Hi lovelies, it’s Dr Chantel here from Rise Chiropractic. I hope you enjoy this blog as much as I loved putting it together. It’s a great follow on to my previ0us VitaSoul blogs: Building brains, how to boost your babies brain development and Chiropractic care during pregnancy a little unknown saving grace.
As a small child, I have memories of my mother locking herself in a dark room for hours, and I could often hear the sound of heavy retching and painful groans to tell us to keep quiet. Only the day after would she reappear, complaining that her head felt bruised. Not being a headache sufferer myself, I never understood the pain and disability she went through. Now her migraines are less frequent, but they still plague her every so often.
If you don’t suffer from migraines, you likely know someone who does. About 20% of the population get a migraine headache at some time in their life. Migraine is the 9th leading cause of disability among women in the world. That is more common than asthma or diabetes, but it is one of the most painful and immobilising.
Jason is a 26-year-old photographer who has suffered from excruciating migraines since early on in high school. When he walked into my office without a headache, I noticed that the fluorescent lights caused him to squint and he put on his dark glasses (I subsequently kept the lights off). Jason would always wear a cap and keep his dark glasses around his neck – in case his light sensitivity was triggered. Jason also kept his hair shaved at a no. 2 because when a migraine was triggered, one of the only ways he has found to stop the attack or reduce the severity is to plunge his head in ice-cold water.
Thando is an office administrator in her 40’s who has suffered from devastating migraines since she was a little girl. I remember when she first started seeing me as a patient during her last pregnancy and was so elated that during pregnancy she didn’t suffer at all with migraines and would say “I just want to be pregnant forever!”
Every week in my clinic I will sit across from a headache sufferer. My empathy towards people who suffer through these has increased since becoming a chiropractor. I wish now that I gave my mother some slack. The reason being – is that the brain of a Migraineur is massively different to those of us who do not suffer from migraines. Additionally, headaches are only one aspect of how the Migraineur’s brain affects the body.
Types of Migraines
A question I often ask patients is – what type of headache do you suffer with? If a headache is severe enough to stop a person from doing their job or look after their family, they will often label those headaches as migraines. However in many of these cases, with further consultation, it becomes apparent that the ‘migraine’ they are experiencing is just a really severe tension or cervical (neck) headache. It’s important to be able to classify the headaches you experience.
Migraines are classified into three main types:
- Migraine without aura
- Migraine with aura
- Chronic Migraine
The headaches are moderate-to-severe, usually episodic, have a throbbing or pulse-like quality and can be preceded by an aura. The aura is mostly to do with visual changes like flashes of light, blind spots or floating specs. Other aura-type disturbances can include tingling in the hands, legs or face. Other symptoms associated with migraine attacks are nausea, vomiting, light and sound sensitivity. Chronic migraines are those where a person can have over 15 headaches per month, for longer than 3 months.
When should you suspect a migraine:
- Suspect migraine without aura if you have recurrent moderate to severe headaches, where the pain is on one side, throbbing and/or pulsating, and when you have associated symptoms such as nausea, vomiting, and/or light or sound sensitivity.
- Suspect migraine with aura if you have the symptoms above and recurrent, visual disturbances and/or tingling in the hands or face.
- Suspect chronic migraine if you have more than 15 headaches a month.
- If you have a family history of migraine and if the onset of symptoms is at or around puberty.
It is important to know if you are a migraine sufferer because that way you can be empowered to care for your brain, identify triggers and create a lifestyle that protects your brain from tipping over into a migraine attack.
The single biggest misunderstanding about migraines is that it’s just another type of headache. I am going to get technical here, but I hope what I explain next will give you a greater understanding of what ACTUALLY is the environment of the Migraineur’s brain.
So what happens in the brain during a migraine attack?
The migraine brain is fundamentally flawed in that it struggles to regulate nerve activity and maintain chemical balance.
Various triggers create abnormal electrical activity in brain tissues. These areas of altered activity have been found on brain imaging studies in patients having migraine attacks. This activity is called “spreading depression”. Imagine a wave of increased activity of nerve cells, followed by a wave of decreased activity. These electrical waves of increased and decreased activity cause blood flow changes.
The ion channels in a migraine brain can be genetically different in the majority of sufferers, and these have the tendency to generate the above electrical waves. Ion channels are like chemical gates – they control the flow of sodium, potassium, and other elements in and out of nerve cells. Migraines may represent a set of biochemical abnormalities of these gates. In a sense, individuals with abnormalities are “primed” to generate this abnormal electrical activity. The addition of something else can push them over the edge and generate the electrical waves that underlie migraine attacks. This is where other triggers come to play a role: certain foods, weather changes, stress, hormonal changes, sleep disruptions, etc.
The electrical disturbance waves can cause very obvious symptoms. For example, spreading depression in the vision areas of the brain has been found to cause the visual aura that I mentioned previously, such as the appearance of spark-like bursts, wavy lines and blind spots. Distorted activity through other parts of the brain can cause temporary confusion, inability to speak or numbness. These symptoms are usually brief, lasting no more than 20 minutes.
The electrical changes of the migraine tend to also involve deeper parts of the brain that are important processing centres for the senses. It is believed that these centres become “hyper-sensitised” even when a person is between migraine attacks. Meaning that when a person who suffers from migraines senses pain, motion, sound or smell, they may be prone to have an exaggerated, distorted experience of these senses. Light, sound, motion, or even smells can also become intolerable. These changes have been linked to other conditions such as irritable bowel syndrome, anxiety, depression and fibromyalgia, to name a few.
Another aspect of a migraine attack is the release of inflammatory chemicals by the Trigeminal nerve. This nerve supplies sensation to the entire face, scalp, lining of the eyes, nasal cavity and sinuses, teeth and gums, jaw joints, parts of the neck and ears, and even the shoulders. This nerve releases inflammatory peptides – short pieces of proteins – into the tissues nearby. These peptides can cause the local blood vessels to become “leaky”, resulting in swelling and pressure on surrounding tissues. Classic migraine headache pain is as a result of pressure, swelling and inflammation of the branches of the Trigeminal nerve going to the lining of the brain, causing that typical painful throbbing headache.
There is emerging research that shows that people with migraines have higher levels of oxidative stress and that the migraine headache itself is a protective response to brain oxidative stress in a brain that is genetically predisposed. So when the brain has high energy demands, or the powerhouses of the cells (the mitochondria) are unable to produce enough energy for the demands, the brain triggers off the cascade of events that result in the migraine headache.
I find this absolutely remarkable. It is yet another example of the immaculate innate intelligence of our bodies. The ‘headache’ (symptom) that we are trying to ‘treat’ – is actually the intelligent response of the body to potential damage in the short term and neurodegenerative changes in the long term.
Migraines are not JUST headaches
In summary, the Migraeuner’s brain is one that is genetically susceptible, serotonin depleted, lacking in specific neurotransmitters, dopamine sensitive, calcium channel deformed, energy-constrained, magnesium compromised, with hyper-excitable circuitry in a state of delicate membrane stability.
What does this all mean? That the brain is highly reactive and sensitive to both internal and external stimuli. It is a neurological illness caused by abnormalities in brain chemistry. The full picture of why migraine attacks occur is still unclear. Genetic, environmental and hormonal factors are all at play.
Interestingly, talking about the ability of dealing with internal and external stimuli, this is a topic I often bring up with parents of a newborn. With their immature nervous systems and immature guts, newborns are often not able to process all the new sensations their brain is getting and hence can become inconsolable and ‘colicky’. Intriguingly, babies of a Migraineur mother have a two-fold increase of having colic. This comes back to the fact that you can be genetically predisposed to having the type of brain sensitive to being overstimulated easily.
Tips for Migraine management
We are all given a deck of cards, genetically, environmentally or otherwise. It’s important that we understand our unique bodies, or in this case, our unique brains and strive to optimise our health. Migraines are but a symptom of a brain struggling to cope, but there are ways to naturally and effectively help the Migraineur’s brain. For many people, the migraine has been the disorder, with symptoms of pain, nausea and sensitivity to light or sound. But the symptoms of the disorder are not the disease itself but rather part of the bodies defence against it. To really address migraines, we have to look under the veil of the migraine attack to understand the brain’s underlying vulnerability and enhance it’s resilience.
Dr Borkum – a migraine researcher – talks about “neural housekeeping”, or “how the brain maintains and heals itself”.
The below tips have got to do with just that – cleaning up the brain and helping your body do so:
1. Identify and manage triggers – the real key is to understand what triggers YOUR migraines or even other headaches. These are as unique to you as the person you are. The best way to identify these triggers is to keep a diary. Triggers usually don’t happen in isolation but can all contribute to tip you over the proverbial edge. However, avoiding triggers altogether can lead to an unnecessarily restrictive life. Professor Paul Martin, a migraine researcher, shares the idea of ‘coping’ with triggers instead of wholeheartedly ‘avoiding’ them. Particularly those factors that are not detrimental to your health, for example light and not things like sleep deprivation. Focus on good habits that improve the “neural housekeeping” of your brain and this will reduce the impact of the triggers ability to tip you over the edge because strict avoidance can actually result in the opposite – even greater sensitisation.
2. Take care of your sleep – getting consistent, quality sleep is one of the single most impactful lifestyle changes for migraine sufferers. Why? Well when you sleep, a cool thing happens. Your brain shrinks due to reduced activity, and this shrinking gives rise to a fascinating plumbing system. Passages along special cells in the brain appear – this system is called the Glymphatic System. It clears away waste from the brain. Literally the good brain ‘housekeeping’ I mentioned earlier. It ONLY functions during deep sleep. Getting into a good sleep habit is just that – doing the same things over and over, consistently to help the brain prepare to sleep. Sleep hygiene tips:
- Keep a consistent bedtime – the aim is to be in bed, and undistracted rather than actually asleep at the bedtime you’ve chosen.
- Do not watch TV, use your phone or read in bed.
- Prime your mind and body for sleep with a visualised body scan or meditation – Use apps like Insight Timer, Calm, Headspace etc.
- This is a funny one, but really founded on great science and physiology. Try to view the outside light in the 2hr space after sunrise, and 2hr space before sunset. The wavelengths of light at these times have the greatest impact on the brain centres that regulate an optimal body clock, and our mood and alertness.
3. Keep the brain hydrated – I could not write a blog post on headaches without drilling this one home!! DRINK YOUR WATER. Even in us who do not suffer from migraines, even mild dehydration of just two percent results in less concentration, cognitive ability and fatigue. In the brain of a Migraineur, less water affects chemical and neuronal activity which could result in imbalances, creating the perfect conditions for a migraine attack.
4. Focus on Mindfulness – 80% of people with migraines mention stress as a main trigger. On the flip side, a migraine itself is a potent stressor. As a pain condition, the brain can be taught to turn up or down the ‘pain’ volume button. Techniques involved in this are all about self-awareness and stress management, like mindfulness, meditation and relaxation. These techniques also result in improved vagal tone (the Vagus nerve is the 10th cranial nerve, and is the link between the brain and gut, amongst other functions), reducing the fight or flight response and enhancing the parasympathetic (rest and digest) nervous system. This has powerful anti-inflammatory effects too. Five minutes of focused breathing is a great way to start. Use the timer on your phone, close your eyes and focus on your breath. Breathe slower and more deeply, paying full attention to the flow of air in and out of your lungs. Repeat until the timer goes off.
5. Recommended Nutraceuticals – oxidative stress and inflammation are big drivers of migraines. A few nutraceuticals have been identified as recommended supplements to help reduce oxidative stress. It’s important to note that these supplements aren’t to be taken sporadically when a migraine occurs but as a consistent addition to your health regime. These are:
CoQ10 – this is a powerful lipophilic (meaning it loves fat, which is good since the brain is made of 60% fat) anti-oxidant which has anti-inflammatory properties and affects how the powerhouse of the cells (mitochondria) store energy (ATP). Recommended dose: 100-mg three times a day.
Product featured: Coyne PQQ with CoQ10
B2/Riboflavin – this vitamin plays a role in many metabolic processes. Current research suggests that by improving the function of the mitochondria, it has a beneficial impact on migraines in both children and adults. Recommended dose: 200-mg twice a day
Product featured: Viridian High Two B-Complex B2
Magnesium – plays an important role in the inner workings of migraines. For example, it regulates neuronal excitability and helps to control blood vessel tone. Many studies have shown that migraine patients are deficient in magnesium. Recommended dose:600-mg daily for prevention.
Product featured: DNA Biopharm – MLT Magnesium L-Threonate
Omega 3 fatty acids – these are great at reducing the body’s ability to release inflammatory chemicals, called cytokines. Neuroinflammation is a hallmark of migraines. As a long-chain polyunsaturated fatty acid, Omega 3 fatty acids are not only anti-inflammatory, but also have powerful anti-oxidant and neuroprotective properties. Recommended dose: 300-mg twice a day.
Product featured: Good Health Omega 3 Fish Oil
Alpha-lipoic acid – recent research has shown that chronic migraine sufferers have low levels of Alpha-lipoic acid. This molecule acts as a water and fat-soluble antioxidant and plays a role in energy production. Recommended dose: 300-mg twice a day.
Product featured: Viridian Alpha-lipoic acid
Herbs – can be hugely beneficial in conjunction with Nutroceuticals. For 100s of years Butterbur (Petasites hybridus), Feverfew and Arjuna Bark are well known for their healing properties in respect to migraines and tension headaches. Migra-Fast includes all these herbs along with Magnesium L-Threonate, Ginger and Milk Thistle. It is specially formulated to relieve migraines, as well as to lessen the frequency. Recommended dose: Take 2 capsules twice daily until symptoms subside then take 2 capsules with the morning meal.
Product featured: DNA Biopharm Migra-Fast
6. Neck and jaw tension – 75% of Migraineurs report neck pain, stiffness and jaw dysfunction. Typically treatment for this would involve painkillers, muscle relaxants and anti-inflammatories. However, these treatments are often not adequate to address the underlying dynamics of what is actually going on. I could write a whole other blog on this topic. In my experience, I have seen migraines reduce massively once neck and jaw tension were addressed by chiropractic care that involved jaw work, neck adjustments and muscle techniques. This is because for these patients the neck and jaw tension were major drivers for the snowball effect of what caused their susceptibility to other triggers. I urge any migraine sufferer with significant neck, and jaw tension and pain to seek the counsel and care of a chiropractor.
7. Do not skip your meals – my mother was notorious for skipping meals. I am sure she will be surprised, as many of you may be that this habit has the ability to trigger migraines. This has been linked to imbalances in blood glucose levels and triggering off energy imbalances in the brain. Consistency is really important, therefore eating on a regular basis can maintain good blood sugar control. Interestingly though, skipping meals, or cravings is part of the prodrome of migraines. This is a phase before the aura or migraine attack itself. It can be important to identify this phase and up your ‘brain housekeeping’ because it can signal your brain is in the downward spiral towards a migraine.
8. Move your body – would you do something for your migraines that was as effective as some of the most effective drugs used? I am sure you would. And that thing is movement. Specifically moderate aerobic (gets the heart pumping) exercise 3 times a week for just 30 minutes. Exercise can be scary for many migraine sufferers. Find what works for you. Whatever it is, the best movement is whatever you can maintain consistently. Research shows that this can reduce the pain, intensity, frequency and duration of migraine attacks.
Many people that I love suffer from migraines, and I cannot wait for them to read this article. I hope that you all take from it that this illness is treatable, that you can feel much better and that you have a right to make your health and the health of your brain a priority because non-migraine people will never understand what you go through. Caring for your brain as a Migraineur is 25% education and really knowing what it is that is happening in your brain. Because when you know better, you do better. 50% prevention – identifying your unique triggers and brain’s response, enhancing your lifestyle to protect your brain from walking the precarious line that could easily tip over into a migraine attack. And 25% treatment, through natural nutraceuticals that combat oxidative stress, neuroinflammation and drug treatment (which I have not discussed in this article).
Wishing you a well-adjusted journey