Joey Wahler (Host): This is Health Matters: Insights from WCH Medical Experts. Our guest is Dr. Purvi Saraiya. She's a neurologist with Wood County Hospital. Thanks for joining us. I am Joey Wahler. Hi, Dr. Saraiya. Welcome.

Purvi Saraiya, MD: Hi, Joey. Thank you for having me.

Host: Great to have you aboard. We appreciate the time. So first, migraines are very common in the United States. Just how much so, how common are they?

Purvi Saraiya, MD: So, migraines are common. It affects approximately 12% of the population, and that data is predominantly coming out the United States, but it can be applied worldwide.

Host: So, that's very common Indeed. And it seems migraines impact women far more than men, right? Do we have any idea why that is?

Purvi Saraiya, MD: There are may be other factors that affects how women and their anatomy or some hormonal factors affect the occurrence of the migraine. But genetics also play a role. So, that maybe far more common in women sufferers, then their women successors may develop the same.

Host: How can someone tell if they're dealing with a migraine versus a good old-fashioned headache?

Purvi Saraiya, MD: I'm glad you brought that up because when I was told about this podcast, the title was Headaches and Migraine Headaches, and that kind of caught my attention to the fact that all headaches are not migraines, and all migraines may not have headache as a symptom. So, let's help or understand, differentiate between the two.

Headache can be a part of the migraine condition or migraine episode, which may have various stages that it goes through. So, migraine itself is a neurological disorder that typically affects a sensory nervous system predominantly, where people experience symptoms affecting the sensory nervous system, or suggest an involvement in the sensory nervous system a lot. Where a headache is a symptom or can be one of the symptoms in the process of the migraine.

For example, if I say someone is having a headache or a migraine and draw a picture of that person, so you take a piece of paper and start drawing a person who is sick and kind of looks not happy, you can say they're in some kind of distress and their head's in their hand, and they're kind of looking bad. So, someone you can easily say, "Oh, this person's having a migraine." Well, not necessarily. They may be having a bad headache, but migraine sufferer or migraine symptomatology together may have a headache in it as a part of the symptom. So, all headaches are not migraines. When you say migraine, it doesn't mean just a headache. So, that's the difference between the two.

Host: So speaking of which, what would be some of those things that come with a migraine, not with a headache?

Purvi Saraiya, MD: So, migraine progresses into four or five stages of the symptoms. There is something called prodrome of a migraine attack or a migraine episode. Then, there is an aura symptom. Then, it turns into a headache symptom itself along with some other symptoms that I'm going to talk about in a minute. And then, there is something called postdrome. The fifth part of this is called an interictal part of the migraine, where it comes in between the two migraine episodes or two migraine attacks.

To start with the prodromal symptoms, people can experience a little bit of hyperphagia or they may go have increased frequency of urination, or sometimes they feel too much yawning or fatigue or something's not right type of thing, which may proceed the day of the migraine attack. Around a third of the patients experience another set of symptoms called aura, where people experience some distinct visual disturbances where they feel a visual zigzag or like a scotoma, which we call is a blotchy appearance in the eye field. Sometimes they grow in the size and when you move your head in one direction, it moves with that. Those symptoms are visual aura. The auras can be sometimes verbal or speech disturbances, they can be sometimes numbness on one side of the body. Sometimes they can be a brief episode of confusion type of thing. And these symptoms go on for 15, 20, 30 minutes preceding a migraine attack.

 Now, after that person goes into a migraine attack where that is well-known as a headache symptom, where they now start to have a headache, one side of the head hurts, throbs, pounding, light and sound sensitivity. Sometimes people do experience nausea, vomiting, or both. And that goes on for some time. Once that relieves, the patient may feel the after-effect where they feel drained or fatigued or "I don't want to do anything" type of thing. And that is an entire episode I described.

Now, one thing to know, everybody doesn't have all of these in a migraine attack. You may just have an aura. You may just have the middle part where the head hurts, which is the most common. And the later part, sometimes people feel without having to go through others or sometimes they all happen in different times. So, it is to be understood in the timeline. It is to be understood how the symptoms come and go, and that helps the doctor understand what the symptoms are and how do we diagnose it.

Host: Understood. Very well-explained. So, some also suffer from chronic migraine. So, where's the line that constitutes that?

Purvi Saraiya, MD: There are two types of migraine conditions described. Episodic migraines means number of headache episodes that happen in a month. When they exceed, the episodic migraines happen in more frequency, you may have eight days of these episodic migraines happening in a month and, out of eight days, you may have 15 total days of headache days, so total 15 days. Out of these 15, eight are bad that we call them the episodic migraine itself. So when they're happening a lot, it's not how old it is, usually acute and chronic suggest now and ongoing old. Acute chest pain, now happening. Chronic chest pain, which I've been having this chest pain for a while. It's not like that for the migraine to be understood. Episodic migraine, which means the migraine has happened infrequently here and there. There is a time period between the each migraine attack. You are fine or relatively fine. Where in chronic migraines, the number of headache days are almost half of the month. And out of that, eight days are bad migraine days where you are really affected by it.

Host: Gotcha. So having said that, what are some of the most common migraine triggers, Doctor? And how can people start to identify what might in fact be setting theirs off?

Purvi Saraiya, MD: So, there are two types of triggers that I want to differentiate into categories. One category is my internal category, which is me, myself. And the second category is things outside of myself, the environment, or things that's not my body or me, I call it me. So when I say myself or my body, there are many factors: my sleep, my food, what I ingested my hormones, my stress, my health overall or, as a matter of fact, sometimes people do experience as a part of it, like a mental state of it, these all pertains to me. Where I have some degree of control over it and I don't have some degree of control over it in some of them.

There are other categories called external factors, which means sunlight, weather, exposure to various smells, exposure to various chemicals, environmental factors where things are in surrounding of you, but you don't have any control over.

Now, out of these two, there is a joining category that I call it kind of in between. That's the food, which is external, but you bring it to yourself by ingesting it. That includes food, drinks and all the other stuff that you do to you from outside. And it happens a lot daily, multiple times.

Host: So, what would be a couple of examples of foods that migraine sufferers should stay away from?

Purvi Saraiya, MD: So, there are common food products that we know that they have link in causing a migraine. These foods have a very high chemical called tyramine, and these tyramine content is found very much high in some of the food products such as aged or highly processed foods. This includes certain aged wines, chocolates, certain preserved or canned items where there are some high level of sodium in it that also has been linked. There are many products that some people bring to us and say, "Doctor, whenever I eat this, I got migraines." And some of these products made it to these lists. And if someone can go to a National Headache Society Foundation website, they have a whole list of things on it, they can find it, whatever various things that this is not pertinent to a person or everybody, but they make it to the list as people have reported to us. "Hey doctor, when I eat onions, I have migraines." Well, that may not be true for everybody. But commonly, as I said, the aged products, that the process is in the aging of the food; the one has a longer shelf life, that something is put in that food to stay on that shelf with a lot of preservatives, things like that can cause migraines.

Host: Absolutely. Couple of other things for you. As you well know, Doctor, lot of treatment options out there for migraines from over-the-counter to preventatives and injections that are prescription. What's available in a nutshell? And what are the pros and cons? How do people know where to turn there?

Purvi Saraiya, MD: So first of all, I can start with the last part, where to turn to. When someone is suffering from headaches or migraines or migraine symptoms like I talked about earlier, and these are bothering them to the degree, first of all, they must talk to their healthcare providers. The healthcare provider's job is to listen to you, get your history properly, and then arrive at a proper diagnosis. Once diagnosed as migraine, then the proper treatment or an appropriate treatment is offered.

This starts with actually identifying what is the burden of your migraine, how often this is happening. The doctor or provider may ask you to keep a calendar. They may ask you to hydrate yourself well; get a good, healthy lifestyle. Identify triggers. Maybe they'd provide you a piece of paper. They say, "Hey, find out triggers. When you have a migraine the next time, find out what you ate, what you did. What was your exercise, et cetera." Then, they will identify how often these migraines are happening.

So, there are two processes here. First, I would like to treat the acute migraines with a migraine treatment to take care of that particular episode. If we call it an acute migraine treatment or a migraine abortive therapy where a treatment diffuses or releases the migraine or treats the symptom, this treatment strategies range from an over-the-counter treatment products and some of the prescription products. The over-the-counter treatment products are typically recommended as either acetaminophen or naproxen. There are some migraine products available. By name, a combination of acetaminophen and aspirin and caffeine commonly known as Excedrin Migraine, that can be offered if your symptoms are very far and in between. And they're not severe or they're moderate. A physician or a provider can offer you, say, "Hey, try that. See what happens."

By the time we get the patients, they've already tried it actually, to be very honest, because they're available over-the-counter. If that doesn't work, we may provide specific acute migraine treatments, and there are several class of treatments. There is a class of treatment called triptans and they belong to a group of pharmacological category where it targets certain neurochemical changes that happens in the migraine. So, it's a pretty targeted treatment we call it. There are many various types of triptans available. And one of the proper one your provider can choose for you. This is to be taken when you get a migraine. They may ask you-- here's an important point-- "Take it as soon as you feel the headache symptoms coming on or even a migraine symptom coming on." Remember we talked about migraine symptoms before. There are five stages. So, some of the symptoms may be happening. Early on, you want to catch it and treat it right away. That's the key.

Then, there is another medication group is out there. It's called CGRP groups, which can target another neurochemical in the migraine process. So, importantly, it is extremely important for you to discuss your symptoms with your provider because your diagnosis of migraine needs to be accurate. Otherwise, these products, which is very much targeted for the migraine treatment, may not work and you think it's not working. Now, this is an acute migraine treatment. Now, these acute migraines are happening a lot, a couple times a week or even more, and you may not have a headache-free day in a week. In that case, a provider can offer you a preventative migraine treatment, which will decrease each migraine episode's burden. It may cause decrease in the number of the headache days and may improve your quality of life.

So, these products or these pharmacological agents are many, starting from some blood pressure medications to some antidepressants medications, to some antiepileptic medications, to one of the newer class of medications called CGRP medications. So remember, CGRP medications, which are the newer class works for both acute and prevention. So, they have the kind of a dual help. So, your provider can map out your treatment, maybe go step by step and offer you a prevention for these episodes.

Host: And certainly, the good news based on what you said there is there certainly are a number of options. Finally, in summary, Doctor, any red flags that signal a headache might be something more serious than a migraine and merit seeing a neurologist like yourself immediately?

Purvi Saraiya, MD: So, this is an excellent question. Headache is a symptom, which means something is disturbing the normalcy of the head or brain. The brain is a structure, which is kind of very much deep down, so the brain has several layers around it. And then, there is a skull. And then, in between the skull and the brain, there is hair and a scalp and a hair, and all that structures that we know. So, the problem could be anywhere in this area that may be causing a headache. And so, these are what we call as secondary headaches, which means there is some reason behind it. There is some cause for it. The possibilities could be endless.

But what you need to be careful or you need to be aware of, if the headache happens extremely suddenly, you are just fine and, bam! There is a headache. Something wrong could be happening to you. If the headache is happening with fever or fever that doesn't go down; if headache has some neurological symptom with it; vision loss, double vision, numbness, tingling, weakness, troubled speech, and they all come on all of a sudden in a certain way, there could be some catastrophic conditions happening, and you must contact 911 immediately.

 There could be some other factors that suggest to see the doctor, provider, primary care provider or neurology provider if the headache has some characteristics like when you bend down and headache gets worse, when you bear down, like do coughing, sneezing, and headache gets worse; when headache is changing with the laying position or standing position. So, it gets worse in standing position. It gets worse in laying position. And in between, if there is a improvement, that means that there is a postural change happening, and that may suggest some brain-related conditions or intracranial conditions that may affect someone adversely. So, I think that these are some hints that one should be keeping in mind.

Host: And always, of course, better safe than sorry. Well, folks, we trust you are now more familiar with migraines and headaches. Dr. Saraiya, great advice indeed. We appreciate it. Thanks so much again.

Purvi Saraiya, MD: Thank you for having me.

Host: Absolutely. And to make an appointment, please call Wood County Neurology, 419-728-0625. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. Thanks so much again for being part of Health Matters: Insights from WCH Medical Experts.