WEBVTT
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Welcome to the A New Insight Podcast, empowering and inspiring your journey to optimal health.
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Hosted by Dr.
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Supatra Kavar, clinical psychologist, registered dietitian, fitness expert, and author of Deprogram Diet Culture.
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Rethink your relationship with food, feel your mind, and live a diet-free life.
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I follow my guests' journey to optimal health, providing you with the keys to unlock your own wellness path.
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Tune in and evolve with us.
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Hi and welcome everyone.
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I am really glad to have headache specialist and doctor of physical therapy, Dr.
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Jonathan Taves, with us today.
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Dr.
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Jonathan or Jono, how are you doing today?
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I'm great.
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Yeah, and I'm excited to be on the podcast.
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Thanks for having me.
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Absolutely.
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I have been wanting to get somebody on the podcast to talk about headaches because many of my clients experience headaches, and this just helps me better treat them.
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So before we jump into our questions, I'm going to read a little bit about Dr.
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Johnno and we will then just jump right into our questions.
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Dr.
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Johnno Taves is a Mayo Clinic trained doctor of physical therapy and founder of Novera Headache Center.
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He specializes in helping people with chronic and complex headache disorders, including migraines, cervicogenic headaches, occipital neuralgia, trigeminal neuralgia, and post-traumatic headaches.
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Throughout his career, Dr.
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Taves noticed that many people suffering from persistent headaches were cycling through medications without ever identifying the root causes of their pain.
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His work focuses on uncovering overlooked structural, neurological, and musculoskeletal contributors to chronic headaches, particularly in patients who have not found relief through conventional approaches.
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Through a hands-on, evidence-based approach, he helps people better understand their symptoms and pursue long-term solutions rather than simply managing pain.
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Dr.
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Johnna, welcome.
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Yeah, thanks.
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I'm excited to have this conversation.
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Me too.
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I have so many clients who experience chronic pain, particularly headaches.
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And I think that they have really done the same kind of things that we just talked about in the bio.
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They've cycled through medications, they often feel dismissed by doctors.
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They don't really understand the, you know, uh, the origins of their pain.
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And I think that this conversation will really help.
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Um, first of all, what got you interested in uh treating headache pain?
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Yeah, well, it started, I would say, the first year out of school.
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So I I got my foundation of understanding how the body should move.
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As a physical therapist, that's that's really what it boils down to is we help people move better.
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And so I graduated and started working for like a general outpatient practice.
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So think of like low back, shoulders, that sort of stuff.
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This practice was pretty uh hands-on focused.
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Um, so both in that practice and then a few um interactions I had during PT school were with providers that were doing things for the neck.
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And so the like any general PT that graduates will have a basic understanding of like the mechanics of the neck.
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Um, but if you really want to feel like an expert in it, you kind of have to go through continuing education or shadow someone.
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And so I just had the opportunity to be around a few uh practitioners that felt very confident in treating the neck and the jaw.
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And so I started treating um the neck.
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And so the neck, uh, we'll talk more about it, but it refers pain into the head.
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So oftentimes, um, like at this time, it was okay, there's there's some headaches that we can treat, and then neck problems.
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Um, and so long story short, what happened was I would have patients on my schedule, and I remember the first one I had that had migraines.
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And I thought, okay, this is something that your neurologist needs to take care of.
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This is a neurological problem and beyond kind of you know what I what I'm understanding and how to help you.
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And she said, Well, I've tried all the meds, I've seen multiple neurologists, and I still haven't found relief.
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And I know that my neck has an issue.
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So I worked on her neck and her symptoms basically went away.
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Um, she had significant relief.
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And there was probably that first year, maybe 12 people like that.
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And it just like everyone I saw, they had a neck issue.
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And so I started to understand that our healthcare system was overlooking this problem.
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And the more I looked into how neurologists or primary care docs were managing these situations, I realized that um there wasn't really um a focus on finding what's causing the pain itself.
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Um, like why is this happening?
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They weren't asking the why question.
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And so I, through that experience, seeing the impact it was having on our life and the potential for me to help these people, uh, it just was the catalyst for me wanting to have a career in creating something that I didn't see was happening.
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So trying to trying to fill that gap in our healthcare system.
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I love this.
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We're gonna get into more specifics about the neck in a little bit, but I, you know, we know that headaches and migraines affect millions of people.
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Um, sufferers often spend years looking for answers.
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Tell me why chronic headaches are so often misdiagnosed or poorly managed.
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Yeah, so headaches, I would say that there's two things that confuse providers, and they're they're legitimately confusing.
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So this isn't a critique of I mean, I I could probably critique our healthcare system, but like migraines are confusing.
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And they're confusing because both the location of pain and the type of input, the sensory input that you experience, um, is subjective.
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And that's true for anything in the body, meaning like um we know that heart attacks refer pain to the shoulder.
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So if you have shoulder pain, we we understand that there's a connection there.
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The brain's confusing where it's actually coming from.
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Um, so so think of that scenario, but in the head.
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And think of that scenario, but also with like light sensitivity, visual disturbances, maybe numbness tingling.
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So there's a whole slew of symptoms that people are experiencing that we search for an answer, like we scan the head and we look for something in the head, tumor, brain bleed, you know, something that would make sense of your head hurting, and we just don't find anything.
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Um, and so the problem is that because we don't find anything on imaging, we just go into the medication route.
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And then the medications have sort of like validated, in a sense, um, this understanding or what we think is an understanding of the underlying problem, which is more of a chemical-based problem, right?
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So like things like serotonin levels fluctuating and stuff like that.
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So the medication impacts things at the chemical level.
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But what the medication is impacting is really just like how our brain's response, responding and the symptoms.
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Um, but what's actually sending the signal um oftentimes is an overlooked neck issue.
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And the reason it's overlooked is because it's a movement problem.
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So think of it as like when I turn my head, look up and down, there's joints in the upper part of the neck that should be moving.
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And our heads weigh 10 to 12 pounds, so they're kind of heavy.
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There's all sorts of different reasons why, and we can go into that.
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But basically, when you have head pain, think neck problem, and the neck refers pain into the head.
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And so we're we're getting this very complicated, debilitating issue, and we're using you know technology that's advanced, uh, like MRIs, x-rays, CTs, and we're looking for things, we don't find them, and then we're looking for ways to manage the pain.
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And then we say, okay, like since these things manage pain, it's a neurological problem, which um what I like to say is like every problem is a neurological problem, meaning the brain has to receive information for us to realize it.
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Um and so the the brain is always involved, the nervous system is always involved.
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Um, so, anyways, does does that answer your question?
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Just sort of the the complication around it.
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Yes, definitely.
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I think that you know, yes, every problem is a neurological neurological problem because we are experiencing it in our brain, but it may originate somewhere else.
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So give me a picture of the neck.
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It where in the neck might we experience, you know, the the original problem and why.
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Yeah.
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So the neck is um it's so think of the neck.
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Uh I I like to compare it to the shoulder um for one specific aspect of it, in that it's it's very mobile.
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Okay, so we can we can turn, we can look up and down, we can go side to side.
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So we have all this this different um varying degrees of movement in our neck.
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And in order to do that, in order to have the mobility, uh, we have to sort of sacrifice stability.
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Okay.
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So think of it like the hip joint is very stable, but the hip joint doesn't have a ton of freedom, or like the elbow joint.
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It has like one degree or one one plane of movement, right?
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Whereas the shoulder has a lot of movement that it can do, but oftentimes there's a lack of stability.
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So there's like more potential for injury there.
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And so when we think of the neck and its mobility, um, a lot of that comes from the upper two joints.
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So the base of the skull sits on the first bone, um, which is called the atlas, and and it nods and it sidebends a little bit.
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So like these movements uh will come from the upper joint.
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And then the first bone is shaped, so the atlas is shaped like a donut, and then the second bone is called the axis, it's shaped like a thumb-like structure, and it rotates.
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And so about half of our rotation, so 45 degrees or so, comes just from C1 and C2, the atlas and the axis, interacting.
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Okay.
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So lots of movement, the upper part of the neck.
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The reason I'm highlighting those two joints is because we know that anywhere from the base of the skull to C3, like the third bone, if there's irritation or a pain signal sent from that area, it will travel through the brainstem and meet up with other sensory nerves from the head and the face.
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So think of the occipital nerve from the back of the head, the trigeminal nerve that picks up sensation from the face.
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And then it sends a common signal to the brain.
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And then we actually realize what's happening when it hits the brain.
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And so, really, anywhere from head, back of the head, upper neck, um, any of these problems can overlap and refer pain to a different area.
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And so the most likely scenario when you have any sort of pain sensation is that the very mobile neck has an issue and it's up high.
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Um, and that's what we see.
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Just the dynamic with holding up a 10 to 12 pound head about the weight of a bowling ball is hard to do over time and keep that mobility and not have injury.
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And so we just see people with a lot of stressed out necks that have headaches.
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Wow.
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Well, what will lead to the neck issue?
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Is it uh like a postural issue?
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I know a lot of people are over their computers and they're jutting their neck forward.
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Is it the lack of exercise?
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Like, what can lead to these neck issues?
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Yeah, so I tell people to think of it like you're you're going to your dentist and you have a cavity.
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And let's say you live in a world where no one brushes or flosses, and this dentist, uh, you sit down in their chair and they look at your teeth and they go, Okay, you have cavities.
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And you say, like, well, why do I have a cavity?
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Like, why do I have this cavity?
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They would say, Well, there's there's like several dozen reasons that all contribute to the the pH and your dental health that will contribute over time to you having a cavity that will wear down your enamel and then cause your tooth to hurt, right?
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And so think of it like we live in a world where there's there's dozens of things that can impact our neck and add stress to it over time.
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And then when you get to the place where you have that extra migraines and your neck is hurting, and you ask, you know, someone like me, well, why do I have this?
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Um, it can be a complicated thing to answer, right?
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So just like you could appreciate asking a dentist, why do I have this cavity?
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Um, every individual is going to look different.
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But what I can speak to are principles, right?
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So there's things in place um that we see correlate to like having a stressed out neck and contributing to headaches and migraines.
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Um, and I think what might be helpful is laying out our our, we have a three-spoke model um that we go through.
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And so if it's okay, I'll just go over a high-level view of that.
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Is that all right?
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Sure.
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So the first thing we look for is the source of pain.
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So we want to understand where the pain is actually coming from.
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This is typically the neck, the jaw, and the shoulders, um, a combination of those three.
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Um, typically all three are involved to some extent.
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The second thing we want to look for is what we call developmental barriers.
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So these are things that will, this will probably answer your question to some extent.
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Um, we looked for things developmentally that maybe is part of someone's anatomy or how they were raised or like the environment that they were in when they were growing up.
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Um, oftentimes this looks like an airway issue.
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So they have an underdeveloped um airway jaw, they breathe through their mouth at night, they have to thrust their jaw forward, they cock their head back when they're sleeping, and they're just they're not able to breathe through their nose like they should.
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And that builds up tension, leading to this problem.
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So that's like one scenario that fits into what we call our developmental barrier category.
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So we look for things that would have, you know, contributed to someone's scenario, and we want to make sure we remove those.
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And then the third thing is what we call someone's general health.
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Like we want their general health to improve.
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And this is mainly where the threshold comes into play.
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So when we're looking at solving this problem for someone, we need to understand, and this is this is your expertise as well, but like, what does diet, hormones, stress levels, what does their general health have to do with it?
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Because that stuff has a significant impact on their threshold.
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And so if we address the pain over here, which is the postural stuff, the trauma, the car accident they had, like their neck is really stressed out.
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And then we look at the developmental things that maybe contribute to them having this neck issue.
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And then we look at their general health and we try to get them as healthy as possible.
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When we understand all three variables, then we put a plan in place that's very root cause focused and allows the patient to actually take control of their health.
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Oh, I like that very much.
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And I would have to say, for me, uh in the stage one, I was probably all of the running and the crazy skiing I did growing up in Colorado.
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Totally.
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Totally falling and having many yard sales out on the uh the ski slope.
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Yeah, that can for sure do it.
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Yeah.
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Yeah, we were we were the not not the no helmet generation.
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That was probably not the best thing.
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Oh my goodness.
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Well, so give me a picture then of what treatment might look like, uh, you know, if you are taking into account those three areas.
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Yeah, so our so as physical therapists, we're very hands-on.
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So we do a lot of uh what's called manual therapy.
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We restore mobility to the upper part of the neck, we'll work on the jaw, the shoulders, trying to just allow the body to function as it should, in a way that, you know, as you go about your day, you're able to tolerate everything that your day throws at you.
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Um, and then some, you know, we want people getting back into exercise and things like that.
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So a typical treatment is you come in to our office, or we we also do uh virtual sort of coaching um process for people that aren't local.
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Um but if you're local, we do a very hands-on experience where we're putting pressure through the neck, through the jaw, trying to get uh the neck to move, those upper joints that I talked about.
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Um so that would be the focus on like what is causing your pain and how do we reduce it?
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When it comes to things like the developmental barriers, um, I'll just continue with that airway one.
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So, for example, if someone uh has a hard time breathing through their nose, their sleep quality is poor, they wake up with headaches, um, they know they clench or grind their teeth at night.
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Um, just simple suggestions, maybe wearing breathe right strips or mouth taping, something like that.
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Just there's a lot of benefits to breathing through our nose.
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And of course, we need to get into deep sleep and uh have our body recover when we rest.
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And so um it could be suggestions on airway.
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Uh, we could talk about things like sleep position uh or sleep hygiene.
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And then we could also refer them out to a sleep specialist who's someone who could um, from a more holistic natural approach, like help them expand, uh, open up their nasal passage, um, improve their swallow, what what does their tongue do?
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Um, because there's a lot of compensation patterns that can contribute to neck tension there.
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And then the third spoke, we um, so there's sort of a balance there because we'll look for things generally in someone's life that could improve, whether that's diet or you know, reducing stress somehow, um, increasing uh daily habits that are going to be helpful for their general health.
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And we'll make suggestions there.
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Uh, but sometimes that would look like you know, functional medicine or a naturopath or someone that has a background in like um understanding diet and how they could improve gut health.
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And so there's, yeah, like you.
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And so um, we we partner with providers like yourself um so that um that like I said, their thresholds as high as possible.
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And these are healthy people that we're working with because healthy people are able to tolerate pain and get out of pain much quicker than unhealthy people.
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That's very good.
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And by local, y'all, he's meaning Colorado.
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He's also a Colorado like me, and he's located in Colorado Springs.
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Well, let's kind of get into more of the nitty-gritty about headaches.
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I think a lot of people don't really understand the difference between like a migraine attention headache or a cervicogenic headache.
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Um, and tell me about those, like what the differences are and why distinguishing between them is so important.
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Yeah, well, it's important to understand that our our healthcare model is set up to um classify the different types of headaches, and there's there's dozens of different types, uh, but the big ones are the ones you just um laid out there.
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So when it comes to most of them, though, they are what are called um primary headaches, meaning they're gonna be classified in like the headache is the problem itself.
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And then a secondary headache would be a headache that has something underlying that is causing the head to hurt.
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Okay.
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Now, I'm gonna get into where we think differently, but I'm just kind of laying out how our healthcare system looks at them and uh comes up with these diagnoses.
00:19:44.880 --> 00:20:07.359
Now, most of them are gonna be based on symptoms, meaning when you sit down in your doctor's office and you say I have a one-sided pounding-throbbing sensation, and it's accompanied by light and sound sensitivity, and maybe you have a visual disturbance right before you get the pain, they would take those symptoms and likely give you the diagnosis of a migraine.
00:20:07.599 --> 00:20:12.160
Now, not every migraine looks the same, so there's nuances to it.
00:20:12.319 --> 00:20:17.839
One of the things I've seen throughout the years is the consistent thing is that they're debilitating.
00:20:18.000 --> 00:20:22.720
It's an intense pain, and they're usually they're disrupting your life in some way.
00:20:22.960 --> 00:20:38.480
So whether they're both sides or one side, or whether you have, you know, lights or sound sensitivities or not, um, because it's based on symptoms, um, having the diagnosis of migraine is helpful because it communicates to someone in your life that this is something that's debilitating.
00:20:38.640 --> 00:20:47.680
Whereas headache, and this is where I would say the primary difference is, um, saying that you have a headache can mean a lot of different things, you know, because just about everyone has headaches.
00:20:47.839 --> 00:20:58.079
And so the migraine diagnosis for the purposes of like the people we work with, it's helpful to communicate like how severe this is, because it's very debilitating.
00:20:58.240 --> 00:21:05.920
Um, but from the medical side of things, it doesn't necessarily mean that that medical community now knows what is wrong.
00:21:06.079 --> 00:21:10.319
Um, because the migraine itself isn't being diagnosed based on anything objective.
00:21:10.480 --> 00:21:15.920
So they just basically are taking your symptoms, putting them in a nice nice little box and giving it back to you.
00:21:16.079 --> 00:21:23.200
And then you take that little box and you go to all the providers and they give you medication based on like what you're showing them, which is that box.
00:21:23.279 --> 00:21:26.559
It's just a way of communicating to these providers.
00:21:27.200 --> 00:21:34.160
And so when we're trying to understand like why is this happening, oftentimes these diagnoses aren't super helpful.
00:21:34.480 --> 00:21:48.559
And we here at Novera just have to, and I'm sure you're the same, like you just have to work based on like what you see, the tests that you run, and then um because if we just base it off of diagnoses, you know, it's just kind of a a way to lead people to medication.
00:21:48.799 --> 00:21:52.799
Um, I'm probably oversimplifying that, but that's kind of how I look at it.
00:21:53.119 --> 00:21:57.839
So migraine is based on symptoms, tension headache.
00:21:58.000 --> 00:21:59.759
If I were to describe that, it's more.
00:22:00.160 --> 00:22:05.920
Tension headache typically builds throughout the day and is more of a band or strap-like presentation in the forehead.
00:22:06.079 --> 00:22:13.279
Um, tension headaches are seen as secondary headaches because they're connected to some level of tension that's building up.
00:22:13.519 --> 00:22:14.880
And that is generally true.
00:22:14.960 --> 00:22:25.279
Like the shoulders, the neck on both sides are angry, and like the stress of life uh builds throughout the day, and it feels worse typically evening or afternoon.
00:22:25.519 --> 00:22:33.440
Um, and then the other category you mentioned was cervicogenic headache, and that basically is just a fancy way of saying a headache from the neck.
00:22:33.920 --> 00:22:38.559
Now, this is this is mainly what we're talking about is neck headaches.
00:22:38.880 --> 00:22:42.000
And most people, I would say, have neck headaches.
00:22:42.319 --> 00:22:56.960
And so they've received the diagnosis of migraine, but I've been doing this for eight years, seen 1500 plus cases, people from all over the world with the diagnosis of migraine, not cervicogenic headache, and I work on their neck and their headaches get better.
00:22:57.200 --> 00:23:09.759
So based on that, they they have cervicogenic headaches, but for the purpose, I don't I don't necessarily find it helpful to just like correct people on their diagnosis because it doesn't really matter.
00:23:09.920 --> 00:23:15.920
Just like, okay, like you present with migraine symptoms, let's treat the things we find, and then you get better.
00:23:16.079 --> 00:23:18.000
That's kind of the world I live in, if that makes sense.
00:23:18.160 --> 00:23:18.559
Wow.
00:23:18.720 --> 00:23:23.759
So okay, I've only ever had one migraine, and this is very curious to me.
00:23:23.839 --> 00:23:27.440
It was when I was uh probably preteen age.
00:23:29.599 --> 00:23:43.279
I am now I was wondering if it was hormones, but I'm now wondering if it was probably one of those crazy ski accidents and having uh you know a neck injury and it just playing out as a migraine.
00:23:43.359 --> 00:23:44.559
Is that possible?
00:23:45.759 --> 00:23:46.799
Yeah, for sure.
00:23:47.039 --> 00:23:50.720
Um, so the pain has to come from somewhere.
00:23:50.880 --> 00:23:55.519
To say that you have a migraine is basically saying like the pain came from the brain.
00:23:55.759 --> 00:24:09.920
Um, and pain, um I'll I will say that pain can be manifest out of nothing, like the brain can make stuff up, um, like complex regional pain syndrome, things like that.
00:24:10.160 --> 00:24:13.680
But those things usually have a trigger to them initially.
00:24:13.839 --> 00:24:17.039
Um, it's not necessarily like just pain from nothing.
00:24:17.119 --> 00:24:28.240
Uh, and especially when we have a specific pattern like a migraine, um, that's that's kind of unique, like pain that starts here, wraps up and around, um, and is there for an episodic period of time, right?
00:24:28.480 --> 00:24:32.240
And so it would be odd for that to just be a brain problem.
00:24:32.640 --> 00:24:37.039
Um, but that's kind of where we land if we're saying, like, oh, that's just a migraine.
00:24:37.279 --> 00:24:43.680
And so what I would say is with any migraine presentation, we want to understand where the pain's coming from.
00:24:43.839 --> 00:24:47.680
And I haven't had one yet that I don't, I'm not able to find that.
00:24:47.920 --> 00:24:52.160
And so typically people have some history of neck trauma or something.
00:24:52.240 --> 00:24:53.759
Uh, and if they don't, that's okay.
00:24:53.920 --> 00:24:59.119
It's there's about 40% of people that are like, I never thought my neck was connected to this at all.
00:24:59.279 --> 00:25:00.799
So you're in good company.
00:25:00.960 --> 00:25:12.319
Um, the other thing, too, is when you think of hormones, so it's really the the fluctuation in hormones and in particular estrogen dropping that will reduce our threshold.
00:25:12.480 --> 00:25:20.799
And so we see it all the time where people come to us and uh women and they they would say, you know, I have a hormonal migraine or hormones are a big trigger for me.
00:25:20.960 --> 00:25:23.119
And that doesn't mean hormones are the problem.
00:25:23.519 --> 00:25:30.160
Um, it just means that you're again your threshold is uh changing as your hormones change.
00:25:30.319 --> 00:25:39.200
And so the body likes stability, and especially when the brain's having to deal with a noisy pain signal, anything that's not stable is going to put you in a vulnerable position.
00:25:39.839 --> 00:25:41.359
So that's one of those things.
00:25:41.440 --> 00:25:44.880
Like women just unfortunately their hormones aren't stable, they're fluctuating.
00:25:45.119 --> 00:25:54.640
And so it just is like you had a ski injury, your neck is injured, and then you went through your period and you got a bad migraine.
00:25:54.960 --> 00:25:56.319
That probably is it.
00:25:56.480 --> 00:26:00.000
Oh my gosh, the mystery might be solved.
00:26:00.160 --> 00:26:02.559
Seriously, I had no idea why that happened.
00:26:02.880 --> 00:26:07.519
Happened once, it took me out for an entire day, and it was awful.
00:26:07.839 --> 00:26:09.039
I felt yeah, they're terrible.
00:26:10.319 --> 00:26:18.079
But uh a fun fact, y'all, for those of you going through menopause, and what he's saying about estrogen is really on point.
00:26:18.480 --> 00:26:22.480
Um, add a lot of soy to your diet, it's a phytoestrogen.
00:26:22.559 --> 00:26:29.519
I started to do that the moment I was in perimenopause, and I will tell you what, haven't had a hot flash, haven't had a headache.
00:26:29.599 --> 00:26:31.680
I there are so many benefits.
00:26:32.000 --> 00:26:40.480
I mean, and and uh also look into HRT, of course, it's it's completely safe at this point right now, but you certainly don't have to suffer.
00:26:41.039 --> 00:26:45.920
Guys, one of my my my mottos, and I learned this during my dietetic internships.
00:26:46.079 --> 00:26:49.599
Thanks, uh Phil, for this, is never suffer.
00:26:50.319 --> 00:26:52.319
Okay, you do not have to suffer.
00:26:52.480 --> 00:26:54.559
There's always help out there.
00:26:55.519 --> 00:26:57.839
I have so many more questions to ask you, Dr.
00:26:58.000 --> 00:27:00.079
Jono, but we're out of time for this half.
00:27:00.319 --> 00:27:02.400
Will you come back for the second half, please?
00:27:02.960 --> 00:27:03.519
Absolutely.
00:27:03.759 --> 00:27:04.319
Let's do it.
00:27:04.880 --> 00:27:05.200
Okay.
00:27:05.519 --> 00:27:07.519
Everybody, thank you so much for joining us.
00:27:07.680 --> 00:27:10.559
Stay tuned for the second half of this conversation with Dr.
00:27:10.720 --> 00:27:20.880
Jono Taves as we continue exploring chronic headaches, migraines, overlooked causes of pain, and what lasting relief might actually look like.
00:27:21.920 --> 00:27:24.960
Thanks for tuning into the A New Insight Podcast.
00:27:25.200 --> 00:27:32.240
Please remember the content shared on this podcast is for entertainment purposes only and does not constitute medical advice.
00:27:32.480 --> 00:27:35.200
Tune in next time and evolve with us.
00:00:02.000 --> 00:00:08.160
Welcome to the A New Insight Podcast, empowering and inspiring your journey to optimal health.
00:00:08.320 --> 00:00:09.039
Hosted by Dr.
00:00:09.199 --> 00:00:17.359
Supatra Kavar, clinical psychologist, registered dietitian, fitness expert, and author of Deprogram Diet Culture.
00:00:17.600 --> 00:00:22.239
Rethink your relationship with food, feel your mind, and live a diet-free life.
00:00:22.480 --> 00:00:29.519
I follow my guests' journey to optimal health, providing you with the keys to unlock your own wellness path.
00:00:29.760 --> 00:00:32.240
Tune in and evolve with us.
00:00:33.920 --> 00:00:35.840
Hi and welcome everyone.
00:00:36.000 --> 00:00:41.840
I am really glad to have headache specialist and doctor of physical therapy, Dr.
00:00:41.920 --> 00:00:44.079
Jonathan Taves, with us today.
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Dr.
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Jonathan or Jono, how are you doing today?
00:00:48.399 --> 00:00:48.880
I'm great.
00:00:48.960 --> 00:00:50.640
Yeah, and I'm excited to be on the podcast.
00:00:50.799 --> 00:00:51.759
Thanks for having me.
00:00:52.079 --> 00:00:52.880
Absolutely.
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I have been wanting to get somebody on the podcast to talk about headaches because many of my clients experience headaches, and this just helps me better treat them.
00:01:03.600 --> 00:01:07.920
So before we jump into our questions, I'm going to read a little bit about Dr.
00:01:08.079 --> 00:01:12.079
Johnno and we will then just jump right into our questions.
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Dr.
00:01:13.040 --> 00:01:20.319
Johnno Taves is a Mayo Clinic trained doctor of physical therapy and founder of Novera Headache Center.
00:01:20.799 --> 00:01:34.959
He specializes in helping people with chronic and complex headache disorders, including migraines, cervicogenic headaches, occipital neuralgia, trigeminal neuralgia, and post-traumatic headaches.
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Throughout his career, Dr.
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Taves noticed that many people suffering from persistent headaches were cycling through medications without ever identifying the root causes of their pain.
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His work focuses on uncovering overlooked structural, neurological, and musculoskeletal contributors to chronic headaches, particularly in patients who have not found relief through conventional approaches.
00:02:00.159 --> 00:02:10.159
Through a hands-on, evidence-based approach, he helps people better understand their symptoms and pursue long-term solutions rather than simply managing pain.
00:02:10.479 --> 00:02:10.719
Dr.
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Johnna, welcome.
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Yeah, thanks.
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I'm excited to have this conversation.
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Me too.
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I have so many clients who experience chronic pain, particularly headaches.
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And I think that they have really done the same kind of things that we just talked about in the bio.
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They've cycled through medications, they often feel dismissed by doctors.
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They don't really understand the, you know, uh, the origins of their pain.
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And I think that this conversation will really help.
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Um, first of all, what got you interested in uh treating headache pain?
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Yeah, well, it started, I would say, the first year out of school.
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So I I got my foundation of understanding how the body should move.
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As a physical therapist, that's that's really what it boils down to is we help people move better.
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And so I graduated and started working for like a general outpatient practice.
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So think of like low back, shoulders, that sort of stuff.
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This practice was pretty uh hands-on focused.
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Um, so both in that practice and then a few um interactions I had during PT school were with providers that were doing things for the neck.
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And so the like any general PT that graduates will have a basic understanding of like the mechanics of the neck.
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Um, but if you really want to feel like an expert in it, you kind of have to go through continuing education or shadow someone.
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And so I just had the opportunity to be around a few uh practitioners that felt very confident in treating the neck and the jaw.
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And so I started treating um the neck.
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And so the neck, uh, we'll talk more about it, but it refers pain into the head.
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So oftentimes, um, like at this time, it was okay, there's there's some headaches that we can treat, and then neck problems.
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Um, and so long story short, what happened was I would have patients on my schedule, and I remember the first one I had that had migraines.
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And I thought, okay, this is something that your neurologist needs to take care of.
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This is a neurological problem and beyond kind of you know what I what I'm understanding and how to help you.
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And she said, Well, I've tried all the meds, I've seen multiple neurologists, and I still haven't found relief.
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And I know that my neck has an issue.
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So I worked on her neck and her symptoms basically went away.
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Um, she had significant relief.
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And there was probably that first year, maybe 12 people like that.
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And it just like everyone I saw, they had a neck issue.
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And so I started to understand that our healthcare system was overlooking this problem.
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And the more I looked into how neurologists or primary care docs were managing these situations, I realized that um there wasn't really um a focus on finding what's causing the pain itself.
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Um, like why is this happening?
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They weren't asking the why question.
00:05:01.839 --> 00:05:16.480
And so I, through that experience, seeing the impact it was having on our life and the potential for me to help these people, uh, it just was the catalyst for me wanting to have a career in creating something that I didn't see was happening.
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So trying to trying to fill that gap in our healthcare system.
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I love this.
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We're gonna get into more specifics about the neck in a little bit, but I, you know, we know that headaches and migraines affect millions of people.
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Um, sufferers often spend years looking for answers.
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Tell me why chronic headaches are so often misdiagnosed or poorly managed.
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Yeah, so headaches, I would say that there's two things that confuse providers, and they're they're legitimately confusing.
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So this isn't a critique of I mean, I I could probably critique our healthcare system, but like migraines are confusing.
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And they're confusing because both the location of pain and the type of input, the sensory input that you experience, um, is subjective.
00:06:07.600 --> 00:06:13.439
And that's true for anything in the body, meaning like um we know that heart attacks refer pain to the shoulder.
00:06:13.600 --> 00:06:16.959
So if you have shoulder pain, we we understand that there's a connection there.
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The brain's confusing where it's actually coming from.
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Um, so so think of that scenario, but in the head.
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And think of that scenario, but also with like light sensitivity, visual disturbances, maybe numbness tingling.
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So there's a whole slew of symptoms that people are experiencing that we search for an answer, like we scan the head and we look for something in the head, tumor, brain bleed, you know, something that would make sense of your head hurting, and we just don't find anything.
00:06:48.319 --> 00:06:55.439
Um, and so the problem is that because we don't find anything on imaging, we just go into the medication route.
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And then the medications have sort of like validated, in a sense, um, this understanding or what we think is an understanding of the underlying problem, which is more of a chemical-based problem, right?
00:07:07.680 --> 00:07:11.600
So like things like serotonin levels fluctuating and stuff like that.
00:07:11.759 --> 00:07:15.439
So the medication impacts things at the chemical level.
00:07:15.680 --> 00:07:21.920
But what the medication is impacting is really just like how our brain's response, responding and the symptoms.
00:07:22.079 --> 00:07:27.759
Um, but what's actually sending the signal um oftentimes is an overlooked neck issue.
00:07:27.920 --> 00:07:31.600
And the reason it's overlooked is because it's a movement problem.
00:07:31.759 --> 00:07:37.600
So think of it as like when I turn my head, look up and down, there's joints in the upper part of the neck that should be moving.
00:07:37.759 --> 00:07:40.639
And our heads weigh 10 to 12 pounds, so they're kind of heavy.
00:07:40.879 --> 00:07:43.759
There's all sorts of different reasons why, and we can go into that.
00:07:44.000 --> 00:07:50.160
But basically, when you have head pain, think neck problem, and the neck refers pain into the head.
00:07:50.560 --> 00:08:04.560
And so we're we're getting this very complicated, debilitating issue, and we're using you know technology that's advanced, uh, like MRIs, x-rays, CTs, and we're looking for things, we don't find them, and then we're looking for ways to manage the pain.
00:08:04.639 --> 00:08:17.519
And then we say, okay, like since these things manage pain, it's a neurological problem, which um what I like to say is like every problem is a neurological problem, meaning the brain has to receive information for us to realize it.
00:08:17.680 --> 00:08:21.920
Um and so the the brain is always involved, the nervous system is always involved.
00:08:22.079 --> 00:08:24.879
Um, so, anyways, does does that answer your question?
00:08:25.120 --> 00:08:27.360
Just sort of the the complication around it.
00:08:27.680 --> 00:08:28.720
Yes, definitely.
00:08:28.879 --> 00:08:39.919
I think that you know, yes, every problem is a neurological neurological problem because we are experiencing it in our brain, but it may originate somewhere else.
00:08:40.399 --> 00:08:43.120
So give me a picture of the neck.
00:08:43.360 --> 00:08:50.240
It where in the neck might we experience, you know, the the original problem and why.
00:08:50.559 --> 00:08:51.200
Yeah.
00:08:51.759 --> 00:08:56.720
So the neck is um it's so think of the neck.
00:08:56.799 --> 00:09:03.679
Uh I I like to compare it to the shoulder um for one specific aspect of it, in that it's it's very mobile.
00:09:03.840 --> 00:09:07.519
Okay, so we can we can turn, we can look up and down, we can go side to side.
00:09:07.679 --> 00:09:12.879
So we have all this this different um varying degrees of movement in our neck.
00:09:12.960 --> 00:09:19.200
And in order to do that, in order to have the mobility, uh, we have to sort of sacrifice stability.
00:09:19.360 --> 00:09:19.600
Okay.
00:09:19.759 --> 00:09:26.399
So think of it like the hip joint is very stable, but the hip joint doesn't have a ton of freedom, or like the elbow joint.
00:09:26.480 --> 00:09:30.080
It has like one degree or one one plane of movement, right?
00:09:30.320 --> 00:09:35.279
Whereas the shoulder has a lot of movement that it can do, but oftentimes there's a lack of stability.
00:09:35.360 --> 00:09:37.840
So there's like more potential for injury there.
00:09:38.000 --> 00:09:44.639
And so when we think of the neck and its mobility, um, a lot of that comes from the upper two joints.
00:09:44.799 --> 00:09:52.399
So the base of the skull sits on the first bone, um, which is called the atlas, and and it nods and it sidebends a little bit.
00:09:52.559 --> 00:09:56.480
So like these movements uh will come from the upper joint.
00:09:56.639 --> 00:10:05.600
And then the first bone is shaped, so the atlas is shaped like a donut, and then the second bone is called the axis, it's shaped like a thumb-like structure, and it rotates.
00:10:05.759 --> 00:10:15.200
And so about half of our rotation, so 45 degrees or so, comes just from C1 and C2, the atlas and the axis, interacting.
00:10:15.360 --> 00:10:15.679
Okay.
00:10:16.559 --> 00:10:19.120
So lots of movement, the upper part of the neck.
00:10:19.279 --> 00:10:36.799
The reason I'm highlighting those two joints is because we know that anywhere from the base of the skull to C3, like the third bone, if there's irritation or a pain signal sent from that area, it will travel through the brainstem and meet up with other sensory nerves from the head and the face.
00:10:36.960 --> 00:10:43.039
So think of the occipital nerve from the back of the head, the trigeminal nerve that picks up sensation from the face.
00:10:43.120 --> 00:10:45.759
And then it sends a common signal to the brain.
00:10:45.919 --> 00:10:49.519
And then we actually realize what's happening when it hits the brain.
00:10:49.679 --> 00:11:00.000
And so, really, anywhere from head, back of the head, upper neck, um, any of these problems can overlap and refer pain to a different area.
00:11:00.159 --> 00:11:09.360
And so the most likely scenario when you have any sort of pain sensation is that the very mobile neck has an issue and it's up high.
00:11:09.519 --> 00:11:10.879
Um, and that's what we see.
00:11:11.039 --> 00:11:20.080
Just the dynamic with holding up a 10 to 12 pound head about the weight of a bowling ball is hard to do over time and keep that mobility and not have injury.
00:11:20.240 --> 00:11:23.919
And so we just see people with a lot of stressed out necks that have headaches.
00:11:24.240 --> 00:11:24.799
Wow.
00:11:25.039 --> 00:11:28.559
Well, what will lead to the neck issue?
00:11:28.720 --> 00:11:31.840
Is it uh like a postural issue?
00:11:32.000 --> 00:11:37.039
I know a lot of people are over their computers and they're jutting their neck forward.
00:11:37.279 --> 00:11:39.440
Is it the lack of exercise?
00:11:39.679 --> 00:11:42.240
Like, what can lead to these neck issues?
00:11:43.279 --> 00:11:50.399
Yeah, so I tell people to think of it like you're you're going to your dentist and you have a cavity.
00:11:50.639 --> 00:11:59.759
And let's say you live in a world where no one brushes or flosses, and this dentist, uh, you sit down in their chair and they look at your teeth and they go, Okay, you have cavities.
00:11:59.840 --> 00:12:02.080
And you say, like, well, why do I have a cavity?
00:12:02.240 --> 00:12:04.559
Like, why do I have this cavity?
00:12:04.799 --> 00:12:20.960
They would say, Well, there's there's like several dozen reasons that all contribute to the the pH and your dental health that will contribute over time to you having a cavity that will wear down your enamel and then cause your tooth to hurt, right?
00:12:21.679 --> 00:12:31.360
And so think of it like we live in a world where there's there's dozens of things that can impact our neck and add stress to it over time.
00:12:31.600 --> 00:12:39.679
And then when you get to the place where you have that extra migraines and your neck is hurting, and you ask, you know, someone like me, well, why do I have this?
00:12:39.840 --> 00:12:43.200
Um, it can be a complicated thing to answer, right?
00:12:43.360 --> 00:12:47.120
So just like you could appreciate asking a dentist, why do I have this cavity?
00:12:47.360 --> 00:12:49.840
Um, every individual is going to look different.
00:12:50.000 --> 00:12:52.240
But what I can speak to are principles, right?
00:12:52.399 --> 00:13:01.759
So there's things in place um that we see correlate to like having a stressed out neck and contributing to headaches and migraines.
00:13:01.919 --> 00:13:08.879
Um, and I think what might be helpful is laying out our our, we have a three-spoke model um that we go through.
00:13:09.039 --> 00:13:11.759
And so if it's okay, I'll just go over a high-level view of that.
00:13:11.840 --> 00:13:12.480
Is that all right?
00:13:12.799 --> 00:13:13.440
Sure.
00:13:14.000 --> 00:13:16.720
So the first thing we look for is the source of pain.
00:13:16.879 --> 00:13:19.600
So we want to understand where the pain is actually coming from.
00:13:19.840 --> 00:13:24.960
This is typically the neck, the jaw, and the shoulders, um, a combination of those three.
00:13:25.120 --> 00:13:27.919
Um, typically all three are involved to some extent.
00:13:28.159 --> 00:13:32.320
The second thing we want to look for is what we call developmental barriers.
00:13:32.559 --> 00:13:37.360
So these are things that will, this will probably answer your question to some extent.
00:13:37.519 --> 00:13:47.519
Um, we looked for things developmentally that maybe is part of someone's anatomy or how they were raised or like the environment that they were in when they were growing up.
00:13:47.600 --> 00:13:50.320
Um, oftentimes this looks like an airway issue.
00:13:50.480 --> 00:14:03.440
So they have an underdeveloped um airway jaw, they breathe through their mouth at night, they have to thrust their jaw forward, they cock their head back when they're sleeping, and they're just they're not able to breathe through their nose like they should.
00:14:03.600 --> 00:14:06.559
And that builds up tension, leading to this problem.
00:14:06.720 --> 00:14:12.000
So that's like one scenario that fits into what we call our developmental barrier category.
00:14:12.159 --> 00:14:19.200
So we look for things that would have, you know, contributed to someone's scenario, and we want to make sure we remove those.
00:14:19.360 --> 00:14:23.039
And then the third thing is what we call someone's general health.
00:14:23.120 --> 00:14:25.279
Like we want their general health to improve.
00:14:25.440 --> 00:14:28.720
And this is mainly where the threshold comes into play.
00:14:28.960 --> 00:14:42.799
So when we're looking at solving this problem for someone, we need to understand, and this is this is your expertise as well, but like, what does diet, hormones, stress levels, what does their general health have to do with it?
00:14:42.960 --> 00:14:45.919
Because that stuff has a significant impact on their threshold.
00:14:46.080 --> 00:14:54.720
And so if we address the pain over here, which is the postural stuff, the trauma, the car accident they had, like their neck is really stressed out.
00:14:54.960 --> 00:14:59.600
And then we look at the developmental things that maybe contribute to them having this neck issue.
00:14:59.759 --> 00:15:03.279
And then we look at their general health and we try to get them as healthy as possible.
00:15:03.440 --> 00:15:13.200
When we understand all three variables, then we put a plan in place that's very root cause focused and allows the patient to actually take control of their health.
00:15:13.600 --> 00:15:15.600
Oh, I like that very much.
00:15:15.759 --> 00:15:24.080
And I would have to say, for me, uh in the stage one, I was probably all of the running and the crazy skiing I did growing up in Colorado.
00:15:24.320 --> 00:15:24.720
Totally.
00:15:25.039 --> 00:15:29.120
Totally falling and having many yard sales out on the uh the ski slope.
00:15:29.519 --> 00:15:31.600
Yeah, that can for sure do it.
00:15:31.840 --> 00:15:32.320
Yeah.
00:15:32.960 --> 00:15:36.559
Yeah, we were we were the not not the no helmet generation.
00:15:37.200 --> 00:15:39.519
That was probably not the best thing.
00:15:39.759 --> 00:15:40.720
Oh my goodness.
00:15:40.879 --> 00:15:51.759
Well, so give me a picture then of what treatment might look like, uh, you know, if you are taking into account those three areas.
00:15:52.960 --> 00:15:57.279
Yeah, so our so as physical therapists, we're very hands-on.
00:15:57.600 --> 00:16:00.480
So we do a lot of uh what's called manual therapy.
00:16:00.559 --> 00:16:13.840
We restore mobility to the upper part of the neck, we'll work on the jaw, the shoulders, trying to just allow the body to function as it should, in a way that, you know, as you go about your day, you're able to tolerate everything that your day throws at you.
00:16:14.000 --> 00:16:18.320
Um, and then some, you know, we want people getting back into exercise and things like that.
00:16:18.559 --> 00:16:28.720
So a typical treatment is you come in to our office, or we we also do uh virtual sort of coaching um process for people that aren't local.
00:16:28.799 --> 00:16:39.039
Um but if you're local, we do a very hands-on experience where we're putting pressure through the neck, through the jaw, trying to get uh the neck to move, those upper joints that I talked about.
00:16:39.200 --> 00:16:43.759
Um so that would be the focus on like what is causing your pain and how do we reduce it?
00:16:44.000 --> 00:16:49.440
When it comes to things like the developmental barriers, um, I'll just continue with that airway one.
00:16:49.600 --> 00:16:59.919
So, for example, if someone uh has a hard time breathing through their nose, their sleep quality is poor, they wake up with headaches, um, they know they clench or grind their teeth at night.
00:17:00.000 --> 00:17:06.400
Um, just simple suggestions, maybe wearing breathe right strips or mouth taping, something like that.
00:17:06.480 --> 00:17:09.519
Just there's a lot of benefits to breathing through our nose.
00:17:09.680 --> 00:17:15.920
And of course, we need to get into deep sleep and uh have our body recover when we rest.
00:17:16.000 --> 00:17:19.440
And so um it could be suggestions on airway.
00:17:19.680 --> 00:17:24.079
Uh, we could talk about things like sleep position uh or sleep hygiene.
00:17:24.160 --> 00:17:39.440
And then we could also refer them out to a sleep specialist who's someone who could um, from a more holistic natural approach, like help them expand, uh, open up their nasal passage, um, improve their swallow, what what does their tongue do?
00:17:39.519 --> 00:17:43.839
Um, because there's a lot of compensation patterns that can contribute to neck tension there.
00:17:44.160 --> 00:18:02.880
And then the third spoke, we um, so there's sort of a balance there because we'll look for things generally in someone's life that could improve, whether that's diet or you know, reducing stress somehow, um, increasing uh daily habits that are going to be helpful for their general health.
00:18:03.039 --> 00:18:04.799
And we'll make suggestions there.
00:18:04.880 --> 00:18:15.039
Uh, but sometimes that would look like you know, functional medicine or a naturopath or someone that has a background in like um understanding diet and how they could improve gut health.
00:18:15.279 --> 00:18:17.039
And so there's, yeah, like you.
00:18:17.599 --> 00:18:26.720
And so um, we we partner with providers like yourself um so that um that like I said, their thresholds as high as possible.
00:18:26.880 --> 00:18:34.880
And these are healthy people that we're working with because healthy people are able to tolerate pain and get out of pain much quicker than unhealthy people.
00:18:35.680 --> 00:18:36.400
That's very good.
00:18:36.559 --> 00:18:39.279
And by local, y'all, he's meaning Colorado.
00:18:39.440 --> 00:18:43.759
He's also a Colorado like me, and he's located in Colorado Springs.
00:18:44.160 --> 00:18:48.400
Well, let's kind of get into more of the nitty-gritty about headaches.
00:18:48.640 --> 00:18:56.400
I think a lot of people don't really understand the difference between like a migraine attention headache or a cervicogenic headache.
00:18:56.480 --> 00:19:02.640
Um, and tell me about those, like what the differences are and why distinguishing between them is so important.
00:19:04.000 --> 00:19:17.920
Yeah, well, it's important to understand that our our healthcare model is set up to um classify the different types of headaches, and there's there's dozens of different types, uh, but the big ones are the ones you just um laid out there.
00:19:18.160 --> 00:19:28.319
So when it comes to most of them, though, they are what are called um primary headaches, meaning they're gonna be classified in like the headache is the problem itself.
00:19:28.480 --> 00:19:34.640
And then a secondary headache would be a headache that has something underlying that is causing the head to hurt.
00:19:34.799 --> 00:19:35.119
Okay.
00:19:36.000 --> 00:19:44.640
Now, I'm gonna get into where we think differently, but I'm just kind of laying out how our healthcare system looks at them and uh comes up with these diagnoses.
00:19:44.880 --> 00:20:07.359
Now, most of them are gonna be based on symptoms, meaning when you sit down in your doctor's office and you say I have a one-sided pounding-throbbing sensation, and it's accompanied by light and sound sensitivity, and maybe you have a visual disturbance right before you get the pain, they would take those symptoms and likely give you the diagnosis of a migraine.
00:20:07.599 --> 00:20:12.160
Now, not every migraine looks the same, so there's nuances to it.
00:20:12.319 --> 00:20:17.839
One of the things I've seen throughout the years is the consistent thing is that they're debilitating.
00:20:18.000 --> 00:20:22.720
It's an intense pain, and they're usually they're disrupting your life in some way.
00:20:22.960 --> 00:20:38.480
So whether they're both sides or one side, or whether you have, you know, lights or sound sensitivities or not, um, because it's based on symptoms, um, having the diagnosis of migraine is helpful because it communicates to someone in your life that this is something that's debilitating.
00:20:38.640 --> 00:20:47.680
Whereas headache, and this is where I would say the primary difference is, um, saying that you have a headache can mean a lot of different things, you know, because just about everyone has headaches.
00:20:47.839 --> 00:20:58.079
And so the migraine diagnosis for the purposes of like the people we work with, it's helpful to communicate like how severe this is, because it's very debilitating.
00:20:58.240 --> 00:21:05.920
Um, but from the medical side of things, it doesn't necessarily mean that that medical community now knows what is wrong.
00:21:06.079 --> 00:21:10.319
Um, because the migraine itself isn't being diagnosed based on anything objective.
00:21:10.480 --> 00:21:15.920
So they just basically are taking your symptoms, putting them in a nice nice little box and giving it back to you.
00:21:16.079 --> 00:21:23.200
And then you take that little box and you go to all the providers and they give you medication based on like what you're showing them, which is that box.
00:21:23.279 --> 00:21:26.559
It's just a way of communicating to these providers.
00:21:27.200 --> 00:21:34.160
And so when we're trying to understand like why is this happening, oftentimes these diagnoses aren't super helpful.
00:21:34.480 --> 00:21:48.559
And we here at Novera just have to, and I'm sure you're the same, like you just have to work based on like what you see, the tests that you run, and then um because if we just base it off of diagnoses, you know, it's just kind of a a way to lead people to medication.
00:21:48.799 --> 00:21:52.799
Um, I'm probably oversimplifying that, but that's kind of how I look at it.
00:21:53.119 --> 00:21:57.839
So migraine is based on symptoms, tension headache.
00:21:58.000 --> 00:21:59.759
If I were to describe that, it's more.
00:22:00.160 --> 00:22:05.920
Tension headache typically builds throughout the day and is more of a band or strap-like presentation in the forehead.
00:22:06.079 --> 00:22:13.279
Um, tension headaches are seen as secondary headaches because they're connected to some level of tension that's building up.
00:22:13.519 --> 00:22:14.880
And that is generally true.
00:22:14.960 --> 00:22:25.279
Like the shoulders, the neck on both sides are angry, and like the stress of life uh builds throughout the day, and it feels worse typically evening or afternoon.
00:22:25.519 --> 00:22:33.440
Um, and then the other category you mentioned was cervicogenic headache, and that basically is just a fancy way of saying a headache from the neck.
00:22:33.920 --> 00:22:38.559
Now, this is this is mainly what we're talking about is neck headaches.
00:22:38.880 --> 00:22:42.000
And most people, I would say, have neck headaches.
00:22:42.319 --> 00:22:56.960
And so they've received the diagnosis of migraine, but I've been doing this for eight years, seen 1500 plus cases, people from all over the world with the diagnosis of migraine, not cervicogenic headache, and I work on their neck and their headaches get better.
00:22:57.200 --> 00:23:09.759
So based on that, they they have cervicogenic headaches, but for the purpose, I don't I don't necessarily find it helpful to just like correct people on their diagnosis because it doesn't really matter.
00:23:09.920 --> 00:23:15.920
Just like, okay, like you present with migraine symptoms, let's treat the things we find, and then you get better.
00:23:16.079 --> 00:23:18.000
That's kind of the world I live in, if that makes sense.
00:23:18.160 --> 00:23:18.559
Wow.
00:23:18.720 --> 00:23:23.759
So okay, I've only ever had one migraine, and this is very curious to me.
00:23:23.839 --> 00:23:27.440
It was when I was uh probably preteen age.
00:23:29.599 --> 00:23:43.279
I am now I was wondering if it was hormones, but I'm now wondering if it was probably one of those crazy ski accidents and having uh you know a neck injury and it just playing out as a migraine.
00:23:43.359 --> 00:23:44.559
Is that possible?
00:23:45.759 --> 00:23:46.799
Yeah, for sure.
00:23:47.039 --> 00:23:50.720
Um, so the pain has to come from somewhere.
00:23:50.880 --> 00:23:55.519
To say that you have a migraine is basically saying like the pain came from the brain.
00:23:55.759 --> 00:24:09.920
Um, and pain, um I'll I will say that pain can be manifest out of nothing, like the brain can make stuff up, um, like complex regional pain syndrome, things like that.
00:24:10.160 --> 00:24:13.680
But those things usually have a trigger to them initially.
00:24:13.839 --> 00:24:17.039
Um, it's not necessarily like just pain from nothing.
00:24:17.119 --> 00:24:28.240
Uh, and especially when we have a specific pattern like a migraine, um, that's that's kind of unique, like pain that starts here, wraps up and around, um, and is there for an episodic period of time, right?
00:24:28.480 --> 00:24:32.240
And so it would be odd for that to just be a brain problem.
00:24:32.640 --> 00:24:37.039
Um, but that's kind of where we land if we're saying, like, oh, that's just a migraine.
00:24:37.279 --> 00:24:43.680
And so what I would say is with any migraine presentation, we want to understand where the pain's coming from.
00:24:43.839 --> 00:24:47.680
And I haven't had one yet that I don't, I'm not able to find that.
00:24:47.920 --> 00:24:52.160
And so typically people have some history of neck trauma or something.
00:24:52.240 --> 00:24:53.759
Uh, and if they don't, that's okay.
00:24:53.920 --> 00:24:59.119
It's there's about 40% of people that are like, I never thought my neck was connected to this at all.
00:24:59.279 --> 00:25:00.799
So you're in good company.
00:25:00.960 --> 00:25:12.319
Um, the other thing, too, is when you think of hormones, so it's really the the fluctuation in hormones and in particular estrogen dropping that will reduce our threshold.
00:25:12.480 --> 00:25:20.799
And so we see it all the time where people come to us and uh women and they they would say, you know, I have a hormonal migraine or hormones are a big trigger for me.
00:25:20.960 --> 00:25:23.119
And that doesn't mean hormones are the problem.
00:25:23.519 --> 00:25:30.160
Um, it just means that you're again your threshold is uh changing as your hormones change.
00:25:30.319 --> 00:25:39.200
And so the body likes stability, and especially when the brain's having to deal with a noisy pain signal, anything that's not stable is going to put you in a vulnerable position.
00:25:39.839 --> 00:25:41.359
So that's one of those things.
00:25:41.440 --> 00:25:44.880
Like women just unfortunately their hormones aren't stable, they're fluctuating.
00:25:45.119 --> 00:25:54.640
And so it just is like you had a ski injury, your neck is injured, and then you went through your period and you got a bad migraine.
00:25:54.960 --> 00:25:56.319
That probably is it.
00:25:56.480 --> 00:26:00.000
Oh my gosh, the mystery might be solved.
00:26:00.160 --> 00:26:02.559
Seriously, I had no idea why that happened.
00:26:02.880 --> 00:26:07.519
Happened once, it took me out for an entire day, and it was awful.
00:26:07.839 --> 00:26:09.039
I felt yeah, they're terrible.
00:26:10.319 --> 00:26:18.079
But uh a fun fact, y'all, for those of you going through menopause, and what he's saying about estrogen is really on point.
00:26:18.480 --> 00:26:22.480
Um, add a lot of soy to your diet, it's a phytoestrogen.
00:26:22.559 --> 00:26:29.519
I started to do that the moment I was in perimenopause, and I will tell you what, haven't had a hot flash, haven't had a headache.
00:26:29.599 --> 00:26:31.680
I there are so many benefits.
00:26:32.000 --> 00:26:40.480
I mean, and and uh also look into HRT, of course, it's it's completely safe at this point right now, but you certainly don't have to suffer.
00:26:41.039 --> 00:26:45.920
Guys, one of my my my mottos, and I learned this during my dietetic internships.
00:26:46.079 --> 00:26:49.599
Thanks, uh Phil, for this, is never suffer.
00:26:50.319 --> 00:26:52.319
Okay, you do not have to suffer.
00:26:52.480 --> 00:26:54.559
There's always help out there.
00:26:55.519 --> 00:26:57.839
I have so many more questions to ask you, Dr.
00:26:58.000 --> 00:27:00.079
Jono, but we're out of time for this half.
00:27:00.319 --> 00:27:02.400
Will you come back for the second half, please?
00:27:02.960 --> 00:27:03.519
Absolutely.
00:27:03.759 --> 00:27:04.319
Let's do it.
00:27:04.880 --> 00:27:05.200
Okay.
00:27:05.519 --> 00:27:07.519
Everybody, thank you so much for joining us.
00:27:07.680 --> 00:27:10.559
Stay tuned for the second half of this conversation with Dr.
00:27:10.720 --> 00:27:20.880
Jono Taves as we continue exploring chronic headaches, migraines, overlooked causes of pain, and what lasting relief might actually look like.
00:27:21.920 --> 00:27:24.960
Thanks for tuning into the A New Insight Podcast.
00:27:25.200 --> 00:27:32.240
Please remember the content shared on this podcast is for entertainment purposes only and does not constitute medical advice.
00:27:32.480 --> 00:27:35.200
Tune in next time and evolve with us.
