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The Headache Diet: Simple Steps to Treat Migraines in Your Practice · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

• 0:09
  Click on the link in this podcast for free credit that may include CME,
• 0:14
  MOC, or ethics credit, depending on the topic or podcast.
• 0:19
  Today, we're talking about something called the headache diet and what you can
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  treat regarding headaches in your own office.
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  And I feel so lucky today because here in the podcast studio is Dr.
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  Sheldon Gross. Dr. Gross, thank you so much for being here today.
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  I'm very happy to be here with you, Holly. So you've been doing this pediatric
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  neurology for 41 years. That's amazing.
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  That's correct. And I hope to continue doing it. I still have great fun when I see these patients.
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  And you did your med school, residency, fellowship, everything here at the University
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  of Texas Health Science Center, correct?
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  In San Antonio. That's correct. I love the school. They had great training for me.
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  I feel fortunate. And you recently were in private practice and then came back
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  to UT Health San Antonio, where you see patients at the Gateway Clinic,
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  which is on Wurzbach and Fredericksburg, and at University Hospital.
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  That's correct. For two and a half years, I have closed my private practice,
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  and now I'm full-time faculty, and it was a wonderful decision.
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  I'm having a wonderful time.
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  So you started out thinking you would become a psychiatrist?
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  Initially, when I was in college, I was a psychology major.
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  I thought maybe I should be able to prescribe medicine, so I went to medical
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  school to be a psychiatrist, and then I changed my mind.
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  And it was something, there was a book that changed your life?
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  Tell me about that. I was a pediatric resident in my second year doing my neurology rotation.
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  I'd never considered being a neurologist, and I wasn't particularly excited about this rotation.
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  And I think my attending picked up on that and he said you know Dr.
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  Gross why don't you read this book it's kind of interesting you might like it
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  it was a collection of bedside presentations from.
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  From Scotland, Edinburgh, Scotland. It was the most fascinating thing I had
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  ever read. I couldn't put the book down.
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  I'd finished the whole thing in three days and decided right then and there
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  I was going to be a pediatric neurologist.
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  Wow. So it was a collection of recorded bedside rounds and it started out,
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  you say, with a woman who baked cookies in Scotland and those cookies were really popular.
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  That's correct. The organization of this book was not like a typical textbook.
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  This was a collection of stories, stories about people.
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  And one of the things that appealed to me so much was the author of this, Dr.
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  Harry Lee Parker, understood that people are more than diseases,
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  that diseases affect them a certain way and their life changes.
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  And the example he was giving was of a woman who, as you said,
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  was known around her county as being one of the best bakers and had fantastic cookies.
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  People would travel great distances to buy her cookies and pastries.
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  And she started having difficulty handling a cookie tin, dealing with some of
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  the equipment she had to deal with. she became weaker and she lost some of her
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  feeling and coordination.
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  And to make a long story short, she had what is called a peripheral neuropathy.
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  Which must have been devastating for her. Well, it was. In a typical textbook,
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  they would tell you all about peripheral neuropathies, and they would tell you
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  the different types and the pathology and possible treatments.
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  But what they would not give you is someone's life history and how they were affected by it.
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  And that's what made this book so absolutely spellbinding, basically.
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  And that's what you say that you try to do with each patient every day.
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  See the person rather than the case.
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  Well, you have to. People have to know that you're interested.
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  In fact, usually when I first walk into a room, I don't even talk about the disease problem at all.
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  I ask the patient, how is school? Tell me what you're doing this summer.
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  Are you making any plans?
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  What kinds of things are you into? I talk about other things to try to establish right off the bat.
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  I know you're a person. I know you're a human being. I know that you're not just a seizure patient.
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  You're not just a headache patient. and that goes a long way in establishing
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  a doctor-patient relationship.
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  It's shooting the breeze. Exactly.
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  I like to tell the students there's nothing small about small talk.
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  I love it. That's a great, great quote. Is that by Dr. Gross?
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  I made that up all by myself. Okay. We'll quote you on that.
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  And the woman in Scotland who baked the cookies, was she able,
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  did it say, Was she able to still bake the cookies and live with the disease?
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  I'm afraid to say that it was so many years ago when I last read it,
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  I don't remember the conclusion.
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  I just remember what a perfect example that was of how people's lives were affected by their conditions.
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  And part of your job as a physician is to pursue that. And what was the name of the book?
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  Clinical Studies in Neurology by Dr. Harry Lee Parker. Okay,
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  I want to read that. Yeah.
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  So doing this 41 years, you, I think, have some great knowledge and advice about
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  preventing burnout. Tell me about that.
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  Well, first of all, there's huge interest in this right now because there's
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  a real physician shortage.
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  Practicing medicine has changed.
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  People are retiring or quitting or pursuing a different profession.
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  And as a result, there are not enough doctors right now. And we use the term burnout.
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  To me, it means you're no longer getting the same satisfaction,
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  the same enjoyment that you used to.
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  And there can be different levels. It's not just like burned out or not, right? Absolutely.
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  And what I, again, tell the residents and the medical students when they're
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  rotating with me is the way that you avoid physician burnout is to make sure
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  that your practice stays enjoyable,
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  that it stays fun, that you look forward to coming to work every day,
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  that you look forward to coming back from vacation.
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  And that doesn't just naturally happen. You have to take a very active role
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  in making whatever changes you need to make to make sure it stays enjoyable.
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  So kind of take the temperature now and then of your career.
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  You have to ask yourself, and sometimes
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  it helps if you write it down on a piece of paper. Make one list.
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  These are the things I love about being a child neurologist.
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  Make another list. These are the things I really do not like about being a child neurologist.
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  And see what are the things you can change. And for you, it was kind of a big change.
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  Well, it was a major change. It was going from private practice to becoming full-time faculty.
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  And people ask me, how often do I wish I was still back in practice?
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  The answer is never. I think that was one of the best decisions that I've made.
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  I enjoyed private practice for many years, but it was time for me to make a change.
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  And I think as a result, my career is going to last longer than it might have otherwise. wise.
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  And now you have great joy. You see a lot of patients each day,
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  but you also work with med students and residents.
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  Well, that's so much of the fun of it. The medical students we have now and
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  the residents are just so smart.
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  And with their smartphones and the internet, you can ask them questions.
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  And within 45, you haven't finished the question and they've already got the
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  answer. And they have this huge appetite to be taught.
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  And one of the advantages I have is the fact that I've been in private practice for so long.
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  A lot of my colleagues here at the medical school have been academicians from the very start.
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  Their perspective is slightly different than mine is.
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  So, for instance, I will tell them things that patients need to hear from you.
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  I will tell them things that patients should never hear from you.
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  And I try to explain that medicine today is very much a consumer type of interaction.
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  People have to be happy. They have to leave your office with the sense of,
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  God, I'm glad I came to see this guy.
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  And a lot of times that involves much more than just the pure medical aspect of things.
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  Do you want to share an example of what the patient should hear,
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  what the patient shouldn't hear?
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  The most important thing is you have to give people subliminal messages of basically,
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  I care about you as a person.
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  So, for instance, when they leave, I'll say, make sure you pick up one of my cards.
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  Make sure you know how to reach us. I expect you to call me if you've got concerns.
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  So rather than discouraging them from calling me, I try to encourage them to
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  call me if things are not going well.
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  I need to hear from you. That accessibility is so key.
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  And just acknowledging people's concerns, being willing to be quiet for a few
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  minutes and allow people to talk and listen to them is extremely important.
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  And I tell them, this is again something I told the students in residence,
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  one of the most important things you can do is make sure you communicate to
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  the patient or the parents of the patient that you care about them.
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  They have to leave knowing that.
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  You could be the smartest person in San Antonio, but if the patients don't think
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  you care about them, they're going to go someplace else.
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  That's right. And I love the quote, I don't know who said this,
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  but in medicine, we have the privilege of caring for people in their darkest, most vulnerable hour.
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  So nowhere else in the service industry is it more important that we treat every
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  patient with kindness, love, and respect.
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  Well, that's absolutely true. And if for any reason you don't think you can do that.
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  You're the wrong doctor. And on very rare occasion, I have had a handful of
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  times where I've suggested to people, I don't think we're communicating well.
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  I don't see yourself making progress.
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  I want you to get a different set of eyes and see if someone else can do a better job.
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  That's part of what's involved in keeping your practice enjoyable.
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  And if your staff is not treating patients kindly or working well together,
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  that's a red flag. That's equally important.
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  And regrettably, doctors are not well-trained in that aspect of things.
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  And it's a shame because you can be a great doctor and a staff can destroy your
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  practice. And I'm going to do an episode on listening in a few months.
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  We're going to talk to a nationwide listening expert.
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  So that's coming up on Pediatrics Now. And I know you mentioned one case where
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  you saw a patient who had Bell's palsy, and just to see from this medical resident's eyes,
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  seeing Bell's palsy for the first time, and you say enthusiasm is contagious.
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  Well, that's exactly correct. And this is why I told you one of the things that
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  I enjoy the most about being in academics is working with medical students and residents.
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  The patient I was telling you about in private practice had this condition involving
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  facial weakness called Bell's palsy, and I'd seen over a thousand patients with Bell's palsy.
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  The resident that was with me had never seen one and was so excited and was
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  so enthusiastic about seeing his first patient with Bell's palsy that it kind
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  of relit a sense of enthusiasm in me.
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  And it just made the whole experience so much more fun.
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  And it's been that way with every type of patient I see and residents and medical
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  students who've never seen it before.
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  They're fascinated by it. And that is contagious, just as I told you.
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  And it's like you're seeing it with, it's the other saying, with new eyes, fresh eyes.
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  I'm seeing the enthusiasm that I had back in 1975 when I was a third-year medical student.
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  And perhaps it needs to be dusted off a little bit and rekindled.
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  And the medical students and residents do a great job of it.
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  And at the same time, they probe and they ask you questions.
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  And it forces you to think and to make sure you can justify and explain exactly
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  why you do things the way you do.
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  Very stimulating. Do you want to share an example of something that a patient should never hear?
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  Are you saying like anything that could be perceived as something meaning you
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  don't care or you're too busy?
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  It's more, most of those things are subliminal and they're really transmitted
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  by actions rather than specific words.
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  For instance, if someone is in the middle of trying to explain something to
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  them and you cut them off or you're constantly looking at your watch.
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  Or what's even worse is if your cell phone goes off in the middle of a conversation.
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  If you're in a rush, people can pick up when someone's in a rush and when they
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  just want to go in and go out as quickly as possible.
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  That is something that patients really, really don't want to see.
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  And they'll go someplace else unless you're the only possible choice.
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  And again, what I do, again, this is subliminal.
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  When I'm going to see a patient, I sit down as opposed to just standing up the whole time.
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  I sit down. I get comfortable. I give them direct eye contact.
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  I shake hands if I've not seen them in a while. And I'm trying to communicate non-verbally.
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  I've got time. I'm going to sit here. I'm going to listen to you.
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  I care about you a great deal.
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  I love it. Everyone has their own different way of communicating that.
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  I'll tell the residents, this is how I do it. You have to figure out what works best for you.
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  I love it. And I have a chapter on that, the importance of sitting down,
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  even if it's just for a few minutes, in treatment and customer service for clinicians
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  and that eye-to-eye, eye-to-eye level.
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  And we have to think, you know, the patients, they've rearranged their schedule
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  to be there, and they are likely hanging on every word that you say and might be scared.
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  I'm glad you mentioned the eye-to-eye
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  thing. There's a risk with the computerization of medical records.
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  Doctors spend so much time on their computer, a patient tells them something
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  to type in into their computer.
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  And if you're not careful, the whole conversation has the patient looking at the top of your head.
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  And that's not a good way of doing things. You have to figure out how do you
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  do things to where you maintain eye contact and people still feel like they're
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  communicating effectively with you.
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  Okay. Well, and coming up, we're going to dive into what you call the headache diet.
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  I'm Holly Wayman. This is Pediatrics Now, and I'm talking to pediatric neurologist Dr.
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  Sheldon Gross with the University of Texas Health Science Center and University Hospital.
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  Okay, so now we're back. Sheldon, tell me about this headache diet.
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  And this is a way that our listeners, the pediatric practitioners,
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  there's headaches that can be treated in the office.
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  Yes, let me preempt that with a few other statements. Without any question,
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  the single most common neurological problem that pediatricians or family practitioners
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  that care for children are going to see will be headaches.
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  That is much more common than any other type of neurological problem.
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  And the good news is the statistics are very much on our side.
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  I've seen studies that show 95%, 97% of patients with headaches do not have
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  a serious or dangerous problem.
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  That means 3% do, so you have to pay very careful attention.
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  But when I see headache patients, I go in steps. The first step I do typically
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  does not involve medicine.
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  The first step involves eliminating seven different food groups that are well
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  known to have chemicals in them that trigger migraine, take certain vitamins,
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  and make certain changes in your lifestyle.
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  I found that between 40 and 50% of my headache patients never call me again,
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  or they call me to tell me how well they're doing, how much of a difference that's made.
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  So what I would say to a general practitioner, pediatrician,
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  family practice, whoever deals with children that come in complaining of headaches,
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  you first of all obviously have to do a good exam.
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  If you feel comfortable that they don't have anything really acutely dangerous
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  or serious, you can do this in the office and just see what happens.
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  And let me go through. It's very simple. I have a handout. But the seven food
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  groups I tell people to stay away from.
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  No chocolate. Not everybody's happy about that, but that's the first thing.
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  Chocolate is famous for triggering migraine.
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  Any kind, milk or dark or both? Initially, any type of chocolate. I tell them no caffeine.
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  And you have to be cautious with that because if people drink three Cokes every
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  day and they suddenly stop caffeine, they get severe headaches from the caffeine withdrawal.
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  So you have to pursue how much caffeine do you drink. And if they need to,
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  you tell them to spend a week and slowly and gradually taper off of caffeine.
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  They make almost everything caffeine-free now, if you look for it.
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  I tell people that buy deli meats, the salami, bologna, hot dogs,
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  luncheon meats, that many of those use a preservative called nitrite.
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  And I've had many patients that are very sensitive to that.
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  And all you have to do is tell the people that work at the deli,
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  you need something that is nitrite-free.
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  One of the fathers I told that to was a butcher at one of the grocery stores,
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  and he told me they give us a big long list of things that are nitrite-free.
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  So you can still have meat.
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  You can still eat deli meats. You can still eat hot dogs or pretty much whatever you want.
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  You just have to ask for nitrite-free.
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  I tell people to avoid aged cheeses. I tell them if you like cheese,
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  eat American cheese, eat Velveeta cheese, stay away from Swiss and Cheddar and
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  things that have aged for a long time.
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  Feta, I think, would be in there. Very minimal. Try to keep that down to a small
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  amount. I tell people to avoid peanuts and peanut butter.
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  Really? Yes. That can make a huge difference. I tell people to avoid artificial
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  sweeteners, NutraSweet and Sweet'n
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  Low are well known to trigger migraine headaches in some individuals.
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  And the last thing I tell them is to stay away from what's called MSG, monosodium glutamate.
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  That's well known to be in Chinese food, but what I've learned is a lot of the
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  restaurants, if you ask them, they will hold the MSG.
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  So you tell them you don't have to give up Chinese food, just go places where they can hold MSG.
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  I tell people if you're going to buy something salty at the grocery store,
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  soup, crackers, chips, ramen, noodles, Doritos, look on the ingredients.
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  If you do not see MSG, have at it, you're fine. If you do see MSG,
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  don't give that to a patient who's prone to have headaches.
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  And MSG is an additive that is supposed to make food taste better?
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  Yes, that's exactly correct.
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  Once I've gone through this diet, some people tell me they don't eat any of
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  it. Other people tell me, you just named everything I eat, my entire diet.
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  And oftentimes, those are the ones that have the best chance of having their
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  headaches improve dramatically, just avoiding those things.
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  There's two other things. I tell patients to take supplemental vitamin B2,
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  that B as in banana, B2 and magnesium. magnesium, those two vitamin supplements
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  are felt to be as effective as a prescription medicine.
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  I tell all my patients, and anyone who's ever had migraine usually nods their
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  head when I say this, you never skip meals and you always have regular amounts
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  of sleep because we know that a lack of sleep is one of the classic triggers
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  for migraine headaches.
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  And we do have an episode, if you go through, on the scroll down in the Pediatrics
• 20:29
  Now news newsfeed from a sleep doctor with a sleep prescription about how to
• 20:33
  get a great night's sleep.
• 20:36
  Click on the link in this podcast that may include CME, MOC,
• 20:41
  or ethics credit, depending on our topic or podcast.
• 20:45
  Coming up next week, the headache diet. Exercise helps a lot of people,
• 20:50
  particularly strengthening exercises.
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  And I can tell you that it's a faculty member who's going going to remain nameless,
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  who had bad migraine headaches.
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  She started lifting weights. Her headaches are gone, and she's a big-time power lifter right now.
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  What does he mean by this headache diet?
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  I'm Holly Wehmet. I'll see you next time.
• 21:12
  I want to let you know about our sister podcast. It's called Pediatrics Now for Parents.
• 21:18
  We cover a lot of the topics that we cover here in Pediatrics Now for the practitioner,
• 21:24
  but it's health news in small bites for the busy parent.
• 21:27
  There's so much misinformation out there, and I'm a busy mom too.
• 21:32
  We want to get the right information out there from real specialists,
• 21:36
  and we hope that it is one less thing you have to say in the exam room.
• 21:42
  I'm Holly Wehment. Thank you so much for listening. I'll see you next time.