Migraineurs have a different intracranial vascularity than people who don't get migraines.

This study, while interesting, told neurologists something already known, or at least strongly suspected by most. It does support, however, our thoughts that there is a significant vascular cause behind migraines, and especially some of the asymmetry associated with them. We knew it was true at the microscopic and less-microscopic level, but this little study supported the suspicion at even the larger-vessel suspicion as well.

What is the Circle of Willis? Below is a picture of it by itself and what it looks like perched on the underbelly of the brain. In summary, you have four main arteries coming from the heart to supply the brain. The two in front are the carotid arteries and the two in back are the vertebral arteries. The Circle of Willis is essentially the anatomy of how these "trunks" branch into the various recesses of the brain.

In this picture, the Internal carotid artery on one side is labeled, and the Vertebral arteries are NOT labeled but you can see them at the very bottom, joining together as an upside down "V" to make the labeled Basilar artery.

Now, this study was unique in that it looked at these larger vessels for differences in anatomy between different types of migraine patients. As I was saying before, what neurologists have always known however is that that the tiny branches everywhere from a tenth of mm in size (smaller than this period:  .  ) to a mm in size (about the width of this n)-- that these billions of blood vessels that imbue every nook & cranny of your brain are also different by design in some manner, and more likely to show some damage at a greater frequency than other people just like you who don't have migraines. There is something different about a migraineur's brain vasculature. That being said, there are numerous studies (especially in the psychology and psychiatric journals) showing that there is no long-term negative cognitive changes (thinking problems) associated with these small vascular changes, and many non-migraineurs ALSO have this same thing to some degree or another but for other reasons.

Anyway, if you have migraines and you have an MRI showing something like "non-specific T2 changes," or "subtle white matter changes consistent with small vessel disease," or the like, you should know it is a relatively common finding, is a relatively underwhelming finding, not associated with any changes in thinking, and that this below is often what it looks like:

The two white spots toward the front on your left (perhaps a subtle third spot just above can also be seen)

Hydration in the Elderly.... the Coffee-Water Rule

 I see so many older adults with headaches, dizziness when they stand, hypertension, chronic dry mouth & dry eyes, memory complaints...

I could discuss direct and indirect mechanisms by which chronic dehydration leads to worsening of these issues, but that's not the point here. It's just a truth, a known relationship.

I'm often surprised that we in the medical community don't bother our patients enough about the importance of hydration and am often surprised at how often I see my patients internally rolling their eyes when I bring it up, as if they don't see where their lack of hydration, chronically usually, can actually increase their risk for stroke. Or they yawn at such advice because they don't feel thirsty and assume they are hydrating "enough." This little entry is not about how much is right for each person, because there are numerous factors involved, but I do see a LARGE number of my patients walking around with chronic dehydration. It's endemic it seems.

I have a rule for my older adults (and frankly middle-aged adults should follow it too), and I got the idea from my mother, where it was known in my youth as the Grape-Juice-Water Rule.

I love grape juice. Even now, when I'm out with friends at a party, if there's the option of a beer or grape juice, I'll be the one sipping on the purple stuff. But grape juice is expensive. And growing up, my mother couldn't afford to supply me with an endless supply of grape juice when I came in from outside sweaty and thirsty. So she gave me a choice: She could either start buying as much of the purple powder stuff (grape drink) or I could follow her Grape-Juice-Water-Rule

OR

THE GRAPE-JUICE-WATER RULE:

When I come in from outside thirsty, I have to first drink a full glass of tap water BEFORE I am allowed to drink an equal-amount glass of grape juice. And then after that I can alternate between water and grape juice, a half-glass at a time. And if she saw that I wasn't seeming to follow such a rule, I would just start seeing the powdered grape drink in the fridge instead of actual juice.

So, I have modified the rule for my adults who need to work on their hydration.

Dr. Kirk's COFFEE-WATER-HYDRATION RULE:

You can drink your 8 oz cup of coffee in the morning, BUT you have to FOLLOW it with two 8 oz glasses of water afterward, which both keeps you more hydrated (especially since coffee actually makes people lose more water, as a diuretic), and the water coming afterward helps reduce the teeth staining that comes from wonderful coffee.

 AND

I tried to make the glass of water look more exciting.

Migraine Diary Smart Phone App and a Coupon for Cheaper Treximet

When I can, I am always trying to find some way to make medications and treatments more affordable to patients. Patients sometimes mistakenly think I am somehow paid to give them more medications, make them reliant on medications, or am somehow linked to the drug companies or insurance companies.
That could not be further from the truth.

I hate (yes, I used this word) insurance companies and the time-consuming games they make me play to get many medications and treatments for my patients. They battle me on medical decisions all the time, when they have absolutely NO personal knowledge of the patient... nor Neurology/Epilepsy/Sleep Medicine for that matter.

I generally believe that less medication is better if you can get away with it, and feel that, while many drug companies are making earnest efforts to create medications that improve the length and quality of people's lives, they are fundamentally a business at heart and do not feel the sense of self-sacrificial calling that keeps me in the office to late hours not as infrequently as I would like.

Okay, that was my soapbox. Here is the coupon:

This is for Treximet.... IF this medication works for you. Fine. BUT keep in mind there many medications in this family of medications that may OR MAY NOT work for you. This is just one that happens to have a discount easy to get to. REALLY, YOU JUST NEED TO FIND THE ONE THAT WORKS FOR YOU PERSONALLY, WHETHER IT BE MAXALT, RELPAX, etc, or maybe not even a "triptan" but some other medication in the other families of medications used as a migraine abortive. If I come across other coupons, I'll put those up too.

---If you are my patient, then call my office and I'll see if I can find a card or something for your particular medication if it will help defray the cost.--

You can get $50 dollars off your first prescription of Treximet (a "triptan" family migraine abortive medication), and $25 dollars off of refills, as long as you are not on Medicare or Medicaid.

Text  FIFTY to the number 438669 and a coupon will be sent to your smart phone to show your pharmacy. You can use it even if you already have a script. 

OR, BY SNAIL MAIL if you prefer, you can fill out the following form and mail it to:

Glaxosmithkline

PO BOX 29410

Shawnee Mission KS 66201-9625

Extra: You can get an iPhone headache diary application for free, making it easier to keep track of your migraines to help your Neurologist:

Download "Migraine Notebook" from the iTunes Store. It's an easy, great little app once you quickly customize it.