Transcript

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00:00 Dr. Rani Banik

Here are your 'Eye-Q' Questions for this week: What is migraine? How is it different than just a regular headache? What are some of its symptoms? How do you diagnose it? Well, if you're interested in these questions and you wanna learn more, stay tuned for this week's episode of The Eye-Q Podcast™ with me, Dr. Rani Banik. 

 

00:22 Narrator

Welcome to The Eye-Q Podcast™ hosted by Dr. Banik, America's integrative neuro-ophthalmologist. Get ready to explore the intricate connections between the brain and the eye through neuro-ophthalmology journey with Dr. Rani into the world of integrative ophthalmology, where cutting edge science meets holistic wellness. Discover how to protect and preserve vision through powerful preventative strategies based on eye-smart nutrition and lifestyle modifications. Whether you're an eye care provider or just curious about how to maintain healthy vision so you can see the world more clearly. Join Dr. Rani for exciting and eye -opening discussions, will no doubt raise your 'Eye-Q'.

 

01:02 Dr. Rani Banik

Welcome, welcome, welcome everyone. Welcome to another episode of The Eye-Q Podcast™. I'm your host, Dr. Rani Banik, America's integrative neuro-ophthalmologist. And in this podcast, I share useful tips and strategies on how to keep your eyes healthy and your brain healthy.

 

And I'm going to be covering a wide range of topics, both eye -related, vision -related, brain -related, and also general wellness as well. Today, I'm going to be tackling one of the most common conditions that many providers see in their practices, whether they're eye doctors or general practitioners, this particular condition comes up very, very frequently, and it is migraine. Yes, migraine. Now, migraine is so common.

 

It's actually, I'll share some stats with you. It's estimated that one in eight people in the world suffer from migraine, which is a crazy number to think about because that means that at least one billion people in the world have migraine. And my guess is that that number is probably an underestimate because many people may not be reporting their symptoms. Many people may be having symptoms, but not really sure what they are. But in reality, they may have migraine.

 

02:18 Dr. Rani Banik

First and foremost, before we really get deep into this, if you do have any of the symptoms that I'm going to be talking about today, it is really important that you seek medical care and get a formal diagnosis. Yes. Go get it checked out because, it could be migraine, but also you want to rule out some of the other more serious conditions that can happen as well and just get proper medical care. So let's dive right into this topic, migraine.

 

Now, as a neuro-ophthalmologist, I see a lot of migraine. And I'm sure many of my colleagues, even if you're not a neuro-ophthalmologist, let's say you're an optometrist, or ophthalmologist, practicing comprehensive ophthalmology, you probably see migraine as well, because many people with migraine will come in with visual symptoms. They're oftentimes the first symptoms that develop that can lead to the diagnosis of migraine. So it's super common. The visual symptoms are very common.

 

Let me break this down for you, and first of all, describe to you what a migraine is and how it's different than a regular headache, which we oftentimes call a tension headache. So first of all, migraine. I want to just start by saying this. This is really, really important. If you remember one thing from today's podcast, this is the one thing I want you to remember, is that migraine is not just a headache. Many people just equate it with, it's just a bad headache where

 

You know, your head pounds, you have to go into a dark room, go to sleep. You're kind of out of commission for a few hours. That's migraine. It is, it can be that, but it's so much more than a headache. And the reason is because migraine, it's a neurologic condition. It comes from the brain and there are changes in the brain that trigger the many, symptoms of migraine. Now these changes, some of these changes are

 

Vascular changes where vascular tone can change blood vessels may constrict or dilate and that also regulates blood flow to different parts of the brain other changes are electrical changes that happen in the brain particularly in the visual cortex that can lead to certain types of symptoms and I'll go into what those symptoms may be and then there are also Magnetic changes that happen in the brain with migraines. 

 

04:40 Dr. Rani Banik

So really and of course the neurological aspect of things so it's really a combination of electrical, vascular, magnetic, and neurologic changes that happen in the brain. And many symptoms can arise because of all of these changes that are happening in the brain. So it's not just the pounding headache. Many people do have visual symptoms. For example, light sensitivity is very, very common in migraine. People can have light sensitivity in general or just during an attack. That's very, very common.

 

Also, people may see flashing lights. And these flashing lights are what we call visual aura, A -U -R -A. There are other types of aura as well, but the visual aura of migraine are very, it's a very classic pattern that I'll share with you as well. Some people may experience just a general blurring of their vision or trouble focusing. That can also be part of migraine.

 

as well as rarely, some people may have double vision from migraine. That's pretty rare, but it can happen associated with migraine. They may have transient vision loss where their vision goes out in one eye, maybe for a few seconds to a few minutes. And there may even be lid changes or pupil size changes with migraine. So there's a myriad of visual symptoms that happen with migraine. So again, just to reinforce the fact it's not just a headache. The visual symptoms are very common. Then there can be other types of symptoms as well.

 

Sometimes people have vestibular symptoms where they have dizziness, they have unsteadiness, they feel like they're going to fall. They may feel like their world is rotating around them. Sometimes even vertigo where the room is spinning around the person. That's a sensation people get. It can be really, really debilitating. again, migraine is well beyond simply a headache. are so many other neurologic types of symptoms that can happen, visual, vestibular, it's really a complex condition. And unfortunately, we don't really know what triggers it. We don't really know where it comes from. Every person is individual in terms of what their triggers may be. there are, all that being said, migraine is complex, but there are very specific diagnostic criteria for migraine.

 

07:09 Dr. Rani Banik 

So if you're listening, if you're a patient and you suspect you may be having migraine, listen closely to these criteria and see if you may fit them. If you do, definitely go seek medical care. If you're a provider listening to this, I hope that these criteria will help guide you in the care of your patients, whether it's if it's a migraine, OK, then maybe you need to refer the patient to someone who can really help manage their symptoms, a neurologist or even a primary care doctor who feels comfortable with migraine, managing migraine. So there are many providers that treat migraine in addition to neuro -ophthalmologists. So make sure you get your patient to the care provider that can best help them for their particular types of symptoms. now let's go through what the criteria are for migraine and how migraine is different from tension headache. So migraine, first of all,

 

It's not just a one time and done phenomenon. There have to be at least five episodes. So criteria number one is at least five distinct episodes of a migraine attack. Number two, the actual duration of symptoms, including the headache and some of the other symptoms have to last anywhere from four to 72 hours, sometimes even longer, but at least four to 72 hours. So, It's crazy to think that, that yes, it can last a few hours, but in some cases, migraine can last days, yes, days, even up to three days based on the diagnostic criteria. But I have patients who have migraine that is really refractory and it just continues. It goes on and on and on. And it can last not just a few days, but a week, a few weeks, a month, a few months, or even years.

 

And it's not so uncommon for migraine to initially begin as episodic, where it happens sporadically, but then for it to evolve into something that becomes more chronic, where it becomes kind of like a part of daily life for some people, which can be really quite debilitating. I know because I actually went through a phase in my life when I had chronic migraine. More about that later. 

 

09:31 Dr. Rani Banik 

So again, criteria number one-  at least five attacks. Number two- the attacks have to last anywhere from four to 72 hours. The next set of criteria, two of the four following criteria. Unilateral, meaning that's one side of the head. Usually kind of people will point to like this part of my head hurts or maybe it's their forehead or sometimes it's not their head, but it's behind the eye. They may feel like a throbbing pain behind the eye. So unilateral location. 

 

Severity being moderate or severe. So not just a mild headache, but something that really can potentially incapacitate a person where they may not be able to do their regular activities. That's what would fall under the category of moderate to severe.  And then next would be usually it is, it prevents people from doing the things that they want to do. So it is again, debilitating in that sense.

 

And another feature is that it tends to be more of a throbbing, pounding kind of sensation. like a boom, boom, boom, almost like with your heartbeat, you feel this kind of pounding or throbbing. Some people may describe it as a stabbing sensation, which is horrible to think of, like, you know, like an ice pick stabbing you in the head or behind the eye, but it can happen. So let's review this again. Two of the following four characteristics of the headache.

 

One, unilateral in its location. Two, pounding or throbbing type of sensation, three, moderate to severe intensity, and four, gets worse with activity or impairs someone from doing their normal activity. So two out of those four. Then beyond that, there are additional criteria for migraine as well. And so most people with migraine have other symptoms, visual symptoms, auditory symptoms, GI symptoms.

 

But this last criteria kind of speaks to that, which is one out of the three following types of symptoms, nausea and or vomiting, photophobia, which is sensitivity to light, and phonophobia, which is sensitivity to sound. So one out of those three, nausea, vomiting, light sensitivity, sound sensitivity. So to recap, I wish I had a slide for this. I should make a slide for this.

 

But basically, the diagnostic criteria for migraine are at least five attacks, four to 72 hours in duration, certain characteristics of the headache, two out of these four, unilateral, pounding or throbbing, moderate to severe in intensity, and worse with activity and impairing someone from doing their normal activities, and nausea and or vomiting, light sensitivity or sound sensitivity. So you put all that together, if someone meets those criteria, it's migraine, okay?

 

12:24 Dr. Rani Banik

So now what's the difference between migraine and tension? Many people have tension and maybe there is some overlap here in the symptoms, but typically tension headaches tend to be typically bilateral. So usually people will describe it kind of in their forehead area or maybe at the temples. Sometimes it may even be in the back of the head, kind of at the base of the neck or sometimes radiating down into the neck and shoulders. Bilateral with a pressure sensation.

 

So almost like someone is putting a vice around your head. So imagine that where someone's wearing like a really tight hat or something like that, where it's really tight, it's squeezing, that tends to be more tension headache. Also, tension headache tends to be less severe than migraine. So most people will have mild symptoms. If you ask people, okay, on a scale of one to 10, how bad are your headaches? People with tension will probably say, one to five or less. Usually two to three is kind of the average versus people with migraine will say, my goodness, it's the worst headache of my life. It's like a 10 out of 10 headache or 20 out of 10 headache.

 

So it does tend to be a lot more severe in migraine. Now going back to tension, another feature of tension is that it tends to be of a shorter duration. So many of us have had these types of tension headaches. It may last maybe for half an hour or an hour or two, and then it just goes away. But tension is super common, common in children and adults. Migraine is also common. And again, I said one in eight people have migraine. I mean, you can do the math there, but it's a significant portion of the population. It's about 12 % of the population has migraine.

 

00:22 Dr. Rani Banik 

You've been listening to The Eye-Q Podcast™ with me, Dr. Rani Banik. We're going to take a short break and then we'll be right back with more insights to help you raise your 'Eye-Q'

 

14:49 Narrator

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15:21 Dr. Rani Banik 

What are some of the predisposing factors for each of these two types of headache syndromes, migraine and then tension? Well, for migraine, there definitely is a genetic component. So studies have shown that if migraine runs in a family and let's say a parent of a child has migraine, that child is 50 % more likely to have migraine than someone in the general population. 50 % if one parent has migraine. What if two parents have migraine? Well, if two parents have migraine, then that number goes up to 75%. Yes, that child has unfortunately a 75 % chance that during the course of their lifetime, they will develop migraine. So yes, it's unfortunate, but it's the reality.

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16:17 Dr. Rani Banik 

Now, one point I wanted to make about genetics is that there have been many genes that have been identified that are linked to migraine. think that last at last count, I think it was at least 50. It may be a lot more by now. It may be like closer to 75. I'm not exactly sure, but let's say at least 50 different genes have been identified that are linked to migraine. Now, just because you may have one of those genes or maybe a couple of those genes doesn't necessarily mean that you will be predisposed to migraine.

 

You may never have a migraine, even though you have those genes. So the genes are there. They're kind of like the trigger, but there's something else layered on top of that that may actually trigger the attack. So yes, you may have a genetic predisposition to migraine, but it's other factors that play into whether you actually may have an attack of migraine or not. So what are some of these other factors? Well, I would say number one, two, and three are

 

Stress, yes, stress, stress, stress, one, two, and three, in that order. Stress is such a common underlying feature of migraine attacks. What is it about stress that triggers the migraine? We don't understand, I wish we did. There's been lots of research done, but we still don't quite understand all the intricacies of migraine and why stress is a trigger. Maybe it has to do with hormone levels like cortisol.

 

Maybe it has to do with release of inflammatory markers, inflammatory mediators that trigger the nerves to be irritated in the brain. We don't really know. But from my patients, I know I see a lot of migraine in my practice. About 50 % of my patients have some migraine or a variant of migraine or headache syndrome. So I see a lot of it. But I always ask them when they're having a lot of migraine attacks, what's going on in your life? And almost inevitably,

 

they will say, I have a lot of stress going on, a lot of stress. So keep that in mind. Stress is a big trigger for migraine attacks, but there are other factors as well. And I'll just go through what some of these many, many, factors are. So this is not a complete list by any means. This is a short list, I'll say, based off of what I see most commonly in my practice. So stress one, two, and three.

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19:00 Dr. Rani Banik 

Then I would say dehydration. Dehydration is a major factor for migraine trigger in my patients. Many people will be out on a hot sunny day and they're just, you know, wouldn't have, maybe they didn't drink enough. And so they're very dehydrated and that can definitely trigger migraine in them. And I know I've been there for sure. Like on hot sunny days, I make sure to drink extra my daily hydration needs because I know that I'm going to be prone to a migraine.

 

So that's one trigger. Also, people who do excessive exercise, like if you're working out, you're doing a really intense workout at the gym, you need to stay really well hydrated during the workout because if you're not, then your brain may be predisposed to migraine. So that's another trigger. Now, food. Food is a huge topic when it comes to migraine. I could talk about this for hours and hours and hours. I don't want to bore you with all the details or maybe...

 

Maybe I'll dedicate a future episode of The Eye-Q Podcast™ to the topic of food and migraine. But the bottom line is your brain craves regularity. So when it comes to food, if you're prone to migraine or if you treat migraine, just remind patients to stay regular with their meals. Do not skip meals because if you skip meals, your blood sugar goes low. You're much more likely to develop a migraine attack. So stay regular with your meals. and then also.

 

For some people, there may be dietary triggers that trigger migraine. Certain people may be predisposed to food sensitivities that trigger migraine. And some of the common foods identified in research studies that may trigger migraine include histamine -rich foods. Now, histamine seems to be in almost everything, like certain fruits, bananas, strawberries, other citrus fruits. Also, my gosh, so many other histamine releasing foods. Tomatoes, for example, there's just a huge list of histamine rich foods that may trigger migraine. A histamine is a chemical compound that's also found in the body that triggers other compounds, but it also helps to dilate blood vessels and sometimes that leads to migraine. Another big category of food triggers could be tyramine. So tyramine is a compound that's naturally found in some foods and other foods it's added to foods.

 

20:55 Dr. Rani Banik 

But it's commonly found in fermented foods. And so that may be triggering migraine in some people. And then there may be other triggers for certain people. I've had, now this is not a blanket statement by any means, but I've had definitely had patients who are very sensitive to dairy. And if they have dairy products, let's say milk, cow's milk or butter or cheeses or ice cream, guaranteed they will get a migraine. 

 

Now again, this is not for everyone. It's not a blanket statement I can apply to everyone. You kind of have to investigate, a little bit of detective work when it comes to you, if you have migraine, what your particular food triggers may be. But think about that. Could dairy be a trigger for you? For other people, it's gluten. Some people have a gluten sensitivity, not necessarily celiac disease, but a gluten sensitivity. And if they have foods that are rich in gluten, which is a protein found in various types of grains, they develop migraine. And for other people, it could be something totally different. For some people, it's specific types of alcohol. Like there are certain compounds called tannins that are found in red wine that can trigger some people's migraine. I know personally for me, I cannot have red wine because guaranteed I'll get a migraine. I can only have very limited types of alcohol because of either it's fermented or it has other compounds in it that may be triggering migraine.

 

So really when it comes to food triggers, you have to be your own detective and really think about, okay, what is it that you may have recently eaten in the past 24 to 48 hours before the migraine attack that may have triggered the migraine? So that's a big category in itself. So again, I talked about hydration status and then also foods and of course stress, but also another big trigger for some people are hormonal changes.

 

Whether it's for women, hormonal changes around their period, around their menses. There are changes that happen in estrogen and progesterone levels right before a woman's period starts. And that sudden drop in estrogen and progesterone may potentially trigger a migraine. For other people, it's changes in hormones during certain periods of life that may trigger a migraine. For example, for young teens, girls who are just getting their cycle, their menstrual cycle, as their hormones are shifting, they may be predisposed to having migraine at that time. 

 

23:40 Dr. Rani Banik 

For other people, it could be when they're going through midlife, either perimenopause or menopause, their hormonal changes during that time may trigger migraine. For men, it could be changes in testosterone levels, also during midlife or later on in life that may trigger migraine. So these are some factors to consider is one's hormonal fluctuations and where they are in their life cycle with respect to their hormones. Other triggers. So there are other triggers, for example, toxins. Now, I know my personal experience. And in a future episode, I'm going to share my personal experience with migraine because I do think that it's important for people to realize that migraine can affect anyone, even their doctors.

 

It can get really bad, there is hope for improvement. There is hope for recovery from symptoms, and there is hope to lead a normal life even with migraine. But going back to toxins, I know that there are certain chemical smells that may trigger a person's migraine. For some people, it could be cigarette smoke. It could be perfume. It could be other odors that may trigger migraine.

 

People with migraine in general tend to be very, very sensitive. Their senses are almost on hyper alert. So anything in their environment can potentially trigger a migraine, whether it's a smell, whether it's a taste, whether it's a vibration, whether it's flashing lights. These are all, again, potential triggers for migraine. So I talked about a lot there, but again, this is kind of just like the tip of the iceberg when it comes to triggers for migraine.

 

But basically the brain and migraine craves regularity. So the more regular you can make your daily routine with respect to stress, know everyone has stress, but trying to modulate your stress, modulating your diet, your hydration levels, trying to modulate your hormones as best as possible and avoiding certain chemical triggers or sensitivities. And another thing I didn't mention earlier is sleep habits.

 

25:39 Dr. Rani Banik 

So oftentimes people will have not the best sleep habits where they're not sleeping on regular cycles. They're waking up at different times and going to bed at different times during the week. That fluctuation can definitely trigger migraine, going to bed too late, waking up early, not getting enough sleep. The quality of sleep can also trigger migraine. know for myself, I know when I don't have a great night's sleep, let's say I'm traveling, difference in time zones, I'm much, much more likely to get a migraine.

 

And another big trigger is the weather. So oftentimes people with migraine feel like they're human barometers. I know I definitely do. I can detect when there's gonna be a storm coming, whether it's a rainstorm or snowstorm, I can definitely pick it up and I'm much more prone to a migraine attack. And why is it that these weather changes, barometric pressure changes trigger migraine?

 

Again, we don't fully know. We think that it maybe has to do with the external barometric pressure on blood vessels in our body. When there is lower pressure, the blood vessels may dilate more, leading to more likelihood of attacks. We don't quite understand it. But definitely we know that people with migraine can sense the weather. They can definitely sense the weather. Similarly, there are people who have achy joints, for example, people with rheumatoid arthritis or fibromyalgia or chronic fatigue syndrome, they can also detect weather changes before they happen. So there is something about the nervous system that is very intricately tied in with the weather. so definitely migraine can be triggered by oncoming storms and things like that. how are all these triggers different from the triggers for tension headache? Well, tension headache, there is definitely overlap. are people who have tension, who develop a tension headache, may have had a lot of stress going on in their life recently. They may be dehydrated. They may be more prone to weather changes. They may have eaten certain foods. So yes, there are definitely overlapping triggers. But again, the characteristics of migraine are at a totally different level than tension headache. And so just keep that in mind. 

 

27:56 Dr. Rani Banik

Now, I know I've covered a lot here in this past, I guess like 25 minutes or so when it comes to migraine, migraine versus tension. There is so, so much more. We're just kind of at the very outer aspect of migraine. There's so much deeper that we can go. But one thing I just want to mention about migraine is that it's a chronic condition.

 

And yes, it may be episodic where people get these episodes once in a while, but the underlying pathophysiology, what's happening in migraine is something that can crop up during periods of life. know, for example, if someone's going through, I've had definitely had patients who they're in their young adulthood, they're in their late teens, early twenties, and they have a lot of migraine. You know, they're in school, they're in college, they're just starting a new job. There's a lot of stress on them. They have a lot of migraine.

 

And then miraculously, their migraine almost disappears for decades. They can go for 10, 20, 30, 40 years, even 50 years with no migraine whatsoever. And then suddenly later on in life, whether it's midlife or not in life, they start to get their migraines again. So it can crop up. It can evolve. It can morph from being episodic into being more chronic.

 

So the bottom line here is migraine is complex. It has very diverse set of features, different triggers for different people. Yes, there is a genetic component, but oftentimes lifestyle and diet play a key role in the triggers, but also in the management of migraine. And it can come and go during various stages of one's life. So I've given you a basic primer on migraine today. I know it seems like we're just kind of scratching the surface, which we are. There's so much more I want to talk to you about when it comes to migraine. And then of course, the ways to manage it. There are a multitude of ways to manage migraine. We have a lot of different tools now in our migraine toolkit that can help manage migraine. But what I'll say is that in the future, I'm going to be sharing with you in a future episode the visual symptoms of migraine.

 

30:18 Dr. Rani Banik 

So there are at least five different unique visual symptoms of migraine that I think people need to hear about. Again, whether you're a patient or you have a family member with migraine and you're trying to help them out, maybe it's a friend or coworker who has migraine and you're trying to help them out, or maybe you're a provider and you just want to understand migraine better to take better care of your patients. There is a lot when it comes to vision health that is very closely linked to migraine.

 

Stay tuned for a future episode where I'm going to be talking about the five visual manifestations of migraine and what you can do to manage them. That's, think, the key there is, yes, we can understand the visual aspects of migraine, the symptoms, identify them, but what can we do to prevent them? And what can we do to manage them? If they do happen, there are so many things that we can use in our toolbox to manage these symptoms.

 

Thank you so much for listening to this episode of The Eye-Q Podcast™. I am so excited to share this information with you. And I hope that in this Eye-Q Podcast™, remember I started off with the question, what is migraine? What are the diagnostic criteria? How is it different from tension headache? I do really hope that you have a better understanding of migraine now. And I hope that you can share this with friends and family.

 

Remember, if you're enjoying The Eye-Q Podcast™, please, please, please, please leave a review and please share with friends and family members who can benefit as well. Thank you so much for joining me today and I look forward to seeing you next time on The Eye-Q Podcast™. Thank you for tuning into The Eye-Q podcast™.

 

31:59 Narrator

We hope you enjoyed today's episode and learn something new to help elevate your 'Eye-Q'. If you loved what you heard, don't forget to subscribe, leave a review and share the podcast with your friends.​ Stay connected with Dr. Banik for more eye-opening insights on eye health, nutrition, and lifestyle. Until next time, keep your vision clear and your 'Eye-Q' sharp!