ATTACK YOUR MIGRAINE HEAD ON BY TACKLING THE ROOT CAUSE

 Migraines affect lives

Migraines are a debilitating condition with 190,000 migraine attacks occurring every day in the UK.1 Migraines affect 1 in 7 people and is more widespread than those suffering with diabetes, epilepsy and asthma.1

A migraine is a condition which is characterised by severe episodic headaches which are commonly incapacitating. Migraines decrease quality of life by reducing productivity, missing events, having prolonged periods off work and causing chronic pain which is not relievable effectively with the painkillers available on the market.2

Chronic migraine is almost 3 times more common in woman than in men, and for women chronic migraine usually peaks between 18–29 years old and again at 40-49 years old.3  Patients report feelings of intense headache, nausea, light-headedness and light sensitivity.4  Although the exact cause of migraines is still not fully understood, recent studies have demonstrated that diet and lifestyle changes can lessen the severity of a migraine attack helping those who suffer to be able to lead a normal life.

Here we consider the potential causes of migraines and the possible treatment strategies targeting the underlying cause of migraine rather than just the presenting symptoms.  This will give more options to sufferers to find release from the shackles of migraines in everyday life.

So, what causes the symptoms of a migraine?

There are currently two theories in respect of the cause of a migraine. One (older) theory suggests that migraines are caused by vascular (i.e. blood vessel) contractions and dilations. The other hypothesis is that migraines are caused by neuronal (i.e. nervous system) events. Present understanding is that migraines are caused by both components, however, more recent research seemingly supports that neurological stimulus of the condition is the most significant attribute to its painful presentations.5

There is good evidence to support that the initial phase of a migraine “with aura” (with sensory disturbances) is started with ‘cortisol spreading depression’. This refers to an event in the brain where there is a wave of biochemical and electrical disruption which encapsulates the brain, putting it in a fragile state which is easily unbalanced.6 This concept is consistent with the experiences of those patients who suffer from migraine who describe the initial onset as specks of light in their central vision which gradually widens to their peripheral vision before the full impact of the migraine is felt.

The energy building blocks in the body’s cells, mitochondria, which produce all the body’s energy to function properly, seem to play a key part in the cause of a migraine. If the mitochondria are not working efficiently, especially those that are located in the cells in the brain, then it could be hypothesised that the other systems in the brain which rely on that energy source will be weakened and a cascade of events will then follow which may lead to a migraine attack.7

Mitochondria also play an important role in the homeostasis (i.e. biological balance) of calcium in the cell as well as moderating the concentration of “reactive oxygen species” which are extremely volatile compounds that can cause mutations in DNA as well as impacting central systems in the body.5 These are thought to play a role in the cause of migraines.

The tumbling effect of increased intracellular calcium then causes dysfunction of astrocytes, which are vital glial cells located in the central nervous system which require optimal energy to perform properly.8

Inflammation worsens the symptoms of a migraine as elevated calcium levels trigger inflammatory processes which promote further inflammation to those areas in the brain causing increased pain and unhinging of the body’s processes, such as perception of balance and light tolerance.

An excitatory neurotransmitter called glutamate has also been shown to indorse the symptoms of migraines, as it stimulates neurons by binding to a receptor known as NMDAr (N-methyl-D-aspartate receptor). The NMDAr is stimulated in normal bodily functions ordinarily, but too much stimulation by glutamate and other substances which bind to the receptor cause over stimulation of the nerves causing pain, depression and, in some cases, neurodegeneration.5

Glutamate can be beneficial if converted into a substance called inhibitory GABA (gamma-amino butyric acid), which causes a calming effect on nerves and the brain, but this is dependent on adequate amounts of vitamin B6 (pyridoxine).9 As such, deficiencies in this nutrient could contribute to the start of migraines.

The precipitating factors which trigger migraines is still under debate, but it is widely believed that food allergies may contribute to a migraine’s commencement, such as foods containing tyramine and other amines which are found in aged cheese, chocolate, citrus fruits and red wine and beer.10 It is hypothesised that this reaction is due to a person’s inability to breakdown tyramine which, if not metabolised properly, can stimulate the release of neurotransmitters such as noradrenaline which can kindle migraine symptoms.10

The integrated effects of inflammation, impaired energy processing and over stimulation of nerves in the brain, caused in part by nutrient deficiencies, stimulating (allergenic) foods and increased absorption of calcium in the cells, are all factors which have been demonstrated to play a part in the onset of migraine. These should be considered when developing a treatment strategy to manage the illness, rather than developing medicines which only treat the peripheral pain temporarily.

Can we eat to beat the pain?

Due to the increased understanding of the mechanisms underpinning the cause of migraines, there are now various dietary supplements which can be taken to ease the condition. Here we discuss a number of nutrients which may help to alleviate migraine symptoms:

o   Moderating migraine with Magnesium

Magnesium deficiency can contribute to migraines in numerous ways.  Magnesium is involved in the prevention of excessive nerve stimulation – it facilitates the energy production cycle in the mitochondria and also increases vasodilation – so in short supply it promotes all the factors associated with migraine onset.5 Magnesium supplementation is therefore normally recommended for migraine sufferers as it is safe and effective, unless there are specific issues with the patient that might be worsened by increased magnesium such as kidney disease.11

o   Qualifying Coenzyme Q10

As discussed above, the health of mitochondria is significant in migraine sufferers.  Defects in a patient’s energy generating processes is one of the potential causes of migraine, so ensuring that energy supply is sufficient is essential in migraine treatment. Coenzyme Q10 is suggested for sufferers as it helps to moderate the dysfunctional energy processes in the cells, thereby optimising energy production and circumventing the cascading destructive events which lead to migraine onset. Coenzyme Q10 is also thought to control the immune system so can prevent the over-stimulation of inflammatory cells and can ease the pain in the brain.12

o   Reroute to calmness with Vitamin B6

Studies have demonstrated the effects of vitamin B6 on the conversion of damaging glutamate to comforting GABA, so in patients suffering with migraines supplementation of this vitamin should be considered. It is worth noting that as vitamin B6’s effects are reliant on the presence of magnesium, vitamin B6 should be supplemented in conjunction with magnesium to obtain the best results.5

o   Freeing Feverfew

Feverfew is one of the most studied plants for the treatment of migraine symptoms which may be due to a component in it called parthenolide.  It has anti-inflammatory properties, inhibitory effects on serotonin release from platelets (which may alleviate excitatory effects on nerves in the brain) and the ability to relax and dilate vessels. Although the results in human studies vary, it is believed to have beneficial properties for migraine relief, as long as the feverfew is from a good quality source and the quantities of supplementation are optimal.13

Peace-making lifestyle adaptations

o   Cut out the cause

As discussed above, there are various types of food associated with provoking migraines, so a well-documented approach to treating migraines is to embark on an ‘elimination diet’.10 This method is formulated to remove all allergenic foods from the diet to ensure any inflammatory triggers of migraine are minimised, however, there is no conclusive evidence to support this technique.  A better solution would be to keep a ‘food and migraine journal’ to see if there is any connection between attacks and certain foods and try removing these foods from the diet rather than a complete elimination of a variety of different foods which may have beneficial nutritional properties as well.

o   Heal with movement

Certain ‘myofascial trigger points’ (i.e. muscular tension) for migraines have been identified in some people in the upper back and are well treated with exercises and stretches around this area. If, when this area is palpated (examined with touch), there is pain in the person’s head or face then this might be the underlying cause of the migraine. 5 In this situation, a movement approach is most suitable for migraine management and healing.

Mitigate the migraine and live again

Research has shown that common antimigraine analgesic (i.e. painkiller) and anti-inflammatory drugs may relieve migraine pain momentarily, but they can actually make migraines worse in the long run – leading to a cycle of pain and respite.14 A better resolution for migraine sufferers is to tackle their migraines from the bottom up and avert the triggers and dysfunctional biochemistry that lead to pain by lifestyle changes – for example, diet and supplementation interventions which supports optimal brain function and modulation of the immune system. This may take some trial and error to find the root cause, but it does mean that once the problem is recognised a more targeted treatment plan can be adopted.  This means that a sufferer can prevent migraine attacks for the long term, rather than experiencing temporary lapses of liberation and living the rest of the time in distress!

Stand up to migraines head on by addressing their fundamental root cause and live a fulfilling and enlivening life free of hindering headaches.

 

 

 

 

 

 

References

  1. The Migraine Trust (2018). Available at: www.migrainetrust.org/ (Accessed: 9 April 2018)
  2. May, A. & Schulte, L.H. (2016) Chronic migraine: risk factors, mechanisms and treatment. “Nature Reviews Neurology12, 455–464 doi:10.1038/nrneurol.2016.93
  3. Ibekwe, A., Perras, C., and Mierzwinski-Urban, M. (2018) ‘Monoclonal antibodies to prevent migraine headaches.’ CADTH issues in emerging health technologies, 167.
  4. Gaul C, Diener H-C, Danesch U, on behalf of the Migravent® Study Group. (2015) ‘Improvement of migraine symptoms with a proprietary supplement containing riboflavin, magnesium and Q10: a randomized, placebo-controlled, double-blind, multicenter trial.’ The Journal of Headache and Pain. 16:32. doi:10.1186/s10194-015-0516-6.
  5. Vasquez, A. (4th Edition) Brain Inflammation in chronic pain, migraine and fibromyalgia: the paradigm-shifting guide for doctors and patients dealing with chronic pain. ICHNFM.ORG, Available at InflammationMastery.com/pain
  6. Cui Y, Kataoka Y, Watanabe Y. (2014) ‘Role of cortical spreading depression in the pathophysiology of migraine.’ Neuroscience Bulletin. 30(5):812-822. doi:10.1007/s12264-014-1471-y.
  7. Yorrns, W.R & Hardison, H.H (2013) ‘Mitochondrial dysfunction in migraine.’ Semin Pediatr Neurol. 20(3):188-93. doi: 10.1016/j.spen.2013.09.002
  8. Capuani, C. Marcello Melone, M., Tottene, A.,  Bragina, L., Crivellaro, G., Santello, M., Casari, G., Conti, F., and Pietrobon, D. (2016) ‘Defective glutamate and K+ clearance by cortical astrocytes in familial hemiplegic migraine type 2.’ EMBO Molecular Medicine. 8(8):967-986. doi:10.15252/emmm.201505944.
  9. Ciranna L. (2006) ‘Serotonin as a Modulator of Glutamate- and GABA-Mediated Neurotransmission: Implications in Physiological Functions and in Pathology.’ Current Neuropharmacology. 4(2):101-114.
  10. Arora, H. and Kaur, R. (2008) ‘The Role of Diet in Migraine Headaches.’ DELHI PSYCHIATRY JOURNAL 11.1
  11. Sun-Edelstein, C. & Mauskop A. (2009) ‘Role of magnesium in the pathogenesis and treatment of migraine’ Expert Rev Neurother. Mar;9(3):369-79. doi: 10.1586/14737175.9.3.369.
  12. Rozen, T.D., Oshinsky, M.L., Gebeline, C.A., Bradley, K.C., Young, W.B., Shechter, A.L., Silberstei, S.D. (2002) ‘Open Label Trial of Coenzyme Q10 as A Migraine Preventive.’ SAGE Journals. 22:2:137-141
  13. Angèle Guilbot, A., Bangratz, M., Abdellah, S.A. and Lucas, C. (2017) ‘A combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study’ BMC Complementary and Alternative Medicine 17:433 doi.org/10.1186/s12906-017-1933-7
  14. Diener H. C., Holle D., Solbach K., and Gaul C (2016) ‘Medication-overuse headache: risk factors, pathophysiology and management.’ Nat Rev Neurol. 12(10):575-83. doi: 10.1038/nrneurol.2016.124.

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