Unpacking the Mystery of Headaches

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So download the ladbooks app and give ladbooks a wheel of free spin to get started. 18 plus T and C supply, gamble aware.org. Don't be gambling if you haven't read all the stuff about it. At New Balance, we believe if you run, you're a runner. However you choose to do it. Because when you're not worried about doing things the right way, you're free to discover your way. And that's what running's all about. Run your way at newbalance.com slash running. Hi, I'm Raj Punjabi Johnson, head of identity content at Hubpost. And I'm Noah Michaelson, head of Hubpost Personal. Welcome to Am I doing it wrong? The show that explores the all-too-human anxieties we have about trying to get our lives right. Hi Raj. Hi. Alright, we have one that I'm excited about today. Me too. Are you doing headaches wrong? That's a good question. I recently just started getting them. It's like I'm chalking it up to the fun journey of aging. I haven't really had them before. And I don't really know what to do. I'll just pop an ad-viller or whatever and it helps most of the time. But I'm kind of like, should there be a lifestyle change? Should I be lying down? I have no idea. What about you? Yeah, I know nothing about them. And that kind of freak out. I'm not going to be lying down. I know nothing about them. And that kind of freaks me out. And they seem so mysterious. Do you get headaches? I do. But I don't know why. And I don't really know why they go away. I'm the kind of person who doesn't like to take medicine. Yeah. So I kind of just like tough it out. Sure. Which also seems dumb. Not dumb, but not compassionate to yourself. Yeah, and like just take it and feel better. So yeah, I am excited to learn like, why are these happening? What even is it? And how do we do it better? Well, who do we have today? Alright, so today we have Dr. Christopher Gotchock. He established the first headache medicine program at Yale. And he's also a professor and treats patients there. Get our lives. Gotchock. Dr. Gotchock, thank you so much for being here. We have so many questions about headaches. Glad to hear it. I'd love to talk about them. Let's start right at the beginning. Because I feel like there's such a mystical, mysterious thing. Medically, when we talk about headaches, how are we defining that? What is a headache? Well, in the simplest terms, it is still true that the term headache, which is a, an everyday term, a copial term, means any form of pain in your head. So there are different things that can do that. You could have trigevenal neuralgia. You could have migraine. You could have cluster headache. You could have a terrible sinus infection that does find pain in the head, although that's actually a very rare bird. But the general term headache, which is part of the official field of medicine, called headache medicine, refers to the entire spectrum of things that can cause pain in your head. And although there are many, many different things that theoretically can cause pain or occasionally cause pain, it's also true that our main message is almost everything that people talk about when they're talking about a headache. And that point is something that we're still working on trying to get people to understand better. So what's a migraine? How would you define a migraine? So there are official criteria for that. But the simplest way to put it is, if people have headaches that are getting in their way, if people have headaches that mean they have to stop what they're doing or slow down, or do something different ever, that is almost certainly migraine. So it's more of a category rather than a cause. I guess what you're saying is, and I've never thought of this seems so simple in a way, but a headache is really defining a pain, but it's a symptom of something else. Well, that's an interesting point and a really worth talking about. So yes and no, in our field, or the way we sort of divide this up is, we talk about primary headaches and secondary headaches. Primary headache means the headache is the disease. You have episodes of head pain and everything that goes along with that. And that's the whole problem. It's not a symptom of a brain tumor and aneurysm and infection, whatever. Yes, it's true that any of those bad diseases will also give you a headache and other symptoms. But for reasons that are still not at all clear, most of the time when that system gets set off and gives you that whole set of different symptoms, that is the disease. It's simply that you have a hair trigger. In technical terms, the stuff on the inside of your skull, the covering of your brain, called the meninges, the blood vessels, the veins, etc. Those are all innervated. The nerves that give you sensation to those structures are part of your trigeminal nerve. And they're there to tell you if there's a serious problem. If you suddenly get blood in your spinal fluid from an aneurysm, if you have an infection that caused meningitis, whatever, it will set those nerves off and you will have what, for all intents and purposes, looks like a terrible mind ring, throbbing pain in your head, nausea, sensitivity to light, etc. So yes, those are symptoms of an alarm that's gone off in your head. But amazingly and surprisingly, most people, including most doctors, almost all the time when those symptoms exist, it isn't because of one of those things. It's just that somebody has that that happens a lot, or happens from time to time, but really bad. My mind is already like, balloon and we're three minutes in the same. I know, I know, I know, I'm both terrified and comforted somehow. Okay, so let's start with what are the common causes you see of someone getting, you know, like a level three or four headache? Like something that's annoying. Well, so it depends a little on what you mean by that. So if you're saying people get bad headaches and what we now know is that that's almost always a migraine. Why does a bad migraine happen? Is that what you're saying? Yeah. Yeah. So that's another part of the demystification and the mythology of migraines, I like to say, is the whole concept of triggers is just completely wrong. So we've all grown up with this world telling us, oh yeah, if you get headaches, it's probably because you are dehydrated. It's because you're stressed. It's because of weather changes. It's because of some food you need and all those things. We have studied all of those things. None of them is true. Wow. I mean, I knew that this was like constantly developing headache medicine. I knew that, you know, because I read different things every day. And it's like, it's in your head. It's hard to do testing on this, but this is wild. Yeah. The in your head thing is a big part of the problem here. And it relates to the terribly stigmatized view of headaches that exists. So multiple strikes against you, right? Headache is an invisible disease, meaning when you have those symptoms, there's no scan or blood test or biopsy that can say, oh, yes, this is migraine. So you have to take people on faith that their symptoms are real. And, uh-oh, there are many more women who have migraine than men, which of course means they're exaggerating. They're making it up because women are hysterical and they lie. They exaggerate. And they're fragile at all those ridiculous ideas that inform how we listen to women as opposed to men when they say they're in pain. So all of that is happening when somebody said, my head is feeling me and I feel like I want to puke. Mm-hmm. But I'm also thinking of some things like I was having really bad headaches when I was waking up in the morning and I didn't know why. And I went to the dentist and he was like, you're grinding your teeth. You need a mouth guard. And I got a mouth guard. It was $800. I wanted to jump out the window. But it has changed my life. It is literally my best friend now. Yeah. And I freak out if I miss one night without it. So in a case like that, that is something that is causing it, right? Yes. And part of that gets to, yeah, there are a few specific conditions that can cause pain in your head or that can even make migraine worse. So either what you have is simply what we call broxism, grinding, sort of compulsive, grinding of your teeth while you're asleep. And that will make your head hurt by the time you wake up. So if one of a headache doctor had talked to you about that, like what exactly were you having? Was it just achy pain in your temples and jaw? Or did you have throbbing pain? Did you have sensitivity light? So my guess is the headaches you were waking up, we wouldn't even call migraine. We'd say that's something else. And sure enough, treating the grinding did it. But the next thing on the list there would be, or maybe you even had some degree of sleep apnea. Because no question a person who has even a little migraine and then has sleep apnea, the migraine gets much, much worse. Because that repeated intense stress overnight of not breathing just drives the whole thing through the roof. So that's one of the things we look for most commonly. If someone comes to me with a lot of migraine, I'll say you need a sleep study because half the time that's half the problem. Wow. Yeah, I feel like not good sleep is the root of so many symptoms, conditions. Also true, but let's talk about that, right? So when people are asked what do you think your triggers are for migraine? Stress is always number one. Lack of sleep is right up there, weather, and so on. So we have studied this. So apparently if people don't sleep, well, they get a headache. So you measure their sleep quality with a device for nights in a row. And then you look at whether or not a headache happens and there's nothing there. There's no, we can't find any evidence that getting less sleep or bad sleep is actually causing it. However, people will say, well, yeah, I wake up and I'm tired. And then later that terrible head, what does that mean? That's what we've come to understand is there are all kinds of symptoms of migraine that develop hours or even a day or two before the headache. So your brain is getting ready to have a migraine for a long time before the actual thing happens. And what are the symptoms of that being in what I call first year of migraine is feeling really tired or irritable or having trouble concentrating or lights are bothering me and smells or nasty. And then you get a headache. What we've been taught to think is well, there you go. Being tired gave me a headache or right lights gave me a headache. No, no, no. Your brain is on alert because migraine is about to happen. And so you experience the world differently for some number of hours or more. That is something you can learn to identify. And then you can jump in early like, oh, yeah, when I feel like this, I'm going to get a migraine. And there's medication you can take where there are techniques you can practice that might turn the corner in the better direction. Before we get into the intervention, I have to really go back to dehydration. Are you saying that dehydration is not necessarily linked to headache? Because then what about hangover? Like tell me what you know about this. That's a good question. So yes, I can say dehydration is not a cause of a migraine event. And on the other hand, the physical trauma of hangover is enough to among other things set off your headache system. And yes, you're right that drinking a lot of ethanol means you dehydrated cells all over your body, including in your brain and your nerves and all that. And so you wake up with something is really wrong and that system is running like crazy. But outside of that, many people who get a migraine say, oh, I feel really dehydrated. That must be what's wrong. When in fact, what that is is migraine doesn't just cause pain. It causes the nerves that control the lighting of your nasal passages to change. So symptoms of migraine are dry mouth or runny nose or puffy eyes or any of those things because migraine sets off lots of nerves, not just the nerves that control pain. I mean, I'm still trying to get my head around this. I'm definitely not smart enough for. So most of us are experiencing migraines, even though most of us would say, like I would say, I've never had a migraine, but you're saying we're thinking about it absolutely in the wrong way. Correct. So here's an example, 20 years ago, somebody who was interested in this idea did a big study. They took 100 different primary care practices in 10 different countries and they said, all the people who walk in the door and say, I get headings for the next few months, we're just going to look carefully at them. So over a thousand people walk in and say, I get headings and the question is, what's the chance that that turns out to be migraine? And when I ask even other doctors that question, they say, oh, I don't know, 50% or something because there's all these other things. Yeah, no, the answer is 95%. Wow. So if a person says to a doctor, I'm getting headings enough that they need help. It is migraine to prove another was, and the chance that it's aneurysm or tumor or whatever is like two or three percent. And it's not hard to tell when that's the case. So for the most part, if headings are getting in people's way, that's what's going on. Even in the emergency room, people coming in with, oh my god, I'm terrible shape. Same statistics. It is almost all migraine. So looking at the criteria, well, how do we define migraine? The migraine, the pain has to be two of severe throbbing, one side of your head worse with activity. And then it has to cause some sensitivity, lighted noise or nausea. All of you know, some combination of those. So the problem is everybody agrees if you have a terrible one-sided throbbing headache that makes you lie in the dark and throw up, that's a migraine. But the same criteria say that a moderate headache on both sides of your head that's not throbbing, but is worse when you try to do stuff and makes you queasy, that's still a minor. And that's where people get tripped up. We have this idea that muscles in your head can give you a headache. Yeah, not really. Maybe in something like, chewing your, you know, grinding your teeth all night, that eventually hurts. But that's not the same as throbbing pain that's worse with activity and nausea in the daytime. Right. Or if a feeling of pain in your head when you have a sinus infection or a cold, that would not be migraine either because that is being caused by a specific localized thing. Right. So somebody who has bad allergies or a cold will say, yeah, my head feels stuffy and kind of achy. But the notion that sinus headache is a problem, sorry, no such thing. Right. Even the idea of sinus headache, where, where does that come from? That came from advertisers on Madison Avenue in the 1970s trying to sell signing. And they came up with this term. And it worked well. There's a lot more signing. But then doctors were like, wait, who's idea was this? And sure enough, if you take a hundred people who say, I have signed his headings and you ask them careful headache questions, 90% of them have migraine. Every parent less the key to unlock their child's potential. A future where they learn the skills they need to succeed. Whether that's getting a job or further study, but the key isn't a key. It's the support you give them. All right, done. Thanks, you're prune, and that's all. I've been reading about technical education and it looks a business. Technical education opens doors for your child. Search talking futures to find out how T levels, apprenticeships and HTC's can unlock their full potential. Hey, it's Anna and Mandy from our podcast Sisters in the City. And we're currently sponsored by the department for work and pensions. Life's busy and admin gets forgotten. But if you're claiming benefits, listen up. If something changes, you need to tell DWP. Otherwise, you could face a penalty. That could be a partner moving in, even if they keep their own place. Or if your car doubles up as a taxi and a family car. You must only report work related costs. Or forgotten savings like premium bonds. To find out if you need to report a change, search tell DWP. This is an ad from BetterHelp. Some days, it feels like you're carrying something no one else can see. Stress, grief, responsibility, the kind of heaviness that doesn't show up in photos but follows you everywhere. You don't have to hold it alone. With BetterHelp, you can talk to someone who helps lighten what you've been carrying for far too long. Take the weight off. Start therapy any time from anywhere online with BetterHelp. Visit BetterHelp.com slash random podcast for 10% of your first month of online therapy. Okay, I have a follow up. So why does allergy medication like Xeritech work for me when I have a quote unquote allergy headache? Well, so that says the type of pain you have is related to inflammation in your nose. Got it. Okay. But if we if we talk to you when you had one of those headaches and ran down those different features of headache, I would guess that you would absolutely right wouldn't sound like migraine. It's different kind of thing. Yes, accurate. All right. We have a question from a listener Katie saying. Again, I feel like all bets are off now. Now that we're in this weird new world that I didn't even know existed. She's asking if the location of a headache, so say it's in the front of your head versus the back of your head or the side of your head. Does that make a difference? Is there one that means like, oh, I should drink more water versus I'm getting sick headache? Excellent question. Surprisingly enough for the most part, the answer is no. So the trigeminal nerve is the nerves that gives you sensation to the upper part of your face, the eyes and forehead and the cheek and the jaw. And so that's where we think of headache pain being is right around your temples front of your head and sometimes in the back. But it turns out that the nerves in the back of your head are literally connected to the trigeminal nerve in your brain still. So all kinds of evidence that shows if you do something that's going to make your trigeminal nerve irritated, the nerves in the back of the head will come along with it. So that fact that 75% of people with a migraine will say, oh, yeah, my neck starts out feeling really stiff and sore. And people think that means somehow your neck is given you a headache on the contrary. Headed gives you pain and other symptoms in your neck. So for the most part, that location thing doesn't matter. Sometimes it does. People who say, I always get painted back in my head and it seems like it happens when I get up and I'm upright. But if I lie down, it goes away. That's actually a pretty common story for what we now know is more common than we thought, a spinal fluid leak. So a headache that is there when you're up and goes away when you're down, that definitely needs someone to look into. Well, it sounds scary. I don't even like the phrase spinal. Don't love it. Yeah, fluid leak. We have another listener question that I want to know too from Angel. Are some people just more prone to getting headaches? Sure. And that's the thing that we're trying to understand better. It's very clear that if you have people with migraine in your family, you are unfortunately more likely to have migraine as well. But then there are people who get migraine two or three times a year and they're people who get a migraine two or three times a week. So what's going on there? Well, it's hard to tell, but some things are pretty clear like having had a head injury is means you're much more likely to have headaches. And you're more likely to have had a headache all the time. Having sleep apnea means you're much more likely to have had a lot of time. And importantly, if the medicine that you take to treat a headache doesn't really work very well, then you will end up over time with headache all the time. Now, we used to call that medication overuse or rebound and basically blaming the victim, right? You have had a lot of time, you take this medicine, apparently you've made yourself sick. And that's not really, turns out not really correct. What we should be saying is, gee, I guess that medicine doesn't really work. That's right. You would have a headache, take it, and stop it, and you'd wait until the next one. But if you take something that just kind of kicks the pain down the field for a few hours, then you're going to need to take it again. And again, and again, and again, and eventually you would look with some headache almost all the time. That is a problem of not the right medicine, not good enough medicine, but not that medicine makes you worse. We want to get into the medicine in a second, but I just want to know before we get there, how often is too often to be getting a headache? When should someone come and see someone like you? Is there like three times a week, six times a week, or is it just like when it starts to intrude into your life and makes your life not livable? It's the last one. If you ever have headaches that ruin your day or take you out of commission for even a while, you deserve good treatment because you don't have to live with that. The point I met to other doctors all the time is years ago, something called the Global Burden of Disease Study, was set up around the world to say, what diseases caused the most trouble? Like how do we decide what we should focus on policy issues? So they came up with the idea that the only way you can compare illnesses is to think about how much disability they cost. A disease cuts your life short, cancer, heart disease, or a disease means you spend a lot of time or some of that of time disabled. You can't do normal stuff. So when you measure disease that way, migrating is the most important cause of disability in the world. Wow. That makes total sense, though. And absolutely, because it happens over and over again, it might be two hours, it might be 12 hours, it might be three days, but it's your for decades. So in that same context, you can say, a bad migraine, that's the same as quadriplegia. You can't move, you can't talk to anybody, you can't get out of bed, it's the same as being paralyzed. And then, suddenly people think about it differently. If you were quadriplegia twice a month, I think you probably go see a doctor. But somebody gets a migraine a couple times a month and you're like, oh yeah, I just need a drink more water. Not really true. What you need is good treatment. Yeah, it's scary. I mean, migraines are debilitating for a lot of people. And then if you don't figure out the medication, which we're just about to get into, my mom has tried geminal neuralgia. And she found a medication that is working for her. And before that, it was, headache a lot of times, you know this, like people come to you because it's a mystery. You're like, what am I doing? Like, what am I missing here? And you're, you know, for two, three hours of the day, even like missing out on life. And it's, you got to find out what's going to make you feel better. And it's out there potentially, you know, let's start with the kind of over the counter stuff for people who just have headaches. They're not migraine, they're not sure what it is. A set of menophaned, which is Tylenol versus ibuprofen, motrin, adveil. Like, what works better? How did those work? Can you tell us a little bit about that? A little bit. So in general, the so-called NSAIDs, the non-sterroidal anti-inflammatories, which is ibuprofen, proxen, etc., but not Tylenol, those are generally better than Tylenol. Although there are people who say actually Tylenol works pretty well for me. And that's okay. But those are just one part of a formula or a recipe for a good treatment for an attack of headache. And again, what really matters in the end is does it work? So what we want to be true is if you get a headache and you take whatever it is, that should be totally gone within two hours. And it doesn't come back. And that has been the FDA definition of a clinical trial of a drug for a migraine that works for 30 years. I meet people all day long every day for decades with headaches. And the first thing I say to them is, I would like to be sure that when you treat a headache, it's gone in two hours and doesn't come back. And they're just dropped. They're like, that would be amazing, which makes me feel good. But it also says, apparently nobody bothered to mention to you that this is the way it's supposed to be. Right. But don't believe that that's possible. And yet, we have all kinds of tools that can do that. And what we see over time is that when somebody has the right tools and uses them to snuff out ahead of a fast every time it happens, they do great. And they get better over time. But somebody who says, yeah, you know, it takes the edge off, get worse. You know, I don't know what actual medication this is, but you know what's my girl, a leave. That's the problem. That's the problem. And I agree. That's the drug I prescribe for people as an anti-inflammatory for headache routine. I agree with you. Knocks it out for me in 30 minutes. I don't mean to be advertising a drug. We're not getting paid by a leave. No, we're not getting paid by a leave. It's that money. But truly, headache is it's terrible when you have it. So you want to find the thing that's going to make it go away quickly and then stay away. Well, I want to get your thoughts too on medicines that say they're specifically for headache. I think there's one called, etc. And tension headache relief. Is that just marketing or is that doing something? No, etc. and my brain is the same as etc. It's just label differently. I love it. It's like when they had those pens for women, but they were just pink. I can't not. And it's like, it's just a pen. Oh, okay. I have a question about the marketing on that. Does the placebo effect work in your opinion? Do people buy this marketing enough so that their headache gets better? Or it's an exaggerant anyway. Both are true. So I mean, etc. can work pretty well for a headache. And even for a migraine, if it's, if that migraine is not too severe, if it hasn't been there for too many hours, one or two, etc. can work. And if it does, great. You're all set. But what I care about is most people who have headaches have them in different levels. Sometimes it's not a big deal. Sometimes, ooh, this took me by surprise. And sometimes I wake up and I can't move. And the point is you should have a toolkit that is ready for any of those. If you wake up with a raging migraine, some exception is not going to cut it. But there are things that can actually turn that off in an hour or two. Or you start to feel that crazy, funky way that you do before a migraine. And you can tell that this is going to be a problem in a few hours. There are things that you can take then that will keep it from getting there. Just a slight digression because you've mentioned this. Why do headache and nausea go together? Because really, the only times I have a bad headache, I want to barf immediately. Is it just like a direct... It's just like a direct... So that's technically because in the brainstem, the trigeminal nucleus, where all those fibers go first, is directly connected to the vagus nerve, the vagal nucleus, which controls your entire geriatric. So with an episode of something irritates your trigeminal nucleus, along with that comes nausea or even vomiting. And even if people only have a little bit of nausea, they also have what we call gastroparasis, meaning their stomach stops working. So fairly early in a migraine, your stomach is offline, which means you throw some pills in there, they may just sit there. So half of the thing that people say of like, yeah, if I get enough excision in early, if I take this smother and fast enough, yeah, because if you do it fast enough, it actually gets into your body. But if you miss that boat, it just sits there. And that's why we commonly prescribe an injectable medicine for a migraine, or a nasal spray that gets into your... That doesn't need your stomach, because they get around that problem. You know, Dr. Gachok, I just have to say that I feel so much better understanding the biology of this. There's some guilt that comes along, especially as women, or like, there's guilt that comes along with feeling shitty. And feeling like it's your fault somehow, or that you're exaggerating it or whatever. But understanding that just that simple biology that he explained to me, actually be like, no, my body is malfunctioning right now, F you. It's not your fault. Yeah. It also makes me think that our bodies are such wonderful and also terrible things. Like, I just, you know, Raj, I just want to say I really appreciate you saying that. And that's a big part of what we try to do, right, is if people understand better why all these things are happening, what they are telling us, and why it makes more sense to do this than that, then everybody is better off. And people don't get headed because they're lazy or fragile or anxious, or whatever that embedded notion that it's a sign of some kind of moral weakness, absolutely not. But it's out there every day. No, I appreciate you because you're doing this psychological work alongside the headache. That's important. We got a question from Matt and he has chronic headaches and he said, is taking Etc. Or ibuprofen one to two times a week bad for my liver, kidneys doing other damage to my body. Should I be worried that I'm taking pain meds too often for my headache? Well, I think it's the right question asked, could I be in general? I would say if it's really once or twice a week, probably not. And if you compare Tylenol with any of those other things, aspirin ibuprofen, the proxin, Tylenol is the one that has a much higher risk of liver damage than it should. If Tylenol were presented to the FDA today to be approved, it would absolutely be a prescription-only drug. Because every year there are a thousand or two people in the US who either die of liver failure or need a liver transplant, just because they've taken too much Tylenol. So it's a real thing. And that's not likely to happen with things like ibuprofen, but ibuprofen and its cousins can irritate your stomach, can cause bleeding. So once or twice a week, probably not a big deal, but next time you see your primary care doctor, you should talk about that. There's a couple of tests to do to make sure that things are okay. You know when I was living down in New Orleans where the drinking culture has even bigger than here? My friends taught me that you never drink while you've taken Tylenol. Apparently it's very bad for your liver. And I love that it's just a widespread culture, but they know how to not screw yourself over a long time. They're like, take an ibuprofen if you need to. Don't do the acetymidaphean and alcohol. And I'm like, okay, Dr. Drunkie, let's go. I love that. Probably a hard learned lesson, but definitely good choice. Beyond medication, there are some like old wives' tales. I've heard one is if you stimulate a pressure point in your hand, in between your thumb and your finger, that can help with headaches, is that have any truth to it? I think it's probably the kind of thing that has some use for people who have relatively mild headaches. So, yes, whatever it is that acupuncture points and acupuncture points are telling us that we don't really understand physiologically yet, something about having headache makes that a sensitive spot and pressing it either distracts you a pain system a little bit or relaxes something that can give you a little relief for sure. But there's no study that says you can stop a migraine by doing that. Can we continue to ask about natural remedies that some people we know anecdotally have found relief from and ourselves? For me, this is so crazy peppermint oil on the temples or just smelling peppermint oil. It has really helped me. Is that psychological? Is that placebo? What's going on there? No, I don't think so. And that's an example that, again, we wish we understood more deeply, but a migraine means a combination of the nerves on the outside of the head become sensitized, become more sensitive than normal to things, and also inside the head. So, the part about, you know, I get a migraine and, ooh, I got to take my glasses off, don't touch me. I can't take a shower. My head is on fire. Is literally sensitized nerves and peppermint, menthol. Those are things that cool off those nerves. It's almost like an ovecane. So, yes, it'll actually cool or relax those nerves in the outside a bit, and that maybe helps nudge the whole process in the right direction of cooling down. If it works, super. What about caffeine? And I also have friends who get, quote unquote, I don't even know if I'm using this term right anymore, headaches because they haven't had their morning cup of coffee. Yep. What's going on there? So, no question that caffeine withdrawal will cause a headache in most people. And the more you drink, the worse it'll be if you try to stop suddenly. And interestingly, if you are somebody that has had migraines from the time to time, and you suddenly start drinking coffee, you're more likely to get a bad headache, something that feels like a migraine. So, whatever the exact biology of caffeine is an adenosine antagonist that it changes something about the way nerves are functioning, your body gets used to a certain level of that. You suddenly pull the rug out and the system flips out a little bit. However, you go through that withdrawal for a couple of days, you're done. And then the system has reset, and you can, you don't care anymore. But on a short term basis, it feels like caffeine withdrawal is a problem. Yes, so you either gently taper down over time, or you just keep doing what you were doing. But over time, people in the headache field, there was a time when people thought that was the main thing. Like, anybody with headaches can't drink coffee ever. That's definitely an overstatement. Okay. One more that works for me, 95% of the time, is a small dose of cannabis, a little edible. I know there's like limited research, but what do you know about weed for headaches? So it's still a very mixed bag, right? There have been a few small studies that try to look directly at, either in just in THC during a headache, or people who have a lot of headaches, if they start having a daily dose, does that reduce it? And it's basically some of the times it helps, and a lot of the times it doesn't, and it's not clear why, is it about getting the ratio right, and the dose right. We know for sure that there are cannabis receptors in the brain, so they serve a purpose, they have a function in your body, but how exactly to take advantage of that in headache is not at all clear. For the most part, what we have so far says it does not appear to be one of the better tools that we have, but then for some people it seems to be a pretty good thing. Well, when you're ready to work on your next clinical trial, I volunteer, it's tribute. Well, let me tell you that the one that has this really excited in this area is psilocybin, right? Oh, wow. Oh, I know, I know, I've been reading a lot about that too. That's so cool. Can you say, are you, do you, are you a believer? Like, do you think? It's not even a believer. There's no question that psilocybin and other serotonin and agonist drugs that happen to be psychedelic are phenomenally effective, my, our headache drugs. So how do we know this 25 years ago, some Irishman posted on an internet chat board, I think LSD cured my cluster headaches. Oh my god. Turns out he was wrong, he was actually talking about psilocybin, it doesn't matter, but just having said that, he set off a worldwide investigation of by-heading, by cluster headache patients, if this is true, we got to know more about it, and they now have an international group called cluster busters has a scientific meeting every year where they talk about having refined a protocol of tiny doses of psilocybin, five or so days apart, two or three doses can shut off cluster headache for months. And at Yale, one of my colleagues is studying this in doing controlled trials. Dr. Schindler has studied psilocybin for migraine and cluster headache, and so far the data says, yep, absolutely. And it's no surprise at all to us because the first approved drug in US history to prevent migraine, a drug called methasurgide, was basically a drug that was produced basically a derivative of LSD. It was produced by the same chemist Albert Hoffman who created LSD out of her body, and this is a non hallucinogenic cousin of LSD, works fantastically well to prevent migraine. Unfortunately, that particular drug was turned out to cause very rare serious side effects so they pulled it off the market. But there's many lines of evidence that show these drugs that have a strong certain type of serotonin activity are fabulously effective and also are telling us something about the biology here, right? Cluster headache means I go into a period of time where I get attacks of the most severe pain known to human beings multiple times a day. It might only last 15 or 30 minutes, but I would rather shoot myself than have another one of these. And then that lasts for weeks or months, and then suddenly stops. No one has any idea what turns out on or off. But what psilocybin will do is you start into one of these periods, you take a few small doses, and it stops. That is so cool. So that says there's a switch that this drug can flip that switch. No one knows what that switch is or where it is. We just need people to get funding to study that and figure it out. That's really cool. I mean, I've been reading so much about psilocybin and treating mental illness, the potential for that. This is newer to me. I'm really enjoying the destigmatization. It's the plant medicine. Yeah, I love it. Yeah, okay, I have a question for you and I almost regret asking this. Can a cluster headache be a migraine? Is a migraine a cluster headache? It's just that that this I know they're not. No, but it's a great question. So on the one hand, there are people who are so unlucky that they have both. That's a different problem. But if you know how to ask the questions the right way, a cluster headache is easily distinguished from migraine. Cluster headaches only ever happen on one side of the head. They are a very brief, 30 minutes on average. And they always have so-called autonomic features that go within attack. So you have intense pain and a runny nose or a red eye or tears. Those autonomic things often make people think it's a, quote, unquote, sinus problem. And they try for a sinus, whatever until somebody says, yeah, that's apparently not right. But the fact that they're so brief, so intense, and have those autonomic features makes it pretty easy to distinguish from my migraine. Okay, got it. If we feel a headache coming on, what can we do to prevent it from becoming worse? Are there things we can throw at it? Is that when we take the medication right away? What have you learned in your research about that? Well, so the thing we can say for sure is that, yes, the sooner you take a good effective migraine treatment, the better it will work. Okay. So if you take, for example, the triptans, things like inattrics, maxol, rail packs, the ones that have been around the longest, we've careful research has shown they work really well in the first hour or two, maybe three of a migraine. But once you get past a certain point in migraine and the head becomes sensitive, they don't work anymore because the migraine has literally, literally moved from the outside of your head to the inside into the brain. And those drugs don't get in there. So that's when you need an injection of something or some IV treatment or whatever. But the practical take home there is, if you intervene early, you're much, much more likely to be successful. And then a more recent study with one of these fancy new drugs, right, we have Nurtek and Ubrelvy, we've had all these ads. They are totally different in terms of their biology from something like image checks or maxol. But those are perfectly decent medicines to take for a migraine attack, especially if it's not too severe. But they last in your system quite a while. So some smart person said, well, let's just try this. Take a bunch of people who recognize their pro-drome. I know that if I feel sensitive to light and queasy or I'm really irritable and foggy, whatever that is, that I'm going to get a migraine in the next six or eight hours, take the medicine then before you have a headache. They were half as likely to get ahead. So at least we can say there's an example of if you are mindful and you know where you are in the process, you can intervene and completely turn it off. Amazing. So could that be true about meditation, about deep breathing, about some kind of exercise? Probably. We just need to look. That's cool. That's very open minded. Mine's kind of related to that. I was telling Noah that the worst headache I've ever gotten in my life was when I was landing in a small plane in the Caribbean and the plane that was flying really low. It was kind of lingering before it landed. I still don't understand what happened. It was such a bad headache and then as soon as the plane landed, it ended. It was the pressure thing. And what should I, like, the intervention? Like, what should I have done? What should I take with me on the plane? That's a tough one, but there's a good chance that that really was related to the sudden shifts in outside pressure, a barometric pressure that go along with your up high, you drop down, the pressure shoots out. It's in a small plane. They don't regulate that pressure as well as in a big plane. And you may very well have had one of the little airways in your sinuses got stuck. And you suddenly had a high pressure in one of those that just felt like the end of the world and then once that opened up, you were fine. So that's an example of an off brand of what can cause bad pain in your head. And is there anything I could have done or could do to prevent that from happening again? Like a medicine? Maybe in a situation like that equalizing the pressure, holding your nose and then blowing hard or maybe if you had some nasal spray that would open up your passages that could have helped. So those are possibly things that would fix it. Free medical advice, Al. Exactly. You just send us the bill. I guess for the last question, this is one that I think is really interesting. It comes from Caroline, a listener. She said, I became terrified of brain aneurysms after a friend's mom died after complaining of a headache one day. When should we be worried about a headache? Are there any symptoms or situations that would make you say go see a doctor ASAP? A question. Super question. And yes, so the most, the main rule there is if you suddenly get the worst headache of your life, especially if it's something that went from zero to 60 in a minute or two, you should call an ambulance because there's a chance that that's something like an aneurysm. Even in that situation, the chance is maybe 30%, but that's much, much higher than somebody who says, yeah, I get bad headaches here and there. So a sudden, severe, explosive headache that makes you miserable and sensitive to light noise, that probably deserves a workup pretty fast. Other than that, it's, you know, we're mostly talking here about people who are in middle age, right? 20, 30, 40, 50 year olds who get headaches, it's almost certainly mind-brained. A person who starts to get headaches for the first time in their life when they're 60 and they're having trouble walking. Yeah, it's probably not mind-brained. That deserves some evaluation. But for the vast majority of people walking around the street who get headaches, it's just a matter of getting access to the right treat. So we wanted to close with one more and then again related. Is there anything we can do preventatively to try and alleviate or lessen the headaches in our lives? Just lifestyle choices. You know, like lots of physicians that come in here and talk to us. At the end of the day, they're like, try to eat your veggies and be active. Gets sleep. Gets sleep. Super important. Is there anything you would say that you would implement in your own life to avoid headaches? Well, it's not so much I think about avoiding headaches as those, that kind of advice is true for just general health. That yes, it's true. If you eat healthy and you have good exercise and you get regular sleep and you practice any form of mindfulness to destress yourself, all of those make your quality of life better and are at least going to prevent you from making a disease that you have worse. So, and that's whether it's high blood pressure or seizures or you name it. A healthy lifestyle is only going to help you. But the flip side of that is what we're trying to get away from, which is it is not true that people get headaches because they're not taking care of themselves. Right? That's just blaming the victim. And figuring out how to say that in a way that says, sure, take good care of yourself. It's good for anything that else you, but it's, but you don't have this problem because you aren't living right. That needs to be. That feels great. A couple of messages. Yeah, that's beautiful. That feels like so permissive. Because I'm definitely not living right. But I'm trying every day. Not at all right. I'm trying every day. So, so, right, let me just, you know, riff on something you said a few minutes ago about feeling relieved that this was not something you're doing wrong. So, about two years ago, a friend of mine, a colleague, Bob Shapiro and other colleagues published a study that said, well, let's take a look at stigma and how that impacts people with migraine. So, you know, look at some measure of quality of life with migraine. How often is it true that migraine means you can't be a good partner, a good husband, a good father, a good worker. And no surprise, the more days of migraine you have in a month, the worse your quality of life is. Then they asked, how much of the time do you feel stigmatized? How much of the time do you feel like people are saying to you, come on, you have a headache. So, the why? But it doesn't get in my way. So, what's the matter with you? Why are you exaggerating or worse? Yeah, sure. You have a headache, right? You have a hangover or you forgot that your kid's recital is today and you just want to say that you have a headache. I mean, you know, headache is not really a thing. So, when you ask people about that and you look at, if somebody experiences stigma all the time about headache, their quality of life is much worse than somebody who never has that reaction for people. To the point that you could have 30 days of headache a month, but if you live in a compassionate environment, your quality of life is much better than somebody who has two days of migraine a month, but who feels like everyone thinks they're full of crap. Wow. So, that's my knowing. Yeah. So, how the world sees you and your disease has a direct impact on whether or not you can function. I'm sure that's true of many illnesses. Absolutely. But here with migraine, it's saying, if people are giving you a hard time about this, somebody needs to do something to educate them because that's just crazy. Wow. That's a beautiful takeaway. Yeah, for sure. Dr. Gotchock, thank you for this. I feel like I might IQ. I feel like I need to go lay down. Yeah. No, truly, thank you for imparting your wisdom path. That's because I think there are a lot of misconceptions. Yeah, it's great. Well, I appreciate the opportunity to talk to you both very much. This has been a blast. Hello, we're Jane of Fee from the Off-Air Podcast. And we're currently sponsored by Stripenstair. Stripenstair, Nickers, are some of the softest things I've ever worn made from breathable wood fibers. They're perfect for women juggling a million things at once who want to be stylish and comfortable. They've got 10 shapes in sizes 6 to 22, so there's a fit for everybody. Plus, their sleepwear is like sleeping in a cloud. Oprah and Vogue are obsessed for a reason. Go to Stripenstair.com and use the code Off-Air 20 for 20% off. Amazing deals on package holidays. Pay now. I've got tickets to that sold out show. Message now. Your subscriptions been suspended. Update your payment details. Final warning. To receive your package, pay the fee immediately. Mom, I've had an accident. Please send money. There's been suspicious activity on your bank account. And I need a few personal details. Fraud is getting more sophisticated. Always stop, think and check. Stay ahead of scams at gov.uk slash stop think fraud. Back from holiday with everything stained and smelly. Here comes another long day of a laundry. This calls for new vanished turbo. Pick crew with me. New vanished turbo removes dust stains and works against odours with intense freshness on a quick wash. Even a 30 minute one. Affirmative. Vanishes unique accelerator turns every quick wash into a deep clean. All good to go, Mom. Quick wash on. Deep clean done. So clean, so fresh, so fast. Trust vanished forget stains. Okay, it's time for better and five. These are our top five takeaways from this episode. Number one, okay, it's going to blow your mind. But most of what we refer to as a headache is actually a migraine. I still can't believe that. Number two, headache pain can be caused by specific things like grinding your teeth. But that's a different phenomenon. Okay, number three, this is one that I can attest to. Advil, Motrin and Alive tends to work better for headaches than Tylenol does for most people. Yep. And the earlier you take it, the better. Number four, if you're experiencing sudden severe pain, you should go see a doctor immediately. That might mean something dangerous is actually happening. And number five, having headaches is not a moral failing. And the stigma that comes with them can be super damaging to our health. So we want to remind you that if you have a question or something you want us to investigate, you can email us. It's am I doing it wrong at halfpost.com. We love to get emails. We love to get ideas. Some of our best episodes come from your ideas. So hit us up. That being said. All right, Noah, were you doing headaches wrong? Absolutely. This is one of those episodes where like I didn't seem to understand anything. Do you have a headache now? I have a headache right now. But what I learned is that that's not my fault actually. Yeah. And we shouldn't be so hard on ourselves. I like this whole thing about the compassion and the stigma. The idea that like if you have you're in a community where people are supporting you and you have bad headaches a whole month, that's better than having really bad headaches two days a month, but having no support. That really, I thought was kind of a beautiful thing for him to tell us. Mel did my cold, cold heart truly. Have you been doing it wrong? I've definitely been doing it wrong. I think there's again this societal idea, especially for you and I don't love running to the drugs unless it's weed, that you like wait until it gets really bad or whatever. And I love that he reiterated like if you start to go down this road, do what you need to do to feel better. You know, don't be a soldier and I'm going to react quicker. I will say though, this is one of those episodes where I'm not exactly sure we figured out how to do them better. Yeah. Like other than being more compassionate, taking drugs earlier that kind of thing, I'm still a little bit cloudy about like, what should I be doing? I argue that nobody knows how to do them better. We're just trying to understand headaches right now. Okay, that makes me feel good. Yeah. Yeah. Anyways, as long as there are things to get wrong, we're going to be right here to help you do them better. I love you guys. Am I doing it wrong? Is a co-production between half-post and A-CAST. Our producers are Eve Bishop, Carmen Borca Carrillo, and Malia Aguadello. Our executive producers are Jenny Kaplan and Emily Redder. Special thanks to half-posts head of audience Abbey Williams, Head of Video Will Took, as well as Kate Palmer, Marta Rodriguez and Terry DeAngelo. And we're your hosts, Raj and Javi Johnson, and Noah Michelson. Back from holiday with everything stained and smelly. Here comes another long day of laundry. This calls for new Vanished Turbo. Pick crew with me. New Vanished Turbo removes tuss stains and works against odors with intense freshness on a quick wash. Even a 30-minute one. Affirmative. Vanishes' unique accelerator turns every quick wash into a deep clean. All good to go, Mom. Quick wash on, deep clean done. So clean, so fresh, so fast. Trust Vanished forget stains. I can't believe it. Vaxes asked me to move in with him. I mean, you practically live with each other already, but that's great. Did you hear that, Joe? Yes, thanks for letting us know. I see you've updated your universal credit claim. Now you're going to be living together. If you're telling other people about a change in your circumstances, tell us too to avoid a penalty. Search TELDWP. Hello, it's Sam and Pete. Hosts are staying relevant and our podcast is currently sponsored by the parents of the new Oreo Cream Egg Flavor Cookies. Stop everything, Sam. There's a new salibin town, Oreo and Cream Egg, two icons. They've had a baby. We're hired, so it's just a cookie. No, it's the nepot baby of the snacking word. It's a nepot cookie. It didn't have to work a day in its life. It's just succeeded off its parents' fame. It's got the Oreo crunch and that legendary cream egg flavor. To be fair, it does sound iconic. The new Oreo Cream Egg Flavor Cookie in stores now. There once was a woman who lived in a shoe. A size-to-snug book. What could she do? But that's not where her story ends. Thanks to a little help from her experienced friends. She got her score into much better shape and relocated to a box fresh new place with room to grow and a mortgage to suit. 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