[00:00:00] Pete Waggoner: This is Neurology Now, the podcast that explores the fascinating and complex world of neurology. Join us as we explore the human brain and beyond with expert guests who share their knowledge and insights. Welcome to the Neurology Now podcast. On today’s show, we welcome in Dr. Janiece Aldinger from the Minneapolis Clinic of Neurology.
[00:00:21] Pete Waggoner: Dr. Aldinger specializes in neurology and has a particular interest in headache, EMG, and neurohospitalist care. I can’t wait to ask you what that means. Dr. Aldinger, thanks for taking the time to join us here today.
[00:00:36] Janiece Aldinger: You’re welcome. It’s my pleasure.
[00:00:38] Pete Waggoner: Quite the topic here. So obviously we’re going to be focusing on migraines and how they affect women and all of the things that surround that and learn more about what you know in the process, how things are treated and a lot more in depth with this one. But before we start that doctor, I would like to learn a little bit more about you and let us know, how did you get started in the whole medical [00:01:00] field where there are moments in your life when you’re young? You said, here’s that time. I want to be in the medical field. What drove you to there?
[00:01:06] Janiece Aldinger: I think I always had an interest from the time I was a child in medicine and healthcare. My mother was a nurse. And so I think that kind of stimulated my interest as well. I actually went in to pharmacy school as part of my undergrad and I became a pharmacist.
[00:01:23] Janiece Aldinger: And I was out in practice for a couple of years, and I realized that what doctors did was more of my interest than being a pharmacist. So that’s when I decided to go to medical school. And I think through the course of medical school, I did some research in neurology, and I went on rotations, and I just felt neurology was the right field for me, mainly because a lot of neurology is about solving mystery type puzzles or that sort of thing.
[00:01:53] Janiece Aldinger: And that’s what I really like the most about it. And that’s why I chose that field.
[00:01:58] Pete Waggoner: And in this field, [00:02:00] how much time do you have, or do you get any, to get involved in research and looking deeper into things?
[00:02:06] Janiece Aldinger: It’s really up to the neurologists themselves how much research they like to do. The research itself, I don’t do research studies or that sort of thing.
[00:02:18] Janiece Aldinger: But as part of my day to day practice, every patient that comes into my office might have something unusual about their history or their treatment and care. So every day you’re really doing research in some way as a physician to kind of get patient the best care possible.
[00:02:37] Pete Waggoner: So as we get into the topic of migraines, women obviously are more prone to it than men.
[00:02:43] Pete Waggoner: What is the reason for that?
[00:02:45] Janiece Aldinger: You are correct. I mean, in general, migraine is a common condition. The latest research shows that about 17 percent of women get migraines during the course of their lifetime compared to men, which is down around 6%. And [00:03:00] probably the greatest factor in terms of what makes the difference is hormones.
[00:03:05] Janiece Aldinger: And we just know that from the time women reach puberty, they have fluctuations in their hormones, specifically the estrogen cycle. And we know that that has a lot of relationships to when the migraines might occur and what makes them prone to migraines in general.
[00:03:24] Pete Waggoner: So, when you see those fluctuations, are there some times in life when they’re a little more intense than others? Menopause, does that play into it too?
[00:03:33] Janiece Aldinger: Well, like I mentioned before, with puberty, when estrogen cycles start to go up and down, for example, the estrogen in the couple of days right before a woman has her period, the estrogen plummets, it just goes down.
[00:03:49] Janiece Aldinger: So what we know is, is there’s something about estrogen that interacts in those, the neurochemistry involved in migraine that just makes, it’s very [00:04:00] complicated, but there is something about that cycling of the estrogen that increases the pain sensitivity of those neural networks. And that’s what can kind of contribute to the migraines.
[00:04:12] Janiece Aldinger: Through the course of a woman’s lifetime, for some women it means they will get migraines around the time of their periods, either a couple days before or during the period, or it might be at another phase of the cycle, like at ovulation. Sometimes there’s no predictable pattern to it.
[00:04:30] Janiece Aldinger: As women get older and as they get to menopause, like you were mentioning, what happens during menopause occurs over a long period of time. So, women, as they get into their 40s, might start to experience irregular periods or some of the other symptoms that might occur related to hormone fluctuation. And in that perimenopausal period, the hormones actually fluctuate more rapidly, and so what can happen in [00:05:00] that perimenopausal period, which can be anywhere from 5 to 10 years, the migraines might become more unpredictable or even more severe that continues even a couple of years after the last period.
[00:05:13] Janiece Aldinger: And then once a woman gets to actual menopause where hormonal fluctuations don’t occur in a lot of women, the migraines actually improve quite a bit or reduce in frequency.
[00:05:26] Pete Waggoner: So that was the next point there in the frequency and in the severity. Within this somewhat predictable time of when it occurs, can that vary from month to month for people that have them?
[00:05:39] Janiece Aldinger: Yeah, it is very complex as far as there’s not going to really be a lot of predictability with the migraines, even between cycles. A lot of factors can play into it. Diet can be a big part of it. Um, in general, we think healthier diets, which mean more fruits and vegetables, less [00:06:00] sugar, less artificial sweeteners, in general, felt to be better in terms of reducing the chance of having migraine.
[00:06:07] Janiece Aldinger: So diet’s one factor. Sleep is another one. It’s really important for people with migraine to get regular sleep. In general, most people need somewhere between eight and nine hours of sleep a night. That’s particularly important in patients with migraine, and it sometimes even depends on keeping a regular schedule of going to bed at the same time and waking up at the same time to improve the migraine patterns.
[00:06:35] Janiece Aldinger: Another factor is just lifestyle. We know stress can be a factor that provokes migraine or sometimes people will have stress and it’s not until after the stress is over that they actually get their migraine. Something that we call let down migraine.
[00:06:53] Pete Waggoner: Well, that’s one I’ve never heard before. And obviously pregnancy can lead to a different situation too.
[00:06:59] Pete Waggoner: I [00:07:00] suppose there’s some more adjustments that are happening there. And what happens in the case of pregnancy?
[00:07:04] Janiece Aldinger: In general, migraines will continue for that first trimester, like if a woman’s prone to migraine, generally they may continue or might even be a bit worse that first trimester. But the general trend is in the second and third trimester, women can generally look forward to an improvement in their migraines.
[00:07:26] Janiece Aldinger: And I think that happens in about 80 percent of women with migraines, that it improves in the second and third trimester. But then what happens Postpartum, after they deliver, the migraine incidence can increase back up again.
[00:07:39] Pete Waggoner: You sort of talked about diet and things like that, stress obviously, but are there other triggers that can impact hormonal shifts within the body, or is that just pretty much on a timeline and a clock that you don’t know about?
[00:07:53] Janiece Aldinger: I think that that really would be somewhat unpredictable as far as other factors. There are other [00:08:00] foods though that we’ll notice can be triggers for their migraine, and it can vary from person to person, but some of the bigger items that are more common are things like red wine. Like I mentioned before, high sugar type of foods can be a trigger.
[00:08:16] Janiece Aldinger: Certain types of foods and certain spices can be factors contributing to their headaches.
[00:08:23] Pete Waggoner: Let’s get into treatment and therapies, if there are such. I guess I’d be curious with your career, what you’ve seen from when you started versus what’s here today. Is there anything different that’s really making an impact?
[00:08:36] Pete Waggoner: And if you can kind of take us through what are effective migraine treatments for women.
[00:08:41] Janiece Aldinger: There’s been a huge change in the type of treatment that we’ve had to offer, you know, in my 27 years of practice, I’ve seen a huge change, you know, when I first started residency, the first medication ever to treat, specifically, migraine came out, that [00:09:00] was sumatriptan or what’s also known by the brand name imitrax. Different forms of that class of medicine, triptans, came out in the subsequent years. And so we had a lot more to offer patients in terms of pain relief then compared to what we ever had before. But then even in the last 10 years, our treatment options have really even skyrocketed further.
[00:09:25] Janiece Aldinger: There’s always been preventative medications that people can take every day. And we’ve borrowed those from the fields of depression management or anxiety management. blood pressure management, seizure management. We’ve borrowed some of those medications from those other fields and that those do have success for some people in cutting down the frequency and severity of the migraine.
[00:09:48] Janiece Aldinger: But as far as Today, we have certain types of medications called CGRP inhibitors, which are different antibodies that people take [00:10:00] that counteract CGRP, which is one of the chemicals involved in migraine. And then we also have some other medications that also interact in the cycle. So there’s a lot of new treatments out there that are very exciting to offer our patients.
[00:10:15] Pete Waggoner: Have you seen some tangible results that have excited you from some of these new treatments?
[00:10:22] Janiece Aldinger: Some of them have been real game changers like the CGRP inhibitors. It’s an injection you give yourself once a month. I’ve seen people having 15 migraines or more per month and they go down to just one or two per month.
[00:10:37] Janiece Aldinger: So that can really change a person’s work and reduce anxiety about being at events. That are important to them. So it’s really a satisfying area to be in, in terms of the benefits that we can offer our patients.
[00:10:51] Pete Waggoner: And you had mentioned in some of the medications where you borrowed from some other areas.
[00:10:56] Pete Waggoner: And one of the things that triggered this question is from a mental health [00:11:00] perspective, I think it can be very wearing if every other day you’re dealing with this, if you’re having up to 15 a month. How does this impact mental health and other things that maybe are immeasurable in regard?
[00:11:11] Janiece Aldinger: It is somewhat of a chicken or the egg type of situation.
[00:11:16] Janiece Aldinger: In general, for women that have frequent migraine or unpredictable migraine, there is an element of anxiety and stress related to not knowing when that migraine is going to occur. On the other hand, people in general who are prone to anxiety or depression, some of that wiring and the chemistry involved with anxiety and depression makes the person more prone to conditions like migraine in terms of how it can affect the neurochemistry of our brain as well as the rest of our body.
[00:11:47] Pete Waggoner: Genetic predispositions, do those exist in this?
[00:11:51] Janiece Aldinger: There’s definitely a hereditary component to migraine. There’s many families that certain genetic tendencies of [00:12:00] their neurochemistry that make them more prone to migraine. It isn’t, though, like it’s directly inherited, like just because your parent had migraines, you’re definitely going to get migraine.
[00:12:11] Janiece Aldinger: It just increases the likelihood or risk that you will have migraine.
[00:12:16] Pete Waggoner: We kind of touched on the mental a moment ago, but does this also impact other functional health issues within people that have migraines?
[00:12:26] Janiece Aldinger: I don’t really have any direct kind of relationship that I would really think that important to mention today.
[00:12:32] Pete Waggoner: So there’s no physical correlation to this can become a problem internally with some other things. So this is really kind of focused to one area, correct? I mean, that’s it.
[00:12:43] Janiece Aldinger: It is, but frequent migraine, what you have to understand about migraine, it’s not a condition just of the brain because the neural networks involved with migraine have connections to other parts of our bodily function.
[00:12:57] Janiece Aldinger: For example, our gut in our [00:13:00] stomach, some of those networks involved in migraine interact with your digestive system. So sometimes, people with migraine might be more prone to irritable bowel syndrome or problems with constipation or those types of things. So there can be a relationship there. Also, sometimes the medications we use to treat migraine can have indirect effects on our stomach or on our blood pressure or those sorts of things.
[00:13:27] Pete Waggoner: So there is a tumbling effect in ways that from a lay person’s perspective, like I said, we all have loved ones that deal with this in one way or the other. Sometimes it’s hard for those around those that have it. If you were a caregiver or a loved one, how would you best advise them to help manage the process and understand?
[00:13:48] Janiece Aldinger: I think becoming educated about migraine. There’s lots of excellent websites out there about migraine in terms of just understanding what it is, that it is a [00:14:00] real process and that there are certain triggers for it. And so sometimes it’s helpful just to kind of be aware of the problem and just showing that you’ve invested the time and understanding that can be a big support for the family member.
[00:14:15] Janiece Aldinger: I think understanding when the person is having the migraine, that they may not be able to function at the same level that they are when they don’t have a migraine. So, you know, kind of lowering the expectations as far as home responsibilities, as far as that goes, and just cutting someone the slack when you know that they’re having a migraine, I think, would be an important thing.
[00:14:41] Janiece Aldinger: Helping to recognize those factors that can be triggers for the migraine, such as stress. And helping the person to deal with the stress, either to say, okay, this part of our daily routine is becoming too much. So as a family member, you might need to help that person to [00:15:00] understand what do you need to kind of cut off schedules so that you can get enough sleep at night, or how can we help you to eat better and make sure that we have the food in the household that is healthier and going to be better for you.
[00:15:13] Janiece Aldinger: I think those kind of things are the most important, maybe understanding the treatments that person has available to them and being able to kind of understand when you see something happening and making sure that they’re taking the appropriate medications. People with migraine tend to want to tough it out and sometimes that means that they’re may be not taking the medication early enough.
[00:15:39] Janiece Aldinger: Other times, though, it might be that they’re taking the medication too frequently. And sometimes as a loved one, if you see the person’s topping a lot of pills to manage the headache, maybe that’s a sign to say, Hey, I think things aren’t working so well that you’re having to use this medication. And that’s a sign to maybe encourage them to get into the doctor and have things [00:16:00] reviewed.
[00:16:00] Pete Waggoner: You just answered my next question. When is it best to continue the process to see the doctor and review? And then when you get to the very beginning of it, if you haven’t been diagnosed or didn’t know about it, how do you take those, you know, ignoring it and saying, this is just a headache, but it’s more.
[00:16:17] Pete Waggoner: What are some of the things you would say to those that are maybe toughing it out, as you said, to actually get in and that it’s okay to get looked at and get on this?
[00:16:26] Janiece Aldinger: I would say if anyone’s taking, let’s say, more than 10 dosages in a month of some over the counter agent to manage their headaches, that’s time to get in to see someone because sometimes those medications, if you start using them too frequently, first of all, it may not be good for your whole body or your stomach.
[00:16:46] Janiece Aldinger: The other part of it is, is sometimes that’s a sign that people could be developing overuse headaches that can actually even though they’re a form of migraine can kind of make the migraines even harder to control. [00:17:00] I think we were on the track of talking about when to get help for the migraines. And so you see the person is missing work, going into work late very often, or missing important family or fun activities because of the migraine.
[00:17:16] Janiece Aldinger: That definitely is something that seeing a doctor who is aware of migraine treatments would be very critical to kind of get a better sense of control over things.
[00:17:27] Pete Waggoner: If your day to day life is frequently stopping and you’re not able to do those things, if you’re not willing to, it’d be really helpful if those that love you around you are able to say, hey, we need to do this.
[00:17:41] Pete Waggoner: I just think so often people ignore things from what I’ve observed, and it’s so important to listen to yourself and understand what you’re feeling is real.
[00:17:49] Janiece Aldinger: I think you bring up a really good point. And I think one of the misconceptions out there is some people will actually diagnose themselves, or [00:18:00] maybe had been told at one point they have sinus headaches.
[00:18:03] Janiece Aldinger: But a lot of what people are calling their sinus headaches actually are a form of migraines. A lot of times I’ll get sent patients from the ear, nose and throat doctors because the patients had gone to them thinking it was a sinus problem. When it turns out, it’s more of migraine.
[00:18:20] Janiece Aldinger: The other misconception out there that I think it’s worth talking about as well as some people think a migraine has to be one of those headaches that puts you in a dark room and you just have to be there for a couple hours to recover from.
[00:18:35] Janiece Aldinger: There’s a lot of people that have milder form of those headaches and they basically just tough it out. They stay at work or they try to get their work done for the day. They know that they’re not a hundred percent. They can’t concentrate as well. They’re really tired at the end of the day. Those are likely to be some form of migraine or migraine variant.
[00:18:57] Janiece Aldinger: And that is definitely something that if it [00:19:00] occurs frequent enough, that a neurologist or a physician who specializes in headache might really be able to help and have a big impact on.
[00:19:08] Pete Waggoner: That is very interesting. So at the end of the day, are you able to take a look at this through everything that you’ve done and been a part of over the years and say we’ve really had an impact on people’s lives and allowing them to do those day to day things such as work, family events, fun, and better life for them and allow them to get through it?
[00:19:31] Pete Waggoner: Are you able to really look back and say, wow, this has really been a rewarding situation for me as a doctor.
[00:19:37] Janiece Aldinger: I think actually back to a time when I was in my residency and I had a rotation where I was experiencing a lot of migraines myself, to the point they were happening every day, and I got a lot of negative comments both during the rotation about my performance, and I got some feedback afterwards and looking back I know that I wasn’t And [00:20:00] Not my best because of the migraines. And so that was kind of hard to hear and hard to take as I kind of worked through it and figured things out with the migraines for myself.
[00:20:10] Janiece Aldinger: I think that gives me insight in terms of my own patients, what they might be going through in terms of when they’re having those migraines, how to get them in a better place where they get that control of feeling like they are performing at their best, or they don’t have to live in fear that in the middle of that presentation, they’re going to have a migraine and not be able to do anything about it.
[00:20:32] Janiece Aldinger: It’s been very satisfying over the course of my career with all the treatment we have for migraine to get people away from that fear and onto kind of living the highest quality life that they can.
[00:20:45] Pete Waggoner: That is awesome to hear, and I think as a patient, anybody that knows that, it always helps to know that the person on the other side that you’re speaking with has experienced exactly what you have or understands it.
[00:20:59] Pete Waggoner: I think that comes [00:21:00] from such a huge line of credibility. And you know, it’s one thing to know things and be able to do this. It’s a whole other thing to know them and experience them. I think that’s just a huge thing. I would urge everybody to come see you.
[00:21:12] Pete Waggoner: Really, really good stuff. So are there any other final thoughts that you want to add to this discussion that maybe we may have missed on that you think are important?
[00:21:21] Janiece Aldinger: I think it’s a really time, it’s a very exciting time in neurology to have these treatments for people for their migraines. There’s a lot we don’t understand yet about the neurochemistry and what we know bits and pieces about the complexity of it, but it’s a really exciting area and as a clinician helping people with the migraines, I’m always excited to hear about the newest treatments that come out in terms of what we can offer people.
[00:21:48] Janiece Aldinger: I mean, we have non medication treatments. We have things like physical therapy. We have the medications. So there’s so many different things out there that for each person, the [00:22:00] answer is going to be a unique solution. And so that’s kind of where I really am very excited about the future for managing people with migraine.
[00:22:09] Pete Waggoner: That is really exciting to hear. Really, thank you for your time today. This has been most enlightening and you know your material, no question. So, thank you for sharing that and I know the listeners are going to be much better for having heard this too. So, thank you.
[00:22:24] Janiece Aldinger: Oh, it’s my pleasure and you’re very welcome.
[00:22:26] Pete Waggoner: Thank you for joining us on this episode of Neurology Now. We hope you found it informative and engaging. If you’ve enjoyed this episode, please subscribe to our podcast to stay up to date and help us educate our community and beyond. We welcome your feedback, comments, and suggestions for future topics, so please feel free to reach out to us through our website or social media channels.
[00:22:48] Pete Waggoner: For Dr. Janiece Aldinger, I’m Pete Waggoner. Have yourself a great day. So long, everybody.