Migraines are one of the most debilitating and enigmatic of all chronic conditions. Over 30 million people suffer with migraine headaches. That’s one out of ten Americans. They dramatically affect quality of life in the short term, as 75% of sufferers (called “migraineurs”) must postpone activities and 50% of migraineurs are completely incapacitated. Over 17 billion dollars are spent annually in the USA on migraine treatment and about 22 millions dollars are lost each year in productivity due to migraine absenteeism.
Migraines vary in presentation from person to person, but share a number of common characteristics. Most commonly, they present with incapacitating pain that brings daily life to a crashing halt. They often present with nausea. They can be unpredictable and may or may not be preceded by a prodrome and aura. Prodromes (such as yawning, slurred speech, hunger pains or frequent urination) can begin an hour or two before the pain but in rare cases can occur up to two weeks before the onset of the migraine. Auras occur about twenty minutes before the pain and often present as sensory distortions.
There is no perfect theory about what causes migraines. Generally, it can be stated that migraineurs are susceptible to cortical spreading depression (CSD), a dramatic wave of electrical activity of the brain that spreads across the surface, or cortex, when something antagonizes it. Behind this super-excitation comes a depression that is relatively unresponsive to stimulation. Once the CSD is triggered, a bath of neuropeptides is released the creates a milieu of instability in the brain and the migraine develops. Many factors seem to be associated with the triggering of a CSD including menstruation, ovulation, weather, stress, poorly regulated blood sugar levels, certain foods and smells, caffeine, strobe lights, etc. It is also worth getting ranked on the MIDAS scale, which measures the impact migraines have on life. This ranking can help to determine the tenacity of migraines and the degree to which prescription medications such as SSRIs, beta blockers or even seizure medications may need to be temporarily part of therapy. The menstrual cycle should be carefully charted. Women are three times more likely to have migraines than men, and the shifts that occur in a woman’s hormone patterns premenstrually and during ovulation make them particularly sensitive to CSD. Dental issues are also worth considering. Smoldering infections of the oral cavity can often go unnoticed for years. They are probably not associated with most migraines, but when all else has failed, look to the mouth for the source of the problem.
Learning triggers can be a frustrating experience, but innovative testing exists that gives the physician insight into developing an effective treatment plan, often without prescription medications. For those people who are already taking medications for their migraines, these tests often will identify triggers that allow the patient to be weaned off of their medications. Many migraineurs have already been subjected to basic testing, but if labs have not been performed, it is worthwhile having your doctor conduct a thorough history with a physical exam, along with a panel of fasting tests that includes basic serum markers, hormone levels, iron levels and inflammatory markers.
As ever, a thorough examination of your daily menu is critical. Food sensitivity testing is available that offers a comprehensive look at how your immune system reacts to proteins on certain food groups. For example, if this test demonstrated a dramatic reaction to cow’s milk, casein, goat’s milk, hard cheese and soft cheese, it would be worth avoiding dairy completely for three months. Certain tests include food coloring and dyes in their profile, which often represent potent but hidden triggers of migraines and other chronic conditions. Finally, it may be helpful to look at nutrient levels inside of the cell; low levels of riboflavin (B1), magnesium and CoQ10 have both been associated with migraines, but conventional tests for these nutrients are inadequate at assessing intracellular levels.
Neurotransmitter testing for dopamine, serotonin, norepinephrine, epinephrine as well as their breakdown products can be an extremely insightful part of the assessment process. It is well established that unstable serotonin levels are associated with migraines (hence the reliance upon serotonin mediating medications to treat migraines). By identifying imbalances, it is possible to develop a treatment plan that establishes a natural, rhythmic pulse of neurotransmitters that is much less likely to trigger a CSD. GABA, phenylethylamine, glycine and glutamate are also included in the test. These neurotransmitters are rarely considered in conventional paradigms, but imbalances in any of them may trigger migraines. Because this test examines so many unusual aspects of physiology, it is often able to identify triggers that have never been examined.
Finally, yoga, acupuncture, biofeedback and intravenous magnesium injections have all successfully impacted those who suffer from migraines. The bottom line is that holistic medicine offers insights into physiology that may put an end to years of suffering.
Dr. Daniel Smith practices at Bear Creek Naturopathic Clinic. His new office is on 2612 Barnett Ave. He specializes in naturopathic oncology, but still maintains a strong family practice, treating all manner of conditions. He can be reached at 541-770-5563 or at firstname.lastname@example.org If you would like to schedule an appointment, please ask specifically for Dr. Dan.