Life Uncut - Mind Over Migraine. Why Women Suffer Migraines More. Uncut with Neurologist Dr Kaitlyn Parratt

Episode Date: October 15, 2024

Today’s episode is all about migraines, a debilitating condition that affects millions of people worldwide, including our very own Britt. Britt has struggled with migraines her entire life. We’re joined by Dr. Kaitlyn Parratt, a neurologist who specialises in headache disorders and epilepsy.   We speak about: Why women experience migraines more than men Periods of our lives when you might experience them more How hormones and other triggers affect migraines The genetic component of migraines The physical and psychological toll they take Treatment options, first and second line therapies The process of qualifying for migraine ‘botox’ Chicken or the egg? Anxiety, OCD, depression and migraines Do orgasms help relieve migraine pain? You can find information and neurologists at Sharp Neurology  You can find Dr Kaitlyn on instagram and Sharp Neurology on instagram You can watch us on Youtube Find us on Instagram Join us on tiktok Or join the Facebook Discussion Group Tell your mum, tell your dad, tell your dog, tell your friend and share the love because WE LOVE LOVE! xx  See omnystudio.com/listener for privacy information.

Life Uncut acknowledges the traditional custodians of country whose lands were never ceded. We pay our respects to their elders past and present. Always was, always will be Aboriginal land. This episode was recorded on Cammeraygal land. Hi guys and welcome back to another episode of Life Uncut. I'm Brittany. And I'm Laura. And today we have a bit of a different episode for you. If you've been following along for a little while, my story or my personal Instagrams, it's something I've spoken about a lot and that is migraines. Like I have been a migraine headache sufferer for as long as I can remember, since like

probably my early teens, I think, like, you know, when you sort of hit puberty. I mean, I've known you for what, almost six years now, Britt, and it has been something that has been such a frequent occurrence for you. Like, I mean, the amount of times where I'll message and you're like, sorry, I'm in the depths of a migraine and then I don't hear from you for a couple of days. Well, that's just my excuse. Yeah, I'm just in Hawaii. I'm in Hawaii.

I'm like, can't contact me. Do not disturb. It's an unusual one because we talk about these unseen diseases that women experience, you know, endometriosis. Pain. PCOS, pain that can be debilitating and it's so hard to explain to another person because you can't see it and you're like, oh, I've got a headache.

You're like, okay, cool, take a tablet and get over it. Migraines are not like that and you feel really guilty. you feel like you're making it up or someone doesn't believe you. And I can unequivocally say when I post stories on Instagram about migraines, it's probably the thing over the years that I get the most responses for. People want to know the most about it. There's so many questions. There's so many people saying, I suffer this too. Thanks for talking about it. This is what I do for relief or did you find this worked? And I thought, wow, this affects so many more people than we realized. So we decided to do an episode all around this. I managed to find an amazing

neurologist, Dr. Caitlin Parrott, who I have somehow managed to convince to come in and talk to us today. She's been treating me for probably six to nine months, majority of this year, I think. We dragged her in here kicking and screaming. We did drag her in here. And she is a specialist in epilepsy and migraines and sort of other headache related issues. So Caitlin, Welcome. Thank you very much, Brittany and Laura. Thanks for having me. Can I ask, because apart from Britt, the only other person I have had experience with having migraines was my mum. But I grew up with my mum having them so frequently that I knew that she would just be blackout in her room and it was a fend for yourself kind of day as a kid. How common

is it for people to get migraines? And is there a time in life where it becomes more prevalent or is it more prevalent when it's gendered? Yeah. What are the numbers that we're looking at? Yeah, so migraine is incredibly common and that's part of the problem. So it affects up to 15% of the population in total, but it affects women more than men. So between the age of say 20 and 40, which is probably when your mum was suffering most when you were a kid, up to 25% of women will be getting migraine. So it's a huge number of people that are potentially disabled by it. And from the point of view of what stage of life does this occur, particularly for women, there's two peaks and that's when you've got fluctuations in your sex hormones. So

oestrogen and progesterone around puberty and heading into young adulthood and then again at the perimenopause. But really it can occur all throughout that lifespan, tends to drop off after the menopause. And it does affect men as well. And I think we can't forget that often it is kind of considered to be a woman's disease, but I look after a good number of men who suffer with migraine as well. And so there's obviously mechanisms other than just hormones going into the cause of the problem. So is there actual data that is linked directly to the hormone headache? Yeah, there is. So sex steroid hormones, of which estrogen, progesterone and testosterone are the big ones, we know that they act on organs in our body, but they're also neurosteroids. So they

actually act on neurons and have an effect. And that's how we think that they promote migraines. So there's scientific evidence that estrogen is excitatory, that it increases the production of some of the substances that drive migraines. So we know that it's involved to some extent. Women just get the short straw in everything, don't they? It's like, and the more, when we're finally putting money into the research behind things that affect women, which we haven't done for a very long time, we just keep finding all these links that we can't escape. Like, and I guess this is the problem.

Sometimes you can't escape it. And I have spent my entire life, like this is the first time in my life at 35. Sorry, I'm 36. No, I am 37. Fuck. I'm much older than you, don't worry. That really snuck up on me. also you know you're getting old if you can't remember how old you are no you know that you're

getting old when you've been lying about it so you continuously get the age wrong you're like 35 how old did I say I was last week no so at 36 was when I got my relief like I'm 37 now but I finally found that relief at 36 and it got to the point where I didn't think there was anything left for me I have accepted and I used to say to people it's okay it's just how it is it's okay it's been like that my whole life. I've tried what I've tried, but it did peak for me now that you say it, 15, 16, when I was getting my little boobies and I was coming into that age. And all the doctors at the time just used to say to me, deal with it. It's hormones. You're coming into pubic, it'll pass. And the fact is it never passed. And the hormones play a role, but the underlying

cause of migraine is almost certainly genetic. Some people have forms of migraine. We know the gene, we can identify it, but most people, it will be a genetic basis, but it's complex and it's a complex combination of genes. And so I say to people I see with migraine all the time, I probably said it to you, we're probably never going to cure this. You're always going to be at risk of having an attack, but what we want is for you to have less attacks and have a really good plan to deal with them. So you're not walking around anxious about when the next one's going to hit. What is the difference though? So, I mean, most people get headaches and it's kind of, I always look in it too, you know how when people get the cold and they're like, I've got the flu

And I'm like, you don't have the flu, because if you had the flu, you wouldn't be here. So what is the difference between a headache and having a migraine? So headache is a big specialty area. There's lots of different sorts of headaches from, you know, commonplace, you get a bit dehydrated, you're out in the sun, obviously your vessels in your brain dilate, stretch your pain receptors and you get a bit of a headache, you have to rehydrate and lie down. Migraine's a very specific type of headache. We refer to it as a primary headache disorder, which basically means that there's not any

underlying lump or bump or problem with your blood vessels in your brain or anything. Your brain structurally looks normal, but intermittently and episodically, there's some sort of dysfunction that drives this very typical type of attack. So a migraine, we think now starts in the neurons and a process is activated by where you get this spread of activity through the brain. We call cortical spreading depression, which then activates areas specifically in your trigeminal nerve and your upper cervical area in the spine, which then results in the release of all of these substances, which causes inflammation in the blood vessels and the meninges, which is like the glad wrap around your brain, which causes the throbbing, very sort of recognizable migrenous headache.

So the nature of the headache is different. The way the headache evolves from the brain signals to that inflammatory process is different to your run-of-the-mill tension headache or dehydration headache. What are the symptoms and the signs that, well, I guess the signs more so that if someone's experiencing it, they can go, okay, this is what characterizes a migraine. And I know that that's what that is now. So if you can broadly divide migraines into classic migraine without aura, classic migraine with aura, achyphalgic migraine, which is where you get the aura, but no headache. And then there's the menstrually associated one. So a typical classic migraine, someone will often get a prodrome, fatigue, agitation, hunger,

and then the onset of a headache and the headache is often on one side of the head it might change sides in between attacks it's throbbing it's really quite severe and then it's followed by nausea some people vomit uncontrollably at times and photosensitivity so don't want to be around light don't want to be around noise sometimes smells can drive you crazy and really just want to be very still because every movement bending what have you exacerbates that headache pain And that's quite different to, you know, you say, you know, tightness around the front of your head with a tension type headache, et cetera. So you can really make a diagnosis of migraine just talking to someone about their history without any auxiliary tests.

Mine have always been the same side. So mine's always the same spot, which is really interesting. That's why I thought I had a brain tumor or something. I was like, how can this just be a migraine every day, like in the same area? So it's interesting because that's, I think that was one of the things for me that differentiated too. I don't want to scoot over something you just said. You just said that there's literally a gene for hormones. So no, there's a gene for some forms of migraine. So there's a particular type of migraine called femoral hemiplegic migraine where the aura, which I haven't talked about yet, but that's the neurological phenomena that can go along with it, is where the person gets a terrible headache and actually can't

move one side of their body. And they've identified the gene that causes that. Wow. So Britt, when you get migraines, what are the things that trigger it for you? I cannot pinpoint a trigger, which is annoying because it means I can't actively avoid something, but I know they're coming. I'll feel it. And I feel a very particular way and I don't know how to explain it. You feel a bit nauseous and you start to get the throbbing pain. You can just tell when you've experienced it that it's different from a normal headache. And I now, thanks to Caitlin, have a bunch of different medications for different things. So I have medication that I can take straight away that will hopefully stop it before it gets that

suffer but most people that suffer them feel them coming for quite a long time like you get that you get that nauseous feeling and I need to just lay down straight away I need to turn lights off I have only ever once like part of my symptoms are I vomit quite a bit from them when they're extreme but only once have I had vertigo where I have never experienced anything like it I could not turn over onto my side in my bed without vomiting you cannot move it is the craziest thing I've ever had. And that's the only time I have personally had that. So for me, it's light sensitivity, noise sensitivity, which is hard. Exactly what Caitlin said. I don't want to move. I don't even want to walk to the fridge to get a drink. Like every step feels like you are being

electric, like a shock through your body. And then yeah, the vomiting's not every single time for me, probably every three to four times I'll get like a vomiting migraine. But for me, they've always been unavoidable and I could take as much medication as I wanted, it did nothing. Like you have to have, what I have found for me is I had to have this really special, specific migraine medication for it to have helped. And I had to go down the track of getting these Botox treatments, which we will get into. Well, I would love to know, that's your specific experience. What are the general triggers for most people? Yeah. So as Brittany said, some people don't have triggers. We always look for something because if you find something that

you can fix, then maybe you'll avoid the attack. Many people don't, but the common things that people do describe a variable. So foods and particularly things like chocolate, cheese. All the good stuff in life. I know. Alcohol, including red wine. I do have a lot of the above. Yeah. And then there's lifestyle things. They're not getting enough sleep, increased stress, dehydration, poor nutrition. And then there's sort of more odd things, I guess, that are more specific to unique people. But some people say it's this change in season, change in weather,

certain odors they smell, light exposure could trigger the attack. And as Brittany was saying, The warning can be that sort of odd, I can't quite describe this, but I know it's coming, or it can just be the pain, but it can also be this aura that I was talking about. And that's the neurological manifestations people have. And that can range from visual disturbance, where you could maybe see bright lights, feel like you're looking through water, can get tingling up one side of the body. Some people aren't able to speak or create language at the time of a migraine. And the dizziness and vertigo is awful.

And that's the vestibular aura. the aura sensation may be different for different people as well. So are people that have those, like is an aura migraine any different to a normal migraine with someone that doesn't get the aura? No, it's thought to be the same process within the brain. That thing I talked about where the electrical activity spreads through the brain before you activate all the pain pathways may travel across an area of your brain that you're conscious of, like your sensory area or your vision or your speech. But it may also cross over a part of the brain that you don't have conscious awareness of. So maybe your balance

center or your gut. And so in that case, you're not going to get a neurological sensation. You're just going to go from prodrome to pain. That's so interesting, isn't it? And also, I mean, considering that people and some people deal with this so frequently, my next thought is if someone doesn't seek any sort of medication or management for this, can being a migraine sufferer cause long-term health effects? Like, can there be long-term problems of being a migraine sufferer? Yeah, I mean, absolutely. And in two ways, physical and psychological, because, you know, having pain all the time is hard. It's hard to do normal things. You expend more energy, can absolutely be associated with depression and increased levels of anxiety. From a physical

perspective, yes, as well, just from a normal lifestyle perspective, because you're not going to be able to do all those things to look after yourself as you would. Migraine is associated with a number of other medical conditions, including cardiovascular disease, rarely stroke, these sorts of things. So yes, is the answer, both physically and from a psychological and life perspective. What way is the association when you say it's associated to other health conditions? Like what comes first, the chicken or the egg? Does the migraine come as a by-product of cardiovascular disease or does the cardiovascular disease come as the by-product of the migraine? And that's a very good question and a question we don't know the answer to. So those sort of

associations are based upon looking at big data about this person has migraine and what else do they have and hundreds of people, things like anxiety and depression, again, it still is chicken or egg. So more people with migraine probably have, you know, a variety of anxious personality traits. We always joke huge amounts of neurologists have migraine and we, you know, we joke that it's because we're all a bit obsessive compulsive and mildly anxious and, you know, helper bees who can't say no but that does associate but also as you would have experienced you become anxious because you're like my god I've got to go out today I've got to do this I've got all these things what if I get a migraine I would and I let's talk about the anxiety side for a while

I would get really anxious if I didn't have and I have it in my bag now if I don't have painkillers in my bag and I I took the wrong bag and I didn't have them it would give me anxiety because I thought if I'm not near somewhere that can that can stop this it used to really worry me but a big part of the psychological side that I have experienced and I believe we spoke about it maybe in our first consult and I probably got upset about it but a huge part of me not knowing if I want to have kids and this might sound over the top to a lot of people but was my migraines I every single time I got a migraine I was like I couldn't have I physically could not have a child right now and I always think what if I had a baby or a kid because it is properly debilitating

and I still think about that every day like I had a migraine just a couple of weeks ago which was the first one I've had in a while and I just thought in my situation with Ben my partner who lives overseas I thought if I had a child right now and I was living alone what would I do I was trying to run through my options I was like would I have been able to call Keisha and say I'm so unwell now can you come and I'm like but you can't rely on it's no one else's issue right like you can't be relying on those people. And a big part of the fact that I'm 37 and haven't had a child is because I don't think I could have done it with this condition. What's a normal length of time that someone might suffer for? I mean, in the gut, in the headache classification thing,

you know, it's a headache lasting between four and 72 hours. So once it goes beyond 72 hours, we call it status migranosis, which is continuous migraine and have to implement a whole new management plan, but they can go for a long time. And you're right. And I look after a lot of women with epilepsy as well. And they have very similar concerns and worries about, well, what if I have a seizure when I'm looking after my baby? So these things are faced by many people with particularly these disorders, which are characterized by recurrent episodic events. You're totally normal in between. And then you're pretty much completely not able to function when you're having the attack. So it is tricky. And I think planning, optimizing your treatment,

having action plans, not just to treat you, but to manage your life and other sort of things that you have to become creative with when you start to have your kids. What does that look like? So what for a lot of people, what are the treatments that are available, the treatment plans? I know you've spoken heaps on the podcast around Botox for migraines. Yes, but that's not an easy place to get to. No, I know. And I also, we're not promoting because we can't, we're just talking about different treatment options. But I think it's really interesting to know, like, what does that look like for someone? Because I think a lot of people live with this type of stuff, thinking that there's nothing that can be done or it's just a byproduct of just being a woman

and being alive. What would be the first steps and how does one kind of go down that treatment path? Yeah, you're absolutely spot on. I always think of this woman I saw and she'd had migraine for 30 years. We can do this. We can do that. She's like, really? Well, that was me too. I was like, I can't believe there was something that could be done. 17 years I've had it. My dad has had them, talk about the genetic link, my dad has had them his entire life. And I don't think he's ever gone and gotten proper help. But that's interesting to me, Britt. Does that mean that you've never really brought it up with a GP before? Or does that mean that a GP didn't give you solutions for it? Because it's to me

quite unusual that something that's a medical problem that you've dealt with so frequently, you wouldn't have just at least mentioned it to a GP. It's a bit of A and a bit of B. So in the early days, I guess the treatments maybe weren't as known. And I say the early days, we are literally talking when I was 15 years old, right? So there was a big period there where I went and got the MRI scans. I went and got the scans that people like, let's investigate this and this and this. Let's see if you've got an allergy. Your brain's fine. So it was sort of like you're on your way. Like it's just something that you'll either grow out of. Actually, I remember a doctor at 15 saying you'll probably grow out of it. It's a hormonal

thing. So when you're told that for about five years, I just got into this train of this is how it is. Like there's, you know, I didn't ever think to go back to a doctor and say, Hey, I'm still getting my headaches. Like I just in my head, I was like, why would I waste my time? There's nothing that can be done. And it's funny, more often than not, when I'm taking a history from a patient about some other problem, I'll say, you know, what are your past medical history and write it all down. And then halfway through the consultation, they go, oh yeah, and I get migraine, but it hasn't been put on their radar to be a real priority from the perspective of their care. But treatment wise, there's lots of things we can do. So, you know, when I see someone

with migraine for the first time, we talk about acute therapies, which is to try and treat that attack, reduce its severity, shorten its length, get you up and going as quickly as possible. And the other treatments are preventative. And that's if you're getting, you know, at least one a fortnight, they're starting to interfere with your life, make you anxious, then you need preventative therapies, which will reduce the frequency of attacks and hopefully the severity as well. And I always think about management of any medical problem as we've got medications that we can use, but you've also got to look at the lifestyle side of things, sleep, stress, nutrition, and your psychological wellbeing, because they all feed into one another.

But medication-wise, the trick with migraine is treating as early as humanly possible. So when you get that warning, that's when you take your medication. You don't wait because we all tend to go, oh, it's not too bad. I'll just put up with it a bit longer. Whereas early treatment is we know is advantageous. And we use a combination of aspirin. Sounds ridiculous, but it's an anti-inflammatory painkiller. Paracetamol, which is a central painkiller.

And then a triptan, which is a specific type of migraine painkiller. And what does that do? So it promotes the release of serotonin, which acts upon those blood vessels and meninges in the brain to reduce the sensation of pain. So what does it take then for, this was a question I was getting a lot, for the general person, everyone was like, oh my God, what is your neurologist name? Where does she work? I'm going to book in.

But it's not as easy as just like going and calling up a neurologist and booking in. You have to go through a process. So can you talk us through that? Correct. So acute therapy like that, if you go and see your local doctor, tell them your symptoms, they recognise it's migraine, you can start on that sort of treatment program. And if your attacks become more minor, you just use aspirin and Panadol and save your trip down for later.

There's a new acute medication, which I can tell you about later as well. But from the point of view of getting to what am I going to do to prevent these medications, as I said, if you're getting one a fortnight, it's interfering with you getting to work, looking after your kids, enjoying your life, then prevention is warranted. And at the moment, we have first-line therapies and then second-line therapies. You need to have tried three first-line therapies before you're eligible for second-line therapies and your GP can initiate those and then refer you on to a neurologist. If they don't work, then you've got all of these options to discuss.

And those medications are really all repurposed. So none of them are specific to migraine. They've all been repurposed for migraine prevention when used for other conditions. So it includes things like riboflavin, vitamin B6, amitriptyline, which is an old fashioned antidepressant, but again, has an impact on the transmitters in the central nervous system to reduce migraine. There's a bunch of blood pressure lowering agents, which can be used as long as you don't have low resting blood pressure. And the use of them is based upon both theory of how migraines evolve and noticing, say, for example, a group of people were treated with X medication.

They also had migraine and that settled down. So sometimes it's just serendipity. And then there's a number of anti-seizure medications, which can be used as preventatives as well. And your choice there depends upon what other medical problems people have, as I said, their blood pressure, whether they're of childbearing age, because we might not want to use the anti-seizure medications for headache prevention. Why is it that a person who gets migraines has to go through these three sort of like milestones first, these three sort of entry options before they can go through to a neurologist?

Well, look, they could go straight to a neurologist to discuss these. and I certainly get people who've literally seen their GP, they've got migraine, they've been given a trip down and they come and see us. It's more the process of prescribing because those first line therapies are, you know, they're easily available, they're inexpensive and for a significant proportion of people, they're perfectly adequate and they'll control the migraine attacks. Second line therapies, you know, we would love to be able to give more people second-line therapies first up, because we know they've got higher efficacy, but they're obviously more expensive. For the botulinum toxin, you need a procedure done. And the CGRP antagonists,

which are the newest group, we've only really had them available to us in the recent past. So part of it's, I guess, choosing the least complicated, most economical, which will work for a lot of people, and then escalating, which is the same sort of process you'll see with regards to prescribing in lots of specialties, you know, oncology, neurology, all those sorts of things. It does seem strange that from our point of view, like from a plebs point of view, we're not a neurologist, you can go and just book in tomorrow to get Botox, right? If you want a wrinkle for aesthetic reasons, if you want to clear your wrinkles. But what I found so strange is I was like, wow, I can get Botox for a wrinkle like that. But to

get something that is going to literally change my life was just so many more steps and so many more hoops to jump through. But apart from that, I didn't know it was available. And that's why I guess we're having these discussions so people know there are other options. Is the reason for that though, because of the volume, like are you getting like massive doses when it's in your neck and your head and everywhere else? Or is it? You are getting a decent volume. So you need two vials per patient. So the cost of that is significant and the government subsidize it. So if you qualify for second line therapies, you know, there are criteria. You have to have 15 headache days a month, eight of which are classic migraine. You've tried three therapies.

Then the pharmaceutical benefit scheme says, look, this is a good investment here because if we use this efficacious therapy, this person's going to get back on their feet. They're going to be working and paying tax dollars. Exactly. Let's get some Botox. Get them wrinkle-free and ready to get back to work. It does seem ridiculous. As healthcare providers, we're all, at the end of the day, most of us are altruists and wish we could just use the very best, brand new, best tolerated medication for everything we do. But health economics, as you indicate, it does intervene. So that's the process and that's why it does take time. But people not knowing about it is a tragedy. How does Botox work though for it? So saying that

it's been something that's, I guess, newly discovered as being very efficacious, what is it about it that is so beneficial and how does it work? So no one really knows is the honest answer. But it works. How does someone even discover this? I always think like, who's the first person that thought that's a good idea? I'll shove up two vials of that in my neck. So one of the major theories is the other thing that drives a migraine is this thing called sensitization. So pain sensitization, which refers to this process where your neurons become more responsive to a certain pain or noxious stimuli. And then your threshold for having those symptoms lowers your response to that magnifies and it spreads so it perpetuates things so botulinum

toxin pretty much switches off one of those sensory receptors in the periphery so then their feedback into your brain is altered it's down regulated and we think that desensitizes those areas of your brain that are responsible for experiencing the migraine attack so i think I'm going to get this wrong, but I remember you telling me in one of our consults, you said that there is a chance that if I do this for a little while and it works and I go migraine free, there's a chance that it almost tricks your body and that when you wean yourself off it, you don't get as many migraines. Is that right? Correct. So a person with migraine can have different phases of migraine in their lifetime, just as you have, you know, high frequency episodic,

low frequency episodic or chronic. So when you were in your puberty years, you were probably getting low to high frequency episodic attacks, which is the only reason you could tolerate it. And then as that sensitization process escalates, it becomes more of a chronic situation. That doesn't mean that we can't deescalate that and get people back to being low frequency migraineurs. So can you get them more frequently because your body expects them? Is that why, When they're coming more frequently, is that your body being like, oh, I know what that pain is, let's go straight to migraine because it's like a learned trait?

Conditioned, you mean? Well, it's like a learned trait, yeah. In a way, that's kind of like the sensitisation thing we're talking about. So, yes, with time, with that whole sensitisation process, it can require far less for you to experience that migraine than what it would have when you weren't sensitised. Better way to say it.

That's what I was trying to get at and I was like, fucking use your words, Brittany. We all know who the urologist is in the room. Hey, are there lifestyle factors that people can change that help to either minimize the severity or minimize the number of migraines people are receiving? Yeah, I think so. And as I said, I'm the threefold neurologist, medications, lifestyle, and psychological well-being is my sort of mantra.

So lifestyle things that we know can be triggers for people are poor hydration. So we need people to stay well hydrated, eat regularly. So often starving yourself for long periods can trigger things. good sleep. So sleep deprivation is a classic, which is why I got my first migraine when I was postpartum. I was going to say so fun for all the new mums out there, which comes back to the anxiety. Yeah. And stress, you know, stress is not just a psychological thing. It's a physiological response. And we throw out all of our stress hormones that bathes our brain. And again, that makes us more prone to migraine attacks, seizures, all of these sorts of things that

affect the nervous system. So actually really proactively dealing with that can help. Can migraine be a byproduct of other illnesses? Can it be a symptom that something else is going on in your body that needs to be addressed? Not in the sense that it is a primary headache disorder, so there isn't an underlying cause for it. It's not like you can have cancer here, that's why you've got a migraine. Correct, no. So it's a primary problem.

It's a dysfunction of the nervous system, but it can absolutely be exacerbated by other illnesses. And I went through a period during the COVID pandemic when my migraine patients would come back and say, it's not working. And it was just that they'd had COVID. it. And that was an absolute trigger for people with migraine to end up with solid migraines for a period of time. So talking about the Botox treatment, because that was obviously what I ended up having and what was of a lot of interest to people, is that protocol that you get, that I

get, is that the same migraine protocol, Botox protocol that anyone would get with a migraine, or is it more specific to my kind of migraines? So yours is more specific now because we've tweaked it to you. There's a standard protocol called the preempt protocol with a series of injections in the forehead, the sides of your head, the back, neck, and your shoulders, it traps. And that's kind of what we do the first time, the first couple of times. Then we can bespoke it to the individual. So now I get my forehead and my crow's feet. You deserve it. So there's a sort of saying in migraine therapy where you chase the pain. So if someone's having more pain in a particular region, you can put more toxin there to try to

switch off that process in that region, less in other places. I adjust the protocol often in the forehead because when I started doing it, people said to me, I love this. My migraines have gone, but I look funny. So I went and did cosmetic training so that, you know, a lot of people are young women so that you can inject in the same muscle, get the same effect, but not have people having aesthetic side effects, which, you know, they're not the main priority, but they do matter to people. Well, yeah, you don't want to drop an eyelid on some, like an eye on somebody. Correct. You've got to have that in mind. You also don't want someone to forego treatment and suffer with a migraine because they're

worried about how it's going to impact the way they look. Correct. And we can always wiggle things around. If people don't want anything to affect their appearance, then we can just slightly move it, say muscles, just different areas. And definitely if people have a focus of pain, say in one side of their neck or one shoulder, we can move the injections around a little bit, but pretty much just stay to the same dose in the same region. speaking about tweaking the treatments i don't know caitlin if you have seen a video i posted on instagram that my fiance and i ben we're learning this first dance if you haven't seen

it please go and watch it it is hilarious we'll bring back memories of my own attempt well no because i so my last treatment with dr parrot we had to tweak it more to me because my migraines were really good they weren't coming but i was getting a lot of other pain that was still problematic and a lot of that was coming down the front of my neck from the side of my skull So we decided to do some injections in the front of my neck and in a muscle there and some extra injections that we hadn't done before down the side. Amazing, right? Like in terms of how I feel, I want it to be known, and I haven't told you this yet,

I could not hold my neck up. It was like a full, I couldn't turn my neck. I had to turn like a robot. All the muscles were so relaxed, which was brilliant for headaches. But hilariously, I couldn't do anything with my neck. and just this week I feel like I've got more movements because it must be slowly wearing off. But Ben would dip me in this dance we're practising

and I couldn't get back up. My head was just like flapping off. That wasn't the intended outcome. I know. Like stop talking about it. No, because I want people to know as well. I don't want people to just be like, oh, cool, you just go get your Botox and there's no repercussions.

Obviously it's dependent on everyone. But at the end of the day, the front and the back of my neck have been relaxed and they were very relaxed but to the point that like, even if I wanted to lay up out of bed, I had to get my hand behind my head and pull myself up. I couldn't just sit up anymore. And for me, it's what's more important. It's important to talk about though, because, you know, and when we discuss doing the procedure, we say the main potential side effect is weakness. So we're going to weaken muscles. We might weaken them too much. And so it's important to know that I've had a number of people come and say,

I love it, but I'm having trouble at Pilates for the same reason. And then we just omit those neck extensors, you know, for a cycle or two until you feel like things are back to normal. The beauty of the treatment is it wears off, as you say. But it's really important to make that known because it's not a sort of, this is magical and there's no potential issues with it, just like any medical therapy. What would you say to people who are listening to this? Because I think that the vast number of people who are going to click on this episode and really want to listen to it are either going to be people who have migraines themselves or they have someone who they love dearly who is absolutely in the depths of suffering from it. What is your first piece of advice to someone

who hasn't started any sort of treatment process for their migraine, but is really, really suffering? First thing to do is to go and talk to your local doctor. Talk to your local doctor, say, I think I've got migraine and see if that is exactly what you've got. So get a diagnosis made. If there's red flags, you know, it's a new onset headache in an older person or other things that we look for, you might need imaging to confirm that. And then they can start you, as I said, on an acute treatment plan. They can begin the first-line preventatives. And if it's been going on for that long, get a referral at that point to see a neurologist because there will be wait times to be seen. And then they can cycle through various preventatives, see if there's

a response, and then talk about the second-line therapies if those haven't been successful. Generally speaking, what happens to a migraine sufferer when they fall pregnant? Does it increase? Does it decrease? Are there still treatments you can take? Look, thankfully, most of the time it decreases, which is kind of odd because your estrogen levels go up, but so do levels of other hormones as well. It's problematic in pregnancy because we can't use a lot of the therapies that we use when people are not pregnant. So we can't use aspirin, except in the second trimester, we try to avoid triptans. Although if it's significant and we talk to the obstetrician about risk, sometimes people use them, but generally they're not

indicated in pregnancy. So it does become an issue. And so we often have to utilize slightly more creative things you know fluids magnesium sometimes people need to have short doses of steroids so there are options but thankfully often it kind of gets better during that period and then when you've got your baby and you're horribly sleep deprived and stressed you can take all the drugs again so basically once i commit to pregnancy i've got to commit for life i've got to be pregnant like non-stop no no we'll please don't do that because trust me that'll give you a few migraines as well the last thing that i wanted to ask you was what are some of the newer and more progressive treatments that have come out?

So the newest treatment we have available to us are a class of drugs called CGRP antagonists. CGRP is like a protein. It's one of those substances that I said was released from that trigeminal region when the migraine is activated. We know that that's involved in the cascade that causes a migraine. And that was identified because they found higher levels of it in people suffering migraine. And these medications are either antibodies. So just like we'd make to a virus, you inject them into yourself, they float around your bloodstream, connect to the CGRP as though it was a virus and your immune system destroys it. So then even though you may still have that predisposition to start the migraine, once it gets to needing that protein

to cause all the inflammation, it stops. So people have a lot less attacks. Well, knowing that it's so hormone related, does that mean as we age and get, you know, in maybe our 40s or 50s maybe when perimenopause starts do they decrease or the idea of perimenopause and menopause because your hormones are changing so rapidly again is that when we get another influx of migraine it's the second one so the two peaks are in that you know puberty bit where you've got fluctuations in estrogen progesterone and then in the perimenopause but it falls off after the menopause so there is potential and so i'll get relief at 60 maybe it doesn't happen to everyone. Not every migraine sufferer has the same pattern. Some people will have an upshot in

perimenopause. Some people won't. So I think it's just being aware of it and having it on your radar and not suffering through it if you are one of those people that it happens to. And again, there's all sorts of different approaches we can take in those sorts of circumstances. Is this a myth or maybe Ben just told me this? I'm not sure he's the person I'd be taking medical advice from. You'll laugh when you hear. Do orgasms help relieve pain and migraine, that kind of a thing? Imagine if you went to a neurologist and they were like,

you know what, you need more orgasms. I've sorted this one out for you. Well, that's why I'm like, imagine if Ben's like, baby, I've been doing some research. Apparently, this is going to help. Lay down. And get on your way. Look, there's two answers to that question.

One is no and one is yes. So the no answer is that, in fact, sometimes sexual activity in orgasm can trigger headaches, whether they're migraine headaches or there is a specific type of headache called benign sex headache where people have sex, climax, and then they develop a horrible headache. That's a headache, benign sex headache. It's a headache, benign sex headache, exactly.

Every day is a school day here. It's in the classification. Wow. There's all sorts of weird and wonderful things. But to the contrary of that, an orgasm would result in release of endorphins and they are natural opioids. So look, maybe but probably not really. So risk it for the biscuit.

Give it a whirl and see what happens. Don't avoid it entirely I guess is the thing. Don't avoid it but I'm not sure that it's not a recognised therapy but it could be analgesic. It might help. Well, to be honest, like you would have to do it when you feel the migraine coming because no one that's in the depths of the migraine is having sex.

Like no one is being pounded. Imagine your partner trying to convince you of that. I do not. You're not being like, I'm in pain, pound me. I've got something that's going to make you feel better, sweetie. Go in. Ew. When you say it like that, yeah, ew. I actually asked my daughter, we talked about myths and misconceptions when we were thinking about this podcast. And I said, what do you think? And she gets migraine. And she said,

you know, the biggest misconception, mum, is people think it's just a headache. And it's actually so bad. And so I think that's the thing is to give people the empathy that they need empower people with migraine to say, well, what am I going to do about it? Do you prefer people to, when they have reached you, to have already had, say, an MRI scan or a CT scan? Is that sort of a prerequisite for you? Are you going to send them there anyway? Look, it's not a prerequisite. I think most people in 2024 who present with headache will end up having a scan. As I said, it's a clinical diagnosis, but we've got access to imaging. Every now and then you get a surprise. So yes, imaging of your brain, including your

blood vessels is helpful. But if you haven't had it and you're a typical migraine sufferer, you know, you don't necessarily need it. Did you get my back scan this week? Have you looked at that yet? I was going to get, I was going to get the results. Yeah. I got my MRI sent to you. So we'll talk about that later. This is a much nicer place than the consultation room though. Not sure if I need to be privy to all the information, but I'll sit through it. It's fine. No, it's fine. Thank you so much for coming on. I really appreciate it. I know this might seem like maybe a little bit left field for Life Uncut podcast, but it was something that I just had an overwhelming response for. And I know that

there are so many people out there like me that are suffering. And if they're not suffering, I know that there are people that they know that are suffering, a family member or a partner or a child. I just guess it doesn't discriminate. No, it absolutely doesn't. We will put the link to your practice. We obviously are based in Sydney for anyone that's listening. I'm sorry if you're outside of Sydney, but there are so many great neurologists. There is like a whole website of where you can find urologists. So we will put that link in as long as you keep space for me, if people fill up your books, Galen. That's my prerequisite. Always, Brittany, always. Thank you. Thanks so much for coming and being part of the podcast. Oh,

that's a pleasure. Thanks for having me. We'll be right back.