Jaime Lewis (Host): Meaningful Medicine is a Novant Health podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical conditions and build a healthier future. Today, I am sitting down with Dr. Susie Platt, a neurologist at Novant Health who specializes in headaches, and she'll be discussing how people can better manage their migraines and when to seek specialized treatment.

Welcome, Dr. Platt. Thank you for being here.

Susie Platt, DO: Hi. Thanks for having me.

Host: So, I think a lot of us have headaches generally at some point. But for those who suffer from regular headaches, how can you tell what the hallmark signs are of a migraine versus any other kind of headache?

Susie Platt, DO: So, a migraine is moderate to severe in intensity, and oftentimes associated with symptoms that can be more debilitating than the pain itself: light sensitivity, noise sensitivity, nausea, and/or vomiting. Some patients get very sensitive to activities and certain smells, and that's just to name a few of the associated symptoms.

Host: I think we all know about common over-the-counter drugs. I know for myself, if I have a headache, I often turn to ibuprofen. Some people lean on aspirin. But at what point should someone come talk to you about more specialized treatment?

Susie Platt, DO: So, a patient should come to see a specialist when they want to get more answers in regards to why they have the headaches or whether it be them having headaches their whole lives or having new-onset headaches, just to get more information about their headaches. Also, I recommend patients come to see a specialist when they have headaches that are not responding to over-the-count medications or headaches that are very frequent. And they find themselves leaning to the over-the-count medications more days than not.

Host: When they do come in to see you, do you find that prescription medication can actually reduce either how often they get migraines or can people get ahead of it, get preemptive with the medication that will actually either cut down or eliminate the headache?

Susie Platt, DO: Absolutely. The medications that both help to prevent the headaches called prophylactic medications and also medications that help to abort the headaches that sometimes we call rescue medications.

Host: I also know that aside from medication, you have something called occipital nerve block treatment. That sounds pretty specialized. But can you walk us through how that works and what patients can expect if they ask for that?

Susie Platt, DO: Yes. So, the occipital nerves come from the upper region of the neck and go over the back of the head. And when the occipital nerves are irritated, often with arthritic changes in the neck, it can lead to different types of headaches, including migraines, cluster headaches, and even just nerve-type pain that we call occipital neuralgia. And what I do in clinic with the occipital nerve block is inject these nerves with a little bit of analgesic, so numbing agents that are commonly used in even dental procedures and help to numb up these regions and provide immediate relief.

Host: Going back to the beginning of or the origin, I guess, of a headache. Why do people get headaches in the first place? Is there a way to prevent them?

Susie Platt, DO: There's usually a familial component. So, some people are more at risk for having headaches. And actually, headaches are very common in the general population. In terms of why patients have headaches, it can be that genetic component, the lifestyle, like poor sleep, stress. But it can also be something else causing the headache and that we call secondary headaches. That's very important to differentiate from the primary headaches because if there's a mass or high blood pressure causing the headaches, that needs to be evaluated.

Host: I've heard that migraines tend to occur more in women than in men. Is that true? And if it is true, why?

Susie Platt, DO: That is correct. So, women have two to threefold increased risk for having migraines. And we suspect there's a hormonal component to it. So, we know that oftentimes migraines will present during the teenage years at the start of menses. And then, we know that oftentimes with the menstrual cycle, females will have more headaches around the periods. And so, that's been known for a time now. And we also know that with pregnancy and with menopause, oftentimes the headaches increase or reduce during those times in life.

Host: I feel like there's sort of an air of mystery around headaches, that it's sort of a known thing that we deal with. And it's never-- I shouldn't say never-- but we're often not sure where they come from. I wonder if that's why you got into this field in the first place. What made you want to go into Neurology and studying headaches?

Susie Platt, DO: I was an active duty neurologist for the past 12 years. And during my time in the U.S. Army, I helped so many soldiers with such debilitating headaches that took them out of the field. This really built up my experience and headache and post-traumatic symptom management. But outside of that, just seeing the level of debilitation made me passionate about providing care in this field.

Host: Well, thank you for your service there, and thanks also for having this conversation with us.

Susie Platt, DO: Of course. Anytime.

Host: Once again, that was Dr. Susie Platt, neurologist at Novant Health. To find a physician, visit novanthealth.org. Or for more information on neurological care, visit nh.team/neuroscience. And for more health and wellness information from our experts, see healthyheadlines.org. And thanks for joining us.