Does Brain health improve Migraine Health?

0:08 Uh welcome. Uh I still can’t
0:10 see that we have
0:14 Okay, so I think we’re we’re
0:16 live now. Um welcome to
0:19 migraine Canada’s ask your
0:22 pharmacist. It’s a series of
0:24 live webinars that aim to bring
0:27 subjects that are not usually
0:28 brought through you know the
0:33 webinars that we usually do
0:34 that are mostly about
0:36 medications and about the
0:37 condition. We would like to
0:39 talk to you today about a
0:41 subject that is that we get a
0:45 lot of questions around the
0:47 brain of people living with
0:48 migraine and it gives me great
0:49 pleasure to have Doctor Crystal
0:52 Kohler and Doctor Crystal is
0:56 the founder of the Virtual
0:58 Brain Centre. She’s a doctor of
0:59 behavioral health, a social
1:02 gerontologist, and a senior
1:03 Atlantic fellow for equity in
1:05 brain health with global brain
1:07 health institute at Trinity
1:08 College, Dublin, Ireland, where
1:10 she completed her residency
1:11 training on dementia prevent
1:13 and social determinants of
1:15 brain health. Uh Crystal has
1:17 held executive level positions
1:19 with health’s non-profit
1:21 organizations has over a decade
1:23 of wellness program experience
1:25 receiving multiple awards for
1:27 innovation and community impact
1:28 and has over 15 years of
1:30 experience working with
1:31 individuals with brain health
1:33 concerns, their families and
1:35 advocacy organizations. Um the
1:38 subject itself is is is of of
1:41 great I think importance to all
1:46 of us, not only people living
1:47 with migraine. For you, Doctor
1:50 Kala, can I, can I call you
1:51 Crystal? Is that okay? Yes,
1:52 Crystal. Great. Thank you.
1:54 Welcome to Migraine Canada.
1:56 Thank you for joining us. Uh
1:58 you are joining us tonight from
2:02 from New York. Uh where you are
2:03 based, right? Mm hmm. Yeah. So,
2:07 welcome to Migraine Canada.
2:08 Yeah. And thank you for being
2:12 our guest tonight. Thank you. I
2:15 appreciate the lovely
2:17 introduction and the time to
2:18 spend with the community this
2:19 evening to talk about all
2:21 things brain health and migrate
2:23 health. Thank you. Um I’m
2:27 getting some I’m getting a
2:31 someone telling me that there’s
2:32 no audio. If someone is
2:35 watching us can you tell us if
2:37 you can hear us? Or if you’re
2:40 if we’re having issues with the
2:42 audio I’ve just got a message
2:43 on our chat saying there’s no
2:44 audio. Okay. Uh
2:50 I’m assuming we should be okay.
2:53 Um if you’re having an issue
2:56 with the audio, we are also
2:57 streaming on Facebook, on
2:59 Migraine Canada Facebook page
3:02 and on the virtual brain health
3:05 center that is on LinkedIn and
3:08 on my own the migraine
3:10 pharmacist Facebook. Um yeah so
3:12 it looks like it’s it’s okay
3:13 now. Thank you very much. Thank
3:15 you Parin. Welcome. Welcome
3:16 everybody. And I think the
3:20 first thing that that made this
3:21 an important subject for us is
3:23 that we’re all worried about
3:25 our brain health. That’s the
3:26 number one worry, I guess we
3:28 all have around cognition,
3:30 especially when we age, when we
3:32 go through tough periods in our
3:33 life, or would we live with a
3:35 condition? And migraine is one
3:36 of these conditions where we
3:39 you know, people living with
3:41 migraine are exposed to
3:44 multiple painful episodes. Um,
3:46 and that that go on for years
3:47 or for most of their lives.
3:50 They are exposed to different
3:51 medications. And they always
3:53 ask, what, like, can I take
3:54 this long term? What will it do
3:55 to me? What about what about
3:58 cognition and a lot of the
4:00 medications that do give that
4:03 you know these these side
4:06 effects are very worrisome for
4:08 them. So I guess that’s your
4:10 that’s your area and that’s why
4:12 we we thought it would be a
4:13 great idea to to talk to you
4:14 today and to hear from you
4:18 about this subject. Um Would
4:22 you like? No, that’s great.
4:23 Would you like to put up the
4:24 slide deck and I can. Yeah.
4:25 We’ll see that here. I think
4:27 you covered everything so
4:28 lovely in the introduction of
4:30 the importance of brain health
4:31 and really what we see in
4:34 surveys all across the world
4:35 especially as we go down the
4:36 aging care continuum. It’s
4:38 brain health is one of the top
4:40 health concerns that people
4:41 have. But then we also report,
4:43 we don’t know what to do about
4:45 it. So, there’s a lot of
4:46 information out there. We’re
4:47 not sure how to access the
4:49 information or how really to
4:50 make these things relevant to
4:51 our daily lives. So, I’m hoping
4:54 that’s what may have picked a
4:55 few people’s at least that may
4:57 be joining us this evening and
4:58 that we can dive into. Um but I
5:01 do like to share a little bit
5:03 about myself before I do a
5:04 talk. I appreciate your lovely
5:06 introduction. But my approach
5:08 and perspective to brain health
5:10 does look a little different. I
5:12 think like everyone else is. Um
5:14 I did train in the social
5:16 sciences but it was actually in
5:18 graduate school. I had an
5:20 isolated seizure event. And I
5:22 think I share the story of many
5:23 people who live with new daily
5:24 persistent you can pinpoint
5:27 that exact moment in time when
5:29 that headache started and has
5:30 never stopped and that’s been
5:32 about a decade long for me and
5:34 then, as life has progressed,
5:37 deal with chronic migraine and
5:39 across the lifespan too and so,
5:42 realizing that living with
5:43 migraine, chronic migraine, new
5:45 daily persistent headache. I’ve
5:47 trained in the brain health
5:48 field but it’s also my personal
5:50 interest as I have to take up
5:52 this charge every day for my
5:54 own health and well as well as
5:56 in the work and projects I do
5:58 to support others. So, I hope
6:00 that shares a little bit of
6:02 insights on the perspective
6:03 that I may have when I’m
6:04 chatting with you this evening
6:06 about brain health and wellness
6:08 as well as migraine health.
6:09 It’s done some training in it
6:11 but also it’s been my personal
6:13 journey and story and getting
6:15 trained up in advocacy. So, I
6:17 am so grateful to Migraine
6:18 Canada to be with you this
6:20 evening. We talked about a few
6:23 questions that we were hoping
6:25 to cover tonight. I’m not sure
6:26 if maybe one of them piqued
6:28 your interest, perhaps more
6:30 than one, for why you’re here,
6:32 but there’s the chat that we
6:34 have, so feel free, and at any
6:35 point in time, there’s a
6:37 comment, a scenario, something
6:38 you’d like to share, put it in
6:40 the chat and we’ll make sure to
6:42 address those questions as we
6:43 go along, too. But it seemed
6:45 like we picked the big ones of
6:47 how do brains age with migraine
6:51 disease, or without migraine
6:52 disease, is it the same? Is it
6:55 different? Do people living
6:56 with migraine disease or
6:58 related headache disorders,
6:59 have to have different
7:00 strategies to maintain brain
7:02 health and what do they need to
7:03 do and as well as at the end, I
7:06 think this is where Hebba’s of
7:08 expertise comes into but what
7:09 do we really know about brain
7:11 fog and some of the medications
7:12 that are very commonly
7:14 prescribed for people part of
7:15 our migraine and headache
7:16 community. So, I want to start
7:18 off today with just defining
7:22 what brain health is and it’s
7:23 really been a topic that’s been
7:26 coming online in recent years
7:28 gaining popularity but it’s
7:31 also one where I can share the
7:32 field has shifted its
7:34 perspective. So, initially, we
7:36 thought of brain health in
7:38 terms of cognitive functioning
7:41 and output. Meaning, what can
7:43 our brain do and how does it
7:44 perform? Thinking about your
7:46 mental processes, your
7:48 cognition, how you learn, your
7:50 judgement, language, and
7:51 remember. So, there’s multiple
7:53 definitions out out from
7:55 different leading
7:56 organizations, included ones
7:58 from the CDC and administration
7:59 on community living because
8:01 they tend to be a little short
8:03 and sleek and I think, hi, what
8:05 it is we mean by the cognitive
8:08 activities we’re asking our
8:09 brains to perform when we’re
8:11 looking under that brain health
8:13 umbrella and definition. And
8:15 historically in our field our
8:17 perspective of brain health was
8:19 different. We thought brain
8:20 health was for people who were
8:23 very healthy. And so a lot of
8:25 times we excluded populations.
8:27 Like older adults. People with
8:29 brain based diseases. Those
8:31 living with migraine or
8:32 headache. It wasn’t necessarily
8:34 we thought that brain health is
8:35 important part of their care
8:37 and treatment. Historically, we
8:39 looked at brain health of as
8:41 this achievable goal of the
8:43 healthy, of the healthy,
8:45 wanting to achieve and attain.
8:46 I can say in the past few
8:48 years, we have changed this
8:50 perspective as a field across
8:52 across the globe for the most
8:53 part. If you’re living in an
8:56 area where they define brain
8:57 health, as part of their
9:01 vocabulary, but the nice part
9:02 is, now, good brain health is a
9:05 state that every individual.
9:07 So, every single one of us can
9:08 realize our own abilities to
9:11 optimize our cognitive,
9:12 emotional, psychological, and
9:15 behavioral functioning. So, you
9:17 can see how that definition has
9:19 really expanded to hit large
9:22 domains of our wellness and our
9:24 lifestyle and we look at how
9:25 that plays a role and how we
9:27 cope with situations. And
9:29 really from my experience in
9:30 the field, the way I’ve looked
9:32 at brain health and have really
9:34 approached it changing on
9:35 training under the lifespan
9:37 perspective, as well as
9:38 spending a lot of time working
9:41 with people with a wide variety
9:42 of brain-based diseases. It’s
9:45 really coming down to our
9:47 brain’s ability to thrive at
9:48 any age. And the bulk of that
9:51 is through our lifestyle. So,
9:53 we say now, brain health is
9:55 about 90% lifestyle and 10%
9:58 genetics. So, there are many
9:59 things we can do that can help
10:01 nurture our brains and our
10:02 bodies to do better and that
10:05 will look different for all of
10:06 us but I wanted to at least
10:08 start off the talk this evening
10:09 on defining what all falls
10:11 under brain health umbrella
10:13 before we spend the bulk of our
10:15 time chatting about that this
10:17 evening. I’m not sure if I saw
10:19 any comments come through just
10:21 yet. But I know the first main
10:23 question we wanted to chat
10:25 about this evening is do brains
10:28 of people living with migraine
10:29 disease age differently? The
10:32 answer of what we are finding
10:33 is no. We don’t age
10:35 differently. It may look
10:38 different for us. And so we’re
10:40 seeing starting to see some
10:42 smaller studies in terms of I
10:44 want to say the amount of
10:46 studies available on what
10:47 happens to people who are aging
10:50 with migraine disease. We know
10:51 the trajectory of migraine
10:54 migraine disease and related
10:55 headache disorders looks
10:56 different across the aging care
10:58 continuum and we sometimes see
11:00 a decrease where people
11:02 reporting less frequency of
11:04 their headaches as we are
11:05 aging. So, we kind of see these
11:07 different fluctuations in our
11:08 headache frequency or migraine
11:10 episode frequency with aging
11:12 but it doesn’t very accelerate
11:15 our brain aging process.
11:17 Migraine has yet to have a
11:19 relationship with damaging
11:21 brain cells and there’s really
11:24 no long-term damage that we
11:25 see. We know migraine disease
11:27 can ebb and flow. It’s very
11:29 painful for a lot of people but
11:31 that pain isn’t necessarily
11:33 causing long term or lasting
11:35 damage to our aging brain. So,
11:37 I hope that gives us a little
11:40 bit of information of what we
11:41 know that the field has found
11:43 out so far. On the other end,
11:46 what we know about people who
11:48 live with migraine disease is
11:50 we tend to talk about more of
11:52 those cognitive functions. More
11:54 commonly with our healthcare
11:56 providers. And we do that when
11:58 we’re younger as well as when
12:00 we’re older. So what we call
12:01 that is our subjective
12:04 experiences of our cognition is
12:05 we’re open with those
12:07 conversations. We entertain
12:08 that dialogue. And we know it’s
12:11 an important part of our level
12:12 of awareness and driving our
12:14 own optimal health well-being.
12:17 And we find that we are
12:18 different as a community in
12:20 comparison to other people who
12:22 may be aging without migraine
12:24 disease. They’re not
12:26 necessarily bringing to the
12:27 forefront some of those
12:28 cognitive concerns they may
12:30 have. Um but in terms of
12:31 general brain aging where aging
12:33 all the same starting in about
12:35 our mid twenties. Just
12:37 depending on the different
12:38 processes. It does ebb and
12:40 flow. And the last part on this
12:44 slide in terms of migra being
12:46 related as a dementia risk
12:48 factor is really getting a few
12:51 studies. I think what I could
12:53 find was maybe five to eight
12:54 studies that start to talk
12:56 about the relationship between
12:58 migraine disease and the
13:00 possibility of a diagnosis of
13:02 dementia later on in life. And
13:05 most of what we talk about in
13:06 the brain health field are
13:08 established lifestyle risk
13:10 factors that we know contribute
13:13 to dementia. And what we know
13:14 right Now, for migraine and
13:17 dementia is somehow, there’s a
13:19 relationship, We’re not really
13:21 sure what it is. So, sometimes
13:24 in some of the studies, it
13:25 shows it can be a potential
13:26 risk factor for Alzheimer’s
13:28 disease and dementia later down
13:30 the lifespan or we’ve seen that
13:33 it starts to come online in
13:35 midlife which depending on
13:38 studies what you’re looking at,
13:39 probably your late 40s to your
13:40 fifties is where they’re
13:41 looking at midlife trajectories
13:43 and saying that we might be at
13:44 a slightly heightened risk but
13:46 we’re not sure why. We know the
13:50 look different from migraine
13:51 and dementia in the brain.
13:52 We’re not sure what the
13:53 pathophysiology is. We’re not
13:55 sure that there’s similarities
13:57 or really stark differences.
13:59 So, there’s a few studies
14:00 starting to really investigate
14:03 and to understand this. So, if
14:04 you’re starting to see this,
14:06 potentially, I like to think
14:07 when media covers research that
14:09 they’ll they’ll highlight this
14:10 but the studies are small.
14:12 There’s some limitations and
14:13 they tend to really look at
14:15 people who have been
14:16 hospitalized with migraine
14:18 disease So, a different subset
14:20 of your average person living
14:21 with migraine disease and
14:23 headache-related disorders
14:25 because they’re looking at what
14:26 they can study in a specific
14:27 hospital and trying to better
14:29 understand that relationship.
14:30 So, we might be having a very
14:32 different chat about this topic
14:33 in a couple years as we learn
14:35 more but to just recognize,
14:38 we’re still disentangling what
14:39 that relationship could be and
14:41 to remember that the
14:42 relationship doesn’t always
14:44 mean that it’s causation.
14:46 There’s all these other things,
14:46 the 90% that we can do in our
14:49 lifestyle. Which I’m sure at
14:51 this point you’re really
14:52 curious since I’ve mentioned
14:54 that of what are those factors.
14:56 So on your screen I try to
14:58 summarize the two large studies
15:00 that we have about brain health
15:02 risk. We get that from the
15:04 Lancet report and another meta
15:06 analysis. And we do have this
15:09 available as a one page PDF and
15:11 reference point that we can
15:13 easily send to anyone here
15:14 who’s interested. It’s also
15:16 available on some of our social
15:18 media to download. you want to
15:21 just quickly look at this, I’m
15:23 going to ask you to focus on
15:24 the colors. So, up at the top,
15:27 you see people in the middle.
15:28 The ones in your light blue are
15:30 brain health risk related to
15:32 your brain. The darker blue, if
15:35 you’re thinking your lower half
15:36 is where we’re looking at the
15:37 body. And our brain and body
15:40 does not exist in isolation.
15:42 It’s in an environment that
15:43 we’re living in. And so those
15:44 are the grey ones that you see
15:46 on the side. So I just want to
15:48 spend a few moments to
15:51 highlight what we know are
15:52 these brain health risk
15:53 factors. the relationship to
15:57 dementia is we know if we can
15:58 control these risk factors, we
16:01 can decrease up to 40% of
16:03 global rates of dementia. So,
16:06 it’s very important to
16:08 highlight our brain health.
16:09 We’re understanding how it
16:10 looks in other specific disease
16:12 states but it’s also for us
16:15 living in a migraine community,
16:16 we might have more level of
16:18 awareness to being in tune with
16:21 our brain, being in tune with
16:23 our bodies, and knowing what
16:24 risk we’re trying to mitigate
16:26 as we’re living with their
16:27 chronic disease that we’re
16:29 managing. And so, if you look
16:31 those top ones in the blue, it
16:33 will be your level of
16:34 education, and or your
16:37 cognitive activity. How do you
16:39 continue to stimulate your
16:41 brain in meaningful ways? How
16:43 do you learn things that are
16:44 new novel and challenging? And
16:46 do it beyond typical school, or
16:49 just a class? Is this something
16:52 you’re continuously seeking
16:53 out, helps build a more robust
16:55 brain? We see that when we can
16:58 protect our brains, this is
17:00 more from head injuries head
17:03 traumas, we get one brain. We
17:05 want to protect it as our most
17:06 valuable resource. So, doing
17:08 what we can there. Ensure it’s
17:11 no surprise to our migraine
17:13 community that sleep is so
17:16 important to our health and
17:17 well-being as well as our brain
17:19 health. And we see a lot of
17:22 relationships with or
17:23 comorbidities, multiple
17:25 diagnosis. Among people living
17:26 with migraine disease when it’s
17:28 coming to sleep. Or depression.
17:30 As well when you’re heading
17:32 down to your body where we’re
17:34 looking at some of these
17:35 chronic disease states and the
17:37 relationships. A lot of people
17:39 have multiple health diagnosis
17:41 that they’re managing in
17:42 addition to living with
17:43 migraine disease or related
17:45 headache disorders. So, the
17:47 ones that come to the forefront
17:49 when it comes to your brain
17:50 health or your heart health,
17:51 your hypertension, or your
17:53 blood pressure, having a
17:55 healthy weight control, your
17:57 diabetes, eliminating smoking,
18:01 and alcohol use, as well as
18:03 putting yourself at risk, if
18:05 you don’t maintain some level
18:06 of physical activity. For a
18:09 long time, we’ve talked about
18:10 people who are physically
18:12 inactive or couch potatoes are
18:13 linked with smokers. As taking
18:16 their lives in their own hands,
18:18 but we likely know our movement
18:20 may need to look different for
18:21 us and it can ebb and flow. But
18:23 this is the idea of having
18:25 movement in some way part of
18:27 your lifestyle and not being
18:29 completely sedentary. The
18:31 majority of your time So, where
18:33 can you have those trade-offs
18:35 to add in a little activity
18:37 Those are the ones that really
18:39 come online for brain health
18:41 and wellness and the one right
18:42 at the top above people, I like
18:44 to just point out, I say,
18:46 stress. It’s the whole mind,
18:48 body system, everything we do,
18:51 in our systems are really down
18:53 to the cellular level, impacted
18:55 by stress in some way. So,
18:56 stress can have profound
18:57 impacts on our health and our
19:00 well-being. In the other recent
19:02 ones as we are in our
19:04 environment and you will likely
19:05 hear our air pollution,
19:07 second-hand smoke, and social
19:10 isolation. We have learned
19:12 since the mid -1940s with the
19:14 World Health Organization’s
19:16 definition of health that you
19:17 wanted to include your mental,
19:19 your physical, and your social
19:21 health. When we are socially
19:24 isolated, we’re at risk. It can
19:26 be as detrimental to our health
19:28 as smoking 15 cigarettes a day.
19:30 So, the power people and
19:33 community to help us thrive and
19:35 live our happiest, healthiest
19:37 lives, our key component of our
19:39 brain health and wellness. And
19:41 so I just wanted to highlight
19:43 those key ones of what are
19:45 those risk factors? And I can
19:46 tell you there is a body of
19:49 literature behind nutrition.
19:51 There’s a body of literature
19:53 behind lots of other aspects of
19:54 our health and well being that
19:56 show it’s good. It’s not
19:58 necessarily come online when
19:59 the big researchers and meet to
20:02 look at dementia prevention but
20:05 we know those other things play
20:06 a role. Like our nutrition,
20:09 relaxate, relaxing, meditation,
20:11 breath work. Those are all
20:12 fantastic for our brain health
20:14 and as well as our migraine
20:16 health. But they’re not
20:17 necessarily on the risk factor
20:19 list. So I wanted to hone in on
20:21 the risk factor list for
20:22 tonight but let you know there
20:23 are many other things supported
20:25 by a lot of research that can
20:27 help us manage brain health as
20:29 well as migraine health.
20:33 and I’d like to just introduce
20:35 our acronym that we use at our
20:37 center as brain care. So, it
20:40 can be very overwhelming to
20:43 hear all these different risk
20:44 factors and some of ’em may
20:46 apply to you. Other ones may
20:47 not but it’s the idea of where
20:50 to start and what can you do
20:52 and our recommendation is
20:55 always to pick one, but if
20:56 you’re looking at our brain
20:57 care acronym is brain care is
21:00 your self-care, it’s going to
21:01 lead to your brain health
21:03 management, as well as your
21:04 migraine health management.
21:05 Looking for balance taking
21:08 breaks, prioritizing sleep and
21:11 our restfulness. Our attitude
21:13 has a great impact on our
21:15 health and our well-being. So,
21:17 practicing gratitude, that
21:19 intellectual engagement again,
21:20 keeping our minds mentally
21:23 stimulated, learning new and
21:25 different things. Nourishing
21:27 things. I I’d like to think
21:29 this is one where the migraine
21:30 community has a better
21:32 understanding of how hydration
21:34 and how nutrition impacts the
21:36 brain and supports our optimal
21:39 health in comparison to other
21:40 populations where they’re not
21:42 necessarily having to think
21:43 about, I ate this. How am I
21:46 feeling now? Let alone when
21:47 it’s involving your your
21:49 headache management or your
21:51 cognitive function. We tend to
21:52 have higher awareness on this.
21:54 And if we move to that care
21:55 component, we’re looking at
21:57 ways we connect. What we’re
21:59 aspiring to do, what is our
22:01 health goal that we want to
22:03 make realistic and achievable?
22:05 And that we Number two is if
22:08 we’re managing chronic health
22:10 conditions, it’s a journey.
22:11 That’s why we kind of have this
22:13 like a roadway. It’s a journey.
22:15 It’s it’s not a sprint and our
22:18 needs may change when we ebb
22:19 and flow. We can get a really
22:20 bad migraine episode or we
22:22 could be in status migraine and
22:24 things change for us in those
22:26 moments of time. Compared to
22:28 when we’re not having as much
22:31 pain or a decrease in our
22:33 frequency of our headaches. So,
22:34 keeping that in mind that we
22:36 can remember that this is a
22:38 daily practice and something
22:39 small we can do all the time
22:41 and then, adding that physical
22:43 exercise kind of ends up that
22:46 brain care model. So, the last
22:48 thing I wanted to share about
22:50 all these topics is a common
22:52 question we get asked. You’ve
22:54 heard all these risk factors.
22:56 You likely are aware of some of
22:58 these self-care routines. So,
23:00 how does this fit in your daily
23:02 life? What can you do tomorrow
23:04 or maybe today depending on
23:06 your time zone that can still
23:07 nurture your own brain health
23:09 and wellness. So, we sat down
23:11 and looked at the research and
23:13 looked at the bare minimum
23:16 intervals that we can spend our
23:17 time on something To show an
23:19 impact on our health and
23:22 well-being. So, we created this
23:24 to say, if you only spend 30
23:26 minutes a day, that’s what you
23:28 can start with or build up to,
23:29 where do you want to invest
23:32 your time for your optimal
23:33 brain health or migraine
23:34 health? You’re going to look at
23:37 some way to unplug, some way
23:39 for your restfulness,
23:40 meditation, and breath work,
23:43 changes the brain, changes the
23:45 body at the cellular level, and
23:46 can be very powerful and we
23:48 know can see positive impacts
23:51 on our health with just a few
23:52 minutes. You can grow and
23:54 nurture a breath work practice
23:56 as well as a meditation
23:58 practice to be in longer
23:59 intervals but you can start
24:00 small and start to see how that
24:02 is having an impact on you. You
24:04 want to spend about 10 minutes?
24:07 Engaging in that mental
24:08 exercise as well as physical
24:10 exercise. So those are your two
24:12 minute intervals. And you know
24:14 you can always build from that.
24:16 So, we find even from research
24:18 from the CDC just 5 minutes of
24:21 physical movement can start to
24:23 offer us health benefits. So,
24:24 on that may be tough or
24:27 challenging if we can just find
24:28 small ways to add in that
24:29 movement, it’s still having
24:31 gains for our health and we can
24:33 start small and build big. Same
24:36 way with taking a brain break,
24:37 we see the power in not running
24:40 full speed ahead, twenty-four
24:42 hours a day, but taking those
24:44 moments to take a break, and
24:46 our community may be also more
24:48 aware of this one, of there’s
24:49 just times where we, we stop
24:51 and unplug, or reset, but also
24:54 planning in times where we
24:55 might want to do that, so that
24:57 we can continue to do things
24:59 that bring us joy, and the task
25:00 that have at hand. So, see
25:02 where you need to fold in some
25:04 breaks to help nurture your
25:06 energy levels and nurture your
25:07 health and your well-being. And
25:10 the last one is a minute of
25:11 gratitude. I know I said 30
25:14 minutes, but I like to think
25:15 the gratitude one you can fold
25:16 in to some existing part of
25:17 your wellness routine. When
25:19 you’re washing your hands,
25:21 think about what’s gone well
25:23 that day. What are you grateful
25:24 for? You may do this in the
25:25 morning, in the evening, if
25:27 you’re sharing a meal with
25:29 someone. But this is something
25:31 that can be done pretty
25:31 quickly, that can help us a
25:34 more positive mindset and that
25:36 kind of trickles downhill to
25:39 improving our overall health
25:40 and our well-being. So, this is
25:42 also a handout that we can have
25:44 available to show you. If you
25:47 want to spend 30 minutes a day,
25:48 where you can kind of invest or
25:50 maybe these, there’s one area
25:52 on here you didn’t really think
25:54 of and that’s where you can
25:55 start but research is
25:56 supporting all of these
25:58 recommendations in these time
25:59 intervals as the as the
26:01 starting point. We can always
26:02 build and spend more time
26:05 moving our bodies, engaging the
26:07 brain, unplugging with
26:09 meditation and relaxation. So,
26:11 I hope that will be helpful to
26:13 everyone this evening and I
26:16 know we’re coming into the the
26:17 last part which is the big
26:21 lingering question about brain
26:23 fog and medications and it’s so
26:27 complicated and so I just
26:28 want to share. It’s was one
26:29 that actually brought me out of
26:32 talking mostly about brain
26:33 health in my professional
26:35 world. That’s what I was doing.
26:37 Uh but then I realized
26:39 navigating and living with
26:40 migraine disease that I have
26:42 brain fog. I couldn’t always
26:44 put a word on it. But I could
26:45 describe some of the side
26:47 effects of what I was
26:49 experiencing when I was trying
26:50 different medications. That was
26:52 either helping on the
26:53 prevention side or the abortive
26:55 side. Um to my own care. And
26:57 learning that any med you take
27:00 just about has some type of
27:01 cognitive side effect profile.
27:03 And so us to have to tune in
27:06 and see what is different in
27:08 our body and I know how about
27:10 you have plenty of tools that
27:12 can help us track this, right?
27:13 When we’re trying a new
27:15 meditation, but to keep in
27:16 mind, there may be entire
27:19 classes of medications that
27:20 have different profiles,
27:22 especially when it comes to our
27:23 cognitive functioning. When
27:25 we’re thinking about the brain
27:27 fog haze, kind of is the way I
27:29 hear a lot of people say it,
27:30 but it’s the lack of clarity,
27:32 the lack of your mental focus.
27:36 Perhaps issues with your
27:36 attention as well and so we
27:39 realize that can be very
27:41 startling to us like with
27:44 confusion and my perfect
27:45 example I had was, I think,
27:46 with my first healthcare
27:48 provider when I started on
27:50 Topamax, and had all these side
27:51 effects I wanted talking about
27:53 them, and moved on to a
27:54 different health care provider
27:56 who later shared what I think a
27:58 lot of people in our migraine
27:59 community may know, but was
28:00 news to me at the time is
28:02 Topamax is called Alpamax. Cuz
28:06 it makes you dopey and that was
28:06 kind of the running joke. And
28:08 at the time that just made me
28:10 feel better because I felt like
28:11 in my own experience with what
28:14 I was living with and was
28:15 trying to articulate to someone
28:18 else that there was a mismatch
28:19 because to me it’s like I
28:21 couldn’t do much without it
28:22 being written on a piece of
28:23 paper. Having notepads
28:24 everywhere. And then I was more
28:27 vigilant of thinking I was
28:28 forgetting something because I
28:29 was knowing. I had that level
28:31 worse of knowing it was beyond
28:32 my no and changing medications
28:35 and luckily, not having those
28:37 side effects can be a big
28:40 difference but for other
28:40 people, there’s many other
28:42 classes and medications that
28:43 may still cause some of these
28:45 cognitive dysfunctions for us
28:47 and I I think that’s what we
28:49 were going to spend some time
28:51 talking about but at least to
28:52 lay the groundwork and the
28:54 generalities, it’s, it’s very
28:55 hard to try any medication and
28:58 not recognize that not only
28:59 does it has side effect profile
29:01 for your cognition but on
29:03 various areas of your body and
29:05 so, what Is that we need to do
29:07 to tune in To our bodies or our
29:11 brains. And at the bottom of
29:13 the screen I I learned this
29:14 from a movement therapist and
29:16 kind of resonated with me but
29:18 in a different way for
29:19 tonight’s talk is taking
29:21 ownership and knowing only we
29:22 know what it’s like to live in
29:24 our body and our brain when
29:26 we’re living with migraine
29:27 disease. And so when we have to
29:29 advocate or have those
29:32 conversations to get the skills
29:34 or the knowledge to be able to
29:35 do that. And to not dismiss
29:37 ourselves that if we’re
29:38 thinking oh Something’s not
29:40 right. Maybe it’s not one of
29:41 the main side effects of a
29:43 medication. It’s a secondary
29:45 side effect or one when you dig
29:47 really deep into these
29:49 pharmacological studies was you
29:50 know other people share but it
29:52 was like less than half of 1%
29:55 or you know these fractions of
29:56 a percentage but you’re not the
29:58 only one out there. It’s just
29:59 not necessarily all that
30:01 information that’s mainstream
30:03 that you’re thinking of. So, to
30:04 honor what your body and your
30:06 brain are telling you when
30:07 you’re, you’re trying medit
30:08 occasions, supplements,
30:10 lifestyle modifications to
30:12 remember to take some time to
30:14 tune in. And then to start
30:16 those conversations with
30:17 providers, people of your
30:19 community or loved ones. People
30:21 that are part of your team and
30:22 and wanting to support your
30:24 optimal well-being.
30:29 That is really where it ended
30:32 on the meds, Heba, because I
30:33 know we were going to chat
30:34 about it. I didn’t see. And I
30:37 think we are, I was streaming,
30:40 our streaming service is not
30:42 showing us the, the the
30:45 comments, but I’m able to go on
30:47 Facebook and I can see a lot of
30:49 comments there, so I can give
30:50 you some comments, but I think
30:52 we went to brain fog, because
30:54 this is the one, me as a
30:56 pharmacist, I hear most, where
30:58 I’m told that, you know, the I
31:01 hear all sorts, yeah, I mean, I
31:03 haven’t heard Dopamax, but or
31:05 Dopamax, but I have heard, I
31:07 feel like a zombie, I can’t
31:10 remember things, I, I cannot
31:13 really focus, I’m, I feel like
31:16 I’m walking all day and I don’t
31:17 remember what I did or what,
31:19 where I was, or I, I hear a lot
31:21 of comments, not only with
31:24 Topamax but with others, and I
31:25 also hear a lot of people
31:28 saying, when my doctor says
31:29 that doesn’t happen with this
31:30 medication, and I love your
31:31 comment around well all
31:35 medications at one point or
31:36 another will have an effect and
31:38 listening to your body and
31:40 trusting that what you feel is
31:42 is what you feel is your own
31:43 experience. Just because I’m
31:46 like I I don’t live with
31:48 migraines so I cannot tell you
31:50 what the medication does to me
31:52 because I haven’t taken it also
31:54 in the middle of a migraine
31:55 attack. Um a lot of the studies
31:58 that were done they were just
32:00 clinical trials. They were
32:00 trying capture the most common
32:03 in the beginning and a lot of
32:04 these medications that we now
32:05 have were not even developed
32:08 for migraine. So brain fog is
32:11 is the one that I I guess the
32:13 community has really talked a
32:15 lot about. I can see some of
32:18 these comments. I have someone
32:19 says, I’m on top of max and
32:21 feel that but it has helped
32:23 with my migraine. So, that is
32:25 also very important because it
32:29 is still that choice that you
32:30 may what is what can you
32:34 tolerate best? Or how can you
32:37 there’s a there’s a trade off.
32:39 If it’s a little bit of brain
32:41 fog that you’re able to cope
32:42 with, still function with,
32:45 that’s okay. Because you need
32:46 to be also pain free or at
32:49 least you need to manage your
32:51 pain to be able to go forward.
32:53 Um I’m just going to. I’m glad
32:55 you, as you say, I was, I’m
32:56 actually really glad you shared
32:57 that. I was on Topamax for
32:58 quite a while, and I some
33:01 different things what I was
33:02 actually able to articulate to
33:03 my provider other than feeling
33:06 the dopey and the fog, it was
33:08 realizing the interval of which
33:10 we were increasing my dose was
33:11 too high. So, I had to go to a
33:14 smaller one and then that
33:15 helped with the cognitive
33:17 symptoms and again, it was
33:19 helping with my migraine
33:19 management. So, it was that
33:20 decision and that trade-off and
33:23 I’ve also talked with other
33:24 providers, another neurologist
33:26 at the time who even shared
33:28 ways to use that when
33:29 traveling. So, Topamax is one
33:31 you can use a little
33:32 differently when you travel
33:33 which I cannot give the
33:35 recommendation for but I at
33:35 least when I spoke with my
33:38 provider, they have different
33:40 insights from all the patient
33:42 populations they’re managing,
33:43 what they know in their
33:44 knowledge, and there’s
33:45 different ways to utilize some
33:47 of the tools that may already
33:48 be part of our daily use and
33:50 what we’re doing. So, think
33:52 that’s an important part of the
33:54 conversation and knowing it is,
33:55 it is a balancing act as as
33:57 well as where you might be on
33:59 insurance. I had one where
34:01 it’s, they want you to take it
34:02 for three months but my face
34:04 swelled up. My eye, my whole my
34:06 whole right side and I thought
34:08 I am not going to inject myself
34:10 with this for two more months
34:11 to decide if it works. It was
34:13 just a really hard decision
34:15 because you’re hoping for
34:16 something to work but I thought
34:17 my body really didn’t like it
34:19 and I wasn’t comfortable again
34:21 because it took a long time.
34:23 So, of course, it was a very
34:25 rare side effect. They hadn’t
34:27 had a patient at that point at
34:28 the Cleveland Clinic that
34:29 really reported it and I
34:30 thought, well, I’m going to be
34:32 the first one to share and I
34:33 have embarrassing pictures if I
34:35 if I needed to but it was
34:37 having to find that tricky
34:38 balance and it is hard and I
34:40 honor everyone who does do that
34:41 but there’s a lot of great
34:44 providers who have different
34:44 insights for what you can do.
34:46 On the pharmacological side but
34:48 also some of the things on the
34:49 lifestyle that bring things
34:51 full circle for yourself. Well
34:54 and again just because it’s
34:56 rare if it happened to you it’s
34:58 a hundred percent. You’re
35:00 hundred percent sure it
35:01 happens. Right? But because
35:03 it’s a point or or or 1% in the
35:06 literature but if it happened
35:07 to me that’s 1 hundred percent.
35:08 It happens. So it’s good that
35:10 we Continue to trust ourselves
35:14 and most important I and that’s
35:16 something as a pharmacist I
35:17 always say, report, report,
35:19 report. Just because it
35:20 happened and someone says,
35:21 well, that’s not related to the
35:23 medication. If you look at what
35:26 what, what the definition of
35:28 side effects and post
35:31 marketing, reporting and all of
35:32 that is that once a a product
35:34 is in the is in use and some
35:38 things happen that are not
35:39 reported when you report you’re
35:41 able to help other people that
35:43 they don’t get also dismissed
35:46 by their care providers or by
35:47 people around them going like,
35:49 no, it doesn’t happen with this
35:50 medication. I have a lot of
35:52 questions. So, I’m going to go
35:53 back a little bit and and start
35:56 talking about risk factors and
35:59 modifiable risk factors. I
36:00 cannot I cannot control control
36:04 pollution but we can control
36:06 control other things. So, one
36:08 of the questions was around
36:09 sugar and how to much sugar can
36:11 actually influence or affect
36:15 your cognition. What about
36:17 people who have low sugar
36:20 levels? The question is, does
36:22 that also affect your brain?
36:25 Yeah, I think that’s a great
36:26 question because there’s a lot
36:28 of information coming online
36:30 about glucose and your
36:31 metabolic health and finding
36:33 out that yes, there’s these
36:34 norm levels but they might look
36:36 a little different for us and
36:38 those of us with different
36:39 health conditions may respond
36:41 differently. I would say talk
36:43 with healthcare provider about
36:46 that. I remember a few years
36:47 ago when I started on my
36:49 migraine journey and they do my
36:51 tasks like my glucose level was
36:53 very low. Um for even what he
36:56 thought. He’s like this is not
36:57 normal. So I had to find some
36:59 different tools and things to
37:00 do at the time and and now
37:02 that’s not necessarily the case
37:03 but at the point in time, it
37:04 was running very low. So, you
37:06 can have both extremes where
37:08 you’re very low or you’re very
37:09 high but seeing what you can do
37:11 in the normal range and I would
37:12 say talk with your providers
37:14 They’re really going to know
37:15 that whole picture about how to
37:17 really give you individualized
37:20 recommendations because we have
37:21 these global ones but that
37:23 doesn’t always work especially
37:24 for people managing chronic
37:26 health conditions or to your
37:28 point when you’re running low,
37:30 that’s going to look different
37:31 than someone who’s running high
37:32 and having these big group
37:34 glucose spikes and then they’re
37:35 dropping off more frequently.
37:37 So, talk with your providers
37:39 and of course, when you’re
37:40 seeing those things to see what
37:41 it is you could do at the time
37:43 member from myself. It was
37:46 smaller meals with a little bit
37:47 more protein because it was
37:49 different for me but that that
37:50 helped because I kept thinking
37:52 they weren’t related but I
37:54 realized it did play a role in
37:55 my headache management. And and
37:57 this is one of the things that
37:59 we do. I mean as I’ve I’ve
38:01 already explained to you with
38:03 the Migraine Pharmacy Network,
38:04 what we do, we do the actual
38:06 medication review, but we also
38:07 do a self-care plan, and in the
38:10 self-care plan, diet is a big
38:11 portion of that, hydration,
38:13 making sure you’re hydrated.
38:15 Not only with water but even
38:17 the electrolytes. Uh your diet
38:19 do not skip meals. Never skip
38:22 meals. It’s not a good idea for
38:23 someone living with migraine to
38:24 skip meals because that will
38:26 cause all these fluctuations in
38:27 blood sugar. And then we know
38:30 that research is coming back
38:32 and saying keto diet and that’s
38:34 higher protein diet. High
38:36 protein, low sugar. Uh people
38:38 who tend to start this diet.
38:41 They do see an improve in their
38:44 symptoms or in the way that
38:45 they are able to manage their
38:46 migraine headaches. Um but the
38:50 the question I have for you
38:51 around diet we also see all
38:54 these health products that say
38:58 you know this is proved to make
39:00 you smart and improve your
39:02 condition and and and that is
39:05 one of these questions that
39:07 like all of us want to buy
39:09 these that make me super smart
39:10 and focused. What what do you
39:14 think of that? Know that you
39:16 know that’s been a a great
39:17 question that’s been following
39:19 along in the field, especially
39:20 down the aging care continuum.
39:22 We had a couple supplement
39:24 companies
39:29 our product, it was the way
39:31 they marketed. So, they made
39:33 big claims that you can have
39:35 gains in your memory, in your
39:36 energy, and then, there’s no
39:37 studies, there’s no
39:39 populations. They’re not
39:40 regulated the same as our
39:41 pharmaceutical and so that got
39:43 them into a lot of trouble. So,
39:45 I’d like to say, if something
39:47 sounds too good to be true, it
39:49 likely is and if you start
39:51 poking around, you’ll see all
39:52 these big disclaimers and
39:54 things but there’s a lot of
39:55 what can do through our diet,
39:58 through, through nutrition,
40:00 through supplements with our
40:02 healthcare providers. I think
40:03 there’s some common ones many
40:04 people with migraine disease
40:05 may already be on but to work
40:08 individually with your provider
40:09 as well as your pharmacist is a
40:11 great resource to find the
40:13 supplements that you may need
40:14 that can help support your care
40:16 and you know, you can spend a
40:18 lot of money on supplements and
40:20 it doesn’t mean it’s not
40:21 going to fix a bad diet. It’s
40:22 kind of like that balance of,
40:24 you may need because you’re low
40:27 on certain vitamin deficiencies
40:29 and those things were a big one
40:30 in our community and even for
40:32 the brain tends to be
40:33 magnesium. Yeah. So, that
40:34 supplement plays a role but
40:36 it’s still not negating the
40:37 fact you don’t want to consume
40:39 magnesium-rich foods or foods
40:41 with healthy fats for yourself.
40:43 So, I hope that can be helpful.
40:46 Unfortunately, I haven’t seen
40:47 enough research or really even
40:49 at conferences, heard people
40:50 talk about one end all be all
40:53 supplement, especially under
40:55 the brain health one. They’ve
40:56 made a lot of claims and they
40:57 got in a lot of trouble for not
41:00 having the research behind
41:00 those points it plays. But
41:04 you’ll still see them on Amazon
41:05 and you can buy them for 90 to
41:06 1 20 a bottle. So at some point
41:09 we’ll regulate how. I guess we
41:11 share those out with people.
41:13 Like we can hope. Well the the
41:17 other thing as a pharmacist we
41:18 see is a lot of these just
41:20 because they’re natural or say
41:22 herbal or say whatever. Um they
41:25 do interact with your
41:26 medications that are
41:27 prescribed. So just because
41:28 they’re on the shelf it doesn’t
41:30 mean that you they will not
41:32 interact with something that
41:33 you’re already taking. Um some
41:35 of cause bleeding disorders or
41:38 cause stomach problems or
41:40 interact, make your medication
41:43 more concentrated or less
41:44 concentrated like build up in
41:46 your, in your body, or actually
41:47 not work, and always, always,
41:50 we, it, the easiest thing you
41:53 can do is just go to the
41:54 pharmacist and say, hey, I
41:55 want to buy this, can you look
41:55 at my profile? And, and tell me
41:57 if this actually interacts with
42:00 any of my medications, and it’s
42:02 a free service. So, please
42:04 leverage it, go to your
42:06 pharmacist, build that
42:07 relationship, and we like to
42:08 know this, like, me, myself,
42:10 every time someone asks me
42:11 about an interaction in the
42:13 pharmacy and I found out
42:15 something new. It meant that I
42:16 can help more people. So, it’s
42:18 a win-win. You will get to get
42:20 individualized and personalized
42:22 information about a supplement
42:24 but also your pharmacist is
42:26 going to learn something new.
42:27 So, go ahead and and ask the
42:29 pharmacist. Um I’m going to go
42:31 back. Thank you. I’m just glad
42:34 you shared that because a lot
42:35 of the times, it’s really hard.
42:38 The brochure you get for a
42:39 medication, the font’s so small
42:40 and there’s all these things
42:41 for some medications, there are
42:43 nuances for, for when for there
42:45 to be administered, what you
42:46 want to take or not take when
42:47 you’re with them, like food,
42:49 even certain beverages, and
42:51 your pharmacist is a great
42:52 resource to that, as well as
42:54 the health care provider,
42:55 sometimes prescribing it, but
42:57 usually a pharmacy tends to get
42:58 like the first calls when
42:59 something like that tapping or
43:01 what you need to know, and so,
43:03 it is great, I’m not sure that
43:04 all the time, we read through
43:06 all those pamphlets we get when
43:07 we’re prescribed, a medication,
43:09 we have the general but it’s
43:11 very tough to get through.
43:13 They’re very dense and it’s
43:14 very easy to overlook something
43:16 small but still can have an
43:18 impact of like some of them I
43:19 know with juices especially
43:21 grapefruit juice. It doesn’t
43:22 work well to take with them but
43:23 if that’s part of your
43:25 day-to-day routine, you
43:25 wouldn’t be aware. So, to ask
43:27 those questions and tap into
43:28 the valuable resources we have
43:30 available to us. Um I think
43:34 another question that I saw on
43:36 Facebook was around menopause,
43:40 migraine, cognition, where
43:42 already you know, you we we are
43:46 seeing more and more brain fog
43:50 and when when menopause is
43:52 added to that, a lot of the
43:54 women in the community ask,
43:55 well, what can I do? What can I
43:58 do with this extra Um burden.
44:01 I’m going to say of having to
44:03 deal with all these changes
44:05 that not only affect your body
44:07 but also affect your brain.
44:08 What do you think? Yeah I you
44:11 know I recommend Lisa. I’m
44:13 going to say her name wrong.
44:14 Doctor Lisa Mascotti’s book The
44:16 XX Brain. Because she takes the
44:19 deep dive into the female brain
44:21 and she can it’s much more
44:23 knowledgeable even her Ted Talk
44:24 in comparison to what I can
44:26 share. Yeah. But from what I do
44:27 know is we’re still trying to
44:30 understand the sex based
44:32 differences of the brain. And
44:33 we know there’s pivotal time
44:35 points like menopause where it
44:36 looks different for women and
44:39 we already know we are
44:40 disproportionately impacted as
44:42 women with migraine disease,
44:44 with multiple sclerosis, with
44:46 other brain-based diseases,
44:47 even dementia. Two out of three
44:49 are women being diagnosed. So,
44:52 we’re really starting to
44:53 understand what we know. The
44:55 limits and data that we had as
44:57 well before women were even
44:58 included in research or that we
45:00 even looked of, are there
45:02 differences between males and
45:04 females? And so, we’re, I’d
45:05 like to say there’s some great
45:07 brain initiatives that are
45:09 really digging deep into those
45:11 questions with those
45:11 researchers but I recommend her
45:13 book and website or her Ted
45:15 Talk because she’s really
45:17 started to take the dive in
45:18 that as well as Doctor Sarah
45:20 Mackay out of Australia. They
45:23 they have published the two
45:24 most recent books on women in
45:26 brain health and a lot of it
45:28 does come around our child
45:29 rearing years. Into menopause
45:31 and then even post menopause
45:33 because trajectories for, you
45:35 know, migraine, headache, and
45:36 frequency can different at
45:38 those times but also they
45:39 really dive deep on the role
45:41 that hormones can play or the
45:43 limits of what we know about
45:44 hormones. Cuz I’m sure we hear
45:46 a lot about that of, that’s
45:47 usually the first thing they
45:48 say, if you’re a female, oh,
45:50 it’s your hormones, but there’s
45:51 still a lot more to that story,
45:53 and they have great knowledge
45:55 bases and resources to find
45:56 that out. So, but if, if you
45:59 were going to give us one
46:01 advice, that helps with brain
46:05 fog. Is there, does exist even
46:08 that one advice, one thing that
46:10 that I can do to cope with
46:14 brain fog and possibly I’m not
46:18 going to say get rid of it, but
46:20 at least manage it a little bit
46:22 better, yeah, I think if I had
46:25 to pick one, it’s hard, because
46:26 so many of these factors become
46:29 interconnected. I would say to
46:30 work on sleep. Sleep is a basic
46:33 foundation of our health, and I
46:35 don’t want to be discredited,
46:38 for many of us, it’s impacted
46:40 when we’re living with migraine
46:42 disease or headache disorders
46:43 but it can be a very strong
46:45 root to to help our brain
46:48 reset. We clear out all of the
46:49 waste of the day. We
46:51 consolidate our memories and
46:53 we’re still at the infancy of
46:54 understanding all the things
46:56 that sleep does for our brain
46:57 and our body but we know it
47:00 does a lot and and in terms of
47:01 it, consolidating our memories,
47:03 cleaning out the waste of the
47:04 day. Those are really big
47:06 priorities when we’re thinking
47:08 about brain fog because it’s
47:09 helping our brain just even be
47:10 set up to be to perform some of
47:14 those cognitive functions that
47:15 we’re wanting to do like, pay,
47:18 pay focus to something, or
47:20 really not try to divide our
47:22 attention, but just those
47:23 higher outputs we’re asking,
47:25 sleep let’s us kind of get to
47:26 that solid baseline that we can
47:28 build from. I had to pick one.
47:31 That’s what I would say. I, I,
47:34 I know that one of the things
47:35 that you do, you do a lot of
47:36 advocacy around brain health
47:39 and cognition and people living
47:40 with dementia. So, if it, like,
47:43 in case of migraine. We find
47:46 that people living with
47:48 migraine have to advocate for
47:49 themselves a lot. Especially
47:54 when it comes to their
47:54 performance if they have to
47:56 work or you know to to to
47:58 people around them. How how do
48:01 they do this? How do you how do
48:02 you explain that you know my
48:05 brain function changes in the
48:08 middle of of a headache or a
48:11 migraine attack. How do you
48:13 advocate for yourself if if if
48:16 you have to talk to someone
48:17 about this, what do you think
48:19 is the best way to advocate?
48:21 Yeah, I have to honor. It’s,
48:24 it’s for many of us, it’s
48:25 probably a stressful and
48:27 difficult conversation ‘cuz
48:29 we’re thinking about how to
48:30 word it. If you’re in the
48:32 workplace, there’s some great
48:33 initiatives to help support
48:34 that, but we have some laws
48:36 that are a little vague, at
48:38 least in the US, where you’re,
48:39 you have to be an employee
48:41 somewhere before you can do the
48:42 FMLA and have leave. So, if you
48:45 have status migraine, you have
48:47 leave in your job secure. Um,
48:48 under we can get some
48:51 accommodations and I could say,
48:53 I worked with my neurologist
48:54 because at first, I thought, I
48:57 want to do well. I want to do
48:58 well at my job. I want to
49:00 thrive but if I’m under
49:01 fluorescent lighting, I cannot
49:03 do well. I can start in that
49:05 morning and by 10 AM, I am
49:07 sick. And so, I had to work
49:09 with my neurologist who was a
49:10 great resource to help me
49:12 articulate what are some small
49:13 practical things that I could
49:15 do and I could say, they came
49:16 back with this whole list of
49:17 like, well, this is very
49:19 reasonable so that I could have
49:21 that conversation with my
49:22 workplace or to have that in
49:24 what we find in general is most
49:28 of the things we’re asking for
49:28 are very low cost. The benefits
49:32 most people because whether you
49:34 have migraine or not,
49:36 fluorescent lighting can be
49:37 draining on what it is you’re
49:38 trying to do. There’s certain
49:41 filters and maybe being in a
49:43 more quiet work space or an
49:44 environment. but at the same
49:46 time, employers in theory want
49:48 you to thrive and so when they
49:50 can set up those environments.
49:52 But I would say initially, I
49:53 wasn’t sure I was asking for
49:55 and then as I worked with my
49:57 neurologist and they helped
49:59 give me some suggestions, then,
50:00 I knew more of the the tangible
50:02 items, and I was also more
50:04 informed on what are my rights,
50:06 what are my rights as someone
50:08 living with a disability, who
50:09 wants to be a contributing
50:11 member of the workplace, or I’m
50:13 at this point where I can still
50:14 contribute to the workplace.
50:16 What are my rights so that I
50:17 can be set up for success, just
50:19 like anyone else with some
50:20 other type of disability that,
50:22 whether you can see or not,
50:25 minimal things can still let
50:26 people product, be productive,
50:28 and thrive to the best of their
50:30 abilities. So, I I’d like to
50:31 honor that that’s a very
50:33 difficult and challenging
50:34 situation but if you work with
50:36 your health care provider,
50:38 they’ve likely helped a lot of
50:39 other people navigate this,
50:42 they have the resources. they
50:43 have the paperwork, and they’ll
50:45 support you in the
50:46 documentation with your request
50:48 too. Um I I think I have one
50:51 more question. We’re we’re
50:53 almost we have 10 minutes or
50:55 less than 10 minutes to go. So
50:57 I’m just going to post this one
50:59 where I’m seeing this in my own
51:02 practice where a lot of people
51:04 are coming back and saying
51:05 COVID and my cognition. So
51:08 COVID migraine plus COVID plus
51:13 migraine and cognitive health
51:15 or brain health. What do you
51:17 think? Are there any studies?
51:18 Is there anything coming up? Or
51:19 coming out on on on this? I
51:24 think that’s a great question.
51:25 I could say in my initial
51:26 search, I didn’t see anything.
51:28 Does it mean they’re not coming
51:30 or or coming through the
51:30 process but I know from myself,
51:32 I recently completed the
51:34 American Migraine Foundation
51:36 Advocacy Training Program. So,
51:38 working with other people or
51:40 providers in this migraine
51:41 space and realized there were
51:43 some commonalities. Many people
51:44 who lived with migraine disease
51:45 who had COVID. It kind of
51:48 rocked the boat for them and
51:49 the night is the nicest way I
51:50 could say it. It changed a lot
51:52 of things that was their normal
51:54 routine or their maintenance
51:55 plan. A lot of people, whatever
51:57 medications they were on on the
51:59 prevention and abortive side
52:00 were no longer working. So, it
52:02 was like back to the drawing
52:04 board again of what I could do
52:06 and it’s this flip side too as
52:08 well as I I believe from my
52:10 experiences in the long Covid
52:11 space is those are
52:13 conversations people are really
52:15 hesitant to have as well as
52:17 providers to say, is it long
52:19 COVID or is it not long COVID?
52:21 The criteria isn’t as cut and
52:24 dry but we’re able to
52:25 articulate things that look
52:27 different and what I’ve seen
52:29 with kind of a wide variety of
52:31 symptoms with long COVID. Um
52:33 headaches do come on board but
52:34 it tends to be a different type
52:36 of headache. I haven’t heard in
52:38 the chat so much about it being
52:39 related to migraine onset or
52:41 anything for people who didn’t
52:43 necessarily have it before.
52:45 Doesn’t mean it’s not out
52:46 there. But headaches is usually
52:47 one of those leading factors
52:49 along with fatigue and brain
52:51 fog. And so if you were living
52:53 with a brain based condition or
52:55 disease that you were managing
52:57 as well as people autoimmun who
52:59 went through COVID, the, the
53:02 presentation of your disease or
53:02 condition afterwards, may have
53:05 been altered, and that’s what
53:06 we’re seeing through different
53:07 patient population groups, at
53:09 least, you know, people talking
53:10 to one another, and learning
53:12 that. So, I’m not sure how long
53:13 it will take for our research
53:15 to really reflect that,
53:17 considering, the whole bigger
53:19 picture, our systems are
53:21 reluctant to point out how big
53:23 the long COVID issue is, and
53:25 how long it will be around.
53:27 It’s not going to go way. It’s
53:29 our brain but there’s a lot of
53:31 things we can change and do to
53:32 nurture it. But it is what are
53:34 those recommendations? What’s
53:36 the dose of those
53:37 recommendations? And a lot of
53:39 it is lifestyle. Uh but what
53:41 are those changes and how can
53:42 we support people along that
53:43 way?
53:47 I I think when we started
53:48 talking me and you, one of the
53:51 things I, I explained is how
53:53 fascinated I am with that years
53:55 ago, when I went to school,
53:57 they told us, once you lose
53:59 your brain cell, you, it,
54:02 that’s the only cell that does
54:03 not grow back, like you don’t
54:04 get new ones, you’re born with
54:06 a certain number, and that
54:08 certain number actually
54:11 depletes and you don’t get new
54:12 ones, and then a few years ago,
54:14 I was very happily surprised
54:18 when all the research was
54:18 saying, no, no, no, you can
54:20 have new cells, but most
54:22 important is the, the, the new
54:25 pathways that you can actually
54:27 between existing cells. So,
54:29 even if we’re not building as
54:31 many as we have lost, or are we
54:33 not producing as many new brain
54:36 cells as the ones we’ve lost,
54:36 we are able to utilise the ones
54:39 we have a little bit better by
54:41 building you know, neuronal
54:43 pass ways that help us overcome
54:47 our brain aging or our brain
54:49 our cognitive decline that
54:52 comes with aging or that comes
54:53 with significant trauma or that
54:57 that comes with different
54:59 things. What do you think about
55:00 this? What what what is your
55:02 take on on on this? I think
55:05 it’s been one of the more
55:06 exciting things to learn is you
55:09 know we’re not necessarily
55:10 stuck with the brains we have.
55:12 And through and lifestyle, the
55:15 way we’re living, activities
55:16 we’re seeking out, how we’re
55:18 spending our leisure time, we
55:20 get to mold and sculpt our
55:22 brains to an extent. So, much
55:23 like you said, you can grow the
55:24 new neurons. We’re working with
55:26 those pathways but you know,
55:28 meditation does that. Exercise,
55:29 physical movement does that.
55:31 The mental stimulation does and
55:33 so, it’s linking how I’m
55:35 spending my time in this
55:37 activity. What it’s doing to my
55:38 brain and then, how is that
55:40 linking to my overall health
55:42 and it’s very exciting. I like
55:44 to say it’s not necessarily a
55:45 perfect science because you’ll
55:47 see people who are very healthy
55:49 still end up with some
55:50 brain-based diseases or even
55:52 dementia but it presents a
55:53 little differently because they
55:55 built up what we call is that
55:57 cognitive reserve. So, that
55:58 bank where you buffer your
56:01 decline because you built up
56:03 more neurons, more neural
56:04 pathways. So, you’re able to
56:06 how do I want to say, kind of
56:09 work around things where that
56:10 pathway may have went around
56:11 and still access that in
56:14 information or still perform
56:15 that task. Whatever that
56:17 neuropathway was for. And so I
56:19 think the idea and the notion
56:20 of cognitive reserve is
56:21 exciting. It’s always potter of
56:23 our our conversation with brain
56:25 health. But what really for me
56:27 I take away is the way we’re
56:29 spending our time with those
56:31 activities. So their studies
56:33 even of people in their 90s
56:35 living with dementia can grow
56:37 new neurons in the area of
56:39 their brain commonly associated
56:41 with memory. The hippocampus.
56:43 through meditation. A few weeks
56:45 of meditation 12 minutes a day.
56:48 So, we’re starting to see how
56:49 these lifestyle effects, the
56:51 dose that we have, and it’s not
56:53 limited to whether we have a
56:55 quote, unquote, normal, healthy
56:57 aging brain, or even if we’re
57:00 experienced deterioration, we
57:01 can still have that new
57:02 neuronal growth, and we can
57:04 still have that impact of how
57:06 we’re spending our time to help
57:08 support our optimal health and
57:10 our well-being.
57:13 that exampl
57:13 e because it’s we
57:15 think when we’re so far along
57:16 that there’s nothing that we
57:18 could still do or control but
57:20 those healthy lifestyle
57:22 factors, the way we’re spending
57:22 our time, the food we’re
57:24 eating, are all an investment
57:26 and it it will have an impact,
57:28 and it would look different. If
57:30 we were eating a lot of fast
57:31 food, it’s going to look a lot
57:33 different. Our overall health
57:34 than when we’re trying to eat
57:36 less processed foods, eat more
57:38 plants and vegetables. You
57:40 know, the plant slant, those
57:42 types of things. It’s, we’re
57:43 going to see these all gains
57:45 although it it’s hard to
57:46 quantify because it’s not this
57:48 huge gain that you see
57:50 immediately. It’s it’s the
57:50 slower gradual pace but I hope
57:53 that will encourage people to
57:54 continue with just one thing a
57:57 day that you can do better for
57:58 for your brain health or your
58:00 migraine health and for me,
58:02 there’s days after having all
58:03 the nausea from a migraine
58:05 attack. It’s I need to hydrate.
58:07 So, I need the extra
58:09 electrolytes and to hydrate and
58:10 that’s my one thing that day
58:11 because probably exerci isn’t
58:13 it going to be high on the
58:15 priority list and that’s just
58:16 having to listen to my mind and
58:17 body and and honor that. But
58:20 just think what’s that one
58:21 small tangible thing you can do
58:24 each day or trade off that
58:25 supports your brain health and
58:26 your migraine health. And
58:27 there’s probably a lot of
58:28 little insights in there that
58:29 you can try but it is
58:31 achievable. And and I think we
58:35 have one minute to go. If you
58:38 wanted to give us one advice
58:41 going forward. Uh in our
58:44 journey with migraine and
58:45 people living with migraine. Uh
58:48 in the journey. How what would
58:51 that be? What is that one
58:52 advice? Again, I I like the
58:55 principle of one that you’ve
58:56 just said. What would be your
58:58 advice to people who want to
59:01 have better brain health and
59:03 better cognition living with
59:04 migraine? Yes, I appreciate you
59:07 asking that question. I jumped
59:08 ahead with the one thing a day
59:10 but also honoring of what
59:12 you’re doing for your migraine
59:14 health. For us and our
59:16 community, what we’re managing,
59:17 what we’re living with, the
59:20 decisions we’re making or or
59:21 looking to kind of be a
59:22 detective and understand.
59:24 That’s a role in our brain
59:26 health. So, they’re very
59:28 interconnected. And so we can
59:28 see when we make small gains or
59:31 even a change in one or the
59:32 other. Where I like to say
59:34 we’re we’re supporting the
59:35 Bright Health and Migraine
59:37 Health. So what we’re doing
59:38 that it’s for our own optimal
59:39 health and well being. And
59:40 we’re going to see those gains.
59:42 Maybe not as immediately but we
59:44 know like you can think about
59:46 dehydration. You can start
59:48 feeling that in your mouth or
59:51 your throat. And by the time
59:51 you’re already thirsty you’re
59:52 usually about 2 percent
59:55 dehydrated. So, thinking about
59:57 ways where you’re hearing these
59:58 signals, how you can tie that
59:59 in to your optimal health and
01:00:01 well-being and so, knowing it
01:00:03 all is going to support your
01:00:05 migraine plan, your life with
01:00:07 migraine, as well as your
01:00:08 migraine management. Thank you
01:00:11 very much. I know I asked you
01:00:13 this yesterday because I said,
01:00:16 how can I find out more if I
01:00:17 want to take full advantage of
01:00:20 this expertise and of what you
01:00:22 do for people you know to
01:00:25 maintain their, their, brain
01:00:28 health. I know you told me that
01:00:30 you, your, the virtual brain,
01:00:35 centre that you that you work
01:00:37 with actually offers a lot of
01:00:39 free resources to people who
01:00:42 would like to take care of
01:00:44 their brain. Is can you just
01:00:46 tell us a little bit more? And
01:00:49 where can people find you?
01:00:50 Yeah, luckily we try to be
01:00:53 simple. It’s virtual brain
01:00:54 health center. com. And we have
01:00:57 information on a wide variety
01:00:59 of brain health topics. The
01:01:01 infographics that I shared as
01:01:02 part of the slide we have
01:01:04 available to download. So it’s
01:01:06 kind of a one page tool that
01:01:07 can summarize brain health for
01:01:09 you or your action steps and if
01:01:12 there’s nothing available on
01:01:13 there that you can email us,
01:01:14 I’ll be sure to get you
01:01:16 anything that we saw this
01:01:17 evening and the Email’s info at
01:01:20 Virtual Brain Health Center.
01:01:22 com but we are we aim to be a
01:01:24 resource around brain health
01:01:25 and wellness and if you have
01:01:27 questions, our goal is to get
01:01:28 you the resource that will be
01:01:30 the most supportive to you in
01:01:31 that time and so we do offer
01:01:33 that available as well. Thank
01:01:35 you very much. Thank you
01:01:37 Everybody for joining us
01:01:39 tonight. Um it has been a
01:01:41 pleasure to have Doctor Crystal
01:01:43 Khaler come and talk to us
01:01:44 about brain health and
01:01:46 cognition. Um it’s it’s it’s
01:01:49 always a pleasure to listen to
01:01:51 all these ideas that that might
01:01:55 change our lives. Uh small
01:01:57 small changes that we can we
01:01:59 can embrace in our lives that
01:02:01 will have an impact. Uh this is
01:02:03 not only for people living with
01:02:05 migraine. Uh but thank you my
01:02:08 Canada for giving us the
01:02:10 opportunity to talk today and
01:02:12 to to share this information
01:02:14 with people living with
01:02:15 migraine not only in Canada. I
01:02:17 know we have had some I’ve I
01:02:20 can see that we are
01:02:22 broadcasting to a few platforms
01:02:24 and I see that we have people
01:02:26 joining us from other places.
01:02:28 Thank you very much. And I hope
01:02:30 to see you after the new year.
01:02:33 Uh happy holidays. I hope that
01:02:35 you have a a good time with
01:02:36 your family loved ones. And I
01:02:39 will see you next year where we
01:02:40 will continue the ask your
01:02:42 pharmacist. Again Doctor Kala
01:02:44 thank you very much for your
01:02:46 time. It’s been a pleasure
01:02:46 having you here tonight. Yep.
01:02:49 Thank you so much and thank you
01:02:51 everyone who tuned in with the
01:02:52 great questions and for their
01:02:53 gift of presents to talk about
01:02:56 brain health and migraine
01:02:57 health. I hope you can feel
01:02:58 empowered to to use this
01:03:00 information in your day to day.
01:03:01 Thank you very much. Thank you.
01:03:04 Yes thank you.