Why Do I Always Have a Headache? Experts Break Down What Might Be Causing You Pain.
June 9, 2024 | Episode 20
Producer’s Note: The following is an AI-generated transcript of The Wellness Conversation, an OhioHealth Podcast
SPEAKERS: Marcus Thorpe, Lindsey Gordon, Rafia Shafqat: OhioHealth Neurologist, Headache Specialist
Marcus Thorpe 00:13
Welcome back to the wellness conversation and OhioHealth Podcast. I'm Marcus Thorpe.
Lindsey Gordon 00:18
And I'm Lindsay Gordon. In this episode, we are talking about something that impacts just about everybody at one point or another, the dreaded headache. Most people either brush it off, maybe take a pain reliever - lie down. But do you know what's really going on?
Marcus Thorpe 00:34
Could it be a chronic issue or are you suffering from migraines that might be triggered from something in your life? Well, we have you covered with this podcast. Dr. Rafia Shafqat is an OhioHealth neurologist, and a headache specialist with OhioHealth. Dr. Shafqat it's good to see you. Thank you so much for joining us here on the wellness conversation.
Dr. Shafqat 00:50
Thank you for having me. It's an absolute pleasure being here.
Lindsey Gordon 00:53
Yeah. Let's talk about your journey to becoming a specialist in headaches. Was this a route you thought you'd always take? Is it something you knew you wanted to do early on? And why is the headache space so important within OhioHealth neuroscience space.
Dr. Shafqat 01:08
So in medical school, a lot of people don't realize that headache medicine is a specialty of its own. And I was one of those people. And when I was doing my neurology residency, I realized how many people are impacted by migraine. And I'm a patient myself, I saw my mother suffer with headaches her whole life, and her primary doctor would treat it as a headache, but never really migraine. And it made me realize that not a lot of people get proper care. And we don't have enough headache specialists in the United States, which really made me want to specialize.
Marcus Thorpe 01:42
We always talk about these topics, what are we going to talk about with the podcast. And when we were talking about headaches, everybody's head kind of went up and said, that would be a great topic, because it is one of those things where I think, in one way or another, it impacts everybody at different stages of their life. You know, everybody can raise their hand and say, Oh, I've totally had a headache, or I've had a migraine. Can you talk about in general, what? What causes headache? Is that a tough question to even answer? Because it's different for everybody?
Dr. Shafqat 02:09
Yes, there are a lot of different factors that a headache can occur from, such as lifestyle changes, genetics. And there can be secondary causes as well, such as hypertension, or tension, headache, neck pain. So it does impact people in a lot of different ways. And trying to figure out the cause can help treat the pain as well.
Lindsey Gordon 02:35
How common is it to say, Oh, you're not drinking enough water? Like is that? Is that a common reason for headaches? I think about that with myself. I think about that with my my son who has headaches from time to time, is it? Is that a common cause?
Dr. Shafqat 02:50
It is a common cause? Interestingly, there's been a lot of videos online about that, where when someone complains of a headache, their partner or friend says did you drink enough water today? It is true. It is true. Because we our brain is 70% water and we are doing activities throughout the day that allow water to evaporate or you're using up the hydration. So drinking water throughout the day is definitely one of the ways to treat a headache. But it's not the most common or the only help for headache.
Marcus Thorpe 03:26
Let's break down. I guess in general terms, the different kinds of headaches, right? You mentioned that. Can you talk about migraines, like what is a migraine so people can finally understand when they say I have migraine, this might be a migraine. I'm curious what that actually means.
Dr. Shafqat 03:42
So under the International headache society, guideline diagnosis guideline, a migraine is defined as a severe moderate to severe headache that is throbbing pulsating feels like a heartbeat worsens with activity and should have nausea and or vomiting as well as light sound or noise sensitivity. So those are the criteria’s that three out of four should define it as a migraine. And mostly women suffer with headaches that are mostly migraine, because there is a component of hormones that trigger migraine and headaches. But I've seen a lot of men in my clinic as well, that have migraine headaches as well and not realize it.
Lindsey Gordon 04:31
You mentioned women suffering from headaches and hormones. What about pregnant women? I mean, how does how does pregnancy play a role in in headaches?
Dr. Shafqat 04:39
So interestingly, when a woman who has migraine headaches gets pregnant, 9090 to 95% of them actually have relief from headache because there's a steady hormone level in their body. And then there's a rare population that actually gets worsening headaches that can be in their first trimester or the last trimester. But it can be a debilitating symptom to deal with while you're pregnant because there's not a lot of medication you can take.
Lindsey Gordon 05:11
And it has to be frustrating when people are just telling you drink more water. Exactly.
Marcus Thorpe 05:17
What are treatment options? You know, you're a headache specialist, somebody comes in that says, you know, I'm dealing with chronic migraines that, you know, I'm experiencing daily or several times a week or those kinds of things. When somebody comes in to see you from a specialist perspective, walk us through the steps, how do you start diagnosing something? How do you start treating something?
Dr. Shafqat 05:37
So I have a questionnaire that really goes through all the details of their headache? How often are they happening? Describe the headache? Is it sharp stabbing, is it more located in the back of the head? And asking them about timing? And all these questions help me figure out if it is a headache due to too much medication. Because unfortunately, when someone is dealing with a headache, they want to find relief quick. So they start taking medications over the counter like acetaminophen, ibuprofen, Excedrin, migraine, any of these combination medication, and it does help them for a short while. But the headache comes back because you're not treating the root cause of the pain, which is chemical signals in the brain and over sensitization of the trigeminal nerve. So that's my number one differential diagnosis is trying to rule out medication overuse headache, or in the headache world, we now say, medication adaptation, patient headache, and then I tried to figure out if it's a migraine, how often it's happening, is it really impacting their life missing work, not being able to be there for their children, family. And that's when you try to figure out if they need a preventive medication where they take something every single day. And luckily, now there's a lot of options available. In the last few years, there's been a huge influx of new medications for migraine that are specific, less side effects, and have been life changing for a lot of people.
Marcus Thorpe 07:13
That's funny, because I do think about, I have a headache, I run to the medicine cabinet, and I grabbed something right. And I think that's, that's normal for everyone. But I see what you're saying how that masks the pain for a little while, or it gives you that instant relief. But if you have something that's overriding that it's constantly there, it's always going to be there until you get it taken care of.
Lindsey Gordon 07:35
And so with that, how do you know when it's time to go see a specialist? I think you mentioned a few things like interrupting your daily life. I mean, is that a warning sign that hey, maybe you should go talk to a specialist?
Dr. Shafqat 07:47
Yes, definitely. I see a lot of people that are missing work, they are not being able to be productive at work. I have patients that tell me that they tell their children to be quiet throughout the day, because Mommy has a headache. And so that's one of the warning signs, you should ask your primary for referral to a neurologist. And if you notice that you're using more and more of the over the counter medication, but with no relief, or you're having a constant headache that's just not getting better. It's definitely time to see someone
Marcus Thorpe 08:21
I know, you know, growing up, if you're around your grandparents, they have these old school remedies, like oh, just take some chicken soup and everything will be fine. Or put this on your feet and everything will be fine. I would imagine in your line of work. You've probably heard some pretty crazy remedies that people use for a headache. Could you share any of those like what have you heard in your career where people say, well, this is working for me and you think to yourself, there's no way that works?
Dr. Shafqat 08:48
Well a headache has been an enigma for mankind for hundreds 1000s of years ago when I was doing research for headache medicine, like were started from what's going on in the 17-1800s. They actually used to burn a hole in the skull, because they assumed that there was pressure building up in the head and the brain and that would help relieve their headache. Oh, that's yeah, that was a little aggressive. Back then. Now, I've noticed there's a device online where it's called ear pressured and you blow air into your ear canal and they claim that it helps relieve headache. And I'm not sure... not to say anything about chiropractors, but it was developed by a chiropractor and there's a lot of unresearched data on their website.
Lindsey Gordon 09:48
I heard also like pressing on your thumbs or your big toe...
Marcus Thorpe 09:53
Yeah this little meaty part right underneath your thumb. I think somebody told me that when I was a kid "if you push this part right here," I've told my kids that and they're like, is that true? Like? I don't know?
Dr. Shafqat 10:03
Yeah, yeah, there are devices where actually presses on that meaty part of your thumb that can help. I think that comes from acupuncture standpoint, like using pressure. And it can help distract the pain, but I don't think it's taking away the pain completely.
Marcus Thorpe 10:20
It does not help the pain I have tried that for myself. It doesn't help.
Lindsey Gordon 10:25
Caffeine and headaches and no, I'm heavy coffee drinker. I go a day without coffee, I will get a headache. And it could be from something else. But I just automatically associated with the lack of my cup of coffee. Is that Is there any truth behind that? Yes.
Dr. Shafqat 10:40
So caffeine a lot of people don't realize is a chemical that is working in the brain causing chemical changes. And interestingly, caffeine can be used to help relieve a headache if it's taken early enough. But fluctuations of caffeine throughout the day can be a trigger for headaches as well. So if you are used to having one or two cups of coffee during the day, if you deviate from that that can trigger a headache. And if you're having too much coffee that can also turn into overuse caffeine overuse headache.
Marcus Thorpe 11:15
Yeah, I'm a Diet Coke drinker and there are days where if I if I don't have it, I start every day with just like a quick Diet Coke and the days I don't I feel it. I feel that headache. Yeah,
Lindsey Gordon 11:26
we know it to just get
Marcus Thorpe 11:29
around me too much. Let's talk about triggers. For migraines, especially you mentioned a little bit when you were listing some things but environment, sometimes light sensitivity and other things. Can you walk us through what can be a trigger for people with migraines?
Dr. Shafqat 11:46
Yeah, so there's a lot of triggers that can cause a headache and it can actually vary individual to individual and it can even vary within a migraine attack in one person. So one time you can have a headache from weather changes, other times you can't. So generally, common triggers for headache is weather changes, barometric changes, caffeine, overuse, withdrawal, neck pain, and certain foods. There has been misconception about MSG being a trigger for headache, which is not true, it has been debunked. So a lot of people still think that processed foods or MSG, specifically as a trigger for headache, and over sleeping or not sleeping enough, missing meals can be a trigger for some people. And strong odors. I have some people say cigarettes or different types of perfume can trigger a headache, and cold. If it's extremely cold or your skull gets cold. Like if there's air blowing on it. Some people say AC can trigger a headache.
Lindsey Gordon 13:02
You just settled a very long debate in my household growing up my dad never let us paint our nails or use nail polish remover around him because it would trigger a headache for him. And I always just thought okay, dad, but no, I think he was right. And now that I'm an adult and have my own place to live, I paint my nails freely. And it's so nice. And I think of that all the time. But funny. There's truth to that. You mentioned your family and your mom as your motivation for becoming a headache specialist. Can you sort of tell us more about that sort of what you saw your mom go through and what you experienced and how hard that was on you and your family? Yes,
Dr. Shafqat 13:41
so she would have migraine headaches and she would describe them as a different type of headache because we didn't know the word migraine, she would say this one is a really bad one. And she would need to lay down and she would be out of commission for at least a day or two because she was going through the different phases of the migraine. And I didn't realize at the time that it was migraine, I get migraine myself. I've had them since I was 10 or 11 years old. And I think it was later in life that I realized oh I do have migraine because I have I get extreme nausea, light sensitivity, brain fog, I have to lie down I cannot function and sometimes vomiting helps relieve the headache. So I would have to wait for my migraine to go through. Yeah, and at that time, I didn't have any medication prescribed medication, I would try to take over the counter Tylenol, Advil, and I would need to do more and more dosages to try to help relieve the headache until I learned there's proper medications.
Marcus Thorpe 14:44
That's really interesting. I think of somebody who you know, has a cold and they know if I follow this regimen then I'm going to feel better. Is there is there a roadmap for somebody who has a migraine or has chronic migraines when they come to a specialist like, what's the path to relief for those people at the end of the day? Are there things that you are confident that if we follow X,Y and Z, we're going to get to where we want to get where maybe this isn't so debilitating on a daily basis for us, right. So as
Dr. Shafqat 15:15
I mentioned, there's preventive medications that you take everyday to prevent a really bad headache or migraine from interrupting your life. And then I also prescribe people, multiple medications for acute treatment of a headache that they can reach for. So when someone is having a headache, there's three things going on in the brain that we are sure of. So far, there's a lot of other things that we haven't confirmed. One is inflammation, which is why anti inflammatories work, like NSAIDs, acetaminophen, so I prescribed them a higher dose of ibuprofen, if over the counter doesn't work, or diclofenac. And then there's chemical changes in the brain like serotonin and dopamine is out of balance, and that is what causes the nausea sometimes associated with the headaches. So that's where neuroleptics, which are anti nausea medication, such as Metoclopramide or Raglan, I prescribed that as well, so they have an option. And then the third medication is migraine specific so that's where the Triptan's like Sumatriptan and Rizatriptan are helpful in relieving a headache and, and there's been an influx of new medication as well. There's been ads about Nurtec and Ubrelvy, those are the brand names, they are classified as G pants. So they are targeting a certain molecule in the brain called CGRP. That is migraine specific released in the brain when there's migraine and propagates the pain cycle. So using that medication helps relieve the migraine symptoms and headache as well. So those are the three medications I prescribe. I also instruct people to use them all together, if it's a really bad headache, to try to target different things going on in the brain. If all that doesn't work, we do give them rescue medication, like things that are next step. So they don't have to go to the emergency room. And those involve like nasal spray, injections, Toradol injection if they're comfortable injecting themselves at home. And I know this is a long answer. But there's also non medication ways of treating a headache. Now there's neuromodulation devices that have been FDA approved for migraine treatment as well. And they target different pain cycles. There's six of them on the market right now. The two most common one that are used is called CEFALY, which is a 10s unit for the trigeminal nerve. And it looks like a little Cyclops device that you put on the forehead, and it feels like a little buzzing sensation. And it is stimulating the trigeminal nerve and resetting the pain path and all that. So that one is approved for as needed when you are having a headache, which is a 60 Minute device use. And you can use it every day for 20 minutes to prevent headache. Yeah. Unfortunately, it is not covered by insurance, which is what precludes a lot of my patients from being able to use it. And I have a couple of patients that are able to use it with their FSA or HSA funds. And they have had some success. The other device that I have really had good success with is called a Nerivio device, which is a neuro modulation. And it's a little band that you put on the arm and it triggers the small pain nerves in the arm. And that information travels to the brain resets the pain cycle and sometimes can help relieve the headache and in the clinical trials and in my clinical practice... 70% of people say that it helps relieve their headache. And yeah, this one's also not approved by insurance, but it was invented or I guess available on the market in 2019 and was actually considered a best invention back then. So yeah.
Marcus Thorpe 19:17
We've come a long way since holes in the head.
Lindsey Gordon 19:22
The holes in the head, oh my gosh, yeah. How about a forever nap? Right?
Marcus Thorpe 19:28
Can we talk about environment? Screens. We're on screens all the time. We're constantly getting stimulation from something whether it's the TV or a radio or whatever it is, how can environment how can the screen impact you and what's going on with a headache or a chronic issue that you're having with migraines.
Dr. Shafqat 19:49
So we've heard a lot about blue light being not good for your eyes, and that is what is impacting during a headache as well. The blue waves can be harsh for the eyes and can worsen a headache for some people. And on that note, a lot of people say that fluorescent light is very triggering for headache as well. For some people, it can be a trigger, and some people, they say their headache worsens when they're in fluorescent lighting. So for those people, I tell them to try to get blue light filter glasses, there's actually lenses that help filter out the more waves blue length wave, FL 41 is a lens. And it's looks like a rosy colored glasses. So you're actually seeing the world through rose colored glasses. And then there actually has been research trying to figure out what is helpful during a headache because you can't sit in the dark if you're having a headache or people who have chronic migraine always. So there was a scientist from Harvard that discovered a specific band of green wavelength that is very soothing for a migraine. So green light therapy has been proven to be good for migraine patients as well.
Lindsey Gordon 21:16
That's so interesting, because I see a lot about like red light therapy for skin benefits. I don't know if there's, I mean, obviously, that's another podcast for another day. But interesting to hear green light, because I've seen a lot of talk about red light, but green light. That's interesting.
Dr. Shafqat 21:30
Yeah so it's like a lamp. You can buy or a bulb you can put in your lamps. So put it around, they can read with it. Work on your computer with your glasses.
Lindsey Gordon 21:41
Turn your house into OZ you'll be headache free.
Marcus Thorpe 21:45
I know we covered quite a bit there. But is there anything that you think people need to know about headache as we start to wrap up this podcast?
Dr. Shafqat 21:53
I think it's to recognize when the headache is interrupting your life. And if you are noticing debilitating headache, nausea, as well as other symptoms, because people don't realize that migraine is more than just a headache. It's a chronic neurological disorder. And it can have symptoms such as numbness, tingling, weakness, people get difficulty speaking slurred speech. So they look like stroke symptoms. But once that has been ruled out, it can be diagnosed as a migraine and prevented with appropriate treatment.
Lindsey Gordon 22:35
Gotcha. Well, this was super informative. I feel like I'm walking away learning so much more about headaches and migraines and how to support friends and family who deal with that. So thank you so much for this and as with every podcast, we like to have a little fun and get to know you a little bit better. And so we still have a little bit of time left for that.
Marcus Thorpe 22:58
Best Restaurant or meal you've had I know that you've been with OhioHealth for about three or four years what's the best food you've had here in central Ohio. What's your go to? Where do you like to go?
Dr. Shafqat 23:08
So there is a restaurant owned by a local couple in Victorian Village called Pelino's pasta, then there twice it is so good. And interestingly they have different meals every month, so you can't have the same meal every time so it's the best meal every month.
Marcus Thorpe 23:26
Like a four course where they just bring you different dishes.
Lindsey Gordon 23:29
Really? What if you fall in love with something? Can you like request? Hey, two months ago you had this?
Dr. Shafqat 23:38
You can hope for it to come back.
Lindsey Gordon 23:42
So you can't be a creature of habit.
Marcus Thorpe 23:43
No. Keep you on your toes though.
Dr. Shafqat 23:46
Yeah, but their dessert is the best. They have tiramisu. Yes, that his wife makes and it's the best.
Lindsey Gordon 23:52
Oh my gosh, and it going in a completely different direction. I love asking this question. If you weren't working in this field. What else could you see yourself doing? Is there anything else you'd like to do?
Dr. Shafqat 24:04
I have thought about it a lot. And I think I would probably be a baker of some sort. I don't know I just like creating things. Following a recipe to bake something is kind of like a chemic chemical experiment. Trying to figure out the right amount and timing and dosages. Yeah.
Marcus Thorpe 24:25
Are you a book movie podcast or magazine person?
Dr. Shafqat 24:28
I am a book and audio book and podcast this this podcast obvious obviously love this one. Yes. Every time it comes out.
Marcus Thorpe 24:38
I love it. Well, doctor Shafqat thank you so much. It's been great to learn a little bit more about headaches and get to know you a little bit better. Thanks for what you're doing for the patient population. I know it's a tricky space and headaches and I know it can be debilitating. So I know you get some great joy when you see people start to kind of turn the corner on those things.
Dr. Shafqat 24:55
It is definitely satisfying and it does get me out of bed and excited to get to work everyday.
Marcus Thorpe 25:00
Well, thanks for joining us. We really appreciate it.
Dr. Shafqat 25:01
Of course, my pleasure, it was good to meet you all.
Marcus Thorpe 25:02
And of course, we thank you for joining us for this episode of the wellness conversation and OhioHealth podcast. Before we do wrap up, we invite you to join us on all the major social channels, staying up to date on any new episodes as well as other health and wellness topics. Of course, if you're looking for more information on OhioHealth services and locations, including doctor Shafqat and the headache team, you can go to ohiohealth.com
Lindsey Gordon 25:27
The information in this episode will also be available in written form at the OhioHealth wellness blog you can find that@blog.ohiohealth.com Thank you for joining us and be sure to subscribe as we continue our exploration of important health and wellness topics with OhioHealth experts!