Dr. John Lieurance was recently interviewed by SRQ Magazine. Read the interview here.
What exactly is a migraine? There are several types of migraine headaches. Migraine is being called the migraine syndrome. By syndrome I mean that a lot of things accompany the headache. Symptoms include dizziness, visual problems, “spots” before the eyes, swelling, tearing of the eyes, muscle contraction, irritability, nausea, vomiting, constipation, or diarrhea. These symptoms often arise before the headache hits. The headache itself may last for a few minutes to a few days, and the severity may range from minor discomfort to immobilizing agony. They are almost all associated with a vascular consequence in the brain. Increasing evidence supports that excessive activation of cells in specific areas of the brain causes migraine. Special brain scans show that patients having migraine attacks may have waves of abnormal activity that spread across the surface of the brain (the cortex), as well as excitation of nerve centers deep within the brain (the brainstem). Both of these patterns of abnormal activity may involve the neurotransmitter glutamate. Experimental studies also show glutamate receptors play a key role in the sensation of head pain, which occurs in brainstem nerve centers. Drugs cannot block excessive glutamate activity without interfering with normal brain function. That’s why medications may not be the best long term answer if we can change the brain to down regulate glutamate receptors. So if certain brain cells are being excited leading to upregulation of glutamate then what if the cause of this excitation? This is best answered by using the neural network concept which is the most contemporary model for brain function. Each nerve in your brain receives an input from multiple other nerves which is modified by a certain electrical strength. The neuron will combine these strengths of neron inputs and, with reference to a threshold value and activation function, use these to determine its output. Many aspects of brain function are learned behavior and are functional issues with how things are wired together through neural networks. This suggests that if you change the neural networks through environmental and functional changes you can change the response of the brain to the various stresses or triggers of migraines!
Are all headaches migraines? No there are many different types of headaches and migraine is often diagnosed improperly. The most common headache is a tension headache which comes from tight muscles in the base of the skull which is often associated with a upper neck vertebrae mis-alignment.
What causes a migraine? Migraines are caused by imbalance and instability in the neural networks of the brain which up regulate glutamate and attacks are brought on by “triggers”. Most common triggers include hormonal fluctuations; environmental stimuli like weather or bright lights, certain smells, alcohol, certain foods, poor sleep, and high stress. However, not everyone has a clear trigger for their migraine attacks.
Are migraines hereditary? Yes they do seem to run in family’s and can be passed down. I often shy away from this subject with my own patients because often times when you say it’s genetic or runs in the family then folks can feel less powerful to take control over that specific health condition. The way it works is we are given certain genes and they are expressed by what’s called phenotypes. This means the way your specific genes relate to environmental conditions such as diet, thinking behavior, various pollutants or toxins etc… This means for migraine sufferers it’s a matter of finding out what’s turning on those genes so they express themselves. Could it be that we can inherent the behavior of the neural networks in our brain from our patterns just like many other more obvious behaviors such as likes and dislikes?
How can I identify my headache triggers? A diary that includes foods, activities, your emotional states, weather and sleep can help you shed some light on what triggers your migraines.
Are migraines more common I men or women? Migraine is 3 times more common in women than men. Migraine affects 30% of women over a lifetime.
Are children prone to getting migraines? Migraine is most common with folks in their 30’s through their 60’s in both men and women. However, migraine affects people of all ages, including children and the elderly.
What food or beverages trigger Headaches? There are multiple foods that are thought to possibly trigger a migraine attack. Nearly all foods have been generated by patient self report and almost none have any scientifically valid backing from high quality studies. The most commonly reported food triggers are alcohol (33%) and chocolate (22%). Although the majority of headache sufferers cannot identify specific food triggers, headache patients are often given a broad recommendation to monitor their headaches after eating foods that historically have been thought to contain possible headache-triggering chemicals, such as tyramine (e.g., cheeses), beta-phenylethylamine (e.g., chocolate), and nitrates (e.g., processed meats). In actuality, there have been no studies or only negative trials for headache provocation for cheeses, chocolate, dairy products, soy isoflavones and vegetables. Processed meats containing high levels of nitrites and nitrates may be highly predictable migraine triggers in some individuals. Certain alcoholic beverages, especially red wine and beer, are frequently cited migraine triggers. Food additives have been linked to migraine attacks. Monosodium glutamate (MSG) is probably the best known of this group, and has been demonstrated to cause rapid cramps, diarrhea, and a horrible migraine in 10% to 15% of migraineurs. Some spices as well as garlic and onion have been labeled as possible triggers of migraine attacks, yet no studies support this.
Are there some lifestyle changes that might help prevent my headaches, such as exercise or meditation? Stressful events can have a negative effect on neural network function. The onset of migraine were positively related to stress in studies! Stress can cause excitability of the nerves in the brain. Of course you can try avoidance of stressful situations but that can be difficult for many people. The other option is to make changes to your neural networks through activities such as yoga, exercise and meditation all of which have great evidence in research to improve how we respond to stress.
How can migraines be prevented? Finding out triggers and avoiding them can be helpful. Changing the neural networks response to triggers is a new concept that also makes good sense. By changing the brain and how it is responding is a real and powerful option now for many migraine sufferers.
How can they be stopped? Once a migraine starts then resting in a dark room with ice over the back of the head can be helpful. There are several drugs in The “triptans” family of drugs that were developed to treat acute migraine headache. Your doctor may have prescribed you one of the oral triptans: Imitrex, Amerge, Zomig, Maxalt, Axert, Frova , or Relpax. Alternatively, he/she may have prescribed one of the two triptans marketed as nasal sprays: Imitrex nasal spray or Zomig nasal spray.
Are there any vitamins or supplements that can help? Among the most commonly recommended vitamins and supplements are magnesium, riboflavin, and Coenzyme Q10 (CoQ10) while the most common herbal preparations are feverfew and butterbur.
Each of these compounds has a theoretical mechanism or reason for the effect on migraine, and has had at least one placebo-controlled trial that has demonstrated efficacy.
Is there anything new (innovative medicine or technology) for migraines? There is a new technique involves pressure stimulation around the ear using a piece of medical equipment called a pneumatic otoscope. In a clinical migraine study results were published in the Functional Neurology, Rehabilitation, and Ergonomics Journal which showed this technique can stop most migraines in a matter of minutes without a drug or injection. This air stimulation to the ear canal has a powerful activation to a part of the nervous system called the trigeminal nerve. This is the same nerve that provides sensory from the head and face. By stimulating the trigeminal nerve this way with a specific frequency and on a specific side of the head your changing certain neural networks that trigger excitation in the brain. This is proving to be a be a very powerful tool in the treatment of migraine. Whats exciting is that there are several other methods that can be used to alter neural networks that lead to migraines. Our clinic is currently in the middle of a study on the use of endo-nasal balloon stimulation and it’s effect on migraine. The endo-nasal balloons have the same effect in that they effect the trigeminal nerve. Best part about these more functionally based treatments is there is no side effects. If you are interested in participating in the study you can contact our office directly.