Episode 57 - Migraines

Transcription

Chad: This is Dr. Chad Edwards and you’re listening to podcast number 57 of Against the Grain. Are you tired and fatigued? Are you frustrated with doctors because they just don’t seem to listen? Do you want to fix your pain without surgery? If you answered yes to any of these questions, then we are the clinic for you. We offer Tulsa Prolotherapy, PRP or platelet rich plasma therapy and stem cell injections, IV nutritional therapies, bioidentical hormone replacement therapy and functional medicine to get you back on track to optimal health. Call our clinic at 9-1-8-9-3-5-3-6-3-6 or visit our website at www.revolutionhealth.org to schedule your appointment today.
Recorded: Welcome to Against the Grain podcast with Dr. Chad Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready because we’re about to go Against the Grain.
Chad: Hello, this is Dr. Chad Edwards and we’re once again without Mr. Marshall, the ever-tall, almost ever-present host of Against the Grain podcast. You’re stuck with me, but the cool thing is back for the second time, well I guess there are many times. We’ve got Dr. Crystal Lewis, our amazing upper cervical chiropractor. We’re tagging on to last week’s episode or last episode’s podcast discussion on headache. This time we’re going to focus a little bit more, just because it’s so common, we have so many people that complain about this. What are we talking about today?
Crystal: We’re going to be talking about migraines, which is a type of headache that people have commonly like just Dr. Edwards said.
Chad: Yes, I obviously work in the emergency room; work in the clinic, I get a lot of patients that say, “I got migraine.” What I find out –I don’t know what your experience is, but what I find is that a lot of patients will say that it’s almost like they define any bad headache as a migraine.
Crystal: They do.
Chad: Is the definition of a migraine just a bad headache?
Crystal: No, there’s actually a criteria that you have to meet to be actually diagnosed with a migraine. In layman’s terms, of course, people will say migraine to mean a bad headache, but medically that’s not what it really means.
Chad: Right.
Crystal: One of the things that you have to have at least five of these bad headaches or five different attacks. Then whether they’re being treated or not, they’re going to last between four to 72 hours. I don’t know about you, but a 72-hour bad headache is bad, four hours is enough Tulsa prolotherapy.
Chad: I see it.
Crystal: But yes, I have to where they’ve had a headache for a week and you’re thinking, “Oh my goodness.” At least four to 72 hours. Then there’s a couple of symptoms I’m going to describe and they’ll have to have at least two of these symptoms in this grouping. It’s going to be on one side of the head or the other, so it has to be unilateral. It can be pulsating and some people will say that throbbing, they can coordinate with their heartbeat, it feels like they feel their heartbeat in their head kind of thing, they’ll describe it that way.
Chad: Which is different than just a pounding headache? It can be different than a pounding headache?
Crystal: Yes and moderate to severe pain. These are pretty bad in intensity, they’re not just a mild achiness, this is going to be a pretty bad intensity. What I have found a lot of times is that it makes you not functional. If you have a true migraine, you can’t really do anything else. Then if you try to exercise your way out of it, it gets worse. If you ever have a headache and you go for a run, and it gets better that’s probably not a migraine.
Chad: I’ve even seen — sorry to interrupt you. I’ve even seen patients that just walking upstairs, any kind of physical movement, those kinds of physical movements make the headache worse. Certainly, the physical exercise but even just activity can make it worse. Some of these people will just want to go lay in a room and not move.
Crystal: Yes, they don’t even want to open their eyes or they can’t even watch television. We’ll talk about a couple of that as well. They can also have photophobia, which is sensitivity to light, sensitivity to noise is called Phonophobia. If they have kids, they’re telling kids to be quiet, they’re being in a dark room. They can’t listen to the television or the radio, they really just have to lay there. Which is really not fun if you’ve ever had one of these.
Then the thing is nothing else can – it’s not attributed to anything else; not having a headache because they walked out in the heat all day or [pause 00:04:47] or if they get hit in the head with a hammer, that’s not going to cause a migraine, that’s going to be an injury, right? Or any of those. What I mean, because I have patients that go and they do yard work and they have a tree branch fall over them or they fell and hit their head on the door frame. That’s not going to cause a migraine because it can’t be attributed to any of those things, it has to come on its own.
But what’s really interesting is they don’t really know the cause. If you read further, they don’t know the cause of migraines, they just — this is a group of symptoms that they know how to categorize it.
Chad: Yes. Also we got those two or more of the following, you got those four things. You got the unilateral pulsating, moderately severe pain, increased physical activity. Then in the next section under the IHS criteria, is you’ve got to have at least one of, and you mentioned the Photophobia, Phonophobia, but those are considered one. Then the other one’s nausea and vomiting. That’s so common. I had one the other day that came in the emergency room and they said that they were having a migraine and they’ve been having migraines, so they’d had the five. They didn’t really have the Photopho — that one.
Crystal: It’s a tongue twister Tulsa prolotherapy.
Chad: The light thing and they didn’t have the ear thing. They didn’t have either one of those and I said, “Nausea or vomiting.” She said, “No, I got nausea the one time” and I was like, “It actually doesn’t meet criteria for a migraine. This is a bad headache.” The way I deal with that differently in the emergency room because I agreed with that neurologist where — did we talk about it this episode or was it the last episode, where we talked about the neurologist?
Crystal: The last episode.
Chad: Okay. I was listening to a CME thing and a neurologist was talking about migraine, and she liked seeing patients with migraine. In fact, her medical students would say, “You like making everything a migraine”. She said, “Well, I do because when I can it’s easy to fix with medication”. I don’t totally disagree with that, but again, we’re not looking at the underlying cause.
Crystal: We’re not and I have a hard time believing that everybody that walks in with a true migraine can get fixed by medication.
Chad: Totally true, I agree. Then you have to qualify fixed with treated and made to feel better or making the headaches go away where they don’t come back, and that kind of stuff.
Crystal: Agreed.
Chad: Yes, because we can give enough morphine to people and make their headache go away but —
Crystal: You can drop a hammer on somebody’s foot and make their headache go away maybe?
Chad: Yes, sometimes you can. We joke about that a lot but sometimes you can. Tell me about — I’m sure you’ve had some good experiences with patients that have had headache with migraine?
Crystal: I have and it can range, experiences can range from someone having — and I’ll give you a story, having immediate relief to taking some time for that to happen. But at some level, it’s pretty successful. I’ve got a pretty good success rate on it. We do look at some other reasons, but I had a patient come to me last year and she’s young she’s in her 30s. She had been battling headaches. It was ultimately diagnosed with migraines for a while. If I remember correctly, it was at least four to six months, if not a year of dealing with these everyday headaches. They wouldn’t be constant all the time but she would have them every day.
Chad: I can’t even imagine.
Crystal: No, I can’t imagine either. I’ve had a headache and the longest is one day and I was like, “This is not good.” She had tried everything, she had actually lost some weight, started exercising, felt better, ate better and she was also doing this because she wanted to become pregnant. But she was doing all of these things and when she thought she’s feeling better then still had the headaches. They medicated her, it didn’t work. They tried different medication, it didn’t work. She just said she thought there’d be a better way. When she’s wanting to get pregnant ,she didn’t want to take those medications.
Chad: You mean medicines didn’t work?
Crystal: I know.
Chad: Shocking.
Crystal: She came in and she was referred by another patient. We went over everything, I was able to get her adjusted. Then I don’t get to see the results and in something like that, I don’t necessarily expect you pop up off the table after I adjust you and you’re like, “Hey, my headache’s gone.” It doesn’t always quite happen that way. Now, I’m not saying never, because it has happened, but that’s not typical. Of course, it’s not because we have a body that’s first going to have the time to respond to something. Usually, typically, I follow up in about a week. When she came back in a week — and I don’t ever know what – I always expect people to do better but I always want to make sure I’m listening to what’s going on with them Tulsa prolotherapy.
She had no headache that entire week and she could not believe it. It’s pretty profound. Now, I’d like to tell you she never had a headache again or never had a migraine again, but that’s not the case. After that, it’s a big wonder to say, “This is really what’s going to be working for you.” But at some point, she did have some headaches come back, but they weren’t as intense, they weren’t as bad and we continued to address it. Over time she had longer and longer periods of times of no headaches. She was having headaches every day. To have entire week of no headaches and then over time. Then the only time she will start having headaches again is when she got pregnant. For that first trimester, second, with some hormonal stuff on top, but it also could have triggered that a little bit as well. It’s one of those things that we do want to keep maintenance. We do want to keep it up. It’s not a magic pill per say, but it is a really good foundational step and It can give us really, really good results, really simply, really fast.
Chad: That’s just absolutely amazing. I hope it’s encouraging to the listeners that even amongst chiropractic therapy, there are options. Just because you’ve been in one, it doesn’t mean that — on any spectrum, it doesn’t mean that every chiropractor is going to function the same way. You go to a physician, it doesn’t mean they all practice same way. You go to a neurologist, you go to whatever, they all bring different things to the table. My opinion with rare exception, you shouldn’t have to live with your headache.
Crystal: I agree 100%. I don’t believe we were created to live with pain every day.
Chad: I agree with you.
Crystal: I just don’t think that’s optimal.
Chad Let’s take a quick break. When we come back we’ll talk a little bit more about what we can do for migraine if medications aren’t the best way to go.
Recorded: Vertical Limit Fitness constantly strives for better. Better mind, function and fitness capacity, and community. They accomplish this through body weight boot camp style classes and high intensity functional fitness. Group classes to private training, Vertical Limit fitness elevates your health and wellness while helping you become able to do anything and prepare you for everything that life may bring along. Call 9-1-8-4-0-9-1-6-3-3 or visit their website at www.verticalLimitfitness.com. For more information and to sign up for our weekly classes.
Chad: We’ve been talking about migraine and getting to the root cause of these migraines. My approach to migraine when I was practicing a more traditional mainstream form of medicine was I just want to give a medication because that was the easy thing. Basically I had a 10 minute interaction with the patient in which I could get their entire history, do a physical exam. Hopefully, I make an accurate diagnosis and then prescribe them their appropriate pill.
When was the last time you saw a patient that had a migraine and the cause of that migraine was because they had an Imitrex deficiency?
Crystal: Never.
Chad: Why did I as my primary intervention say, “Oh, we just need to give you Imitrex?” I’m not opposed to medications in their right place, but why is it going on? My traditional approach was medications. I would consider, “Okay, we got to look at identifying triggers, what’s causing these migraines?” Honestly, if the patient had three headaches a year, I wasn’t going to spend the time because I’ve only got like 10 minutes.
I might tell him, “okay, go look up triggers for migraine on the Internet. Google that bad boy and see what you come up with, and avoid that stuff.” It might help, might not but you I’ve done my due diligence and I’m checking my box. Medications and certainly as a DO, I didn’t do enough manipulation on my own so I would say, “You know you might consider going to see a chiropractor, you might consider some osteopathic adjustments. We might do physical therapy. Just see if we can make any difference with that.”
What’s your thought? Of course we did talk about hormone replacement therapy and prolotherapy. We’ve seen some great results with that as well. What’s your approach? What’s your thought on how do we fix this?
Crystal: Well, I look at primarily muscular skeletal. We’re going to be looking at the structure. Obviously, we can have some physiological things, hormones that can be part of the problem, your high blood pressure can be part of the problem. But we need to stand a foundation. If you’re out of alignment which can actually affect all the functioning of those things, then we need to make sure that’s the correct.
Looking at the structure of the spine, how is it sitting? How is it standing? How is it moving? How the muscles are being addressed? When you come in, what I usually do is, again, take a full history, I see what’s going on with you. If you’ve already seen Dr. Edwards then I have a lot of that information already. It can be a little bit more streamlined.
But then I will do what we call leg check. You lay flat on the table and I’m looking if you have a short leg or not. Now, you’re not really having a short leg for most of us, some people actually do. But it’s the leg that’s pulled up on one side. When we lie flat, we’re bilateral, we should be laying pretty flat with our legs even. Not one leg turned out in the end than the other, then I’m looking for that. Then I’ll see how they’re lying on the table or they are. Is their back arching, are they relaxed? You’d be amazed how many people can’t lie flat on their back without discomfort.
Then I have an instrument called an anatometer. If you go to any of upper cervical doctor’s office, they’ll have a little bit different instruments. Some of them will have plates that they stand on that tell weight, they’ll have other types of ways that measure posture. But I have something that’s called an anatometer and it measures if there’s a difference in your hip height, if they’re twist or not, if you’re leaning one way than the other Tulsa prolotherapy.
Then I take it further and I’ll look at head tilt, shoulders, if one’s dropped or not. For the most part everybody — and I have to look at it past musculature. Because sometimes musculature — I have a patient that she’s real beefy on one side than the other because of the type of work that she does. If you have a pitcher, they’re going to have to be more muscular one side. You can’t just look at, “oh, that’s a right shoulder because they are muscular.”
I’m looking at what does the spine look like? I’m looking through that. If it’s not balanced, if it’s not centered then we definitely have a misalignment, we have an issue. If we don’t address that, then we can’t really, in my opinion, properly address the rest of the migraine if there’s any other reason for the cause. But that is a primary reason we should look at.
Chad: Makes absolute sense to me. I just love that structural evaluation because it’s just so common. It’s so common that I see — in fact, if I — just based on my experience, without running the actual numbers, and I saw five patients that had — I don’t really know. But just my gestalt, my perspective is that it’s more common to have muscular skeletal or muscled tension type headache that becomes a migraine because that tension headache can trigger a migraine. It starts off as one headache and then triggers a completely different kind of headache. If we abated the tension type headache, the migraine would probably have never come about.
Crystal: Agreed and even though we talked about what the international headache – is that what they are called?
Chad: Society.
Crystal: – Society, yes. What they determine what a migraine is, I read a study that was talking about — which makes complete sense, that when they evaluate people with migraines, that on the same side the migraine was they had neck tightness, stiffness, muscle tension, tenderness. Where people who didn’t have headaches or migraines said, but what they found was migraine sufferers had it and then people was headaches had it as well. There is definitely, whether it’s the cause or the fact a proponent. The muscular scale system is affected or is the effector one way or the other.
Chad: From a diagnostic perspective, we like to have these criteria by which we put things in a box so that we can get the right code. We can submit to insurance and justify what we’re doing. We have to come up with these artificial walls of the box so to speak. We’re trying to make sense out of physiology, which is very dynamic. We’re trying to make it black and white and say, “This is a migraine.”
It helps us understand what’s going on but it doesn’t explain why and all of those kinds of things. I think the criteria are important but I completely agree with you that you got to look at that structure and function component way early, if not first, way early.
Crystal: yes. I will say and migraines aren’t always the end up issue, but I see structural dysfunction from birth. If you’ve been living with this structural dysfunction since birth and it could be major or minor depending on your situation. There’s a lots of other factors, it needs to be addressed.
Chad: Sometimes it’s literally from birth, from the birthing process.
Crystal: Literally. If anybody has ever seen the birthing process, you would know sometimes. You’ve delivered a baby before, haven’t you?
Chad: At least a handful, over 100 to be exact.
Crystal: See, so just one or two, few. You know what it entails and then what can happen and all that stuff?
Chad: Yes. Had my share of complications and all those fun things. I did a lot of women’s health when I was on active duty and did a lot of labor and delivery and OB and all those.
Crystal: It’s fun stuff.
Chad: It was. It was a great part of my practice. You almost can’t practice that way now. I can’t. If I ever wanted to be away from home, it’s just —
Crystal: Correct, if you wanted to be a good doctor and be there for when your patients are having babies, you’re pretty. Yes.
Chad: Very, very difficult to do it that way, although I love that approach. You really need to live in a small town the middle of nowhere and have one doc and that’s it. It did it makes sense?
Crystal: Yes, it is. But I see that. Like you talked about when you see that they baby coming out the birthing canal if you’re not taught how important it is for the baby to be delivered then — I was going to be delivered by midwife but couldn’t and my friend that came who worked with me, she understands spine alignment. She told me after my daughter was born, she said, “I made sure he didn’t pull on her neck and stuff.” She’s like, “I just made sure –” she said he was so gentle and good. It actually is very important.
Chad: My daughter, when she was born, I looked at her and was like, “Oh my goodness you need to put her back or something.” Her forehead was — she was like cone-headed, all that good stuff. Her mom is a very small person and there was a lot of molding of her head that had to occur in order for her to —
Crystal: Safely get –yes.
Chad: — have that kind of delivery. Everything went fine and the next day she looked like a different kid and I was like, “What happened to the cone head?” Of course, now she’s absolutely beautiful. It’s amazing how the head can form.
Crystal: Can form and it’s really.
Chad: That molding process, it’s no wonder that there could be problems.
Crystal: Yes. That and then just the fact that how was the mother carrying the baby as well?
Chad: Sure.
Crystal: If the cord wrapped around the neck, if it got pulled. There are so many scenarios and the easiest thing to do is bring in the baby to get checked and then we can hopefully prevent things like migraines and things like that feature and other issues. Then we look at why ,in my perspective, what causes because if you look at medically they’ll say, “We don’t know what causes it, it just happens” Well, that is a bunch of crap. I don’t really say that too often in front of people because I try to be proper most of the time. I’ve been working with Dr. Edwards for a while and it can’t be proper.
Chad: There’s a lot of crap out there. Let’s just call it what it is.
Crystal: Now, I lost my trail thought because I said crap. It’s one of those things that we — when we’re looking at the criteria, it doesn’t really matter. We don’t know what cause, we do know what causes, I feel like I know what causes it for most of my patients. There are a few that it’s just like, “I don’t know what’s going on,” and that’s part of practice where you are trying to figure out. I really try to figure out, but if I can’t help — I will say I’ve never talked to anyone and I said, “I absolutely cannot help you.” But maybe didn’t get the results, so then we talk about prolotherapy is an adjunct. No, I can’t prescribe medications I can’t recommend prescription medications and I don’t want to. I will say, “Okay, talk to Dr. Edwards about prolotherapy or about acupuncture or about massage therapy.” Depending on what’s going on within their lifestyle and then looking at their hormones, and all of those things.
Chad: It’s important to look at that whole picture. Thank you so much for coming on–
Crystal: Thank you.
Chad: – talking about migraine. I think it’s one of those things that’s so important. I wish that every patient that came in to see me would go in to see you first, if migraine or headaches are their primary complaints. If we could knock that out across the board, I think would be far more effective about treating our patients in an optimal manner. There’s all those cases that have gotten their upper cervical neck corrected and their hormones get better. Their blood pressure gets better.
Crystal: Yes. It’s pretty amazing.
Chad: It really, really is. I have been shocked at some of the results that we’ve gotten. Frankly, in some cases, better than I could ever do with the hormone replacement therapy and all those things. I’ve been working with one for a while and got her upper cervical neck adjusted, and came back and I was like, “Oh crap, I could have done that.” Anyway, but we got it taken care of, so that’s what matters. Again, thank you so much for coming on, always a pleasure to have you on Tulsa prolotherapy.
Crystal: Thank you.
Chad: I look forward to having on again. Thanks so much for listening. You guys have a great day and we look forward to hearing you next time.
Recorded: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week where we’ll be going Against the Grain.