Clinical Brief – Migraine

What is Migraine?

I know, you’re thinking I’ve misspelled the word “migraine” and should have used an “s” to make it “migraines”.  Well, let’s correct this common mistake first before moving on. Migraines with an “s” is an inappropriate use of the word. You’ll still see this misspelled all the time on the internet but that’s the way things usually go. So, when you’re talking about the subject, drop the “s” and use the word migraine in singular form.

Migraine is a complex episodic, neurovascular syndrome involving multiple systems in the body, causing multiple and varied symptoms such as headache, nausea, light, sound and odor sensitivity, visual symptoms, sweating, poor concentration, fatigue and neck stiffness.

There are two types of migraines. One with aura – or visual symptoms that happen before the pain sets in – and one without aura or visual symptoms. Roughly 12% of people in the US suffer from migraine 13-16% women and 6- 7% men and 33 million people in total are diagnosed with Migraine in the US.

Causes

The causes of migraine syndrome are still being investigated, but we know that the symptoms begin in many people with “triggers”. The triggers can be poor sleep, skipping meals, dehydration, eating certain foods with compounds called Tyramines, hormone imbalance, neurotransmitter imbalance, genetic alterations, and likely many other things that have not been identified.

Symptoms

Migraine is not only associated with a headache, it can cause symptoms all over the body. The symptom breakdown is as follows and it includes :

• pulsating headaches (usually single-sided) 85 %
• nausea -73%
• visual symptoms – 44%
• light sensitivity – 80%
• sound sensitivity – 76%
• pain on one side – 59%
• vomiting 29%

other symptoms include:

• sensitivity to smells
• difficulty concentrating
• sweating
• loss of appetite
• fatigue
• neck stiffness

The Progression

Prodrome phase – a couple of hours to days prior to aura or pain, migraine sufferers can experience warning signs that something is going to happen. Symptoms include fatigue, mood dysregulation, cravings, neck stiffness (we’ll talk about this later), and overall sense that something isn’t right.

The Aura – the Aura is experienced by anywhere from 25-40% of migraine sufferers. It is a phase where neurological symptoms dominate and people with aura often complain of numbness and tingling, visual spots or lines and some people experience what they think are hallucinations

The Pain – The pain in migraine is usually pulsating in nature and it can start in the upper back and radiate to the front of the head into the eyes.  It can be unilateral (one sided) or bilateral (two sided). The diagnosis is often missed because doctors focus on unilateral pain.

The Postdrome – this is phase after the pain of the headache remits. People often experience gastrointestinal symptoms, mood changes, weakness and fatigue.

Physiology of Migraine:

One thing that happens during migraine is the blood vessels constrict and then dilate.  This dilation, when carried out for too long, can cause pressure and pain and often involves a complex set of local reactions that can be present in many tissues. Regulation of vasodilation and constriction is carried out in the hypothalamus where receptors are constantly monitoring blood temperature fluctuations and input from the nervous system.

Standard of Care treatments

So here is is the party line with how migraine is treated with modern medicine.

• Elimination of stress – Lets face it, you’re never going to eliminate stress altogether. Learning how to cope with distress will buy you a healthier and happier life and this one of the two treatments that we help people with in clinical practice.
• Elimination of triggers – As I mentioned above, triggers, especially food have been known to kick start migraine and research has shown that tyramines, found in several foods and histamine can trigger migraine symptoms
• NSAIDS and acetaminophen for the pain – NSAIDS decrease pro inflammatory compounds and Tylenol tricks your brain into thinking you don’t have pain. They are effective for minor pain and can reduce severity of pain if used by themselves or in combination with triptans.
• Dopamine antagonist antiemetic for vomiting – Physicians prescribe this to help with vomiting. Keep in mind that anything that affects the dopamine system will also affect the serotonin system.
• Triptans for severe pain -Triptans are an abortive medication that binds to serotonin receptors in blood vessels to prevent them from inflammation and triggering pain, and they work quite well in some instances.
• Dihydroergotamine for severe pain – constricts blood vessels and decreases pro-inflammatory compounds and reduces pain.

What do we do in our clinic?

We treat the cause!! The drugs work well to abort symptoms but they do nothing to prevent the cascade of effects that cause migraine. I’ve seen my share of people with migraine and invariably we are able to reduce the severity and duration of symptoms in about 90% of our patients. In short, we address the three issues below to get these results:

1. Musculoskeletal conditions – Cervical joint dysfunction in either the Atlanto-occipital joint (between the skull and the 1st cervical vertebra) or the C2-C3 joint can cause headaches that are vascular in nature. Not enough is known about the biochemical causes of migraine to rule these out as possible triggers. You can find chiropractors who specialize in adjusting the first cervical vertebra, and in my experience it can be very effective.  Don’t look past this as a potential fix for migraine issues. The second technique targets the C2/C3 vertebra and is used by physical therapists and chiropractors.
2. Hormone imbalance – We deal with these all of the time. For some, especially women, there is a correlation with the menstrual cycle and migraine symptoms. Rapidly declining estrogen and progesterone levels in the later half of the cycle can lead to a decline in GABA and serotonin levels. When these levels dip below an undetermined threshold symptoms can develop. We use a lab in Oregon called Precision Analytical http://precisionhormones.com/ that sells a dried urine test.  This test is loaded with information that tells us what we need to know to correct hormone imbalances. Tell your doctor about this lab if you think you are having hormone issues.
3. Neurotransmitter dysfunction secondary to a relative or absolute nutritional deficiency. Relative nutritional deficiency or RND is a nutritional deficiency of the nutrients used to manufacture serotonin and dopamine. It cannot be corrected by consuming more of those nutrients in food because you’d have to eat more than a person could possibly consume in one day to make that happen. It can be corrected through supplementation in the correct amounts and ratios.  We have been treating patients for several years this way and we’ve had amazing success when combined with and ruling out the above causes.  

References:

http://www.merckmanuals.com/professional/neurologic_disorders/headache/migraine.html?qt=Migraine&alt=sh

http://en.wikipedia.org/wiki/Migraine

http://chriskresser.com/headaches-hives-and-heartburn-could-histamine-be-the-cause

After taking Equilibrate, I’ve decreased my usage of Imitrex intake to anywhere between 5-9 a month, and when I get migraines, they are not nearly as severe.

B.H. / Toledo, OH

After taking EQ for the past 2 months, I've experience no unusual side effects. I've been feeling less irritated, more alert and have more energy during the day. I'm also sleeping better!

W.L. / San Deigo, CA

I’ve been taking antidepressants for years and I never thought I’d be able to get off of them.With the Equilibrate I’m free of the anti-depressant med and feeling great!

P.W. / Portland, OR