Episode 135. Headaches with Dr Michael Eller
Headache is an extremely common symptom, and collectively, headache disorders rank among the most prevalent nervous system disorders. Approximately 95% of the general population have experienced a headache at some point in their lives, with a one-year prevalence rate of about one in every two adults. Headache accounts for up to 1 in 10 general practitioner consultations, remains a frequent reason for neurology referrals, and in Europe, constitutes up to 4% of emergency department visits, with migraine being the most common type.
The World Health Organization includes headache among the top ten causes of disability. While the impact on the economy and an individual’s quality of life may be challenging to quantify, in the case of migraine, up to 75% of patients report functional disability during an attack, and about 50% require the assistance of family and friends. Headaches do not discriminate; they affect people of all ages, races, and socioeconomic statuses, but they are more common in women.
Headaches are generally categorized as acute or chronic. Acute headaches may be new and severe, potentially indicating critical intracranial pathology like an aneurysm or meningitis. Chronic headaches are typically classified into primary types such as migraine, cluster, and tension-type, or secondary, which could reflect intracranial pathology or result from conditions like cervical spondylosis, dental and ocular disorders, sinusitis, hypertension, depression, TMJ dysfunction, temporal arteritis, medication side effects, and others.
When consulting with patients, inquiring about the onset of the headache, its frequency and type, duration, recent changes in characteristics, intensity, location, pain quality, associated symptoms like nausea and vomiting, factors that worsen or alleviate it, as well as the presence of neurological symptoms such as visual and sensory changes or alterations in speech, can all aid in establishing a diagnosis.
Migraine often demonstrates a complex polygenic pattern of inheritance, and in the case of familial hemiplegic migraine, it exhibits an autosomal dominant pattern of inheritance.
In my conversation with expert headache and movement disorder specialist Dr. Michael Eller from Richmond Neurology, I was keen to delve deeper into the realm of chronic primary headaches—specifically, migraine and cluster types. The evolving understanding of the pathophysiology of these headaches and the developing treatment approaches, focusing on inhibiting the neurotransmitter called Calcitonin gene-related peptide, is fascinating. This peptide is inhibited by the 5-HT1D and 1B receptor agonist effect of the triptans, as well as by a new family of CGRP-targeting drugs and monoclonal antibodies developed for the preventive treatment of migraine.
Michael completed his medical degree at the University of Sydney in 2003 following a Bachelor of Science and Arts. He has interests in archaeology, neuroscience, infectious disease, and indigenous health. Additionally, he has volunteered as an aid worker in remote locations, including PNG, and underwent training from 2012 to 2014 at The University of California, San Francisco, under Professor Peter Goadsby. I believe you will find this conversation quite engaging. Please welcome Michael to the podcast.
References:
Dr. Michael Eller: Richmond Neurology - richmondneurology.com.au
Headache disorders: differentiating and managing the common subtypes, Ahmed - ncbi.nlm.nih.gov
Current Medical Diagnosis and Treatment.2019: Papadakis, McPhee et al, McGraw Hill Education, Lange