Can Air Pollution and Heat Trigger Migraines? With Prof Gal Ifergane

Can migraines be triggered by what's happening in the environment around us?

In this episode of Causes or Cures, Dr. Eeks talks with Professor Gal Ifergane about his research examining the relationship between migraines and environmental exposures, including air pollution, heat, solar radiation, and weather conditions.

Many people with migraines report being able to "feel a storm coming" before an attack. But is there scientific evidence that environmental factors can influence migraine risk?

Professor Ifergane discusses findings suggesting that environmental conditions may help lower the threshold for migraine attacks in people who are already susceptible. The conversation explores the concept of migraine as a threshold disorder, where both biological predisposition and environmental triggers may interact to influence when an attack occurs.

Topics discussed include:

• The relationship between migraines and air pollution
• Heat, sunlight, and solar radiation as potential migraine triggers
• Whether weather-related migraines are real or simply anecdotal
• How researchers study environmental exposures and migraine risk
• The concept of migraine as a threshold disorder
• Genetics versus environmental influences
• Why migraine sufferers may want to pay attention to air quality as well as weather
• What these findings may mean for people living with migraines

If you've ever wondered whether migraines are influenced by more than what's happening inside the brain, this episode explores the growing evidence that the world around us may play a role as well.

About Professor Gal Ifergane

Professor Gal Ifergane is a neurologist, headache specialist, and clinical researcher who serves as Head of the Neurology Department and Chair of the Brain Medicine Division at Soroka Medical Center in Be'er Sheva, Israel. He is also a faculty member at Ben-Gurion University of the Negev.

His clinical and research interests include migraines, headache disorders, stroke, post-traumatic stress disorder (PTSD), and environmental influences on neurological health. Professor Ifergane has conducted extensive research on the epidemiology of migraines and the factors that may influence migraine risk and severity, including air pollution, heat exposure, and other environmental conditions.

Through his work, he seeks to better understand how the environment interacts with the brain and how these insights can improve prevention and treatment strategies for people living with migraine and other neurological disorders.

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Transcript

SPEAKER_00 0:00

Welcome to the Consort Your SpongeBob, your gateway to understanding health and groundbreaking medical research in the fundamentally easy to understand when we with Dr. East and your health. Join us as we sit down with the world's leading doctors and scientists to unravel the mysteries of health. From practical tips and welcoming to the latest breakthroughs in medical research, we cover it all. Don't forget to subscribe. Now let's ignite our curiosity and together dive into today's episode.

SPEAKER_02 0:30

Hello, hello everybody, and welcome to this episode of Causes or Cures. I'm Dr. Eats, your host, and thank you for joining in for today's show. So, headaches, migraines, migraines. Lots of people suffer with them. They're terrible things. But can air pollution trigger a migraine? What about heat, sunlight, or changes in the weather? Some of you are probably sitting there like, uh, yeah, they can. In this episode of Causes or Cures, I sit down with Professor Gal Ifergain to discuss his research, examining the relationship between migraines and environmental exposures, including air pollution, the air we breathe, heat, and solar radiation, the sunshine. The interesting part is he talks about how a migraine is built in layers, uh, which I think you guys will dig, especially those who are struggling with migraines, essentially where you have your underlying biology, right? But then the environmental triggers can cause you to hit the threshold for a migraine. And he explains that in the podcast, but it's kind of like where your biology is the loaded gun and the environment pulls the trigger. All right. So if you are a migraine sufferer, this one is for you. And give me a few seconds here again while we connect to him and learn more. We are connecting with Professor Gal Ifrigen, and I'm sorry if I massacred that name, but I try. Um, and we're gonna talk about migraines, which a lot of people struggle with. And but first, would you thank you for joining in, first of all, and would you tell our listeners a little bit about you, what you do? Anything else you want to say?

SPEAKER_01 2:24

As you said, my name is Gal Ifergan. And that's the way it is said, it is pronounced. Uh I'm a neurologist, I'm the head of the neurological department, the neurology department in the Sooka Medical Center, the hospital, the central hospital for the southern part of Israel in Beersheva. And I'm a I'm a clinician, mostly specializing in headaches, but uh doing all general neurology stuff, and a researcher, researching uh phenomena that affect the community I live in, I treat and I treat. And um I think you're invited here in the me here in this capacity.

SPEAKER_02 3:13

Yeah. Um yes. So let's talk about migraines. So people with migraines have been saying for years that they can feel a storm coming, right? You hear that, at least we hear it over here. So in your yeah, are they on to something?

SPEAKER_01 3:30

First of all, one thing I learned many years ago is that when patients tell you something that doesn't make sense, usually they are right. And uh usually they are correct, and you and the physics the physician doesn't really know how to understand it in what framework to put it. So when patients say that they can feel the storm, or that they have a migraine in a specific weather, or they can tell which day they will have the headache, uh, they're probably right.

SPEAKER_02 4:03

They're probably right.

SPEAKER_01 4:05

Yeah, they're probably right. And if we don't know uh why that happens, or how is it possible, then we should study it more and we'll understand at the end. But the patients are right.

SPEAKER_02 4:19

Okay, the patients are right. Okay, I like that. And that's kind of what you did in this study that I read. You studied a little more into, I guess, the environment and associations with migraine. And you talked about this layered approach um or layered view of how a migraine happens uh related to environmental triggers and temperatures. So can you just talk a little bit to our listeners about that, like this layered model that uh regarding the other thing?

SPEAKER_01 4:51

The layered model is basically, in other words, of putting what we already know. Uh you know that you hear sometimes that uh someone has migraines because of the stress, or because of hormones, or because of food they're eating, or whatever. But patients don't have migraine because of the stress, or because of what they eat, or because of hormones. Patients have migraine because they have a biological tendency, usually genetic, to develop migraine episodes, which are an episode that lasts from a few hours to a few days, that manifest themselves in headache with typical features and other accompanying features. This tendency is a biological tendency, mostly inherited. About 70% of patients with migraine have a first degree relative with migraine. I suffer for migraine, and actually my entire family suffers for migraine from time to time, and it goes in the g in your genes. So, first of all, is the layer of the biological susceptibility of having migraine attacks. That's the first layer. The second layer is how severe is your migraine. What the determinants of how, let's say, migrant days per month you have. This is something that changes through life. It's not something stable. You can have very severe migraine with, let's say, uh 10 or 12 migraine days per month in certain periods of your life. This migraine can become even worse and become chronic migraine in another period in your life, and it can get much better in other periods of your life. About 60 or 70 percent of women with migraine get much better after they completed the transition to menopause, for example. So things change internal or external factors change the way you uh the migraine, how severe is the migraine, and how frequent the migraine attacks are. And the third layer is the immediate triggers, the triggers that cause you to have a migraine today but not tomorrow. You have it on Monday but not on Friday. Well, you can have four migraine days to a month, but why did it happen today? Why not tomorrow? And those are the immediate triggers. Now, in this uh in this uh article, in this study, we used this conceptual model to look at the environmental influences in an urban in migrant sufferers in an urban community. Uh that that's the layered approach.

SPEAKER_02 8:08

The layered, yeah. I like that. Okay, so biology, first layer, second layer, severity, third layer triggers.

SPEAKER_01 8:16

Yeah. So it's gonna be you don't get migrants because of the stress, for example. Maybe in a certain period of your life you are more stressed, and then your migraine gets more severe. Right. Maybe there is a specifically stressed day that uh cause that you have a migraine, you have the migraine on this this specific day.

SPEAKER_02 8:39

So it's kind of like a threshold disorder?

SPEAKER_01 8:43

Uh another way of looking at it, that looking at it as a threshold. You have migraine, yeah, the threshold for a migraine attack is changing from in different periods of your life. It can be lower, it can be higher. And in certain days you reach the threshold and there is a migraine attack. That's another way of describing the same thing.

SPEAKER_02 9:07

Yeah. Um, and it's like a it's chronic.

SPEAKER_01 9:10

I mean having migraine is a migraine is a chronic condition.

SPEAKER_02 9:15

Chronic.

SPEAKER_01 9:16

Actually, migraine is the most common brain disorder in the world. Approximately between 10 to 15 percent of the adult population suffers from migraine in every community. You look at it. Somewhere between 10 and 15 percent, almost three times more common in women, usually begins at a younger age, in 20s, uh, and people that can start in uh in uh as in kids and can start in the elderly, it can start at every age, but uh the most common age to start suffering from migrant attacks is uh the 20s. And uh people suffer people who suffer from icon suffer from ibn for their entire life in different intensities, in different uh severity.

SPEAKER_02 10:15

Yeah, yeah. And so it's if it's more common in women, it's it is it linked to sex hormones?

SPEAKER_01 10:22

Or first of all, every primary pain disorder is more common in women.

SPEAKER_03 10:29

Okay.

SPEAKER_01 10:31

Second, there is a connection to sex hormones. Yeah, the difference between the prevalence of migraine begins after the age of uh menar. If you take young kids, then it's exactly the same prevalence that there is exactly the same percentage of uh young kids, male and female, suffering from migraine, uh, until you get to the age of men and start men starting menstruating. And then you'll see that it becomes more prevalent in uh women, in girls. And one of the strongest triggers for migraine attacks is uh menstruation just before menstruation, because the estrogen level drops just before menstruation and it triggers a migraine attack. Usually, many women or most women with migraine gets better during pregnancy, not at first, not at the first part trimester, but at the second and third trimester, they get better because estrogen is continuously high. There is no drop in the level, right? And about two-thirds of women get better after menopause because estrogen remains low. There is no, again, there is no going down. There is no estrogen withdrawal, it's always low.

SPEAKER_02 11:51

Right. Well, that's the positive side of menopause.

SPEAKER_01 11:55

Positive side of menopause, yes, but it's only two-thirds. There's a third that doesn't. Oh, many women, many women, menopausal women say they promised me that it would get better after menopause, but they didn't.

SPEAKER_02 12:07

They feel deceived.

SPEAKER_01 12:09

Yeah, they feel deceived, and uh you can understand why.

SPEAKER_02 12:13

Yeah, yeah. Geez. So you were looking at environmental triggers, air pollution, right? I guess, and temperature?

SPEAKER_01 12:24

I was looking at the climatic factors, temperature, humidity, um, solar radiation, and so on. And we were looking for air pollution.

SPEAKER_03 12:39

Okay.

SPEAKER_01 12:40

Air pollution gaseous and particular, particulate matter.

SPEAKER_02 12:45

Right, right, yeah. Um, so can you summarize the main findings for our listeners, kind of like what they would want to know? Um, you measured all this stuff?

SPEAKER_01 12:57

First of all, the the study was done in a city in an urban area.

SPEAKER_03 13:02

Okay.

SPEAKER_01 13:03

Things might be different in non-urban areas. It was done in urban in urban areas where we took uh 7,000 uh migrant patients. Uh, we knew where they lived, and we knew every time that they went to the emergency department or for emergency care because of a severe migrant attack. And we knew how many migrant-specific medications, triptons, how many they were taking each uh three-month period. We had the purchases for uh data, the drug purchases data. And since we knew all that, we knew how severe the migraine is in every three-month period, and we knew when they had a very severe migraine attack. We also knew their address, and according to the nearest measuring station, we knew what were what were the climatic uh factors in every day and what was the level of uh air pollution in those days. The first finding is not surprising. Air pollution is bad for me. Look surprised. It's not surprising. When you have a high level of uh of uh air pollution, you get a higher risk of developing a severe migraine attack that will bring you to medical care.

SPEAKER_03 14:41

Okay.

SPEAKER_01 14:42

So, first of all, it sounds as if it's intuitive, but usually when you think about uh air pollution, you think that it affects the lungs.

SPEAKER_04 14:52

Yeah.

SPEAKER_01 14:52

The people with asthma, people with lung diseases should be careful, and you think the lung that that's the place where air pollution works. And that's a common mistake because particles entering the lungs they uh initiate an inflammatory cascade, an inflammatory process that affects the entire body and affects many systems, it affects coagulability, it affects the risk of you having a heart attack or a stroke, it affects the inflammation level in the entire body. On the second hand, particles entering the nasal cavity activate receptors that interact specifically with brain structures and can uh modulate the risk of having a headache attack, a migraine attack. So air pollution is not only lung diseases, it's basically everything.

SPEAKER_02 15:56

Yeah.

SPEAKER_01 15:57

And uh migraine as well.

SPEAKER_02 16:00

So just going back, it interacts with the receptors in the brain? That's the mechanism.

SPEAKER_01 16:06

It interacts with receptors, the the air pollution does not enter the brain. There's no way it will enter directly the brain, but it interacts with receptors in the nasal cavity.

SPEAKER_02 16:18

Nasal cavity, okay.

SPEAKER_01 16:19

Yeah, nasal cavity. And uh, I apologized in the beginning for the English.

SPEAKER_02 16:26

So I don't know, no. I just I could have tuned out. I just wanted to understand. I was thinking one thought, and I was like, wait, how does it do it exactly?

SPEAKER_01 16:35

Okay, and uh receptors that interact with the particle in the nasal cavities, and they are directly connected to the brain.

SPEAKER_02 16:44

That I know. Thank God. Um well, you know, what I was thinking, because sometimes my brain goes into like a philosophical direction, um, as you were saying all this stuff, you know, we have this whole push for longevity, and well, it's over there too. Everyone wants to live forever, and everyone says what their biological age is, but we're not necessarily talking about air pollution as much as we should be when it comes to like longevity and just staying healthy. Do you know what I mean? Like it's we're talking about wearables and stuff, but air pollution is sort of like an elephant in the room, I feel like. Like some people talk, you're talking about it, but it's not like this, it's not like diet.

SPEAKER_01 17:24

That's all that's and let me take it another step forward. Everybody's talking about climate change. Yes, but climate change, which was made into a political issue, questions there about emissions and so on, but uh I don't know how to stop climate change, and I have no idea. Um but climate change is happening, and no one can deny it. And climate change means that you get heat waves, and climate change means that you have more sandstorms, and you have more wild fires, and you have more extreme days in regard to um to air pollution, and all of those are parts of the climate change. Once in Europe, you had a heat wave once in a decade, and they would write books about it. Today it's an expected thing that happens a few times a year. Wildfires in California or wherever were once a rare event. They are a common event now, and huge areas are affected by the particular matter that is uh driven from it.

SPEAKER_03 18:44

Yeah.

SPEAKER_01 18:44

So that's the climate it's not only that air pollution is an issue, but extreme conditions, extreme climatic conditions and extreme uh pollution conditions are something that has become a part of our life, and it will be more so in the years to come. And uh I don't know how to stop the climate change, but as a physician, I must study what it means for the health of my patients, for the health of communities, and try to find ways, and we need to find ways to mitigate it because it's here to stay.

SPEAKER_03 19:29

Yeah.

SPEAKER_01 19:31

Even if we like to believe that we will stop it somehow.

SPEAKER_02 19:35

Yeah. Well, it like you said, it's a political issue, and now it's so interesting.

SPEAKER_01 19:41

I have no understanding in it, and but uh it doesn't seem that as a species, the human race is doing a very good job in stopping climate change. So probably it's gonna continue.

SPEAKER_03 19:56

Yeah.

SPEAKER_01 19:58

And uh we need to be prepared and we need to think about living and treating patients and uh and uh managing our lives in uh in areas that have extreme conditions from time to time, heat waves, uh, extremes of uh particular monetary pollution, extremes of other pollutions, and we need to study it and to study how to mitigate it. Burying our heads in the sand will not help us prevent those effects.

SPEAKER_03 20:40

Right.

SPEAKER_01 20:41

They will they are already here and they will get worse.

SPEAKER_02 20:46

Yeah. That's kind of a dismal thought because it's like it's not gonna stop because then we'd have to change our whole way of life, which we're probably not gonna do.

SPEAKER_01 20:57

We always change the way of life, we adapt to the conditions that we face.

SPEAKER_02 21:02

Yeah, but live in a bubble. I don't want to do that.

SPEAKER_01 21:07

You don't necessarily have to live in a bubble. It's not the when you think about uh global heat and global warming and climate change, you think about the oceans flooding everything and us living in bubbles under the sea. But that's not what's gonna happen then, let's say, in a decade or two. It's gonna be a little bit warmer. There are gonna be more days of extremes, there are gonna be more days of extreme temperature, more days of extreme particular matter uh pollution and gaseous pollution, and we will have to find the ways to mitigate the health effects of those things and find ways to uh to maintain good health and maybe live forever. As you said.

SPEAKER_02 22:01

No, don't want to. Don't want to do that.

SPEAKER_01 22:05

Um, but humans are looking for that since the beginning of time.

SPEAKER_02 22:09

Kudos to anybody who does. I'm I'm hoping that there's something better after this world.

SPEAKER_01 22:16

Yeah, I'm I'm with you in that.

SPEAKER_02 22:18

Um okay, so I digress. So air pollution is bad.

SPEAKER_01 22:25

Air pollution is bad. That's the first thing.

SPEAKER_02 22:27

Okay, what are the other things?

SPEAKER_01 22:29

The other thing is that air pollutants affect us differently in different times of the year. In summertime, particular matter is way more and may work worse than it is in the winter. It gets probably because it gets uh stuck in your lungs uh better in the heat and the humidity of the summer, but not in colder weather. So things affect you differently in other times of the year. And the third thing is that the cumulative effect of those uh of those factors changes the threshold, changes the second layer, changes the severity of your migraine. If you had a few months of uh higher levels of pollution, then your migraine is gonna get worse. Not specifically on the day of the pollution, but in the next few months.

SPEAKER_02 23:37

Oh, that's interesting. The timeline is interesting.

SPEAKER_01 23:41

So uh you're not only the severity of your migraine is not only affected by factors controlled by you, what you eat, what you the stress levels, the how much you sleep or whatever. Yes, it's also determined by external condition and by your exposure to um uh to air pollution and to extreme climatic uh factors.

SPEAKER_02 24:09

Yeah. So uh did anything surprise you about the results you found?

SPEAKER_01 24:16

No, no. It wasn't surprising. That was the hypothesis.

SPEAKER_02 24:20

So nothing surprised you. Did anything was anything like better or worse than you thought it might be?

SPEAKER_01 24:27

Um first of all, no. No, but the the issue the issue is that understanding that and the not only understanding but the establishing those factors makes it possible for us to start to the next level, which is to study who is more affected than others or less affected than others by the changes in pollutants or in heat. Who is protected from that? Who is uh specifically vulnerable to that. Is that the study you're doing? We are currently starting to look at at this at uh types of buildings. What types of uh buildings that you live in? Let's say if you live in a in a house or you live in an apartment in a 25-storey uh building, who is more vulnerable? Which one which where is it better to live in order to mitigate the effects of uh of uh of the pollution in a city? Which people are more prone of suffering from that? If you lived in those conditions your entire life, is it the same as someone who emigrated to those conditions?

SPEAKER_03 25:58

No.

SPEAKER_01 26:02

That's the question that we that we ask now. And maybe in a year or two we'll uh talk again and uh have this answer. But establishing those factors was the first step in trying to understand mitigation, to understand how we can what kind let's say of a city should we build in the future so people will be uh more protected from those effects.

SPEAKER_02 26:32

Or should people not live in the city at all?

SPEAKER_01 26:36

Uh people live in cities.

SPEAKER_02 26:39

What if they don't have to? If what would you say? Would you say, hey, go say I had a migraine, I'm like, should I move to the city or should I live next to the cowfields?

SPEAKER_01 26:48

That's another question. By the way, if you look at uh at urban areas versus um non-urban areas in the US, for example, you don't find less migraine in non-urban areas. The city is not the cause for migraine. Again, the biological trend. You don't get that from uh you have it the same way if you were living outside the city. But uh that's another question. We are focusing on the city, on the on Beersheva, uh, but which is where I work.

SPEAKER_02 27:30

Is it a big city?

SPEAKER_01 27:33

No, it's not it's not a big city.

SPEAKER_02 27:36

Well, I mean it's relevant.

SPEAKER_01 27:37

For someone from New York, it's not a big city, yeah. It's uh 200,000 uh people city. Okay, a large town.

SPEAKER_02 27:46

And your your summers are hot.

SPEAKER_01 27:51

Like super yeah, so Texas hot.

SPEAKER_02 27:56

You're like in like the desert. Oh, so we have like cool nights, kinda cool nights?

SPEAKER_01 28:03

Cooler nights. Higher temperature during the day in the summer we get for more than uh 40 degrees Celsius. I don't know how to say it.

SPEAKER_02 28:12

Yeah, that's just hot. That's just hot.

SPEAKER_01 28:14

But that's very hot. Uh but there are areas in the US that are exactly like that.

SPEAKER_02 28:19

Yes, yes, there are. That's true.

SPEAKER_01 28:22

Um and you see that in Europe you get more and more days. In Southern Europe, you get more and more days with such temperatures.

SPEAKER_02 28:34

Right. So basically, you're saying like your results would be you can generalize them to different things.

SPEAKER_01 28:40

More than that. Belcheva today is uh Paris in uh 15 years.

SPEAKER_02 28:49

That's scary. That's scary for summer travelers, and yeah.

SPEAKER_01 28:54

That's scary for uh Parisians, yeah. That's scary for Europeans.

SPEAKER_03 28:59

Yeah, yeah.

SPEAKER_01 29:01

They have to live there. Yeah not for summer travelers.

SPEAKER_03 29:04

Yeah, I guess.

SPEAKER_01 29:05

Summer travelers can go to Iceland, but uh there are people who actually live and work in those areas.

SPEAKER_02 29:13

So what do people do with this information now? I mean, because it you have you obviously treat patients with migraines, and now you did this research. So, would you tell them to start like following the weather or educate them or don't go outside?

SPEAKER_01 29:32

First of all, people don't need me in order to know that for themselves. They know that you started our conversation by saying that. Yeah, people with migrants know that.

SPEAKER_03 29:44

Yeah.

SPEAKER_01 29:47

Now, not everybody has a choice, but let's say you have a choice and you can work from home two days a week. Um, let's imagine that. In which ways uh days would you prefer working from home? On the days in which the weather uh forecast is telling you that there will be extreme con extreme um air pollution conditions or extreme heat conditions, those will be the days that you will rather stay at home uh with air conditioning, maybe with filtering systems for the dust. And you will play use those days to work from home. Or maybe choose not to walk too well or not or to commute in other ways that make you less exposed.

SPEAKER_03 30:46

Yeah.

SPEAKER_01 30:47

Now people do that, they do that by themselves. And that's not much that's not something that uh you have to tell them. People automatically do that without knowing that they are doing that.

SPEAKER_03 30:58

Yeah.

SPEAKER_01 30:59

But uh here we have a rational explanation for that, right?

SPEAKER_03 31:05

Right.

SPEAKER_01 31:06

And the weather forecast tells you when it's gonna be an especially hot day, and it also tells you when there are gonna be an extreme air pollution conditions.

SPEAKER_02 31:17

Right. You also looked at sunlight itself, right? Sunlight?

SPEAKER_01 31:26

Solar radiation, yeah.

SPEAKER_02 31:28

Solar radiation. The sun. And that was a trigger too, right?

SPEAKER_01 31:34

Uh that's also a trigger. It goes with extreme heat, it goes with uh extreme exposure, yeah, extreme exposure to uh to sunlight. Yeah, it goes together, and it's also a factor that affects you. And uh by the way, migrant patients know that there are days that they should leave home with shades, with sunglasses, with sunglasses, yeah. And to uh prevent the effect of the extreme light on the on the migraines. Look around you, you'll find people that do that um intuitively without even knowing knowing why.

SPEAKER_02 32:18

Yeah, no, no, no, I that makes sense. Um I mean I do this, but I have asthma, so like I always pay attention to air quality, and like right now the air quality is terrible. Um, so but I like to work out, so but uh it's it's it's New York City.

SPEAKER_01 32:33

I think the air quality is terrible 365 years a month uh days a year, no?

SPEAKER_02 32:40

Yeah, I don't know. It feels worse because I feel like I've been having more issues. Like um, I mean I just feel it, you know. You just I just know like I'll be like, okay, that's not good. Even this morning I was outside working out and I was like, oh, but I started like bringing like a huge thing of water with me and my albuterol with me.

SPEAKER_01 32:59

The the shiva conditions are um we look at them as unique, but the same changes and the same issues affect everyone. Yeah, the particulars are somewhat different. Yeah, and they you don't get many dust storms in New York City, right? But you have other types of uh of uh uh pollution, yeah, and the the principles are the same.

SPEAKER_02 33:30

Yeah, I remember.

SPEAKER_01 33:31

You have more and more days that are extreme.

SPEAKER_02 33:34

I remember from public health school, um, in one of my classes, the professor talked about particulate matter in the heart, you know, and how like it was a really strong association. And again, not something you like you wouldn't really think about, like how like, oh, it's messing your heart, like air pollution.

SPEAKER_01 33:52

You just messing your coagulation system, it's messing with your inflammatory system and affects every organ and every system in your body. Yeah, it even affects your mood if you think about it.

SPEAKER_02 34:05

Oh, for sure. Yeah, mood's connected to everything. But you haven't mentioned the microbiome yet.

SPEAKER_01 34:11

That's a first- No, I didn't say anything about microbiome, and I have nothing to say about microbiome.

SPEAKER_02 34:17

Usually I every podcast I have, somehow the microbiome enters the conversation. I'm like, there it is again, there it is again, but not this.

SPEAKER_01 34:25

But in this podcast, you mentioned it. Nothing to you come for me.

SPEAKER_02 34:29

I did because I was like waiting for it. It was like, I mean, I joke. I'm like, it's like okay, everything is connected to the microbiome.

SPEAKER_01 34:35

Like I didn't say anything about AI as well.

SPEAKER_02 34:39

I know. But I know I it is interesting. So okay. Here's a here's a strange question for you, but one that the listeners will like. And you so feel free to answer it or not. But if you could give migraine suffers one superpower, would it be the ability to predict the weather or the ability to predict the air quality?

SPEAKER_01 35:02

I'm not in the business of granting superpowers. That's a that's not me, that's someone else. Um but you don't need a superpower for that. You can predict the weather and you can predict the air quality. It's on TV, it's on TV, it's on the internet.

SPEAKER_03 35:22

Yeah.

SPEAKER_01 35:23

They are publishing it every day, there's a forecast. You don't need a superpower.

SPEAKER_02 35:29

Yeah.

SPEAKER_01 35:30

If you can have only one superpower, get something else.

SPEAKER_02 35:34

Yeah, something else. Yeah, I agree with that. Like I would pick flying or teleporting or something like that.

SPEAKER_01 35:39

Something more fun.

SPEAKER_02 35:40

For sure. Yeah, for sure. Um, but this is like a nerdy podcast. So so when you talk about climate change and air pollution, and you kind of say like it's happening no matter what. I mean, do you can it would you say it's like the biggest health threat of our time, or that you know we're not ready for it? Or are you like I mean, because it's not just migraines, it's not just lungs, it's tick-borne illnesses, mosquito-borne, you know, vector-borne illnesses, and then all the other stuff.

SPEAKER_01 36:11

It affects every aspect of uh health.

SPEAKER_02 36:16

Yeah.

SPEAKER_01 36:16

Every aspect of health. Uh transmissible diseases, like you just said, uh degenerative diseases, uh, cardiovascular diseases, cancer, whatever, whatever you want. And it's something new. It's something that is changing in front of our eyes. And we have to adapt for that. We have to change. The way we practice medicine, the way we run our lives. Maybe if you go back to migraine, maybe a patient should use one medication for certain days and another medication for other types of days. When you are exposed, maybe you need a treatment, a preventive treatment that you will take when you are highly exposed, and another treatment when you are not. Maybe we should treat patients, let's say, make a cardiovascular prevention differently for people who are exposed to more pollution and for people who are exposed to less pollution. Maybe we should be more precise in the way we practice medicine according to people's exposures. Maybe. But it's changing in front of our eyes. The conditions are changing, and we can't rely only on the data that we had, and we need to study and to be prepared to study this issue in order to have the ways of practicing medicine and the way of treating people in the decades to come. We need to be more flexible in the way we think of what are the factors that determine health and how to give precision treatment to people with chronic conditions.

SPEAKER_02 38:21

Yeah. My last question for you, just because you deal with migraines, uh, do you recommend any kind of like lifestyle changes or diet things, like I don't know, yoga meditation, or does it just vary from person to person?

SPEAKER_01 38:39

First of all, do whatever is good for you.

SPEAKER_02 38:43

That could be dangerous advice.

SPEAKER_01 38:47

When you look for, for example, for on for diets, you can always find someone who will tell you that a lactose-free diet made his life amazing and these migraines go away, and someone else will say that it's a ketogenic diet that did it, and someone else will say it's a carrot-free diet that uh made these migraines go away. But if you systematically examine, you system, you you do a clinical trial, and you take people and give them a specific diet, a lactose-free diet, and others don't, you see that it's systematically, it it's you can't find a specific diet that is good for you. Some people find actose-free diet better than other one other, but those are specific people and that are suited for that. Another thing is you always ask, uh, we recently published a paper in Cephalgia about uh physical activity and migraine. And you always say, well, physical activity is good for you, right? Yeah, but if you have severe migraine, let's say you have 10 days a month, you get a migraine, and people with severe migraines often have uh higher depression rates and also have more uh burnout, uh occupational burnout, and whatever. If you have all those, your ability to be involved in physical activity. I mean, the physician can recommend it, and you can say, Yes, you should work out, but you can't work out. You need to get better in order to work out. So, first of all, you need to treat to decide to treat your migraine, get better, and then start working out, and then maybe you will need less drugs, less medications. Right. But you can't we have a tendency in medicine to blame the patients. You're sedentary, you don't work out, you live in a lot of stress, whatever. But we for we sometimes forget that our duty is to help a patient achieve a be uh the best uh condition we can for the lifestyle that they chose for themselves. I mean, I live, I'm a physician, I work in a hospital, I live in a lot of stress uh lifestyle. I get phone calls in the middle of the night and whatever. If a physician will tell me that I should uh remove the stress part of my life from my life, I will probably laugh to his face because that's my choice. I chose to live this kind of life. That is my choice. I chose to live in a specific way. So some lifestyle modifications are not relevant because that those are the kind of things that I chose for myself, or every other patient chose for himself. Others are factors that the patient just can't change. They can't change because of their migraines or because of their medical conditions. And there are things that are just the reality of life. You know, during March and April, during the uh Iran war, people in Israel were walking in the middle of the night a few times because of air-aid silence, because of Iranian missiles. You can recommend them to get seven hours sleep a night. That will be healthy for them, but it's not healthy not going to the air aid shelters or to the safe room in your house when there's a missile approaching you. The risk is higher.

SPEAKER_03 43:01

Right.

SPEAKER_01 43:02

So and they don't sleep. They don't sleep because that's reality.

SPEAKER_03 43:06

Yeah, yeah.

SPEAKER_01 43:07

And you can't avoid looking reality in the in the eyes.

SPEAKER_03 43:13

Right, right.

SPEAKER_01 43:14

So lifestyle modification is very it's very popular to talk about lifestyle modification, but many times you can't, or you don't want to change your lifestyle.

SPEAKER_03 43:29

Right.

SPEAKER_01 43:29

That's the life child style you chose.

SPEAKER_02 43:32

Right. No, that makes sense. And sometimes you'll hear someone can't sleep because their kid can't sleep, and you know, the uh the parent is obviously gonna like stay up with the kid if the kid's troubled, and it's just something like it just reminded me of a story I heard recently, something like that. But yeah, you're right. Sometimes you should do this, but um like real life has other plans.

SPEAKER_01 43:55

So it can be wonderful if you will sleep seven hours a night, but you have a young kid that is sick, for example.

SPEAKER_03 44:02

Right.

SPEAKER_01 44:02

Or just all just needs to be fed every for about four hours.

SPEAKER_03 44:06

Right, right. Yeah.

SPEAKER_02 44:09

Well, life is complicated.

SPEAKER_01 44:11

Yeah, life is complicated.

SPEAKER_02 44:14

Well, this was great. Thank you uh so much for joining. And hopefully it'll get my audience thinking about you know air pollution temperature and migraines. Uh and you know, and then the bigger picture stuff too. Um, hopefully.

SPEAKER_01 44:30

And then maybe And maybe we'll be able to talk about it in year or two, and I'll tell you some new stuff about it.

SPEAKER_02 44:36

Yeah, definitely. The precision stuff. Yeah. Yeah. Um, but thank you for coming on and enjoying. Yeah, the rest of your evening there.

SPEAKER_01 44:47

Goodbye.

SPEAKER_02 44:48

Bye-bye. All right, everybody. Thank you so much for joining in. Please share this episode, especially with anyone struggling with migraines. They suck. They really do. Not your friends, uh, the migraines. Don't forget to subscribe to the podcast and the newsletter. There's the good stuff in the newsletter. I'm trying to grow it. I hope you subscribe. And now it's time for the closing quote. This one is from Ivo Morales. Sooner or later, we will have to recognize that the earth has rights too, to live without pollution. What mankind must know is that human beings cannot live without Mother Earth, but the planet can live without humans. Yes. All right, guys, that's it for now. Uh, I hope you tune in next time. Have a great day out there or night, wherever, you know, whatever, whatever the sun is doing in your backyard. And uh goodbye for now.