The Mindful Migraine

The next instalment from my file notes from the ever-giving 2024 Migraine World Summit is a discussion on whether increased knowledge about biomarkers could improve migraine diagnosis.  Dr Patricia Pozo-Rosich, the head of neurology at a Spanish institute was interviewed, and the short answer to the hypothesized question is yes… but.

A ‘biomarker’ is a way of measuring a biological condition in a clear and controlled way that helps diagnose an illness or predict treatment responses.  Preferably the tests should be easy to do, in a practical, generalized, consistent, applicable way.  Current examples include blood tests, taking someone’s blood pressure, imaging, and genetic testing.  [Online notes add urine testing, tissue sampling, x-rays, cat scans and Covid-tests: anything that can tell a doctor whether your body is healthy and functioning ‘normally’.]

For migraine analysis researchers, they are only in the FIRST STAGE of trying to identify potential biomarkers.  One example of a future migraine biomarker might be testing an individual’s CGRP levels.  There are apparently saliva tests which have been able to show that elevated levels of CGRP are released during a migraine attack. 

For the test to be useful, however, it has to be systematically validated.  For protein levels in a migraineurs blood, for example, the test results will fluctuate [one test result is therefore not an adequate diagnostic tool].  Moreover, to be truly efficient, the same test has to be able to be conducted around the world, with the same processes and data analysis. 

Making it more complicated, symptoms for migraineurs are ‘all over the place’ – we really need to understand more about migraines in general to fully understand what biomarkers are doing and why.

Dr Pozo-Rosich said that she was confident that in the future we will be able to run biological tests and see the genetic markers for migraines (what genes and peptides make one person more likely to be susceptible to migraines than others).  In the same way that a glucose test can determine if someone might have diabetes, and then medical treatment can be tailored accordingly, she thinks the same will be true of migraine and one day there will be a diagnostic test for migraines and to determine someone’s risk of being susceptible to chronic migraine.

However – she said it “might not be in my career”.  [Be patient patients!]

In terms of brain imaging, she said that researchers have mapped different parts of the brain being activated during different stages of a migraine attack; the hypothalamus is active in the early stage, then it’s the thalamus, then in the ‘hangover’ stage activation moves again.  The migraine-brain apparently reacts differently to light and noise input to non-migraine-brains.  And, apparently migraine-brains have thicker and enlarged frontal lobes – maybe, she suggested, because it’s always working overtime (but they still don’t really understand what’s overworking or hyperactive or why.)

[Remember – I’m not a doctor – I have lived experience with migraines not medical expertise – so please don’t take my summary notes too literally as I could have heard it incorrectly – always check with a doctor or do your own research before making any decisions about how to move forward.]

The question was raised whether a migraine-brain shrinks from chronic migraines [I certainly feel like my IQ is dropping] – and the answer was no – any shrinkage tends to be related to aging [yeah, well, there’s that too!]

When asked whether the migraine-brain is more susceptible to other pain sensations, Dr Pozo-Rosich wasn’t able to answer with certainty, however, she did note that researchers do seem to think that the more pain signals the brain receives, the more it sensitizes the brain to pain, and the more often it finds pain signals.  The sensory system trains itself to trigger what you think of as pain at lower and lower thresholds.  Moreover, if you have inflammatory pain, that inflammation finishes up somewhere else – maybe creating an inflammatory brain state that facilitates other pain signals.  On a clinical level, if you study chronic pain patients, they apparently tend to have many other comorbid conditions such as fibromyalgia and rheumatoid arthritis.

There was a conversation I got a bit lost on, but it sounds as if not all of our DNA is active all the time – some of it remains dormant until activated.  Activation triggers include changes in diet, lifestyle, pollution, medications, general health and environmental issues.  These can apparently turn the DNA markers on or off, making us sicker or healthier.  Aiming for the best health and lifestyle was therefore recommended.

She spoke of “becoming friends” with our migraines – “don’t treat it as the enemy”.  Migraine attacks are a way of protecting you and helping you survive – admittedly, she acknowledged, not in the best way – but the brain is trying it’s best to tell you there’s a problem and you need to rest.  In the same way a sore arm makes you take notice and move differently, a sore head should alert you to other complications.  A migraine is the brain’s way of trying to shut down thinking, unfortunately in an ‘exaggerated way’.  The main thing she said was, “you need to stay calm – don’t fight back – or it just gets so much worse”.

[This is definitely something I have learnt – try not to cry or rage against the pain. Instead, take deep breaths and try to accept it for what it is and let it run its course.  Often, the migraine attack is shorter and less dramatic when you just ‘go with it’.]

Keep learning about your condition, Dr Pozo-Rosich said, and remember that any treatment will be a combination of understanding the best medication for the disease and improving your lifestyle. 

One day, she said, there might be a “migraine-fingerprint” that tells you exactly what you have and why, and then we will be able to tailor treatment to suit you precisely.  Then the stigma around migraines might also be reduced; you can ‘show’ someone that you are sick, that your disease is real, and measurable, grounded in science.  The path for migraineurs is improving all the time… But the changes won’t happen overnight.

Take care everyone, Linda x