MYTH: Medication Is the Only Treatment for Migraine

Emily: 0:00

Hey, nice.

Vanessa: 0:00

Hey. Um, so have you ever suffered from migraine?

Emily: 0:06

um, only a couple of times have I had one in my life. It was when I was really, really young, but something that kind of drew me to today's guest Kelly eights is that I've noticed a lot of my friends have issues with migraine this year who have maybe even never had it before. And I think it's just kind of due to that general 20, 20 stress that we've all been under and it's clearly manifesting in the way of migraine for a lot of people. So I think this guest will be very timely that we have today.

Vanessa: 0:42

Yeah, it was going to say from talking to Kelly, it seems like stress is a big trigger in 2020 has had a. Ton of stress and 2021 is following suit a bit

Emily: 0:53

So let's get into it. Hi, welcome to wellness myths. Today. We have Kelly Yates here. She's a private practice dietician that specializes in migraine and gut health. She was inspired to pursue natural interventions for migraine after dealing with her own diagnosis for over two decades and knowing medications could not be the only solution. She currently lives just outside of Atlanta, Georgia with her husband, David and three cats. Welcome Kelly.

Kelli: 1:28

Hi, thanks for having me.

Vanessa: 1:30

Hi, Kelly. We're so excited to have you on today. I wanted to start with, so I'm guessing a lot of our listeners, if they're tuning in today specifically to listen about migraines, they might suffer from migraines, or they probably at least know what they are. But I just want to make it clear for anyone who isn't so sure. Can you tell us what a migraine is?

Kelli: 1:52

Of course. Yeah. I'll go into kind of the definition and then I'll throw a few stats in there just for fun. So migraine and I have to correct. Most people said, please don't feel bad, but we refer to it as migraine instead of migraines. And that's a more recent change in language and how we speak about migraine. We've changed it to migraine because it is a neurological condition that we have. 24 seven, those of us who have migraine, it's characterized by, you know, that intense head pain, which is probably the first thing you think of when you think of migraine, but there are actually a lot of other symptoms that can come along with it that you may experience during an actual migraine episode or attack, but also in between attacks. So these can be things like. Nausea vomiting, trouble speaking, even numbness and tingling, sensitivity to light and sound. And then there's also different forms of migraine. One of them is vestibular migraine. So you experience a lot of like dizziness or motion sickness, things like that. It's a much more diverse condition than a lot of people realize when they first think of migraine, but there are actually. A lot of different symptoms that can come with it. And it is actually the third, most prevalent illness in the world and the sixth most disabling condition in the world. So it has a really big impact.

Vanessa: 3:19

And I know you mentioned, there's a lot of manifestations of migraine. Most people think of head pain? Have you had anyone who suffers from the other symptoms and doesn't get that pain?

Kelli: 3:34

Yeah, so that's a good question. A lot of people who have the vestibular migraine, they may not always have head pain with their. Episodes or they may never experience head pain. And then there's also something called silent migraine, which, um, you know, we'll include some of those other symptoms, but not the head pain itself. And then there's abdominal migraine, which is more common in children, which again, you know, the head pain part of it, isn't the most prevalent symptom. It's more of those, you know, abdominal pain symptoms.

Vanessa: 4:07

I think a lot of people just think of your head or at least people who don't suffer from migraine. I'm really having to be careful to say migraine without that s. It's kind of hard.

Kelli: 4:18

I still mess up. So it's fine.

Vanessa: 4:20

So what's the most common conventional treatment for migraine.

Kelli: 4:25

That a lot of times depends on the severity and the frequency of somebody's migraine episodes. So if someone has what they call episodic migraine, so if it's less than 15 migraine days a month, then sometimes they will only be given an acute treatment. So for some people they can still get by with over the counter medications, like ibuprofen or Excedrin migraine. but then some people need prescription medications. One of the most common classes are called triptans and those are kind of one of our standbys when it comes to acute migraine care. And then for people who either are, you know, significantly impacted by their migraine and or they have. Chronic migraine. So more than 15 migraine days a month, they will be given a preventative. And there are a lot of preventatives out there. Some are pills, some are injections. Uh, some are not, you know, they weren't created for migraine like Botox, but they seem to be effective for it. And then there are, you know, a lot of new treatments coming out in the last few years that are migraine specific, which is better.

Vanessa: 5:35

And did you, or do you suffer from migraine yourself? Is that how you got into this particular field?

Kelli: 5:43

Yeah, it is. So I have migraine myself. I've had it. I mean, Honestly for as long as I can remember, but at least, you know, two decades or so. But yeah, that's, that's how I got interested in this space. And it's really, you know, like you mentioned in the intro, I was starting to go down the path of medications, which there's nothing wrong with that. And I still take acute. Prescription medications when I need them. But I just wasn't being, given any other options. And as someone who was already studying dietetics, I thought, you know, there's gotta be some way I can approach this from, you know, nutrition and lifestyle and even maybe supplements. And there was so that's, that's kind of what got me interested in pursuing this as a career path.

Vanessa: 6:29

And have you found that with clients, do you have clients that start getting migraine out of the blue or do a lot of them suffer from it? Early age or is there an event that might cause that to start happening?

Kelli: 6:46

Ooh. So yes, to all of those, those can all be true for different people. And migraine can really begin at any time whether you're, you know, a child or it's more common to onset between, um, you know, childhood to early adulthood. But I mean, it really, at any age, it can start happening for someone But it can be triggered either just by things like puberty. This is a little bit more common for females. It can be triggered by some sort of traumatic event. So whether that's physical or emotional trauma, these can both kind of trigger migraine onset. And then there's some theories that hormonal birth control can actually trigger migraine onset as well. So lots of different things can bring up migraine and someone who's predisposed.

Vanessa: 7:34

Yeah, Emily and I were actually just talking about hormonal birth control causing migraine before you got on the call. Can you elaborate on that a little bit more?

Kelli: 7:46

yeah, sure. And this is an area that I've been getting more in depth with just recently. I've been more into gut health and how that impacts migraine, but hormones are linked with gut health and it it's all kind of connected. So, Hormonal birth control is actually I didn't mention, but it, it can be one of the treatments prescribed for migraine. We have a term called hormonal migraine or menstrual migraine, and that's used for someone who feels like their symptoms are linked with certain parts of their menstrual cycle. So sometimes their doctor will give them birth control to help suppress those symptoms. And it, it may or may not work. But some people notice that. Either once they begin taking hormonal birth control, or once they go off of it, if they go off of it, then that may actually trigger the onset of their migraine. So it's, it's very individual because you know, birth control affects us all differently depending on our, our personal chemistry. But that can be a contributing factor for some people.

Emily: 8:53

That's really interesting Kelly, because I've had a friend that right now was just experiencing migraine for, I believe like just started happening to her. And her physician right away had told her to get off the birth control that she was taking.

Kelli: 9:10

Wow.

Emily: 9:12

Yeah. I don't know exactly why. I think maybe there was like, I don't know if there was another test or something, but they were just saying that it was risky to be on it.

Kelli: 9:20

Oh, and I wonder if, um, I'll mention this because I think it's important. I don't know if that was her situation, but people who have migraine with aura. So, um, the most common aura is visual disturbances. So they'll see lights or colors or kind of TV, static, things like that. People who have migraine with aura, shouldn't be put on combination hormonal birth control because it can increase the risk of stroke. So that, um, yeah, that's a big one that, you know, people's doctors don't always ask them if they have migraine, if they don't already know. So sometimes people are kind of blindsided by that when they find out

Emily: 9:59

Yeah. That's I think that's what happened with hers. I had, known actually quite a few people this year, who hadn't really had migraine before. And then all of a sudden started getting really debilitating ones. I don't know if you've seen that in your practice.

Kelli: 10:14

I have, I saw a big increase in migraine symptoms in the past year. And I don't think that's too surprising considering what all happened to everyone in the past year, but yeah. Stress is a huge migraine trigger.

Vanessa: 10:32

Yeah, everything that's been happening in our world. Seems like it could trigger just about anything right now. So,

Kelli: 10:38

Exactly.

Vanessa: 10:42

so do you know if migraines are more common in men or women?

Kelli: 10:48

Yeah. So as far as you know, the statistics tell us migraine is More than twice more likely to happen in women. So I think about 20%, 18 to 20% of women in the U S have migraine, whereas it's less than 10% for men. Although, you know, stats always have a little bit of wiggle room for error and it may just be that women are more likely to go to the doctor for their symptoms than men. but it's still a pretty big gap. And there is such a strong link with those female hormones and migraine. So. We do still think that it's more likely to happen in women.

Vanessa: 11:24

Yeah, that's really interesting. That's like you said, that's a pretty big gap.

Kelli: 11:30

Yeah. Then children of course can also experience migraine. And sometimes it does go away. Um, once they reach adulthood, but about 10% of children also experienced migraine.

Emily: 11:44

That you mentioned that because literally just before we started recording Vanessa and I were saying how I used to get them when I was really young. I don't even really remember like realizing that at the time, but I remember I just had to be in a really dark room and my eyes would be really sensitive and feel very strange. And I would get the abdominal symptoms.

Kelli: 12:06

Oh yeah. Yep. That's that's migraine.

Emily: 12:10

Yeah. It's, it's so interesting. I think that my mom had that as well. And then she had told me, Oh, I just grew out of it. So hopefully you will too. And then I ended up, I mean, I never got one again, knock on wood, but yeah.

Kelli: 12:22

Yeah. And it definitely, it does run in families. Um, it's not that there's a really large genetic component to migraine.

Emily: 12:32

Oh, interesting. I never knew that one. Um, okay. So. My question is how do food sensitivities relate to migraine? Because I hear this often and I know that food sensitivity testing can be a little controversial. So I would love to hear your take on that.

Kelli: 12:51

Yeah, I love to talk about this. So the first thing that I just want to make the distinction of, and this can get a little bit. Confusing, but there, when we talk about migraine, you know, food allergies could potentially contribute to symptoms, although probably not as significantly. But we were really talking about food sensitivities and then food triggers. And these are two different things. Food triggers. Are more foods that kind of act on the nervous system for someone who has migraine, where as food sensitivities, which is what you asked me about, act more on the immune system so they can both contribute, but they are kind of two separate things. But with food sensitivities, that the role that they play is that they contribute to what we call our trigger load. So for someone with migraine, they kind of have their own unique migraine threshold, where if they experienced enough triggers throughout the day throughout the week, they eventually will cross over that threshold. And that's when they experienced a migraine episode. So food sensitivities can act as a trigger for someone and they can also contribute to other issues like inflammation and kind of be an indicator that there's an underlying issue. That itself, maybe making your migraine worse, like, um, dysbiosis or something like that.

Emily: 14:19

People typically, um, have an idea of what they're sensitive to already. Is it something that's apparent or,

Kelli: 14:27

Ooh, so that one's a hard one. Um, food triggers. So the, the ones that kind of act more on your nervous system, those tend to be easier to pin down. Although not always and easy is probably not the right word. To use, but, um, food sensitivities are a lot more difficult because the, the reaction can happen, you know, 30 minutes to an hour after you eat the food or even a day or two after you eat the food. So it's really. Challenging to pin it down without using some sort of testing and even better using someone like myself, like a dietician who can help you sort through the testing and help you work through an elimination and reintroduction diet. Now the food sensitivity testing, um, is definitely controversial. And I mean, in my opinion, there's no perfect food sensitivity test. Um, we just have. Okay. Options and much better options, but the, um, the most common ones that you can, you know, just anyone can order themselves online like Everly, well, that test for just the IgG. I honestly just, I don't feel that they're super helpful just because IgG can be harmful and it can actually be protective. So using an IgG test is really only going to contribute to. Even more frustration for someone who's trying to use those to figure out what they should or shouldn't eat.

Emily: 15:54

Yeah. I hear often that people who take those kinds of sensitivity tests are confused because I'll oftentimes it's the foods that they eat the most.

Kelli: 16:05

Right. And, and that could, you know, there could be some truth to that because you know, if we're eating broccoli every day and we're sensitive to broccoli, that's okay. That reaction is probably going to get worse, but it could just be that our body's developing IgG antibodies to that food because we're eating it frequently. So it could be, you know, either one. And there are other types of tests that look more at the reaction that your cells are having to food rather than just specific antibodies. And I feel like those are, are a much better measure of. You're accurate food sensitivities. Although again, that's why we want to do an elimination and reintroduction diets so we can know for sure. Exactly which foods are sensitive to.

Emily: 16:48

Yeah. So let's talk a little bit more about how I think there's almost everyone at some time who struggles with a health-related thing, whether it's digestive or sundae feel has a food trigger has thought about an elimination diet or, um, as I'm sure, you know, oftentimes physicians will prescribe something like that. But then kind of leave people to navigate it on their own. Um, so can you tell me a little bit about that? It's always like, someone's like, how am I supposed to stop eating literally 800 foods at once and then

Kelli: 17:20

Yes.

Emily: 17:20

put them back in. So I would love if you could talk about that.

Kelli: 17:24

Yeah. And it's funny, you mentioned that because a lot of my clients will tell me that their doctor handed them a list of foods. To not eat and it's foods that they love and that they don't necessarily want to give up. So, um, it can be frustrating to not have that guidance, but honestly, I mean, that's, that's what a dietician is for. Right. We're here to help you with the food side of stuff. I love elimination diets as a tool. Um, but as a short term tool, so one thing that can happen if someone's trying to do it on their own, which a lot of people are successful in, but some people get kind of stuck in that elimination phase because they're afraid to add foods back in, which is understandable. But that adding foods back in part is. Really important, um, and helps you figure out what your specific triggers are or food sensitivities are. So if you approach it in that way, with the intention of, you know, adding foods back in, I think it can be really helpful for the right person.

Emily: 18:29

I think there's a lot of. negatives to being stuck in an elimination diet where now we've kind of vilified certain foods that might actually not be triggering.

Kelli: 18:43

Yes. Yes, definitely. It can kind of create. Some food fear because you, you know, especially if you're starting to feel better, if the elimination diets actually working and then. You're really supposed to add back foods that may make you feel worse. I mean, that's hard. It's definitely important to add foods back in just for your relationship with food, so that you can kind of get past some of that initial food fear and, and start to have a healthier relationship with food. But it's also just good for your health overall to have a good diversity to your diet. It's good for, you know, getting all the vitamins and minerals we need and it's good for gut health. So you really don't want to stay in that elimination phase for more than, you know, in my opinion, a few months.

Vanessa: 19:29

you ever see? And I feel like all of us have probably seen this in some capacity at some point, but people who swear, they. Um, there's a certain food that doesn't make them feel good and it could be a food. Maybe that's been vilified by society or our latest diet trend. Then maybe you do some testing and nothing is showing up for that. Do you ever

Kelli: 19:54

Yeah.

Vanessa: 19:54

that situation happen?

Kelli: 19:56

Yeah. So this, honestly, it happens more with those food triggers, those quote, common migraine food triggers, which I, I personally don't think there are any common food triggers. But that aside, some people, you know, one of the, uh, common food triggers is chocolate, which. It's such a bummer but not everyone's going to react to chocolate. I don't react to chocolate. A lot of my clients don't react to chocolate, but because it has such a stigma of being a migraine food trigger sometimes it's really hard to get people to try it again, which, you know, we, we don't need chocolate to live, so that's not the biggest deal.

Vanessa: 20:38

Yeah, it does make life a lot more fun

Kelli: 20:40

Exactly. Yeah. And, and the less restriction you can have in your diet, the better, in my opinion. So I want to get people eating as many foods is as they want.

Emily: 20:51

Yeah, definitely. That was, um, going to be one of my questions was, are there any popular triggers or sensitivities that can lead to migraine? But you're saying it's very individual

Kelli: 21:04

Yeah, well, and there, there are, I mean, alcohol and caffeine, are definitely, you know, everyone with migraine is going to react to a certain extent to those well drinks. Caffeine can be helpful for migraine episodes like it's in migraine or Excedrin migraine, so it can have a. A beneficial effect, but it can also cause caffeine withdrawal and cause symptoms on its own. So that's definitely a factor. And then alcohol of course can trigger migraine. And there are some other, you know, like artificial sweeteners and MSG, those teams seem to be more common triggers, but again, it's always going to be individual.

Vanessa: 21:49

do you know, I know you mentioned, you know, chocolate being a bigger one and to me, you know, things like alcohol and caffeine kind of makes sense, but do you know why chocolate has been something that has been labeled as a maybe it isn't, but it's been labeled as a big trigger.

Kelli: 22:07

Yeah, so that, that's a really good question. Most of these foods that are considered common triggers contain certain food chemicals. So for chocolate, I mean, one of them is caffeine, but one of them is also Tyra amine, and Ty remain is a food chemical that's seen as a common. Migraine trigger. Some other ones are histamine and nitrates and nitrites. So any foods that have these specific food chemicals in them could be considered a common migraine food trigger. Although I will say chocolate does not have a lot of tire meat in it. So it's probably one of the caffeine in that one

Vanessa: 22:47

Or maybe the combo.

Kelli: 22:49

or yeah, or the combo.

Vanessa: 22:52

So we know, you know, everything with a nutrition is so individual. And so if you are someone who experiences migraine and Stephanie Best to work with someone one-on-one like Kelly. But are there any tips that you give just common tips that could be helpful for anyone.

Kelli: 23:13

Yes, definitely. So there are some things that will be relevant for anyone with migraine, and that is to eat regularly. So really every three to four hours is going to be best for most people with migraine. Cause we want to keep your blood sugar as steady as we can because blood sugar spikes and depths can be a trigger for a lot of people. And then making sure just to have balanced meals. So having protein with each meal, having some sort of carbs, fiber fat, those are all important. And I find that a lot of my clients just tend to forget protein. Because they're reaching more for some of those comfort starchy foods. So adding protein can be really helpful. And then this can be a little bit triggering for people with migraine, because they're always told to drink water, but it is important to stay hydrated. I usually recommend around 75 to a hundred ounces a day. It's a lot more than a lot of people may be drinking. So staying hydrated can definitely help.

Emily: 24:14

Those are really great tips.

Kelli: 24:16

Thanks. Yeah. And Oh, one other one, if they haven't already then keeping a symptom journal can be helpful to track, you know, what may be contributing to their symptoms. And at the very least, if it's overwhelming for them to try and interpret, then bringing that to their doctor or their dietician or whoever they're working with so that they can help them interpret. It can be really helpful.

Vanessa: 24:41

Yeah. And are those tips, um, as far as, you know, eating balanced meals and balancing your blood sugars, staying hydrated, are you saying that across the board for, during a flare or not in a flare, or is there a difference of maybe what you would tell someone to do? Um, during a flare.

Kelli: 25:02

Yeah, and I love that you're using the term flare because that, that is a perfect description. Um, but I mean, having those balanced meals and eating frequently is going to be helpful anytime. So just in day-to-day life, it's definitely going to be more challenging. And when you're in a flare, especially for someone who has. Intractable migraine. So they are in an episode 24 seven. that's when having some strategy to these things and figuring out how to get in those calories and protein, when you don't feel good all the time can be really helpful. So getting support with that and having some strategies that work for you can be really beneficial because it is so important to make sure you're getting enough calories and protein and water all the time.

Emily: 25:52

Oh, I feel like I learned so much about what affects migraine over the course of this conversation, because I think for a lot of people, it just seems like something that people just have to deal with and there might not be all these different lifestyle adjustments. So it's really interesting.

Kelli: 26:08

Good. And honestly, yeah, it can feel like something you just have to deal with for someone who has migraine too. Especially if. If they haven't been given these other options. So it is, there is a lot we can do outside of medication to support our ability to manage our migraine.

Emily: 26:25

So I know that there's going to be some people who would love more resources and to hear it more from you. So where can people find you?

Kelli: 26:34

Yeah. So I hang out most of the time on Instagram and you can just search the migraine dietician. My username is. At the dot migraine diet, dietician, and dietician has no C in my spelling. So, um,

Emily: 26:48

to everybody. Dietician has no seat.

Kelli: 26:51

no se, um, and then I also have a Facebook group, a private Facebook group and my website, the migraine dietician.com. But those are all places to find me and learn more than you ever wanted to know about migraine.

Emily: 27:07

Yes, it's so informative. I've already been watching all of Kelly's stories and learning a lot just over the past couple of weeks. So we'll definitely put your Instagram handle in these episode notes too, just to make it real easy for everybody to be able to find you. thank you so much for your time.

Kelli: 27:23

Yeah. Thank you so much. It was such a pleasure to talk with you all today. Anytime I can ramble about migraine, I am down.

Vanessa: 27:31

We love it. Thanks Kelly.

Kelli: 27:33

Thanks. Yeah.

Vanessa: 27:42

Thank you so much for tuning into this episode of wellness myths. Please. Sure. Remember to rate, subscribe, and review we'll be dropping another episode next Wednesday with registered dietician, Ashley kitchens about meal prep. See you then.