- Good morning, and welcome to Access Health.
We've all heard the expression an ounce of prevention
is worth a pound of cure.
For the 38 million Americans who suffer from migraines,
prevention may be exactly the solution
they've been hoping for.
Also, my husband and I take on the health
and ancestry service from 23andMe
to find out what our genes might be telling us.
All this, coming right up, stay with us.
(bubbly music) ∫ Access Health ∫
Often described as one of the most debilitating conditions,
migraines affect more than 39 million Americans.
In fact, the World Health Organization
considers them to be one of the most disabling
medical illnesses worldwide.
With symptoms ranging from vision changes to vomiting,
migraines often leave 90% of sufferers unable to work
or function normally during the attack.
The focus of the treatments in the past
was on pain relief and targeting the symptoms
once the migraine has already begun.
The good news is that there are migraine treatments
designed to reduce the frequency of migraine attacks.
Seeking to better understand the condition
and uncover more about innovations
in migraine prevention, Access Health traveled
to Thomas Jefferson University Hospital in Philadelphia
to meet with Dr. Stephen Silberstein,
professor of neurology and director
of the Jefferson Headache Center.
- Migraine is an extraordinarily common disorder.
It's estimated about 12 percent of the population
of the United States has migraine,
39 to 40 million Americans.
Migraine is a disabling headache that comes and goes.
It's often one sided, throbbing, and aggravated if
you move around.
Migraine is associated with sensitivity to light,
sound, and odors.
It's often associated with nausea and even vomiting.
If you have a headache that disables you,
more than likely, it's migraine.
- [Ereka] Dr. Stephanie Nahas, director
of the Headache Medicine Fellowship Program,
sees countless patients every year
who are seeking diagnosis and treatment for their migraines.
Dr. Nahas explains the complexities of the condition.
- We take a multidisciplinary approach
at the Jefferson Headache Center because we recognize
how complex migraine is.
It's not just a headache.
It's also not just the other symptoms
like nausea, light and sound sensitivity,
neck pain, et cetera.
It's how the attacks affect that person's day
to day existence.
Even when they're not in the throes of an attack,
migraine is still there in the background,
looming, waiting to emerge, and to cause a problem.
- The characteristics of migraine
are the fact it impacts your life.
Migraine affects the entire life of the person, their
job, and their family.
- [Ereka] Many people don't understand
how debilitating a migraine can be.
Nikkie knows this all too well.
- Describing a migraine is really difficult.
The pain is overwhelming.
It's so intense, it's like the heaviest boulder
is sitting on top of my head.
My neck is really stiff, I see spots,
it's like someone's poking me in the eye.
You just want to curl up in a ball and just sit
in the darkest, most soundproof room
and just wait for it to pass.
There's really nothing you can do.
Living with this pain for years just,
slowly became my new normal.
I would take an over the counter pain reliever
and just try to go about my life.
- [Ereka] There are millions of people just like Nikkie
who have resigned themselves to thinking
that migraine is just a fact of life.
- Migraine is a serious disease, but it should never be something
that a person just settles with its existence,
and learns to live with and trudge on.
It can be managed.
Getting an accurate diagnosis is perhaps the
most important step in all of headache management,
and when it comes to headache, it hinges upon the history,
and what we mean by that is a detailed description
of the symptoms, and the pattern of when
these symptoms occur.
Migraine is characterized by recurrent attacks,
and these attacks we typically conceptualize
as having four phases.
The first phase, or the prodrome,
is before the attack even really gets going,
and this can be hours to days beforehand,
of changes in the way that person feels.
Certain cravings for food, thirst, urinating to excess,
being sleepy or being energetic, mood changes, et cetera.
The next phase could be the aura phase,
which doesn't occur in everybody,
but about 30 percent of patients with migraine.
And these are neurologic symptoms
that gradually appear, spread, hit a peak, and then fade away.
The third phase tends to come as those symptoms are peaking
or fading away, and that's the headache phase.
When the headache phase is complete, after hours to days,
we have the final phase, or the postdrome.
Some call it the migraine hangover,
where although the pain and other symptoms are largely gone,
that person still just doesn't feel quite right.
- I believe there are two or three
real triggers of migraine.
Not eating, not getting adequate sleep,
MSG, and withdrawal from caffeine.
Most of the things that we think are triggers, are not.
If you go out and eat a box of chocolate,
and get a migraine headache, well, the chocolate
gave me a headache.
No, the migraine gave you the desire to eat chocolate,
and the reason that is is, the day before a migraine attack,
you'd have food cravings, neck pain, not feeling right.
That is part of the migraine attack.
- Triggers can be tricky, because most triggers aren't
like an on and off switch.
They're more like dials on the stereo,
where you have to turn up the volume to a certain degree
before it will trigger an attack,
and sometimes, you might need two
or three triggers in play at once.
For example, the menstrual cycle is often something
that serves as a trigger, but not every woman
gets a migraine attack with every menstrual cycle.
It might only be if they have their menstrual cycle
and they're stressed out, or dehydrated,
or the weather is bad, so I tell patients, try
not to focus too much on identifying triggers.
Go with the obvious ones, and either avoid
or mitigate those.
- The goal of treating migraine is to prevent you
from having attacks and to treat an attack
when you get it.
What's important is what the patient wants,
desires, and gets.
(bubbly music)
(bubbly music) - I decided to see
a doctor because I was having more
days of pain than not, and it was just
becoming exhausting.
The treatment he chose to go with was an abortive,
which is something you take at the onset of a migraine.
I found it hard to recognize the onset of migraine
because I felt like I always had one,
so the abortive medication just wasn't enough.
I was getting pretty discouraged just because I felt
like I was chasing after something that
was never gonna happen.
My doctor did recommend a treatment called Topamax.
It's taken daily to prevent migraines from occurring.
I did find Topamax to be beneficial,
however, I did experience some side effects
from the medication.
I had tingling in my fingers, I was exhausted
and I had occasionally a hard time concentrating.
After years searching for answers,
I was just really frustrated and ready to give up
and just quit.
- We have a lot of options when it comes
to migraine prevention, and in selecting a treatment
for a particular person, we have to consider
a number of factors, and one of the most important
is how well that treatment works.
Topiramate has high level evidence
and comes with a level A recommendation
from the American Headache Society
and American Academy of Neurology
for the prevention of migraine, and for that reason, it's
often one of our first choices.
Based on the last decade of research,
the first line preventive treatment
is the prescription of medicine such as topiramate.
Trokendi XR is an extended release version of topiramate
available by prescription.
Topamax is an immediate release version of topiramate,
a medicine that has been on the market for two decades,
and is approved by the FDA for migraine prevention
in adults and adolescents.
Trokendi XR is a true once daily migraine prevention.
Trokendi XR provides steady, 24 hour migraine
prevention coverage, with slow rate of rise and low
peak to trough fluctuation.
- Patients taking topiramate immediate release twice a day
can easily convert Trokendi XR once a day.
- My doctor recommended that I switch
over to extended release Trokendi XR,
which is similar to topiramate, which I was already taking.
What appealed to me about Trokendi XR
was the fact that just one pill a day
would provide 24 hours of coverage.
We discussed the possible risks, which are similar to Topamax,
and we decided to give it a try.
I've been pleased with how Trokendi XR
has been working for me.
The frequency of my migraines have been reduced.
The regimen is simple and straightforward.
It's one pill a day.
I make mine part of my routine.
I take it at the same time every day.
Even though the medication is working for me,
I still do get migraines, just not as frequently.
Now, I do have pain free days, which I'm really excited about.
I still experience some side effects
from extended release Trokendi XR,
but for me, they're manageable.
Of course, this is just my experience
and others could have a different outcome.
- [Announcer] Do not take Trokendi XR
if you have recently consumed or plan to consume alcohol,
i.e. within six hours prior to and six hours after
Trokendi XR use.
Swallow Trokendi XR capsules whole.
Do not sprinkle on food, chew, or crush.
Trokendi XR can cause serious side effects,
including eye problems.
Serious eye problems include sudden decrease in vision
with or without eye pain or redness,
a blockage of fluid that may cause increased pressure
in the eye, secondary angle closure glaucoma.
Call your provider right away if you have new eye symptoms,
including any new problems with your vision.
The most common side effects include tingling
of the arms and legs, paresthesia,
not feeling hungry, nausea, weight loss,
abnormal vision, a change in the way foods taste,
nervousness, speech problems, dizziness,
slow reactions, upper respiratory tract infection,
sleepiness, diarrhea, pain in abdomen,
and difficulty with memory.
- I think more than anything else,
we tell them, we give you hope.
- What I do every day and what really gives me joy
is to see when patients are getting better.
When they come in and tell me that I've given them hope,
this is why we're in this game.
This is why we do this.
- [Announcer] Talk to your doctor today
to see if Trokendi XR may be right for you,
and please stay tuned for important safety information.
For more on the migraine prevention therapy
discussed here today, visit TrokendiXR.com
and as always, you can go to our website at AccessHealth.tv.
(upbeat music) (bubbly music)
(bubbly music) (moderate rock music)
- Hi, everybody, I'm Ereka Vetrini,
and if there are two things that I am passionate about,
it's my family and my health.
I love my Italian heritage and I embrace it
by cooking homemade meals for my family,
and I do as much as I can to maintain my
strength and energy.
But I was curious, was there something more
I could do to understand who I am and how my body works?
Am I more than just Italian?
I heard about these DNA kits, ones that can tell us
about heritage and our health, so my husband and I
took a 23andMe health and ancestry test.
I mean, I'm pretty sure I know where I'm from.
Italian.
But I have no idea what my husband's ancestry is.
I don't think he knows, either.
The other portion is that at 23andMe,
they have a ton of health and wellness reports
which I think is super important when you're building
a family, so, we're making this
family together, I think we could use
all of this information just to make smart decisions.
So take a look, though, and see what happened
when Randy and I decided to take the test.
(moderate rock music) I'm here with Randy, my husband,
and we're so excited because, we get to
submit our 23andMe kit, which is pretty exciting.
Didn't you say you've always wanted to do this?
- I did.
Yeah, mostly because, you know, you like to make fun of me that,
saying that I don't know where I come from,
but I think you're gonna be a little surprised
about how wide your lineage is.
- Okay, okay, so this is where it goes.
I'm Italian, my parents, they were born in Italy.
I'm pretty sure I'm 100 percent Italiana, okay?
(laughing) This one, on the other hand.
You have no idea.
- Yours will be Mediterranean and Northern Africa.
You're gonna be, maybe more widespread than I am.
When we got the 23andMe Health and Ancestry,
it couldn't have been easier.
When you open it up, it really lays out very simply
with just a few steps what you need to do
to get them the sample and get started.
- We have to register our kit. (upbeat rock music)
No food or drink for 30 minutes.
- Deal, done.
- I don't trust him.
He's a snacker.
- You might not want to plan that around a meal,
a major meal.
- I was right.
That was hard for us, wasn't it.
A little bit.
Step two was filling up the little vial
with saliva.
(laughing nervously) - Favorite part, into it.
- Just did it.
A little bit, by the way.
- You spit saliva into that?
- And tell everything it needs to from your saliva.
- Sealed it up, we're gonna mail them in,
and they give us a wonderful little package
that goes into the mail, so I'm gonna send this off today,
and soon enough, we will find out
all his awesome information, is that good?
- Fantastic, very.
- I was genuinely curious to know
because your grandfather was adopted,
and we really legitimately don't know what that line was.
- But then also, what's more important now
is kind of the health information
and the health reports that you get,
so I was really intrigued to get those.
Any details like that about your lineage,
I don't have anything.
- The cool thing about 23andMe, is that we learn much more
than just our ancestry, right?
We've got genetic health risk report,
wellness, information about everything
from our coffee consumption to deep sleep, carrier status,
so it shows us if we are carriers
for certain inherited conditions like cystic fibrosis
and sickle cell anemia.
Traits shows us how our DNA influences our facial features.
That's pretty cool!
Eye color, well, he does have the blue.
He has the blue, I have the brown,
and she's got something in between.
- Hazel.
- So fun!
I'm so excited.
There was a lot to learn about 23andMe,
so Access Health traveled to Silicon Valley
to speak to Emily Drabant Conley,
VP of business development, to get some answers.
Take a look.
- 23andMe is a DNA test that can tell you
what your DNA has to say about your health
and your ancestry, and the process of doing it
is very simple, you order a kit, and spit into a tube, and
you send that off to our lab, and we look at hundreds
of thousands of points in your DNA, and we tell you
what that information has to say about your health
and your ancestry.
Genetic information is a really powerful tool
to learn about yourself, and if you do the 23andMe
Health and Ancestry service, not only do you get
information about your genetics of your ancestry, but you can
also learn about your health.
With the 23andMe ancestry reports,
you can learn all kinds of interesting information
about where you're from.
We look at over 150 different geographic regions
and we can link that to your DNA so that you can better
understand your ancestry.
The genetic health risk reports give you information
about diseases that you could be at risk for,
so we actually received authorization from the FDA
to provide this information directly to consumers,
in a way that is easy to understand and actionable.
We had an entire family that did the test.
One of the family members found out
that he carried two copies of a genetic variant
for something called hereditary hemochromatosis.
He had a lot of symptoms in his life,
but he'd never been diagnosed before,
and so, he got the 23andMe result,
and then shared it with his doctor.
They did confirmatory testing and it turns out
that in fact, he did have hemochromatosis
and now he's being treated, and the whole family
has really become aware of this particular condition
and how it could be passed down through the generations.
There's a variety of wellness reports
that are provided through the 23andMe
Health and Ancestry service, and these are reports
that are really about how genetics can
interact with the environment to affect your health.
So, for instance, how do genetics impact
the way that you sleep?
So there's a lot that we can tell you
that's relevant to your wellness that's really
connected to your DNA.
The Carrier Status reports are about diseases
that could be passed on to a child,
so these are hereditary conditions,
things like cystic fibrosis or Tay-Sachs
or sickle cell anemia, and really the only way to
know if you're a carrier and could pass this on,
is through a DNA test.
There's a whole variety of physical traits
that we have that are linked to our DNA,
so for instance, if you're a man,
we can tell you if you're likely to go bald later in life
and then a whole variety of different physical aspects.
Are you likely to have blue eyes or brown eyes?
Curly hair or straight hair?
We believe that knowledge is power
and having access, direct access,
to your genetic information is a really powerful tool
in understanding your ancestry and thinking about your health.
You know, there are a lot of different things,
actions people can take to prevent disease,
but in order to do that, you really have to have
the information first and this is a place where
genetics can really help.
- [Ereka] Coming up, Randy and I get our results.
Stay with us.
(bubbly music)
(bubbly music) - Hey, the results are in.
- No way!
- Yes, check it out.
- Already, that's awesome.
Hmm, who was right?
- What do you mean?
- I was right.
- About what?
- I'm pretty much 100 percent Italian.
- I mean, 78 percent, right?
In school, 78's a C, that's barely passing.
You're barely passing as an Italian.
- [Ereka] What is your breakdown?
You're primarily what?
- French and German, and then it's British and Irish,
and then it's largely Iberian, so,
Spain and Portuguese, I guess.
- Oh, that's crazy.
- Just a very surprising...
- So cool.
- One area that was also really interesting
was the genetic health risk section
because, obviously when you go in,
that's one of the things I went to pretty quickly.
It was good to know I don't have the likelihood
of getting Alzheimer's or Parkinson's.
Again, not knowing my family history that well
and having some blank spots there,
it's good to see that it's not something
likely for me to have.
- [Ereka] The wellness reports were pretty spot on.
- [Randy] They were.
- The sleep one was amazing, it said that I'm likely
to move more than average.
I am likely intolerant to lactose.
My favorite one was that I have the muscle composition
of an elite power athlete, and I was bragging
to you about that.
- Yes, and when that came through,
I knew I was gonna be in big trouble
if I didn't have the exact same thing,
so luckily, I had that as well.
- [Ereka] So traits, there was some good news there.
- [Randy] Very interesting stuff.
- Right, likely, no early hair loss for this gentleman.
- Big relief on that one.
- Carrier Status report is really insightful as well
because while these variants may not affect our health,
they may affect the health of our children.
- The reports included sickle cell and cystic fibrosis,
and a lot of others that we had never even heard of,
so it's important when you have kids
that you know about these things and you plan for them.
- All around, it was just a wonderful experience.
- I agree, and it's good, not just for us,
but for the kids and it's funny because,
now my brother's taking it, my nephew's taking it,
like everybody's, they want to know.
- But also, it's just fun because we,
you know, we get a chance to look internally
but then we also understand sort of the community around us.
I'm so glad we did it.
- Me too.
- Yeah.
- Fine.
- [Ereka] For more information on 23andMe
Health and Ancestry test, go to 23andMe.com
or just log on to AccessHealth.tv.
Thanks for watching, we'll see you next time
on Access Health.
(upbeat music) ∫ Access Health ∫
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