Dr. Ahmed Shatila, Neurology Consultant, joins Maria Botros in this week’s Tell Me Why podcast episode to talk about the characteristics that distinguish a migraine from a headache.
A migraine is a severe, throbbing headache that can last from 3 hours to 3 days, impacting a person's quality of life, says Dr. Ahmed
Dr. Ahmed: A Migraine is not a curable condition; you learn to live with it
Around 10-15% of people suffer from migraines, which account for 1 billion people worldwide, says Dr. Ahmed
Dr. Ahmed: Migraines aren't fatal, but they can severely impact one's ability to function throughout the day
Read the full story here:
See more videos at https://gulfnews.com/videos
Read more Gulf News stories here: https://bit.ly/2HLJ2km
A migraine is a severe, throbbing headache that can last from 3 hours to 3 days, impacting a person's quality of life, says Dr. Ahmed
Dr. Ahmed: A Migraine is not a curable condition; you learn to live with it
Around 10-15% of people suffer from migraines, which account for 1 billion people worldwide, says Dr. Ahmed
Dr. Ahmed: Migraines aren't fatal, but they can severely impact one's ability to function throughout the day
Read the full story here:
See more videos at https://gulfnews.com/videos
Read more Gulf News stories here: https://bit.ly/2HLJ2km
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NewsTranscript
00:00There are many misconceptions first about migraines.
00:03A lot of people think migraine is just a regular headache.
00:06It's not a regular headache.
00:08But people need to understand that it may not be complete.
00:12It's not a curable condition.
00:14And you learn to live with it.
00:28All right, welcome back.
00:29Welcome back to a brand new episode of Tell Me Why.
00:33Today, we are podcasting from Abu Dhabi from a very special conference.
00:38And we're going to be talking about an issue that I face personally,
00:42and that I know a lot of people face as well,
00:45which is the pain that we go through when we experience a migraine attack.
00:50With me is Dr. Ahmed Shatila,
00:52neurology consultant at Sheikh Shahboot Medical City.
00:55How are you?
00:56I'm excellent today.
00:57Thank you, Maria, for asking me.
00:59How are you?
00:59Yeah, all good.
01:00It's lovely to have someone to ask me, how am I?
01:03I mean, it's good.
01:04Well, you're important too.
01:05So thank you for asking me.
01:07And thank you for having me today.
01:09It's part of being a doctor.
01:10You always ask how people are.
01:12So I feel like it's in your nature, right?
01:13Yeah.
01:14That's actually the first part of the interview is to know how the person is,
01:17to get an understanding of the basic well-being of the person,
01:22because you don't want just treat them.
01:23You want them to get back to the way they were.
01:26Yeah.
01:26Hopefully better.
01:27Absolutely.
01:28I like that.
01:29Thank you for joining us today.
01:30Because as I mentioned in the intro, we're talking about a topic that,
01:34I mean, it resonates with me personally.
01:37I get a lot of these migraine attacks.
01:39And we're going to talk about migraines.
01:40We're going to talk about treatment.
01:41We're going to talk about lifestyle changes that can really help you get over certain attacks.
01:47So before we get started, we always hear about migraines.
01:52A lot of people might not have experienced migraines before.
01:55They've experienced your average headache.
01:58So we want to know what's the difference between a migraine and a headache?
02:02And how do you treat both respectively?
02:05You know, that's an excellent question.
02:06So migraine actually is very common, actually.
02:10Okay.
02:10About 10 to 15% of the people suffer from migraines,
02:14which account for about a billion people worldwide.
02:17Wow.
02:18So it's very common.
02:20And what we need to know is migraine is not your regular type of headache.
02:26We all get headaches.
02:28It's common.
02:29People get headaches.
02:30And it's actually very uncommon not to get a headache at some point in your life.
02:35Right.
02:36But the migraine is different.
02:37It's actually a severe form of headache.
02:40And it has specific characteristics.
02:43Usually what we say is a migraine is a severe, throbbing headache that tends to be pulsatile.
02:50People describe almost as if something is pounding on their head.
02:54Right.
02:54As if a hammer is just hitting them on the head.
02:57They're sensitive to light, sensitive to sound.
03:00They may get nausea, vomiting.
03:03They like to go to a dark, quiet room, just tell everyone,
03:06don't talk to me, I'm tired, now's not a good time.
03:11Right.
03:11And it can last for about three hours to three days,
03:16severely impacting a person's quality of life.
03:20Okay.
03:20And how is that different from a regular headache, let's say?
03:23So believe it or not, there are hundreds of types of headaches.
03:28Hundreds?
03:29Hundreds.
03:30Okay.
03:30There are actually, there are books,
03:33volumes dedicated on how many types of headaches and the different types of headaches.
03:37I didn't know that.
03:38Many types, actually.
03:40We're talking hundreds of types of headache.
03:42And migraine is only one type of headache.
03:45Okay.
03:46Out of the many hundreds that you may suffer from.
03:48Okay.
03:49But when we look at out of the hundreds, migraine is actually probably
03:54one of the most common type of headaches there is.
03:58Are the triggers different?
04:00Is it stress-induced?
04:01Is it not?
04:02Like, what are the triggers, maybe?
04:04So if we go back to what separates a migraine from the regular type of headache
04:10that we may experience, and it really comes down to the characteristics, like
04:15the sensitivity to light, sensitivity to sound,
04:19the pulsatile headache, it's throbbing in nature.
04:22Right.
04:22It can start on one side, go to the other side.
04:25So it may start on the right, go to the left, and vice versa.
04:30And if you have these type of characteristics, that would really classify as a migraine.
04:37Now, other type of headaches may, they may, you may have pain,
04:41but it may not have the sensitivity to light.
04:43You may not be sensitive to sound.
04:46It may be pulsatile, but, you know, different characteristics.
04:51But when you put them all together, if you have what we say a unilateral headache
04:56that starts on one side and goes to the other with photophobia, which is light sensitivity.
05:01Right.
05:02Phonophobia, sound sensitivity, nausea, and vomiting,
05:07and throbbing in nature that lasts from three hours to three days, that's a migraine.
05:12Right.
05:13And if you have those, you have a migraine.
05:15If you don't meet those criteria, you have a headache,
05:18which could be one of the other hundreds of types that we discussed.
05:22Right.
05:23So that's really what it comes down to is really,
05:26do you meet all the checkboxes to what a migraine is?
05:29Because there is no, there is no test per se that like, unlike blood pressure,
05:35if you have elevated blood pressure, you would say you have hypertension.
05:39Right.
05:40Or if your sugars are elevated, you would say you may have diabetes.
05:44Migraine, there is no test.
05:46It's really characteristics.
05:48Okay.
05:48You just really, if someone meets those characteristics or have a certain headache
05:54that with certain characteristics or qualities, that's the migraine.
05:58So it really comes down to the history.
06:00Okay.
06:01And what causes it?
06:02I mean, I've been trying to figure this out ever since my late teens,
06:06because that's when I started getting migraines.
06:08What causes it?
06:09Is it stress induced?
06:10Is it like our environment?
06:12Many causes.
06:13Okay.
06:14And there are many causes of migraines and everyone has a different.
06:18So your causes may not be the same as my cause.
06:21Oh, okay.
06:21Like I suffer from migraines.
06:23And for me, my migraines tend to be more triggered with caffeine.
06:28So if I drink a lot of coffee, I may get a migraine.
06:31Okay.
06:32Other people may be sensitive.
06:34If they're exposed to bright lights, they may get a migraine.
06:37A lot of women, they will experience migraines at around the time of menses
06:42due to hormonal changes.
06:44So stress can cause migraines in certain people.
06:48Lack of food.
06:49We see it a lot during Ramadan when people are fasting.
06:52Right.
06:52They'll all describe, oh, my headaches are coming back.
06:56So really different people have different triggers of what a migraine is.
07:01But what we know is we do know that it's more common in women
07:06and it's more common in young women between 20 to 40s.
07:09Now, does that mean younger people can get migraine?
07:13No, you can.
07:14And older people can get migraine older than 40.
07:18But predominantly, it's between 20s to 40s and mainly women.
07:24But men can get it, such as myself.
07:27Right.
07:27And children can get it.
07:29So there is really no per se one type of person who can get migraine.
07:36It affects all members of the community and really all ages.
07:40All right.
07:40We're going to get to that women part.
07:42It's one of the questions I have in mind.
07:45But before we get into that, I just wanted to ask,
07:49what happens if you ignore a migraine or if you don't treat it?
07:54Could it lead to other physical health ailments?
07:59Could it trigger something else?
08:00Or is it just the throbbing pain and that's it?
08:04That's an excellent question.
08:06Migraine is not a fatal condition.
08:09Right.
08:09And it doesn't cause physical disability, but it can cause a lot of disability.
08:18When I mean it's not physically disabling, meaning it doesn't cause paralysis,
08:24you won't end up in a wheelchair, you won't die if you get a migraine.
08:27Right.
08:28But it can still be extremely disabling.
08:31And it can affect someone's quality of life and emotional well-being.
08:35And what do I mean by that?
08:38If you're getting migraines a lot, you may want to withdraw from society.
08:43You don't go to work as much.
08:45Right.
08:45Or you may avoid going out with the children or with your family or even meeting other people
08:51because you're always worried, oh, I'm going to get a migraine.
08:54Or I have a migraine and I don't want to go out.
08:57So it can cause people to be withdrawn from society, which is disabling in a different way.
09:04So in that sense, it is a disabling condition, but it's not a fatal condition.
09:10And if you don't treat it, it's not going to get worse,
09:14but it's still going to be disabling.
09:16You know what I mean?
09:16Right.
09:17If you don't treat your migraines, there is no long-term sequelae about it,
09:21but it's still equally disabling, meaning that for the reasons I just mentioned.
09:26Right.
09:26Yeah.
09:27I mean, we are always told that your physical and mental health are interconnected.
09:31Exactly.
09:32That's the new line that everyone is using.
09:34I mean, as you said, it sort of halts you from moving on with your life,
09:39from enjoying certain things that you usually enjoy if you don't have the migraine,
09:44like spending time with children who can be loud,
09:47which is a sensitivity that you develop when you have a migraine.
09:52But that's essentially what happens when you leave it untreated.
09:55Exactly.
09:56Because if you're getting a migraine, you want to go to a dark, quiet room
10:00and you want to tell the kids and the family, don't talk to me right now.
10:04And now it's not a good time.
10:06And if that's happening, some people can get up to 15 headaches a month, if not more.
10:11Oh, my goodness.
10:12If you're getting that many headaches a month,
10:14and you are withdrawing from your family that many days a month,
10:19that's disabling, that's time lost from your family.
10:23You know what I mean?
10:24Yeah.
10:24So it can cause a lot of anxiety.
10:27It may cause you to be depressed.
10:28Yeah.
10:29I want to spend time with my children or my family,
10:32and I can't because I'm suffering from these severe headaches.
10:36Right.
10:36That makes me sensitive to light or sound.
10:40Or you know what?
10:40I want to go work, but I can't work because I'm always taking sick days to go to work.
10:45And I can't function.
10:46I can't help pay the bills.
10:48Right.
10:49So there is a lot of anxiety, and it can cause depression.
10:53So it is one of those illnesses that carries a high burden, a high cost to society.
11:00Even though, like I said, it's not a physical,
11:02it's not a disabling condition in the sense physically.
11:06Yeah.
11:06It's still disabling.
11:08But in different ways, as I mentioned.
11:10Right, right.
11:11And I feel like along with that is also lack of sleep.
11:14I mean, I can't even begin to mention how many times I've gotten these migraine attacks,
11:19and I cannot even sleep.
11:21I can't even switch off or stop the pain or stop the pulsing, throbbing pain just to sleep.
11:30And that because of the headaches, you can't sleep.
11:34And also the problem is the lack of sleep causes even more headache.
11:38Exactly.
11:38So then you go into this vicious cycle of headaches, beget headaches.
11:42Yes.
11:43And you kind of spiral downwards, and you can't seem to fix yourself.
11:47Right.
11:47Or break that cycle.
11:48Which leads to the lack of productivity and whatnot and everything you mentioned earlier.
11:54So you mentioned that it's more prevalent in certain segments of society and specifically women.
12:00Yeah.
12:01Why is that the case?
12:03Well, we think it's related.
12:05Well, we know at least for women, hormonal changes and hormones play a role in migraine.
12:11Right.
12:12So that's why during menses, the monthly cycle, a lot of women will experience a migraine
12:19or migraine-like symptoms.
12:21If you're taking any type of hormone, oral contraceptives, it may trigger migraines in women.
12:27But now that being said, that's only part of the picture.
12:31Because men, we don't have the same hormones as women, but men still suffer from migraines.
12:36So while hormones play a role, it's not the only reason why, or it's not the only explanation.
12:43It's just one piece to that puzzle.
12:45Okay.
12:46Are there people that are more at risk of getting migraines?
12:50Or is it just one of those things that you might be prone to it or not?
12:56It affects all members of society, all races, all ages, all genders.
13:02So there is, I mean, we do know that certain genders are more,
13:06like women are more likely to get migraine than men.
13:10But that doesn't mean it's not a female-only disease or a male-only disease,
13:15or it's not a disease of only young people.
13:17It's a disease of every age, every gender, every socioeconomic background.
13:24Rich people get migraine, poor people get migraine, young and old.
13:28So it affects everybody equally.
13:31It's an equal opportunity offender, if you want to call it.
13:34I like that.
13:35Okay.
13:35So the next question is everyone's question.
13:39What's the treatment?
13:40I mean, what can I do?
13:42Are there new treatments?
13:43Are there any advancements in the medical field that are promising to people
13:49suffering from migraines, giving them promising results or the results that they need?
13:53You know, first of all, I think when someone comes to see me in clinic
13:58and they suffer from migraines or they have characteristic symptoms of migraine,
14:03it all starts with the history.
14:04And what do I mean by history?
14:06If you know your illness, if you know what causes your illness,
14:10you know how to avoid it.
14:12As we say in Arabic,
14:16Right?
14:16So if you know what causes your symptoms, I would tell you, avoid it.
14:20Right?
14:21Right.
14:21If you say, every time I drink coffee, I get migraines.
14:25Well, then the obvious answer would be cut down on coffee.
14:29Exactly.
14:30You know, if lack of sleep or certain foods cause migraines.
14:34So it's important to find what are the triggers.
14:37Everyone has different triggers.
14:39Like I just mentioned, I suffer from migraines.
14:42It's not very common, but still, I get them and I'm very caffeine sensitive.
14:47I still drink coffee though, by the way.
14:50But I know these are my headaches.
14:52Other people get migraines if they eat certain foods,
14:56you know, like foods that contain nitrates or processed meats.
15:01They may trigger migraines in that group of people.
15:05So it's important to know what's your trigger.
15:08And a lot of times you may not know what your trigger is until
15:12you really sit down and think about, well, why am I getting these headaches?
15:16What's causing it?
15:17So the first thing I tell someone is do a diary.
15:21Write a headache diary.
15:23First write down when you get a headache, what's happening, how long it lasts,
15:29what was happening around the time you had the headache.
15:33Did you do something differently?
15:34Did you eat something different?
15:37And see if you can start noticing a trend of, you know,
15:41every time I get a headache, I do a specific thing.
15:43Then you know, okay, you should avoid it.
15:45Right.
15:46And sometimes that works.
15:48And then that works a lot for a lot of people who have triggers.
15:52If that doesn't work, we have many medications for migraines.
15:56And I think we're lucky is that we can tailor medications to your specific needs.
16:02So we have oral medications.
16:05We have injectable medications.
16:07We have nasal medications that have been recently approved
16:10that work very well and very quickly.
16:13So what's the right medicine for you?
16:16Well, it depends.
16:17It's based on a lot of factors.
16:19And I think it's important to sit down with your physician
16:23and let them lay out the different options that are available.
16:26And you see what works best for you.
16:28Right.
16:29I'm going to ask a really basic question.
16:31And it might be obvious, but I mean, I'm just going to ask it
16:34because I know a lot of people might have the same question.
16:38Are migraines curable or are they just a chronic condition
16:42that you're going to have to live with and you need to manage one way or the other,
16:45either through treatment or prevention, as you mentioned?
16:49Migraine is a chronic disease.
16:50OK.
16:51So by hence being chronic, there is no cure.
16:55OK.
16:56It's something that you learn to live with.
16:59It can be managed.
17:00So the goal of treatment, there is nothing that will say you take one medicine
17:06and you'll never have migraines for the rest of your life.
17:09Right.
17:09You'll need to take some medicine for a specific amount of time, whatever works for you.
17:16But it can be manageable.
17:18And the goal is to either decrease the frequency.
17:21So meaning if you get multiple headaches a month, let's say 15.
17:26Yeah.
17:26We want to try to bring it down, let's say, to five or 10.
17:29Right.
17:30Or even zero, which sometimes happens.
17:32And sometimes if we can do that, that's great.
17:35But I'm also looking not only for frequency,
17:38I'm looking to decrease the severity.
17:41So sometimes people would say, oh, well, I still get 10 headaches a month,
17:46but they're not as bad.
17:47You know, I can still function.
17:49So yes, you get 10 headaches a month.
17:51No, the frequency is the same, but they're not as disabling anymore.
17:55You can still function.
17:57You can go out.
17:58You got a mild headache, but you can still do the things that you want to do.
18:02OK.
18:02And that is the goal of treatment.
18:04Ideally, I would like to get no headaches with no side effects,
18:08and you can live the way you want to do.
18:11But sometimes we're looking also to decrease just the frequency or the severity.
18:16OK.
18:16As well.
18:17I like that.
18:18So you get a lot of patients, I'm sure.
18:20And, you know, a lot of people complain of migraines.
18:23What are some of the misconceptions or the myths that people have told you
18:27from a patient suffering from migraines?
18:30There are many misconceptions, first, about migraines.
18:33A lot of people think migraine is just a regular headache.
18:36It's not a regular headache.
18:38So a lot of people sometimes say, oh, it's a sinus headache.
18:42I have sinus headaches.
18:44And no, you don't have sinus headache.
18:47Sinus headaches are very particular.
18:50They have a certain type of symptom.
18:52They present differently.
18:54Their presentation is differently.
18:56But a lot of times people say, oh, I have sinus headaches.
18:59You're like, no, you probably have migraines.
19:02A lot of people think that, oh, maybe this is one of those things, one of those illnesses.
19:08Oh, I take one medicine for a short period of time and I'll be cured.
19:12It's a chronic illness.
19:14It can be managed.
19:17We can probably try to achieve a goal of no headaches or at least a better quality of
19:22life with decreased headaches.
19:24But people need to understand that it may not be complete.
19:28It's not a curable condition.
19:30And you learn to live with it.
19:32And you learn to manage it.
19:33If you know what your headaches are, you are empowered.
19:37If you know what causes your headache, if you know your own illness, then you're able
19:42to manage your illness and empower yourself to live a life as active as possible, I think.
19:49Right.
19:50Okay.
19:50So I'm going to take it a step further.
19:52Sure.
19:53So further from the migraine attacks.
19:55But when do you know that it's not a migraine attack?
19:59Maybe it's something worse.
20:01What do you look out for?
20:02What are the investigative procedures you would say are necessary at that point?
20:07You know, that's a great question.
20:10And what are the red flags?
20:13So first of all, like I said, there is no test.
20:17There is no migraine test.
20:19And because there's no test, we actually, the diagnosis can be done based on symptoms.
20:25I don't need to do imaging for someone with migraine.
20:29You don't need an MRI.
20:30You don't need a CAT scan.
20:32Actually, guidelines recommend if you have, give me a history.
20:38That sounds like migraines.
20:40And you meet all the checkboxes for a migraine.
20:43And you have a normal exam.
20:46We don't need to even do imaging on you because it's probably migraines.
20:50Right.
20:50Common things being common, you have migraines.
20:53Now, what are the red flags or what are the times when we think it's not a migraine?
20:59When the headache quality changes.
21:01So let's say you, someone comes into my clinic and they say,
21:05I've been suffering from a specific type of headache my whole life.
21:09It's always like this.
21:11And it's caused with certain symptoms and it presents a certain way.
21:15Okay.
21:15But now it's different.
21:18My headache changed.
21:19It's no longer the same type of headache that I used to experience.
21:23Something's different about it.
21:25That's a red flag.
21:27Okay.
21:27If you have any type of neurologic symptoms, what does that mean?
21:32Nuance at weakness, numbness, unsteadiness.
21:37Without a headache, another big red flag.
21:40That would need further workup.
21:42Okay.
21:42If you present, like I told you, migraines are most commonly present
21:46in 20s to 40s, as I mentioned.
21:49But if someone comes to my clinic for the first time, older than 55,
21:55that would be another red flag.
21:57Nuance at headache for someone who's never experienced a migraine in their whole life.
22:02And now they're saying, oh, I think I have migraine.
22:06That's a red flag.
22:07It may be, but it warrants further workup and further investigation.
22:12Right.
22:13Okay.
22:13And is there anything specific to the UAE when it comes to migraines that you can share?
22:20Well, the UAE, just like everywhere else in the world, migraines are common here.
22:25Okay.
22:27But we also know that migraine, because of heat, we do know that certain people,
22:32and a lot of times we know that dehydration can be a trigger for migraine.
22:36Right.
22:36And you know, in the summertime, it can get very hot and people can get dehydrated
22:42and that can trigger migraines, bright lights, sunlight.
22:46Sometimes people say, you know, when I'm driving,
22:49just the right sunlight can trigger a migraine in me.
22:52Moving on to you a bit more and how you feel when you treat these patients with migraines,
22:58like how rewarding is it?
22:59Like, how do you feel that you're actually helping people relieve that pain?
23:05It's extremely rewarding because if done correctly,
23:10you can significantly change someone's quality of life.
23:13Okay.
23:14I mean, by what do I mean by change?
23:16Sometimes by just knowing that you have a migraine and knowing what causes your migraine
23:23and what triggers your migraine, you may actually be able to reduce the quality
23:27and severity of migraine.
23:28Hence, that person can go back and be a father, a mother, a brother,
23:34sister, or a functioning member of society and go back to work.
23:38That's extremely rewarding to see someone who is debilitated from their disease, I'll call it,
23:45and now you notice you're able to bring them back to what they want
23:50or what they would like to do.
23:51So seeing, and it is an extreme, and migraines is a very treatable condition,
23:58meaning that you can get very good response.
24:01You can live an excellent quality of life because we have many treatments for it.
24:07And then because of that, I think that's extremely rewarding to see people just
24:13live a life free of headaches or where the headache is not disabling them like before.
24:20Absolutely.
24:21I know you had a very long day and you were just telling me before the show
24:24that you spent your whole day in the clinic and now you're here with us and we're very grateful.
24:28But before we let you go, your last piece of advice for anyone that might be experiencing
24:35these symptoms, but they just don't know where the solution lies,
24:39and they don't know what to resort to at this point, what's your advice?
24:43My advice is if you suffer from a headache, and it's not just the headache I get every now and
24:50then, if you're suffering from a headache that's disabling, and the headache has a certain
24:56characteristic, what I just described, don't self-medicate, don't start go to the pharmacy
25:03and take a bunch of over-the-counter pain meds because you actually may only make your headaches
25:08worse and you may not actually solve the problem. Go see a physician, preferably see a neurologist,
25:16that's what we specialize in, we take care of headaches, that is what we do. So see an expert,
25:24see someone who knows how to diagnose this condition and then properly manage it.
25:31But also don't self-medicate yourself, I think that's the most important thing.
25:35I love that, that will be my takeaway, don't self-medicate, don't self-diagnose,
25:41the likes of WebMD or TikTok now obviously, all these self-diagnoses, I mean it's just,
25:49it's not accurate.
25:50Exactly, and I would say definitely don't ask Dr. Google, because if you ask Dr. Google,
25:56if you put all the symptoms, you probably are going to say you're dying of a brain tumor.
26:01In fact, you probably have a migraine. So don't go to the internet, try to look for answers of
26:08what you have and how to treat what you don't know. Leave it to the people who actually studied
26:14this and spent their lives treating this condition, that's what I would say.
26:19Absolutely. Dr. Ahmed, thank you so much for joining us today.
26:22Thank you so much for having me, thank you Gulf News, this was excellent, I had so much fun today
26:29and thank you Pfizer today for allowing me to speak. So it's been so much fun and I hope we can,
26:37I hope if only one person knows or learns something today, that is a success for me.