Friday Author: Seth Kaplan
This post, my second about migraine, drills deeper into causes and treatments.
One of Steve Martin’s characters on “Saturday Night Live,” Theodoric of York, Medieval Barber, once observed:
”You know, medicine is not an exact science, but we are learning all the time. Why, just 50 years ago, they thought demonic possession or witchcraft caused your daughter’s disease. But nowadays we know that Isabelle suffers from an imbalance of bodily humors, perhaps caused by a toad or a small dwarf living in her stomach.”
This is not unlike the various modern explanations given for causes of migraine. Ask any woman with migraine whose doctor has told her she is hysterical and should take antidepressants. Progress sometimes moves slowly.
What Is A Migraine?
Most primary-care doctors cannot give you a definition for migraine, in part because there is no one universally accepted explanation. If you are lucky, yours will refer you to a neurologist, who (presumably) has the training and clinical experience to scope out your condition. However, if you saw two or three neurologists, you might get two or three explanations of migraine and an equal number of treatment options.
Generally speaking, migraines bring severe pain, vascular throbbing (on one or both sides of the head), nausea, sensitivity to light/sound/cold/touch. If you have migraine, you know your pre-migraine sensations, triggers, auras (with classic migraine; common migraines have no auras), and malaise specifics.
Science follows its nose in trying to understand migraines. When I first learned that I had migraine, the prevailing theory stated that vascular spasming was the entire migraine cause and expression. As imaging techniques became more sophisticated, the vascular explanation morphed into inflammation of the meninges, the three membranes that surround the spinal cord and brain, with vascular throbbing seen as a symptom of the inflammation rather than a cause. The meninges comprise the dura, the arachnoid, and the pia (the innermost layer separated from the other two by cerebrospinal fluid).
To complicate the explanation further, researchers then determined that “something” triggered the trigeminal nerve, the big one that runs up each side of your face to the brain. The trigeminal nerve then released calcitonin gene-related peptides (CGRP; don’t worry, there is no pop quiz). These peptides caused inflammation and sent messages to pain receptors in the meninges. Still, though, the root cause of migraine eluded detection.
The search continues to this day.
The Gut-Brain Connection
The explanation that intrigues me the most relates to the gut-brain connection. The digestive system, which houses about 80% of the body’s serotonin, in addition to 100 trillion flora in the microbiome, communicates with the brain via the vagus nerve, one of the longest in the body. For example, when serotonin leaves the brain, it looks for a place to “hide.” It likes the receptor sites in the gut. If it can hide in these, after thirty minutes these receptors will release dopamine. When that reaches the brain, it causes migraine, and you are toast.
Some of you, like me, may experience barometric-pressure migraines. Fluctuating barometric pressure can cause awful migraines because you can feel them coming on, but by that point it is often too late. Odors of everything from solvents to perfume can stimulate an olfactory pathway, which in turn causes the trigeminal nerve to initiate its role in the migraine cascade.
How To Treat Migraine
Never ones to let an unknown root cause stand in the way of developing treatments for symptoms, and genuinely wanting to help suffering patients, pharmacology has developed several allopathic medicines which some people use with success (too big a topic to cover in this post). Do not take the advice of Theodoric of York that “You’ll feel better after a good bleeding.” Today’s doctors also offer several other approaches:
The Tyramine Avoidance Diet: One neurologist told me that I needed to eat a diet with low or no tyramines (produced from the natural breakdown of tyrasine, an amino acid). You inherit a threshold for tyramines from your mother. When you exceed that threshold, a message goes to the trigeminal nerve, which tells the brain to “dump” serotonin.
- Aged cheese
- Fava or broad beans, sauerkraut, pickles, olives
- Any fermented soy products (i.e., miso, soy sauce, teriyaki sauce)
- All nuts
- All fermented beverages
- Pork chops
- Red wine
- Cheddar cheese
- The list goes on. And on.
I tried this diet and it seemed to work. When I found myself feeling tired a lot, though, I discovered that many of the foods listed contain potassium, a trace mineral needed for energy, among other things. When I replaced those foods in my diet, my pep returned. This doctor did give me other advice that helped more. He instructed me, at a migraine’s start, to take two Excedrin for Migraine with a liquid containing caffeine that would “boost” the medicine through the blood-brain barrier. To this day, I do this, and it still helps.
Avoid migraine triggers: For many years, I knew that, if I ate chocolate, cheddar cheese, red wine, or anything containing caffeine, I could get a migraine as a result. I also knew that a nap of even sixty seconds, missing a meal, or oversleeping could give me a migraine. I find, now that my system is more “mature,” that I can eat these foods sometimes and not pay the price.
Take magnesium: This mineral is a relaxant, the theory being that, if you can relax inflamed areas in the brain and elsewhere, you will either shorten in duration or prevent a migraine. There are a number of ways to use magnesium:
- At the first hint of a migraine, take at least 800 milligrams of magnesium, either powder mixed with cold water or pills. This will often blunt the onset of the migraine.
- Use a product called Migra-Eeze. It contains magnesium, butterbur, and Vitamin B2 (riboflavin). The last item is key. Scientists conducted a study about 25 years ago in Iceland to determine the therapeutic dose of B2, which turned out to be 400 mg. Even today, some neurologists will prescribe B2 for migraine.
This product, and a similar one called Migralief, which contains B2, feverfew, and magnesium, are prophylactics; i.e., take them twice a day every day. Do this for six months, then stop and gauge the frequency of migraine. If there is no improvement, repeat another six-month course. I have used Migra-Eze successfully.
This is a huge topic, so I have tried to give you the kinds of information I would give to someone who suffered from migraines. Let me know if you find this information useful, and what other topics in nutrition and alternative health care you would like me to write about.