Migraines Podcast Transcript

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[00:00:00] Pete: 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.

[00:00:11] Pete: Welcome to the Neurology Now Podcast. On today’s show, we’ll bring in Dr. William Kte from the Minneapolis Clinic of Neurology. Dr. Kte specializes in headache disorders. It’s also well versed in all aspects of child neurology. Thanks for joining us, Dr. Kte, and I’m looking forward to diving in on this as we’re gonna talk a little bit deeper to the migraines and it’s just such a common thing out there in what you’ve learned from what you do.

[00:00:36] Pete: So thanks for joining us here today.

[00:00:38] William: Happy to be here.

[00:00:40] Pete: So tell us a little bit about you, obviously your medical doctor and there’s lots of things to choose from how did you get into the neurological part of it, and then what drove you to the areas because you’re well-versed in the aspects of the child neurology too, as well.

[00:00:55] Pete: So can you kinda share your background in decision making there?

[00:00:58] William: Yeah, so [00:01:00] if you ask my parents, I’ve always said I was interested in medicine and being a physician. And I can recall going to visit my family in Israel in the summers and their summers start a little bit later than ours. And so all my cousins would still be in school and I was bored. And so I was very curious too.

[00:01:21] William: And so I went to the nearby orphanage to my aunt’s house and that orphanage, there is a number of children there being cared for that had neurologic issues and unfortunately those children were probably there because of their neurologic issues. And so I just felt that those children needed help and they needed support, and I’ve always had a special place in my heart for people in that situation.

[00:01:46] Pete: I brought this up to you before we jumped on the podcast. I love hearing those stories and it invariably goes back to something rooted when you were younger that really connected with you. And then when you go on the journey[00:02:00] into medicine, do you find that, boy, this has really been everything I would’ve expected it to be.

[00:02:06] William: Yeah. I think that it is easy to say that now. When I’m in the place of getting to see patients every day, and I work for my patients, I don’t work for anyone else. And so that makes it a very joyful experience and trying to connect with people where they’re at. In part of training we work for various bosses and so we encounter all the personalities that you might expect.

[00:02:34] William: And so you have to be a pretty flexible person with pretty thick skin along the way, but, but I’m very happy with where I am now.

[00:02:43] Pete: That’s wonderful. So we’ll get into the world of migraines and an area that you work closely with. I think you hear the word thrown around a lot and to a lot of people that don’t have to deal with it, they don’t really understand what it is. Can you quantify the difference [00:03:00] between what a migraine headache is or a migraine, if you will, versus just a normal headache?

[00:03:04] William: Yeah, so migraine is more of a spectrum of symptoms and it’s more of a syndrome. It’s a brain disorder. And in that brain disorder we have a release of pain proteins. And the pain proteins affect our brain in different ways to different people. But for everyone with migraines, it results in some moderate to severe pain.

[00:03:26] William: And if that situation occurs to a lesser extent, it might be more of just a tension type headache or muscular tension type headache.

[00:03:36] Pete: Does a migraine know a demographic of any sort? Does it happen at a certain age? Does it come later in life? Can it be earlier?

[00:03:44] William: Yeah, good question. So we see that it affects boys and girls equally up until about puberty. And then unfortunately women began getting migraines three times more likely than men. And so that can be due to various factors[00:04:00] I would suspect, mostly hormonal. But over time yeah, it begins to affect women significantly more and results in significantly more missed work and disability.

[00:04:11] Pete: So we know a lot in life about physiological changes in the body from childhood to puberty, and as we age and things come along with that. But when we look at the female versus the male, it obviously appears to be so many more things going on. Is it fair to say that it may affect you later in life if you hadn’t had it younger because of some of those types of changes too?

[00:04:34] William: That’s right. Some people unfortunately don’t experience migraines even when they’re postmenopausal, for example, when those hormone changes occur. So it can happen at any age, but we do tend to see it more in the young population.

[00:04:47] Pete: How does someone go about, I gotta get a hold of Dr. Qubty to figure out what’s going on. I mean, do you find that some people sort of brush it under the carpet and say it’s just a bad headache? And then what are your symptoms to [00:05:00] say, what, this is something more than just a small nuisance.

[00:05:02] Pete: This is a big deal.

[00:05:04] William: Yeah, well, it should be pretty easy to find me if you just go into Google, especially Google Maps and you put in cup tea, there’s not a lot of competition, so, For that name, and so you’ll find me that way. Or through the Minneapolis Clinic of Neurology website. And I would say that headaches, people tend to minimize their symptoms, right?

[00:05:23] William: They don’t want to slow down what they’re doing. They wanna keep being busy, busy. They wanna push, push it all the time. And unfortunately, the brain doesn’t care what your agenda is. If it’s having a problem, it’s gonna let you know about it. And the more we let pain run rampant, the easier it is for the brain to produce pain. That’s scientifically true.

[00:05:44] William: And so the more pain we have, the more pain there will be in the future. So it’s really important that people address their pain from the beginning.

[00:05:52] Pete: So each day I try to learn something new. I did not know that. And that’s really interesting about the [00:06:00] pain producing more pain with your brain. So obviously the message here is to listen to your pain. There’s a reason for it. And there’s no reason someone really should feel offended when you’d say, well, I really don’t think there’s a big deal, because everybody has different thresholds.

[00:06:14] Pete: Correct.

[00:06:15] William: That’s right. I always tell people that if you feel you need to see me, I’m happy to see you. If it’s a very simple conversation, you’re not bothering me, I’m happy to help you decide what is serious, what’s something that we can manage with, you know, a few visits versus a lot of visits.

[00:06:29] William: So I’m happy to work with you and figure that out.

[00:06:33] Pete: One of the things you mentioned a moment ago was potential missed work, and those types of things. Do you find it in American culture, let’s say that if you can’t physically see what’s happening, that sometimes there’s a little discrimination or however you wanna say it, against someone that can’t work or function.

[00:06:55] Pete: What do you see goes on in the workplace psychologically for the [00:07:00] employee and the employer?

[00:07:01] William: Yeah, absolutely. Migraine is the number one cause of disability in 15 to 49 year olds, so it’s a huge problem that is causing a lot of missed work. Missed social interactions, missed relationship potentials. There are some people that when they cannot see the problem, they will be biased against the problem.

[00:07:23] William: And that’s unfortunate because it’s a true scientific abnormality that we can scientifically say is true.

[00:07:31] Pete: So what are some of the things you can do when you determine that this is what’s going on? What are some of the therapies or procedures that you can do for people that suffer from this?

[00:07:42] William: Well, the first thing is I take a very comprehensive history from someone. So for my new patient appointments, I like to make sure I cover what their day-to-day life is like. What is their sleep schedule? What is their hydration status? How regularly are they eating? [00:08:00] What is their activity, exercise level?

[00:08:02] William: And so once I get a good understanding of what day-to-day life is like, I try to make some suggestions to empower people to improve on things that might help them experience less pain. If, and once that, with those suggestions, I also expand on what are the treatment options. Some of those things are pretty straightforward.

[00:08:23] William: Something like a vitamin that’s been scientifically shown to help produce headaches, I would definitely be suggesting those to my patients first line.

[00:08:31] Pete: So there are some things that they can do from almost a habits perspective. So, From a consumption of water, hydration to food, what does the diet look like that can impact it. But then there’s even some basic things like vitamins, over the counter type things that if it works and fits, you can suggest that too.

[00:08:50] Pete: And then for the more severe if I have it very bad.

[00:08:54] Pete: So I have friends that have it, let’s say. And let’s say we are going to get together and it would [00:09:00] be something like, I can’t, I’ve got a migraine coming on. And so they know what’s happening and then they’re pretty much out of the quote lineup for that time. For a period of time, shorter, however it may be.

[00:09:13] Pete: How often do you see that occurring in people?

[00:09:15] William: Yeah, so two out of three people with migraines have some sort of warning signs. They call it premonitory symptoms that can give people clues that they’re about to have a problem. And so I always encourage patients to think about how you’re feeling right before a migraine. Are you having a change in your appetite, in your mood, in your fatigue level.

[00:09:37] William: Not to overanalyze things, but just to be in tune with how you’re feeling. So the frequency of headaches varies from person to person, though, I’ll see patients that have headaches every single day and they can become bothersome enough to miss weeks and months of school before they see me or work.

[00:09:57] William: I see two and three year olds with daily [00:10:00] headaches, so it really can be a huge problem. And so the frequency is something, and the symptoms are something that we talk about kind of at the very first visit.

[00:10:10] Pete: Ask a tactical question. The two or three year olds, I guess gotta know. How in the world do you get that diagnosed with, because some of ’em are real, it really, big communicators, almost like, look at this. But then there are others where it’s probably tough. Like, so how do you do that?

[00:10:25] William: Well, kids give you all the clues if you know what you’re looking for. And so a child, when they’re in pain, may be a bit more irritable. So they may tend to cover their eyes, they may tend to prefer to lay down and be less active. And so just basing their interactions. And if you ask them, are you experiencing pain, they may hold their head.

[00:10:48] William: So you’re having a child that’s holding the front of their head and seeming to avoid the light, then that’s probably a migraine in some cases that make it even more obvious by vomiting.

[00:10:58] Pete: Oh, really? Does that happen [00:11:00] on the adult level too though?

[00:11:01] William: Absolutely. Yeah. Migraines can progress and you can have sensitivities to lights or sounds or smells. You get nauseated, vomit, dizziness ringing in the ears. Those are all symptoms of a migraine.

[00:11:16] Pete: So on a number scale, I don’t know if you really know off the top of your head, is there a number nationally of people that would, I know I think you threw a percentage out earlier, but how much. Many people are dealing with this in our country today.

[00:11:32] William: So there are almost 50 million people in America that suffer from migraines.

[00:11:37] Pete: Wow. And from where you’ve begun as far as treatment and diagnosis and just overall knowledge of what you can do. Has it evolved and developed? Two levels that you can look at today and say, wow, we’ve made advances here.

[00:11:53] William: Absolutely. Even going back 10 years ago, the ways we treat migraine have changed [00:12:00] significantly. We used to believe that migraine was a vascular disorder in which the blood vessels were changing in size, and that was what was triggering the pain. But now we know it’s a brain disorder due to pain proteins, and that’s genetic for the most part.

[00:12:16] William: And so we all have learned that by treating and addressing the underlying root of migraine and developing medications and treatments that reduce that issue, that’s how we’re learning to treat migraines more effectively and with fewer side effects.

[00:12:32] Pete: You’re early on in learning that you have this. Are there quick things people can do to mitigate that pain because sometimes I think it could bring on a bit of a panic too when they’re first learning about this.

[00:12:46] Pete: Like, is this a brain tumor? Is it an aneurysm? I mean, there must be all kinds of different things people are thinking when they first are really learning what this is.

[00:12:54] William: Yeah, I know that pain in the head is not a natural feeling and we, that can of [00:13:00] of course, be very alarming to many people. But you have to work with your doctor who has seen this many times. For us it’s the day-to-day activity that we were familiar with and comfortable with.

[00:13:11] William: We can help guide you before you turn to Google and decide that something bad is happening.

[00:13:16] Pete: At what point would you say to somebody to come see you? If they’re experiencing, if they have a fine line between a headache or between being migraine where would you say, this is when you should really cross it and come see me.

[00:13:30] William: If pain is causing you any change in your day-to-day life, then I would want you to come see me cuz that’s not mandatory.

[00:13:39] Pete: That’s an impressive statement right there. And I think not only does that pertain specifically to this topic, but any other topic really. And I think sometimes people, I think we believe, live in a culture where we’ve been told to kind of suck it up. And just deal with it and tough it out and you kind of hope things will fade away.

[00:13:57] Pete: And one of the things this leads me into the sports world, [00:14:00] and I know concussion a completely different topic, but I’ve always wondered if you were an athlete who suffered a number of concussions, could that lead to migraines later on in life?

[00:14:13] William: It’s a complicated question. I think we all have predispositions to things, and under the wrong circumstances, like a concussion or traumatic brain injury, we can activate that underlying predisposition. And so you can see some people. Have some head injuries and they seem to do well afterwards without any prolonged symptoms.

[00:14:34] William: We find that some people with even less injury have very protracted and long symptoms. So there’s some predisposition we all have to pain, and once we have that injury, it depends also on how we take care of ourselves following the injury as to how quickly we could recuperate from it.

[00:14:52] Pete: So if I take my very novice mind here, it sounds to me, without question, this is a [00:15:00] very deeply rooted hetero hereditary genetic type of situation. I mean, you’ve said it a few times, but after hearing that answer, I’m like, oh, I get it completely. Is that a fair assessment?

[00:15:10] William: That’s exactly right.

[00:15:12] Pete: Great stuff.

[00:15:13] Pete: Are there a few other things that you wanna add to the mix here before we wrap it up here that maybe we didn’t cover or that you would like to bring out about the entire situation of what you work with?

[00:15:23] William: I do wanna emphasize that the treatments for migraine are expanding all the time, and so there are so many different things that we can do to help people with their pain. And I know a lot of people have severe headache disorders, have seen many doctors, and different specialists and different treatments, but there’s so many new things now that if you have not addressed it in years, you’ve given up.

[00:15:50] William: I would not give up. I would come back and see what else there is to offer.

[00:15:54] Pete: Isn’t that the most amazing thing about medicine is it’s never status quo and it’s always [00:16:00] improving and evolving. If we looked at how things were. 18 hundreds. And then, fast forward through the 1920s, fifties, even when I was young in the seventies, eighties, and you look at it today, what’s occurred over the past 40 to 50 years and incrementally has been so impressive.

[00:16:17] Pete: It’s a tip of the cap to each and every one of you in the industry. That is focused on people first. And I think of you saying, I work for my patients and we’re all very lucky to have that. So I think with this type of thing, it’s very encouraging for everybody.

[00:16:34] William: Absolutely. I would also like to say that there’s different personalities in medicine too. If you’re finding that my goal is always to understand my patients and get myself out of the way so I can understand what they really need. And so if you’re working with someone and you’re not sure if it’s working well, don’t feel bad to get another opinion either.

[00:16:54] Pete: You’re not hurting someone’s feelings, right?

[00:16:56] William: Yeah, I always hope to have no ego. [00:17:00] I’ll tell my patients, I want what’s best for you. And so I would hope that their other doctors they’re working with would feel the same way. And so if you’re ever just not sure, you’re going down the right path please keep that in mind.

[00:17:12] William: You’re not wrong for feeling that way and for wanting a second opinion sometimes.

[00:17:16] Pete: That’s wonderful stuff. So again, you mentioned earlier how they can get ahold of you. Will you please put The information out there for everybody listening to this podcast.

[00:17:26] William: Of course. So again, I’m at the Minneapolis Clinic of Neurology. I have locations in Coon Rapids, Maple Grove. I sometimes go out to different hospitals for outreach to help them as well. If you’d like to make an appointment with me, you can reach out to our schedulers at 7634278320.

[00:17:47] Pete: That’s great stuff. Thank you for taking the time to join us between patients and maybe a bite to eat cuz we know you’re busy. And this is great information and I’m looking forward to seeing what everybody thinks about it. Dr. [00:18:00] Qubty, you’ve been wonderful.

[00:18:01] William: Thank you very much. I’ve enjoyed it.

[00:18:02] Pete: Thank you.

[00:18:04] Pete: Thank you all for joining us here on this episode of Neurology.

[00:18:07] Pete: Now we hope to be founded, informative, and engaging. If you’ve enjoyed this episode, please subscribe to our podcast and 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.

[00:18:24] Pete: That’s gonna do it for today’s show. Great stuff on migraines with Dr. William Qubty. I’m Pete Wagner. So long everybody.