May 23, 2025 • 35 mins
Hey Get Real Listeners here's a show we think you'll love. The healing power of fitness goes far beyond physical benefits—for today’s guest, it’s a form of self-expression and a celebration of what the body can do. In this episode, host Nora McInerny sits down with fitness personality Ivylis Rivera, who shares her deeply personal journey of navigating life with Chronic Migraine while holding onto her passion for movement. Ivylis opens up about the struggle of staying active while facing the fear of triggering a headache or migraine attack and the resilience it takes to keep pushing forward—a resilience that carried her through the challenging journey of finding a Chronic Migraine treatment plan that worked for her.
Join Nora and Ivylis as they explore the concept of “soft living,” a philosophy Ivylis embraces—staying active, listening to your body, and building trust in oneself.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Ruby.
Speaker 2 (00:08):
Life sometimes has a way of blindsiding you with a
feeling of being overwhelmed at the worst possible time. That's
why you have your self care, your coping strategies, That's
why you have us. I'm Norah Mcinernie and this is
the head start Embracing the Journey, a podcast where we'll
be taking all those things you usually say for your
(00:29):
friend group out into the open so we can all
find a bit of optimism for those battling chronic migraine.
These conversations are going to be even more helpful and relatable,
so definitely stick around. This show is brought to you
in partnership with ABVI, So first let's hear some important
safety information and stay tuned to the end of the
(00:51):
podcast for more.
Speaker 3 (01:00):
Indication. Botox on a bochulinum toxin A is a prescription
medicine that is injected into muscles and used to prevent
headaches and adults with chronic migraine who have fifteen or
more days each month with headache lasting four or more
hours each day in people eighteen years in older. It
is not known whether botox is safe and effective to
prevent headaches in patients with migraine who have fourteen or
(01:21):
fewer headache days each month, or episodic migraine. Important safety information.
Botox may cause serious side effects that can be life threatening.
Get medical help right away. If you have any of
these problems any time hours to weeks after injection of botox.
Problems swallowing, speaking, or breathing due to weakening of associated
muscles can be severe and result in loss of life.
(01:43):
You are at the highest risk if these problems are
pre existing before injection. Swallowing problems may last for several months.
Spread of toxin effects. The effect of botulinum toxin may
affect areas away from the injection site and cause serious
symptoms including loss of strength and all over muscle weakness,
double vision, blurred vision, drooping eyelids, coarseness or change or
(02:04):
loss of voice, trouble saying words clearly, loss of bladder control,
trouble breathing, and trouble swallowing. Please stay tuned for additional
important safety information within this podcast. Today's guest Evalise Rivera Salgado,
is an actual botox patient who was on prescribe therapy
when she shared her story. Changes in therapy status may
have occurred since that time, Evilise was compensated by ABVI
(02:27):
for sharing her story.
Speaker 2 (02:43):
Welcome back everyone for season three. Yes, I said, it's
season three, fourteen episodes of great stories.
Speaker 1 (02:51):
Later.
Speaker 2 (02:51):
If you are new here, we have two seasons ready
for you to go back in Binge. But today we
are talking about health, wellness and what it means to
live a soft life in a hard world. I am,
as you may know, a recovering girl boss. For many years,
I thought that more was more and more was required.
(03:13):
I had to work more, do more, be more. I
had to be perfect. I treated myself like a machine
that should have maximum output with minimal input. Sleep was optional,
food was an afterthought. Working out was essential, but only
because I needed to be thin, because thin was a
form of perfection. Of course, don't worry, I am fully
(03:35):
rolling my eyes at that now. I kept my days
filled to the max with back to back to back
meetings and projects. I woke up at five, I went
to the gym, I came home to get my kids
ready for school. I worked a full day and then
opened up my laptop to keep working once they were
in bed. From the outside, things looked pretty good. On
(03:55):
the inside, they did not feel good. I did not
feel good. I was scattered and stressed. I was not
connected to my body or really to myself in any way.
It is hard to slow down, but if you have
chronic migrain, you know that the body keeps the score
and the body also calls the shots. It can make
you slow down even if you don't want to. It
(04:16):
took a lot of time for me to deprogram and
reprogram myself for exercise to become a part of my
day that makes me feel good instead of just something
I do to look good to feed myself like I
am a beloved friend, because I should be a beloved
friend to myself. We all should. This is one reason
why I'm so excited to share this conversation with you
(04:38):
today because today's guest is a star in the health
and wellness space. But she's not the type to tell
you that you need to rise and grind and squeeze
the most out of your day. She's not here to
punish you, or judge you or tell you that you're
doing it wrong. She is here to encourage you to
live a softer life, and especially if you're living with
(05:01):
chronic migraine, like our guest, your body deserves every bit
of extra grace and attention that you can give. Today's
guest is Evalise Rivera Salgado, and I cannot wait for
you to hear our conversation. But first, a familiar voice
of the show. Guys, he's back, my good buddy and
(05:24):
the headache specialist who has been guiding us through all
of these episodes with his perspective and his advice, doctor
Christopher Ryan.
Speaker 1 (05:33):
It has been a while, Hei, Nori, it's Grady be
back on the show. I'm excited to listen in to
the conversations that you have with Evelise. I don't think
we've talked about the important and oftentimes challenging relationship between
fitness and chronic migraine, So I'm looking forward to this one.
Speaker 2 (05:48):
All right, Well, let's meet Evalise Evealise. Great to finally
meet you.
Speaker 1 (06:01):
Nora.
Speaker 4 (06:01):
I just want to say, like, I am so happy
to meet you. It's such an honor to be here.
And you know, this is my first little podcast and
I can't wait to share my story and my experience
with everyone.
Speaker 2 (06:12):
Me too. I have seen your recipes, the things that
you make, the things that you suggest, They're not just beautiful,
but really good for you. I am not a cook.
I did bake bread earlier this week.
Speaker 4 (06:25):
Oh, so you're a chef.
Speaker 2 (06:27):
I am not the person in my family who cooks,
but my husband cooks. So what are recipes that you
would suggest, things you've made recently that are easy enough
for a busy person who has a wife who can't
cook and children.
Speaker 4 (06:48):
I'm gonna go with the burger bowl. I love a
good burger bowl. I love the fact that the only
thing you truly have to cook is the meat. Like
I do frozen fries, I'm not doing the from scratch,
So I just pop in some frozen fries and the
air fier simultaneously start cooking the meat, and then you
just assemble it with the lettuce and the tomato and
(07:10):
the onion, and there you have it. You're a chef.
Speaker 2 (07:14):
Okay, this is why you're popular, because you're making it easy.
Speaker 4 (07:18):
No see, I think you know. I was born with
the what is the quickest way possible, the easiest way
possible for me to get this done. I think it's
because I have a mom who she loves to make
things from scratch. She's made everything my whole life from scratch.
Prom dress we had we had chickens, she would make bread.
I witnessed the extra steps and I'm like, I'll just
(07:41):
go to the store. So I like the shortcuts. I
like to do things quick and easy.
Speaker 2 (07:46):
Okay, you say that, but you are also a person
who has done so many impressive and difficult things, like
you were an athlete, you served in the military, which
thank you for that, thank you for that, your support.
All of that is like so physically demanding, so mentally
demanding in so many different ways. What do you think
(08:08):
it is about fitness, nutrition, wellness and how you talk
about it that resonates with people.
Speaker 4 (08:15):
When I first started my journey on social media, I
was just doing like little vlogs, like just silly things.
But within the past couple of years, I started to
become a little bit more open about my health journey
or what I was struggling with, and that's when I
found that people really started to connect with me. I
was shocked because I do this thing where I think
(08:35):
that I'm the only person in the world that is
dealing with how do I start my fitness journey? And
then when I started to talk to the camera, talk
to social media like I would talk to my Diarrye
or talk to my friend. That's when I found that
people would resonate with me. I mean, I got a
message from somebody that said, hey, I followed you because
you were funny, used to post funny vlogs, but you
(08:57):
started posting your fitness and your wellness and it motivated
me to start my health journey.
Speaker 2 (09:04):
Yeah, isn't that incredible. It's you're in Dallas and you
were a part of people's lives around the world.
Speaker 4 (09:11):
Yeah, it's crazy.
Speaker 2 (09:13):
Going back to your experience in the military, when you
are in the service, you are on a schedule, somebody
else is making sure you're doing everything. What made you
want to share your you know, civilian fitness journey with people,
especially the part that intersects with that chronic migraine journey.
Speaker 4 (09:33):
Well, I love that question. And you know, when I
was in the military, Yeah, it was people controlling my schedule,
and you know, they're like, you have to wake up
at five am you're running ten miles, or you wake
up at five am you're doing push ups, and I
don't naturally want to do that at five am. So
I really wanted to share my journey because most people
(09:54):
couldn't really relate to like the being forced to work out.
When I was active duty military, that's when I first
started getting my migraine attacks. It made me hate fitness.
Sometimes I would have to work out with a migraine,
and especially with something that is an invisible disease. This
is an invisible illness and so there's no physical manifestation
(10:15):
of what's happening to me right now, So you know,
people would think I was being dramatic, so I would
try to like push through. It Actually made me hate
fitness at first because it it was a trigger for
me actually like running, which was devastating for me because
I used to be a huge runner. I used to
run a lot. I used to love running.
Speaker 2 (10:36):
What are your chronic migraine triggers?
Speaker 4 (10:40):
Well, I have a bunch, but to name a few.
For me, like my my triggers would be getting really hot,
So that was like working out. Like most workouts, you're
gonna get really hot. Which is why I when I
was actually actduty military, I started doing pilates before it
was cool, before it what's cool, you guys, I was
(11:02):
to do pilates.
Speaker 2 (11:04):
It was developed as a military exercise.
Speaker 4 (11:06):
Wait was it for?
Speaker 2 (11:08):
After World War One? For disabled veterans to like build
up their core strengths that they could like live independently.
Speaker 4 (11:14):
Yeah, and I'm about to tell everybody that, yeah it
was a hospital workout. Wow, that's actually I actually love that.
Speaker 2 (11:21):
Look a up Joseph Pilates. He was like, I got
to do something for disabled veterans and I got to
get them like feeling good and capable, and it's all
about your core.
Speaker 4 (11:30):
And it is.
Speaker 2 (11:30):
And meanwhile, I go to pilates and I'm I'm a
danger to myself and others at pilates. What does fitness
and wellness do for you now with your chronic migraine?
Speaker 4 (11:42):
Yes, I love that question. I don't know how to
describe it. Like, on the days where I do have
a migraine attack, I will tailor my workout to be
less intense. I'll do something in the ac, i won't
go outside. I'll walk on the treadmill, I'll do a
light walk. Because to me, it's not really about the
intensity of the workout. It's more so keeping that consistency
(12:05):
and making sure that I am a dependable person to
myself because I've learned that, you know, sticking to your
goals and actually doing what you're saying you're going to
do it actually makes you trust yourself, so that that
has helped me a lot.
Speaker 2 (12:22):
It's that soft living you talk about.
Speaker 4 (12:24):
Soft living is being kind to yourself but holding yourself accountable.
For me, it's like doing little tasks that I said
I would do. If I say I'm going to make
my bed in the morning, I do. If I say
I was going to go to the gym, I do.
And you know, it's the small tasks like that that
make you feel like you can trust yourself. That that's
what adds up. So every single time I say what
I say I'm gonna do, that's building trust within myself.
(12:48):
And just like slowing down.
Speaker 2 (12:50):
It's hard to slow down. It's hard to slow down,
especially in a culture that wants you to do more.
That's such a beautiful way of saying it, and such
a beautiful way of like being gentle with your and saying,
you know, I'm trying to make sure that I'm a
person I can trust. And if walking on the treadmill
is what I'm doing today, then that's what I'm doing
and that I'm doing. Yeah, that's great. You mentioned heat
(13:10):
is your trigger. What are your other triggers.
Speaker 4 (13:14):
Perfume, really really strong perfume or strong sense loud, abrupt noises.
So if I'm like sitting on the couch reading a
book and my dog barks, a migraine attack will come on.
And those are triggers that I really can't control, Like
I don't know when my dog is going to just
randomly start talking. So perfumes, yeah, and since like those,
(13:36):
I kind of can tailor my life around them. However,
I will say I've been to places where people just
love cologne and they love perfumes, and I'm not.
Speaker 2 (13:45):
Madild Yeah, I'm not mad at it. I do. It
does bring me back to like my middle school days
where I was like if one spray is good.
Speaker 4 (13:53):
I used to go to like the stores in the
mall and I'd have like all the colors, like the pink,
the blue, the purple. And it's just crazy because I
had no idea that something like that would affect somebody
in such a negative way. But now that I'm living
with chronic migraine, I am very aware of those kind
of things.
Speaker 2 (14:15):
After the break, I'll be back with doctor Ryan. So
stick around, Welcome back to the head. Start embracing the journey,
(14:53):
Doctor Ryan, I want to bring you back in your
being the first episode of this season. Can we go
over some common terms and definitions that often come up
when we're addressing chronic migraine. I think it would be
helpful for the listeners and also for me. First, let's
just define what chronic migraine is and how it's different
(15:14):
than episodic migraine.
Speaker 1 (15:15):
Let's do it so. Chronic migraine is defined as fifteen
or more monthly headache days, and eight of those days
meeting the criteria for a migraine headache. Those headaches need
to last for four hours or more. Less frequent would
be considered an episodic migraine. To help put that into
context of people's actual lives, it's important to look at
the number of headache free days that you've had per month,
(15:37):
and not just the number of migraine attacks per month.
Many times people don't have a true count for their
headache date, confusing those two things. For example, you may
have only counted four headaches or migraine attacks last month,
but when you look at the actual number of days
you didn't have a headache or migraine attack, it could
have been only a few, So getting a clear picture
of the headache days you have each month is key
(15:59):
to helping your doctor or understand what you're experiencing and
making the right diagnosis.
Speaker 2 (16:03):
Okay, that's an important difference to point out. So we
have chronic migraine, which is a distinct disease associated with
frequent headaches and migraine attacks. What are some common triggers
for the symptoms of chronic migraine?
Speaker 1 (16:18):
So important to talk about triggers, Nora, So let's get
into it because it's a huge deal. Triggers can include
increases in stress, changes in hormones. There can be external
triggers that can set off those hormones like barometric pressure,
changes in weather changes like extreme heat or cold. There
can be even triggers like specific smells. Sometimes folks have
(16:40):
a hard time with things like cleaning agents or particular perfumes.
There are different types of light exposures or sound exposures
that can set off migraine attacks, and so understanding those
triggers is really critical.
Speaker 2 (16:52):
Thanks doctor Ryan. Let's get back to evilise for our listeners.
Can you describe vibe how your migraine attacks feel, How
do they come on? What is the experience like for you.
Speaker 4 (17:07):
For me, the most recent one that comes to mind
was for my mom's fiftieth birthday. We were at a
theme park and it had all the triggers for me, heat, smells,
you know, loud noises, you know. I was having fun,
and all of a sudden, the migraine attacks started coming on.
(17:28):
I started seeing floaters like little specks in my vision,
and it just progressively starts to get worse for me.
I'll get like indications that it's coming on, and that's
when I'll like know, like, okay, I need to go
sit down, I need to try to cool off, but
at that point, like it's coming. I ended up having
to leave the theme park early. My family was still
(17:49):
there like they're enjoying their time, you know. Like I
completely separated myself, and I felt when I had the
floaters in my vision, I stepped away because I'm like,
I don't want them to see me like this. I'm
not trying to ruin the birthday. But I had to
separate myself and I had to go back to the
hotel and have my migraine attack by myself. And usually
(18:10):
when I do have those and I'm able to get
to a room. I make it dark, I make it cold,
but I do like to get under the covers or
like have something waited on me, maybe for like the
the comfort of it, and I'll just be in the
dark waiting it out.
Speaker 2 (18:26):
That means you're missing out on things, right, You're missing
out on life moments of your own and you know,
with people you love, how do you manage that emotionally?
Speaker 4 (18:38):
At first, I didn't. I didn't manage it emotionally. I
had no tools in my toolkit to make myself feel better.
But as time went on, I'd learned to be kind
to myself and learned to give myself grace and also
learning to be transparent with people, because at first I
didn't want anybody to know that I had crownic migraine.
I really tried to keep it a secret for a very,
(19:00):
very long time because I was, for lack of better words,
like embarrassed. As somebody who was always fit, active, upbeat,
life of the party. I did not want to be
the person with a disability. But that's the thing about
disabilities and invisible illnesses like chronic migraine. They don't discriminate
(19:20):
like it could happen to anybody and it happened to me.
So just managing it mostly just like being transparent with
people and saying, hey, this is something that I deal
with because letting them know that, Like if I have
to cancel plans last minute, they'll be understanding. But if
they have never had knowledge of me having these chronic
migraines before, I feel like they might think that I
(19:40):
was lying or something if I like randomly canceled last minute.
Speaker 2 (19:43):
Yeah. Yeah, it's like building that empathy for yourself, I
think also helps you extend that to other people.
Speaker 4 (19:50):
Absolutely.
Speaker 2 (19:52):
When were you officially diagnosed?
Speaker 4 (19:54):
I was officially diagnosed when I was twenty years old
my chronic migraines first started and twenty fifteen, and I
didn't get officially diagnosed by a neurologist until twenty sixteen,
like I had an inklink. But of course, something about
getting that diagnosis, like something about it. I just left
(20:16):
feeling so seen, so empowered, ready to tackle this disease,
like ready to tackle it.
Speaker 2 (20:22):
Yeah, I'm assuming there's kind of a journey to finding
the right treatment. What was your journey.
Speaker 4 (20:27):
Like, Well, I will say that for me, like the
whole treatment journey taught me being resilient I had never
experienced something so mentally and emotionally taxing and draining in
my life. Because when I first started seeing a neurologist,
I'm like, Okay, maybe we'll get along, like maybe she'll
(20:49):
listen to me. And she's like, okay, we'll try this.
So I tried a medication, didn't work, and she's like, okay,
we'll try this one. I tried, it didn't work, And
I tried so many different medications and at one point
just wanted to stop because I was getting side effects
from these medications in addition to still getting my migraine attacks.
(21:11):
After that, I remember showing up to my exa appointment
being like, I need something else, and I actually ended
up looking for another doctor, And I think that that's
really important to because I felt bad at first. I
was like, man, I don't want her to be mad
at me, which is so ridiculous. Thinking back, you know,
that's so ridiculous, Like yeah, I'm like, I didn't want
her to have her feelings hurt, but just looking back, ridiculous.
(21:35):
Because it's my job to make sure that I get
proper care.
Speaker 2 (21:38):
Figuring it out feels like so isolating, which is also
so heartbreaking, and I think that's why it is so
generous of you to be here with us and be
sharing this experience with us, because there is somebody listening
to this who is feeling that way, who needs to
know like it's not just them. So it's thank you
(22:00):
for that.
Speaker 4 (22:00):
Absolutely.
Speaker 2 (22:01):
Yeah.
Speaker 4 (22:02):
But I got a new doctor and I remember walking
into his office and he's like in the military, just
like me. He looked at me and he's like, well,
have you heard of botox for chronic migraine?
Speaker 2 (22:12):
I am curious. I want to hear your take on
the treatment procedure itself.
Speaker 4 (22:19):
The neurologist's office was three offices down from where I
worked because I was a radiology text so I would
schedule my appointment and then I would just be like, Hey,
I'm going to go get botox from my chronic migraine.
I'll go to the appointment, I get thirty one shots.
It takes about ten minutes, and I get to go
back to work. I don't have to worry about taking
something every day. I don't have to worry about, you know,
(22:42):
when when's the next refill?
Speaker 2 (22:45):
Yeah, and you just sit down, they do it and
I go back to work, So tag me back in
doctor Ryan Evelise his share bared how botox has helped
reduce her headache days. Can you tell us more about
(23:05):
botox as a treatment option for chronic migraine?
Speaker 1 (23:09):
Absolutely, and I've been familiar with botox for a long time.
In fact, botox has been an FT approved treatment for
chronic migraine for around fifteen years now. It may not
be what you initially think of when you hear botox,
but it's been a part of our arsenal as a
preventative treatment option for a long time. Botox is a
prescription medicine injected into muscles and used to prevent headaches
(23:31):
and adults with chronic migraine, which is fifteen or more
headache days per month, each lasting for four or more hours.
Botox is not approved for adults with migraine who have
fourteen or fewer headache days per month. Effects of botox
may spread hours to weeks after injection, causing serious symptoms
and so you want to alert your doctor ride away
as difficulties swallowing, speaking, breathing, eye problems, or muscle weaknesses
(23:55):
can be a sign of a life threatening condition. Patients
with these conditions before worth the injection are at higher
risk of those effects, and side effects might include allergic reactions, rash,
breathing problems and dizziness, neck and injection site pain, and headache.
Don't receive botox for chronic migraine if there's a skin infection,
(24:15):
and tell your doctor your medical history, muscle or nerve
condition history like ALS which is Lukeriic's disease, mysenea gravis
lambored eaton syndrome. Any medications, including other bochulinum toxins that
you might be utilizing as they may increase the risk
of these serious side effects. It's important for you to
talk to your doctor or headache specialist about the important
(24:37):
safety information you'll hear throughout this episode and in the
link to the product information.
Speaker 2 (24:44):
Evelise was able to see some changes with the number
of headaches eventually becoming manageable about six months into her
botox treatments. How does botox help prevent headaches and chronic
migraine and how important is that dedication to treatment for
feeling the full effects of the botox treatment.
Speaker 1 (25:03):
Awesome question and it's one that I get all the time, Nora.
In the data that was presented to the FDA, botox
prevented on average eight to nine headache days and probable
migraine days a month at twenty four weeks versus six
to seven with placebo. Patients may see results as soon
as four weeks, but the full effect should be evaluated
after two treatments six months, So the botox experience is
(25:24):
going to be different based on the patient. This is
one of my favorite things to do with patients because
there's such a preconceived notion around what botox is and
what the process is to go through with botox. The
first thing we need to understand when it comes to
botox for chronic migraine is that there is a fixed
injection protocol. So we talk to patients about that experience.
We let them know that they're going to be seated
(25:46):
in a clinical setting. Maybe it's a procedural suite like
I use here at the hospital that I work out of,
or maybe it's your physician's office. Botox is injected in
thirty one sites into seven muscle groups that the FDA
is approved. Those areas are going to be in the
head and neck. You start with two treatments and those
are going to be twelve weeks apart, and then we
continue every twelve weeks. Thereafter, we do this every three months,
(26:08):
four times a year, for about ten minutes each when
you come in for a session. We try to fit
treatment into people's busy schedules as much as possible.
Speaker 2 (26:16):
All right, So one last thing that I need your
pov on doctor Ryan. There is sometimes hesitancy and misconception
around botox. What is the usual response when you first
bring it up as a treatment option for your appropriate
chronic migraine patients?
Speaker 1 (26:32):
Understandably, patients always have a bit of hesitance to you
when I first bring up botox. Patients are going to
ask what's the experience, Like how effective is that therapy?
Cost tends to be a hurdle for some patients, and
oftentimes they're surprised to hear that most insurance providers, as
well as Medicaid and Medicare programs, do cover botox for
chronic migraine. I'd advise patients interested in botox to contact
(26:55):
their insurance providers. I think it's really important for patients
to know that providers are not allow to contact insurance
on their behalf to find out costs or benefits associated
with a particular therapy botox or otherwise. Additionally, there are
patients support programs like the Botox Savings Program, which I'm
a huge fan of. This helps eligible, commercially ensured patients
(27:16):
to save uncertain out of pocket costs related to both
botox medicine and the injection procedure.
Speaker 2 (27:22):
All right, I'd imagine the fear of needles comes up
for some people too, right, Is that a common concern
or is that just my own projection.
Speaker 1 (27:31):
Not projection nour I have a lot of patients that
have the same concerns as ev being nervous about the
needles when coming to their first treatment, But some of
my patients describe the injections as feeling like tiny pinches,
and from what I've seen with my patients, most people
get comfortable with the process after the first treatment.
Speaker 2 (27:46):
Doctor Ryan, Thank you as always.
Speaker 1 (27:49):
Thanks Nora. Really excited to be here, Excited to talk
some more with this new season that we're kicking off.
Speaker 2 (28:03):
All right, one last question for you, Evalise. Why do
you love fitness and wellness so much the.
Speaker 4 (28:10):
Way that I express myself. It's an outlet for me.
It's a celebration of what my body can do. I'm
so grateful that I'm able to walk on the treadmill.
I'm so grateful that I'm able to lift twenty pounds.
I'm so grateful that I'm able to squat whatever. You know.
That for me, when I put it in that perspective,
it's like, Okay, get up and go work out, Get
up and go move your body, because there are people
(28:31):
right now dealing with something that would just love to
trade places with you. And I feel like it's foolish
of me to understand that perspective and then not move
my body. If you are somebody that's struggling with your
health or chronic migraine right now, just keep going through
the motions. If you have to chop your day up
into little segments, do that, but you'll get through it.
(28:52):
You have to have the rain to see the rainbow.
Speaker 2 (28:56):
Oh that was beautiful. That was really beautiful. Do you
see what I mean about this conversation about her energy?
Evelise in one conversation made me feel so much better.
I sat down to this conversation in quite a frantic week,
on quite a frantic day, and her calm energy softened me.
(29:21):
And what makes her even more incredible is her story.
She started out in the military stepping into active service
with so much dedication, and when life threw her a
big challenge, chronic migraine, she didn't let that stop her.
She kept going, She kept advocating for herself, She kept
showing up. She is an inspiration and I hope that
(29:45):
it gave you permission and encouragement to live a softer life.
To be softer with others, of course, but also with yourself.
Thanks for listening to the Headstart Embracing the Journey. We
hope you've found something worthwhile here with us today. A
new coping strategy, a relatable story, the comfort of knowing
(30:08):
you're not alone. I'm so happy to be a part
of creating this community for all of us, and especially
for people living with chronic migraine. If you haven't found
a treatment plan that is working for you, please do
reach out to your headache specialist to explore your options.
I truly hope this has helped you find a bit
(30:28):
of comfort and maybe a smile. Maybe see a next
episode and stay tuned for more important safety information. The
head Start Embracing the Journey is hosted by myself Norah McNerney,
executive produced by yvon Shehan, our head of post production
is James Foster, our researcher is Sierra Kaiser, and our
(30:50):
writer is John Irwin. The show is mixed by Michael Hardman.
Original music by Soundcat Productions and art List.
Speaker 3 (31:04):
Important safety information continued. There has not been a confirmed
serious case of spread of toxin effect away from the
injection site. When botox has been used at the recommended
dose to treat chronic migraine. Botox may cause loss of
strength or general muscle weakness, vision problems, or dizziness within
hours to weeks of receiving botox. If this happens, do
(31:24):
not drive a car, operate machinery, or do other dangerous activities.
Do not receive botox if you are allergic to any
of the ingredients in botox, see medication guide for ingredients.
Had an allergic reaction to any other botchu linum toxin
product such as myoblock rhymobochelinum toxin B, disport abobochelinum toxin A,
(31:45):
zeomin incobotchel item toxin A, JEVO probochul item toxin AXVFS,
daxify daxibotchelinum toxin A l A n M or lettibo
lettibotchel item toxin AWLBG. This may not be a complete
list of all botulinum toxin products have a skin infection
at the planned injection site. The dose of botox is
(32:07):
not the same as or comparable to another botulinum toxin product.
Serious and or immediate allergic reactions have been reported, including itching, rash, red,
itchy welts, wheezing, asthma symptoms, dizziness or feeling faint. Get
medical help right away. If you experience symptoms, further injection
of botox should be discontinued. Tell your doctor about all
(32:29):
your muscle or nerve conditions, such as ALS or lou
Garrig's disease, Myasthenia gravis, or lambert Eton syndrome, as you
may be at increased risk of serious side effects, including
difficulty swallowing and difficulty breathing from typical doses of botox.
Tell your doctor about all your medical conditions, including if
you have or have had bleeding problems, have plans to
(32:51):
have surgery, had surgery on your face, have weakness of
forehead muscles, trouble raising your eyebrows, drooping eyelids, and any
other abnormal facial change are pregnant or plan to become pregnant.
It is not known if botox can harm your unborn baby.
Are breastfeeding or plan to. It is not known if
botox passes into breast milk. Tell your doctor about all
the medicines you take, including prescription and over the counter medicines, vitamins,
(33:15):
and herbal supplements. Using botox with certain other medicines may
cause serious side effects. Do not start any new medicines
until you have told your doctor that you have received
botox in the past. Tell your doctor if you received
any other bochulinum toxin product in the last four months.
Have received injections of bochulinum toxin such as myoblock, disport, zamin, Jevo, Daxify,
(33:38):
or Letibo in the past. This may not be a
complete list of all bochulinum toxin products. Tell your doctor
exactly which product you received. Have recently received an antibiotic
by injection, Take muscle relaxance, Take an allergy or cold medicine,
Take a sleep medicine. Take aspirin like products or blood thinner.
Other side effects of botox include dry mouth, discomfort or
(33:59):
pain at the injection site, tiredness, headache, neck pain, eye
problems such as double vision, blurred vision, decreased eye sight,
drooping eyelids, swelling of your eyelids and dry eyes, drooping eyebrows,
and upper respiratory tract infection. For more information, refer to
the medication guide or talk with your doctor. You are
encouraged to report negative side effects of prescription drugs to
(34:21):
the FDA. Visit www dot FDA dot gov, slash MedWatch,
or call one eight hundred FDA one zero eight eight.
Please see Botox full product information, including boxed warning and
medication guide by clicking the link provided in the podcast description,
or by visiting www dot RXABV dot com slash pdf
(34:44):
slash Botox underscore PI dot pdf. If you are having
difficulty paying for your medicine, ABV may be able to help.
Visit ABV dot com slash Patient Access Support to learn more.
Ruby.
Speaker 2 (00:08):
Life sometimes has a way of blindsiding you with a
feeling of being overwhelmed at the worst possible time. That's
why you have your self care, your coping strategies, That's
why you have us. I'm Norah Mcinernie and this is
the head start Embracing the Journey, a podcast where we'll
be taking all those things you usually say for your
(00:29):
friend group out into the open so we can all
find a bit of optimism for those battling chronic migraine.
These conversations are going to be even more helpful and relatable,
so definitely stick around. This show is brought to you
in partnership with ABVI, So first let's hear some important
safety information and stay tuned to the end of the
(00:51):
podcast for more.
Speaker 3 (01:00):
Indication. Botox on a bochulinum toxin A is a prescription
medicine that is injected into muscles and used to prevent
headaches and adults with chronic migraine who have fifteen or
more days each month with headache lasting four or more
hours each day in people eighteen years in older. It
is not known whether botox is safe and effective to
prevent headaches in patients with migraine who have fourteen or
(01:21):
fewer headache days each month, or episodic migraine. Important safety information.
Botox may cause serious side effects that can be life threatening.
Get medical help right away. If you have any of
these problems any time hours to weeks after injection of botox.
Problems swallowing, speaking, or breathing due to weakening of associated
muscles can be severe and result in loss of life.
(01:43):
You are at the highest risk if these problems are
pre existing before injection. Swallowing problems may last for several months.
Spread of toxin effects. The effect of botulinum toxin may
affect areas away from the injection site and cause serious
symptoms including loss of strength and all over muscle weakness,
double vision, blurred vision, drooping eyelids, coarseness or change or
(02:04):
loss of voice, trouble saying words clearly, loss of bladder control,
trouble breathing, and trouble swallowing. Please stay tuned for additional
important safety information within this podcast. Today's guest Evalise Rivera Salgado,
is an actual botox patient who was on prescribe therapy
when she shared her story. Changes in therapy status may
have occurred since that time, Evilise was compensated by ABVI
(02:27):
for sharing her story.
Speaker 2 (02:43):
Welcome back everyone for season three. Yes, I said, it's
season three, fourteen episodes of great stories.
Speaker 1 (02:51):
Later.
Speaker 2 (02:51):
If you are new here, we have two seasons ready
for you to go back in Binge. But today we
are talking about health, wellness and what it means to
live a soft life in a hard world. I am,
as you may know, a recovering girl boss. For many years,
I thought that more was more and more was required.
(03:13):
I had to work more, do more, be more. I
had to be perfect. I treated myself like a machine
that should have maximum output with minimal input. Sleep was optional,
food was an afterthought. Working out was essential, but only
because I needed to be thin, because thin was a
form of perfection. Of course, don't worry, I am fully
(03:35):
rolling my eyes at that now. I kept my days
filled to the max with back to back to back
meetings and projects. I woke up at five, I went
to the gym, I came home to get my kids
ready for school. I worked a full day and then
opened up my laptop to keep working once they were
in bed. From the outside, things looked pretty good. On
(03:55):
the inside, they did not feel good. I did not
feel good. I was scattered and stressed. I was not
connected to my body or really to myself in any way.
It is hard to slow down, but if you have
chronic migrain, you know that the body keeps the score
and the body also calls the shots. It can make
you slow down even if you don't want to. It
(04:16):
took a lot of time for me to deprogram and
reprogram myself for exercise to become a part of my
day that makes me feel good instead of just something
I do to look good to feed myself like I
am a beloved friend, because I should be a beloved
friend to myself. We all should. This is one reason
why I'm so excited to share this conversation with you
(04:38):
today because today's guest is a star in the health
and wellness space. But she's not the type to tell
you that you need to rise and grind and squeeze
the most out of your day. She's not here to
punish you, or judge you or tell you that you're
doing it wrong. She is here to encourage you to
live a softer life, and especially if you're living with
(05:01):
chronic migraine, like our guest, your body deserves every bit
of extra grace and attention that you can give. Today's
guest is Evalise Rivera Salgado, and I cannot wait for
you to hear our conversation. But first, a familiar voice
of the show. Guys, he's back, my good buddy and
(05:24):
the headache specialist who has been guiding us through all
of these episodes with his perspective and his advice, doctor
Christopher Ryan.
Speaker 1 (05:33):
It has been a while, Hei, Nori, it's Grady be
back on the show. I'm excited to listen in to
the conversations that you have with Evelise. I don't think
we've talked about the important and oftentimes challenging relationship between
fitness and chronic migraine, So I'm looking forward to this one.
Speaker 2 (05:48):
All right, Well, let's meet Evalise Evealise. Great to finally
meet you.
Speaker 1 (06:01):
Nora.
Speaker 4 (06:01):
I just want to say, like, I am so happy
to meet you. It's such an honor to be here.
And you know, this is my first little podcast and
I can't wait to share my story and my experience
with everyone.
Speaker 2 (06:12):
Me too. I have seen your recipes, the things that
you make, the things that you suggest, They're not just beautiful,
but really good for you. I am not a cook.
I did bake bread earlier this week.
Speaker 4 (06:25):
Oh, so you're a chef.
Speaker 2 (06:27):
I am not the person in my family who cooks,
but my husband cooks. So what are recipes that you
would suggest, things you've made recently that are easy enough
for a busy person who has a wife who can't
cook and children.
Speaker 4 (06:48):
I'm gonna go with the burger bowl. I love a
good burger bowl. I love the fact that the only
thing you truly have to cook is the meat. Like
I do frozen fries, I'm not doing the from scratch,
So I just pop in some frozen fries and the
air fier simultaneously start cooking the meat, and then you
just assemble it with the lettuce and the tomato and
(07:10):
the onion, and there you have it. You're a chef.
Speaker 2 (07:14):
Okay, this is why you're popular, because you're making it easy.
Speaker 4 (07:18):
No see, I think you know. I was born with
the what is the quickest way possible, the easiest way
possible for me to get this done. I think it's
because I have a mom who she loves to make
things from scratch. She's made everything my whole life from scratch.
Prom dress we had we had chickens, she would make bread.
I witnessed the extra steps and I'm like, I'll just
(07:41):
go to the store. So I like the shortcuts. I
like to do things quick and easy.
Speaker 2 (07:46):
Okay, you say that, but you are also a person
who has done so many impressive and difficult things, like
you were an athlete, you served in the military, which
thank you for that, thank you for that, your support.
All of that is like so physically demanding, so mentally
demanding in so many different ways. What do you think
(08:08):
it is about fitness, nutrition, wellness and how you talk
about it that resonates with people.
Speaker 4 (08:15):
When I first started my journey on social media, I
was just doing like little vlogs, like just silly things.
But within the past couple of years, I started to
become a little bit more open about my health journey
or what I was struggling with, and that's when I
found that people really started to connect with me. I
was shocked because I do this thing where I think
(08:35):
that I'm the only person in the world that is
dealing with how do I start my fitness journey? And
then when I started to talk to the camera, talk
to social media like I would talk to my Diarrye
or talk to my friend. That's when I found that
people would resonate with me. I mean, I got a
message from somebody that said, hey, I followed you because
you were funny, used to post funny vlogs, but you
(08:57):
started posting your fitness and your wellness and it motivated
me to start my health journey.
Speaker 2 (09:04):
Yeah, isn't that incredible. It's you're in Dallas and you
were a part of people's lives around the world.
Speaker 4 (09:11):
Yeah, it's crazy.
Speaker 2 (09:13):
Going back to your experience in the military, when you
are in the service, you are on a schedule, somebody
else is making sure you're doing everything. What made you
want to share your you know, civilian fitness journey with people,
especially the part that intersects with that chronic migraine journey.
Speaker 4 (09:33):
Well, I love that question. And you know, when I
was in the military, Yeah, it was people controlling my schedule,
and you know, they're like, you have to wake up
at five am you're running ten miles, or you wake
up at five am you're doing push ups, and I
don't naturally want to do that at five am. So
I really wanted to share my journey because most people
(09:54):
couldn't really relate to like the being forced to work out.
When I was active duty military, that's when I first
started getting my migraine attacks. It made me hate fitness.
Sometimes I would have to work out with a migraine,
and especially with something that is an invisible disease. This
is an invisible illness and so there's no physical manifestation
(10:15):
of what's happening to me right now, So you know,
people would think I was being dramatic, so I would
try to like push through. It Actually made me hate
fitness at first because it it was a trigger for
me actually like running, which was devastating for me because
I used to be a huge runner. I used to
run a lot. I used to love running.
Speaker 2 (10:36):
What are your chronic migraine triggers?
Speaker 4 (10:40):
Well, I have a bunch, but to name a few.
For me, like my my triggers would be getting really hot,
So that was like working out. Like most workouts, you're
gonna get really hot. Which is why I when I
was actually actduty military, I started doing pilates before it
was cool, before it what's cool, you guys, I was
(11:02):
to do pilates.
Speaker 2 (11:04):
It was developed as a military exercise.
Speaker 4 (11:06):
Wait was it for?
Speaker 2 (11:08):
After World War One? For disabled veterans to like build
up their core strengths that they could like live independently.
Speaker 4 (11:14):
Yeah, and I'm about to tell everybody that, yeah it
was a hospital workout. Wow, that's actually I actually love that.
Speaker 2 (11:21):
Look a up Joseph Pilates. He was like, I got
to do something for disabled veterans and I got to
get them like feeling good and capable, and it's all
about your core.
Speaker 4 (11:30):
And it is.
Speaker 2 (11:30):
And meanwhile, I go to pilates and I'm I'm a
danger to myself and others at pilates. What does fitness
and wellness do for you now with your chronic migraine?
Speaker 4 (11:42):
Yes, I love that question. I don't know how to
describe it. Like, on the days where I do have
a migraine attack, I will tailor my workout to be
less intense. I'll do something in the ac, i won't
go outside. I'll walk on the treadmill, I'll do a
light walk. Because to me, it's not really about the
intensity of the workout. It's more so keeping that consistency
(12:05):
and making sure that I am a dependable person to
myself because I've learned that, you know, sticking to your
goals and actually doing what you're saying you're going to
do it actually makes you trust yourself, so that that
has helped me a lot.
Speaker 2 (12:22):
It's that soft living you talk about.
Speaker 4 (12:24):
Soft living is being kind to yourself but holding yourself accountable.
For me, it's like doing little tasks that I said
I would do. If I say I'm going to make
my bed in the morning, I do. If I say
I was going to go to the gym, I do.
And you know, it's the small tasks like that that
make you feel like you can trust yourself. That that's
what adds up. So every single time I say what
I say I'm gonna do, that's building trust within myself.
(12:48):
And just like slowing down.
Speaker 2 (12:50):
It's hard to slow down. It's hard to slow down,
especially in a culture that wants you to do more.
That's such a beautiful way of saying it, and such
a beautiful way of like being gentle with your and saying,
you know, I'm trying to make sure that I'm a
person I can trust. And if walking on the treadmill
is what I'm doing today, then that's what I'm doing
and that I'm doing. Yeah, that's great. You mentioned heat
(13:10):
is your trigger. What are your other triggers.
Speaker 4 (13:14):
Perfume, really really strong perfume or strong sense loud, abrupt noises.
So if I'm like sitting on the couch reading a
book and my dog barks, a migraine attack will come on.
And those are triggers that I really can't control, Like
I don't know when my dog is going to just
randomly start talking. So perfumes, yeah, and since like those,
(13:36):
I kind of can tailor my life around them. However,
I will say I've been to places where people just
love cologne and they love perfumes, and I'm not.
Speaker 2 (13:45):
Madild Yeah, I'm not mad at it. I do. It
does bring me back to like my middle school days
where I was like if one spray is good.
Speaker 4 (13:53):
I used to go to like the stores in the
mall and I'd have like all the colors, like the pink,
the blue, the purple. And it's just crazy because I
had no idea that something like that would affect somebody
in such a negative way. But now that I'm living
with chronic migraine, I am very aware of those kind
of things.
Speaker 2 (14:15):
After the break, I'll be back with doctor Ryan. So
stick around, Welcome back to the head. Start embracing the journey,
(14:53):
Doctor Ryan, I want to bring you back in your
being the first episode of this season. Can we go
over some common terms and definitions that often come up
when we're addressing chronic migraine. I think it would be
helpful for the listeners and also for me. First, let's
just define what chronic migraine is and how it's different
(15:14):
than episodic migraine.
Speaker 1 (15:15):
Let's do it so. Chronic migraine is defined as fifteen
or more monthly headache days, and eight of those days
meeting the criteria for a migraine headache. Those headaches need
to last for four hours or more. Less frequent would
be considered an episodic migraine. To help put that into
context of people's actual lives, it's important to look at
the number of headache free days that you've had per month,
(15:37):
and not just the number of migraine attacks per month.
Many times people don't have a true count for their
headache date, confusing those two things. For example, you may
have only counted four headaches or migraine attacks last month,
but when you look at the actual number of days
you didn't have a headache or migraine attack, it could
have been only a few, So getting a clear picture
of the headache days you have each month is key
(15:59):
to helping your doctor or understand what you're experiencing and
making the right diagnosis.
Speaker 2 (16:03):
Okay, that's an important difference to point out. So we
have chronic migraine, which is a distinct disease associated with
frequent headaches and migraine attacks. What are some common triggers
for the symptoms of chronic migraine?
Speaker 1 (16:18):
So important to talk about triggers, Nora, So let's get
into it because it's a huge deal. Triggers can include
increases in stress, changes in hormones. There can be external
triggers that can set off those hormones like barometric pressure,
changes in weather changes like extreme heat or cold. There
can be even triggers like specific smells. Sometimes folks have
(16:40):
a hard time with things like cleaning agents or particular perfumes.
There are different types of light exposures or sound exposures
that can set off migraine attacks, and so understanding those
triggers is really critical.
Speaker 2 (16:52):
Thanks doctor Ryan. Let's get back to evilise for our listeners.
Can you describe vibe how your migraine attacks feel, How
do they come on? What is the experience like for you.
Speaker 4 (17:07):
For me, the most recent one that comes to mind
was for my mom's fiftieth birthday. We were at a
theme park and it had all the triggers for me, heat, smells,
you know, loud noises, you know. I was having fun,
and all of a sudden, the migraine attacks started coming on.
(17:28):
I started seeing floaters like little specks in my vision,
and it just progressively starts to get worse for me.
I'll get like indications that it's coming on, and that's
when I'll like know, like, okay, I need to go
sit down, I need to try to cool off, but
at that point, like it's coming. I ended up having
to leave the theme park early. My family was still
(17:49):
there like they're enjoying their time, you know. Like I
completely separated myself, and I felt when I had the
floaters in my vision, I stepped away because I'm like,
I don't want them to see me like this. I'm
not trying to ruin the birthday. But I had to
separate myself and I had to go back to the
hotel and have my migraine attack by myself. And usually
(18:10):
when I do have those and I'm able to get
to a room. I make it dark, I make it cold,
but I do like to get under the covers or
like have something waited on me, maybe for like the
the comfort of it, and I'll just be in the
dark waiting it out.
Speaker 2 (18:26):
That means you're missing out on things, right, You're missing
out on life moments of your own and you know,
with people you love, how do you manage that emotionally?
Speaker 4 (18:38):
At first, I didn't. I didn't manage it emotionally. I
had no tools in my toolkit to make myself feel better.
But as time went on, I'd learned to be kind
to myself and learned to give myself grace and also
learning to be transparent with people, because at first I
didn't want anybody to know that I had crownic migraine.
I really tried to keep it a secret for a very,
(19:00):
very long time because I was, for lack of better words,
like embarrassed. As somebody who was always fit, active, upbeat,
life of the party. I did not want to be
the person with a disability. But that's the thing about
disabilities and invisible illnesses like chronic migraine. They don't discriminate
(19:20):
like it could happen to anybody and it happened to me.
So just managing it mostly just like being transparent with
people and saying, hey, this is something that I deal
with because letting them know that, Like if I have
to cancel plans last minute, they'll be understanding. But if
they have never had knowledge of me having these chronic
migraines before, I feel like they might think that I
(19:40):
was lying or something if I like randomly canceled last minute.
Speaker 2 (19:43):
Yeah. Yeah, it's like building that empathy for yourself, I
think also helps you extend that to other people.
Speaker 4 (19:50):
Absolutely.
Speaker 2 (19:52):
When were you officially diagnosed?
Speaker 4 (19:54):
I was officially diagnosed when I was twenty years old
my chronic migraines first started and twenty fifteen, and I
didn't get officially diagnosed by a neurologist until twenty sixteen,
like I had an inklink. But of course, something about
getting that diagnosis, like something about it. I just left
(20:16):
feeling so seen, so empowered, ready to tackle this disease,
like ready to tackle it.
Speaker 2 (20:22):
Yeah, I'm assuming there's kind of a journey to finding
the right treatment. What was your journey.
Speaker 4 (20:27):
Like, Well, I will say that for me, like the
whole treatment journey taught me being resilient I had never
experienced something so mentally and emotionally taxing and draining in
my life. Because when I first started seeing a neurologist,
I'm like, Okay, maybe we'll get along, like maybe she'll
(20:49):
listen to me. And she's like, okay, we'll try this.
So I tried a medication, didn't work, and she's like, okay,
we'll try this one. I tried, it didn't work, And
I tried so many different medications and at one point
just wanted to stop because I was getting side effects
from these medications in addition to still getting my migraine attacks.
(21:11):
After that, I remember showing up to my exa appointment
being like, I need something else, and I actually ended
up looking for another doctor, And I think that that's
really important to because I felt bad at first. I
was like, man, I don't want her to be mad
at me, which is so ridiculous. Thinking back, you know,
that's so ridiculous, Like yeah, I'm like, I didn't want
her to have her feelings hurt, but just looking back, ridiculous.
(21:35):
Because it's my job to make sure that I get
proper care.
Speaker 2 (21:38):
Figuring it out feels like so isolating, which is also
so heartbreaking, and I think that's why it is so
generous of you to be here with us and be
sharing this experience with us, because there is somebody listening
to this who is feeling that way, who needs to
know like it's not just them. So it's thank you
(22:00):
for that.
Speaker 4 (22:00):
Absolutely.
Speaker 2 (22:01):
Yeah.
Speaker 4 (22:02):
But I got a new doctor and I remember walking
into his office and he's like in the military, just
like me. He looked at me and he's like, well,
have you heard of botox for chronic migraine?
Speaker 2 (22:12):
I am curious. I want to hear your take on
the treatment procedure itself.
Speaker 4 (22:19):
The neurologist's office was three offices down from where I
worked because I was a radiology text so I would
schedule my appointment and then I would just be like, Hey,
I'm going to go get botox from my chronic migraine.
I'll go to the appointment, I get thirty one shots.
It takes about ten minutes, and I get to go
back to work. I don't have to worry about taking
something every day. I don't have to worry about, you know,
(22:42):
when when's the next refill?
Speaker 2 (22:45):
Yeah, and you just sit down, they do it and
I go back to work, So tag me back in
doctor Ryan Evelise his share bared how botox has helped
reduce her headache days. Can you tell us more about
(23:05):
botox as a treatment option for chronic migraine?
Speaker 1 (23:09):
Absolutely, and I've been familiar with botox for a long time.
In fact, botox has been an FT approved treatment for
chronic migraine for around fifteen years now. It may not
be what you initially think of when you hear botox,
but it's been a part of our arsenal as a
preventative treatment option for a long time. Botox is a
prescription medicine injected into muscles and used to prevent headaches
(23:31):
and adults with chronic migraine, which is fifteen or more
headache days per month, each lasting for four or more hours.
Botox is not approved for adults with migraine who have
fourteen or fewer headache days per month. Effects of botox
may spread hours to weeks after injection, causing serious symptoms
and so you want to alert your doctor ride away
as difficulties swallowing, speaking, breathing, eye problems, or muscle weaknesses
(23:55):
can be a sign of a life threatening condition. Patients
with these conditions before worth the injection are at higher
risk of those effects, and side effects might include allergic reactions, rash,
breathing problems and dizziness, neck and injection site pain, and headache.
Don't receive botox for chronic migraine if there's a skin infection,
(24:15):
and tell your doctor your medical history, muscle or nerve
condition history like ALS which is Lukeriic's disease, mysenea gravis
lambored eaton syndrome. Any medications, including other bochulinum toxins that
you might be utilizing as they may increase the risk
of these serious side effects. It's important for you to
talk to your doctor or headache specialist about the important
(24:37):
safety information you'll hear throughout this episode and in the
link to the product information.
Speaker 2 (24:44):
Evelise was able to see some changes with the number
of headaches eventually becoming manageable about six months into her
botox treatments. How does botox help prevent headaches and chronic
migraine and how important is that dedication to treatment for
feeling the full effects of the botox treatment.
Speaker 1 (25:03):
Awesome question and it's one that I get all the time, Nora.
In the data that was presented to the FDA, botox
prevented on average eight to nine headache days and probable
migraine days a month at twenty four weeks versus six
to seven with placebo. Patients may see results as soon
as four weeks, but the full effect should be evaluated
after two treatments six months, So the botox experience is
(25:24):
going to be different based on the patient. This is
one of my favorite things to do with patients because
there's such a preconceived notion around what botox is and
what the process is to go through with botox. The
first thing we need to understand when it comes to
botox for chronic migraine is that there is a fixed
injection protocol. So we talk to patients about that experience.
We let them know that they're going to be seated
(25:46):
in a clinical setting. Maybe it's a procedural suite like
I use here at the hospital that I work out of,
or maybe it's your physician's office. Botox is injected in
thirty one sites into seven muscle groups that the FDA
is approved. Those areas are going to be in the
head and neck. You start with two treatments and those
are going to be twelve weeks apart, and then we
continue every twelve weeks. Thereafter, we do this every three months,
(26:08):
four times a year, for about ten minutes each when
you come in for a session. We try to fit
treatment into people's busy schedules as much as possible.
Speaker 2 (26:16):
All right, So one last thing that I need your
pov on doctor Ryan. There is sometimes hesitancy and misconception
around botox. What is the usual response when you first
bring it up as a treatment option for your appropriate
chronic migraine patients?
Speaker 1 (26:32):
Understandably, patients always have a bit of hesitance to you
when I first bring up botox. Patients are going to
ask what's the experience, Like how effective is that therapy?
Cost tends to be a hurdle for some patients, and
oftentimes they're surprised to hear that most insurance providers, as
well as Medicaid and Medicare programs, do cover botox for
chronic migraine. I'd advise patients interested in botox to contact
(26:55):
their insurance providers. I think it's really important for patients
to know that providers are not allow to contact insurance
on their behalf to find out costs or benefits associated
with a particular therapy botox or otherwise. Additionally, there are
patients support programs like the Botox Savings Program, which I'm
a huge fan of. This helps eligible, commercially ensured patients
(27:16):
to save uncertain out of pocket costs related to both
botox medicine and the injection procedure.
Speaker 2 (27:22):
All right, I'd imagine the fear of needles comes up
for some people too, right, Is that a common concern
or is that just my own projection.
Speaker 1 (27:31):
Not projection nour I have a lot of patients that
have the same concerns as ev being nervous about the
needles when coming to their first treatment, But some of
my patients describe the injections as feeling like tiny pinches,
and from what I've seen with my patients, most people
get comfortable with the process after the first treatment.
Speaker 2 (27:46):
Doctor Ryan, Thank you as always.
Speaker 1 (27:49):
Thanks Nora. Really excited to be here, Excited to talk
some more with this new season that we're kicking off.
Speaker 2 (28:03):
All right, one last question for you, Evalise. Why do
you love fitness and wellness so much the.
Speaker 4 (28:10):
Way that I express myself. It's an outlet for me.
It's a celebration of what my body can do. I'm
so grateful that I'm able to walk on the treadmill.
I'm so grateful that I'm able to lift twenty pounds.
I'm so grateful that I'm able to squat whatever. You know.
That for me, when I put it in that perspective,
it's like, Okay, get up and go work out, Get
up and go move your body, because there are people
(28:31):
right now dealing with something that would just love to
trade places with you. And I feel like it's foolish
of me to understand that perspective and then not move
my body. If you are somebody that's struggling with your
health or chronic migraine right now, just keep going through
the motions. If you have to chop your day up
into little segments, do that, but you'll get through it.
(28:52):
You have to have the rain to see the rainbow.
Speaker 2 (28:56):
Oh that was beautiful. That was really beautiful. Do you
see what I mean about this conversation about her energy?
Evelise in one conversation made me feel so much better.
I sat down to this conversation in quite a frantic week,
on quite a frantic day, and her calm energy softened me.
(29:21):
And what makes her even more incredible is her story.
She started out in the military stepping into active service
with so much dedication, and when life threw her a
big challenge, chronic migraine, she didn't let that stop her.
She kept going, She kept advocating for herself, She kept
showing up. She is an inspiration and I hope that
(29:45):
it gave you permission and encouragement to live a softer life.
To be softer with others, of course, but also with yourself.
Thanks for listening to the Headstart Embracing the Journey. We
hope you've found something worthwhile here with us today. A
new coping strategy, a relatable story, the comfort of knowing
(30:08):
you're not alone. I'm so happy to be a part
of creating this community for all of us, and especially
for people living with chronic migraine. If you haven't found
a treatment plan that is working for you, please do
reach out to your headache specialist to explore your options.
I truly hope this has helped you find a bit
(30:28):
of comfort and maybe a smile. Maybe see a next
episode and stay tuned for more important safety information. The
head Start Embracing the Journey is hosted by myself Norah McNerney,
executive produced by yvon Shehan, our head of post production
is James Foster, our researcher is Sierra Kaiser, and our
(30:50):
writer is John Irwin. The show is mixed by Michael Hardman.
Original music by Soundcat Productions and art List.
Speaker 3 (31:04):
Important safety information continued. There has not been a confirmed
serious case of spread of toxin effect away from the
injection site. When botox has been used at the recommended
dose to treat chronic migraine. Botox may cause loss of
strength or general muscle weakness, vision problems, or dizziness within
hours to weeks of receiving botox. If this happens, do
(31:24):
not drive a car, operate machinery, or do other dangerous activities.
Do not receive botox if you are allergic to any
of the ingredients in botox, see medication guide for ingredients.
Had an allergic reaction to any other botchu linum toxin
product such as myoblock rhymobochelinum toxin B, disport abobochelinum toxin A,
(31:45):
zeomin incobotchel item toxin A, JEVO probochul item toxin AXVFS,
daxify daxibotchelinum toxin A l A n M or lettibo
lettibotchel item toxin AWLBG. This may not be a complete
list of all botulinum toxin products have a skin infection
at the planned injection site. The dose of botox is
(32:07):
not the same as or comparable to another botulinum toxin product.
Serious and or immediate allergic reactions have been reported, including itching, rash, red,
itchy welts, wheezing, asthma symptoms, dizziness or feeling faint. Get
medical help right away. If you experience symptoms, further injection
of botox should be discontinued. Tell your doctor about all
(32:29):
your muscle or nerve conditions, such as ALS or lou
Garrig's disease, Myasthenia gravis, or lambert Eton syndrome, as you
may be at increased risk of serious side effects, including
difficulty swallowing and difficulty breathing from typical doses of botox.
Tell your doctor about all your medical conditions, including if
you have or have had bleeding problems, have plans to
(32:51):
have surgery, had surgery on your face, have weakness of
forehead muscles, trouble raising your eyebrows, drooping eyelids, and any
other abnormal facial change are pregnant or plan to become pregnant.
It is not known if botox can harm your unborn baby.
Are breastfeeding or plan to. It is not known if
botox passes into breast milk. Tell your doctor about all
the medicines you take, including prescription and over the counter medicines, vitamins,
(33:15):
and herbal supplements. Using botox with certain other medicines may
cause serious side effects. Do not start any new medicines
until you have told your doctor that you have received
botox in the past. Tell your doctor if you received
any other bochulinum toxin product in the last four months.
Have received injections of bochulinum toxin such as myoblock, disport, zamin, Jevo, Daxify,
(33:38):
or Letibo in the past. This may not be a
complete list of all bochulinum toxin products. Tell your doctor
exactly which product you received. Have recently received an antibiotic
by injection, Take muscle relaxance, Take an allergy or cold medicine,
Take a sleep medicine. Take aspirin like products or blood thinner.
Other side effects of botox include dry mouth, discomfort or
(33:59):
pain at the injection site, tiredness, headache, neck pain, eye
problems such as double vision, blurred vision, decreased eye sight,
drooping eyelids, swelling of your eyelids and dry eyes, drooping eyebrows,
and upper respiratory tract infection. For more information, refer to
the medication guide or talk with your doctor. You are
encouraged to report negative side effects of prescription drugs to
(34:21):
the FDA. Visit www dot FDA dot gov, slash MedWatch,
or call one eight hundred FDA one zero eight eight.
Please see Botox full product information, including boxed warning and
medication guide by clicking the link provided in the podcast description,
or by visiting www dot RXABV dot com slash pdf
(34:44):
slash Botox underscore PI dot pdf. If you are having
difficulty paying for your medicine, ABV may be able to help.
Visit ABV dot com slash Patient Access Support to learn more.