Since 53-year-old Rosa was a child, she has counted the number of days each month that her head explodes with pain. Since 2008, that number of days has been 15 to 30 every month, and it is completely disabling.
Rosa used to work as an office manager, but now, it’s not only the pain that crushes her, but nausea; vomiting; and hypersensitivity to light, sound and smell. She cannot hold a job.
She gets Botox injections and intravenous lidocaine anesthetic, as well as drugs called triptans. These help somewhat, but don’t solve the problem.
What is the problem?
There are stress headaches, tension headaches, sinus headaches, anxiety headaches, digestion headaches and more. And then there are migraine headaches, a type of headache that involves both your blood vessels and your nerves.
Migraine is not a disease, per se. Rather, it is a set of symptoms (a syndrome) that include, like Rosa, a visual or sensory aura, followed by headache on one side of the head along with nausea and vomiting and sensory sensitivities. They may last a few hours to a few days. “Migraine” is derived from a Greek word meaning “half skull.”
Even today, medical science can’t say for sure what causes migraines, although the neurological mechanism that results in pain is beginning to be understood. The fact is that the first cause of a migraine in one person differs from that in another, and this gets in the way of scientific modeling.
“Trigger” events are conditions that start a migraine, and one must recognize that the trigger is generally the primary cause for the start of a migraine. Eliminating the trigger will usually eliminate the migraines. This, however, is not a simple nor, in some cases, even possible task.
What’s happening in your head?
There are almost two dozen types of migraine. The three most common involve a headache alone, a visual aura followed by a headache and an aura with no headache.
Modern research tools have shown the migraine process to be a complex combination of both neurological and vascular functional problems. The latest hypothesis represents a work-in-progress, not yet consistent enough properly to be called a theory. However, there is mounting evidence that it is correct.
The sequence of events starts with an electrical disturbance that spreads over the surface of your brain; this is the result of one of your unique triggers. The disturbance occurs in the ophthalmic branch of your fifth cranial nerve, the trigeminal nerve (TGN), which innervates your eyes, as well as your meninges, the protective coverings of your brain. The meninges contain the only tissue in your brain that can feel pain.
There is then an abrupt cessation of the disturbance that results in what’s called a cortical spreading depression (CSD), a wave of neurological silence during which there is no neuronal activity whatever. The TGN association with your eyes accounts for the visual aura that some people see.
The CSD causes the TGN fibers in the meninges to release an assortment of chemicals, one of which appears to be a primary cause of the migraine pain; it’s generally called CGRP, calcitonin-related gene peptide. CGRP releases inflammatory factors that dilate the vessels in your brain, causing pain and further exciting the TGN to release more CGRP, a vicious, painful feedback cycle. This cycle of increasing pain finally subsides in a time that corresponds to the four- to 72-hour duration of a typical migraine episode.
Currently, somewhat effective medications focus on a soothing neurotransmitter chemical, serotonin, that has receptors all over the brain. The medications based on serotonin are called triptans and have trade names like Zomig and Imitrex. These can be somewhat effective in reducing the severity of a migraine episode. In the meninges, they may help block the release of inflammatory chemicals. In the brainstem, they may inhibit pain impulses, and they may act on central pain perception, as well.
However, the main culprit in migraine pain is CGRP. If one is to use medications, then it seems the proper goal is to find one that either blocks the release of CGRP or blocks the CGRP receptors in the brain. The good news is that this past May, the FDA approved the first in a new class of drugs designed to prevent migraines, the CGRP blockers.
What if you don’t like medications?
In my practice, my experience is that when your nervous system and body are in balance, you will be pain-free. And so, I focus on determining and correcting the imbalance related to a specific condition. Usually, the result is relief from the pain or numbness conditions you experience, as well as increased range of motion and improved functionality.
For migraines, the imbalance is clearly related to the TGN and related structures. Treating that part of your nervous system seems to have a beneficial effect on migraines.
After just three treatments, for example, one of my patients reported her migraines going from being debilitating once every couple of days to once in two weeks, in which the episodes were so minor that she needed no medication.
At base, what needs to be discovered is this: If you and I have the same trigger, say a food allergy, then why do you get migraines and I do not? The answer seems related to the fact that about 70 percent of migraine sufferers have a family history of migraines. This suggests a genetic factor, and genetic research is beginning to explore this factor.
Although really in its infancy, genetic research has discovered that in certain genes there are mutations that seem common only to those who suffer migraines. The good news is that over time, possibly a long time, there may evolve gene therapies that can mitigate these mutations.
What can you do yourself?
The simple answer is: Discover your triggers, and eliminate them. This will probably involve diet, lifestyle and other changes. That is, while meds can modulate a migraine episode, the best way to get rid of migraines is to discover the cause that is unique to you.
Here are some common categories of cause:
Food allergies. The least expensive way to determine food allergies is to undertake an “elimination diet.” This means that for a few weeks you eliminate from your diet everything that could possibly be an allergen. This includes gluten, dairy, eggs, yeast, corn, grains, soy and caffeine. Then, every few days, one at a time, you add back the foods you have eliminated, noticing how the addition affects your headaches or other symptoms. It’s important in this exercise to keep a diary of the foods you eat and how you feel each day.
Chemical substances, such as aspartame, MSG, nitrates, sulfites and other additives. These counterproductive chemicals are widespread not only in diet sodas, but in all processed food. Even if you don’t have migraines, eliminating these elements will help you to better health.
Hormone imbalance. A good overall approach to balancing hormonal fluctuations consists of eating whole foods, a diet low in glycemic load (low carbohydrates) and high in phytonutrients (fruits, vegetables, grains, nuts and beans). You may also consider B6, which is involved in producing serotonin. And get regular exercise, avoiding stress, alcohol, caffeine and refined sugar.
Magnesium deficiency. The need for magnesium is widespread in the body. It’s required for energy production, contributes to bone development and is required for DNA/RNA synthesis. The recommended daily intake from teenage on is 300 to 400 milligrams, and your family care provider can guide you through the several methods available to determine magnesium levels. Magnesium is widely available in foods containing dietary fiber, including leafy green vegetables, legumes, nuts, seeds and whole grains, as well as in supplements.
Tired mitochondria. Mitochondria are the powerhouse parts of a cell, and their dysfunction is implicated in many diseases. They generate the energy we need to live healthy, active lives. If yours are tired, then consider increasing your intake of B2 (riboflavin), a primary vitamin for converting food into fuel, and coenzyme Q10, which generates 95 percent of the human body’s energy.
And at last
Migraines, as with many other medical conditions, respond amazingly well to invoking the body’s natural healing processes. This is the most effective way to achieve relief.
Bob Keller maintains a holistic pain management practice in Newburyport. His book, “Making Sense of Medicine: Medical Matters Made Simple,” is available locally or online. He can be reached at 978-465-5111 or firstname.lastname@example.org.