Now that we've covered a little bit about the classification and diagnosis of headache, I'd now like to talk about preventing chronic headaches. A good place to start here is identifying headache triggers, and what I will refer to as contributing factors. I will cover contributing factors in greater detail as we move forward. So what about headache triggers? This slide gives a list of different triggers that are important for triggering, that are important and can trigger a headache. This list includes conditions that will trigger both tension type headaches and migraines. Hormonal changes tend to be mainly associated with migraine headaches. But otherwise there's an overlap, and certainly dietary factors, are much more associated with, migraine headaches than with tension type headaches. I think it's important when we think about triggering a headache, we think about, and this is the discussion I often have with my patients, is a bucket. If you have an empty bucket and you start throwing in triggers, eventually your bucket begins to fill up. And you do okay with many triggers, and, without experiencing a headache. But if the bucket overflows, then one has, it will experience a headache and it will be a signal that the bucket is full. So one of the things we try to do in managing people with headaches, is to help them empty out their bucket, keep their bucket open. And so that they can if such factors in life occur, they have some reserve before a headache is triggered. Now, a few years ago a patient came to me and said, Dr. Clavell, and this was for someone who is having migraines. Said, you know, Dr. Clavell, I think chocolate triggers my migraine. And I of course said, well why do you think chocolate is a headache trigger? And she goes, well last week I had a candy bar at 2 o'clock. And at 4 o'clock I had a horrible migraine. It was one of the worst I ever had. And I think it was that, that candy bar. I said, well that's, it's very possible the chocolate contributed to your headache, but I'm curious why did you have a candy bar at 2 o'clock? And her response was, well, I missed lunch. Oh, okay. Why did you miss lunch? Well, I had this very important meeting at 1:00, that I had to prepare a presentation for, and I was so worried about it that I was practicing, and I just didn't have time to eat. I said, okay. Do you think that could have been another contributing factor to your headache? Well, I, I guess maybe it could have. And I go, just out of curiosity when did you start worrying about this presentation? Well, I, I couldn't sleep the night before, I was I was tossing and turning all night long, worrying about this, my presentation. And this is a typical example one hears when talking with a patient that has episodic headaches, is that triggers do not just occur by themselves. They occur in a setting of the individual's life, the individual's lifestyle, and you really have to understand the pattern of these triggers and when they become important. In this particular case, this individual was able to recognize that at other times in her life, when she had gotten a good night's sleep, she wasn't in a lot of stress. And she hadn't missed meals, that she could actually eat a candy bar without triggering a migraine. And so this slide, well, brings together about how this kind of works together in an individual's daily life. When we think about triggers such as stress, daily hassles, hectic schedules. Issues of tension, vigilance, anxiety, or fatigue. A pattern sometimes emerges. And this is a classic pattern for migraine, where the person will either have stress, busy hectic schedule in the morning. As the day builds, they experience a sense of stress, maybe some tension in their shoulders, tension in their jaw. In the evening, their experience is one more of continued stress and fatigue. The body's actually worn out, so to speak, and then something magical happens at that point. Either they recover, ie, they get home, they have dinner, they relax, they rejuvenate themselves and do well. Or, if the stress and tension continues, they often will go to bed, go to sleep and clench their teeth during the night and often wake up, feeling fatigued, restless with a throbbing headache. And so, we think about these patterns and we help people, identify patterns on how they fit together in their individual life, as a way of managing and preventing headaches. Obviously, some people can go from being relaxed to being under stress, tension, fatigue, and a severe headache in a matter of hours. So, this whole time frame here can be condensed into a very short period of time. [NOISE] [BLANK_AUDIO]