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Migraines and Headaches Live Chat

August 12, 2020 11:00 AM with Dr. Susan Rubin

In the United States, over 15 percent of all adults complain about severe headaches or migraines. Dr. Susan Rubin of the NorthShore Neurological Institute will answer your questions on these two very common problems. She will field questions about symptoms, solutions, and effectiveness of treatments, or any other questions you have. Submit your questions now, or sign-up for a reminder and ask your questions during the chat.

man with a headache

Dr. Susan Rubin (Evanston Hospital) - 10:48 AM:
Thank you for joining me today on this chat. I am Dr. Susan Rubin and I am the Chair of the Department of Neurology here at NorthShore University HealthSystem. My interest has been in women's issues in neurology which resulted in me seeing a large number of patients with migraines since this is a female predominant disorder. I am happy to answer your questions today regarding migraine management.

Ben (Moderator) - 10:51 AM:
Welcome, Dr. Rubin, and welcome everyone else to the NorthShore University HealthSystem's latest chat: Migraines and Headaches. The chat will begin in 10 minutes, but please start submitting your questions now.

  Emily (Niles, IL) - 11:00 AM:
How might my migraine headaches affect my life, and what changes, if any, should I make?
Dr. Susan Rubin
That is a tough question to answer since I would need to know more about your life and your headaches. However, migraines can be very disabling and result in reduced work productivity, decreased social interactions and can even increase your risk of stroke if you have migraine with aura. In terms of changes, you need to see if you can determine what is triggering them to avoid if possible. You can also start a preventative medication to reduce the frequency and there are alternative treatments that can be helpful too.

  Shahnaz Fatima (Chicago, IL) - 11:05 AM:
I have migraines and it wobn't go away no matter what I do. What would be the best next steps to take?
Dr. Susan Rubin
If you haven't seen a neurologist for management that would be the next step. There are lots of treatments available. I always recommend a four pronged approach: Avoid triggers you can avoid, take the appropriate pain reliever as soon as you know you are getting a migraine to get the best response (but never more than twice in a week), start a preventative medication if you have more than three to four headaches a month to reduce the frequency and try alternative treatments like supplements, good health practices and complementary medicine techniques to help reduce them.

  Sarah (Buffalo Grove, Il) - 11:08 AM:
This past week, my migraines have increased suddenly. Is there something in the weather that has caused this?
Dr. Susan Rubin
Weather is a common trigger and especially when there have been big changes in the barometric pressure. However, lots of other things could also be triggering them including stress, foods, sleep, etc. Often headaches are triggered by a combination of things such as being more sensitive to certain foods when the weather is changing or wine only does it when you are also overtired so it is hard sometimes to determine the specific trigger. You should always talk to your physician if there is a sudden change in your headaches to make sure it isn't being caused by something else like an infection.

  Barbara Sanchez (Evanston, Illinois) - 11:12 AM:
For the last 2-3 weeks, I’ve had a pain on the left side of my head, at the base of my skull. It is not a throbbing headache, but an actual pain. The pain is somewhat controlled with ibuprofen, but returns once it wears off. Sometimes it seems that the pain is affecting my left eye, it has the sensation or feeling that it’s swollen, but it’s not. Occasionally with the head pain, I feel a bit dizzy and nauseated. Could this be a tension headache? (Even though it’s not a throbbing pain)?
Dr. Susan Rubin
Tension headaches actually don't cause throbbing pain (throbbing pain is one of the criteria for a migraine) so that wouldn't exclude a tension headache. However, they are more often bilateral and squeezing in quality so it doesn't sound like a tension headache either. You should see your physician to see if that is actually coming from your neck or being caused by something else.

  Sandy (Chicago, Illinois) - 11:15 AM:
Can menopause affect the severity or frequency of migraines?
Dr. Susan Rubin
Love this question since it is actually right in my area of interest. The short answer is yes. Typically headaches reduce after menopause but not for everyone. The people most likely to do better are those who had headaches associated with their menstrual cycle since those will go away when your period goes away. Hormone replacement can be helpful or harmful so you need to watch your response if you start taking it. As long as it is taken continuously it is usually helpful since you are not getting fluctuating hormone levels but it is contraindicated if you had migraines with aura.

  Olga (Glenview,Illinois) - 11:21 AM:
Have had a high platelet issue since 2012. Currently 870,000. Headaches have gotten worse and am wondering if I can do something naturally, w/o meds, to relieve pain?
Dr. Susan Rubin
Obviously working with your doctors to manage your platelet count would be helpful. Use of Magnesium 500-600mg daily and Vitamin B2 (riboflavin) 400mg daily can be helpful in reducing headaches naturally although I don't have any data on it impact on headaches triggered by high platelet counts. Other natural options include stretching (yoga/tai chi) to reduce neck and shoulder pain that can trigger migraines. Finally, acupuncture, massage, biofeedback have also been shown to be helpful in managing headaches.

  Sandy (Chicago, Illinois) - 11:28 AM:
Is there a link between spinal cortisone shots and migraines/tension headaches?
Dr. Susan Rubin
Not directly. If the cortisone shot is in the neck it can be helpful in reducing headaches if they are being triggered by the neck pain. However, cortisone shots in the low back rarely have any impact on headaches positive or negative. Rarely, if the injection causes a spinal fluid leak, it can lead to low-pressure headaches which are headaches that feel like tension headaches but are worse when you are up and better when you lay down but that is very rare.

  Stephanie (Evanston, IL) - 11:36 AM:
How do I know if my pain is a migraine or a headache?
Dr. Susan Rubin
That is a tricky question because I don't think there is a big difference between the two and a migraine is a type of headache. The criteria for a migraine is two of the following: unilateral pain, throbbing pain, worsening with movement and moderate to severe intensity along with one of the following: nausea or vomiting or sensitivity to light and sound. However, even a bilateral aching pain that is moderately severe and worse when you bend down and is associated with some queasiness qualifies for a migraine so most headaches that are bad enough that you need to take something probably qualifies as a migraine. Tension headaches are essentially the opposite with bilateral, aching, pain that is mild and not worse with movement and without nausea, sensitivity to light or sound. I think the severity is the key.

  Tyler (Evanston, IL) - 11:43 AM:
Are there any demographics (Race, Gender, etc.) that are more prone to headaches or migranes?
Dr. Susan Rubin
The main demographic difference is in gender. Women are three times more likely than men to get migraines. Socioeconomic factors can also play a role especially in tension headaches but race does not seem to be a factor.

  James (Skokie, IL) - 11:47 AM:
I'm a 23-year-old otherwise generally healthy guy, is there a chance my migraine symptoms might go away in a few years?
Dr. Susan Rubin
There is no way to know that but appropriate management can help reduce their frequency and once they are under control we can sometimes reduce the medications and not see the headaches come back.

  Tim (Northbrook, IL) - 11:49 AM:
How bad should a headache be before I go to see the doctor for my headaches?
Dr. Susan Rubin
If they are bothersome to you, you should seek help. You certainly should be getting more treatment if they are occurring more than three to four times per month or if they are disabling so you are missing work or social engagements due to you headaches. If you are having other associated symptoms like loss of vision, vertigo, numbness or weakness down one side or other focal neurologic symptoms you should seek attention right away. While that can be a symptom of the migraine you want to make sure it isn't due to something more serious.

  Sarah (Chicago, IL) - 11:54 AM:
What are the most common causes of headaches?
Dr. Susan Rubin
There are a number of different kinds of headaches: Migraines, Tension headaches, and Cluster headaches are the most common. We don't really know what causes a headache but people who are prone to headaches likely inherit a gene that makes them more sensitive or reactive to triggers that others would not react to. The most common triggers for migraines include the weather, the menstrual cycle, red wine, lack of sleep or missed meals, dehydration and sometimes bright sunlight but there are a lot more and everyone is different as to what will trigger a migraine.

Ben (Moderator) - 12:00 PM:
That's all the time we have today for questions. Thank you, Dr. Rubin, for your time and expertise!

Dr. Susan Rubin (Evanston Hospital) - 12:04 PM:
Thank you for participating in this chat. I appreciate all the great questions. I hope you found this helpful
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