Good evening.

Thank you so much for watching HealthLine on PBS Fort Wayne.

>> I'm your host Mark Evans.

A very important topic tonight, something that actually affects many, many people of all ages and I don't think we've ever discussed this particular topic before unhealth.

>> But we're talking about migraines and headaches and we're going to find out whether the most common headaches and what you can do about them and some actually require going to a doctor.

>> So let's talk about that and we have somebody here who has never been on the show before.

Right.

And it's a pleasure meeting you.

It's Dr. Rita Richardson, a neurologist.

>> Right.

Thank you for having me.

Oh, absolutely.

I've been wanting to do a show on this because in the green room prior to the show I think I told you that I had a grandmother who the sweetest soul on the face of the earth but she lived with a terminal headache and this was 30 years ago when she passed away.

So I'm hoping to hear that we've come across some advanced in the medical industry that will help people get relief.

>> There's there's all kinds of treatments and you're right.

I mean I think almost one in four households have someone who has had migraine or headache in general.

>> So it's a very common problem for four families.

Yeah.

And during my research preparing preparing for the show I found out that there are more than 150 different types of headaches.

>> Now we're not going to talk about all of those tonight but we will talk about some of the most common and there are a couple of here I've never heard of before.

>> Also want to remind our viewers that June is National Migraine and Headache Awareness Month.

>> That's one of the reasons why you're here.

It worked out great an opportunity to raise awareness about migraine and other headache diseases and I didn't know headaches could be classified as a disease.

>> Yes, migraine impacts 40 million people in the United States, one billion people across the globe and recognizes a number two cause of disability worldwide and currently about 16 million people with migraines in the U.S. are undiagnosed and approximately 400000 Americans experience recognized as the most painful diseases anybody can have.

>> Hmm.

So that's all the more reason why we're going to talk about exactly.

And I want to go ahead and remind our viewers that we have our phone lines open at (969) to seven to zero but one 866- in front of that if you're long distance and will be here to answer your calls for the next half an hour again with Dr. Rita Richardson, a neurologist talking about headaches and migraines that let's before we get into the migraines, we're just going to be the biggie I think for tonight and I think there's one called Cluster headaches we need to talk about.

>> I never heard of that but there's exertional headaches.

>> What does that exertional headaches occur when people are working out or doing activity there also occur like if you cough or sneeze those are kind of exertional headaches.

>> OK, so what causes that is that blood vessels swelling or what would cause that pain?

>> Well, headaches in general many times are due to the I want to say the nerves taking in the information and then pouring out all these neurotransmitters and so there's a covering on the brain called the meninges and that houses a lot of nerves that caused the pain for headaches.

So many times when you have exertional pain you're having some increased pressure or release of those neurotransmitters and then that causes a headache.

>> OK, well that makes sense.

And then there's another one here on the list called Hypnotic Hwi and I see yes, that's a very rare kind of headache occurs that night.

It starts in a different part of the brain than our typical headaches like migraine and tension type and amazingly enough it has caffeine sometimes as the treatment oh right.

>> So keep you up on it.

I know what it takes the headaches.

>> All right.

Of course there's the sinus headache we've all had one of those caffeine related as you mentioned that is a type of headache head injury of course and then menstrual.

>> Yes, very much hormonal for women as they go through different stages in their life and hangover course.

>> And then we want to talk about some of the most common and I guess the most disability or you know, it's causing the most disability I should say cluster medication overuse migraine and of course tension and you know, tension.

I think everybody can relate to that.

>> So let's start with tension headaches.

I think tension headache is one that people learn.

They just say well, I just have to deal with that because I'm stressed or I'm not moving the day and age now where we sit at computers a lot and we're not up and moving many times people will develop tension TypePad and their shoulders and their upper back are our muscles in our back are not very strong and so we're trying to hold up our noggin and so people start developing headache and it's a little different than migraine.

It can last a few hours.

It can last seven days.

Some of the treatments can be more manual at times where you know, sometimes just a good massage helps that but also getting out moving around is helpful for those folks.

Certainly there are over the counter medications that can be used but we don't like to use them all the time.

But also sometimes heat will be helpful for for attention headaches for those muscles and just understanding that stress can also be a big trigger for people so that stress in trying to believe it in different ways for people.

>> OK, and then I also under the classification of tension headaches, dehydration can cause those yes it can because what happens again when you're dehydrated is that the meninges or the covering of the brain kind of gets tugged a little bit and so we like to really have people hydrate up sixty to sixty four ounces of water a day and interestingly enough I think there's a misconception that all our fluid is is water.

It helps us but anything that has a coloring is actually a diuretic and so people you know, instead of drinking something that has a coloring in it water or something clear is the best versed hydration OK and a loud noise obviously that would cause some tension.

Lack of exercise is mentioned.

Yes, I think that's important.

There was a study a while back that took one of the oral headache medications and put it against 40 minutes of exercise four times a week and it actually did just as well as the oral medication.

So I think exercise is good because it does many things.

First of all it gets these muscles moving that maybe we've had problems with.

The other thing is that it helps us sleep better which many times people are suffering from probably one of the the most frequent causes of triggering headache and it kind of helps our mood.

>> OK, and then you mentioned posture.

Yes.

And then skip meals.

Oh yes.

That can cause headaches very much so and it kind of varies I would say a lot of young people even if they're eating their metabolism is so high, you know, and they're out doing physical therapy or not physical therapy, physical exercise.

They're doing activities after that after school and they're not eating in between and they really need to have a little snack in there and sometimes you can get rid of the headache just by doing that.

>> OK, I want to talk about medication overuse headaches which seems to be rather common these days.

>> But we do have a call coming in from Philip.

>> Philip, what is your question for Dr. Richardson?

Hi, Dr. how are you tonight?

We're doing great, thank you.

Now you pretty much mentioned drug various things you're talking about things that can stop the headache that are there like any old school myths like Sarcone solders.

>> Oh like remedies old school remedies for helping a headache.

>> Are you talking about other than taking aspirin or Tylenol or something like that?

No, my point is I was just to question you on the right track.

My point is are there the old school remedies like throwing the salt over your shoulder?

Oh no.

>> Gotcha.

Is there anything I can cure headache like that.

>> All right.

One I you know, as I'm listening to you it's hard for me to think of some kind of wives tale, so to speak that that would be helpful.

Although I do have some people that come in and they say, you know, if I just take a band or a scarf and tired really tied around my head, it makes it feel better.

And so because they're putting more pain here than up here.

>> Right.

And so, you know, you could think of that as an old school remedy just because what happens it's it's kind of similar to the fact that when you hit your elbow and you're you're really in a lot of pain and then you start rubbing you're basically sending a different signal back in those pathways so it can't bring the pain out and that kind of happens when I think people put a soft, you know, scarf or something around their head and do that.

>> Well, what about if you've got a tension headache and you know it's because you're been working so hard family issues or whatever the case might be.

>> What about taking a nap or lying down?

I mean some things like that that help a lot of people do get rid of their headaches by sleeping.

It's really hard to have a headache when you're asleep just that some people have a hard time falling asleep when they have a headache.

But other things that can help too or are people doing relaxation exercises sometimes listening to music, going in a quiet room doing that also sometimes just coloring or something else that is completely different will send out different transmitters and it really helps people who meditate.

They may be able to do that you know, going to get a massage or asking a friend or family member hey, can I have a little massage to help with that?

>> And that will help to yeah I can see that that may be a nice way to get rid of a headache.

Let's go ahead and move on to in fact I'm going to mention the phone number again because we'll take more calls like we just did with Phil.

Oh looks like one just came in and line five Lee by away says he'd rather be off the air.

>> That's OK.

So we've transcribed that question for him.

What kind of treatment should I get if I have dizziness with my headaches?

>> That's a very good question.

Yes, this is a common problem that people have.

They may even have ear ringing or changes in their hearing and sometimes we call those vestibular migraines and the dizziness can be any kind of dizziness.

It can be vertigo or spinning.

It can be light headedness.

It can make people feel off balance and actually we treat those just like we do any other kind of migraine headache and sometimes you don't have to have a headache with the dizziness you can have the dizziness and not have the headache or you can have just a small headache.

But if you treat it just like you do a migraine it will go away.

Oh OK. Yeah very good.

>> The telephone number is on the screen it's 866- (969) 27 two zero.

We're talking with Dr. Rita Richardson who is a neurologist.

>> Our topic tonight headaches and migraines.

It is national Headache and Migraine Month.

So let's move on to the medication overuse headaches and I honestly haven't heard of that before but I know it is very common.

>> It is very common.

I would say, you know, probably 50 percent of people may come in with medication overuse headaches and this is a type of headache that tends to be something that maybe they started off with a headache.

They started taking acute medication whether it's over-the-counter or prescription and you start you keep taking it.

And so what happens is that if you take those medications more than two days a week longer than two weeks you can develop this medication overuse headache and it's felt that, you know, maybe these are OK to to take like that because they're not strong medications.

So it can happen with prescription medications that are used specifically to treat acute headache headache that you have that's really going on and you need to take something now to get rid of it.

But it also can happen with over-the-counter medications such as acetaminophen, ibuprofen, naproxen, anything like that can also do it.

You were talking about caffeine.

It's kind of similar to that at one point eight years go I think people would say have an aspirin in caffeine.

Well, that can be seen in some of those over-the-counter analgesics as well.

And so we don't really want people to get in the habit of taking those headaches and so many times to get rid of that we it with a different kind of medication because if you stop the medication all of a sudden it gives a very, very bad headache.

>> OK, yeah.

So you change the medication.

>> Yes, we do.

That was going to be my next question.

So how do you treat somebody who has headaches, overuse of medication?

>> Do you give more medication but you have to change them, you have to change it and then many times the frequency of the headache will decrease but they may have a typical headache but it's not as often it might be once a week or once every couple of weeks and they may may be able to find a trigger for those headaches then where when you have this medication overuse headache it's hard to know what's triggering the headache.

>> OK, we want to talk about migraines next.

We have a call coming in.

Fred is on the phone actually he's asking us to ask the question for him are headaches associated with Parkinson's disease?

>> I have some people who have headaches that have Parkinson's disease and what I find usually is that Parkinson's disease many times people are pretty stiff and they're not moving very much and so sometimes it's mostly muscular or sometimes you know, with Parkinson's disease many times we see people that are older that have that disease and they might have some arthritis in their cervical spine.

And those folks many times it can be relieved for seeing physical therapy.

Sometimes injections are helpful.

So it's something that you can see not everyone has it and just because you have Parkinson's disease doesn't mean you're going to have headaches.

>> OK, thank you for that call, Fred.

Let's go ahead and talk about the elephant in the room, so to speak for migraine.

>> Yeah.

How are migraines so much different than other headaches migraines when people say oh my headaches are not migraines usually because migraine is thought to be a very severe headache.

You can have light and sound sensitive, Betty.

You can have your vomiting, you can have dizziness, you can have imbalance.

The the headaches tend to be moderate to severe in intensity.

There's somewhat unilateral meaning.

It's one sided.

It doesn't have to be but it can start out that way and then become your whole head.

It can be seen worse with it any kind of activity you'll find those people many times want to go into a room.

They don't want to move.

They want to have the blinds down.

Don't turn on the light.

Don't make any sound so those people find that it's a real disruptor for their function within their family as well as the work.

And many times people are taking a lot of time off of their work because they can't function with that because it's just it can make them feel nauseated and vomit too.

>> Well, I was a assignment manager for one of the other TV stations several years ago and we had my assistant as a matter of fact had recurrent migraine and the poor woman she could not function.

She she had to go home.

She would sometimes even get sick to her stomach.

>> Yeah.

But just could not think and she would be off for a couple of days.

>> Right.

And this was you know it seemed like kind of a monthly thing going on.

Yes.

So are these recurrent when people have migraines I mean okay you're going to have migraine headaches the rest of your life .

>> Is that how that's going to happen?

>> I would say that it doesn't have to be but many times it is it's a recurrent repetitive type of headache.

It doesn't mean it has to be all the time.

You know, some people may only have migraines two times a year.

Some people might find it's two times a year but then it becomes more frequent in times of stress or they're not sleeping or something else changes in their body.

They've become ill or hormonally it changes for people.

So it's something to that attention type headache many times will transform into migraine.

So just because you have one type of headache doesn't mean that it can't transform to a very severe headache where you have some of those qualities that we talked about are those inherited migraines.

It can be it doesn't have to be but it can be.

Yeah, there's a type of headache called hemiplegic migraine and that is inherited where people become weak on one side of their body.

It's not a frequent type of headache but it happens to occur and it is inherited.

>> And I noticed your triggers of the migraine could include the stress and anxiety and sleep disruption.

>> Yes.

Make sure you get some good sleep harmonic changes as you mentioned skipping meals.

>> We talked about that with other types of headaches.

Dehydration comes into play some foods and medications can cause definitely some people will have problems with monosodium glutamate and this is used as a flavor enhancer in many foods I've over probably the last ten or fifteen years found folks that had problems with gluten or processed carbohydrates.

And so we've this is a kind of a topic that's been around in the literature.

A lot of people are talking about it and not only for headache but for other types of pain in their body.

But once patient will kind of take that or eliminate that out of their diet, they will find that their headaches are much better.

>> Good, good.

We have a call coming in Rosano is online for Rossana.

>> Your question for Dr. Richardson please.

Yes.

Oh, I get headaches from a blood pressure like it's like 130 over 80 or a little bit greater.

I get headaches but when it's like if the diastolic in the 70s that I feel better so is a blood pressure related.

>> Yes.

Many times people with high blood pressure that's one of the symptoms are headaches and especially sometimes it's a different type of headache.

They may have migraines in their background but this headache is different.

One of the problems that come up is that because of pain the blood pressure can increase.

So sometimes when people come in with very high pressure we don't in a very severe headache.

We don't know if that's because the pressure is basically driving the headache or the headache driving the pressure.

Right.

And what you have to do is kind of treat both of those things.

But many times if you are having blood pressure problems and you're having headaches, I just encourage you to go see your primary doctor because that's really important to take care of that.

>> Yeah.

I was going to ask you the next question as a matter of fact went to speak with the doctor but first before we get into yes.

>> Cluster headaches.

Yes, I'm really curious about what a cluster headache is.

A cluster headache is a particularly different type of headache than say migraine or tension.

It's usually a stabbing headache.

It can last a minutes to a few hours where you have repetitively many times people will wake up with them at night.

It is one that instead of unlike migraine where you want to go to a dark room and not have anyone around and not move cluster headache many times people are up and pacing .

It's a completely different headache.

It's it can be very severe even worse than a migraine.

I think sometimes people would say that yes indeed.

And it is treated a little differently.

You can actually if you would go to the E.R.

they might put a mask on you and give you one hundred percent oxygen.

Sometimes we give medications that are instead of oral we give injections or nasal sprays to try to eliminate the headache quicker because once you take an oral medication it might take 30 to 60 minutes for it to start working before you're able to get some relief where there are some other treatments using injections and nasal sprays and cluster headache.

Many times it's one of those that we use them we use them for the other headaches too.

But commonly we try to do that so the patient can get back to sleep.

>> OK, so we're human beings.

We're going to have headaches, right?

Yeah.

One in fact the information I have here is every human being will have two headaches a year of one sort or another.

>> So when is it time to go see a doctor?

>> Right.

I think it's time to go see a doctor if the headaches are causing problems for you, you're missing work.

You're not able to be with your family.

You're not able to be with your children.

You're unable to, you know, do your household chores.

You feel like you are not able to rely upon your body to know if you're going to have a headache or not.

People will start staying home instead of participating in things I usually say that if you're having four or more headaches per month it's important for us to start some sort of medication to relieve those.

Also it's important if you're having headache and you're having atypical things that we talked about tonight, you know if you're having vision problems now granted some people will have aura with migraine where they'll see squiggly lines or they might lose part of their vision for a period of time.

But those should go away.

They shouldn't be long lasting .

If people are having symptoms that are lingering, they should go see their their primary doctor go to the emergency room especially if you've never had that kind of headache before and what kind of headache or headaches would drive a person to an emergency?

>> I think people who are vomiting OK, people who as we talked about that the severity of the headache is one where they can't eat, they can't get up, they're missing work.

They're not able to participate and take care of things at home.

Many times we need to get hydration because we've not been drinking much water and as we talked about earlier, the hydration is really important to keep the headaches away if are vomiting many times then the oral food can't come down.

We can't use oral medications so we need to get get a hold of that headache differently.

>> Definitely.

Definitely.

And of course if you have a family history of headaches right.

Your family they need to know about that too.

>> That's right.

Let me ask you this has headaches would that ever cause a need for surgery in some cases where you have a very serious cause of headaches hemorrhage into the brain had trauma that involves bleeding many times those people will have to do it.

There are some people who have aneurysms and this is a change in the in the size of the blood vessel in the brain.

Right.

And these are very rare.

It's something we think about because folks will have a lot of problems kind of deciding should I go or should I not go?

>> But with anything that's kind of atypical for you, you should go to the emergency room .

>> All right.

Well, I'd love to talk about this a little further and we will have you back again.

OK, I want to do it.

>> It's my pleasure.

Dr. Rita Richardson, a neurologist, thank you so much for being on HealthLine tonight .

>> Thank you so much for watching and all these great calls we have we always invite those and we'll see you next Tuesday night here on PBS fourth one until then, good night and good