Dr. Adam Harcourt  00:00

The decrease in caffeine from, let's say, 10 to or to one or five to one or five to two, any decrease whatsoever doesn't make a difference. Doesn't really make a difference at all. But when you start looking at the change from having any amount of caffeine to zero, the change is huge.

 

Dr. Ayla Wolf  00:18

Welcome to Life after impact, the concussion recovery Podcast. I'm Dr Ayla Wolf, and I will be hosting today's episode where we help you navigate the often confusing, frustrating and overwhelming journey of concussion and brain injury recovery. This podcast is your go to resource for actionable information, whether you're dealing with a recent concussion, struggling with post concussion syndrome or just feeling stuck in your healing process. In each episode, we dive deep into the symptoms, testing treatments and neurological insights that can help you move forward with clarity and confidence. We bring you leading experts in the world of brain health, functional neurology and rehabilitation to share their wisdom and strategies. So if you're feeling lost, hopeless or like no one understands what you're going through, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact. Dr Adam Harcourt, welcome to life after impact. How are you?

 

Dr. Adam Harcourt  01:24

 I'm great. Thanks for having me.

 

Dr. Ayla Wolf  01:25

Yeah. So you are a fourth generation chiropractor, a Board Certified functional neurologist, and you have a clinic in Pennsylvania called the Harcourt Brain Center. Is that correct?

 

Dr. Adam Harcourt  01:36

Yep, that's right.

 

Dr. Ayla Wolf  01:38

Awesome. Well, I've had the honor of taking courses with you on migraines. You teach a 150

 

Dr. Ayla Wolf  01:44

hour course called Mastering Migraine, which was life changing for me and my practice and my patients. And I know you have people that fly from all over the world to see you to work. And so you're an expert in treating these very complicated headache patterns. And so I wanted to talk to you today about the, you know, kind of the patient that I see often, which is somebody who walks into my clinic, they've had a concussion, or maybe multiple concussions, they're suffering from all different types of headaches and head pain. They've maybe tried a lot of different medications. I assume these are the patients that walk into your clinic as well. Yeah, absolutely. Yeah. So talk us through your kind of clinical process, your thought process, and working with these people. Yeah,

 

Dr. Adam Harcourt  02:25

and actually have a great example as of last week, just kind of randomly. But we see these all the time, and this is why I'm so passionate about kind of the teaching and whatnot. Is I feel like when I first started getting into this, my education and understanding of these conditions was wildly off of what is actually happening, and it's also makes it really difficult to treat people right. If you don't know what headache they're having, how are you supposed to treat them properly? And so typically, when people are coming in with post concussion or what they think is migraine or whatever, there is a lot of overlap, which makes it challenging, and there's not an objective criteria for either one. That's my big problem. And so the most common thing you probably see as well is people come in and they've, you know, had had trauma or whatever, and they say, Well, you know, I've been diagnosed with migraine, they say, and you go through the list, well, I've tried Topamax, I've tried rhizobritin, sumatrip and Imitrex, Relpax, ubral aymavig, Jovi, and they list this whole list of things. And I go, well, have any of them helped you? They go, No, not really. And you're still trying these Medicaid they're just for migraine, that's what they're for. And I say, well, they said it was post traumatic headache, but then when I had it for a long time, they said it was migraine. And I go, it just like hurts my soul, because I'll see these people sometimes that have been in this situation for 10 years or 20 years or 30 years, and the changes you can make in a couple weeks, right? Is life changing? And it goes well, what if we did this 30 years ago? Right? And so when I'm looking at what is going on with this patient, my first question is always, history, right? Because if you're 40 years old and you've never had a migraine your entire life, and you get in a car accident. Now you have headaches and they you get diagnosed with migraine. I can almost guarantee you it is not migraine, okay. Migraine is genetic. Works differently than other headaches. Post traumatic. Headache is not that okay. The problem is it presents very similar, right? So if you have a subjective diagnosis, and you have subjective symptoms that look similar to migraine. I mean, technically, the medical doctor, neurologist, whoever diagnoses you, isn't wrong, right? They're using the gold standard criteria, but when it comes to actual treatment, then you don't get good results, and it's frustrating for everybody. And so what I found is we start with things that we can objectify, right? We look at things like blood pressure differences side to side. We look at oxygen level side to side. We look at things like palatal paresis and just ways that we can look at the system. Say, hey, does this look like it is migraine, or does this look like concussion? And I'll have a good example for you in just a second.

 

Dr. Ayla Wolf  04:57

Okay and so what you're describing with these exams is actually looking. At a difference in, say, the sympathetic output or parasympathetic output from the brainstem, and is it different from the left side versus the right side? And that kind of gets into this idea of imbalances within the brain have these kind of both motor and autonomic output consequences that can actually be objectively measured?

 

Dr. Adam Harcourt  05:21

Yeah, and it's really exciting, because we're getting better at measuring these things. So for perfect example is with post concussion syndrome. You know, when I was even starting school, the prevailing thought process was that only about 15% of people that get a concussion have long term effects, and the reality was, we just didn't know how to measure it, right? So that was the best number we had. Now, you look at research that comes out, and we're going, Oh, crap, it's like 70, 80% of people that get concussion, that end up having long term, you know, consequences, because we can see it. And I don't know about you, but this is a weird thing that I've seen commonly, is people will get knocks to the head, whether it's car accidents, falls, things where, you know, again, 20, 30 years ago, you thought if you got a knock to the head and you didn't pass out, then it wasn't a concussion, right? So they think nothing of it. I recovered. I'm fine, but what happens is they got a concussion. There was damage to the brainstem, or some area that is common with concussion, the brain was able to deal with the symptoms to where you felt like you were okay. And then in this, like 15 to 17 year window, they start getting strange symptoms, and they'll come and say, Yeah, I'm dizzy, or I get lightheaded when I stand up, or my headaches are coming out of nowhere. My neck's been really tight or whatever. And you do an exam and you see all the same signs you see after concussion. You go, Wait a minute, like, do you get in a car accident? No, no, not. Last couple years go, What about like, 15, 16 years ago? They go, Oh, yeah, you know, I got hit. I got, you know, rear ended sitting in that stoplight. It was fine, right? You go, maybe, like you didn't die, right? That's good, but there was trauma there, and because we didn't really pay attention to it, we didn't know how to measure it, people forever have just been told that they're okay. And, you know, again, yes, in the emergency, not going to die. Sense, that is true, but there was an injury, and so it's one of those things that we're seeing more commonly. And so I always recommend, you know, if you get any knock to the head, get an evaluation. Because if it's fine, it's fine. I've done that with many, many patients where I say, Oh, you're fine. Go home, rest. You're good. But a good number of them, you do an exam, you go, Oh my gosh, if you live with this for the next 1015, years, you're going to be miserable, and you won't know why. And so I always encourage people to just get checked out, because we have better diagnostics these days than we ever have, and you're able to kind of nip this in the bud before it becomes a long term problem.

 

Dr. Ayla Wolf  07:31

Yeah, absolutely. Yeah. I can't remember when I was probably in my 30s, when I had kind of my first X-ray of my neck. And they were like, well, you have no cervical curvature anymore, and they're like, it's probably because of all your concussions. And so I think people don't recognize that even if they get a concussion, and like you said, all their symptoms go away, there can still be these patterns in how your brain functions that then downstream causes a loss of extensor tone or a loss of certain firing down pathways that are meant to promote the proper tone and posture, to maintain a cervical curvature, and to do all these things that are kind of unconscious, that we don't have to actively think about, but they can change over time. When you hit your

 

Dr. Adam Harcourt  08:12

head absolutely Yep.

 

Dr. Ayla Wolf  08:15

So you mentioned you have kind of a good case that just came in recently.

 

Dr. Adam Harcourt  08:19

Yeah. So this kind of highlights. What I talk about is we had a case young girl, and, you know, about 10 years old, and she came in because another patient had come in for migraine, and was like, Well, you know, go see him. And the reason they came in was because, unfortunately, out of nowhere, she started having these intractable, miserable headaches, and she was in the hospital for two weeks, which I have, a nine and a half year old. So I'm thinking, oh my goodness, this is goodness, this is I can't imagine. And so they dealt another couple weeks with these headaches, and they said, Well, you have these migraines. And I didn't find this out till later, but turns out they had three independent neurologists all diagnosed her with chronic, intractable migraine. And so they said, Okay, well, here's all the medications we're going to start, they could not break the headache until they gave her a massive cocktail in the hospital, intravenously. And that brought it down a little bit, and then it came right back. And so she's, I mean, she can't go to school. It's awful. So luckily, this is why I say luckily, I ended up seeing her about six weeks after this happens. And so she comes in for the exam. The mom's there, and real sweet little girl, and we're doing the exam and, and they said, Yeah, it's for migraine. And during the exam, these eye movements are just rough. Now, in migraine, we see aberrancies, commonly with things like convergence, or I'm or pursuits and whatnot. But they're, they're minor, right? They're not horrendous. This was to the point where, I mean, she couldn't even follow a target. If I was I'm like, Look at this thumb. Please look at this. And could not do it. And you know, her eyes, if you bring them in like that, they start going like this, like crazy. What the heck is going on? And so I just kind of mentioned to her mom, I go, You know what? This doesn't really look like migraine. It looks like she had a concussion. And the mom kind of looks at me sideways, and it's like, okay. And. The we keep doing the exam and we're finishing up, I go, Yeah, this looks like concussion. I said, Well, you know, it's possible it's migraine. She's young, you know, we'll see. But I said, and just off handed, I go, you know, what's interesting is I found a number of patients where I tell them I think they have a concussion, and they swear up and down, they didn't have it, and then later on, we found out they did. It's not because they were hiding it from me. It's because they got hit so stinking hard they forgot that it happened. And I'm telling this to the mom, and the little girl looks up. She goes, Oh, Mom, I got hit really hard in the face with a basketball. And the mom looks at us, go, what? And she goes, When did this happen? You never told us this. She goes, um, the day before, I started having headaches. And the mom's like, what? And so I start going through it, and I say, Well, you know, she's probably gonna have trouble in the car. She might have trouble in like, grocery stores or crowds. I was like, Oh my gosh, that's exactly what's been going on. And she goes, this makes so much more sense, because they tried triptans and other things. None of it was touching it. I go, Well, trippins are specific for migraine. They don't work with post traumatic they go, Oh my gosh. And so we got her in. We treated her when within like, two days of treatment, no headache, and I just saw her yesterday. She's been fine ever since back in dance class and school, and she's great. She's fine. And the reason I was so excited about that case is I typically see that little girl 20 years in the future, right? Didn't go to college, having trouble at work, on 15 different medications, no idea what's going on. And we ended up doing the same type of thing for that person when they're 30, and it's great because we help them out, but that was 20 years that they know what to do. And so that was a for me, it was really exciting case, just because it kind of puts into perspective all the things that we keep trying to teach, like, Hey guys, if you're not getting this success, if people keep telling you, hey, it's migraine, but every migraine medication doesn't even touch it, you got to look for something else. Okay. And so this is, this is one where, you know, the mommy said, she's like, well, what the heck's going on? You know, these neurologists, they all said it was migraine. I go, technically, they're all right, right? Because by the diagnostic criteria, she had the intensity, she had the light sensitivity and sound sensitivity. She had the things that meet the gold standard diagnostic criteria. They're not wrong, right? The way we diagnose it, they're not wrong. But again, this is why I emphasize in teaching and everything, how we have to look at migraine completely differently than it's currently looked at because it's wrong. It's just not it's not a good way to diagnose these conditions. And if you can differentiate between the two now, these people get better wildly, quicker.

 

Dr. Ayla Wolf  12:33

And can you talk a little bit? I know that you use a lot of different therapies. You practice functional neurology, and so you're creating individualized treatment programs for everybody that comes in. In this individual case, Were there certain things that you felt really made the difference for her within just those two days where she had this really quick recovery?

 

Dr. Adam Harcourt  12:51

Yeah, so there's a few things. The one big one, and this is actually, well, one of the first ones to hear about this is we're in the process of doing a new research paper looking into certain eye movements and the correlation with migraine, because I see it so commonly, and so there's certain movements that if I see that, they're often like, oh my goodness, that's that's probably a bad migraine. And sure enough, they're the ones that have 20 or 30 so we're going to actually look into this a little bit more closely so we can, because a lot of what we do, there's evidence in the literature that this kind of thing could be helpful for migraine, but there's no indication why or when or how you do the therapy, or what the background is. So we're kind of going to start from the ground up and say, Okay, here's the problem we're seeing, and then once we see that problem, we can quantify it. Now we're going to do therapy for it the way you and I do, and then show the outcomes and show that this gets better, and it it helps bring it back to the fact that this is not a blood constriction problem or dilation problem. It's not, you know, anything else that we used to think. It's a hyper excitability problem in the brain, and we can make that more stable through treatments. And so in her case, specifically, we saw big issues with what are known as, so gaze stabilization. So big gaze stabilization problem, she could not keep her eyes on a target to save her life. So we had to do we had to modify those a few times where she couldn't look at a target because she would keep looking away from it. She couldn't keep her eyes on so we had to modify that. And then we also found, really interestingly, I thought it was more the eyes that were the problem. But then when we started looking at neck proprioceptive activity and had her moving back and forth, we found that that was really challenging and started to flare up quite a bit. And so I think what happened is, when she got hit, she got extension of some of these neck muscles, and that proprioceptive change made a big difference in the way the eyes were moving. So we did a combination of basically having her look at a target with, you know, a head laser, so she's focused on a target, and then we would rotate her. And what was really interesting is, when she went one direction, she was really good, and then when she went the other direction, the head kind of goes with it, and it can't stay still. You go, what the heck is going on? And what's interesting is you think about that stuff, you know, as a patient. Or somebody that's not familiar with this, you go, who cares, right? What's the big deal? But then you think about it. Wait, the way our muscles are controlled, the way our eyes are controlled, are all unconscious, and they're just supposed to work. Now, imagine if you're turning to look at your computer, or you're driving, or you're seeing all this stuff, and you're constantly processing this information, but you're not doing it properly. That is exhausting when you do it throughout the day, and it gets to the point where the brain just goes, I can't do this anymore. It shuts down, right? It locks the neck muscles, it makes a headache, Dizzy, and it basically gives you symptoms to say, Hey, quit moving around. We don't know what's going on right now. And so when you fix these very simple, basic things, which are not simple and basic to fix, but simple, basic ideas, and they get better. Now you've laid the foundation for the rest of the nervous system to function properly. And so that's how I kind of look at my treatment approach, is, if there's very basic stuff that's not working, I could care less about everything else. I hammer that until it's better, right? I just I want the basics to be good. Once they're better, then we could do more interesting stuff. I had her up dancing by Friday, and she's doing all these different movements. And, you know, I have her doing d2 which is like that light board exercise, and she's having a good time. But if you start there, because that's the end goal, but you don't fix the foundation. These these people go through, I may just had one that went through rehab for three years with zero change whatsoever, because, again, they're working on things that the foundation can't handle. So I think that's a really important point.

 

Dr. Ayla Wolf  16:25

It is the the the kind of order of operations, of how to kind of rebuild a nervous system is, is key. And I see that all the time too, that people are maybe doing great therapies, but they were just the wrong therapy at the wrong time,

 

Dr. Adam Harcourt  16:40

exactly. I always liken it to like, you know, if you had a twisted ankle and the goal was to run 10 miles, so your first therapy was to run 10 miles, that ankle is probably not getting better, right? It's not a bad therapy. It's not quite there yet, you know? And it's also like, if you get the ankle to where you can put some weight on it and you can take two or three steps, it's like, that's great. We're making progress, but if you go out and run two miles, it's probably going to hurt, right? And so that's another tough thing with recovering from this, is you can't see the area in the brain or brainstem that's damaged, so it doesn't feel like an ankle or a broken bone, but it's the same problem. And so a lot of times, you'll get people that have concussion that, let's say, they have really bad headaches or really bad dizziness, and you get them somewhat stable to where they're not having that all the time. That's great. But the first time they do something that overstimulates the system, they have them come back. They go, Ah, I thought I was better, and now I'm not. It's like, No, you're just taking five or six steps right now. You're not to the three miles yet, and that's okay. And everybody does it. It's not unusual. It's a very common thing. It's just it's really tough for us to process, because once you feel better, you kind of feel like you you're always gonna feel better, and that's just kind of not how recovery works,

 

Dr. Ayla Wolf  17:49

right? We want it to be very linear and upwards,

 

Dr. Adam Harcourt  17:53

but we do too. I want the same thing. It's just unfortunately not how it works.

 

Dr. Ayla Wolf  17:58

Yeah, yeah. Now there was something that you had taught in the courses that I took from you, and it was a little kind of like sensory trick to help abort a migraine, which is where you take an insulation bulb and you just do a puff of air into the ear, like once every three seconds for 90 seconds, I have used that with, like, absolute great, phenomenal success in my practice. Oh, isn't it? Yeah, yeah. So can you talk about that? Because most of my patients are like, what are you about to do? And why is this working? And then I do it, and then within 10 minutes, they're like, oh my gosh, my migraines gone.

 

Dr. Adam Harcourt  18:34

It's the craziest thing. And I'll give credit to another neuro doc that actually published the first paper on this, Dr Dave Sullivan. He's the one that kind of discovered this, if you will. And he published a simple paper. He said, You know what? We take this insufflator bulb, we pump it into the ear, and we see migraines go down. I go, that's interesting. And so I started using it, and I found a couple couple nuances to it. And one is, you can't just puff air into the ear. It has to actually deflect the tympanic membrane. I don't find that it works very well if you don't do that, don't do that. The other thing is, with the stimulation, the reason it works, we think again, this is somewhat experimental, is there's about three different cranial nerves that are all innervated into that tympanic membrane, and they relate to migraine, right, trigeminal being one of them, vagal being another. And so what we think happens is it's a neuromodulatory effect, just like peripheral nerve stimulation, just like laser, just like anything else. And what they found is, if you do the insufflation and you can do it differently. So a lot of times, I'll start at maybe 30 seconds, do like two hertz, right, pump it once or twice a second, and then I'll go longer shorter, depending on how they respond. But what he showed in his paper is, if you do about five rounds of that, and they don't really get much better, they're probably not going to get better, right? But if they're improving after five, they can keep improving up to about eight or nine rounds of that, you know, 30, 40 seconds. The other thing that I found personally is that if they've already taken like a triptan, like a rescue med. It doesn't tend to work as well. It can. I've had one or two where they get responses, but usually if they say, Yeah, I got a migraine. I took my immature x and then I came in. That's fine. It's just probably not going to work as well. So I use this as kind of part of my armamentarium to knock out a migraine, but it's one of the first things that we start with, because it's non invasive. It usually doesn't bother people. Some people have an issue with it, but most people feel okay, and it's like, well, the worst case scenario is it doesn't help, right? But best case scenario is, you take your eight or nine out of 10 migraine down to like a three. You don't have to take meds, no rebound effects. It's pretty, pretty cool and interesting modality. And I again, I don't know the specifics, but I believe there's some people in our group that are working on more of an automated version of it, where you could just put it in the ears, set it to whatever you want, and then it could either be an at home unit or one you can use in your office. So there's some cool stuff coming down that'll make this a little bit more kind of accessible and tangible for people,

 

Dr. Ayla Wolf  21:00

yeah, I really like it, because usually I can knock that headache, like you said, down from an eight out of 10. Then all sudden you said, like you said, it's, oh, you know, like, they're like, instead of this throbbing pain, maybe I now just feel like a little bit of a dull pressure. And so then, obviously, once you've knocked their pain down a few notches, then it's easier for them to do the other therapies afterwards to help, like you said, help stabilize a hyper excitable brain, essentially,

 

Dr. Adam Harcourt  21:27

Yep, yeah, that's that hyper excited. But that's the cool part about what we do, is the only way to fix this is either through fixing the genes, which we don't know how to do, or creating protein, because protein is negative. And that's the cool thing about these therapies is, it might be good for them, but if you do too much, they get migraines, okay? And if you do less, then it doesn't it's not enough to make a change. And so, like you said, part of our, part of the difficulty in the early stages is finding that sweet spot where you're pushing it enough to make that protein production, but not too much to push them over the edge. So I always have that conversation with people, because, you know, very a lot of them have, you know, got adjusted, and then they get a migraine. They go, Oh, chiropractic is terrible for my migraine. I go, that's great. They go, what? I said, No, no, not because you get a migraine. I said, that means that pathway is directly involved in your migraine. There's just too much stimulation, right? And so we have protocols to fix that. So it's an exciting thing, because there's no one perfect way to fix this stuff, and each person with a migraine has different areas that are involved, so you might benefit more from acupuncture for patient one, but then from massage from patient two. And so that's what's exciting, I think, about the model is it doesn't say, here is the treatment. If that doesn't work, good luck. It says, Well, we have a good idea of what we're going to treat with you, but that's going to change based on how you respond, and we can adjust from there. So I think it's just an exciting way to go about these cases.

 

Dr. Ayla Wolf  22:46

Yeah, absolutely. And I have some people that can handle acupuncture very well. I have other people that, they'll come in and they'll say, you know, anytime I get acupuncture, anywhere on my head, it triggers a migraine. And I'm like, okay, cool, to know we're not

 

Dr. Adam Harcourt  22:59

good to know exactly. Well, that's the thing is, that's what I love, is it's not because, you know, in the courses, we have chiropractors, acupuncturists, PTs, massage therapists, dos, MDS, like everybody has different backgrounds. And so the point isn't you have to do this one thing. The point is, let's zoom out and understand migraine, and from there, if you have all the modalities to address it, hallelujah. But if not, you take care of what you can take care of and then send them to somebody else that takes care of something else that you know, that they need. And it just, it's my big problem with with kind of primary care for migraine is nobody treats it like that. Everybody treats it for what they do and not for what migraine is. And that's why people tend to bounce around so much. It's just, it's a really frustrating cycle,

 

Dr. Ayla Wolf  23:41

yeah, and then you're, you're involved with a company called Biogenic Nutrition, and they make a very interesting product, which is a ginger migraine abortive product. And I love that as an option for people, because a lot of my patients, they are really trying to limit the amount of, say, sumatriptin or those triptan abortives that they have. And so to give people an option that's more natural if it works for them, awesome. So, or how often are you using that ginger in your practice?

 

Dr. Adam Harcourt  24:11

Yeah, so we use it for every migraine patient, not because it works for every patient, but because, if it doesn't, no problem, right? It's not like you're giving a bunch of meds, but if it does, what we find is then they can kind of come off of their triptans, and you have a lot less rebound headaches and hangover headaches. And that was interesting, because I helped formulate that as well as MQ7. And the reason was the program, the migraine program, when I was going through this, we had our, you know, three days where we just talked about nutrition and hormones, and I'm going through all these supplements, like, Oh my goodness. I looked them up and to have all of those on a monthly basis was like, over 200 and some bucks a month. This is ridiculous. So I didn't know these guys. I called them up and said, Hey guys, I'm doing this program. They had some other products I liked. Is there any way you could just make something that has all this stuff in it? Would that be okay? And they were like, yeah, no. Has ever asked us that before, but sure. And so it took them, like, a year, and they were able to put together the MQ7, which essentially has all of the vitamins, minerals, nutrients, you know, anything that's been shown in literature to help with migraine in the right dosages and right combinations. So we started using that back when the program started, and it's been fantastic for prevention, again, not because it prevents all migraine, but if supplements are going to help, that's going to do it. It's wildly more affordable than if you were to get all this stuff individually. And so I have people start with that, because if that helps out, then we don't need to take other supplements, right? We're done. And if it doesn't, well, we don't keep trying a million different things. Because sure, there is a possibility that other stuff could help with individual patients, but at that point, now you have a million different options. And so then there was a study back in 2013 where they were giving people ginger capsules, and it was helping with migraine. And the cool thing was, it was equivalent to sumatriptin as far as what patients felt like they got benefit from and so I started doing that, and I liked it, because we would give them ginger capsules and it would help. But because it had to go through the GI tract, it took like, two, three hours to work. So I asked the guys at Biogenic again, hey, could you make this sublingual? And they go, Sure. And so it's literally just MCT oil and high dose ginger, that's what it is. But because it's sublingual, it gets into the system within 1520 minutes. And what I found personally is if you've responded well to triptans in the past, you'll probably do well with the MGR. The other important point is a lot of people confuse their different headaches for migraine, so they might get cervicogenic, where it hurts back here 10 days a month, and then two days a month, it goes into the eye. Well, what they're telling you is they have 10 cervicogenic headaches and two migraines. And so what I tell them is, I say, hey, these, these headaches back here, MGR is not going to help, but if it's up here, there's a good chance that it's going to work for you. And so, you know, full disclosure, I had nothing to do with the company up until recently, and so they actually asked me to come on to help create content and talk more about migraines. So I am working with them now, but I've been using it for six years, and it's just such an easy, simple thing to add into their care, instead of trying to, you know, take 50 different things a day. So it's been a really neat thing. And I think looking at the literature, there's some new stuff coming out, and as new things come out, I want to actually incorporate that into the product. And that's kind of the goal long term, is to keep up with with the literature, awesome.

 

Dr. Ayla Wolf  27:29

And I find too, that a lot of people are out there searching for answers on the internet by themselves, and then they they hear, Oh, well, this supplement is supposed to help, and that supplement is supposed to help. And then they start ordering things off Amazon, and you don't know what the quality is, and then all of a sudden you got to cover it full of 20 bottles, and you forget kind of why you're taking what. And so the fact that q7 takes all of the kind of evidence based vitamins, minerals, herbs, and puts it all together in one bottle is like, very nice for people.

 

Dr. Adam Harcourt  27:59

It's so simple, I know I actually got kind of overwhelmed when I was teaching the program, like, how are people going to take all this stuff every day and it just makes it simple, and now that's also what it's also kind of the basis of what I do for hormone treatment, which we probably won't get into that too much, but the only time that I'll really give other stuff then is if we do actual testing and we find out, yeah, actually we need to, You know, add this or add that for you personally, but we don't know that till testing. And so I feel like that's the best way to do it. Is, here's the blanket. This helps kind of a bunch of people no matter what. And then for you personally, let's do some individualized testing. And if you need other, you know, vitamins, supplements, hormones, whatever, then we can address that, like for each individual person,

 

Dr. Ayla Wolf  28:38

yeah, yeah. Well, and I find too, that sometimes when you got somebody with really severe migraines that are having migraines like 20 days out of a month, a lot of times for women, as they get better and as their brain stabilizes, then all of a sudden it becomes much more obvious that the migraines are now coming on hormonally during the cycle. Yeah. It's like, Okay, now let's dive into those hormones and figure out that piece, yeah. And

 

Dr. Adam Harcourt  29:01

I always tell people, if somebody comes to me and they're having 30 a month and I get them down to two, I can guarantee those two are going to be right before their cycle starts every time. And so what I've what I used to do, was run the hormone test right away, but then I was finding a lot of that was inflammatory, and the diet was taking care of it anyway. So what we do is we do dietary stuff first, for like, a month or so, and then if they're, you know, getting better, and they still have those hormones issues, then we do the hormone test, because at that point they've been on the diet, they're anti inflammatory, all that. And if they still have abnormalities in in the the hormones, we know that that's a problem we have to address. And that's where, you know, every month we see it get a little bit better, a little bit better, and that that's a goal care. I don't expect it to go away like that. It's not how it works. But as long as we see a decrease in frequency, intensity or duration month to month, we know we're doing doing the right thing. Yeah,

 

Dr. Ayla Wolf  29:52

yeah, absolutely. And in terms of the diet, since you brought that up, are there, are there certain like things that you feel like are the biggest. Offenders that you absolutely say to people like, let's cut this out.

 

Dr. Adam Harcourt  30:04

Our favorite beverage I'm offending right now, and it's the word the worst thing is, like, because I don't get migraine, but I love coffee, and you know, it's something that I have all of my migraine patients off of, and so if I make the big mistake of having coffee out in the thing I get heck from all of my patients. What are you doing to me? He got me off with it. Come on. So real quick about caffeine and because there's a bunch of arguments. And what irritates me about literature, actually, is if you look at each individual paper, there's one that says, No, it doesn't make a difference. And then, oh, it makes a huge difference. And no, it doesn't actually make a difference. But if you just look at all of the literature in an aggregate, and what their conclusions are, what they actually find, not just what they think they found. What you notice is that the decrease in caffeine from, let's say, 10 to one or two to one or five to one or five to two, any decrease whatsoever doesn't make a difference. Doesn't really make a difference at all. But when you start looking at the change from having any amount of caffeine to zero, the change is huge, right? And what they found is that caffeine itself does a couple different things. You know, it is a drug, so it changes your brain confirmation, specifically, it changes like CSF production and things like that. But more importantly, related to migraine, there's studies that directly say, caffeine directly increases neuronal hyperexcitability. What are we trying to do with migraine? Decreased focal, excited hyperexcitability, right? So it just it makes sense across the board that it's likely to contribute. And so my spiel is always the same with every patient, because I've done this with 1000s at this point, and I say, Look, we're going to get off this caffeine for a few weeks. Okay? If you have withdrawal, it's all the same. It's a bell curve, right? And so what happens is, day one, you're kind of tired, but you're okay. Days two and three, if you're going to have withdrawal, that's usually when you have fatigue, headaches, all the miserable stuff, where most people are like, This is worse than being on caffeine. Like, I'm just, I'm going back on right? But if you can get over that hump, then everything levels out, and you get better. So let's say we're doing our treatments. You're off caffeine, you're doing good stuff, and you get to a point where you're like, Man, I'm doing a lot better. I was having 20. I'm down to one a month. The MGR takes care of it. This is great. If you then try the caffeine again, and you start getting migraines. I don't have to tell you to stop, right? You know what, what's going on there. But in conversely, I do have a small number of patients that, say 10 to 15% that go back on caffeine, they're feeling great and they have no problems. Well, I don't care, like, I'm not anti caffeine, right? It's not like, I just don't like it. It's just, I don't want it to cause your migraines, and so if you go back on and it's fine, well, hallelujah, good for you. That's That's fantastic, but that's why we only have the conversation one time, and after that, it's like, either, you know, it's not good for you and you just stay away, or it doesn't bother you and you're fine, right? We just want to make sure we cover our bases, because when it comes to migraine, there's so many little things that can create a problem. I just want to make sure that we're being comprehensive, because I've had cases where, you know, everything should be good, and turns out pineapple was the thing that was driving their migraines. You're like, who would have guessed sinking pineapple? And so we have all these things that sound kind of silly, but it's because I've had one or two or three cases where they just did not go the way I expected, and I'm so confused, and it ends up being something silly like that. So I always tell people I'm very mean for the first couple weeks, and then I get a lot nicer as you're feeling

 

Dr. Ayla Wolf  33:23

Yep, got it. And I guess that brings up the the histamine conversation too. Like some people are very sensitive to histamine production certain foods that are higher in histamine, so how, how much attention are you placing on that?

 

Dr. Adam Harcourt  33:35

A lot. Yeah, I actually it's funny. I had a patient yesterday where I was going through this stuff. And they're like, that's really weird, because, like every food I would point out in the histamine they go, wait, I have an allergy to that. I'm sensitive that I have an issue there. And it was literally every histamine food. I said, Well, I think we know what the problem is there, but most people don't have that reaction. Because the big problem with migraine diet is most people are looking for what, what you would consider triggers, right? So I took gluten out and it didn't really help my headaches. I took dairy out and it didn't help my headaches. Well, I found, in my experience, almost zero people have triggers, right? Not zero. It's like 3% maybe almost everybody, though, has sensitivities, meaning that if you are sensitive, let's say to gluten and dairy and tomatoes and pineapples, right? Well, none of them are driving or causing migraines as soon as you take them, but what they do is they are inflammatory to you. So if you take out gluten, for example, but you're still eating dairy and tomatoes and whatnot, you're still getting the inflammation. So you don't notice a change to go, Oh, it wasn't gluten. Then you go off the dairy, right? Same experience. So what I found is we get off all the things that can cause a problem, including histamine. So that includes, you know, things like your nuts, your eggs, pineapples, papayas, tomatoes, those types of things. When you get off of everything, see how you're feeling when you add them back in. What typically happens is, I ain't get a migraine, but you know what? I got really congested, or I got really tired, or my stomach felt weird. Word, something that just says, this is an inflammatory food. And then you end up finding about three or four of these. You go, Holy cow, I eat these things every day. And so once you know what they are, doesn't mean you can't have them again. It just means okay, I'm not going to have a pineapple pizza every day, right? Because for me, all those foods are a problem. So if you're going to eat them, you know, do it every once in a while. Try not to eat them together. But also, I just find the control of knowing that is so just relaxing to migraine patients. So then if they do go have a pineapple pizza, and they have three glass of red wine, and they wake up the next day with a migraine, they're like, Yeah, sucks, but I know why that happened, and it's not as stressful. And I find that that control is really, really important for long term compliance, because nobody wants to be on a super strict diet their whole life. But if we can say, Well, I went on this diet now, I know there's a couple things that kind of flare me up now, then, now it's your decision, right? Just like if I want to go out and have five beers tonight, you know, might be my decision. Might have fun, but I'm probably not gonna feel great tomorrow, right? That's that's okay. Yeah.

 

Dr. Ayla Wolf  36:03

And then I find too like people do when people are experiencing true migraines, they do usually come in and they'll tell me, these are the certain foods I need to avoid, whereas when I have people with post traumatic headaches, they're not coming in saying, Oh, when I eat this food, I get a headache there. And so I think those little clues just in people's intake too, can kind of guide you into being like, okay, you know, does this look more like a real migraine, or are we dealing more with a post traumatic

 

Dr. Adam Harcourt  36:32

headache? For sure, yeah. And I have a couple basic questions I always ask. I always say, Where exactly is the headache located? Okay, that's my, my number one. Then I was just asked their history of medication use, right? What helped them, what didn't? Because, can you have migraine and tryptops don't work for you, sure. But normally, the reason that that happens is each trippin works on different serotonin receptors, and so if they've tried three or four, none of them have worked. Now it's less likely to be migraine, still not impossible. But if they say, Well, none of the trips have worked when I say migraine, it's top of the forehead or it's back of the neck or it's on the sides. Well, those two things combined, right there. Tell me that's probably not migraine, right? And then if they say, Well, I got it, and it started right after a head injury, and I never had a history before, probably not migraine, right? And then they'll say, Well, I, you know, I actually can't be migraine, because I don't get any of those auras, the visual stuff. Well, only a Well, only about 33% of people with migraine have aura, right? So most people don't. So there's just, there's all these little clues that I kind of walk through, and then when I'm doing the exam, for example, the differences in blood pressure and all that, they're usually pretty subtle with migraine, where they can be a lot more accentuated with post traumatic headache. And just as you talked about the importance of, like, diet, nutrition and hormones, huge in migraine, not as not, I don't want to say not important. It's just not as many people have that as a big problem. So like 98% of my migraine patients there's a hormone, nutrition component. I'd say like 40 or 50% of post traumatic headache that actually ends up playing a part. So that's a case by case basis, which is why I don't, I don't kind of emphasize it as much. I typically go right in for the neuro treatment. On those cases, get them treated right away, and then if they need more, we do diet and hormones. Whereas if you have migraine, I'm making you do the diet and hormone testing, all that before I even see you if you're coming from out of town. So that way we know all of that is dialed in. So when I see you for the neurological treatment, we know that any changes are due to the care and not from withdrawal from caffeine or blood sugar issues or those types of things.

 

Dr. Ayla Wolf  38:35

Yeah. And how often are you seeing people who you think are actually suffering from medication overuse

 

Dr. Adam Harcourt  38:40

headaches. Yeah. So this is, this is interesting, is they used to put migraine, kind of way down there in the disability, you know, kind of scale. And it wasn't until a few years ago where they go, Wait a minute in the medication overuse category. Like 99% of those are from people that have migraine. And so once they combine those two, they found, wow, migraine is the second leading cause of disability worldwide period, and in people under 50, it's the leading cause which is just wild. And so the reason that if you take triptans, they say no more than about nine or 10 a month, is because once you get past that, your brain gets used to that kind of flood of serotonin receptors being being activated, or the agonist to them, and they get used to it. And so now it's really, really hard to not have headache, because you're basically having withdrawal from the medications, which increases your stress levels, which increases your probability of migraines. So you take another medication, and it's just like this snowball effect. It's awful. So that's why the first thing I do is get them on MQ seven and MGR, because even if I can take them from 15 or 20 triptans a month, which, again, they're not supposed to do, but people got to get through. If I can get them down to taking like five a month, that already starts to reverse this process right away. And so that we try to do everything we can to kind of lessen the load, and that helps them get off the medication overuse headache, because that that it's like a. Drug withdrawal. It is a drug withdrawal. It's like a caffeine withdrawal. It's just, it's really, really rough, but if you get them over that hump, they do wildly better,

 

Dr. Ayla Wolf  40:08

yeah, and I find too, like some people will take their triptans as prescribed, meaning they might only take them nine or 10 days of the month, but then they're taking ibuprofen or, you know, Advil every other day of the month, and it's like, okay, well, that's also a problem too,

 

Dr. Adam Harcourt  40:23

yeah, doing what you got to do. And that's why I tell people, is that? Well, you know, I tried Botox, but I didn't want to. I'm on this medication. It's like, well, if you didn't have any other options, I mean, what do you do? You got to get through life, right? And so when we talk about what, what to take when you have a migraine, I never say there's a good or bad thing to take. I just say, look, there's kind of a hierarchy of stress levels, or what we call allostatic load, to the system. So if we can just lay down, take some MGR and put some ice on the front of your neck, and you feel better. Hallelujah, right? That's great. But if that doesn't work, and you end up having to take a triptan, and that gets rid of it, well, that's what they're for, right? So you just want to use these things as needed when you haven't been given any other options, and this is basically all that you have to do. Well, then that's all you have to do. And so that's how people tend to get in this medication overuse kind of spiral. And that's why, again, we try to get out and talk to as many people as we can. I just did a grand rounds down at Johns Hopkins, and we had a great conversation with the doctors there, because they're in this same kind of boat. They're like, look, we go by the objective diagnostic criteria that's given to us, and based on that, then we follow the protocols that are laid out for these conditions. And in that scenario, a lot of people fall into migraine. And then the sequence is, you know, you take the Topamax, or you take the, you know, rhizo triptyans, or you take the whatever it is, the Ayla is Jovis, and that's kind of the model, and they're doing the best they can. But you also have to realize, with medical neurology, they're also dealing with life threatening conditions, genetic disorders, rare condition, things that just take a wild amount of time to keep people from dying, from like, that's that's really what they're doing. So when you end up with migraine, it's like, yeah, it's miserable, but you're going to be okay, meaning this person is not going to die. My other one over here might, so I'm going to put all my effort into keeping that person from dying. And so our my I feel like our responsibility is say, Okay, that's great. We need to start putting out a lot more literature and education to say, thank you for ruling out the tumors and strokes and all the stuff that could be causing terrible things. Now our expertise is making sure that this functional, debilitating condition can be cleared up and get, like a nice kind of continuation of care into what do you do once you rule out the scary stuff, and that's what doesn't exist right now. So that that's kind of my next goal is to open that line of communication and make it a lot more simple for your general practitioner neurologist to say, Great. Everything's rolled out. That's fantastic. You're going to say, see dr Wolf, and she's going to take care of the migraines, right? That's where we want to get

 

Dr. Ayla Wolf  42:57

to, yeah, and then talk to me about vestibular migraines. And I'm also curious if you've had, if you found that the MQ seven helps in those cases too, or if you're approaching them completely different,

 

Dr. Adam Harcourt  43:09

yeah, and I'll lump that in with hemiplegic migraine as well, because I would what's interesting about all these different variations is they get treated as different disorders. They're all migraine, right? They're all migraine. And so when we talk about, you know, the bucket theory and this hyper excitability and all this stuff, it's the exact same thing. But instead of being in the area that inhibits head and face pain, it's in the area that controls balance or controls facial movements or whatever. I just had a hemiplegic case come in two days ago, and it was post surgical. They had a history of migraine. They had a history of a little bit of facial drooping, but now, after surgery, they came out full facial drooping. They have full tingling and numbness. And at first they go, you're having a bunch of tias. And then they're like, but we're not seeing them on imaging, so we're not sure what's going on. Which is common? Hemiplegic migraine is not, not super common. And so with vestibular migraine or hemiplegic I still do the MQ seven and Mgr. Now, for me, with hemiplegic migraine, I had no reason whatsoever to think that MGR would be helpful with the hemiplegic symptoms, and so I never recommended it. And I had a few cases where they had both hemiplegic migraine and classic migraine. And I had about three, about three patients in a row. I'll say, You know what was weird? I had the headache. I also had the hemiplegia. Come on. I took the MGR and my hemiplegic symptoms went away. I don't know why. I'm just being I have no idea why that happened, but it has helped. So I go, All right, well, it's better than whatever else you were taking. And so we still start with the diet, the hormones, like I had a hemiplegic case that had been couch bound basically for seven months. They couldn't move, and we just started remotely, because they were in central they were in the middle of the country, and they just did the nutrition and hormones and got like, 78% better just from that. And they're like, but it was stroke. Why are they getting better? It's like, no. What was migraine. And so if it's vestibular migraine, I still start with the base of the nutrition and hormones. But the therapy, as opposed to being straight, you know, trigeminal or going after that, that kind of upper mid brainstem, we do a lot more that affects the lower brainstem, right, the vestibular system and things like that. So the neurological rehab might be a little bit different, but the approach is still exactly the same and same thing with hemiplegic migraine. Yeah.

 

Dr. Ayla Wolf  45:23

So as kind of a take home for our listeners, there's this concept that whether you're having a migraine manifesting as head pain or a vestibular migraine manifesting as extreme vertigo or disequilibrium, or a hemiplegic migraine, which is manifesting as paralysis, temporary paralysis of the face, or an abdominal migraine, where you're having nausea, it's that this is a hyperexcitability in the brain, and based on where the hyperexcitability is, it's affecting different systems, and then people are having these different symptoms as a result.

 

Dr. Adam Harcourt  45:57

Exactly, yep, that's exactly right. And interestingly, about abdominal migraine, you might see something different than I have, but I have yet to see a case that was actually abdominal migraine. Every one that I've had ended up coming back to figuring out, oh no, they actually had a really bad concussion that brought on all these symptoms. Not saying it doesn't exist. I'm just saying every case I've ever seen. Initially they would say, yeah, it's migraine. Came out of nowhere. But upon like I had one kid, he came in and again they say, it's abdominal migraine, abdominal migrants. It's miserable. And they came in and turns out, he goes, Oh, yeah. All this started after I was sailing and the boom came around and hit me and knocked me off the boat. I go, and you didn't have ever had any symptoms before that, they go, no, maybe that was it had something to do it and so, I mean, again, they because these are, there's not an objective way to say which is which. My guess is, there are people that have these abdominal migraines that are really lower brain stem, and that's where that's coming from. But the vast majority, I feel like are diagnosed as abdominal migraine because of the nausea and the different symptoms that aren't as classic, I guess, with post traumatic headaches or post traumatic concussion syndrome, and when, in reality, they're just a knock to the head, right? And so that's just an interesting observation I've had over the years is I just haven't seen one yet. It's very interesting.

 

Dr. Ayla Wolf  47:24

Yeah, yeah, interesting. And then let's talk about barometric pressure. Because a lot of people that suffer from migraines become their own weathermen. In a sense, as soon as the barometric pressure changes, they get a migraine.

 

Dr. Adam Harcourt  47:37

Yep, yeah. The way I describe that is when we talk about the bucket theory, which we talk about the bucket theory, which we didn't talk about here, but I'm sure you've talked about it is, if you imagine that part of the brain that's hypercitable for whatever type of migraine you have, you imagine it as a bucket, because as stressors, right? Hormonal stress, musculoskeletal stress, nutritional stress, whatever it is, fills up that bucket and the bucket overflows. That's when you get migraine. Now we technically, we talk about this hyper excitable state and all that, but the bucket all that, but the bucket makes sense. And what's interesting is, over time, the bucket can either get bigger or smaller. So if you have two migraines a year, right? You have a big old bucket. It takes a lot of stress for you to end up having that migraine. But now it starts being every month, every two weeks, every week, every other day, and eventually get to the point where the bucket is so small that even if you go in, let's say, you get acupuncture, and it's wonderful for you, there's too many other things filling up the bucket, so it looks like, oh, that didn't work. I'm going on the next thing, and you try chiropractic, and it's great for you, but the bucket so small, so it looks like it didn't help. And you move on to the next thing. And this keeps happening over and over. That's why, with chronic migraine, we approach it in this comprehensive manner where we look at all the different things, and we try to remove things from the bucket, but stimulate the area that is involved in the migraine so that it creates more proteins, makes it less hyper excitable and makes the bucket bigger. The way this relates to barometric pressure is, believe it or not, I haven't figured out how to control the weather. Can't do that yet, so I can't empty the bucket, but what I can do is I can make the bucket bigger. Okay? And so what we find is as people get better and they get more stable, they'll get to a point where they'll feel the bare they'll still feel the barometric pressure, they'll feel everything that usually leads up to that migraine, and then it just doesn't, doesn't come on, right? And what that tells me is the buckets gotten big enough where it was filling up, right? It was getting close to being hyper excitable. And it didn't quite make it over the edge. Okay, we've got it big enough. Hallelujah. We know we're in great shape then. And that's, that's kind of how you treat exogenous stressors that you have no control over whatsoever. You're not going to get rid of that stressor just like I had one one time where she was doing really well, and then she started spiking up headaches. I go, What the heck happened? She's like, happened? She's like my mother in law moved in with us. I go, Oh, I can't, can't take that stressor away. Sorry, let's keep working on the things to make that bucket bigger. And that's what we did. So there's always things you can't control. That's why I'm a very, very kind of staunch advocate of continuing with Ayla. Exercises until you feel really, really stable, not because you're going to get a migraine if you stop doing them, but because we want to make that bucket as big as we can. So when inevitably those big stressors come along, it's not taking you out for for weeks or months.

 

Dr. Ayla Wolf  50:13

Yeah, yeah, that makes sense. So it's when people tell you that it's really just an indication of kind of where they're at in terms of how full is their bucket, or how big or small is their bucket, and your approach is still technically the same. Let's try to decrease the hyperexcitability in the brain. Let's try to stabilize the brain through active neuro rehab, create those proteins that create the proper voltage of the cell membrane so that's not so hyper excitable. That's

 

Dr. Adam Harcourt  50:39

exactly right. Yep,

 

Dr. Ayla Wolf  50:41

awesome. Well, why don't you give us some information on where people can find you, where your clinic is, and then some of these other things you have going on. I know you also wrote a book that is probably chock full of helpful information for people.

 

Dr. Adam Harcourt  50:53

Yeah. So we're at hardcore brain center, right? It's the easiest thing is just look on Google. You can find us pretty easily. We're in New York, Pennsylvania. We're also on Instagram. It's at migraine doctors, so we've been on there for quite a while. A lot of content. There anything? I think I have part of my speech from Hopkins, we were on when was with Dr Drew, doing his podcast. That's on there. So lots of cool stuff to look up, lot of helpful hints. You know, we do things for the holidays, things like that. So it's a great resource for us, I did write the book. It's not not available very easily right now, but that hopefully will change soon. So you just be on Amazon, it'll probably be available on a different website. We are, we are working with biogenic nutrition. So there's some really exciting things that will be coming out in the next couple months through them. So some at home, things that you can do on your own. And then, as we kind of alluded to, we're also looking at a couple different research papers. One, actually with laser therapy, because there's, there's not a lot out there about it, but there's some really cool things that we've been doing. So that's one study that's going to be coming out. And then there's another one we're going to start looking at with with eye movements, being able to track those and then kind of quantify that. So again, that's that's all coming down the pipeline, but easiest way is just look us up online, or go to migraine doctors at Instagram.

 

Dr. Ayla Wolf  52:29

Medical disclaimer, this video or podcast is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice, no doctor patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice diagnosis or treatment, and consumers of this information should seek the advice of a medical professional for any and all health related issues. A link to our full medical disclaimer is available in the notes foreign.