Finding relief from the headache of headaches

The Means Report

Almost everyone has experienced a headache at one time or another. Sometimes they are caused from stress, other times they are caused by another ailment. The key is knowing when a headache requires the attention of a doctor. Dr. Ned Pruitt, the Vice Chair of the Department of Neurology at the Medical College of Georgia at Augusta University, has information to help you know when you need to take the next step.

Brad Means: We want to welcome to The Means Report set, Dr. Ned Pruitt, he is the Vice Chair of the Department of Neurology at The Medical College of Georgia at Augusta University. Dr. Pruitt, thanks for what you do for people with headaches and thanks for being here.

Dr. Ned Pruitt: Thanks, Brad.

Brad Means: First questions is this, I talked to a lot of people who are impacted by headaches, and I’m talking about random people. I just said– Have you ever had a headache? Or has it ever bothered you? They all said yes. It’s never normal for our head to hurt, is it? Except for in the event of trauma. It’s never supposed to hurt, is it?

Dr. Ned Pruitt: Well, you would hope it’s never supposed to hurt, right. But actually headaches are one of the primary reasons people see a physician.

Brad Means: And when do we know that it’s time? When do you cross that line between oh my head just hurts versus I have to go to the doctor now?

Dr. Ned Pruitt: I would say, if you are disabled by your headache–

Brad Means: Mm hmm.

Dr. Ned Pruitt: In other words, you have to stop your daily activities, or slow down your daily activities, obviously, some mothers can’t stop their daily activities, but if you feel like you’re in any way disabled by your headaches, you probably should see your physician.

Brad Means: Are you concerned with frequency at all? Or could it be a lone incident that does incapacitate you, that makes you go? Or do you want it to happen more than once before they see you?

Dr. Ned Pruitt: No, actually, one severe, disabling headache would be a reason to see a physician. But certainly, people frequently have disabling headaches. So, therefore, the frequency is important to us, as well. If you look at headache as a disease, more than 10% of the world’s population suffers from chronic, recurrent, disabling headaches. And it can lead to a lot of disability over the course of a life span for patients.

Brad Means: How long do they usually last, or does it vary?

Dr. Ned Pruitt: It varies, if we’re thinking about migraines specifically, they can last from 48 to 72 hours at a time.

Brad Means: I had a coworker tell me before you came into the newsroom that a migraine, her mother gets them about once a month. Shuts her down for maybe 72 hours where she has to remain in a dark room.

Dr. Ned Pruitt: Right.

Brad Means: It is a debilitating. And it’s okay to call it a disease, right?

Dr. Ned Pruitt: Yes, oh, absolutely.

Brad Means: Talk about what happens when people come in to your office. What sort of tests do you run? How do you diagnose what it is and then how to treat it? How do you know?

Dr. Ned Pruitt: Right. They come in, sometimes they’re saying, “I’m having daily headaches.” Sometimes they say, “I have intermittent, severe headaches.” But we’re talking about primarily first, the character of the headaches. Usually a migraine’s gonna start at least on one side of your head, have a character that’s throbbing or pounding. Oftentimes, you’re very averse to light because of that, like your mother-in-law who stays in the dark for three days.

Brad Means: Sure, Yeah.

Dr. Ned Pruitt: And then you may get to the point where you’re nauseated, as well. Sometimes you may actually know that you have certain triggers. Some patients will know, hey, if I eat chocolate I will get a severe headache.

Brad Means: I was going to ask you about food. Let me interrupt real quick. How can that cause a headache? What’s it do inside your body?

Dr. Ned Pruitt: Well, we don’t know exactly why it happens. Many times, patients have many triggers. Common triggers for patients with migraine include: aged cheeses like sharp cheddars, red wine, especially, sometimes the preservatives in red wine, especially wines made in America. As well as preservatives in deli meats will be what triggers the migraine, and those are nitrites. For some people it’s loud sounds, smells, lack of sleep.

Brad Means: Mm hmm.

Dr. Ned Pruitt: Not eating on a regular schedule. All those things will trigger a migraine.

Brad Means: A couple of things that you’ve mentioned, especially the sleep and the diet, we could fix on our own. Am I assuming too much or can we?

Dr. Ned Pruitt: No, you’re exactly right, you’re exactly right. So, a lot of what we do in that evaluation, we talk about it, make sure we have the right diagnosis and then we talk with the patient about, let’s do some lifestyle changes that may help you and not require that we always use medications–

Brad Means: Mm hmm.

Dr. Ned Pruitt: To decrease the frequency of your migraines.

Brad Means: If someone’s watching right now, and they have a lot of the symptoms that you’ve mentioned, is it possible for you to make their headaches go away?

Dr. Ned Pruitt: I can’t make them go away, but I can certainty help them control them.

Brad Means: Mm hmm.

Dr. Ned Pruitt: You know, in medicine as a whole we don’t really cure anything to speak of anymore other than infections and if you’ve got a bad appendix it can come out.

Brad Means: Sure.

Dr. Ned Pruitt: Or things like that, but you know, we manage hypertension, we manage diabetes and in the same way we manage migraine headaches so that it becomes a minor component of your life and not something that disables you once a week, twice a week for a decade or 20 years or 30 years. It can be, over the course of a lifespan it can be very disabling.

Brad Means: Do your genes play a role? Can you inherit the tendency to have headaches?

Dr. Ned Pruitt: About 70% of patients with migraines to have–

Brad Means: Wow.

Dr. Ned Pruitt: Members of their family who also suffer from migraines. And many of my patients who are in their 20’s and 30’s will tell me already, “Yes, my daughter has migraines.”

Brad Means: Mm hmm.

Dr. Ned Pruitt: “My son has migraines. “I wish they were old enough to come see you, too.”

Brad Means: Yeah, can teenagers make you have headaches?

Dr. Ned Pruitt: Can teen, well. Stress is definitely a trigger.

Brad Means: Stress is a huge trigger.

Dr. Ned Pruitt: And I think, I think teenagers would fall under the triggers of stress, right.

Brad Means: Definitely, definitely. So, yeah, let’s talk about stress management. Is that a lot of the therapy that you recommend sometimes? And if so, how would that work? How would you send a patient of into the world with some marching orders to destress?

Dr. Ned Pruitt: Well, of course we’re always gonna have stresses in our life.

Brad Means: Sure.

Dr. Ned Pruitt: We all respond differently to those stresses. So we talk a lot about how are we gonna manage our stresses. One of the best ways to manage stress is to exercise on a regular basis.

Brad Means: Mm hmm.

Dr. Ned Pruitt: And that’s usually what we do. We also encourage people to try to simplify their life. Sometimes it takes just a little bit of simplification to get on a regular schedule. That means, okay, I know things are busy at home. I know there’s clothes that are unwashed, but at 10 o’clock, you need to be in the bed. And you need to be getting good sleep. That will help you manage your stress better.

Brad Means: That leads into my next question: How quickly could we see results? I know that you can’t make these things go away forever but as far as treatment and then results, when might relief come after we leave our doctor’s office?

Dr. Ned Pruitt: Well, we’d think about it in two different ways. We would have medications that you can take when you have a migraine that would shorten that attack from 48 to 72 hours to hopefully no more than four to six hours.

Brad Means: Mm hmm.

Dr. Ned Pruitt: But then, if we have very frequent migraines, we have medications that you would take on a daily basis that we should be able to see a decrease in the frequency of your migraines within four to six weeks.

Brad Means: What about people who just need eyeglasses? You ever see that anymore? I remember when I was coming up, that caused headaches with some of my fellow students.

Dr. Ned Pruitt: Yes, well, that’s where defining the character of the headaches helps a lot.

Brad Means: Mm hmm.

Dr. Ned Pruitt: Poor vision or old prescription glasses will cause you to have kind of a frontal, achy type headache; but that won’t be a disabling headache. And of course, now, just yesterday I was reading about people spending too much time on the computer and getting a lot of neck pain from doing this all day. Looking down at their phones or their tablets or staring at the email for a great period of time. Again, the character of those types of headaches or neck pain would be different than what the history we would get from a migraine patient.

Brad Means: Right, that’s a good point to make. Those things that you described could cause headaches, but they probably wouldn’t meet the threshold of debilitating, right?

Dr. Ned Pruitt: Correct, absolutely.

Brad Means: And so, another thing I meant to ask you about and you’ve touched on this in your answers, there are primary headaches and secondary headaches from what I understand.

Dr. Ned Pruitt: Yes.

Brad Means: The secondary headaches are more the migraine type? The primary are more the stress related?

Dr. Ned Pruitt: Well, actually, we would say migraine headaches are primary headache disorders.

Brad Means: Got it, okay.

Dr. Ned Pruitt: Secondary headaches are what we are always worried about and what patients are worried about when they come to us. They’re like, “I have terrible headaches.”

Brad Means: Mm hmm.

Dr. Ned Pruitt: “I had a cousin who had an aunt who had a sister who had a brain tumor with terrible headaches.”

Brad Means: Right.

Dr. Ned Pruitt: “I’m here to make sure my headaches “are only migraines and not something secondary, “or more terrible,” right.

Brad Means: Do headaches become more frequent in older patients? Is there a certain age where we should probably expect it to start happening?

Dr. Ned Pruitt: No. Actually, headaches, disabling headaches that begin in later life would usually be a secondary headache phenomenon and therefore they get our attention quite quickly. Most of the time migraineurs, or people with migraines usually start having migraines in their teen years, in their early 20’s.

Brad Means: My last question, and I don’t wanna scare anybody, but are there instances where you have to recommend or refer a patient down a road that might lead to surgery? And if so, what might be the problem? I’m guessing a tumor, or I’m guessing something else that might be noticed inside the head or the brain.

Dr. Ned Pruitt: Right.

Brad Means: s that ever a final option?

Dr. Ned Pruitt: Well, part of the evaluation of course, other than just the history is we do an examination. So, if we find something abnormal on our neurologic examination, then we would go on to further head imaging, brain imaging.

Brad Means: Mm hmm.

Dr. Ned Pruitt: And then, depending on what we find, there may be a surgical option that would require dealing with it, but usually headaches are not the primary sign of something like a brain tumor.

Brad Means: Okay, alright, it’s not usually an indicator?

Dr. Ned Pruitt: No.

Brad Means: Yeah, and that’s happened before, I’ve gotten a headache. The first thought is I wonder if I have a blockage or a tumor.

Dr. Ned Pruitt: Right.

Brad Means: You know what I mean?

Dr. Ned Pruitt: Right.

Brad Means: People are fearful of that. Alright, so here’s what I’m taking away from you, Dr. Pruitt, because I know what you’re saying resonates with a lot of viewers out there. A lot of people have headaches. If it reaches the point that it’s interfering with your life

Dr. Ned Pruitt: Right.

Brad Means:  Relief is out there.

Dr. Ned Pruitt: Yes, absolutely.

Brad Means: Alright. Well, I hope a lot of people are encouraged to take that first step; see Doctor Pruitt. See your doctor and go from there. Thanks for your time, I appreciate you.

Dr. Ned Pruitt: Very welcome.

Brad Means: Absolutely. Doctor Ned Pruitt, Medical College of Georgia at August University.

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The Means Report first aired in January of 2009 offering coverage that you cannot get from a daily newscast. Forget about quick soundbytes -- we deliver an in-depth perspective on the biggest stories. If they are making news on the local or national level, you will find them on the set of The Means Report. Hosted by WJBF NewsChannel 6 anchor, Brad Means, The Means Report covers the topics impacting your life, your town, your state, and your future.