"Caffeine causes headaches."
Caffeine is a double-edged sword.
"The best way to cure a hangover is hangover food."
The best cure for a hangover is time.
Oh, boy. "Migraines can be cured."
Migraines cannot be cured.
And I am sorry to deliver this news today.
I'm Dr. Deena Kuruvilla.
I'm a neurologist and a headache specialist
with the Westport Headache Institute
in Westport, Connecticut.
Hi, I'm Dr. Cynthia Armand.
I'm a neurologist and headache specialist
at the Albert Einstein College of Medicine
and headache fellowship director
at the Montefiore Headache Center.
And today we'll be debunking myths
about headaches and migraine.
Ugh. "Migraines are just headaches."
That is just the most aggravating myth that I've ever seen.
And I'm sure many of my patients will say the same thing.
I 100% agree.
A headache is a very nonspecific term
for having discomfort or pain in the head.
Migraine is a neurological disorder
that's not only headaches, but is associated with nausea,
with vomiting, with sensitivity to light,
with sensitivity to sound, and so many other symptoms.
It's a disease. Just like asthma, just like diabetes.
But within migraine disease, there are migraine attacks,
and an individual can have many or very little of them.
It's very important to know
the difference between headache and migraine,
because the treatments are different.
"A nap will cure your headache."
Armand: There really isn't evidence to show that a nap
is helpful for managing a headache or a migraine.
Many of my patients tell me that they take medication
and then they go take a nap,
and by the time that they wake up,
the headache or the migraine attack has gone.
That creates a false sense of treatment.
I've certainly found that sleeping too much
or sleeping too little is a big trigger
for patients with migraine.
So I always counsel patients: Keep your sleep times,
your wake times the same every day
so that you don't end up triggering a migraine.
Instead of napping, and this depends on the person,
you can start with medication
that your doctor had prescribed to you,
some mindfulness and meditation,
and making sure that you keep your schedule consistent.
"Caffeine causes headaches."
Caffeine is a double-edged sword.
Yes, caffeine can be a trigger to headaches,
but caffeine can also be helpful for headaches.
Have fun, drink your latte,
but it's really important to recognize
increasing the amount of caffeine you take in
can trigger more headache attacks or migraine attacks.
And also, right after the period that you increase
and you decide, "Oh, I'm gonna try and cut it down,"
suddenly that abrupt withdrawal
can also trigger a migraine attack or a headache.
Now, caffeine can also be useful in treating headaches
or migraine attacks as well.
Like Excedrin, that can have caffeine in it,
which is Excedrin Migraine.
Kuruvilla: Just remember, you're adding
that caffeine from Excedrin Migraine
to the caffeine you're already taking.
That could certainly produce a worsening of headaches.
Just something to be cautious about.
"Dehydration is the most common cause of headaches."
That is definitely not true.
Dehydration is not the most common cause
for headaches in general.
The part that annoys me about this is "cause."
What you just talked about are triggers, right?
So triggers are certain circumstances or situations
that lower one's threshold to have a migraine attack
in someone who's already susceptible.
Kuruvilla: While dehydration is a common trigger for folks,
there are so many different triggers
that have been reported by patients.
The most common ones I hear about are alcohol,
too much caffeine or suddenly stopping caffeine,
not getting enough sleep, and stress.
Armand: It's really important to keep
a headache diary or a migraine diary,
because that allows you to know more about your body,
and that allows you to put tabs on triggers
and when attacks happen.
And that helps you decide with your doctor
what really is triggering you,
because what triggers one person
may not trigger someone else.
Oh, boy. "Migraines can be cured."
Migraines cannot be cured.
And I am sorry to deliver this news today.
Essentially, migraine disease is managed.
Migraine management consists of preventive treatments,
which may be a daily medication, a monthly injectable,
or a procedure or treatment with a device,
which is a very popular non-pharmacological option now.
We always recommend as-needed treatments
to limit your disability with each individual attack.
And then we also talk about non-medication options.
We talk about meditation, mindfulness,
acupuncture, vitamins.
There are so many options available now
that you can seek help to really get your life back.
"The best way to cure a hangover is hangover food."
There's no cure for hangovers.
The best cure for a hangover is time.
The duration really varies per person.
I've heard 24 to 72 hours.
That sounds like a really long time,
but everyone's body is different.
Headaches are usually a symptom for hangovers
because of two things.
The first thing is, we know alcohol to be a trigger
for migraine attacks and headache in general.
The body actually releases histamine
with alcohol intake in general,
and that can certainly also cause a migraine attack.
And the other portion is the dehydration of the alcohol.
Dehydration is a trigger for migraine attacks and headache.
Kuruvilla: You could aggressively
hydrate yourself with water,
or you can receive fluids through an IV.
You can take acetaminophen or an anti-nausea medication.
These are all options that are out there
to use before a night of drinking,
but certainly not proven enough for that purpose.
"Taking Advil will always treat headaches and migraines."
Advil is an as-needed over-the-counter medication
which is meant to be used as-needed only
less than two days a week
and is not used as a preventive treatment.
This is the bane of my existence,
because when I see patients for the first time,
they're always on an over-the-counter
anti-inflammatory medication.
What we call NSAIDs, the nonsteroidal anti-inflammatories.
And these NSAIDs, like Advil,
treat the inflammation portion.
However, migraine involves all sorts of chemicals,
and they wouldn't so respond
to the over-the-counter anti-inflammatories.
If medications such as Advil are used more frequently,
they can produce medication-overuse headache.
The newer term for it is medication-adaptation headache.
How I explain this is that
your body kind of gets used to it,
so you take more of the medication,
and you get more headache,
and it's just this vicious cycle.
If you find out that you're using your
as-needed medications like Advil too frequently,
please talk to your doctor about a preventive option
that will overall cut down on your headaches
so you don't have to use so much as-needed medications.
Ooh.
"All migraines are the same."
No, not all migraine attacks are the same.
Migraines come in all different flavors,
and we can differentiate them
in terms of how often the migraine occurs,
like chronic migraine versus episodic migraine.
So chronic means any attack that occurs 15 or more days,
and then episodic means less than 15.
And then we can differentiate them
on the symptoms that individuals have.
There can be something called hemiplegic migraine,
where individuals have weakness on one side.
There can be migraine with and without aura.
And what aura is, is a transient neurologic symptom,
which could be something that you see
in your vision that comes along.
It could be numbness on one side of your body.
It can be difficulty talking.
And then there can be other specific ones
like retinal migraine. That's specific to the eye.
Kuruvilla: The different types of migraine
have different risks and different management patterns.
For example, people who have migraine with aura
may be at a slightly higher risk of stroke.
There may be a specific treatment that works
for that type of migraine.
So for counseling purposes and treatment purposes,
we really need to know what type of migraine you have.
"Migraines and headaches only happen
on one side of the head."
It's definitely false,
but we always like a textbook definition of things.
If we look up what migraine is,
most commonly you'll find that it says
it's one-sided throbbing headache
that has nausea, vomiting.
But actually, again,
every individual with migraine is different.
Kuruvilla: Migraine pain can be in the forehead,
sides of the head, back of the head,
the face, the nose, and the neck.
Around 80% or more of patients with migraine
also have neck pain.
There are more rare headache disorders
that only occur on one side of the head.
Cluster headache happens
on only one side of the head, classically.
So, the location of your pain
doesn't necessarily pinpoint what your diagnosis is.
What I really find is it's a compilation of symptoms,
which is why I always talk about the diary.
"Having a headache means something is wrong with your body."
Oh, that's a very interesting question.
Having a headache doesn't necessarily mean
there's something wrong with your body.
Headaches can signal more dangerous things going on
in the brain, like a stroke, like a tumor,
like a tear within one of the arteries of the head or neck.
But there are everyday things that can cause headache.
Ponytail headaches, for example, are very common.
You're tying your hair back in that really tight bun.
Armand: Braids. Kuruvilla: Braids, yes!
Armand: Braids do the same thing.
Kuruvilla: Swim caps. There's ice cream headache,
where you eat that ice cream
and you notice that headache that comes on right away.
And that's because you're kind of
stimulating the upper part of your palate
with that cold temperature.
So, important to know the red flags
of when something may signal something more dangerous.
If you already have headaches or migraine disease,
you might want to pay attention to
if there's a changing pattern,
if it's still responsive
to the usual treatments that you take,
if you are having extra symptoms added to the migraine
that you haven't had before.
Those are indications you need to see a provider
to make sure to do some sort of workup
for any other secondary cause.
Ooh.
"Mental health has nothing to do with migraines."
Oh, no.
I just can't with this one.
So, we have to set the record straight on this one.
Migraine is the second-leading cause
of disability worldwide.
And actually, 50% of individuals with migraine
do experience anxiety disorders.
And what that's called is comorbid conditions.
We know that depression, anxiety,
and other mood conditions are more likely to happen
with individuals with migraine.
Migraine affects individuals at home,
their ability to take care of their family,
their ability to earn a living,
their ability to enjoy and engage in social interaction.
And a lot of the times that leads to guilt.
That leads to a sense of worthlessness.
And if you don't treat one condition,
it's difficult to treat the other.
What we do is we treat both at the same time.
Many of the brain chemicals that are released
during a migraine attack,
like dopamine, serotonin, norepinephrine,
they're the same chemicals that are also involved
in mood disorders like depression and anxiety.
So a lot of these medications
that are first indicated for mood disorders
actually work well in individuals with migraine.
And there are individuals who specialize
in both migraine and mood disorders that can help.
So, do you want to do the honors?
Sure, I'd love to.
Go ahead.
Let's really rip this one up.
Headaches and migraine disease are quite complex.
They're experienced differently
in many different individuals.
So it's really important to keep a diary.
Keep track of your individual triggers
and what really makes your headaches worse.
And have that dialogue with your provider
in order to help with proper management and treatment.