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Scot: What would you say to any man listening that's suffering from migraines? What would be your one or two sentences?

Dr. Pippitt: Man up and go see your doctor.

Scot: It's a different kind of man-up.

Troy: I like it. I like it.

Scot: Instead of don't be a wuss, just deal with it. It's man up and see your doctor. Get something done about it.

Dr. Pippitt: Yeah, absolutely. You don't have to live this way. There are things to be done about it. And like, this is real. I mean, you know, sometimes I'll tease patients like, yeah, this is all in your head, but there is something we can do about it.

Scot: Dr. Pippitt, thank you very much for joining us today to talk about men and migraine headaches. I want to get into migraines in general, and then also talk about if there are any special considerations for men. Have you met Dr. Troy Madsen, one of our emergency room physicians and cohost of this fine show?

Dr. Pippitt: We have met I think in meetings, but probably never face-to-face.

Scot: Troy, I know you said . . . I didn't know this about Troy, Troy said he suffers from migraines, and I never knew that.

Troy: Yeah. As is often the case on our podcast, I am aiding an example of what not to do. I'm often a bad example. I am a self-diagnosed sufferer of migraines, and it's been, I mean, I had headaches as a child and it's been at least 20 years and it took me forever even being a physician to say these are migraines. And I finally concluded, well, they're probably migraines, so we can talk more about that.

Dr. Pippitt: Well, I think you're going to get at what is exactly the issue is that migraines are traditionally thought of as very much a female disease or a disease that afflicts women, but men really do get migraine as well.

But I think there's . . . you sort of brought up the two things that happen. One, men don't often go to the doctor as much as women do necessarily and so you may not seek treatment. And then, because I think the classic teaching is so often that men don't really get migraines as much as women, you don't get the diagnosis of migraine when in fact you actually meet all the criteria to have a migraine.

Scot: Is that a problem? Is it a problem that Troy's self-diagnosed, or is it a problem that men don't get that diagnosis?

Dr. Pippitt: I would say the biggest issue is that because men don't get a diagnosis and often don't get an accurate diagnosis, then they don't get the correct treatment. So that's really the biggest issue is we're delaying treatment and the best care possible because we're not getting the right diagnosis.

Scot: And then, as a result, men just get these terrible headaches and it just impacts their life and their work and their home relationships. Is that usually what ends up migraines end up impacting, or what is bad about migraines? Luckily, I've never had them.

Dr. Pippitt: I think what's the worst, I mean, as someone else who suffers migraine is, you know, the number of, you know, the time away from work, the time away from activities that you enjoy. Those are really important parameters.

Some people think, "Oh, it's not a migraine if my level of pain isn't severe enough. If I'm not like my aunt or my mom who was, you know, down in bed in a dark room with the lights off. And I can function with my migraine, it just hurts and I can't concentrate super well and I kind of feel like I want to barf." Well, you still have a migraine. It's not a matter of intensity of pain. And I think that's an important thing for people to understand.

Troy: Well, here's where fortune has smiled upon us. As good luck would have it, I have a migraine right now.

Scot: What?

Dr. Pippitt: Perfect.

Troy: I am not joking. It started this morning. I was like, wow, isn't that fortuitous. It started yesterday. I just felt kind of tired yesterday. And I don't know that I really saw it coming on because I had a lot of meetings. I was like, "Oh, I'm just tired because I've had a lot of meetings," and, you know, doing lectures, etc., etc. And then today I started to feel it.

And I typically will feel it. It comes on about once a month. It's kind of like my left side of my face and kind of like the back of my nostril on my left side and then I'll feel it up into my forehead. I feel it really around my left eye, I have trouble focusing and, you know, then I just feel very tired while I'm experiencing this with some nausea. It usually lasts about 48 hours. So I'm looking, I've got a shift tomorrow. I've got a shift on Friday. So maybe by the end of my ER shift on Friday, I'll feel better.

So I guess my question for you, Karly, is number one, am I mistaken in thinking these are migraines and then number two, you know, if yes or no, how do you typically diagnose these, and how does someone know if they're having migraines?

Dr. Pippitt: I would say I think you're spot on, Troy. I think you do have migraines. There's a really great three-item questionnaire that's been validated that if two out of three are positive, your chances are pretty good that you've got a migraine.

So one is, do you have nausea or do you feel sick to your stomach when you have a headache? The other is question two is, do you have sensitivity to light or sound? And then question three is, does the level of pain sort of impact what you need to do? Did it impact did you have to skip work? Did you skip activities for fun? Did it alter your activities because the pain was so bad?

I loved what you said about yesterday maybe it was coming on and you felt a little tired. And headaches definitely and migraines definitely have a prodrome, and if you can recognize some of those symptoms, you can actually sometimes catch your migraine before you even get to the pain level.

I often tell people with, you know, the aura that happens before a migraine, which for most people is visual that they get, you know, something that looks like a heat wave or some shimmers or squiggles in their vision. I tell them they're kind of lucky because they know. Whereas some of us who don't have aura, I think to myself, some days, is this just a headache or is this a migraine?

And I'll tell my patients, that's the answer to your question right there. If you're questioning is this just a regular headache or is this a migraine? Should I go take my migraine-specific medicine? That's the answer to your question. You should just go do it because you're probably right. If you're already thinking that, it probably is going to be a worse headache.

Troy: And I wonder too how often you see this, how many men are out there where maybe they're not sure that it's a migraine. They've just dealt with headaches for years. They just said I've had headaches. I went through a process. I remember during med school thinking, "Wow, I need to go to the dentist because this pain came on and it just hurt in my teeth, but I could feel it like up into my sinuses."

And then later I thought, "Well, I'm getting these recurrent sinus infections." It hurts on the left side of my nose and around my sinuses and my face, and maybe I just get these sinus infections and they go away after a couple of days.

How often do you see people that have just struggled either trying to self-diagnose or maybe even going to, you know, specialists who aren't headache specialists and have not had the appropriate diagnosis of migraines?

Dr. Pippitt: Yeah. I think this goes back to that training we got in medical school really like presenting migraines as a disease of women that, you know, when someone comes into the ER, when someone goes into your clinic, this might not be the first thing that you think about. Like, sure, it might be on your differential, but you're not going to move it up the list in one way or another as much as maybe you should.

This is where getting some of the other key features of a migraine history so in particular things like family history. I was talking to a patient of mine the other day. She's got migraines, her mom has migraines, her kiddo, you know, we were talking and she's like, "I don't know. He's kind of been complaining, he had bumped his head. Should I worry?" And we started talking about migraines.

I said, you know, he's only like 9 or 10, but knowing your family history, that may be something that's going to come his way so we should start thinking about it and should start talking about it so that the treatment is there sooner.

I think some of the people we see in the headache clinic have not had anyone ask them those questions about migraine or not had anyone ask questions about a family history for both sexes of patients, men and women. So these are questions we should be asking that is additional helpful information to help you decide is this migraine or is this just a headache?

Scot: If there's somebody listening like Troy that gets them about once a month, but it doesn't seem to like, he seems to just work through it. I mean, should that person seek help or should they just work through it? Would you consider Troy a candidate for some sort of medication or something?

Dr. Pippitt: Help.

Scot: Help. Yeah, that's a good word, "help." I'm a man. I'm going to have a hard time saying that word "help."

Troy: Troy would need to reach out first, which I have not done.

Scot: Do you find that guys just won't admit it? They don't want to admit it. We're tougher than that. We don't get it.

Troy: Maybe that's part of it. And I'm curious that maybe for me, that's been part of it. I've just tried to self-treat with, I'll take, you know, Tylenol every four to six hours and caffeine and that's kind of how I get through it, but yeah, I'm curious if that's what you see, Karly.

Dr. Pippitt: I think what's really hard is that you know, headaches, there's usually nothing that if we were actually meeting each other face to face, Troy, and I looked at you, I couldn't look at you and say like, "Oh, I think you have a headache or it looks like you have a migraine," as opposed to, "Hey, I can see that you have this huge laceration on your arm that needs, you know, stitched up."

So there's I think that's one big problem is that, you know, my level of pain, your level of pain, pain is just such a subjective thing that it's hard for people to say, "Oh, this is bad enough to need something or maybe I'm just not tough enough." So since no one else can see, there is no like definitive blood test or something that it really does come down to the history and asking the questions.

So I think that's one reason that some people don't necessarily get a diagnosis because the questions aren't being asked. They're not thinking sort of more broadly or thinking they're even, this is something that could happen to them.

I would say, Troy though, you definitely could get treatment. You're totally a candidate for it. And when we talk about treatment, we talk about two sort of different arms. One is rescue, which for you, someone who's maybe just getting one migraine a month, I think that would be a very reasonable thing to think about.

So something you'd take, you know, ideally yesterday when you're like, "Oh, I don't know. I feel kind of tired. This might be a migraine," then you would take it then, and hopefully, that could actually minimize your symptoms to more like 24 or even 24 hours or even less time than that.

Now there's nothing wrong with over-the-counter. I just want to be clear about that first of all. So what you're doing isn't incorrect, but I think the question is could something be better?

Troy: And what about for the person who's say experiencing headaches on a weekly basis, or, you know, it's keeping them out of work, say several days a month, what do you recommend for them?

Dr. Pippitt: Yeah, absolutely. That's when we start talking about preventive treatment or something that you take every day to try to prevent migraines. And even then, I mean, you're hitting kind of right at that mark where I'll start to talk to people about it where if it's more than once a week or sometimes, you know, you said your migraines will usually last about 48 hours.

Well, if you were having two of those and you know, those were each two days, that's about four days a month where we'll start to talk about, "Hey, what do you think? Do you think you want to take something every day that might help you prevent it?" It would be a different conversation if you had a medicine that you took for rescue and then you never got a migraine. Then you're probably like, well, I don't really want to take something every day because I already have something when I think it's coming that I take it and I don't ever have symptoms after that.

Scot: What about men and the triggers? So, you know, when migraines I hear triggers mentioned, does it apply to men as well as it does to women, and are there things that somebody could do in their life that could reduce the severity or the longevity of their migraines?

Dr. Pippitt: Absolutely. I mean, I think that's a good question for Troy. You said like, hey, you thought maybe you were just in a bunch of meetings yesterday. Have you ever thought about what some of your triggers might be?

Scot: It's meetings.

Troy: Meetings. Can I get a doctor's note? I want a doctor's note for meeting and night shifts. Night shifts and meetings. I know what my triggers are. It's lack of sleep. It's often, you know, stress, those sorts of things. Yeah, so you're right.

I mean, it does seem to follow a pattern that once a month thing, but then I know if I have a night shift coming up about when it's due, I know that within about, you know, 36 hours of that night shift, I'm going to have a migraine. So I imagine others are in that same boat where it's a similar sort of thing.

Dr. Pippitt: Yes. Sleep is a really big trigger, either not enough or too much or even just what you're describing sort of changing your sleep schedule. That's a huge trigger for most people to get that and to get a migraine.

And then other things, you know, are you staying hydrated? I mean, I know like a call shift was sort of a classic day after for me to get a migraine. Like you've disrupted my sleep, I probably didn't eat very regularly and I didn't stay very well hydrated. That's, you know, sort of like the trifecta there of badness going to happen the next day.

Troy: Well, what's the outlook, you know, for let's say someone like me where you say, "Well, I've got this." Do I just expect this is something I will just continue to have the rest of my life? Can I expect it's going to get worse? It's going to get more frequent or is it going to go away someday?

Dr. Pippitt: The natural course of migraines is they're usually with you for your lifetime, and they will wax and wane in intensity sometimes for reasons that make sense. So if you're in a particularly stressful period of your life like in residency training or something where you don't have as much control of your schedule, well, yeah, I think you would obviously think they would get worse.

For some people, as they, you know, as their career changes, some people they move so there might've been something in the environment that was really making them worse for them. For a lot of women once they go through menopause, sometimes that will make it a little bit better.

So we think about like puberty and menopause in women as sort of being a trigger and then sometimes a bit of a release valve. Men don't necessarily go through menopause unless we want to go down a whole other rabbit hole of manopause but maybe we shouldn't talk about that.

Troy: I was just going to say it. Yeah, we won't go there.

Scot: There's no such thing, right? Please tell them there's no such thing.

Dr. Pippitt: Podcast for another day, but you know, there isn't maybe as much of an off-ramp in that sense that we think about for, you know, people who are men but I think some of it is just your life sort of changes. As we get towards that age, maybe you're not quite as busy, you're not doing as many night shifts, you've hopefully gotten a little bit wiser and, you know, don't do the things that give you a migraine in the first place if you can help it.

Scot: I have a question about triggers. So alcohol use in men, you know, it can be problematic at time because we have episodes that you can go back and listen to if that's something you're struggling with, but alcohol is a trigger, isn't it? Or is it just wine? So then, of course, you know, the stereotypical men drink beer, women drink wine, alcohol wouldn't be a trigger, or is it?

Dr. Pippitt: Yeah, I would say alcohol definitely is the trigger. Red wine is sort of the classic trigger for a lot of people. And it's either the sulfates or the sulfites I have to double-check, but it's one of those that really tends to be the trigger in red wine. And you can find some red wine that doesn't have that in it, but beer can do it too for people. Other like common foods are things like MSG or chocolate for some people, preserved meats. So things like, you know, salamis, hot dogs.

Scot: Don't say beef jerky, don't say beef jerky.

Dr. Pippitt: Preserved meat. I'll just say preserved meat.

Troy: There's nothing unpreserved about that.

Dr. Pippitt: But if you don't have migraines, then that's not necessarily it. And I'll tell people, you know, sure. Look for your triggers. That can be a helpful thing. Like a headache diary can be a helpful thing for like, you know, just what Troy said. He's clearly figured that out. "Oh, the day after I do a night shift, I'm pretty much guaranteed to get a migraine."

So he already knows kind of where that trigger is, but I also tell people don't torture yourself because you can look at every single thing in your lifetime and you know, in a day or in your headache diary and not come up with a single answer for what is it that gave it to you and that's okay. There may not be one perfect, one little thing.

An analogy I heard at a headache conference was think of it like, you know, you had the one match of you had a night shift and then you had another match that you got dehydrated and then you had another match that maybe there was a whole bunch of smoke in the air and all of those make the inferno that is migraine. So it's not usually if X then Y or sort of one thing and then another

Scot: What about hard liquor? Is that a contributor as well? Is that a possible trigger? Does hard liquor have sulfates in it or is that just really wine?

Dr. Pippitt: I think it's mostly just wine. And I think, again, some of this is just you. If you were going to drink liquor, then maybe you weren't as likely to be drinking water that day, or maybe you're outside with a bunch of friends where it's, you know, you're camping and it's warm and so you get a little dehydrated. So it's kind of that whole picture that goes together.

Troy: Knowing now that maybe I should try a medication like I said, I just try and self-treat. I've found that I just take Tylenol like every four to six hours, I take caffeine. I've tried ginger as well. I've read some stuff about ginger. So I'm kind of trying to max out the over-the-counter stuff without a prescription.

How effective would a prescription be if someone has a migraine, you know, whether they're in my shoes or more frequently whatever the case may be?

Dr. Pippitt: I mean, I would hope that the prescription treatment because it's more targeted is going to be more effective. The key with any rescue medication in migraine is that you take it early. So back to that earlier statement of like, well, do I think this is a migraine or do I think this is just a headache? And just taking it, you can often like ward off something from there.

And with any medicine, you know, like you said, Troy, you've tried a bunch of different over-the-counter medicines. Yeah. You may find one that works better. Like Tylenol may work better for you. Excedrin may work better for Scot if he suddenly got diagnosed with migraines or any of those things. So you have to decide what's going to work best for you and it probably is going to be a matter of trial and error before we find the right one.

Even in prescription medicines, there's a whole bunch that are in the same class that we use for rescue. Typically, the triptans is the first place we start, but sometimes, you know, I personally went through a couple of triptans before I found the one that seems to work the best for my migraine rescue treatment.

Scot: Other than the treatments Troy mentioned, are there other over-the-counter things or more natural things that a person could do?

Dr. Pippitt: I liked that you brought up ginger, Troy. Like I said, in the criteria for, you know, if you have a migraine, one of them is nausea. We know that people who have migraine have gut stasis, meaning that your things just aren't moving through your GI tract like they're supposed to, which is why most people feel nausea with migraine. So treating the nausea can be a really important component.

And for some people, if you can treat the nausea alone and ginger has some pretty good data about helping with nausea, that can sometimes be enough to get you over the hump that maybe you don't need your caffeine or, you know, your Tylenol, your Excedrin, your whatever else you need to do.

Scot: So Troy, are you going to go get a prescription? You're going to get a diagnosis and a prescription or you're going to just . . .

Troy: You're going to get me to commit, aren't you?

Scot: Well, no, I'm just wondering, like, you know, are you?

Troy: I struggle with it. Like I feel, and maybe that's maybe that's my problem because I feel like, "Hey, I'm able to function." I get by. Like I said, I've been dealing with this now for about eight hours today and I think I've found a combination that seems to work for me, that I'm able to get through shifts and I'm able to kind of get by.

But again, you know, maybe I do need to look into that and having something more definitive and that's more effective. So it's not like when this hits, I'm like, wait, okay, here we go. Forty-eight hours, power through it. So I'm not dealing with that. So it's a good discussion for me to have for sure.

Dr. Pippitt: I think that's what makes it hard when you feel like you can work through it. You're doing okay. You're maybe not doing the best that you could be, but when it's been this way for so long, sometimes it's hard to realize how bad it actually is.

Troy: That's true.

Dr. Pippitt: Because it's still two days that you're taking medicines for two days, you know, and that just sort of gets you to like limp along to get there. But, you know, don't be afraid to bring it up because I think what we found is that if men aren't really getting the diagnosis, so if you go in and you feel sort of silly because they're like, "Well, dude you have a headache. Why are you coming in to see me?" And then I think you can very much ask the question. Well, could this be a migraine?

Troy: And where's the best place to go? I've got my primary care physician. I actually have an appointment with him coming up in I think a few weeks. Is that the best person to talk to about this? Or should I, you know, come and see you or see a headache specialist or what do you typically recommend to people?

Dr. Pippitt: I would say absolutely start with your primary care. This is a bread-and-butter diagnosis of migraine. So it's making that diagnosis initially. So if they can make that diagnosis, then you can get better treatment.

Some of this too is like you said, people just don't really bring it up. Like if this podcast hadn't have happened, you might not have brought it up next week at your appointment even though you had a migraine just the week before, because you know, it's not happening every day. It's just once a month, you can get through it. It doesn't seem that important.

So make sure you bring it up with your primary care and then they can help you decide, you know, do we need to have another appointment to discuss this further because maybe you went in for your physical and other things where they're like, hey, this is really important. Let's make another appointment to talk about your headaches. Because I think headaches too often get put on the back burner and we don't give it the due, the time that it really needs to give it the proper treatment.

Troy: Okay. I think, you know, Scot and Karly, I think, you got me committed. I'm going to do it.

Scot: All right.

Troy: I will bring it up when I talk to my primary care physician. Karly, it is just a routine sort of thing and it does make sense to say, "Hey yeah, sure. I can power through this." But if you don't need to just power through it, if there are other options, it's worth exploring. And it makes sense to me to, you know, and hopefully, others out there as well who are just in the same boat I'm in to at least bring it up with your primary care physician and look into some other options.

Scot: Hey, Mitch. Did you have anything that you wanted to ask?

Mitch: No. I just, I guess for me, I'm kind of on Karly's side. I don't have migraines, but like the fact that people are like, "Oh, I'll just work through 48 hours of nausea or whatever," that is so bizarre to me. Why are you not going to a doctor? That sounds miserable. Or am I just a baby? Like, I don't know. Maybe I'm just like . . .

Scot: The nausea part to me sounds more miserable than the headache almost, but, you know, there again, I'm a guy who's never had them.

Troy: It is miserable. There's no doubt. It is. I think, you know, for me and probably others, you just have to learn to get by and you kind of just deal with it. And you accept that it's part of your life and you find that it happens in a certain pattern and but yeah, it is miserable.

Dr. Pippitt: So seriously, Troy. I'd love to hear the follow-up on this, that you talk about it, that you get a diagnosis, and that you get treatment. This is the primary care provider in me. I have to know what happens. I like to know the, it's not really the end of the story that makes it sound like something terrible happened but I want to know that you get the right diagnosis and treatment.

Scot: So is the hope that I mean, are you fairly confident, Dr. Pippitt, that he's going to feel better having the recovery medication?

Dr. Pippitt: Yeah. Absolutely. I think it might be a little bit of trial and error to find the right one. I think I probably tried like three with my own provider before I finally found the one that worked best for me, but I'm definitely confident we can . . . Especially this 48 hours nonsense, if we can knock that down, I think that would be huge.

Troy: That would be. Yeah, no, if I can knock that down even if it's, you know, down to 24 hours or something, that's a lot better than looking ahead at the next 48 hours and thinking, "Wow, I've just got to deal with this." So that would be a significant improvement.

Scot: And I can't imagine a world with 100% functioning Troy. I mean, I have a hard enough time keeping up with him when he's got migraines apparently.

Troy: Thanks, Scot.

Dr. Pippitt: Have I just changed the whole podcast now? Oh my goodness. We're not even going to know.

Troy: There's just going to be so much energy, you're not going to know what to do. This is me with a migraine. Without it, it's just going to be like overwhelming. Get ready.

Dr. Pippitt: I see the numbers climbing already.

Troy: Exactly.

Scot: All right. Well, Dr. Pippitt, thank you very much for talking to migraines with us today. We'll follow up with, Troy, here and see how his treatment ends up going. And if you're listening and you suffer from migraines, know that there is help. Dr. Pippitt, thanks for being on the show and thanks for caring about men's health.

All right. So we had to pop the mics back on because after we turned the microphones off talking to the headache expert, Mitch who was quiet the whole time and not only was he quiet the whole time, I actually asked him if he had anything to add and he said then starts talking about, "Oh, I can't believe, Troy, that you're able to function and do this podcast with your headaches because when I get a headache, I tell my partner like shut all the curtains. I'm going to go curl up in a ball." You didn't bring up the fact that you had headaches when we had the headache expert on.

Troy: Thanks, Mitch.

Mitch: I know. I know.

Scot: What's up with . . .

Troy: He just left me out there alone like I'm the weirdo here that gets migraines.

Mitch: I did.

Troy: And you've got headaches too.

Scot: Explain to me your thought process please behind why you didn't jump in.

Mitch: Yeah, no, it totally didn't dawn on me while we were talking because it was just, you know, "Oh, well I get headaches, but they're probably not as bad as Troy's are because he's talking about nausea, he's talking about whatever."

And even as we're talking about how men undervalue their own headaches or that they have to power through, I just, it's the same thing. If I miss sleep or something like that, I'm just . . . I do. I get really bad headaches and I have to like shut my eyes and like disappear for a couple hours. It's not 48 hours, but at the very least, it probably is something I probably should talk to my doctor about at least for Karly . . .

Scot: You think?

Mitch: Yeah, probably.

Troy: And then she made the point too. Again, we didn't have that on there. Like when you look at those criteria she listed, you meet at least a couple of those.

Mitch: I do.

Troy: Yeah. I mean, it's interesting because again, I'm not blaming you because I do the same thing. I see the really bad, bad cases in the ER, people who have severe migraines that come in and they have to get IV medications and they are just completely disabled.

And so that's where I'm coming from. I'm like, "Well, I'm not like that. I'm fine. Look, I have a migraine now and I'm taking care of them so what's my problem? I don't need to get treatment." So I think we all kind of do that where we do hear really bad stories, but maybe, you know, others are out there with headaches that are in your boat as well, that maybe there's some benefit to getting some treatment. I don't know.

Scot: Yeah. I love the fact that you sat there through the whole thing and it wasn't until after the fact that you finally have [inaudible 00:25:42]. It's exactly as Dr. Pippitt was talking about.

Mitch: What were her three things? Nausea, sensitivity to light, and the . . .

Troy: And it affects . . . It gets disabling. Like it affects the sensitivity light or sound, and then it somehow affects your ability to function. Because I mean, it sounds like there you're closing the curtains, you're turning the lights off. I don't know if you have sensitive. Well, it sounds like you do have sensitivity to light if you're closing the curtains.

Mitch: That would be it.

Troy: That would be it.

Scot: It sounds like it's impacting your ability to function.

Mitch: It sure does.

Scot: You have to remove yourself from the world.

Troy: Yeah, it sure does.

Scot: Wow.

Troy: Sure appreciate you letting me fly solo there, Mitch, through that whole thing.

Mitch: All right. You're good.

Troy: Thanks, man.

Scot: I think it's a good lesson though. I think it's a good lesson that even though you were engaged in this show, you know, in a way that a regular listener might not be completely engaged, it still took you a while at the end of the conversation to realize that, you know, maybe this is something I should talk to my primary care provider about. Are you going to do that?

Mitch: Yeah, I'll talk to him next time. I kind of have to now.

Scot: Begrudgingly, he says it. All right. Good episode.

Troy: Good. Well, we can all follow up in a few months. Sounds like, Scot, you still are in the clear, but maybe two of us. One of us for sure has migraines, maybe two of us. Who knows? But we can follow up in a couple months and see how things are going with us.

Scot: Hey, thanks for checking out the podcast. We'll follow up with Troy and Mitch and their journey with migraines. If you suffer from migraines or know somebody that does that would benefit from hearing this episode, please think about who that one person might be and share this episode with them.

Also, another great way to help out the podcast is to join our Facebook group, become an active community in the Who Cares about Men's Health group at facebook.com/whocaresmenshealth. And thanks for listening and thanks for caring about men's health.

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