In this episode of What the Health, John Salak is joined by Angie Glaser, an editor at Migraine Again and blogger of Chronic Migraine Life. They discuss the debilitating nature of migraines, shedding light on the fact that you have the power to manage this condition. They delve into the widespread prevalence of migraines affecting millions of Americans, the difference between migraines and headaches and the significant impact migraines have on individuals' daily lives.

Angie provides a personal account of her experience with migraines, discussing the different phases and types of migraines, risk factors, genetic influence and the latest treatment options and lifestyle strategies to manage the condition. The episode underscores the need for better diagnostics, increased funding for research and proactive prevention steps for those suffering from this chronic condition, emphasizing that your proactive steps can make a difference. 

00:00 Introduction to Headaches and Migraine

01:44 Understanding Migraine: Symptoms and Impact

02:54 Migraine Statistics and Demographics

06:41 Phases and Types of Migraine

14:14 Personal Journey with Migraine

18:25 Medical Treatments and Advances

26:21 Lifestyle Adjustments and Future Outlook

35:16 Conclusion and Resources

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Connect with WellWell USA:

• Website: https://wellwellusa.com/
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Connect with Angie Glaser:

• Website: [Migraine Again] (https://migraineagain.com)
• Angie's blog: [Chronic Migraine Life] (https://chronicmigrainelife.com) 
• Migraine Self-Quiz: (https://www.migraineagain.com/id-headache-vs-migraine-quiz/)

WW - Migraine’s Painful Truths with Angie Glaser

Migraines can lead to fatigue, nausea, vision changes, irritability, and much more, none of which is any good. Sadly, migraines are pretty common, affecting millions of Americans every year. It's possible that the number of sufferers may even be growing. All this painful news brings questions. Why are so many people getting migraine attacks?

Who's at risk, and what can be done about it? June is a perfect time to ask these questions, as it is officially Migraine and Headache Awareness Month. Thankfully, our upcoming guest is an authority on all things migraine, who can help answer these questions and provide some relief. So if you suffer from migraines, or you know someone who does, it's worthwhile listening up. So welcome to what we always consider the best part of our podcast and that's where we dive into the topic for the day with an expert on migraines, both from a professional and a personal level, and that is Angie Glasser. She's an editor at Migraine Again, and she also has her own personal blog which is Chronic Migraine Life.

So, Angie, welcome to our podcast.

[00:02:23] John Salak: We do want to talk about how it's affecting you. Let's get some, just some basics out there for people. Everyone knows about migraines. I mean, everyone has heard of migraines if they haven't suffered from them directly or they know somebody who suffered from them. How many people are dealing with migraines or migraine attacks?

And that's another aspect I want to talk about because there seems to be a issue in the migraine or neurological communities to whether we should call the migraines or migraine attacks. But first of all, how many people are suffering from these severe attacks?

And more and more people are getting diagnosed, but that doesn't necessarily mean that more people have the condition, although some researchers do suspect that pollution and climate change might increase that global incidence over time.

Some estimates that up to 50 percent of people with migraine actually have not been diagnosed. Migraine tends to run in families and it's really stigmatized. So it's not uncommon for somebody to watch their parent struggle through a migraine attack. They just take themselves out. They go lie down.

They don't talk to a doctor. They just make do. So then when they start experiencing migraine attacks themselves, they just cope with it the way that they've seen their parents. So with less stigma comes more diagnoses, which we're seeing now.

If it does differ, is it just a more severe headache or is there something significantly different about a migraine?

And even though it is invisible, a migraine attack, if you were to get a functional MRI while you were experiencing one, they would be able to tell that the activity happening in your brain is not normal.

[00:05:36] Angie Glaser: So that's one of the biggest misconceptions is that migraine is a headache. Head pain and neck pain during a migraine attack can be really severe, but those are not the only symptoms that cause disability. As I mentioned, the light sensitivity, sound sensitivity, smell sensitivity. There's also vertigo, dizziness, fatigue, nausea and vomiting, tinnitus, cognitive effects like brain fog, difficulty concentrating.

These are all really common symptoms. Now, if you compare that with a tension headache, which is a very common type of headache, tension headache is usually typically pretty mild and moderate, and it doesn't typically affect someone's functioning. 90 percent of people who have a migraine attack experience some kind of disability.

during that attack. Disability is not a bad word. It simply means that you're unable to perform your usual work and life tasks. And it's really unfortunate that a migraine attack can last a long time. So there's actually four phases that your brain goes through during an attack. There's a warning phase we call the prodrome where people can experience cravings for salt or sugar, or they'll yawn a lot or they may even have to go to the bathroom.

More often, the second phase is called the aura phase. About a third of the people with migraine experience aura. I'm one of those folks. The most common aura symptoms are visual disturbances, either like a blind spot in the middle of your vision, or you'll see kind of a jaggedy line on the edge of your vision, or flashing lights.

The one that I experience most often is that everything just looks kind of shimmery, kind of sparkly, like I maybe might have something in my eye. So that's the aura phase. The third phase is the headache phase or the pain phase. That's where the worst of it happens. That's where you're really in it. But then we have a final phase called the postdrome phase, which we like to refer to as the migraine hangover.

It does feel a little bit like an alcohol hangover, of course, without the fun. So during that postdrome phase, the electrical and chemical storm that is happening in your brain during a migraine attack, it's still going. The pain is maybe teetering down a little bit, but people tend to feel just really worn out, like they got hit by a bus.

fatigue is really common, and then also more of those cognitive effects, just having difficulty concentrating. So it can be really difficult to bounce back from a migraine attack, especially if it lasts three days, which it can. Now compare that to a tension headache, which is typically pretty mild and doesn't interfere With your ability to function. A migraine attack is really a neurological storm that affects the whole body.

[00:08:31] Angie Glaser: Yes! So, like ice cream, migraine comes in lots of different flavors. The two main ones are migraine with aura and migraine without aura. As I mentioned, a third of the people will experience aura symptoms. You don't have to experience it with every attack to have migraine with aura, but they do experience it with some attacks.

There are some rarer types. A hemiplegic migraine is a pretty rare sub variant that has some kind of scary symptoms that can resemble a stroke. So tingling in the feet, sometimes one sided weakness. And then vestibular migraine is another subtype that's more common. This type of migraine is characterized by dizziness and vertigo, and sometimes people won't have any kind of head pain at all with the vestibular migraine.

So that's another reason why migraine is not just a headache.

Not all the time, but I can remember six or eight really bad migraines. But I've only gotten one or two since then. So does age play a factor? Can it play a factor? Are there other aspects? Who's most susceptible and what are the other variants in terms of demographics we might look at?

So migraine is genetic, but it's also influenced by environmental factors like hormones, as I mentioned, or stress. People who experience early life stress or ongoing trauma, they're going to have a greater risk of developing migraine. In fact, veterans of the Iraq and Afghanistan War have some of the highest incidences of migraine as a result of the physical trauma from concussions, but also the emotional stress that comes with it being in active combat.

[00:10:47] Angie Glaser: So scientists have identified about 30 different gene mutations that can lead to migraine. So no two people with migraine have the exact same thing going on. Someone may be born with that migraine gene. Like, You, for example, you have that migraine gene. You experienced some migraine attacks as a kid.

You maybe were not exposed to external environmental factors that would have kicked your migraine into a higher gear. So you were kind of able to come back from it and it doesn't affect your life too much. Now, somebody who was born with that same gene, who experiences these environmental factors, hormones or stress. That person may have more migraine symptoms in their lives. And the hormonal connection, once again, is another reason. My migraine attacks didn't get really bad until middle school, and that's until I hit puberty in middle school, and that's really common and pregnancy and menopause are also kind of life experiences that can trigger migraine attacks in somebody who has that genetic disposition.

[00:12:07] Angie Glaser: It can. Some folks will, if they have a strong hormonal connection and they hit menopause, their migraines may go away completely. Some people, however, find the opposite, where menopause can trigger more migraine attacks.

So it's really difficult to kind of predict how migraine is going to act in any given person and during any stage of their lives.

Also, in terms of perhaps a number rising.

That can be the catalyst that gets somebody into a doctor's office to get that initial diagnosis.

Bring about.

[00:14:06] John Salak: Mm hmm.

[00:14:14] John Salak: Can you tell us how it's impacted your life, given the fact you reference that it started in grade school or middle school, it got really bad. Can you tell us what's your journey been like?

When I hit college, however, I started to get them more and more frequently. I saw a doctor, he got me on a preventive medication, I got them under control once again. And then a couple years after I graduated, I entered the workforce and over the course of a year, my migraine attacks went from Maybe three a year to once a month, and then twice a month, and then three times a month.

So in the course of a year, I progressed pretty drastically. I was working as a park ranger actually in Yosemite National Park,

[00:15:21] Angie Glaser: and I had to resign my job, unfortunately, because I just could not get out of bed.

[00:15:28] Angie Glaser: Eventually, I applied for Social Security Disability Insurance at the ripe old age of 24, I believe.

I applied for Social Security Disability Insurance at the ripe old age of 24, I believe. so that was my low point. But a huge lifeline for me during this time was the online community. You mentioned that I have a blog I love to write. So that was really cathartic for me to just kind of get my story out there, connect with other people.

There are tons of people out there who deal with this. I have had some success with treatments. I'm a lot less disabled now. I have a full time job. I've been able to go back to work, which is great. So huge. I do work from home, which is incredible. I have accommodations that make it so that I can work,

[00:16:08] Angie Glaser: I've been on a bit of a roller coaster and my experience is not that uncommon.

It's pretty common for people to kind of cycle back and forth different seasons of their lives. They'll have, migraine will have a different impact.

[00:16:42] Angie Glaser: It's really hard to say, unfortunately. So I definitely have a genetic component. I mean, it could have been that, you know, my, my card was just up that time in my life, my brain was just, this is what's going to happen.

[00:16:58] Angie Glaser: I wish I had an answer because then I could maybe undo it.

[00:17:29] Angie Glaser: The very first attack that I had, I was three and a half. I had terrible headache. I was crying, holding my head. And then I vomited and I felt better. My dad gets migraine attacks, so my mom recognized that. The headache plus vomiting equals migraine in most instances. So I was able to get diagnosed early.

acute attack. There's actually two. But those just did not work for me. So I was kind of just in a waiting, holding pattern. I'd get an attack and I would just have to wait for it to go away.

That right there is a huge risk factor for it turning into chronic migraine. And it's pretty important. to treat those attacks as soon as you can.

[00:18:31] Angie Glaser: So, since 2018, we've seen some really huge advancements in migraine treatment, but I want to back up a little bit and set the stage

[00:18:40] Angie Glaser: So, every person with migraine should have an acute medication or an acute treatment that they take when they get an attack.

Most people with migraine, if you experience four or more migraine days a month, you can benefit from prevention.

In 2018, however, we saw the first migraine preventive medication that was actually made just for migraine. This drug hit the scene in 2018. It was called Aimovig. And it was followed by three more medications in that same class. And Galadie, What makes these drugs kind of exciting for people with migraine is they're super targeted.

They're created to act on a neuropeptide, in the brain that's called calcitonin gene related peptide, CGRP. CGRP is just one of the chemicals that's involved in a migraine attack. If you take a blood test during a migraine attack, you can see that you have elevated levels of CGRP.

And because these are so targeted, they come with few side effects, so people can tolerate them. Now, since then, we've seen even more CGRP drugs. A second class has come out that we call the G Pants. This includes Nurtec, UBRELVY, QULIPTA and ZAVZPRET. Even better, the FDA has also cleared a handful of neuromodulation devices.

These are non invasive devices that you put on your forehead, your head, or your arm, and they use magnets or electricity to interfere with your nervous system. Very similar to a TENS machine.

And these are great because they don't use medication, so younger kids can use them, adolescents can use them, and you can also combine them with your medications to get more relief.

So we're now seeing, for the first time in history, this menu of migraine options that were developed just for migraine that deliver really spectacular results for some people. I am not the only person who was on social security disability and was able to go back to work. I know a handful of other folks in that same boat.

So these can be really life changing. They don't work for everyone, however, but I want listeners to know that there is research in the works now looking at a different neuropeptide. So we may see more treatments coming in the future. So if you tried one of these drugs and they didn't help you, maybe talk to your doctor about trying another one, but definitely do not lose hope because we should see even more.

treatments come on the scene.

[00:21:49] Angie Glaser: Migraine research is unfortunately incredibly underfunded. However, the scientists who discovered CGRP, they discovered it back, I think, in the 90s. They discovered that it was part of the migraine. They were working under the NIH, so they were using federal research dollars to discover this mechanism. The first drugs they made that acted on CGRP had some liver issues.

[00:22:34] John Salak: Why is it so hard to develop preventative measures? Is it because it's different, affects everyone differently, or the triggers are different for you versus my wife who suffers from migraines or someone else is that the real stumbling block to finding a blanket cure, a blanket preventative medicine?

different for everyone.

[00:23:12] Angie Glaser: Before, unfortunately, that lack of funding, in part because it was stigmatized, and also because Women suffer from it more, and of course it's not a fatal disease, so

Should rightly go to fatal diseases, but a lack of research over decades has kind of put us in a position where we're a little bit behind on migraine treatments.

[00:23:54] Angie Glaser: I believe it has to do with stigma coming from both the patients and the doctors.

Some people are reluctant to go get a diagnosis. Some people may go to their physician and get a misdiagnosis. That happened to me. Actually, I was misdiagnosed as having sinus Headache.

[00:24:14] Angie Glaser: So there's some stigma on the patient side, but there's also stigma on the doctor's side.

I've heard of headache specialists being kind of denigrated among peers because they've chosen an unfancy

So

Comes with the lack of research. The NIH has funding. Patient organizations have been working very hard in DC to increase that funding.

And it is there. It's starting to increase.

But the second issue now is that we don't have a ton of researchers who have devoted their lives to studying this. They are there, but we're just a little bit behind when it comes to federally funded research.

[00:25:42] Angie Glaser: Definitely. Every person who has migraine attacks should have some medication in their toolbox that they take when they get an attack. And some folks Can use over the counter medication, and it works well. Ibuprofen works really well for some people not everybody. If those over the counter drugs are not helping, that's when you really need to talk to a doctor about getting a migraine specific medication.

It's interesting, these tryptins, they're not painkillers. If you have any other kind of pain, it won't affect it at all. It just interrupts that migraine path

[00:26:40] Angie Glaser: Yes, that's a fantastic question. A very important question. So, some of the risk factors for migraine evolving, you can't control. Like, being a woman, your genetic makeup, or experiencing trauma. But there are risk factors that you can control, like not smoking, trying to keep a healthy weight, If you have another condition along with migraine, anxiety, or depression, or sleep apnea, managing that condition as best as you can is really helpful because those conditions tend to feed off of each other.

A few of the lifestyle strategies that I personally swear by are sleep hygiene. Irregular sleep is one of the most common universal triggers. Broken sleep, not enough sleep. So I am very conscious of my sleep habits. I try to go to bed around the same time every night and wake up around the same time every morning, on the weekends, which isn't that fun, but it really helps me.

I don't wake up with a migraine attack as often. And then when it comes to food and diet, some folks are able to identify a food trigger and they avoid it and it helps them manage their condition. I have not been able to, I mean, except for maybe alcohol, but I haven't found a real trigger. The most important thing with diet is to not go too long without eating.

So the migraine brain really likes routine, snacks, every three to four hours. Try not to let yourself get to a place where you're, too hungry.

Is that a misconception?

[00:28:57] John Salak: Okay. Alright. And okay, so, and I know we could go on, not on and on, but there's so much to talk about here. Where do you think we're going to be in 5 or 10 years in terms of dealing with migraines, identifying migraines, getting in front of it? I know you're saying there's some more research, there's some more funding coming in. Do you have hope for progress on a wide scale in terms of dealing with this in 5, 10 years?

We'll also have greater access to the treatments. that exist. So these preventive medications have been out for several years. They work really well for some folks, but some folks just don't have access to them if they haven't been diagnosed, if their physician doesn't know about them.

So there's a real push to increase use of these, and that really comes also with prevention. Really trying To get people who live with migraine to be really proactive about prevention. It's not that some Of those preventive medications are a pill that you take every day, which some people may be a little wary about.

But chronic migraine, once that wildfire gets going and you're experiencing symptoms on 15 or more days each month, it's so difficult to manage. So really being proactive about prevention, even if it's just your sleep schedule or not drinking too much alcohol, those kinds of things can help

[00:30:25] Angie Glaser: doesn't progress.

[00:30:37] Angie Glaser: or all days. So,

[00:30:39] Angie Glaser: that's my experience. It's been so frustrating. I, it was like a flip switch. On July 3rd, 2013, I remember the day. Since then, I've had daily symptoms. And this is

pretty common, people with migraine. Like I mentioned earlier, there are these different phases of migraine. So I'm not always in that headache attack phase where I just really need to check out.

But I do have a low lying headache and light is always a little bit brighter for me. So it can be really tricky once you're in that position and it's just really entrenched in your brain.

[00:31:28] Angie Glaser: Gratefully no.

[00:31:31] Angie Glaser: of people in my family who have it and nobody has it quite as bad as I do.

[00:31:36] Angie Glaser: Yep. Yep. Yep.

[00:32:03] Angie Glaser: This is a big push within the migraine advocacy community to change the way that we talk about it. Most people will say colloquially, I get migraines. Which sounds pretty casual if you say I have migraine disorder, or I have migraine disease, or I have a migraine attack. Those terms more accurately describe the experience.

And the goal here is to try to legitimize the experience migraine is not just this inconvenience that comes up every once in a while, but a chronic condition like asthma. You wouldn't say, I have asthmas, or I'm getting asthmas. You refer to the condition by a singular name.

[00:32:57] Angie Glaser: biggest misconception about migraine is that it's an inconvenience or an episodic issue that pops up, you take a couple ibuprofen, you go about your day, and everything's fine. That is not true, unfortunately. Migraine is a chronic condition. Even if you aren't experiencing a migraine attack, you still have that disorder.

[00:33:23] Angie Glaser: Migraine attacks begin really deep in the brain, and in some folks who have chronic migraine, they can experience symptoms. all the time. So the biggest misconception is that it's merely an inconvenience or just a headache, whereas the impact that it has on people's lives can be really substantial.

[00:34:06] Angie Glaser: It is, and at MigraineAgain. com, we have a three question quiz that can help you know if you have migraine attacks. if you suspect you might have it, head over and take that quiz.

[00:34:40] Angie Glaser: Thank you so much .

Joining our WellWellBeing community is easy and free. Just visit us at WellWellUSA. com, go to Milton's Discounts on the pull down menu, and you'll see the sign up sheet. Signing up takes just seconds, but the benefits can last for years. Enjoy. So, migraines, or migraine attacks, are obviously serious matters.

They are also widespread, with at least one in four Americans suffering from these bouts. This number may even be rising, which should put everyone on notice that it is essential to effectively diagnose and treat these attacks. The problem is that migraine episodes can differ widely from person to person, making treatments challenging.

There is, however, good news and wise counsel to consider if you're one of the millions of people dealing with these attacks. First off, funding and research are improving, clearing the way for improved treatments. Diagnostics are also improving, and this lets medical professionals identify and treat these attacks earlier.

A wider variety of treatments are also now available, making it easier to effectively ward off these attacks. 4. And Even if treatments aren't exactly right for everyone, new ones are being developed constantly, which should give all sufferers hope for relief. Finally, lifestyle adjustments can help limit or lessen attacks.

These adjustments include watching or limiting alcohol consumption, stopping smoking, Focusing on improved nutrition and making sure those predisposed to attacks get enough sleep and get regular sleep. Well, that's it for this episode of What the Health. We'd like to thank Angie Glasser for her personal and professional insights into migraine attacks.

We'd also recommend visiting MigraineAgain. com. That's MigraineAgain. com and reading Angie's blog, Chronic Migraine Life, to learn more. They're both great sources of information. Thanks again for listening in, and we hope you'll join us again for What the Health?