Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice. 

Caitlin Whyte (Host): Ugh, having a headache? That's a sure sign of a bad day. But a migraine? That could really knock you off your feet for a while. So, what can you do to ease that head pain and when is it time to go see a doctor? Joining us today to discuss migraines and some relief options is Dr. Peter Struck, a neurologist at Skagit Regional Health. 

Welcome to Be Well, the podcast from Skagit Regional Health. I'm your host, Caitlin Whyte. And thank you so much for being with us today, Dr. Struck.

Dr. Peter Struck: Thank you, Caitlin, for having me.

Caitlin Whyte (Host): Well, to start off our conversation today, I'm sure our listeners are wondering, what exactly is a migraine headache? 

Dr. Peter Struck: So, a migraine headache is a severe headache that you can think of as fulfilling the following characteristics. It is two of the four, it's either severe unilateral throbbing, or worsened by activity, and is usually associated with nausea and/or sensitivity to light and sound.

Caitlin Whyte (Host): And can you tell us about the different types of migraines? Do you see a lot of different types?

Dr. Peter Struck: Yes, there are different types. Generally, we divide migraines into those with an aura and those without an aura. The aura is defined as coming from the Greek for breeze. And we think that it's associated with electrical changes in the brain that send information to parts of the brain to present with symptoms such as visual illusions. Those are visual spectra that appear usually in the periphery of the visual field associated with spots of bright light or flashes of light. Other types of aura, depending on where in the brain there is this electrical explosion, may manifest with numbness and tingling on one side of the body. It may also manifest with difficulty speaking or difficulty getting words out. Very rarely, an aura can present with weakness on one side of the body. The majority of migraines are without aura.

Caitlin Whyte (Host): Well, you touched on this earlier, but what exactly causes migraines?

Dr. Peter Struck: So, we don't really know, but we think that there is a strong genetic and environmental component to the development of migraines. And the reason we know that is that 80% of people with migraines have at least one first-degree family member that has had a migraine. We think the changes in the brainstem and its interactions with the trigeminal nerve, which is a major pain pathway, are involved. We also know that serotonin, which is a brain chemical, is involved in the development of migraines. And right now, this is an area of active research to try to identify what exactly is the interplay between the genetic risk and the environmental risk? 

Caitlin Whyte (Host): You know, for many, a headache seems like an everyday occurrence or something we just got to live with sometimes. But when should someone seek out medical help and go to their doctor for their migraines?

Dr. Peter Struck: Any headache that is new or unusual, or interferes with activities of daily living, or is associated with nausea.

Caitlin Whyte (Host): And on that note, how are migraines then diagnosed?

Dr. Peter Struck: Migraines are diagnosed, it's a clinical diagnosis. So, when you see your physician, he or she will ask you different questions and try to exclude other potential causes for your headaches. These are much rarer, but based on their examination, sometimes they will order some brain imaging studies. But in many cases, in migraine patients, these brain imaging studies are not needed.

Caitlin Whyte (Host): Well, let's look for some relief. What treatments are available for those suffering from migraine headaches? 

Dr. Peter Struck: So, there are different categories of treatments. As I mentioned earlier, we do know that serotonin plays a role in the generation of migraines, and we do have serotonin-specific medications, which are a class of medicines called triptans, which are very effective. At this point, we also are investigating more the role of CGRP antagonism, calcitonin gene-related peptide, which is again just like serotonin, it is actively involved in the generation of migraine. And we do know that targeting the receptor for this particular type of hormone does reduce the frequency of migraines. 

In terms of treatments, we have calcitonin gene-related peptide antagonists, which are newer medications that have come to the market. And in addition to that, for migraines that do not respond to these classes of medicine, we also have botulinum toxin, which we also believe antagonizes the nerve endings that give rise to the generation of chronic migraines.

Your doctor may also start you on older medications, which are effective in many cases at reducing the frequency of migraines. These come from three classes: anticonvulsants, antihypertensives and antidepressants.

Caitlin Whyte (Host): Great. Well, as we wrap up, doctor, what are some preventative tips for migraines?

Dr. Peter Struck: So, one of the major preventative tips that I recommend is to stay hydrated. Dehydration is a frequent trigger, and many of us don't realize that we're dehydrated. So, it's important to recognize how much caffeine we intake every day and its effect as caffeine can worsen dehydration. 

The other recommendation I have is to obtain a regular sleep cycle. Ideally seven to eight hours of sleep. And we know that stress can also trigger migraines. So, we do recommend mindfulness, which is a form of deep breathing, exercises that one can do. Just five to ten minutes every day can make a difference in how the body perceives and deals with stress.

One last thing, there is a vitamin called magnesium. And we do know that if you have migraines, your brain does not absorb magnesium properly and it requires more magnesium than the general population. So, we do recommend magnesium supplementation.

Caitlin Whyte (Host): Wonderful. Well, doctor, thank you so much for your time and for all this great information. I know we will help a lot of people suffering from migraines. 

For more information, go to SkagitRegionalHealth.org. And thanks for listening to Be Well, the podcast from Skagit Regional Health. If you found this podcast helpful, please be sure to tell your friends and subscribe, rate, and review it on your favorite podcast app. I'm Caitlin Whyte.