♪♪ Welcome to
“Your Fantastic Mind.” I’m Jaye Watson. This is a show where
we explore the mysteries and the science of
the amazing human brain. More than 38 million people
in the United States suffer from migraines. Seventy percent of them
are women. Physicians use
evidence-based therapies to help stop
and prevent migraines. But what happens
when you’ve tried everything, yet nothing works? When the migraine is unusual
and debilitating and all of it’s happening
when you’re an elite athlete on the cusp of realizing
a lifelong dream. This is Lauren’s story.How does a
long-pursued dream
wind up here
in the ER
far from home
in blinding pain?
When it happens
it’s like– it’s almost like
it’s so painful, like, you can’t–
you can’t even breathe. It’s something you never
forget when you witness it.(Jaye)
To trace the path
to that ER room,
you’d have to go way backto when Lauren Burke
barely came up
to her parents’ waist.Just a few years
into her life,
this little girl discovered
a singular passion.
I just always
loved soccer. It was my favorite. I-I just love, like,
the-the skill behind the game
and just, like, how much planning there is
and just, like– I just loved everything
about the game. Get another one here.(Jaye)
This is what Marsha and
Steve Burke have been doing
for the past 15 years.
Embracing sideline life.
(Steve)
Yeah! Woo-hoo!
(Jaye)
Proud parents of
the goalkeeper.
A very good goalkeeper.To see her passion
and her willingness to be at the soccer field
five days a week.To travel every weekend.To miss school events
and social events
and all ofthat.(Steve)
Yeah.
And love it?(Jaye)
The pain began
in high school.
Every day when
I would wake up,
I’d have a headache.It was always,
like, frontal. Up top. And sometimes
under the eyes, which is what kind of got them
thinking about sinuses. And so, I was always
treated with antibiotics and sometimes steroids
for sinus infections and we even, um, went as far as
doing sinus surgery. And, um, w– even after
that, it didn’t help.(Jaye)
Surgery didn’t help
because Lauren didn’t have
sinus problems.
She was having
migraines.
Once doctors
figured this out,
they gave her daily
medication to control them.
It helped, but didn’t
stop the headaches,
which were made worseby her intense
training and exercise.
Then Appalachian State
University in North Carolina
came calling.Come Pack the Mack
at 5:30 tomorrow!(cheering)We were recruiting
in Atlanta, and we found her, and we knew there was
something special about her.(Jaye)
Lauren had reached
the pinnacle.
A college freshman,
ready for the chance
to prove herself.But then,
things fell apart.
App State is in
Boone, North Carolina.
The views are breathtakingat more than 3,000 feet
above sea level.
But was it
this higher elevation
that was part of
Lauren’s breakdown?
Tell me about the trip
to the hospital.
Which one?We were in a cycle
of being in the ER
probably every ten days.(Jaye)
App State Head Coach
Sarah Strickland says
these weren’t
normal migraines.
(Sarah Strickland)
She couldn’t move
her left arm.
Um, her face would-
would have, um,
what looked like
a Bell’s Palsy-kind of– Yeah, I mean–
well, it just–(Jaye)
Like a droop?
she couldn’t–
she couldn’t smile, she would–
when she would talk, it wasn’t moving. I mean, it was a scary
thing to witness.(Jaye)
Lauren’s migraines,
something she had kept
to herself,
were no longer
a secret.
I was really scared. In the ER, I-I think
I used the word “stroke” five times, um, at least,
that I said to the doctor, uh, “Are you sure?” And the doctor
was– said, “No, “that’s not what this is.”(Lauren)
I was pretty scared.
Like, I didn’t know
what was going on.
I couldn’t feel my hand,
I couldn’t move my fingers.
And I just–I– like, it was
a really weird feeling not being in control of, like, that part
of your body at all. Hemiplegic migraines
can be scary.(Jaye)
Emory Brain Health Neurologist,
Dr. Gregory Esper.
(Dr. Gregory Esper)
Hemiplegic migraines,
when you go weak,
you can’t move your arm,
or you can’t move your leg,
or you can’t talk.It feels and looks
like a stroke.(Jaye)
Hemiplegic migraines are
caused by something called
the cortical
spreading depression,
a wave of decreased
neuronal activity
that spreads over the brain
very slowly.
If it significantly affects
the part of the brain
called the motor cortex–which controls
body and face movement–
it can cause weakness
on the side
opposite the part of
the brain that is affected.
These trip to the ER videos
taken of Lauren
by the team’s trainer
show a cycle that began
and that drugs
could not stop.
I was in such a bad cycle
at that point of having a headache pretty much
every day from when I woke up to
when I went to bed non-stop.(Jaye)
How long did that go on?
Three months.Three months.Yeah.Of incredible pain.Yeah.How did you function?Um, I mean, it was–
it was so tough and–You went to practice?Yeah.(Jaye)
The breaking point came.
Vomiting violently yet again
on the team bus
on the way back
from a game,
Lauren’s parents
met the bus
and drove her to
Emory University Hospital
where she was admitted.It took four days
to break the migraine.
(knock on door)Hey, guys.(Lauren)
Hey, how are you?
(Dr. Esper)
How are you?
What’s goin’ on?
(Jaye)
Dr. Esper knew that getting
Lauren playing headache-free
was going to require
an outside-the-box approach.
By the time
I got involved, I’m going, well,
why is she having these types
of headachesat Appalachian Stateand she’s not
havin’ ’em,
you know,
when she comes back home?
Is it the exercise? Well, she was vigorously
exercising before, when she was playing
soccer in high school. Is it that Boone,
North Carolinais 3,000 feet
above sea level,
or whatever it is?If you look in the
International Headache
Society criteria, you have exerduce–
exercise-induced headaches, you have
hemiplegic migraines, but you don’t have
exercise-induced hemiplegic migraines, which is when she was
really getting ’em triggered.And so,
the question becomes,
how do you treat ’em?
What do ya do?
Did a little reading.Called a couple of
my national friends
who are the national
headache gurus.
I said, you know,
“What would you do
“in a setting like this?”And everybody said,
well, you’re kind of,
like, an N of one,
you know, this doesn’t happen
that often. It’s going
to be trial and error, but you might wanna try
some new therapies, um, called the
sphenopalatine
ganglion blocks.(Jaye)
Sometimes, hemiplegic
migraines are inherited.
Researchers have found
four genes linked to them.
Dr. Esper says
Lauren’s migraines
are more likely sporadic,
not inherited.
Possibly aggravated
by altitude,
or exercise, or something
in the environment.
Sphenopalatine
ganglion blocks,
SPG blocks, are an option
that revived hope.
(Dr. Esper)
Sphenopalatine
ganglion blocks
is a procedure
where you inject
a numbing agent
into the cluster of cells
called the ganglionthat is part of
the migraine cycle.
And so, what happens is,
on– it’s on both sides.
You have a sphenopalatine
ganglion on both sides
of the face,
way in the back.
And you inject
bupivacaine,
which is like Novocain
that you get at a dentist
but it’s longer-acting,and you inject itonto the sphenopalatine
ganglion, which kind of calms
that cluster
of nerves down.
(Jaye)
He uses a catheter
to reach the ganglion
behind her nose.The bupivacaine
helping to numb,
to shut down
an overactive system.
It’s a two-minute procedure
that needs to be repeated
every two weeks.After just the
first block, it works.
No more
hemiplegic migraines.
Lauren is back with
her team in practice,
ready for her chance.And then, a setback.(Lauren)
One of our forwards
was really close range,
probably, like,
ten yards away–
ten, eight yards away
and just nailed a shot
and I-I-I didn’t have
time to react. And it just hit me,
like, in the– like, in the side of
my head as I was diving.(Jaye)
A teammate checked on
Lauren after the hit.
(Lauren)
And she was like,
“Lauren, are you okay?”
whatever.And she was like,
“Lauren, what’s my name?”
And I couldn’t
tell her her name.
(Jaye)
It was a concussion.
Her first.Lauren returns to Atlanta
to see Dr. Esper.
Your MRI was negative. That’s awesome. Normal. No blood. Really good news.(Jaye)
But the memory of this
“A” student
is now suffering.(Lauren)
And then a chemistry test,
which I studied
for, like,
ten to twelve hours,
I got a 52 on.
Put your arms up. Pushing down. And I want you
to walk the line. Okay.(Jaye)
Dr. Esper gives her
a physical exam
and cognitive test.(Dr. Esper)
Good.
I want you to read
the list of words
and you have to
repeat them.
Face, daisy,
church, red velvet. I know that wasn’t
the right order. I want you to tap your hand
every time you hear the letter “A.”A. A. A.J. A. M. O.
F. A. A. B.
If you have another
concussion, you know, we have to seriously
evaluate what’s goin’ on because, you know,
repeated brain injuries–you’re–
it’s not good.
I mean, you’re not– I don’t think
you’re normal yet.Your memory is not
all the way back yet.
But I think you’re kind of
probably over the hump.
So, I want you to do
some memory stuff. I want ya to do a little
work over the summer, a little academic stuff. Get your, you know,
get your thinking back. Okay.(Jaye)
She has played through
unimaginable pain for years.
Pain that would have
led many people to quit.
Even now, giving up
is not an option.
How important
is soccer to you?
So important.I think about it
all the time–
I wouldn’t want to go through
college without playing it.
I love my teammates.I love my coaches.I love the process
of playing a sport
and how you have to
work for it.
(Jaye)
Steve and Marsha Burke’s
relief that their daughter’s
hemiplegic migraines
were gone
is quickly replaced
by devastation
over the concussion.(Steve)
I hope she gets to play.
She wants it.She’s worked hard.She’s good
at what she does.You always
want your kids
to kind of live out
their dreams.
(Jaye)
That dream is uncertain.
As Lauren returns
to App State,
unable to play
while her brain heals
from a new assault.To have a concussion
on top of it was just gut-wrenching on even having
to tell her “no,” that you can’t do anything,
and you’re shut down. How’s your
concussion symptoms? Good. Um, like– Nausea’s gone? Gone.(Jaye)
One month later,
Lauren is mostly
recovered.
I even was talking to
one of my teammates, one of my friends from, um,
from school and, like, I was just talking to her
on the phone and she was like, “You sound,
like, a lot better.”(Jaye)
Focused, as always,
on playing.My biggest thing is just
wanting to be ready come fall, you know? Um, what do you think–
I-I mean–(Dr. Esper)
We’re not gonna know
until fall.
Are you currently,
right now,
doing heavy exercise?Yeah. I mean,
rel-relatively heavy.The other day,
I ran five miles.
And so,
it’s more like– On the elliptical. That’s it?
No, I’m just kidding.(laughter)(Jaye)
With the concussion
happening in the spring,
Lauren has had
the summer to heal
and begin reconditioning.Hemiplegic migraines
are still gone,
but mild post-exercise
headaches have returned
despite the SPG blocks.(Dr. Esper)
Arms. Pull. Push.
Dr. Esper adds in
a medication.
We also had to add
another medication called nimodipine.Again, migraine is a
vascular type of headache.
Nimodipine is a medication
that reduces the vasospasm,
or the spasm
of the blood vessels.
The long-term goal is make
sure that you can compete
without getting headaches.So, the best way
to do that
is to do what
we thought was working
before you had
the concussion.
Okay.That means injections,
et cetera.
Okay. I mean, I’d say
stick with it just so I can
go into col– like, ’cause I’m going
back in a month. Okay. All right,
here we go. We’re goin’ in
the left nostril, which is on
that side, okay? Okay.(shouting, cheering)(Sarah)
She’s been
through a lot
with an unbelievable
attitude
and the mentality
of, there’s more–
there’s more
on the other side,
and-and
just what awaits.
(Jaye)
Lauren has never lost faith
that the other side
did await
and that somehow,
she could get there.
Well done, Em!(collective cheering)(Jaye)
She doesn’t know
today is that day.
Here we go, up, first and
second ball, let’s go! So Ava finds you, then you find
the outside back. Right? Yeah. Simple? Like that.(shouting and cheering)♪♪ Hey, 22!Go, come on.
Come on.
(cheering)(Jaye)
Lauren’s parents are here.
She’s always, you know,
soakin’ things up like that and, you know,
her time will come.(Jaye)
Her time does come
a few minutes later,
when the coach
tells Lauren
she’s the goalkeeper
for the second half.
Now checking in
at goalkeeper for your Mountaineers,
number two, Lauren Burke!(Jaye)
This moment is one
Lauren and her parents
weren’t sure she would get,
but now it’s here.
Uh, here we go.Play it.
Make her play it.
Make her play it.
Make her play it.
There we go.
There we go. There we go.
Get it out!(Marsha)
There we go!
Stay with her.
Stay with her.
Stay with her. Nice! Nice play. ♪♪(clapping)
Oh, yeah.
(Jaye)
Lauren makes every save.
App State wins.In the weeks
that follow this day,
Lauren is named
Defensive Player of the Week
and gets more chances
in goal
to help lead her team
to victory.
After so many years of
struggling to play the game
she loves,
she is healthy.
And it’s something
she does not take
for granted.
(Lauren)
I don’t know what’s ahead,
but there’s a perfect
plan for that.
And whatever it is,I’ll accept it
and I’ll be okay with it.
Go Kate! ♪♪ Lauren’s hemiplegic
migraines are still gone, but her exercise-induced
headaches are not. She’s trying a new drug in the hopes that she can
continue to play the sport she loves pain-free. And this is where migraines
are often a mystery. So, we decided to take
a trip inside the brain during a migraine. Watching what happens to cause these often
excruciating headaches. Once again, here is neurologist
Dr. Gregory Esper, who is also a
migraine sufferer.(Dr. Esper)
I get migraines.
I was in residency
when I started getting them.
It was probably
the lack of sleep,
the stress,
the poor diet.
It happens though,
when you’re a resident.
For me, the worst part
about the migraine is– I get moderate pain. I get probably seven,
eight out of ten. Um, but the worst part
for me is the nausea. Oh, gosh. The nausea is like,
the worst. Nausea’s the worst. And that feeling of just
being totally drained. Completely drained.Lifestyle’s a huge
part of migraine.
Um–(Jaye)
What did you give up?
Or what did you add? Well, I, uh,
I gave up a lot of, uh, processed foods. I don’t drink red wine
very often at all. Um, because red wine, um, is a big trigger
for migraines. Um, for s–
smoked almonds. Smoked almonds were
a major trigger for me– I was like, why am I
getting these migraines? And I had this huge,
you know, thing of smoked almonds,
which were– I was snacking on
and, you know, just because you don’t
get lunch sometimes, and you know,
and I’m goin’, every time I have
smoked almonds, I get a headache. Migraine is the most
common type of headache. Um, it actually comes from
the French migraine, which is “half the head.”Migraines typically are
unilateral– one-sided,
effecting half the head.They have a very
specific pain type.
It’s throbbing,
pounding pain.
Pulsatile pain
on the side of the head.
It can be bilateral–
both-sided–
but typically,
it’s unilateral.
And it has to be a moderate
or a severe type of pain,
as opposed to
a more mild pain.
That’s what the International
Headache Society
says migraines need to be.They can last between four
and 72 hours in duration.
Some can last longer,
but it’s unusual.
And they have to be
associated with certain things
like nausea and vomiting,light and sound bothering
the eyes and ears,
triggers that may
start them.
That’s a common migraine.What are the
environmental triggers?
We mentioned some before–foods,
drinks like alcohol,
specific types of alcohol
like red wine,
lack of sleep, stress,
those types of things.
All can cause the brain
to react in a way
that produces a migraine.There were two huge studies
that looked at people
that thought they had sinus,
or allergy-type headaches.
Over 90% of people in both
of those studies actually had migraine,
or migrainous-type headaches. The average time
to diagnosis? Eleven years.We believe
that the trigger,
the area that
triggers migraine,
is probably somewhere
in the hypothalamus.
And the hypothalamus
is a structure–
small structure–but it basically regulates
all the body’s functions.
And it sits in the very
deep part of the brain
called the diencephalon.And some of those areas
get activated
and they wind up
causing a cascade
that activates a system
in the brain
called the
trigeminovascular system.
Trigemino
for trigeminal nerve,
vascular because migraine is
a vascular-type of headache.
The trigeminovascular
system gets activated.
The blood vessels dilate.The blood vessels
on the meninges,
which is the part of the
head that experiences pain.
Those blood vessels
dilate on the meninges
and inflammatory mediatorsleak out on to
the meninges.
What are the meninges
innervated by?
The trigeminal nerve.All of those
inflammatory mediators
are activating
the trigeminal nerve.
The impulses are going
back into the brain.
The trigeminal nerve
is getting more
and more excited,
and it causes
the blood vessels to get
more and more leaky,
and the pain becomes
a vicious cycle.
And so, you have to
shut down that vicious cycle by giving drugs that
affect the blood vessels, by giving medications
that attack the area in the brainstem where
the trigeminovascular nerve is activated,
trying to, um, give medicines
that work on serotonin, which is one of the,
uh, uh, neurotransmitters that’s implicated
in migraine. Research into the science
of migraine is further unlocking
the mystery. New targets have been
revealed in the brain, and advanced therapies
just recently available are providing relief
for migraine sufferers. That’s gonna do it
for us this week. See you next time,
on “Your Fantastic Mind.” ♪♪

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