Welcome back to the Healing Pain Podcast with Dr. Trupti Gokani
There are approximately 45 million Americans that complain of headaches each year. That works out to about one out of every six people or about 17% of the population. More than 8 million Americans visit their doctor for complaints of headache each year. It’s on the top list of the World’s Health Organization as diseases to be treated. Headache disorders are among the most common disorders of the nervous system. It’s been estimated almost half of the population have a headache at least once in their life, and worldwide a minority of people with a headache disorder are diagnosed appropriately by their health care provider, which means that there are many, many millions of people in the United States as well as around the world who are seeking relief and have yet to find a proper diagnosis and effective treatment.
Here to speak with us today is Dr. Trupti Gokani who is a Board Certified Neurologist and who has dedicated her life to developing a unique blend of modern medicine and Asian philosophy. She’s best known for her revolutionary integrated approach to treating headache pain by focusing on healing the head and identifying the disconnect between the mind and body. When not in the clinic, Dr. Gokani dedicates her insights to help Americans understand the purpose of their pain and how to heal themselves through a deeper appreciation of the mind, body, spirit connection.
Bridging Ancient Wisdom with Modern Science to Resolve Headaches and Pain with Dr. Trupti Gokani
Dr. Gokani, welcome to the Healing Pain Podcast. It’s great to have you here this week.
Thank you so much for having me. What a pleasure to be here.
When I first discovered your work, I was so excited because you blend traditional medicine with integrated functional medicine, as well as Ayurveda. I’m trained in functional medicine, I went to physical therapy school, so I’m good with the traditional medicine and functional medicine approach, but I’m fascinated by Ayurveda. It’s something I’d like to study more. Can you tell us what Ayurveda is to begin with?
Ayurveda is a fascinating science. It’s actually believed to be the most ancient one and actually believed to be the first system of healing known to mankind. It’s originating over 5,000, 6,000 years ago. The belief system is that all of us are made up of these five elements. The five elements are part of our constitution. Once you get a sense of what your nature is based on these elements, you can understand your mind, your physical body, your mental constitution, and so many things become unraveled once you get that basic foundation of your state and your natural authentic constitutional makeup.
It’s a different way to look at the body-mind interconnection, so to speak?
Yes. There are some other traditional medicine that uses elements also. It’s this idea that all of us have a unique us. The key is getting to know yourself. Once you get to know who you are, then you have a template to follow in terms of what foods to eat, what exercise to do, even which friends to hang out with, because a lot of it is based on your nature and what supports you and then what imbalances you.
I love the friend part. It’s just so important to create groups that support you or people around you that support you and lift you up, especially when you are working through a chronic pain type syndrome. Tell us first how traditional headaches are diagnosed and treated in traditional Western medicine.
Traditional medicine is where I started. I have to say, I do blend Western with Eastern medicine and do functional medicine too. I believe there’s a role for all of these approaches. Traditional medicine really looks at the idea that when you look at chronic pain, especially chronic migraines, it’s a sequence of events in the brain of, after they shield the brain, trigeminal nerves get activated then the inflammatory peptide release occurs, and the moderate headache becomes more severe based on how much inflammation, how much activation there is of the brain. What we do with our traditional medicine tool is we stop the pain with some pretty aggressive tools, the anti-inflammatories, stronger medications. Quite frankly, we package headaches into one big box. We call the ICD-10 Coding with direct to the insurance so we have to say this is a migraine. We have to package it. It’s really challenging to do that because everyone is so unique.
When you start to implement Ayurveda into your practice, how does Ayurveda look at headaches and migraines?
To be really frank with you, when I started practicing about fifteen years ago, I was using the traditional medical model. I myself, when I was a medical student, discovered Ayurveda because I had severe insomnia and I did not want to be on medications. I was offered Prozac, I was offered Ambien. I said, “No, thank you.” I didn’t know where to go and so I found Ayurveda then. I decided when I started practicing medicine, I couldn’t just give out narcotics and I couldn’t just give the anti-inflammatory meds. Fifteen years ago there was quite a heavy use of narcotic medications for pain and it just didn’t feel right. I started to explore Eastern medicine. I knew a little bit about it because of my medical school experience with my insomnia. It really allowed me to fine tune my approaches with patients in terms of saying, “Maybe with someone that has the fire-type headache,” we call the Pitta, that one type of headache, “anti-inflammatories may work better.” I actually started to delve into, “Where does inflammation come from? It’s the gut link to the brain. Let’s work on the gut.” It opened the doors to a whole approach that was not available with Western medicine.
It’s interesting that you mentioned that fifteen years ago, we were prescribing a lot of narcotic opioid pain killers, and to you as a practitioner it just didn’t feel right. You had an inner feeling, an inner sensation, an inner calling. That’s very interesting to me because you’re the first physician on my podcast who has really said something like that. I think many people have looked at the research that came through and looked at what the pharmaceutical companies were publishing and at times wound up on that cycle of prescribing. They didn’t really know they wound up on that cycle of prescribing and people kept coming back, so they kept prescribing.
I know this is a bit off out topic today but it just came up and I have to ask you the question. How do we teach other practitioners to listen to their instincts when they’re working with patients or when they’re prescribing a certain medication? Both of us treat people with pain. I think anyone, especially people on the pain space, have this yearning to stop human suffering. When there’s someone in front of you, you want to do everything you possibly can to help that. At times, there is definitely a need for medication and in other times it’s something like Ayurveda or something like physical therapy or functional medicine or a different approach. How do we make more practitioners aware of the moments that they could be more mindful in the moment before they prescribe?
This is something that I myself really worked on because I am not just in this to really help the patients only but to help physicians see the bigger picture because quite frankly, we are missing a lot in medical school training. There’s just so much that’s been missed in residency. I have them think about it this way, and this may help the listeners and help yourself, is I say when we went to medical school we took an oath, first, do no harm. When you’re in the clinic with the patients and you are thinking about and looking at them, I have to be honest, the mantra I’ve heard fifteen years ago was “Get rid of the pain. You’re a good doctor if you can get people to pain freedom. Do everything you can to get people to be out of pain.” At that time, we had tools like OxyContin. I had Methadone prescriptions ready to deliver. I was being told, “You have to get people to pain freedom,” but there was another quote that was helpful. In Stephen Covey’s book, The 7 Habits of Highly Effective People, that second habit is, “Begin with the end in mind.” I was a business major in college before I went into medicine and I’ve read that book somewhere down that path. I remember that second habit, “Begin with the end in mind.”
You put this all together. If you’re going to begin with the end in mind, if I’m going to give you a narcotic today, where are you going to be a month, two months, three months down the road? I knew there was something and I know that every single person out there has that little voice in them that’s speaking but we often suppress it. If I have them, the physician or the patient, even think from that aspect, let’s not just get rid of the pain and get you to zero and not think about the future of where this condition is going to go, we’re really not helping ourselves or others if we don’t think in that bigger way. That perspective has helped me and I share that with as many people as possible, patients and physicians alike. Once people really hear that, they’ll start listening more to themselves. We all have really strong voices. We just tend to suppress them.
Listening to that voice as a practitioner as well as a patient, because sometimes as a patient you say, “I don’t really know if I want this surgery or if I want this medication.” Of course, as a patient listening to your inner voice as well and going with your gut and saying, “I’m going to go see someone like yourself and I’m going show how Ayurveda, instead of a traditional narcotic or instead of surgery.” I find it interesting that Ayurveda looks like gut health as well. Can you talk about the connection between Ayurveda and gut health and headache relief?
That’s actually the foundation of Ayurveda, the gut is the origin of disease. I remember hearing that when I first read my books in Ayurveda way back when I was a medical student, and then I heard that again. It was so clear to me in my clinical practice, how many patients come in complaining of digestive imbalances, be it reflux, nausea, constipation, gas bloating. Ayurveda separates these things out so if you’re more of air and space elements or side elements, air space, fire, earth and water, if you’re more of this air and space element individual, we call it the Vata Dosha type. That individual tends to have more gas, bloating and constipation. If you’re more of the fire type, you have more nausea, vomiting, diarrhea. More earth type, you get more sluggish, heavy and full easily after meals. What’s interesting is the basis of Ayurveda is looking at gut health and looking at your disconnection from your authentic state and those go hand in hand.
If I am, for example, having a lot of gas and bloating and constipation, then you have to ask yourself, “Is that coming from foods? Is it coming from what you’re bringing in in terms of actual foods or is it what’s coming in your mind? Is it emotion, is it fear, or is it anxiety?” Back to even that intuition conversation we just had, a lot of physicians I know, when I ask them, “Why don’t you listen to that voice? What is it that’s preventing you or patients? Why don’t you try something besides the anti-inflammatory steroids?” “I’m scared.” It’s fear. There’s something that holds people back. If we just allow ourselves to be compassionate and say, “We’re all scared a little bit, but just let the fear be put to the side, bring in some compassion into your life and allow yourself to explore, things start happening.” The gut is the foundation in Ayurveda and the gut is actually linked into these three gut types. Once you understand your gut type, then you can actually start to use foods and actually use mantras to work on your mind. It’s really cool. It opens up a whole avenue that’s very neat.
I’ve been told that I am fire, correct?
Out of the five you mentioned, is there one that is more likely to present with headaches?
There are actual classic combinations for headache individuals. I break down headaches wind-type headaches, Vata headaches are more like the tension-type headaches, neck pain, back of the head, tight band around your head. It’s really not that severe. We all get those once in a while. That’s more the Vata, the wind headache, and it’s usually back of the head and neck is involved.
The fire headache is typically more of the migraine headache. Inflammatory, linked to liver, linked to anger, linked to frustration. The wind headache is a little bit more linked to anxiety, fear, restlessness. The fire headache is more of the classic migraine. One thing just to keep in mind, everybody that has pain has a Vata imbalance. There’s too much wind in their body. Wind is the energy of movement, and so when you’re moving, going, doing too much and you have too much of a build-up of those air and space elements, you start to activate the neurons and activate the trigeminal nerve in the body, and you start to then become excited. Then your wind blows on the fire, the Pitta Dosha and you start to get migraine-type headaches. There’s nobody out there with a migraine that doesn’t say that they don’t get neck pain once in a while or tension headaches.
The Kapha, the earth headache, is more of a sinus type headache or condition. It’s more heavy, congestive, front-of-the-head. As you know, if anyone’s a headache sufferer out there, you can get all three. You can jump from one to the other to the other. Classic migraine is a wind, it’s a Vata-Pitta combo. That’s where I typically start with a migraine and then I break it down a little bit.
It’s really interesting that wind example. Even though they didn’t have the technology to look into the brain, it sounds very similar to what we know today as central sensitization where there are central changes happening in the brain and nervous system that we’re now just discovering. People had known this, it sounds like, for centuries.
It’s so beautiful. This is why I still practice Western medicine. It’s so beautiful to see Western medicine supporting the things that you and I know intuitively and these things finally show themselves. It’s beautiful because I have to tell you we’re in a great place now because western medicine is starting to really see the value of our functional medicine and Eastern medicine approaches. I have to say be patient, be kind, this will all start to show in terms of the data. Central sensitization is definitely linked to that excitable brain. It’s carrying a lot of energy of excitation, and it’s just one little shift in barometric pressure and your body can start to react to that. It’s depending on how much of that energy you’re carrying over time how sensitized you are.
You mentioned mantras before, which I think can be really powerful for people who need to really get themselves into that relaxed nervous system state, into that parasympathetic state. So often that they’re busy, they don’t have the time to meditate for 40 minutes like you would do in a traditional mindfulness-based stress reduction program, or maybe they just feel like, “Mindfulness-based stress reduction is not for me.” A simple mantra may be a really easy way. Do you have a couple of mantras that you could share with us that have worked for your patients?
Absolutely. Most people that come to see me are really chronic migraine. By the time they come to see me, I can’t tell you how many doctors they’ve gone through, or they’ve gone through so many places. Most of them are really fiery Pitta and inflamed and very angry, very anxious and worried and fearful that they’ll never get out of this pain cycle and it’s a really hard place to be. I ask them just to recite a really simple mantra that is, “I love and accept myself exactly as I am.” If they start to push, which many of them do, push themselves to want to get better, push themselves to want to believe the med will be the answer and feel that energy of fire within them, say something very simple, “I’m doing the best I can at this moment in time.” You don’t have to make it a big deal. This doesn’t have to be an hour a day of chanting and meditation and yoga. Who has time for that? Personally, I would love to be able to add that into my schedule, I cannot.
What I do is when I start to feel myself getting activated, I feel that energy building, take a breath and say, “I’m doing the best I can at this moment in time. I’m doing the best I can at this moment in time.” Then you start repeating it in the back of your mind. If you can get it in twenty times that day, just really subtle in the back of your mind as your day is flowing, keep doing what you’re doing, you’ll see that the brain starts to shift. You get all that reptilian deep brain limbic fear-based mode into the higher brain that’s really joyful abundant and there to help you do it. You’ll see that pain and that fear and that anger starts to subside. The more you practice this, the better you get.
What I love about that is that, like you said, if we could all take an hour out of our day to do some Hatha yoga and some meditation, all our health will be better. The truth is we can’t, but what I love about what you just said is that really life becomes the meditation. When you can work in simple mantras like that into your daily life, you can still be at your desk and be busy, but you take just a moment or two to pause and give yourself some of that love and kindness and give yourself some of that ease and that pause. Through that, your entire nervous system relax, your blood pressure comes down, your stress and cortisol levels drop, and then ultimately you feel better, even your digestion improves. Isn’t that correct?
Absolutely. What you’re talking about which is the key is connection. It’s maintaining connection. It isn’t about going to a one-hour yoga class and then jumping right into your car, drinking a cup of coffee, and going to a busy day at work. It is about maintaining connection the entire day. You can’t just tune in and tune out of this. This has to be something that’s a practice, it requires attention, it requires just being aware. That’s all. Once people start to get awareness, it’s just beautiful what unfolds. It’s that everything else then right comes to what you’re going to eat for lunch. Again, back to those friends, which friends are you going to hang out with tonight? You start to just become more aware and that’s when the intuitive voice becomes real loud and very clear and you just begin to know what to do.
You also integrate functional medicine into your practice. I’d like to talk about some of the nutrients that you might choose or integrate if you’re not using the medications first or maybe you are using some medications in small doses for short periods of time but you’re using the nutrients that support the person through the process.
One of the rules in my clinic and it’s just something that I’ve stood by is that I do not use medications first for prevention when a patient comes in for a new patient visit. I used to pull up a Topamax before, the Botox injections right away, and start someone fifteen days a month in chronic pain right away in one of those tools. I have actually found that at this point, they have gone to so many doctors. Let’s just see what their mind, physical body, digestive shifting and nutrient replenishment can do for them. I actually don’t start with meds right away. I have people do this first. I have them assess what they’re potential nutrient depletion is. We can tell from the clinical forms, and I know you’re very well-versed on this, a little magnesium is probably of one of the most common nutrient I’d say every single one suffering with pain. Magnesium is just very highly likely to be low. Magnesium is involved in so many processes in the body. Most importantly, when you look at that excitable brain you talked about, that central sensitization, magnesium blocks glutamate receptors. Glutamate is a very excitable neurotransmitter.
Magnesium in a very natural form can work like a seizure med because it actually has that ability to quiet down the excitable nervous system, the excitable brain and body, and helps us with muscle pain and all sorts of different things. The thing about magnesium that’s interesting is I find it needs to be paired. I find that it works really well with Vitamin B2, Riboflavin, CoQ10, helpful in Ubiquinol form. I do like to check Vitamin D levels, and we know that’s more of a hormone than it is a vitamin. You will find that that level can really fluctuate when someone’s in pain, especially in a really inflamed and your gut isn’t healthy. They tend to become very consumptive and use up their nutrients and hormones very quickly. Those are probably my top three: magnesium, B2, CoQ10 in Ubiquinol form, a little Vitamin D or sometimes a lot depending on their levels, then putting in something maybe like milk thistle to detox their liver as an herbal. Based on where they are, I like to add even some B6 and B12. B12, we find a lot patients because of that adrenal cascade, they need it for cortisol production, they need it for the Krebs cycle; very helpful. The big picture is a lot of these, if you look at these nutrients, it’s boosting mitochondrial health, boosting the Krebs cycle and the mitochondria, right?
Yeah. When you start to mention magnesium and CoQ10, my brain goes right to mitochondria and mitochondria health because we know obviously your mitochondria is dense in your muscle tissue and your nervous system. Those are two places where you need more of those nutrients just naturally. Like you said, so many people with pain are depleted in those areas, so it’s really important that they obviously get tested and figure out what the nutrient depletions are, and then replete people in a way that’s healthy. How soon would you see those nutrient repletions happen in people? Sometimes people have headaches plus they have other conditions like metabolic syndrome or they have diabetes or they have autoimmune disease. These are in a case by case basis, but how soon can someone see those repletions happen?
The interesting thing with that and to answer that question, it really to me is linked on how much stress they have and how healthy their digestion is. If I were to recommend a nutrient plan for a patient and they have a very high level of daily stress and their digestion is very weak, step one is will they absorb the nutrients you give them if you’re giving them the oral form of a nutrient formula or different blends of nutrients in oral form and how well they absorb it? The second thing is how quickly will they use them up?
I’m just thinking of my really kind but very hardworking attorney-patient that is really working hard on a trial and is not getting any rest, not sleeping well, stressed all day, I give him some magnesium. Let’s say he has severe reflux and he’s taking a proton pump inhibitor. How quickly is that going to work for him? It’s very different than the wonderful yogini that comes in that has once in a while migraines that is really protecting her gut, eating really healthy food, making lunch the greatest meal, and getting a good night’s rest. Those nutrients for her will really get absorbed quickly and work more efficiently because they won’t be utilized so quickly.
I hate to say I can’t answer that really easily because it really depends. The good big picture answer is that, as I mentioned earlier, I don’t like to start meds. I have found that if I start with the nutrients first, a little digestive work, a little mantra work, I’m going to tell you, about 90%, if not higher, of my patients, you can even say 95%, don’t need really any further medical intervention when they come in for the second visit to see me. If that’s the case, then it is working probably within a month because that’s when I typically see follow-up patient. That’s pretty cool for people that have been suffering for years and seen so many physicians to say that back to you, “A few of these tricks: working on diet, working on mind, bringing in some nutrients, and within one month I don’t have to pull up a Topamax prescription or the Botox injections.” It’s a really nice thing to say and to see it happen.
You have a passion for helping patients. In your future, do you see yourself helping other headache physicians such as yourself integrate some of these principles into their practice and helping them get trained on some of the basic functional medicine and/or the Ayurveda? I think people can really benefit from having that in their clinic.
Thank you for saying that. I actually ran my first training course last year in November. It was a trial run. You’re going to enjoy this story. I love how the worlds collide. I was speaking for a pharma company and it was a patch delivery of one of the key medications used for abortive, to get rid of a migraine. The group is called the Triptans family, Sumatriptan, Imitrex is the most commonly known. There’s a whole bunch of these Triptans. They’re FDA approved for migraine. What they’ve done over the years, because they’re hearing us, they’re hearing that the gut links to the brain, is they’re coming up with formulations of these products that are non-oral, so there was a delivery that was a patch form, a nasal delivery. I was speaking for the company that was actually recommending a non-oral transdermal patch delivery of a product. As I was speaking to physicians, they were asking me, “How would you recommend this very expensive product, Dr. Gokani, when there’s a generic version that’s oral?” I said, “Do you all know about the gut and how it’s linked to the brain?” I was only speaking to neurologists and pain specialists. The number of doctors that just really get into that conversation and loved it, it was so fun to hear that enthusiasm.
What happened was I collected a database of those physicians that really loved that message, and I ran a two-day training course. It was awesome. It was really fun. It was a lot of work. I pulled together fifteen years of a lot of different tools and tricks that I’ve used in my practice. I definitely want to do that. Right now I’m a little busy with a few different things but it’s something that is my calling. I think I’m torn, to be honest with you, between the active patient care, because I’m still in practice and seeing patients, and training doctors. I know if I train more doctors, I’m going to have to reduce my patient care and I love my patients so much, I don’t really want to make that switch quite yet.
I think it’s something that a lot of practitioners struggle with, especially those of us in integrated space where we have collected evidence-based data from all these integrated strategies that we now have worked into practice and we know it works. We see it work in hundreds and thousands of patients. The trick is, do we keep treating patients which is important, or do we help other people serve more people? There’s a lot of joy and good in that as well. It’s been fascinating speaking with you. If you ever hold that course, I’ll be the first one there to take it, so please, please, please let me know. Can you tell all of our listeners how they can learn more about you and the things you’re up to?
Right now, I’ve just updated my website. I have a new website. It’s TruptiGokani.com. I have added some things to the site because I really want to reach as many people as possible, so we added a video course. It’s a really nice six-video course session that just takes you into my practice. I know that it’s hard to come and make an appointment with me and see me and it can be a little cost-prohibitive. What I’ve done is I’ve created what I think are the key lessons that are in my practice that could help people that are struggling today get this knowledge right away, sent to your doors so then you can start to implement these protocols and then expand your knowledge. There’s so much to learn from you and from others. Expand, get into more functional medicine, learn more about what you can do to heal your mind and body. There are so many of us out there that can help you. The video course is one thing. I do have a book, it’s called The Mysterious Mind. Those are just nice tools to use in addition to the clinical visits. I found a lot of patients have benefitted from that and people that haven’t even seen me have done that and not needed to see me, which is nice. My goal is to really get rid of pain and suffering.
I want to encourage everyone to make sure you go to Dr. Gokani’s website which is TruptiGokaniMD.com. Make sure to check out her book, The Mysterious Mind, and her six-part free video training series is available for you as well. Make sure you go on to iTunes and give us a five-star review. Share this podcast out with your friends and family, especially if they have headaches or migraines or tension headaches or any other form of headache they’ve been diagnosed with because it’s a really great integrated approach that Dr. Gokani has. Each week, stay connected to DrJoeTatta.com for the latest podcast and how you can learn integrative strategies for healing chronic pain naturally. See you next week.
About Dr. Trupti Gokani
There are approximately 45 million Americans complaining of headaches each year. That works out to about one in every six people or 16.54% of the population. More than eight million Americans visit their doctor for complaints of headache each year and is on the list of WHO.
- Headache disorders are among the most common disorders of the nervous system.
- It has been estimated that almost half of the adult population have had a headache at least once within the last year.
- Headache disorders, which are characterized by recurrent headache, are associated with personal and societal burdens of pain, disability, damaged quality of life, and financial cost.
- Worldwide, a minority of people with headache disorders are diagnosed appropriately by a health-care provider.
- Headache has been underestimated, under-recognized and under-treated throughout the world.
Here to speak with us today is Dr. Trupti Gokani who is a board-certified neurologist who has dedicated her life to developing a unique blend of modern medicine and ancient philosophy. She’s best known for her revolutionary integrative approach to treating headache pain by focusing on healing the head by identifying the disconnect between the mind and the body. When not in the clinic, Dr. Gokani dedicates her insights to help Americans understand the “purpose” of their pain and how to heal themselves through a deeper appreciation of the mind- body-spirit connection.
Link to speaker: https://truptigokanimd.com
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