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PRx Host : |
Tonight we welcome Larry Newman, M.D., who will teach us how to treat -- and perhaps avoid -- headaches, including those the holidays often bring. Dr. Newman is chatting with us from New York City, where he's a founder and on the staff of the Headache Institute at Roosevelt Hospital. He is one of only a handful of people who treat only headaches. Welcome to PlanetRx.com, Larry!
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Dr. Newman : |
Thank you, it's a pleasure to be here!
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PRx Host : |
To start, could we define what we are discussing; i.e., what exactly is a headache?
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Dr. Newman : |
Well, there are lots of different causes of headache. There are about 300 conditions that have headache as a symptom, so, headache could be associated with serious or benign diseases.
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PRx Host : |
What we hear about most often is the migraine. What is that?
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Dr. Newman : |
A migraine is a specific type of headache that is characterized by a one-sided throbbing pain. In fact, the word migraine means "half of a head." Associated with the pain, patients also experience nausea, vomiting, and sensitivity to light, noise, and smell.
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PRx Host : |
How many people are affected by migraines, Larry? Is it a serious problem?
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Dr. Newman : |
Yes, recent studies show that about 24 million Americans suffer from migraine. Migraine accounts for a $15 billion loss to our economy. So it's a very serious problem.
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PRx Host : |
Do we know the cause of migraines?
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Dr. Newman : |
We're gaining some new insight into the cause of migraine. We now believe that it's due to changes within the brain: chemical, electrical, and changes with the blood vessels.
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PRx Host : |
Who is most susceptible to a migraine?
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Dr. Newman : |
Migraine can affect anybody, but affects women three times more than men. They can begin during childhood and persist throughout the person's life, though most patients who have the most cases are between the age of 25 and 55.
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PRx Host : |
Do we know why women get more migraines? And why it affects these particular ages?
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Dr. Newman : |
It's probably due in part to hormones. In fact, boys get migraines as commonly as girls in childhood. It's only after puberty that girls start to get migraines more often.
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PRx Host : |
Do migraines decrease as you age?
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Dr. Newman : |
That's one of the common myths that patients have been told over the years, although migraines tend to decrease as patients get older, and especially around menopause. Doctors no longer allow women to go through menopause because they keep them on hormone replacement therapy.
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PRx Host : |
Do you think that is wise?
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Dr. Newman : |
Sure. The benefits of hormone replacement therapy include decreased risk of heart attack and stroke. And not everybody continues to get headaches with hormone replacement therapy.
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PRx Host : |
What triggers migraines?
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Dr. Newman : |
Good question! There are a number of classic triggers of migrain. They include menstruation, birth control pills, stress, changes in sleep patterns, weather changes, and certain foods.
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PRx Host : |
Let's now turn to some audience questions.
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joely : |
Why are red wine, beer, and chocolate associated with headache?
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Dr. Newman : |
Among the most classic triggers with migraine include alcoholic beverages, such as red wine. The reason why this happens is not entirely known, but it probably has to do with wine causing changes in the brain chemistry, which triggers the headache. Chemicals found in chocolate have also been shown to lower a person's vulnerability to developing migraine for similar reasons.
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col858 : |
What are some alternatives (herbs, supplements) that work? I don't like to rely on aspirin or other drugs.
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Dr. Newman : |
There's a whole host of treatments that are available for migraine sufferers, both medical and non-medical. Non-medical therapies include biofeedback, stress management, and certain vitamins, such as vitamin B-2 and magnesium. Herbal supplements such as feverfew have been shown in some studies to help and in others not to help.
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PRx Host : |
Larry, is the treatment for migraines the same in all people?
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Dr. Newman : |
No, migraine has different features in different people. We try to tailor the treatment to what the patient is experiencing. The medication is divided into acute treatment, which are medications used to stop an ongoing attack, and preventative treatments that are taken on a daily basis to prevent subsequent attacks.
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col858 : |
Can sex bring on headaches? Seems strange, but I've read that's true. If so, what's the cause?
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Dr. Newman : |
Yes, there's a type of headache that occurs during sex, specifically during orgasm. In general, headaches that occur suddenly during sex need to be evaluated by a physician, but in some patients, repeated episodes occur during sex and are benign. It is believed most commonly to occur because of changes in blood vessels similar to those seen in migraines.
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cayenne01 : |
I have a younger family member, she's about 11, who suffers from migraines. Are the causes/treatments for young people different from adults?
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Dr. Newman : |
The causes are the same. However, most physicians try to avoid medications [for children] if at all possible. Children tend to do well with biofeedback.
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PRx Host : |
What treatments do you recommend for adults, considering migraines of different severity?
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Dr. Newman : |
Acute treatments include analgesics and anti-nauseants. But the majority of patients have found that the newer treatments known as the triptans are wonderful. These medications treat not only the pain, but also the associated nausea, vomiting, and sensitivity to light and smell rapidly, and they work anytime during the attack.
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PRx Host : |
Are you indicating that sensitivity to light and smell increase with migraines?
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Dr. Newman : |
Yes, and during a migraine, patients find themselves more sensitive to light, sounds, and even smells, and therefore prefer to retire to a dark, quiet room.
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PRx Host : |
What is happening in the brain that causes the increased sensitivity?
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Dr. Newman : |
Different changes in chemicals and different chemical messengers increase this sensitivity.
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PRx Host : |
Is a tendency to migraines inherited?
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Dr. Newman : |
Yes, if you suffer from migraine, you have between a 70% and 90% chance of having a family member who suffers.
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joely : |
I knew a woman who thought she had a migraine, and then died of a stroke not long after. How can you tell the difference between a "normal" headache and a life-threatening pain that needs immediate attention?
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Dr. Newman : |
That's a great question! Warning signs of serious headaches include headaches that occur suddenly with an explosive onset, headaches that are new or different from your usual ones, headaches associated with numbness or weakness on one side of the body with high fever or neck stiffness. And lastly, headaches that begin with exertion coughing, straining, or during sexual activity, need to be investigated further.
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PRx Host : |
When should your headache make you see a doctor? Most people with migraines try to wait them out, don't they?
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Dr. Newman : |
Unfortunately, most people who have migraine don't realize they have migraine. From watching the television or reading the newspapers, most people are convinced they have sinus headaches or tension headaches, when in fact, they may have migraine. If your headaches don't respond to your typical medication, or interfere with your life or those around you, you should seek help.
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PRx Host : |
You're a headache specialist. When should someone come to you instead of his/her family doctor?
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Dr. Newman : |
In general, a headache specialist should be consulted in a number of situations. These include: if you're not getting better with the family doctor, your family doctor does not appear interested in your condition, or you just become frustrated and seek another opinion.
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PRx Host : |
If I have a migraine, how long should I wait before seeking treatment? Will it go away on its own? Is there a time limit to expect it to disappear?
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Dr. Newman : |
In general, migraines resolve within four to 72 hours. Obviously, our job is to try and make them go away quicker.
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PRx Host : |
Why are we more susceptible to migraines during the holidays than at other times -- or are we? Does stress affect migraines?
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Dr. Newman : |
Yes, stress does affect migraine. And, in fact, studies have shown that headaches do increase around the holiday season. The reasons appear to be many, and include lack of sleep, stress associated with deadlines, eating the wrong foods, and overindulging in alcohol.
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PRx Host : |
If you get migraines due to heredity and you avoid the foods you've mentioned, do the headaches decrease ?
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Dr. Newman : |
Only about 10% of people can identify a specific food as a trigger to their headache. If you have no specific triggers that you can identify, avoiding those foods won't be of any help.
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joely : |
Does acupressure work for headaches?
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Dr. Newman : |
There've been a number of studies looking at both acupuncture and acupressure. The results are unconvincing, although many patients swear that these measures work. The classic acupressure point is on the hand, in the webbed space between the thumb and index finger.
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PRx Host : |
What is your own opinion of acupuncture and acupressure for migraines -- or other kinds of headaches?
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Dr. Newman : |
Many patients find that pressing on this spot will relieve the pain, but only while they press it. I'm open to any which way that will help my patients get better.
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zrica : |
How does exercise factor into preventing and/or relieving headaches?
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Dr. Newman : |
Although exercise can trigger some people's headaches, in general, we tell our patients with migraine that getting into a good routine will help them. This includes regular sleep patterns eating regular meals, and exercising regularly. In fact, exercise has been shown to release chemicals called endorphins, which are natural pain relievers.
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PRx Host : |
Should you take something to help you sleep when you are in the worst part of a migraine?
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Dr. Newman : |
Yes and no. Some people find that sleep relieves their headache, but the newer treatment options can actually stop the headache without inducing drowsiness and let our patients resume a normal life.
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PRx Host : |
What are the newer treatment options you're referring to, specifically here?
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Dr. Newman : |
The newer treatments fall under the category called triptans. These include Imitrex, Amerge, Zomig, and Maxalt.
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PRx Host : |
Can certain medications cause more headaches?
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Dr. Newman : |
Yes they can. The regular use of certain painkillers such as aspirin, acetominophen (Tylenol), Excedrin, and Anacin, as well as prescription medications such as Fioricet, Esgic, and narcotics like codeine, if taken too frequently, will cause a daily headache.
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PRx Host : |
What exactly do you mean by "too frequently"?
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Dr. Newman : |
Daily use, or more than three days per week of these agents, will change a headache into a near-daily occurrence.
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PRx Host : |
Is there a way to offset the effects of these medications if you must take them?
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Dr. Newman : |
Yes, by using limits. If a patient needs painkillers too frequently, their physician should put them on a preventative agent.
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col858 : |
What about regular stress headaches? If I make sure I get plenty of vitamin B-2 and magnesium, will I have fewer?
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Dr. Newman : |
We're not sure, since the studies with B-2 and magnesium were looking at patients with migraine.
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PRx Host : |
Does smoking affect headaches?
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Dr. Newman : |
Not necessarily. Although some patients think that when they stopped smoking, their headaches improved.
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BIRMADAY : |
How do you know if you are having a migraine instead of a headache?
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Dr. Newman : |
A migraine is one form of headache. When most people refer to as headache, they're talking about the tension-type headache. Tension-type headaches differ from migraines in that they occur on both sides of the head, and feel like your head is being squeezed in a vice or there is a tight band around your head. Migraines are usually one-sided and throbbing and associated with nausea, vomiting, and light/sound/smell sensitivity, which are not seen in tension-type headaches.
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PRx Host : |
We have a great audience question, interesting for all of us who are working so often at computers.
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zrica : |
Have you seen an increase in headaches as workers spend more and more time in front of a computer? What do you suggest to these workers?
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Dr. Newman : |
Many patients tell us that their headaches are worse when they spend long hours in front of a computer screen. In fact, the flickering lights, such as those with fluorescent lighting or computer screens, can induce migraine headaches. Often, the use of an anti-glare screen can help.
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PRx Host : |
Any other recommendations? This is a serious problem.
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Dr. Newman : |
Limit your time in front of the computer screen. If necessary, you can get your doctor to write a note stating that.
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PRx Host : |
How often should you break from the screen? For how long?
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Dr. Newman : |
I tell my patients to try and break once every hour or so. The break needn't be long, just a few minutes.
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PRx Host : |
How long a day is it OK to be in front of the computer?
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Dr. Newman : |
If you don't get headaches, it's not an issue. If you do get headaches, usually you'll be able to judge for yourself.
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PRx Host : |
How closely related to headaches is eyestrain? And are these always migraine headaches?
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Dr. Newman : |
Eyestrain is a very rare cause of headache. And, in fact, it's often a myth. The true eyestrain headache is felt over the eyes and forehead as a dull ache and typically resolves by resting the eyes. In fact, most people who believe they have eyestrain headache are usually suffering from migraine.
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zrica : |
What about sinus headaches? What's the best way to relieve these?
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Dr. Newman : |
True sinus headaches are also rare. Only acute sinus infections will cause acute pain. Chronic sinus headache is different: These headaches localize over the affected sinus. Therefore, patients describe pain over one side of the forehead or in one cheek. A true sinus infection is often associated with nasal discharge and fever.
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PRx Host : |
Could you tell us more about your institute, please? What led you to start it? As the director, what are your goals?
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Dr. Newman : |
The Headache Institute was founded over one year ago, and it is staffed by physicians who are board-certified neurologists and who have also undergone additional fellowship training in headache disorders. The institute was started to meet the needs of headache patients who are unsatisfied with their treatment or who wanted sub-specialty care. The goal of our institute is to individualize treatment for each patient. In doing so, we can design a treatment plan that meets that patient's specific needs.
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PRx Host : |
How many people come to your institute?
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Dr. Newman : |
We see approximately 2,000 patient visits per year. Many have referred themselves. Others come because their physicians require help.
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PRx Host : |
What about children and headaches? Often adults don't believe children really get headaches. They may think the child is mimicking an adult.
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Dr. Newman : |
That's a great question! In fact, children do suffer from headaches, but, unfortunately sometimes are not taken seriously. Their headaches are often attributed to school phobia or as a way of getting attention. In fact, since headaches do run in families (I'm a parent of a migraine sufferer), it is not surprising that their children may be suffering also.
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AlexFoz : |
What exactly is happening in the head when you get a headache?
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Dr. Newman : |
A variety of changes occur. The trigeminal nerve becomes activated. This activation causes the release of different chemicals that then cause the blood vessels to swell and become inflamed.
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PRx Host : |
Is the environment a factor in headaches?
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Dr. Newman : |
Different parts of the environment can trigger migraine. Weather changes, flickering lights, strong smells, and loud noises often induce an attack.
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AlexFoz : |
Are there special treatments for motion sickness headaches and eyestrain pain?
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Dr. Newman : |
Interestingly, migraine sufferers are more likely to have suffered from motion sickness during childhood. Many anti-nauseants can help with motion sickness.
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joely : |
About every six weeks I get a severe headache, but they don't fit the profile of a migraine. Are there other kinds of severe headache other than migraine?
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Dr. Newman : |
There are many reasons to get headaches. Episodic headaches that occur infrequently can be tension-type headaches.
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BIRMADAY : |
What are the newest treatments for migraine, who should not use them (i.e., smokers), and what are the potential side effects?
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Dr. Newman : |
Again, the newest treatments are the triptans. These agents have been an important advancement in our ability to treat migraine pain. They work anytime during the migraine attack and treat not only the headache, but also the associated features. These medications should not be used in patients with uncontrolled high blood pressure underlying heart disease. They must be used only after an appropriate work-up in patients who have risk factors for heart disease, such as smokers, people with high cholesterol, people with a strong family history of heart disease or stroke, and postmenopausal women.
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PRx Host : |
Do you get migraines yourself?
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Dr. Newman : |
Yes, I get migraines. And, in fact, everybody I've hired at the institute is a migraine sufferer, so "we feel your pain"!
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PRx Host : |
That helps! How do you treat yourself?
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Dr. Newman : |
I treat myself with one of the triptans. I use Imitrex as a nasal spray and can get rid of my headache within 30 minutes.
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PRx Host : |
What's on the horizon for migraines with new research?
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Dr. Newman : |
New research is investigating migraine as a genetic disorder, looking at chromosomes, and also looking into different mechanisms so that we can target new areas for drug development. Although we have many good medications now, not everybody responds. And we are always searching for new and better ways to help our patients. The good news is there's a lot that's available, and the majority of patients can find effective treatments if they just know where to look.
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PRx Host : |
What about facial pain? What is that and why come to a headache center for it?
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Dr. Newman : |
There are a number of disorders that cause pain in the face. The most common one is trigeminal neuralgia, which is characterized by severe electric-like pains that shoot into one side of the face and can be devastating to the sufferer.
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PRx Host : |
Back to the holidays. Is there anything you recommend to decrease our chances of getting a headache?
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Dr. Newman : |
Sure! The best way to avoid headaches is to use sensible planning. Don't save everything for the last minute, don't try to go to every Christmas party, don't overindulge in alcohol, and get plenty of rest! Although it makes a lot of sense, most people don't do it.
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zrica: |
Who is your typical patient?
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Dr. Newman : |
The typical patient is a young, otherwise healthy, woman whose life has become unbearable because of these headaches. Unfortunately, many physicians, many of the patient's friends and co-workers don't consider headache a serious problem. Although migraine and other disorders are not life-threatening, they are definitely life-altering. These attacks interfere with the person's ability to make plans, to work normally, and in many instances, to plan social events. By taking these complaints seriously, specialists can get patients back on track.
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zrica: |
Speaking of the holidays, what exactly causes "hangover" headaches?
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Dr. Newman : |
It's believed that hangover headaches are due to dehydration. Many physicians tell their patients that keeping themselves hydrated with water and taking an aspirin, or a nonsteroidal anti-inflammatory like Motrin, prior to going to bed, may prevent these headaches. Of course, the best way to prevent these headaches is to limit the amount you drink.
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poptart6 : |
What is the best over-the-counter treatment for headaches, in your opinion?
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Dr. Newman : |
Many medications are useful for headache. What we try and do is match the severity of the headache and the associated feature with the medicine we use. The anti-inflammatory agents are useful, and the combination medications that contain caffeine, such as Excedrin, can work for some people whose headaches are not terribly disabling. Again, I must caution you that frequent use of these painkillers can, in fact, induce more headaches.
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PRx Host : |
Is there an increase in migraines now? Is that one reason you started your institute?
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Dr. Newman : |
Migraines have been increasing in our country and worldwide for the last decade. We started the Headache Institute not necessarily because of the increased incidence of these headaches, but to help these people who have suffered all along.
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PRx Host : |
Larry, thank you for a most informative chat .You are a wonderful resource for helping us get through the holidays! Could you give us contact information for your headache institute?
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Dr. Newman : |
Thank you! I wish you all a headache-free new year! The Headache Institute is located at Roosevelt Hospital in New York City. The toll-free telephone number is 877-OMY-HEAD (877-669-4323).
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PRx Host : |
Thank you again, Larry. We hope to see you here on PlanetRx.com again! And happy ho
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