Transcription:

Scott Webb: Headaches are so very common and there are a multitude of reasons why we get them. So today, we're going to focus on the two most common types of headaches that my guest treats, treats migraines and tension headaches.

And my guest today is Dr. Morrell diamond. She has decades of experience treating headaches, and she's the medical director of the diamond headache, inpatient unit at immediate health St. Joseph hospital, Chicago.

This is the AMITA HealthCast. I'm Scott Webb. Doctor, thanks so much for your time today. We were just kind of chatting off the air here. And I was saying we could probably spend all afternoon talking about headaches and why people get them and what we should do about them, but we don't have that kind of time. But here within the confines of the podcast anyway, tell me in your experience, what are the most common types of headaches that people get?

Dr. Merle Diamond: The most headache that people get is a tension-type type headache, which sort of feels like a hat band around your head or a tightness or squeezing, that's kind of a run of the mill thing. Probably 90% of the population suffers from a tension-type headache off and on in a given year. What we see coming to the doctor, however, is much more commonly migraine. And the reason that occurs is because it's disabling, it's recurrent and somewhat unpredictable and, probably most of the time, over-the-counter medication can't really solve that problem.

Scott Webb: I think a lot of us just sort of live with things, right? We tolerate things. We develop a high tolerance for pain, you know, and maybe especially during COVID where people had fears of going to the hospital, going to the doctor. Do you find that a lot of people just suffer from chronic headaches and they just tend to not do much about it?

Dr. Merle Diamond: Yeah. I think, first of all, a good percentage of our patients, a little over 40% of our patients with migraine, for example, don't ever get the right diagnosis. They don't go consult. And some of that is they misname their own headaches, "This was, you know, a sinus headache or a tension headache."

The second thing is I think the idea of not being able to cope with "a headache," you know, put that in parentheses, somehow it's connotated as, you know, you're not being able to manage your headaches. And I think the third issue is that some of the medications, at least historically in the past that we've used to treat more disabling headaches, have had a lot of side effects and so patients are shy about using them. So I think all of those things probably play somewhat of a role, and fear, right? "What's wrong with me?"

Scott Webb: because sometimes we just don't want to go to the doctor because we don't want to know why. You know, we just don't want to know the reasons, what are the underlying causes and sort of in that vein, what are some of the common causes or triggers of these most common types of headaches that people have?

Dr. Merle Diamond: Well, tension-type headache, actually some of the triggers for tension-type headache can be similar to migraines. So skipping meals, not hydrating well, sleep disturbance, overstimulation, which many people call stress, but overstimulation at work or at home. Not having time to do self care, you know, very, very important. And especially around the holiday season, that can be particularly triggering.

With migraine, that tends to be a genetic disorder. So we often see family members who are afflicted with it as well. But again, some similar triggers, inconsistent sleep patterns, skipping meals. Again, holiday, you know, eating weird foods that you don't normally do or having more alcohol than you would normally consume, not hydrating well. Kind of the ABC's of taking good care of yourself are all important.

Scott Webb: Yeah, they really are. And I'm sure you're right. And I know that I'm guilty of it too, over the holidays, a little too much pumpkin pie, maybe that extra beer. And so I'm sure you're right, that a lot of this is just a behavior lifestyle things that we do to ourselves. So if we do feel a headache coming on, what's maybe the first thing we should do?

Dr. Merle Diamond: The first thing I would tell somebody to do is if it's your garden variety thing that you're used to having and you know you have your own remedy for it, be it eating, hydrating, whatever it is that you would normally do, doing those things. If it's causing significant pain, we do recommend a simple over-the-counter analgesic. If it's appropriate, acetaminophen or a nonsteroidal anti-inflammatory drug or a nonsteroidal anti-inflammatory drug with acetaminophen and caffeine, all of those things can be helpful.

Sometimes, and I always say this with an edge. I'll give you the good and the bad with it. Caffeine can often relieve a headache, be it migraine or tension-type headache. The issue is how much caffeine do you usually use? So you can use caffeine as a medicine if you use it infrequently. If you are somebody who slams caffeine all day, you may be giving yourself a rebound headache and you don't want to do more. So that's kind of a good rule of thumb.

Scott Webb: Yeah. If you're someone like me who enjoys a few cups of coffee every day, you know, those OTCs that also have the caffeine, you could be, you know, sort of causing adverse effects or the rebound effect, as you say. Is there anything we can do really to prevent headaches? Is it eating something, drinking something? You mentioned a hydration earlier. Is there anything we can do? Let's say maybe even exercise, like, is there any magic sort of thing that we can wave our wands and say, "I'm not going to get a headache today because I did this"?

Dr. Merle Diamond: Particularly with migraine, but even with tension-type headache, your brain likes things to be regular. It wants to know when it's going to be fed. It wants to be hydrated. It wants a consistent sleep pattern. All of those things are very important. And then last but not least, exercise, which you brought up. I think exercise is very, very important and critical. It's a form of self-care, right? But it also gives you a nice endorphin boost. The caveat is that is if you have migraine and are beginning a migraine and go out and like run a mile, you're probably not going to be happy at the end of it. So, heavy exertion during a migraine attack usually makes it worse. But regularly exercising is very, very important and I think critical. It's one of those self-care things that's very important for our patients.

Scott Webb: Yeah. You know, doing this as much as I do, it's a common theme, a common thread that runs through almost all the podcasts that I do, which is every doctor and nurse basically saying, people need to exercise more, right? That we need to control our weight. We need to exercise more. We need to be physically well and, of course, mentally as well, but there's just so many great health benefits, including possibly preventing headaches by exercising. So I'm glad to have an expert on and hear you say that as well. What's one thing you just wish everybody knew about headaches, that you walk around knowing and you wish the rest of us knew?

Dr. Merle Diamond: I would say the most important thing is if you're having disabling headaches, headaches that take you out of time with your family, work, other activities, go talk to a clinician about that. There are so many excellent therapies today, and they're not all about drugs. There are neuromodulators, which are kinds of machines you can use. There are of course medications, which are super helpful and a lot of them do not have significant side effects these days. Get those tools in your toolkit because we can do a much better job advocating for you and giving you those tools, so you don't have to miss time from, you know, those things that are important to you.

Scott Webb: Yeah, definitely. And as any of us, which is probably all of us who've ever had headaches, sometimes they can be debilitating and it does take you away from family and friends and holidays, perhaps. So, yeah, great suggestions there. Any cool headache hacks, if you will? Is there anything we haven't covered? You know, we've talked about just being regular and consistent in exercising and eating and drinking and all of that. Any other cool hacks that you are aware of?

Dr. Merle Diamond: Well, I think one of the cool things that I think a patient can do particularly if they need to talk to somebody about their headaches is keep a headache diary. My dad was a headache doctor, passed away a couple of years ago, but he was one of the first doctors and he was super bright and recommended that people use headache diaries, because that way they can track and they can help when they have that visit finally to advocate for themselves and demonstrate what these headaches are doing to them. And I think that's really helpful and helps create a good dialogue between you and your healthcare provider. So I think that's really important.

And I also think that organizations, for example, like the National Headache Foundation, which has been around for 50 years, is a great advocacy group for patients. So if you don't know of people in your community that might be helpful to you with your headaches, you could always check into the National Headache Foundation and they can give you ideas of clinicians in your area that can help with your headache.

Scott Webb: Doctor, as we wrap up here, and this has been really educational and fun, but is there ever a time where a certain type of headache is a red flag and that's when we should call 911?

Dr. Merle Diamond: Well, that is really, really important, and I'm glad you brought it up. So first worst headache, if you get an excruciating headache and you've never had anything like it before, absolutely, get in to see somebody. Headache associated with neurologic signs, so if you get a headache and get weakness on one side of your body, confusion, speech problems, you should immediately go see somebody.

Bad headaches that start after the age of 40 to 50, and you've never had anything like it before, you should definitely talk to somebody. Headache associated with seizures or fainting are very important and you should see somebody immediately, call 911 or get in to see somebody as soon as possible. And obviously headaches associated with high fevers or infections, it's important to get checked. So things that present with neurological symptoms or something that you've never had before that's severe, you should definitely check in with somebody.

Scott Webb: Yeah, that could be signs of a stroke, right? And we know that time is brain, as they say, so every minute counts if you're having those neurological associations or symptoms. So, great advice today. As I said, this has been really educational and fun, doctor. Thank you so much for your time and you stay well.

Dr. Merle Diamond: Thank you so much.

Scott Webb: And if you'd like more help with your headaches, visit amitahealth.org/headacherelief. This has been the AMITA HealthCast I'm Scott Webb. Stay well.