Sowhen we're seeing patients who
(03:55):
are at, you know, four headachesa month, you know, one a week,
we say, you know, at that pointin time, we probably should be
considering putting onpreventative medication.
Nancy Barrow (04:01):
Let's talk about migraines, because they are a
different animal. My dad and Iboth had migraines, and we both
had kind of the same thing. Weneeded dark, we needed quiet, I
needed cold, and I think I gotmy first migraine as a teenager,
and my dad was taking Caffergotand I know it's, it's old
(04:21):
school, but it, he said, takeone, and if it doesn't work in
30 minutes, then you takeanother one. And it really
helped. So I think that what,and I may be wrong, but I
thought that we had like, avascular headache, vascular
migraines. And I don't know ifthat's correct the terminology,
but I think it was something,you know, obviously with
(04:41):
caffeine helped.
Gretchen Michaelson (04:42):
Right, well, that was something that I
think we've made great stridesin pathophysiology over the
years, and so we used todescribe them as and relate
pathophysiology more to avascular problem. Now we've kind
of transitioned into atrigeminal vascular Situation.
So the pathophysiology is alittle bit different, and we're
(05:04):
not so concerned, I suppose,related to specifically a
vascular headache.
Nancy Barrow (05:08):
Yeah, well, let's talk about migraines in general.
There are obviously a bunch ofdifferent types of migraines.
Can you kind of talk about thedifferent types of migraines?
Gretchen Michaelson (05:17):
Yes so we like to categorize migraine
first migraine. How frequentlydoes it occur? So is the
migraine episodic, meaningyou're having less than 15
headache days per month, or isit chronic? Are we having more
than 15 migraine days per month?
And then in addition to that, weseparate migraine with aura and
migraine without aura. So noticethat, yes. So for some
individuals, they they can haveand again, it's a small
(05:39):
percentage of individuals, maybea third of individuals with
migraine that will develop priorto the headache developing, can
develop a number of differenttypes of symptoms, whether it
be, you know, shapes that movethrough their field of vision,
sparkly lights, zigzags. You canhave speech involvement. I know
you can certainly watch YouTubevideos of seeing people actively
in a migraine, where theirspeech becomes garbled, they can
(06:01):
have, you know, tingling sincesensory type symptoms and that,
that's what we consider aura,that would only and it usually
lasts about five to 60 minutes,and then the headache follows.
Nancy Barrow (06:16):
Wow, so then they suffer from a headache for how
long after?
Gretchen Michaelson (06:19):
So migraine, per diagnostic
criteria, lasts anywhere betweenfour to 72 hours.
Nancy Barrow (06:24):
What are some of the different treatments that
you have for the variousmigraines?
Gretchen Michaelson (06:29):
So I do have to say there have been such
great strides in what'savailable now. So 2018 was a big
year in the headache world. Wehad the addition of various
types of treatment options thatplay with a molecule called CGRP
or calcitonin gene relatedpeptide, which is a
neuropeptide, which duringmigraine, we see those
(06:49):
neuropeptides rise, and as amigraine dissipates, we see
those dissipate. So we now havetargeted treatment that plays
with this molecule, and theoutcome from using these
treatments has just beensomething we have never seen
before. Wow, which is great. Wecall it like the golden age of
migraine treatments and patientsreally, truly have been able to
(07:12):
be given their lives back.
Nancy Barrow (07:14):
Do you use alternative kind of therapies
like Botox or acupuncture oreven, like cupping,for
situations where it can bereally severe?
Gretchen Michaelson (07:27):
Yeah, so Botox is actually an FDA
approved medication for thetreatment of chronic migraine,
so that's headaches that aremore than 15 days per month. So
we wouldn't even consider thatlike an alternative treatment
that's definitely on label whenwe talk about massage or
acupuncture, sometimes itdepends on what we're targeting.
So for some individuals who havea lot of spasticity that then
(07:51):
seems to trigger theirheadaches, those are patients
that I, you know, will send foracupuncture, which can be very
helpful for that, you know,minimizing that spasticity.
Nancy Barrow (08:00):
Kiind of that of that relief. How much time do
people need away from work? Likeit sounds like it's a long
process to kind of figure outwhat they have and what the
treatment might be.
Gretchen Michaelson (08:12):
Yeah, there with migraine, a lot of it is
more of episodic, you know,unpredictable times where they
may not be able to function.
Because, again, headaches canlast four to 72 hours, and we, I
would love to say that we getthe first treatment right out
of, you know, the gates. Butunfortunately, sometimes it's
trying of different things tofind the right combination so
(08:33):
that that patient can havesuccess. The gold standard of
treatment for us, and I tellthis to all of my patients that
come to see us, is that youwould have complete relief of
that migraine within two hours,and it doesn't return in 24 so
that's what we're striving for.
But it may take a couple of, youknow, or layering of medications
before we find that right fit.
Nancy Barrow (08:53):
An do you try to find out triggers? And are there
always triggers? Because Icouldn't figure out what
triggered mine.
Gretchen Michaelson (09:00):
Right?
Triggers are, they're a hottopic these days because, yeah,
we have years of talking abouttriggers and food triggers and
alcohol triggers or, you know,dehydration, lack of sleep, too
much sleep, all of those overstimulation, stimulation, all of
those different things. I thinksome of those that trigger, you
know, sometimes patients willcome and say, Oh, I ate the
(09:22):
wrong thing. I had chocolate,and that's what, what triggered
my migraine. And we actuallyhave some more recent data to
suggest that actually withmigraine, we have activation of
the hypothalamus, and that thatactually causes food craving. So
you actually might be cravingthe chocolate, for which then
you eat the chocolate, and thenyou blame your migraine on your
chocolate, when, in reality, thepathophysiology was already
(09:42):
preceding that.
Nancy Barrow (09:45):
Well let's go back and talk about cluster
headaches, because I know we haddiscussed this before, but I
know that they affect more menthan women, correct?
Gretchen Michaelson (09:54):
So cluster headache is a unique, you know,
subset of headache. It's. Not ahuge population in general, but
when it occurs, it's profoundlydebilitating. So we see it more
often in men. These areheadaches that last anywhere
from 15 to 90 minutes. We callthem a sidelocked headache. So
they're only ever on the rightside of the head or the left
(10:16):
side of the head tends to feellike they're being it's like a
hot poker in their eye, and thatpain will last for again, it's a
short duration, 15 to 90minutes, but they can have up to
eight attacks a day. Wow. Andhow long usually a cycle can
last four to eight or six toeight weeks would be more
typical.
Nancy Barrow (10:36):
And so if you have one of these cluster headaches
once, are you more susceptibleto getting them?
Gretchen Michaelson (10:41):
So men, they usually tend to cycle.
Spring and Fall is the moretypical times that we see
clusters. Can't we kind of callit cluster season. And you know,
suddenly your phone starts toring and, oh, I'm starting back
in cycle again. Thankfully,these headaches, because they're
so disabling, we have some greattreatments that now are starting
(11:01):
to really make a difference forthese individuals, because
without treatment, there's aextremely high suicide rate with
these types of headaches.
Nancy Barrow (11:07):
Wow, wow. That is frightening. Do you also think
about mental health for peoplewho are who are going through
these cluster headaches, do you,or even someone who's going
through migraines? I mean, it's,it is really debilitating when
you get like, a diagnosis ofthat and you know that it's a
chronic situation for you, doyou suggest that they have,
(11:28):
like, mental health or go talkto someone?
Gretchen Michaelson (11:29):
Yeah mental health is a big part of what we
do in neurology anyway, because,you know, there's that comorbid
condition between anxiety,depression and some of these
pain conditions, partly becauseit's unpredictable. So what
happens is, is they don't knowwhen they're going to get a
headache, and so they try andplan activities, then they're
not able to participate in thoseactivities. And as time goes on,
(11:49):
you know, friends are like, Oh,maybe I don't want to invite
that person or part, you know,include them, just because they
end up canceling all the time.
And then that can send people,you know, kind of down that
road. And by the time they cometo see us at the Headache
Center, they may have very highfrequent headaches, and then
also be struggling with allkinds of anxiety, depression,
that anticipation of, when isthat neck attack going to occur,
(12:09):
right? I think that also goes tohow important treatment is,
because when you have atreatment where you know you can
have complete relief in that twohours and it's not going to
return in 24 it empowerspatients to go, you know what? I
have a plan. I know if itoccurs, I'm not going to be
derailed. I'm going to take mywhatever my treatment is, and
(12:29):
I'll be good to go. And that isso empowering to patients, and
allows them to feel like theycan participate and do things in
life. Yeah? Why I do what I do.
Nancy Barrow (12:39):
Yeah, I mean, you want them to be you want to be
successful in the treatment,right? So, so they can go to
work, they can be a mother,father, sister, brother,
whatever they're trying to do inlife, and have some quality of
life, because it can be sodebilitating. I just know from
my mine that I've had they're sodebilitating, there's no way I
(13:00):
could work through a migrainefor me.
Gretchen Michaelson (13:04):
Yeah no.
And I mean, it would be verydifficult if you didn't have the
if you didn't have theappropriate treatment, which is
why, you know, we really workfor we work through that process
to try and get there.
Nancy Barrow (13:14):
And since 2018 there's these great new meds.
Gretchen Michaelson (13:16):
Great new treatment options yes.
Nancy Barrow (13:18):
That's so amazing.
Gretchen Michaelson (13:19):
So we've seen, not only better efficacy
in treating the actual headache,but also for preventative
medication, so that patientsnow, hey, I used to get, you
know, 18 a month, and now I'mdown to one or two a month, and
I take my medication and I'mgood to go.
Nancy Barrow (13:33):
What kind of therapies do you use? Do you
use, like biofeedback? Or do youuse different types of therapies
for people who have headaches?
Gretchen Michaelson (13:40):
So there's all kinds of different things
that we use. So obviously,medications are a big portion of
what we use, depending onfrequency. We have even, you
know, IV therapies that we do.
We have Botox that we use forthose only with chronic
migraine. That's the onlyindication related to migraine.
With Botox, we have, sometimeseven just therapy, various types
of, you know, cognitive therapy.
(14:06):
We some patients useacupuncture. Some people use
massage. We also talk a lotabout lifestyle changes. You
know, migraineurs are have verysensitive brains, so they we
like to keep everything veryhomeostatic, so everything
that's the same. So going to bedat the same time, getting up at
the same time, which is hard foryour adolescents, who, you know,
they go to school and on, youknow, during the school week,
(14:27):
they have to get up atridiculous times in the morning,
and so on the weekend, they'renot going to get up at six
o'clock in the morning. And yet,they really shouldn't deviate
more than an hour.
Nancy Barrow (14:34):
Oh my gosh!
Gretchen Michaelson (14:36):
wake up time that brain really likes to
have everything very much thesame, eating at regular
intervals. All of thosecomponents will play into
headache.
Nancy Barrow (14:42):
So being a mom and having two kids who've had had
headaches and migraines, how didyou look at them differently?
Gretchen Michaelson (14:50):
There wasn't a question in terms of
diagnosis. And I think that's abig barrier for a lot of
individuals, and I thinkunfortunately, our medical model
right now doesn't play well withthat, because. Such a limited
time. And so I'll have, you'llhave individuals who have seen
multiple people before, they'vecome to see a headache
specialist, and, you know, seenor, or maybe even not, felt like
(15:13):
they were, heard that theirmigraines were as debilitating
as they as they are. And so theysay, Well, no, I mentioned it
to, you know, my doctor or to myspecialist, and they were like,
oh, you know, if you take overthe counter medication and it
helps some, okay, that's, that'sgood enough. And I think then
they interpret that to meanthat's, I mentioned it, they
didn't offer anything else, andso there must not be anything
(15:35):
else available. And that's justnot the case. It's not the case,
thankfully nowadays, but I thinkit allows people to function at
very high levels of headache,and, you know, potentially miss
out on like job promotions andall of those things, because
then they miss work when, whenthere are treatments that are
(15:56):
available that really do changelives.
Nancy Barrow (15:58):
And how young Are people that you've treated, are
there really young children thatget these?
Gretchen Michaelson (16:03):
So we at our center, we treat down to the
age of 13, but and for a lot ofwomen, you know that time period
in their lives hormonal changesthat we start to see, that
that's when those headaches willstart to kind of pick up and
kind of rear their ugly head.
That is a geneticpredisposition. So it's not
uncommon for us to see thegrandmother, the mother and then
the child.
Nancy Barrow (16:23):
Connecticut Paid Leave, as you know, can help
with many aspects of migrainesand headaches. You can get up to
12 weeks of income replacement ayear to take care of your own
serious health condition, like aheadache or a migraine, or to
take care of a loved one who issuffering from these and you can
take intermittent leave, or youcan take a reduced schedule
(16:45):
leave, or you can take thatwhole block leave, like say
you're really having clusterheadaches and you need to take
two months off to really dealwith this, or three months off.
How valuable are resources likethis for your patients?
Gretchen Michaelson (16:59):
I think it certainly is a valuable resource
that they can have as someincome replacement, I think
especially that that episodiccomponent, because migraine
tends to be episodic, so it'snot it's not typically that
block of time, but to know thatthey have some time that they
can treat and try varioustreatments, so that we can get
(17:21):
them to a place where they needto be, with the goal of them
being able to say, hey, now Iactually am able to use my PTO
to do fun things like vacation.
Nancy Barrow (17:29):
So it is headache and migraine Awareness Month.
What are you hoping happensduring this month?
Gretchen Michaelson (17:35):
I'm hoping number one, that patients
realize that having headachesand frequent headaches is not
normal. And so if you're havingfrequent headaches, number one,
ask questions, whether it be foryour primary care provider, or,
you know, reach out to us orsomebody to say, Hey, I'm having
these headaches. I'm guessingmaybe this, I should have it
(17:56):
looked at, and then have anevaluation, because I think we
normalize, especially withmigraine, it's such a high
percentage of women that we tendto normalize it and say, Oh,
this is just how I live, and itjust doesn't have to be that
way.
Nancy Barrow (18:09):
And what is the percentage of women that get
migraines?
Gretchen Michaelson (18:13):
So it's about across the United States.
It's about 20% of individuals.
Well, it can have 15 to 20% ofpatients. So one in five.
Nancy Barrow (18:21):
One in five have migraines?
Gretchen Michaelson (18:23):
It's grossly underdiagnosed,
unfortunately.
Nancy Barrow (18:25):
And why is that?
Is there a stigma still attachedto that?
Gretchen Michaelson (18:28):
There is a huge stigma associated with it.
And actually, there's some newerdata coming out now as we're
trying to address stigmaassociated with migraine. And I
think it goes back to even someof those original questions, is
it a headache or migraine? Imean, the reality is that most
of us, over the course of ourlifetime, will experience a
headache at some point in time.
But we have to understand thatmigraine is a different
(18:49):
pathophysiology.
Nancy Barrow (18:51):
And it can be a chronic health condition, which
is another thing that we cover.
Gretchen Michaelson (18:56):
Yes, it is a chronic health condition. We
say once a migraineur are alwaysa migraneur.
Nancy Barrow (18:59):
Migraineur. Oh, yeah. So that's that's me right
there. What would you likepeople to take away from this
podcast, Gretchen?
Gretchen Michaelson (19:06):
Let's see if I had to choose something
just that there's hope thatthere is so many options
available. I hear it over andover again from patients,
especially in these last coupleof years, to say, I have my life
back, and I had no idea it wouldbe possible. And I think again,
it goes back to combination ofstigmatization and not knowing
(19:29):
resources were available. Sojust being able to say, Hey, I'm
going to look into it and seewhat I can do, and then be able
to enjoy life to the fullest.
Now it's a repeated thing tohave patients come back to say,
I mean, I hear it all. I hear Ihave I get to do more hobbies
that I've never been able to do.
I've been able to go to my kidsevents, for patients, to be able
to come back and say I went tomy daughter's wedding and I
(19:49):
wasn't even concerned about notbeing able to enjoy it to its
fullest. And I think those arethose moments that we don't
think about as sometimes, asclinicians. Those are the
moments that are important topatients, and to be able to have
them come back and really beable to live life, it's great.
Or patients coming back andsaying, Hey, I got a promotion
at work, because now I'm not,you know, missing all of this
(20:11):
work or not, that they'remissing work, but they're not
functioning to their fullcapacity, because they're trying
to struggle through going towork while while having a
migraine, that they can reallyadvance and do the things that
they want to do. And it'sexciting to see them come back
and be excited about it.
Nancy Barrow (20:27):
Is that the best part of your job you think?
Gretchen Michaelson (20:29):
For sure, that's the only reason why I
Nancy Barrow (20:30):
With six kids.
(laughter)stay in it! (laughter)
Gretchen Michaelson (20:33):
For sure!
Nancy Barrow (20:34):
I want to thank my guest, Gretchen Michaelson, the
founder and director of theHeadache Care Center in South
Windsor, for being on The PaidLeave Podcast. Thank you so much
for being here.
Gretchen Michaelson (20:43):
Thank you so much for having me!
Nancy Barrow (20:44):
And I got a real education about headaches and
migraines. So thank you so muchfor that.
Gretchen Michaelson (20:49):
You're very welcome!
Nancy Barrow (20:50):
For more information or to apply for
benefits, please go toctpaidleave.org. This has been
another edition of The PaidLeave Podcast. Please like and
subscribe so you'll be notifiedabout new podcasts that become
available. Connecticut PaidLeave is a public act with a
personal purpose. I'm NancyBarrow, and thanks for
(21:10):
listening.
Popular Podcasts
Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.