Scott Webb (Host): For anyone who's ever had a migraine, you know that a bad headache is just one of the symptoms. And due to the debilitating nature of migraines, they often affect our entire families. And here today to tell us more about migraines and how she's helping patients is Dr. Agnes Virga. She's a Neurologist with Emerson Health Neurology.

 This is the Health Works Here Podcast from Emerson Health. I'm Scott Webb.

Doctor, it's so nice to have your time today. I was just thinking about, you know, as I approached this podcast that we've probably all had headaches. Many of us may have had migraines. We may think that they're all part of the same thing. We may not realize that maybe migraines are different than regular headaches. So it's really good to have you and your expertise and we're essentially going to talk about migraines today and what are the symptoms, treatment options, and so on. We'll start there. What is a migraine?

 Agnes Virga, MD: Migraine actually is not just a pain. Migraine, actually, it's very serious. It's a neurological disorder. And what is very surprising for many people, this is practically the most devastating neurological illness which affects people. We would think about tumor or strokes and other things. But actually it is headache and especially migraine. Migraine is usually a very severe headache. It is recurring. It can cause a very severe throbbing, pulsating head pain, usually one side of the head. But the location can be different. It's not always on just one side and the migraine causes other symptoms, which, you know, it makes it different from just a little tension headache because it can come very severe. Nausea, vomiting, people feel generally sick, weak. The lights bother. The sounds bother them often and they have to lie down in a dark room and cannot do their functions. Cannot go to events, cannot take care of their work or family. They lose precious time, so it's a quite severe neurological condition. It's not a simple pain. Very different than when you hit your arm or leg. It affects your whole body. It's like a chemical change in the system.

Host: Yeah, I see what you mean. Right. There are headaches where we could maybe take a couple of things, OTC that we get at the drugstore and it can generally take care of those things, but sometimes migraines are, uh, much more debilitating, much more stubborn, as you say. It's really a neurological condition more so than just a simple little headache. So just take us through again, what are the symptoms? How can we sort of tell the difference between something else, a regular headache, if you will, and a migraine?

 Agnes Virga, MD: The difference is usually that migraine comes with different stages. Hours before a migraine come, you can feel already down. You feel a little nauseated, not well, constipation. It can, you know, goes for hours. It's called prodrome. Many migraines have also some shorter aura. Which is like a neurological symptoms. It can be visual disturbance. Sometimes people even go numb or weak on one side or another, so they think they had a stroke. It's usually just 10, 15 minutes. Then the severe attack comes, which I told you, comes with different symptoms, not only a headache. It can affect the whole body with the nausea, the vomiting, the light sensitivity.

People have to lay down and after the attack, there is a post migraine longer effect when people feel down, just not well, feel depressed. So it has several stages. It can last longer. It is more debilitating and it usually affects one side or another, like Hippocratus in the old time and Galen and, you know, the Greek and the Roman, they already described it beautifully.

And one of the Greek words for it is hemicrania. It is on one side. But I have to tell you that sometimes we cannot differentiate, and that's why it will be so important to talk to a Neurologist because not all migraines put you to the bed in a dark room. Not everybody has an aura. Many patients of mine came and tell me, oh, I just have this headache for 20 years.

It's not really a migraine, it just, you know, I lie down, I go to sleep for a few hours, take several Advils, and maybe I get better in the morning. And so they are going, you know, for many years, like that. So, it's better to talk to a Neurologist than not to differentiate very clearly from a headache and a migraine, and usually simple over the counter medications do not really work for migraines. They work more for pain, but it's, as I told you, it's much more than a simple pain.

Host: Yeah, I'm sure you experienced that a lot where folks tell you that they've been suffering, you know, with what they think aren't migraines, but probably are migraines. But one way or the other, they've been suffering from these things for 10 years, 20 years, 30 years. And I think maybe that's one of the key messages today is we don't want people to have to suffer, but they're going to have to reach out. They're going to have to speak up, right? They're going to have to speak with their providers, be preferred to a Neurologist. And maybe we touch on that a little bit here is, you know, when should someone reach out? Should it be after the first sort of alarming migraine or the 50th? You know, how do we get folks to make that call, to see doctors, to see experts so that they don't suffer?

 Agnes Virga, MD: I think that the most important is to try to keep record. When people have more migraines or more headaches, they keep record, write down how many times a week, how long did they last, what were the symptoms, and also what was going on around them. And if the frequency increases, the severity increases, the person has some new symptoms, which they did not have before, and it starts to affect their everyday life, they take their usual over the counter medication and it doesn't work. They already should be suspicious and see the primary care doctor.

Host: And Doctor, are there types of medications that may exacerbate migraines?

 Agnes Virga, MD: I have a lot of young ladies on birth control pills containing estrogen, and they start to have this visual auras, visual disturbances. They should not be on this birth control pills. So this is just a milder form over the weeks or months to really seek attention. But urgency, for example, a really abrupt severe headache like a thunder clap, or people have fever, stiff neck, confusion, loss of vision, or they have a headache after a head injury or they go numb or weak with the headache or they have a chronic headache, but now it's worse and they are coughing, doing exertion, even sexual intercourse, and they have a horrible headache coming up, or a new headache after age 50.

So that's what I would really suggest to seek primary care visit in as soon as possible. And the other thing is that these headaches could be something else, can be something from the brain, brain problems, even tumor, stroke or other things in the body, other abnormalities, other illnesses, which can do that too.

Host: Yeah, it's, a lot to take in. Obviously as you say, you know, if a simple little tension headache, you grab something from the store, it probably knocks it out. But anything else, these bigger things that come along with all these other symptoms, right? And whether it's a migraine or not, causing what people are experiencing, the best thing to do is to reach out to a provider. Be referred to a Neurologist, if that's appropriate. And, uh, as I wanted to finish up here today, I wanted to give you plenty of time, talk about the latest treatments for migraines. As you said, usually the pills don't work. Maybe they help a little bit. I see them at the store, you know, whatever migraine medicine I'm thinking.

Yeah, those things probably don't work. We probably need something a little tougher to tackle real migraines. So I want to give you an opportunity here. How are you treating migraines? Maybe what was kind of like the old school treatment? Maybe talk about Botox. I was reading about you and how you're using Botox. So tell listeners how you're treating migraines.

 Agnes Virga, MD: Oh, okay. Humankind tried to treat migraines for thousands of years and with a very important and interesting thing, what you ask about the current treatments that I did a lecture about history of migraines and the current treatment many of them were tried in many different ways already, you know, in the ancient times. Like some of these new devices, electromagnetic stimulations, all these, they did like put electric wire in one water bucket. And one hand of the person and the other had hand on the head. So they got shocked, on the head. So things like that. So, uh, also with the toxins, they did the poisoning people, but the Botox is a little bit similar.

Thank God. It's like a lifechanging beautiful thing. So about the treatment, there are medication treatment and non-medication treatments of course. We always encourage the non-medication treatments, like sleep hygiene, stress reduction, yoga, other good things which you can do, lifestyle changes. But I have to tell you, people reach the point when all these relaxation techniques and talking about it, all this, they just don't really work because it can be a really serious chemical change. So we use some chemistry. In the past we used a lot of non-steroidal, of course. Even steroid we covered, got people used antihistamines. The good or midrin or people used Fioricet, Excedrin they are not really so specific for the current migraine treatment with all the chemistry, which we discovered. So the major good things, what we use these days and the newest one everybody knows, let's say about the triptans, sumatriptan, Imitrex.

And, they worked on serotonin, which is a little chemical starting this whole process. But the newest ones, which are really wonderful and can be used for an attack or prevention, these are, calcitonin gene receptor protein, it's just too much in the system, like the whole inflammation, pain cycle and the new medications help to reduce that.

They can be used also to abort an attack, but they can be used also as preventive. There are pill forms of them and injection forms of them, and they have very little side effects and they work beautiful. Other preventive therapy, for example, Botox, which I had been using for like certain years at least, was known for a long time that it can help headache, but somehow insurances did not, you know pay for that.

And then they realize that we can save money even because people spend so much time in the emergency room and all those pills and they approved it. And it is a life changing. It's beautiful. People can go back to work. They go on vacation again. They babysit their grandkids, their marriage improves.

It is an injection, which we do every three months. The needle is very tiny, like insulin needle people never complain and it helps the chemistry in the brain and releases the muscles. So it works in several different ways and many people who have chronic migraines, and on the top of that, neck pain, tightness, jaw pain, TMJ, they have wonderful relief from that.

So I use it a lot, but I use this newer ones, the calcitonin gene receptor, you don't have to remember that. We call it CGRP. So there are a lot of great treatments these days, which are available for people. I love to be a neurologist this age because we can really help people so much. I enjoy using them.

Host: Yeah, I'm sure. And this has just brought a big smile to my face today. You know, I hearing things like life changing. I love that. I love hearing how much you love your job and all the options that are available. All the treatment options available to folks. Like, we don't want to hear that people who have been suffering for 10 years, 20 years, 30 years, whatever it is, talk to their providers, reach out, speak with a Neurologist.

There's lots of good options. Nobody really needs to suffer. So Doctor, thanks so much. You stay well.

 Agnes Virga, MD: Oh, thank you so much.

Host: Call 978-263-2898 to make an appointment with Dr. Virga or visit Emersondocs.org to find her and other Emerson physicians.

 And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here Podcast on Apple, Google, Spotify or wherever podcasts can be heard.