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Melanie Cole (Host):  Headaches are one of the more common medical complaints that physicians hear. And many people experience them at some point in their lives. Welcome to The GW HealthCast. I’m Melanie Cole. And today, we’re talking about headaches. My guest is Dr. Amanda Tinsley. She’s a neurologist and Director of The GW Headache Center and is affiliated with The George Washington University Hospital . Welcome to the show Dr. Tinsley. Do we know why we get headaches? Do we even know what they are?

Amanda Tinsley, MD (Guest):  That’s a great question. So, as common as primary headache disorders are; we are still learning more and more about what actually causes them. So, for example, migraine headaches, one of the most common types of primary headache disorders. We are learning more and more that actually the cause of it is an imbalance of proteins in the trigeminal system in the brain.

Host:  Wow, that’s so interesting. So, you just mentioned migraines. Is that the most common type of headache that you see?

Dr. Tinsley:  I would say that that’s one of the most common types of headache disorders. A close second would be tension-type headaches where most people at some point in their life will experience one of those.

Host:  When people get a headache; whether it’s stress, tension or the ones that get migraines; they kind of know when these things are coming; but sometimes headaches come up very suddenly. What do we do about them? What is the first thing that you recommend people do if they are starting to get a headache?

Dr. Tinsley:  So, if it’s a first time that someone is getting a severe headache; I do recommend getting evaluated by a healthcare professional. Because headaches, there are so many different causes of headaches and some of those causes can be serious. And so if it’s the first time someone is really experiencing a severe, debilitating headache; I do recommend getting evaluated by a healthcare professional. Especially if there are some other accompanying symptoms that could be concerning. And examples of that would be any kind of new neurological symptom like vision changes. Where that is blurry vision, loss of vision, sensory changes like numbness or tingling in the body, weakness in any of the limbs, speech changes, balance problems, dizziness. If that’s the first time someone is experiencing that along with the headache; then definitely that would be kind of a flag to get that checked out by someone.

Host:  Because that could signal a possible stroke, yes?

Dr. Tinsley:  It could. Or any other kind of structural brain problem like a brain tumor or a brain infection, although those aren’t as common as say a migraine. We would hate to miss that.

Host:  What about a normal headache? If you’ve gotten them on and off or if it’s stress that brings them on; do you advocate the use of like ibuprofen or Tylenol or something like that? And what actions do those even have on a headache?

Dr. Tinsley:  That’s a good question. So, I will say that headaches are never normal even though they are common. So, it depends on what type of headache it is. For example, if someone knows that they have migraine headaches or tension-type headaches; it’s completely appropriate to treat those as needed with over-the-counter medications like ibuprofen or Tylenol. The problem that people run into with that is sometimes those medications don’t work. And also, sometimes patients overuse those medications.

And so, a common misconception is that more medicine is better sometimes. But if you take too many over-the-counter medications that are really meant to be taken as needed but you end up taking them very regularly; you can actually make your headaches worse. That’s something that a lot of people don’t know.

Host:  And that’s a really interesting point that you bring up. So, if that’s what people have been trying up until then; when should they go see a doctor? When should they worry that a headache is something more serious?

Dr. Tinsley:  Right, so as I mentioned earlier, some of those red flags symptoms like other neurological symptoms that may go along with the headache. For example like the vision changes, cognitive changes, numbness and tingling, weakness, balance problems. And if you are having other symptoms with your headache; I think it’s a good idea to be evaluated by a neurologist. We can do a thorough exam to make sure there is nothing concerning, and that more workup doesn’t need to be done.

If your headaches are very frequent and you are having to reach for these over-the-counter medications too much, that’s not good for your body. And like I mentioned before; you can actually get stuck in this rut where you’re actually making your headaches worse. That’s called medication overuse headache. It used to be called rebound headache. And that’s something that we see a lot in our headache center. Patients are self-medicating and you can’t blame them because they are in pain; but they don’t even know that they are actually making things worse.

So, I always recommend if you have more than three days of headaches that are really impacting your quality of life, more than three days a month; then I would recommend being evaluated by a neurologist. Because there are so many things, we can do to help you.

Host:  Is there a way to predict headaches? I mean teens suffer from headaches when they are stressed out at finals. There are certain triggers sometimes for people, yes Dr. Tinsley? And if somebody does get that and you don’t want them to medicate and overload on medication; do you have some alternatives, things they can try? Does mediation help? Or breathing or resting? Do any of these things help stop that trigger before it starts?

Dr. Tinsley:  That’s exactly right. So, there is so much that we can do for headaches and one of those things is identifying the triggers. And triggers can be different for everybody but being able to identify those triggers for a particular person, can really help with the overall headache burden because you can avoid those triggers if possible.

You mentioned like stress being a common trigger. We see that all the time. Especially in DC, some very high stress environments. So, stress reduction techniques are very important for headache patients. And that can be in the form of meditation, breathing exercises, yoga, exercising in general can help reduce stress levels. That’s a huge trigger sot a lot of our patients.

Other triggers can include food triggers. So we ask patients to keep track of their headaches and keep track of what they are eating and see if they can identify certain food triggers. Some of them, you’ve probably heard of like chocolate, or red wine can be migraine triggers. But there are other ones that are not as intuitive like avocado and prunes and figs and just a whole variety and everyone is different. So, it’s identifying for that particular person, what triggers their headache.

And other things like sleep deprivation, skipping meals, drinking too much caffeine or alcohol, dehydration, not sleeping well. That’s another big one that we see. A lot of patients struggle with insomnia or even sleep apnea. And so really you need to kind of take care of the whole person because so many things can impact headaches and trigger them.

So identifying triggers, I think is a huge part of what we do at our headache center. But even if you do everything right, and you avoid the triggers and you modify your lifestyle; you may still have headaches.

Host:  And you just segued beautifully into my next question because GW MFA has a headache center. Why is the center helpful when treating headaches and who should consider going there?

Dr. Tinsley:  So, our headache center opened its doors back in 2015 and our mission is to help patients with their headaches. We want to reduce the burden that headaches have on patients’ lives so decrease the frequency, decrease the severity and we do that by using evidence-based therapies. It’s a really exciting time for headaches. There’s newer and newer medications and alternative therapies coming out all the time. So, we like to give our patients access to those.

We like to work with our patients. We really look at this as a relationship where the patients are empowered to better understand their headache disorder so that they can better treat their headache. One thing -- there are two services in particular that we offer that gives us an edge I think over other neurology clinics. One is that we have a headache rescue room. And this is a room where patients can come if they are having a severe migraine that is not breaking with self-administered therapies and so, instead of going to Urgent Care or the emergency room; patients can actually come to our clinic and receive IV migraine medications to stop those headaches that just won’t break otherwise.

It’s very convenient for these patients because going to bright, loud ER we have to wait for hours to be assessed by a physician is that last thing you want to do when you have a severe migraine. And so, they can come to our clinic. We can give them the treatment they need which is evidence-based and we know the patient, so we can adjust their home medications if we need to as well. So, that’s one service that we are very proud of. Our patients really like that. It leads to better patient outcomes and patient satisfaction.

Another service that we have that we are in the process of developing is headache school. And this is a comprehensive education program where patients can come and learn about their headache disorder. Patients want to know what’s going on with their body. What causes migraine? How do we treat it? And so, it’s actually like a three hour class we can go to and really learn about your headache disorder, and meet other people that have that disorder as well. So, it’s nice for networking and connecting with others who are having the same struggles.

Host:  Great information. Wrap it up for us Dr. Tinsley and how patients can partner with the physicians to achieve their best results and what you want people to know about the importance of recognizing headache triggers so hopefully they can stave them off.

Dr. Tinsley:  Yes, so I think education is the most important piece of this. I think understanding what’s going on with your body is so important. Otherwise, you are not going to be able to know why you are taking the medication, know when to take your medication and so working one on one with a headache specialist is really a great way, working as a team to help identify your triggers and help come up with a plan for you individually.

There are so many different options out there, it’s a little overwhelming. It’s a good thing. We have more and more medications, more and more therapies. But it’s a little bit overwhelming and so working one on one with someone that specializes in the area and is passionate about headaches I think is a great way to attack your headache disorder so you can lead the best life you can and not be impacted by your headaches.

Host:  Thank you so much Dr. Tinsley for being with us today and for sharing your expertise in a situation that so many people suffer from. Headaches can be so painful. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Tinsley or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment. I’m Melanie Cole. Thanks so much for tuning in.