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Migraine and Headache Relief Solutions

Dr. Arun Jagannathan discusses the difference between migraines and headaches, the painful symptoms of migraines and treatment options available.
Migraine and Headache Relief Solutions
Arun Jagannathan, MD
Arun Jagannathan, M.D. received his medical degree from the University of Illinois College of Medicine in Peoria, Illinois. He completed his Transitional Internship and Diagnostic Radiology Residency at St. Luke's Medical Center in Milwaukee. He went on to complete a fellowship in Vascular Interventional Radiology at Massachusetts General Hospital in Boston. He is a board-certified radiologist who specializes in interventional radiology procedures.

Kaleb Miller (Host):  Hello and welcome from wherever you’re tuning in and thanks for listening to the Well Within Reach Podcast series by Riverside Healthcare. My name is Kaleb Miller. I’m going to be your host for today. And today, we’re going to be talking about something I think everyone has probably experienced or is experiencing currently and that’s migraine and headaches. And we’re going to be talking a little bit about how we can find some solutions for relief in that here, locally at Riverside. Today, I am joined by Dr. Arun Jagannathan. Dr. Jagannathan is an Interventional Radiologist here at Riverside in Kankakee, Illinois. We’re going to be talking about some of the options that our patients in our community have to find some relief in headaches and migraines. Dr. Jagannathan, thanks for joining us today.

Arun Jagannathan, MD (Guest):  Thank you Kaleb.

Host:  So, Doctor, tell us a little bit about yourself and then your role here at Riverside.

Dr. Jagannathan:  So, Kaleb, I am a Vascular and Interventional Radiologist. I’m the Section Chief of this department at Riverside. So, I underwent four years of medical school training followed by five years of diagnostic radiology training followed by a year of vascular and interventional radiology fellowship before I started working at Riverside straight out of fellowship back in July of 2008. So, I’ve been at Riverside for almost 12 years now.

Host:  So, you are not unfamiliar to the Kankakee area?

Dr. Jagannathan:  Correct. I do enjoy being able to work in this community and I try and provide as good care as we can from the Interventional Radiology standpoint to the people of the Kankakee county.

Host:  Great. And so I mentioned we are talking a little bit today about migraines and headaches. It’s something that has been in my family in the past. It’s something that I’ve dealt with, my parents have dealt with. It’s really common. So, why are migraines and headaches such an issue for those who have them so frequently?

Dr. Jagannathan:  Well, migraines and headaches as you know, and as a number of people know because it’s a very, very common disorder; they can be incredibly debilitating. They can prevent you from functioning, doing any of the normal daily activities that you are used to enjoying. They can make you unable to even work at even a very limited pace. They can completely turn your life upside down and they can be very difficult to control, and they can be very difficult to treat. A lot of people that suffer from migraines and other forms of headaches have gone through all different types of treatments; medical treatments, procedural treatments and even alternative therapies, trying to achieve relief for their symptoms.

Host:  Yeah, absolutely. And there’s been a buzzword that I’ve been hearing associated with migraines and headaches and that is sphenopalatine ganglion or I’m going to shorten it SPG. This is a word that some listeners may start to hear in association with this. What is the SPG?

Dr. Jagannathan:  So, the SPG is just a small bundle of nerves that is located in the posterior nasopharynx area and this is just a bundle of nerves that is one of the nerves that is closely associated with one of the cranial nerves, the trigeminal nerve which is one of the main nerves involved in headache disorders. So, the fact that the sphenopalatine ganglion is this particular location and, in many ways, can be kind of a pitstop for nerve signals that are conducted from the trigeminal ganglion; it can be a significant source of problems in patients that suffer from headache disorders.

Host:  Yeah, and where is that located specifically within the head region? Where would that be located?

Dr. Jagannathan:  So, kind of in the back of the nasopharynx. So, if you think back to how the back of the nasal cavity region just deep to the mucosal layer of the soft tissues back there in the posterior nasopharyngeal area, this bundle of nerves kind of lives in a small little kind of a little alcove back there.

Host:  Yeah so this is obviously playing a really big role, this SPG in the headaches and migraines these patients are experiencing.

Dr. Jagannathan:  Correct. It can. There is a lot that we still do not completely understand about migraines and other types of headache disorders, but we do know that in certain patients, this particular cluster of nerves can play a very, very important role and anything that we can do to potentially disrupt overactivation of this, could be beneficial to these patients.

Host:  Yeah, yeah absolutely. So, you actually perform a procedure that can help relieve this pain and will block the pain to those nerves. Walk us through that procedure and what that kind of looks like.

Dr. Jagannathan:  Sure, no problem. So, for many, many years, people have been trying to control overactivity of the sphenopalatine ganglion through a variety of methods including direct access into the nerve with a long needle which in some cases has been even introduced through the bottom of the optic canal. What we’ve found now is that we can actually administer a numbing agent, lidocaine directly to this nerve bundle through the nasal cavity without using any type of sharp needle, just using a small plastic catheter introduced in the right location and then positioned under x-ray visualization and then a small injection of this numbing agent, lidocaine can potentially quiet this nerve down and quiet down some of the communications and the pathways that are involved with the headache generation.

Host:  So, is this an outpatient procedure, inpatient procedure? What will patients exper- what can patients expect I should say?

Dr. Jagannathan:  This is an outpatient procedure. The procedure itself takes anywhere from five to ten minutes. It’s done in an x-ray room with the patient laying flat on the table after having been kind of described the procedure by myself and or one of my partners and the x-ray technologist. Simply they lay down on their back, we cover their eyes with a small cloth, insert a small plastic tube through one nostril and then the other nostril and administer the lidocaine one at a time on each side, have the patient lay down for about 10 to 15 minutes to allow the lidocaine to soak into the nerve root, nerve plexus and then have the patient stand up and make sure they’re not feeling any significant untoward symptoms from the blockade and then they are discharged home.

Host:  So, really a pretty simple procedure that patients probably shouldn’t be too intimidated by, right?

Dr. Jagannathan:  Correct. Correct. It’s a very simple procedure. The risk of side effects is very, very low. It doesn’t work in everyone with migraines or every type of headache but those that it does work for; it’s a really nice way to be able to potentially get significant pain relief, reduce either the duration and or the frequency of headaches and potentially reduce the amount of medication they need to control their symptoms.

Host:  And from start time at the beginning of the procedure to end; how long does this take?

Dr. Jagannathan:  The procedure five to ten minutes. They’ll probably spend a total of about 20 to 30 minutes in the room. They’ll probably be in the hospital for an hour or less.

Host:  That is some fast work for some pretty great relief.

Dr. Jagannathan:  It is. It is. It’s pretty impressive. In people that it works well, it’s very impressive.

Host:  Yeah, so speaking of that relief; when patients have had this procedure, this SPG block; what kind of result can patients expect from this and how fast can they start to see that relief?

Dr. Jagannathan:  It really depends on the patient. It depends on the patient; it depends on the way their nerve pathways work, and it depends on the type of headaches that they have. Some patients may experience almost complete relief within a few minutes to even an hour or so after the procedure. Some patients honestly may not have relief whatsoever and there’s really no way for us to tell beforehand which type of a patient is going to – what type of relief someone is going to experience. But given the low side effect profile of this procedure and how minimally invasive it is; it’s something that’s worth trying in someone who is significantly debilitated by these headaches.

Host:  Yeah, and I can only think of people who – I’ve personally heard stories of people who have been taken out for the count by migraines. It’s affected work, it’s affected personal life, it’s taken them away from the things that they enjoy doing; so this relief really is life changing for these patients who are able to find it.

Dr. Jagannathan:  Absolutely. The patients that respond well, they do experience significant benefit from it.

Host:  Yeah, that’s great. So, if I’m a listener and I’m someone who experiences migraines frequently or headaches and I am just tired of it and I’m ready to find a solution; how can I as a listener come in to see you about finding this relief?

Dr. Jagannathan:  I would recommend patients that are suffering from chronic migraines or other headaches including cluster headaches and other nerve disorders that result in pain like trigeminal neuralgia, herpes zoster, and other types of headache disorders would contact either their primary care physician, primary care provider, or a neurologist or they can even directly contact us at the Interventional Radiology Clinic and we can evaluate them, talk to them. We can refer them back to their PCP if we feel they are not a good candidate.

Host:  Yeah, and there’s actually a number that they can directly call to reach your office, is that right Doctor?

Dr. Jagannathan:  Correct. 815-802-7577 is the direct number for the Interventional Radiology Clinic.

Host:  Yeah and so, if you’re listening one more time, that number is 815-802-7577 and that’s going to take you directly to their office that you can talk to somebody about getting this procedure done. Dr. Jagannathan, is there anything else you want our listeners to know about this innovative procedure?

Dr. Jagannathan:  The only thing I would like to say is that even patients that have had headaches for years and years and have tried a number of different medications and have just not tried this particular type of therapy for their migraine headaches or cluster headaches or trigeminal neuralgia should really give it a shot. Given the very, very low complication rates from the procedure and how easy the procedure is to do and how minimally invasive it is; I think it’s worth a shot. Even in a patient who is potentially a non-responder, just the potential chance of having significant reduction in their symptoms, frequency or severity of symptoms or reduction in the amount of medications they have to take to control their symptoms; I think it’s worth it.

Host:  Yeah, absolutely. Dr. Jagannathan, thank you for joining us today on the podcast. Again, one more time, that number for you to call and schedule about this procedure is 815-802-7577 to find that relief from migraines and headaches. Doctor, thanks again for joining us on the podcast.

Dr. Jagannathan:  All right. Thank you.