Migraine Headaches Part 1

In 2010 it was estimated that the healthcare costs associated with migraine headaches were 4.3 billion dollars, not including drug costs or indirect costs such as loss of productivity. Migraines affect 17.1% of women and roughly 5.6% of men and at least half of those with migraines have never been diagnosed. Only 12% of those afflicted use any type of preventative treatments for their headaches.

Until recently, the pathophysiology of migraines was thought to be primarily vascular, that is, associated with blood vessel pathology. Current research however highlights a neuronal or brain pathology in patients with chronic migraine. Structural changes in the brain such as reduced gray matter in the pain processing parts of the brain and iron accumulation in other brain areas have been documented. And these changes correlate with the duration of the migraine disorder being more marked in chronic migraine than in episodic migraine. Physiologic changes in the brain in migraine patients include altered brain metabolism, excitability and central sensitization. Taken together these changes lower pain thresholds in patients with migraine, alter the ratios of excitatory to inhibitory neurotransmitters in the brain and promote the chronicity of the attacks.

Natural therapies have proven to be beneficial and effective for migraines. Part of the complexity of the migraine headache may be due to the individual differences in both triggers and underlying pathology. Migraines really do require an individualized treatment plan that takes genetics, nutrient levels, diet and lifestyle habits into consideration.

Migraine is a constellation of symptoms rather than one specific etiology. The criteria for migraine per the International Headaches Society include headaches lasting 4-72 hours, usually unilateral, of pulsating quality, of moderate to severe pain intensity, made worse by activity, and accompanied by nausea and/or vomiting and often phonophobia (fear of loud sounds) and/or photophobia. Not all of these symptoms need to be present and none of them are unique only to migraine. The definition of migraine is one agreed upon by convention and may NOT be reflective of the biochemistry driving the symptoms.

Common to migaineurs however, is that most if not all migraines have a trigger, i.e. some exogenous or endogenous event that initiates the reversible dysfunction known as a migraine attack. This trigger induces a neurologic event which then triggers downstream events like sensitization and activation of the trigeminal nerve (the cranial nerve that supplies the skin of the head and scalp). In a questionnaire survey of 1207 migraineurs, the frequencies for a range of factors as triggers were reported. These included stress (80%), menstrual cycle (65%), hunger (57%), weather (53%), insomnia (50%), odors (44%), light (38%), alcohol (38%), smoke (36%), food (27%), exercise (22%) and sex (5%).

While it is not completely clear what predisposes the patient to that primary neurologic event a number of nutritional factors appear to modulate this sensitivity. Altered histamine physiology and metabolism and an allergy component have long been suspected to play a role in migraine. There are well established comorbidities of migraines and other allergic conditions that support this link. Individuals with asthma, asthma-related symptoms and other respiratory disorders as well as children with atopic disease (tendency to develop classic allergic disease) have an increased likelihood of migraine. In this light, the herb Butterbur, initially used to treat allergic rhinitis is effective in migraine prophylaxis. 45% of adults in a recent trial experienced a 50% reduction in migraine frequency with Butterbur.

We will continue this discussion in the next post. As always, comments are welcome and thank you for taking the tie to read….

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