Microsoft word - 104111500.doc
November 13, 2004
Caucus: New Jersey with Steve Adubato: Migraines
Interview: Migraine sufferers and a doctor and psychiatrist from
the Headache Center at UMDNJ share their experiences with
What every migraine sufferer needs to know, next on CAUCUS: NEW JERSEY.
Announcer: Funding for this addition of CAUCUS: NEW JERSEY has been provided
by the University of Medicine & Dentistry of New Jersey, your resource for
life. Research, education, health care, statewide, UMDNJ.
ADUBATO: Welcome to HEALTHY NEW JERSEY, a very special CAUCUS series looking
at critical health issues affecting New Jersey and the nation. I'm Steve
Joining us here to discuss the latest advances in the treatment and prevention
of migraines are Dr. Michael Gallagher, director of the Headache Center at
the University of Medicine & Dentistry of New Jersey; Barbara McPeak, who has
suffered from migraines for 30 years--they started in your 20s; our makeup
artist here at CAUCUS for the past five years, Maryann Muro--she's not here
because she's a great makeup artist but because she has suffered for 15 years
with migraines and has dealt with it with diet and lifestyle and has been
migraine-free, we're happy to say, for two years; and finally Dr. James
Rogers, a psychiatrist at the University of Medicine & Dentistry Headache
Center. I want to thank you all for joining us.
And I want to remind folks that throughout this program we'll be putting up
our HEALTHY NEW JERSEY information. We put up a--throughout this entire
series, our HEALTHY NEW JERSEY series that we're doing in cooperation with the
University of Medicine & Dentistry of New Jersey, we're doing it because we're
trying to raise important health issues that matter to you.
ADUBATO: It's an educational resource guide. Call the number on your screen.
We'll send you a terrific resource guide with valuable free information about
migraines and other issues and also log on to the Web site on your screen.
ADUBATO: Doctor, let me ask you--right before we were on the air, I said,
`Look, I need to disclose the other reason we're having Maryann on the show is
for the past five years while she's been our makeup artist I have talked to
her about my migraines.' I never even knew what the heck they were called.
But I would know that at certain points in time, during a long day of taping,
I literally felt like my head was going to explode. I needed to be in the
dark. I needed to be away from everyone as opposed to under these lights.
ADUBATO: And I finally started to get treated for it two years ago. How many
Dr. R. MICHAEL GALLAGHER (DO; Director, UMDNJ Headache Center): We'll
probably have about 30 million people in the US alone that have migraine and
that's a conservative estimate. I don't think that that's a real inflated
ADUBATO: How often are people--I mean, I wasn't diagnosed until two years
Dr. GALLAGHER: Well, the most people, I would say about half, a little more
than half, have not only never been to a physician, but they also have
undiagnosed migraine. And of the people that do have the diagnosis of
migraine that have sought medical help at some time in their life, most of
those do not follow through. So a lot of the good treatments we have, a lot
of the innovations that have come about in the last couple of years, a lot of
people just aren't taking advantage of it.
ADUBATO: Well, folks, take advantage of it. There's no reason to suffer
unnecessarily. We're not promising that we can cure your migraines but there
are really some wonderful developments in the last few years that we talk
about here. Let me ask, in your case, Barbara, what specifically did you
experience in your 20s and did you know what to call it then?
Ms. BARBARA McPEAK (Migraine Patient): No, I did not. It just was a
Ms. McPEAK: Excuse me. A pain in my head that wouldn't go away. I was
taking over-the-counter medicine until it got to the point where I was almost
getting ready to get sick to my stomach. I was advised to go to see if I
could find a headache clinic, and I did. Very fortunately I found Dr.
Gallagher. We went through several medicines until I had a medicine that
helps me now. If I get the headaches, sometimes I get them in the middle of
Ms. McPEAK: I do say most of it comes from--I can say diet, stress. There
are certain things that I steer away from, like--you say chocolate. That's
ADUBATO: I was telling you, mine is chocolate.
Ms. McPEAK: OK. Chocolate would be one of mine.
Ms. McPEAK: OK. All processed food. Like lunch meat.
Ms. McPEAK: Well, lunch meat and stuff like that, I really don't--I stay away
from that. Seasonings in my sauce that I make. OK? I was devastated to
ADUBATO: Yeah, I hear you're a wonderful cook.
Ms. McPEAK: Well, I'm--I try. I try. But.
Ms. McPEAK: Not really. I just don't take a lot of it, but if I do take it
and I get my headache I can relate right back to where it came from.
ADUBATO: OK, Maryann--and, by the way, you're dealing with it through
ADUBATO: OK, I am as well, I should say. I'll disclose this. I take Imitrex
when it begins to be a problem. Imitrex is a 20 milligram spray. You can
take it with a tablet or a spray. You have to take it very quickly. You put
it in your nostril. You know, two hours later, if it doesn't work, you can do
it again. I also every night--I can't believe I'm disclosing this--Pamelor,
which is actually an antidepressant, but in very low dosage, it's helped me on
this, 20 milligrams a night. It helps to maintain something in my brain that
ADUBATO: OK. And if nothing else works, it's Prednisone. It's a steroid
that I don't like to take and I try to avoid it but I do when I have to.
Ms. MARYANN MURO (Migraine Patient): Right.
ADUBATO: .we've had this discussion. You said, `Huh-uh, not for me. I'm
not going that way.' You went a different way. Talk to us.
ADUBATO: What were you experiencing, first of all?
Ms. MURO: Well, it started about 15 years ago. I was at the grocery store
with my mother and I just--I thought I was dying. Because I had this horrible
pain in my head and then the lights started to bother me and I wanted to
vomit. Well, I did. I ran outside and I started to vomit. And my mom--my
mom had experienced migraines most of her life so she knew, and my brother,
the same thing, so she knew what was going on with me.
Ms. MURO: Yeah. My brother and my mother. Both of them have had migraines.
And so my mother knew. So she knew I wasn't dying and of course I was crying.
I didn't know what was wrong with me and she took me home and she put me in a
bedroom, you know, turned off all the lights and after probably four or five
times of vomiting, about an hour later, it stopped.
ADUBATO: I want to understand something. I've experienced the vomiting issue
a few times, but not often. What is the connection?. By the way, you've
Dr. GALLAGHER: Yes, I get migraines, yeah.
ADUBATO: And we'll go back to that in a second. What is the correlation
between having a migraine and throwing up?
Dr. GALLAGHER: Well, I think that there's a couple things I want to say about
migraines. First of all, migraine is episodic. It generally does not occur
every day for the vast majority of people.
Dr. GALLAGHER: Episodic would mean the headache occurs, the headache goes
away and then you're headache-free for a period of time.
ADUBATO: But, however, Doctor, some people, that episode lasts longer for
Dr. GALLAGHER: It can last several days. But when it's over, it should be
over, the person should be normal again and then experience a headache at
another time. That's what I mean by episodic.
ADUBATO: How far along by--a month, two months, a week?
Dr. GALLAGHER: Oh, it could be once a week. It could be several times a
month. It could be as infrequently as one to two times a year.
Dr. GALLAGHER: Then there are other symptoms that are associated with the
headache and that would be symptoms like nausea or vomiting, because the--what
happens, when the brain starts processing various triggered information, when
the brain starts changing how it's operating, it not only gives you this
headache, but if you notice it gives you a pale feeling, you're pale,
Dr. GALLAGHER: .you don't feel well. It affects almost every part of the
body, including coldness of the hands, coldness of the feet, and a lot of
times people get nausea because the same centers in the brain that control the
blood vessels in the brain, which generally are affected in migraine, also
control the blood vessels in the stomach.
ADUBATO: And by the way your--experiencing of migraines, how long did it
Dr. GALLAGHER: My headaches would last a day or two.
ADUBATO: Because you do what you do, because you're the professional that
you are, was it that much more frustrating for you?
Dr. GALLAGHER: I think it was more frustrating and I think that although I
was a professional, and doing this kind of thing, I fell into many of the same
traps that migraineurs generally fall into. One is waiting too long to treat,
always wondering whether this headache isn't going to be the big one. Maybe
it won't really occur. And the other thing is to find something that's
definitive that's going to help me and it's going to help me most of the time.
Doctor--and you've been doing a lot of research on this. What have you found?
Dr. JAMES ROGERS (DO; Neuropsychiatrist, UMDNJ): Well, the big change was in
the early '90s with the triptan medications like Imitrex.
Dr. ROGERS: Triptan medication like your Imitrex.
Dr. ROGERS: That's the class of drug that came out. That was a huge
ADUBATO: So we didn't know up until that point that they were helpful?
Dr. ROGERS: No. We had what was called ergot medications which were
effective but which had a lot more side effects, especially nausea and
vomiting. And the triptans are cleaner, more of a magic bullet and they help
ADUBATO: OK. What else is--have we found?
Dr. ROGERS: Well, lately the big thing is in the preventative medications.
You're taking a tricyclic antidepressant like Pamelor.
Dr. ROGERS: More and more anti-seizure medications, like Topamax, are coming
out, topiramate, which help in prevention, and these preventative medications
don't have the side effects of weight gain or dry mouth which the older ones
ADUBATO: Is it fair to say that if someone is diagnosed today with migraines
as opposed to 20 years ago--you're smiling.
Ms. McPEAK: Yes, you're going back to me.
ADUBATO: OK. Are they a lot better off having migraines today as opposed to
Dr. GALLAGHER: I would think so. There's absolutely no question about it.
ADUBATO: Well, but listen to what Maryann says. Maryann is saying, `No.
`I'm not going to take the Imitrex. I'm not doing the antidepressant,
ADUBATO: You changed your diet--because we talked about this. You really.
ADUBATO: .describe what you eat and how you live and how you believe that's
had a tremendous impact--you've been migraine-free for two years.
Ms. McPEAK: I only take the medicine when I need it.
ADUBATO: OK. But you don't have migraines as often as you used to?
Ms. McPEAK: No. No. I--they may come once a month. They may come twice a
ADUBATO: OK. You've been migraine-free for two years. Describe your life.
Ms. MURO: Yes. Well, what I decided was I'm getting migraines,
something--there was something wrong with me. I just didn't look at it like
`OK, it's just genetic. There's something going on in my life because I know
my mom and I know my brother and I'--that's right.
Ms. MURO: So--and I--and they're just like me--we're--we just
constantly--we're like machines. We're constantly going and going and going,
just like you. So I had to change something so I started to change my
lifestyle. I said, `OK, I'm not going to work three jobs a day like I've been
ADUBATO: What does that have to do with it?
Ms. MURO: I felt that when I had a lot of dairy, that it would bring on the
migraine. I started writing down actually what I would--like, in other words,
what I had for lunch, what I had for dinner. And if I had migraine, boom,
dairy. Too much dairy. Too many sweets. And it wasn't like I was a big
sweet eater. But still if I had some chocolate, within two hours, here it
ADUBATO: Let's stay on that. I've said chocolate. You've said chocolate.
ADUBATO: What the heck is the connection there?
Dr. ROGERS: Chocolate is a tough one because often prior to the migraine part
of the prodrome, people crave chocolate.
Dr. ROGERS: The prodrome, prior to the actual pain, there's other symptoms.
Dr. ROGERS: One of them can be craving chocolate so you have to track
how--you know, are you craving the chocolate you take and then you get the
headache or at times you feel fine and you have chocolate and take a headache?
ADUBATO: OK, I'm going to tell you something crazy, and you tell me how crazy
it is. Sometimes--OK, I would have a certain amount of caffeine every
morning. I'm not a big coffee drinker but I would go to Starbucks and I would
get the cappuccino with a little bit of--well, with skim milk. All right.
But a little bit of caffeine. When I stopped doing that, for other reasons, I
would notice that the migraine's more likely to come on. Is there
correlation--sometimes now I'll have a quick diet Coke if I feel something.
Is there a connection--does the caffeine help?
Ms. McPEAK: Absolutely. Yes, it does. I have.
Ms. McPEAK: I take coffee in the morning.
Ms. McPEAK: .and coffee in the evening. If I don't have coffee at night,
OK, I can guarantee I can wake up in the middle of the night with a migraine.
Dr. GALLAGHER: I think--let me just say.
ADUBATO: We don't want to advocate--go around.
ADUBATO: .drinking a lot of coffee so go ahead.
Dr. GALLAGHER: Yeah. Caffeine most certainly can help migraine headaches so
a lot of medications that have been designed or formulated to treat migraine
Dr. GALLAGHER: Small amounts. As well as a lot of pain medicines contain
caffeine. Migraineurs, people that suffer with migraine, as they age, they
tolerate caffeine less and less. So a younger child or a youngster can
probably tolerate more caffeine than a full-blown adult. And then as one
ages, the amount of caffeine that you tolerate well changes. So the average
migraine sufferer who takes about 200 mg of caffeine a day, that would be the
equivalent of about two decent cups of coffee a day.
Dr. GALLAGHER: .usually can get by. And they'll be OK. But if they stop
it suddenly, their body is so used to having the caffeine they will actually
withdraw from the caffeine and they will actually begin to experience a
headache. Or if they change the amount of caffeine they take, so one day they
might have five cups or 10 cups instead of their usual 200 milligrams, and the
same kind of things happen. So everyone is different and we have to
Dr. GALLAGHER: .how much caffeine one takes so basically when we're
treating a patient we say we want to limit the caffeine to about two cups of
Dr. GALLAGHER: .and then we go on with the treatment plan.
ADUBATO: To follow up on Dr. Gallagher's point, I want to remind folks this
is our HEALTHY LIVING series. Please call the number on your screen for our
free-of-charge educational resource guide. I promise you we'll send you
everything we know about migraines and, to Dr. Gallagher's point, everyone is
different. And that's why the resource guide has lots of different
information, lots of different approaches. We'll be talking about the
Headache Center at the University of Medicine & Dentistry of New Jersey. That
is a wonderful place to turn but we'll also provide other information. And
also the HEALTHY NEW JERSEY Web site is up there as well. You'll see that in
Let me do this. Because, first of all, I saw you wanted to jump back in. Did
you? Because I was going to change subjects. But do you have something on
Dr. ROGERS: When people first come in, we recommend, Dr. Gallagher was
saying, one or two cups a day. Some people are drinking six cups, 10 cups a
Dr. ROGERS: And--well, when they come off that, they're going.
Dr. ROGERS: .to have a tough week of rebound headaches.
ADUBATO: OK. Rebound headaches. Let's try this. What is the difference
between someone who's experiencing headaches, once in a while, and migraines?
What's the difference? Where is the point at which you say, `This was
ADUBATO: Didn't know that word until today. What's--I got a regular
headache. I get a headache two months from now. No, you're a migraineur. How
do we know what that is? When did you know that you fell into the category
Ms. McPEAK: That it wouldn't go away, that it just hung in there. And once
I was regulated on the medicine, I can now, in between taking my medicine, if I
sit there and say, `I don't know if this is a full-blown headache or if it's
going to be a migraine,' I can take a glass of cola, Pepsi, or--which has
the caffeine in it and two Excedrin. Sometimes that will help.
ADUBATO: Let's talk about reducing stress. Maryann was talking about running
ADUBATO: Yeah, not sleeping doesn't help.
Dr. ROGERS: No, you have to have good sleep hygiene. You have to.
ADUBATO: But there's the other irony of that. The migraine will wake you up.
The migraine will wake you up and you'll have a hard time getting back to
ADUBATO: .and the longer you go without sleeping, the worse the migraines
ADUBATO: There's a pattern here. There's a downward cycle. Could we talk
about some "practical" ways to reduce the stress in our lives but still try to
be productive professionals and adults and parents, etc., etc.? What are
Dr. GALLAGHER: I think that migraine sufferers first do very well with
regimentation of their lifestyle. In other words, eating regularly and not
fasting, regular exercise, having good sleep patterns and habits, because too
much sleep will give you a headache and too little sleep will give you a
headache. So one of the first things we try to do with anyone is have them
self-exam what they're doing. Are they getting rest during the day, some form
of rest? Are they eating regularly? Their sleep patterns--are they
exercising? And a lot of people that have headaches are people that do a lot
of things, they're aggressive, they bite off more than they can comfortably
chew. So they--sometimes they have trouble saying no and they're always doing
things. And they have multiple jobs and multiple volunteer programs and so
forth and sometimes we have to say to them, `Let's do a diary of everything
you do and let's look at your life and we have to start deciding what's
important and what's not, what is critical and what is not, before we even get
ADUBATO: Before we get--yeah. .(Unintelligible).
Dr. GALLAGHER: .a lot of times if people are serious, really, really
Dr. GALLAGHER: .between some relaxation.
ADUBATO: Describe that because I've been working on this for a while and I
Dr. GALLAGHER: Serious into their saying this is me and in my life I want to
do better with my headaches and I am the kind of person that will not accept
medication or maybe I will accept medication but if I'm the kind of person
that won't accept that medication then I have to be willing to do life
Dr. GALLAGHER: .I have to be willing to do relaxation techniques. I have
ADUBATO: Go back to the relaxation techniques. I'm trying to get this down.
For example, we tape like a dozen shows in a day, two days back to back,
literally, you can't believe how many shows we tape. It's cheaper; we save
money that way. I shouldn't have said that on the air. But it does take its
toll. Now in between the shows I'm running, changing clothes to get ready for
the next show. If I were really smart about this, and I wanted to reduce the
chance that I or anyone who is in a position where you're moving and I don't
mean because you're hosting a television show, I mean, anyone, what could I do
to actually relax, seriously, for the five minutes I have in between a show?
ADUBATO: Is it breathing techniques? What is it?
Ms. McPEAK: I know that's one of my problems because I don't know how to
ADUBATO: Well, let's--OK, we're together on this.
ADUBATO: Let's talk about it. What can we do?
Dr. ROGERS: It can be deeper breathing, it can be listening to a certain
type of music, can be just reading something off the subject you were doing,
ADUBATO: Could it be going into a dark room?
ADUBATO: Going into the room, no sound, no talking to people, no producers in
my ear, you know who I'm talking about, that's it. For five minutes. What
Dr. GALLAGHER: The problem with stress is it's prolonged stress without
interruption. Whether we do experiments on lab animals or even experiments on
humans, if somebody is stressed constantly without a break in that stress.
Dr. GALLAGHER: .then what happens is eventually their body starts to react.
And in the case of a migraine sufferer, they tend to get the migraine
headache. So if one can learn to interrupt their stress patterns during the
Dr. GALLAGHER: .even for 10 minutes, and learning that you don't have to be
constantly at peak level 60 minutes every single hour, and maybe relaxing
between a show or relaxing between--at lunch time or something like that.
Dr. GALLAGHER: But a lot of busy people, and a lot of patients we see, they
Dr. GALLAGHER: And a lot don't know how.
Ms. McPEAK: Sometimes I do, yeah, but it's--I guess it's the spin that I'm
on that I feel as though I have certain things I have to get done in a
ADUBATO: Type A personality? You got to get things done.
Ms. McPEAK: Yeah. I guess so. I can't let go and I guess maybe that's--I'm
ADUBATO: Do you have control issues? You should talk to the doctor. No, I'm
Ms. MURO: Oh, absolutely. I have to take control. I have to.
Ms. MURO: That's it. I have to run the show or--and I do. I mean, I--you
know, I have this business. I have another business. I'm always moving.
ADUBATO: But do--you have family. She's got a kid. You know? You got a lot
Ms. MURO: Absolutely. But I--when I go home, when I leave here, and you know
I go to another job right after here, I try to take a nap for 15 minutes,
ADUBATO: You actually take a nap between here and the other network you go
Ms. MURO: Yes. Yes, I either close the door in the makeup room or if I'm
home I close--I go upstairs, I close the bedroom door, the dogs, everybody--I
just stay by myself, and then after that I try to take a walk. For some--if
I'm outside and I just take a walk. I just look at nature. It works for me.
I can't say it would work for everybody else. But it works for me.
ADUBATO: To Maryann's point, you have to find what works for you. And in
that spirit, the Headache Center, I'm going to talk about this a little
bit--you've been talking about the philosophy of it just as you've been
talking about it. How long has this been in place, first of all, the Headache
Dr. ROGERS: The Headache Center's been--Dr. Gallagher.
ADUBATO: Thirty years. So you--30 years ago, we knew there was a problem?
Dr. GALLAGHER: Thirty years ago very few doctors would really treat
headaches. And let me just point something out. You asked a question about
`Are you better off today if you get a migraine or then?'
ADUBATO: If you were going to be diagnosed, right.
Dr. GALLAGHER: Then, we would bring somebody in and we would go through a
very exhaustive history and we would try to figure out is this migraine or
isn't it migraine? And if we didn't think it was migraine, you got none of
the medications that would normally help migraine. But over the years we've
learned something very simple: If you have headaches frequently, but not
every day, not every day of your life, and if you have symptoms with the
headaches, like we mentioned before, if the head pain ever gets severe enough
that you think you would go to a doctor, even entertain that, chances are as
a screening tool you have migraine. And then a doctor can talk to you and
differentiate whether it's really migraine or not.
Dr. GALLAGHER: Assuming one doesn't have a brain tumor or something like
that. So now we're much more aggressive in giving somebody an anti-migraine
treatment very early in the game whereas 20 years ago I would say a good
percentage of the people might not have even been diagnosed as having
ADUBATO: Therefore, Doctor, they would suffer a heck of a lot longer before
they ever got any treatment, if they got it at all.
ADUBATO: Now the Headache Center, real quick, talk about some of the features
Dr. GALLAGHER: Well, I think that at the center what we do is we concentrate
on the patient and their individual problem, their individual situation. So
no two migraine people are alike. So we have people fill out a questionnaire
which sort of tells us a little bit about what they think about their
headaches, what their general health is, the kind of medications they take,
what they've done in the past and so forth. We also assess how serious their
headaches really are. Do they--are they missing work? Are they missing time?
Are they missing time from their family? And, by the way, if one doesn't have
a job that they go to and work at eight hours a day, they may be working home,
taking care of children or whatever they're doing and.
Dr. GALLAGHER: .when that's interfered with, that causes a great problem
also. So then the doctor will talk to the person, go over this, talk about
their headache, when it began, 20 years ago, 30 years ago.
Dr. GALLAGHER: .10 years ago, get the specifics of the headache, we do a
physical examination and after that we make the diagnosis right then and
ADUBATO: Let's do this. We got about a minute left. How many people are out
there right now suffering from migraines not being treated? Do you have any
ADUBATO: Fifteen million people, suffering today, not being treated
professionally, not even doing what Maryann's doing. By the way, you don't
have any problem with Maryann, what she did here?
Dr. GALLAGHER: If somebody is that serious and you want to really regulate
or undo all the things that you need to do, a lot of people can be treated
ADUBATO: So Maryann changing her diet, her lifestyle, she feels better,
hasn't had a migraine in two years, hey, that worked for her. I don't believe
that would work for me. But that's the point, everyone's different.
Dr. ROGERS: Everyone's different. Everyone has a different threshold,
ADUBATO: Let me ask you, we have a few seconds left, Barbara, what would you
say to those out there who have not gone to be treated or ignoring this but
they're suffering? Say something to them right now.
Ms. McPEAK: That there's help out there for them. And like you say there's
all different levels of the migraine and I wouldn't suffer again with the
migraine. There is help out there for you.
ADUBATO: How much better is your life today than it was 20 years ago?
Ms. McPEAK: Oh, it's a lot better. I can function a lot better. I have not
lost any work from it. I have a family that is very busy and.
ADUBATO: We'll keep talking off the air but you've done--all of you have done
a tremendous public service. I'm sorry. Go ahead.
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Similar 96-week Renal Safety Profile of Tenofovir Disoproxil Fumarate (TDF) versus Stavudine (d4T) when used in Combination with Lamivudine (3TC) and Efavirenz (EFV) in Antiretroviral Naïve Patients JE Gallant1, AL Pozniak2, S Staszewski3, B Lu4, J Sayre4 and A Cheng4 for the Study 903 Team 1Johns Hopkins Univ School of Medicine, Baltimore, MD, USA; 2 Chelsea and Westminster
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