Nov 2, 2021

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Scot: Back in May, we did an episode about migraines, and we learned that men who have migraines aren't likely to seek help or even know that they have them. It's Episode 78 with Dr. Karly Pippitt, if you want to check that out.

And just as I get done recording, I hit the stop . . . We know Troy has migraines. That was really the whole purpose. He hasn't really been doing anything for them. But Mitch was on the show as well, and just as I hit stop, Mitch goes, "Gosh, Troy . . ." Actually, do you want to play the part of Mitch, Mitch?

Mitch: No. I would like to see you play the part of Mitch.

Scot: You're like, "Gosh, Troy, I couldn't imagine what it'd be like having migraines for three days. I just have headaches that I have to go in a dark room for four hours, and can't interact with anybody, and have to close the blinds and roll up into a little small ball."

Dr. Pippitt: Totally normal. It happens to everybody.

Scot: And at that point . . . Dr. Pippitt, do you want to play the part of Dr. Pippitt?

Dr. Pippitt: I don't know. You're doing pretty good. I think you can keep going.

Troy: That was a pretty good impression.

Scot: Dr. Pippitt was like, "Mitch, you have migraines," after the whole episode about men having migraines that they don't even know that they have them sometimes, and they're less likely to seek help. So why didn't you think you had migraines, Mitch?

Mitch: A very almost meta situation of happening in the episode is the same as what was talked about before. I just assumed that it must not be that bad. I assumed that some men out there that are like, "Nah. I'm okay. This is just what happens," not realizing that having a headache for more than an hour or two is not okay, especially if it's bad enough you have to go curl up in a corner and just shut your eyes and whatever, then . . .

So that was the thing that was the most shocking listening back to the episode when I was editing it, is just like, "Man, am I dumb? Or am I just . . ."

Scot: You just sat through a whole episode of us talking about it and didn't realize until the end, until you were told.

Mitch: Right. And I guess that's just it. It's like, guys, if you are listening to this right now, and anything that we say sounds like it, just go talk to your doctor.

Scot: Yeah. They can help you.

Dr. Pippitt: Don't torture yourself.

Scot: Right. There's no need. You're not winning any awards by doing that. The bragging rights aren't worth it. Get bragging rights doing something else, doing something cool. I don't know.

Dr. Pippitt: And probably not just making yourself miserable, but potentially everyone around you miserable as well too.

Troy: Yeah, that's true.

Scot: When you don't do anything about them. So this is the update episode. We're going to have an update episode to find out if Troy went actually to his doctor and was diagnosed with migraines, and if he got any help, and then Mitch, as well, was going to make an appointment. So that's where we're at right now. Who wants to start?

Troy: I'll start off first since I was the first one that put myself out on a limb there on the episode since Mitch left me hanging until the end.

Scot, I was experiencing headaches about every month or so. They would come on usually after night shifts, like a day or two later, left side of my face, head. It would just feel miserable for, like, 48 hours. I'd feel sick to my stomach. I would just want to lie down and sleep. Light bothered me.

And this had been something I'd dealt with for years, and was just trying to treat it with Tylenol. I had read some stuff about ginger helping, and it did kind of help as well with the nausea, and I just tried to power through it.

So we did the episode, talked about it, and I resolved I was going to talk to my doctor.

So I did talk to my doctor. Went in there, told him everything, told him about the symptoms, told him about the podcast, told him about this discussion. He said, "Yep. It sure sounds like you have migraines." And so he prescribed medication for me. Since that time, I have had multiple opportunities to use that medication.

And it's funny, it was just this last weekend, I had three evening shifts in a row when I was getting to bed at 2:00 or 3:00 in the morning. And the first evening shift, everything was fine, and then the next evening shift, I got about halfway through it and it hit me.

Karly, I made the mistake of not taking medication then at work. I just didn't take it. I was just like, "Oh, I'm just tired. It's just a painful shift." And I think it was one of those things where my mentality was, "Just power through. Get through it in general, with the shift," and not getting as much sleep. Ugh, it hurt.

And the next day, I really felt it that morning. So I finally took medication that morning. Had to take it again a few hours later. Got through the next shift that evening, the third in a row of those late shifts, and then had to take medication the next day.

It was bad, but I was so glad I had the medication, because, otherwise, trying to get through those shifts, if I were just trying to power through that migraine those three shifts in a row, it would have been absolutely miserable. So it was a lifesaver.

The other times, I've caught it early. Took one dose the medication and I was good. No issues at all after that. But this was definitely a lesson in taking medication early.

Dr. Pippitt: I think it's okay, especially for that first time you take it, when you're at . . . It's a scary thing. You're at work. You have to think a lot for your job. It's pretty important that you're "on." And you don't know what the side effects of the medication are going to be. That's not to say that maybe you're not your best self when you have a migraine either, but still, I'm not going to chastise you too much because I can totally understand that. You're just a little worried about maybe "What will the response be?"

But you did do it the next day, and more importantly, you repeated your dose. I think sometimes people think, "Oh, well, if this didn't do the trick, then it's just not going to work." And you're absolutely right, it's unlikely to be as effective the longer you get into the headache, which is exactly what you experienced, right? In later headaches, you took it early and magic.

Troy: Exactly. But you can chastise me a bit because I had already had three migraines prior to this when I was at home, and I took it. And so I kind of knew how it felt. When I took the medication, I knew any side effects. So this was more just me being at work and being like, "I'm fine. I don't need anything." Even though I'd taken your advice and I had it in my bag, I had it there in my backpack, I just didn't take it. And I paid the price.

But that being said, it was a good lesson in taking it early. And even though I didn't take it as early as I should have, it was still effective even though I had to take a couple more doses.

Again, so glad . . . it's hard to say anything is a life changer. You don't want to just throw that term out here and there, but this truly has affected my outlook.

So often, I have looked at my calendar, and I have said, "Okay, I'm working a night shift. That's about when I'm due for a migraine. It's going to hit me two days later. What's scheduled that day? Okay, get ready for it. Brace yourself. Be ready for it. Be ready to take a bunch of Tylenol. Be ready to take ginger. Be ready just to feel miserable and get through it." And this has totally changed that, and it's a great feeling. It really has made a big difference.

Scot: Wow, that's awesome.

Dr. Pippitt: I couldn't be happier. I mean, baby steps. You got the medication on your person. You've done this. I mean, to be fair, how many years did it take you to finally talk to someone about this? So I'll give you that extra 12-hour cushion when you should have taken it sooner, given the time it's taken to get here in the first place.

Troy: Thank you. I have to add one other thing in this whole migraine story. Scot, we talk about genetics on our podcast as our "one more," our core four plus one more.

So my cousin listened to our podcast, happened to listen to the migraine episode. She sent me a text. She said, "I was listening to your podcast on migraines. Did you know we have a strong family history of migraine headaches?"

She said, "My grandmother's mother and grandmother both suffered from them." My grandmother told my cousin stories about how her mother and her mother's mother used to talk about needing to go lie down in a dark room because they were having a "sick headache." I mean, we're talking back in the 1800s.

Scot: Wow.

Troy: This goes back many generations. She said she's dealt with migraines from a young age, her sister, her brother, all my cousins there. So it would have been nice if I'd maybe gotten into my family history a little bit more with this issue, but clearly there's a pattern here. Interesting, though. It was great to hear from her. Great that she's listening, and really interesting to hear that from her and what she's had to deal with too. And obviously, she's been getting treatment for years.

Dr. Pippitt: And I think an important reminder to talk to each other about this. I mean, I don't know about your guys' family. Mine doesn't really sit down and share details at the dinner table, or holidays, or anything like that. But there are things that can make a difference in everyone else's lives, and maybe isn't as personal as other healthcare information, that would really make a difference in your family's lives too.

Troy: It really would. Yeah. Next time I get together with my family for anything, I'm talking about my migraines. So it'll be a fun Christmas dinner conversation.

Dr. Pippitt: Party at Troy's house.

Troy: Party at my house. Everyone, come on over. Let's talk about migraines.

Scot: And then, Mitch, did you go and see somebody about your headaches?

Mitch: I did, and I think it's kind of embarrassing in hindsight. Karly, love you, you're so great, but when I went to the doctor, the first thing . . .

Scot: Where's this going?

Mitch: Right. The first thing out of my mouth is like, "I'm on this dumb podcast or whatever, and I think I might have migraines." I don't know what man part of me took over to be like, "Sorry, I know better. Someone has been telling . . ." No. It's so dumb.

But I sat, and my lovely general . . . my PCP, she looked at me for a good . . . She's like, "Well, can you describe your symptoms?" And she just gave me this dead stare, and she's just like, "It sounds like you have migraines." And it was just like, "Yeah. Of course, I do." And she gave me some drugs.

Troy: You got the drugs.

Scot: You mean medication?

Troy: Medication. Yeah. That's what we prefer to call them, but yeah.

Dr. Pippitt: Potato, potahto.

Troy: Exactly.

Mitch: She just got me the rescue medication that you were talking about the last episode that we talked about this, and I have had . . . So she gave me two things. One, she wanted me do the rescue medication, and two, to start tracking. Like the diary of pain, this idea of, "What is causing these migraines?"

The good news, bad news. Good news is I've only had one since we talked. The medication worked spectacularly.

Dr. Pippitt: Awesome.

Mitch: I knew that I get this little bit of pain in the back of my head. It feels like a tension headache, but just keeps on cranking up. Took one of these pills, was fine. I felt a little oogie for, like, an hour, but it wasn't an all-afternoon event. And then I haven't had any since.

So my little pain diary, I've got nothing. I've got nothing over the last couple of months, so . . . I don't know.

Dr. Pippitt: I hope you haven't jinxed yourself now, right? Go knock on some wood or something.

Mitch: Sure.

Dr. Pippitt: Pull out the rabbit's foot.

Scot: How often would you have them before that?

Mitch: Once or twice a month.

Scot: Oh, wow. And we recorded back in May. So you've only had one since then?

Mitch: Yeah.

Scot: When it used to be once or twice a month.

Mitch: It's also when I stopped working my second job. I'm almost wondering if that was a big part of it.

Dr. Pippitt: I do love how often people come back and follow up, and they're like, "Oh, yeah. My migraines are totally better." And I'm like, "What happened?" And it's something exactly like that, like, "Left my spouse. Quit my second job," things that I can't generally recommend as treatment advice.

Troy: So did you have any side effects, Mitch?

Mitch: I was a little dizzy, to be honest. I just had a little bit of dizziness when I took it, but a little bit of dizziness for 15, 20 minutes is tons better than curled up in the corner, feeling like I'm going to die for a couple hours.

Troy: Interesting.

Dr. Pippitt: That's a good point, though, Troy, because if you . . . I will tell you the first rescue migraine medication I had, I didn't actually like how it made me feel. And so then I wouldn't take it, because I was like, "Well, is it worse to feel the side effects of the medication or the headache? I don't think the headache is quite that bad, so I'm just going to hold out," which then didn't really help anything either.

So it's important, if you do have side effects from it, that you tell your doc, because there are other things that you can take in that same class of drugs that often don't have those same side effects.

Troy: Yeah. And I haven't had any major issues. I find about 30 minutes in, my face will feel kind of tingly, and then the migraine just starts to dissipate, and it just feels like the medication is just there working its way into my brain, and making my face tingly, and making the migraine disappear. It's kind of a cool feeling. I kind of like it.

Dr. Pippitt: It is kind of weird when you're like, "Oh, my God." I mean, it's not even . . . I don't want to say a vise, like a tension headache, but you just start to feel it slip away as the medicine starts working. It's a really wonderful thing, especially when you're feeling really crappy.

Troy: It really is. It is a wonderful feeling. And I think for anyone who hasn't experienced migraines, it's hard to describe that sensation, but it's kind of consuming. It's just there, and it's just like you can't focus. You can't concentrate. You just feel sick. I feel like I have an illness, like I'm coming down with something. And just to feel that melt away, it's great. It really is a game changer, and so glad that you talked to us about this, and really convinced us to do something about it. So I'm very happy about that.

Dr. Pippitt: I'm just glad you guys did something. I mean, truthfully, this is the thing. People just think it's not that bad and they don't do anything about it. It sucks because it could be so much better for you guys.

Mitch: Well, that's the thing I wanted to mention. I thought I just had casual headaches, like no big deal. They're just something that happens when you get older. They're just something that happens when you're a person. And if you're listening to this episode right now, if you're out there and you're like, "I get headaches but they're not that bad," maybe you should just mention that you have headaches to someone. Mention it to your doctor, mention it to someone, because these drugs are kind of magical.

Dr. Pippitt: And mention it with some details. Maybe not this casual, "Hey, I think, maybe, I don't know." Just giving you a hard time, Mitch.

Mitch: It's okay.

Scot: And mention it to family members too. That might help you with your detective work.

Hey, Dr. Pippitt, do triggers . . . So triggers are the things that trigger people's headaches. They could be various things. Troy knows his triggers. Mitch hasn't figured out his yet. Are those hereditary as well? Do they tend to run in families?

Dr. Pippitt: That's a really great question. I think it would stand to reason that they probably do, but I don't know that I've ever had anyone specifically come up with that. I mean, I think the triggers are pretty . . . the common ones are common for most people, so hard to say. Is that just because it's a common trigger, or because it's the hereditary aspect of it?

Scot: Yeah. I thought that might be helpful with detective work. If somebody in Mitch's family is like, "Oh, I have them too, and these are my triggers," if that would shed some light. But you're saying it's common triggers.

I would encourage anybody to go back and listen to Episode 78 on May 18, 2021. But quickly, just mention some of those common triggers.

Dr. Pippitt: So Troy gave a really good example of one, when your sleep schedule is disrupted. So if you're not getting good sleep, you're staying up late, or you're sleeping in too much, or just too many hours of sleep, all of that is probably . . . That's one of the biggest triggers for people.

Alcohol. So particularly red wine, beer. Aged cheeses, or cured meats. So things like sausage, bacon, all the delicious stuff. Chocolate, unfortunately, can be a trigger for some people.

Scot: So Mitch mentioned that his diary, he really hasn't had . . . He hasn't had migraines, so he hasn't really been able to track down those triggers. And I know keeping a diary is pretty important. Explain how somebody might do that so then when they finally do decide to go in, like Troy and Mitch, that they've got all the information they need to provide to their doctor.

Dr. Pippitt: So, Mitch, did your doctor tell you to just mark down when you had headaches, or what other things are you supposed to note in your diary?

Mitch: One of the things that I was supposed to look for is when do I have headaches, what my general mood was around those headaches, what I had eaten that day on a day with a headache. And then they kept talking . . . I don't get it, but they kept talking about the aura, or the haziness, or the ooginess. I don't know what the word is. Like, "Do you have that pre-migraine feeling? And if you do, do the same sort of thing. What's going on in your sleep, your food, your mood?" I think that's it.

Dr. Pippitt: Yeah. Some things that I'll add to that would be things like how much physical activity have you had that day. On the diary that we print out, we talk about a couple of different triggers, so foods. We talk about other psychological stressors. So have you just had something really stressful happen in your life? Did someone die? Were you just sick? Do you have a big deadline at work? Things like that.

Weather, I don't actually put that down as something in the diary, but some people will notice that when a storm is coming in . . . In fact, the day that I had a migraine, I had had headache clinic the day before, and I ended up emailing the patient so we could connect virtually. And she was like, "Yeah, I think we're going to have a storm tomorrow." She messaged me the next day because it rained and was like, "I'm better than the weatherman. I'm telling you."

Troy: Wow.

Dr. Pippitt: And that's one that I think people sometimes feel a little like, "Am I nuts that I think that I can predict the weather, that it always happens with a storm?" But that's another really common trigger, just a change in the barometric pressure. So something else to think about watching for.

So to talk briefly about that aura that you're asked about, this is mostly . . . So the technical definition of an aura is a reversible neurologic symptom. So the vast majority of auras tend to be visual, and so people will describe this as either like a black dot or spot in their eye, that regardless of when you turn your head, you still see.

So all of us have done this when you've accidentally looked at something really bright, or looked at the sun, and then you look away. So it's just this like black dot that persists.

The other fancy medical one is something called a scintillating scotoma, which basically is like a zigzag line across your vision, or even sometimes like a shimmer, like a heat wave, that just sort of persists in your vision the whole time.

You can get other aura. So some people get numbness. We sometimes talk about the march of migraine. So that numbness starts in your hand, moves up your hand into your neck and your face, and then the numbness will happen there. It's typically neurologic symptoms, pause, then headache follows, but doesn't have to be that way.

Mitch: What about sparkles, sparkles in your vision?

Dr. Pippitt: Tell me more about your sparkles.

Mitch: Little diamond-y, shimmery. And it goes away after a couple of seconds.

Dr. Pippitt: I want to say that . . . I'm trying to remember the time frame. I think it needs to last a little bit longer than that. Where does it happen in relation to the headache?

Mitch: I've never connected the two. But I'm afraid that I'll be doing the same thing I did on the last episode where we'll turn it off and I'll be like, "Oh, yeah. No. Totally. I've been getting auras all my life."

Dr. Pippitt: I mean, the issues with aura tend to be more around . . . So people with aura have a slightly higher risk of stroke, and it matters in particular for female-identifying persons who want to use birth control for some sort of contraception, just because we know estrogen also puts you at higher risk of stroke. So the two together, if you're someone who identifies as female and you have migraine with aura, you should not be using an estrogen-containing birth control.

Troy: Talking about this and just my experience personally with migraines and seeing people in the emergency department with migraines, migraines are just weird. They are just weird. Do you know what causes them?

Dr. Pippitt: I mean, definitely our understanding of many of these things has changed over time. These new drugs are targeted towards something called the calcitonin gene-related peptide. So we've known about that since the '80s as being implicated in migraines. So it comes from this trigeminal ganglia, and then that's also in the sensory nerve fibers in the meninges. So it is a potent vasodilator. See this is what I'm talking about. This is why you don't know that you want this in there.

Troy: I'm sorry I asked.

Dr. Pippitt: It's what causes the transmission of the pain signals from the meninges to the brain.

So I don't know that we know what it is that activates that trigeminal ganglion that then makes the CGRP get released. But if any of us . . . not you, Scot, but the rest of us, if we got an infusion of the CGRP, we would actually get a migraine. So that's what these new drugs are. They actually are a receptor antagonist or blocker from that.

Troy: Oh, okay. So people who don't have migraines don't have that receptor?

Dr. Pippitt: I think they have the receptor. I just don't know that . . . do you not respond to it?

Troy: Just not so sensitive.

Dr. Pippitt: Is there something else? Yeah.

Troy: Interesting.

Dr. Pippitt: Exactly.

Troy: It's great to hear because, yeah, that's always been my understanding, is migraines are a mystery. But it sounds like there's more and more understanding of what's causing it and treatments targeted specifically at that. So that's great to hear.

Dr. Pippitt: Absolutely. I always tell people it's a good time to have migraine because this is really the first time in a long time we've had any very specific medications for it.

Troy: Right. Yeah, that's great.

Scot: Just want to point out you said 12 sentences in a row before I finally understood one. I was just waiting to see how many of those sentences you could string along with those words.

Troy: Did you not pick up on CGRP, Scot? We've talked about it before.

Scot: Oh, have we? Okay.

Troy: I'm just kidding. Yeah.

Dr. Pippitt: I could have read the next line that was something about being a multimore of a G protein coupled receptor. I mean, this is why I had to pull it up. This is not stuff I talk about to people.

Troy: That would have brought it all together. If you'd only said that, then really that would have brought it home.

Dr. Pippitt: Yeah, it would have been like, "Oh, Karly, you're holding out on me. Geez."

Troy: Exactly.

Scot: You can leave out the most . . . you're burying the headline here.

Troy: "Now I get it."

Dr. Pippitt: Mitch, about your sparkles, though, the other thing I was thinking is we often think about . . . So migraine has very distinct phases. So there's the prodrome, or what happens before you get a migraine, when you get it, and then the postdrome. And so there are some symptoms that people get that can be seen as precursor signs or sort of a premonitory sign.

One of those is yawning. That's actually a really common thing that people have happen. Sometimes you have to go to the bathroom a lot, like just urinate more.

It's a funny question to ask people sometimes, like, "Hey, have you ever noticed that these things happen, or you have cravings for certain foods, and then the next day you get a headache?" And you probably wouldn't notice it. But then someone says it to you, and you're like, "Oh, my goodness. You're absolutely right." And those are different than aura.

That was the only thing I wanted to point out. And it might be something you guys watch for now if you see anything like that.

Scot: Dr. Pippitt, thank you for making both Mitch's life and Troy's life so much better. We appreciate that.

Dr. Pippitt: And yours, I hope, too, right?

Scot: Well, I mean, Troy actually . . . I never knew he had migraines because I don't know if . . . I never . . .

Troy: Yeah, I didn't talk about it.

Scot: Yeah, I didn't know if I just never interacted with him on those days. I knew Mitch did once in a while. But they never really impacted me directly, I guess, that I noticed.

So if you get a chance, go back to Episode 78 because it really is good. You can learn a little bit more about your migraines.

Dr. Pippitt, before we go, though, if somebody does not go back to that episode, how should we wrap this up? What's your message of hope?

Dr. Pippitt: I think the message is there is treatment for this. And don't think that you have to be . . . We keep teasing and joking about curled up in the corner of a dark room. If your pain is significant enough that it interferes with your life activity, it's worth getting checked out.

Scot: Or you just think about it, right?

Dr. Pippitt: Yeah.

Scot: That is interfering with your normal activity, I would think.

Dr. Pippitt: Absolutely.

Scot: And then I think one other thing I do want to try to tease out here before we go is, obviously, Troy is an ER physician, so he tried the medication beforehand because he didn't want it impacting his work. People that drive trucks, heavy machinery operators, people that are in those sorts of things, they might hesitate to get this medication because they don't want to be on medication when they're working. Is it safe for those types of environments generally? Can you generally find an option for somebody?

Dr. Pippitt: Yeah, generally. I would say most of these medications don't cause drowsiness. It's not uncommon for people to say that they feel drowsy, but it's hard to know, "Is that actually a medication side effect, or is it what the postdrome is?" I think most of us would actually say you feel a little bit wrung out after a migraine, and that could be why too.

Scot: Dr. Pippitt, as always, just so wonderful having you on the show. And I went to the U of U Health headache webpage, and there's a link to something called a questionnaire, a new patient's questionnaire. Does that include the diary, all that sort of stuff? Would that be a good resource for somebody to start?

Dr. Pippitt: This would be a great resource. I wouldn't say that it includes a diary, but does a really detailed history of what symptoms you experience, what medications you've tried. In addition to family history, there's a question about what medications have worked best for your family.

It's about 17 pages. It's pretty long. One thing I do like about it is it gives me the most detailed version of your history, and it really forces you to go back and look at . . . Especially people who've seen other providers and had lots of medications tried, it helps you know, "Okay, I think I've tried a lot of stuff, but look at all these other things on this list. There's still a lot of stuff on there."

Scot: And this could be a barrier in and of itself. I could see somebody going, "Oh, I'd rather deal with my migraines than do 17 pages." I mean, can you get away with coming to your doctor with a little bit less?

Dr. Pippitt: To your primary care doctor, absolutely. I will tell you it's a prerequisite for a headache clinic to get people in to do it, but for primary care, yeah. I mean, it'd be a reasonable thing to take a look at. And then bring a diary. You don't have to do anything fancy. There are apps. I just have it on the notes tab on my phone. That's what I do, is just put a little . . . I just mark the date when I have a headache.

Scot: All right. All in favor that Dr. Pippitt rocks, say aye.

Troy: Aye.

Mitch: Aye.

Dr. Pippitt: Aye. Do I get to agree too?

Troy: Yes, you do.

Scot: Aye. Dr. Pippitt, thank you for being on the podcast, and thank you for caring about men's health.

Dr. Pippitt: Absolutely. Thank you, guys. This is always such a pleasure.

Scot: Hey, it's Scot from "Who Cares About Men's Health." Thank you so much for making it all the way to the end. By the way, if there's somebody in your life that you think would find this episode, or any of our episodes, or this podcast useful, do us a big favor and let them know about it, whether it's online, sharing it on your social media platforms, or even if it's a face-to-face conversation or an email. That would be great. That would help us tremendously make sure that more men hear our podcast.

If you'd like to reach out, if you've got a migraine story you'd like to tell us, or a question, you can do so a lot of different ways. You can email us, You can send a Facebook message, You can even leave a voicemail at our listener line, which is 601-55SCOPE. That's 601-55SCOPE.

Thank you very much for listening, and thanks for caring about men's health.

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