The Mindful Migraine

My blog buddy over on Roaring Meg recently published a post called What really causes migraines? The post included a link to a BBC article of the same name (here). The article is written by freelance journalist and migraine-patient Sophia Quaglia. Ms Quaglia describes her migraine flare-ups like this:

…the left side of my head starts to feel like there’s a bit too much space between my brain and my skull. When I tilt it, that space fills up with a dull, liquid pain. The pain creeps behind my eyeball, where it sits like a dagger, and then treads down all the way to my jaw. Sometimes it burns and rings in the back of my mind if I squint. On other occasions, it pulses and thuds, as if knocking and asking to come out.

First up – this IS and IS NOT how my migraines feel. I can relate to the dagger behind my eyeball, the jaw discomfort and the thudding knock of a pain that is asking (no – demanding) to be released. On the other hand, the sensation of “too much space” between my brain and skull is the exact opposite of the sensation I feel, which is that my brain has expanded and is pushing up against my skull, threatening to either break bone, or squish brain cells [insert super-accurate mind-blown-emoji here!].

The reason I’ve taken a moment to explain this (dis)similarity up front is because the end point of the article essentially comes to the same conclusion; there are a lot of commonalities related to individual migraine disorders AND a lot of variations between patients.

Although the title of the article implies that there might be a clear “eureka!” revelation for all of us, the reverse is in fact true. Scientists remain baffled by the confusing dilemma that is migraine. But they are starting to “chip away” at what might be going on, and the potential answer is what the article refers to as a “molecule cocktail”.

Amynah Pradhan, director of the Centre for Clinical Pharmacology at Washington University in St. Louis, USA, is quoted as saying that there are a variety of factors that are probably acting in an intertwined way: “…there’s multiple paths to migraine. Maybe even more than that, I think within an individual there are multiple ways to get migraine and everybody’s got a cocktail of things going on.”

For starters, not only are everyone’s migraine outcomes different (as noted in my introduction) but so are everyone’s triggers. The article references stress, fatigue, fasting, chocolate, cheese, wine, hormones, perfume…

BUT – scientists are starting to think that triggers are actually the earliest signs a migraine is ALREADY UNDERWAY. Ms Quaglia uses her own example of perfume. She can wear it for days on end and not even notice it, but then be super-sensitive to it on the days she has a migraine-episode… but that doesn’t mean the fragrance caused the migraine, only that she is super-sensitive to smells in general when she’s approaching migraine territory.

“…the causal attribution is probably wrong,” says Peter Goadsby, professor of neurology at King’s College London, in the UK. 

Similarly, some patients might crave certain foods (such as cheese or chocolate) in the early stages of a migraine, and then believe that those foods triggered the migraine pain.

The cause and effect relationship is muddy.

So then, “what really causes a migraine?” is a bit misleading as a title. It should probably read “what is potentially causing your migraine?” The answer to that, according to the article is complex, and might include any or all of the following:

+ genetics – researchers have not been able to identify which ‘snips’ of DNA are a definite issue, however, the hereditary aspect of migraine patients suggests there is most likely something going on and they think it might actually be a “constellation” of genes that are in play.

+ blood flow – the old fashioned idea that blood vessels to the brain were to blame is generally debunked, however, there remains correlations between migraine and other conditions such as epilepsy and stroke. The blood-dilation effect might be more of a symptom than a cause.

+ abnormal electrical brain-waves – pain nerves in the brain fire up, sounding the alarm and triggering inflammation, and create a “rogue wave” of electrical impulses that cause a cascading effect of problems. What causes the wave release and how it triggers all the following issues, however, remains “hard to pinpoint”.

+ the meninges (which is “the thick, gelatinous, three-layered outer membrane of the brain”) – ordinarily, the meninges is awash with immune cells which protect the brain, but when they get excited they can trigger inflammation which affects the neurons on the other side of the ‘sack’. There’s also some science that suggests there are structures on the membrane that can detect changes in acidity (which happens due to the rogue-wave), so they send electrical signals to fire the pain fibers involved in migraine attacks. Still other parts of the meninges react to fluctuations of heat and cold (which might be why heat packs and ice-hats also work to relieve the pain).

+ hormones – migraines are often tied to the female menstrual cycle, and research has revealed that a family of molecules known as “prostaglandins” can effect the dilation of blood vessels in the brain.

+ calcitonin gene-related peptides (CGRPs) – these small proteins act like “dimmer switches” which turn neuron activity and sensitivity up or down, and they seem to appear in high quantities in migraine patients. It’s in this area that a lot of research is being conducted, and new medicines are being designed to target CGRPs. But even still, the researchers don’t have all the answers as yet.

The reality is – as Ms Quaglia writes: all of these potential causes are “likely just small bits of a big puzzle, especially as migraine is increasingly thought of as a spectrum-like, chronic condition that affects the whole body.”

The article ends with the following quote from Amynah Pradhan: “We’re just scraping the surface of what’s happening with migraine.”

So – the good news is that research is underway and advancements are being made.

The potential down-side is that we’re not there yet when it comes to understanding “what really causes migraines?”

Knowledge is power – so stay curious.

If you’re a migraine-person, know that I’m sending you lots of love – it sux to be us – but know also that you’re not alone, and you CAN get better (I’m proof of that).

Take care taking care,

Linda x

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PS – Disclaimer – I am not a medical doctor – my blog posts are my best understanding of a complex condition – so please speak to a qualified professional if you are seeking advice on your migraine condition to ensure that you receive information that is appropriate and personalized.

PPS – SPECIAL SHOUTOUT: Amy, a blog-buddy of mine over on the blog “It’s Amy”, I said has just been diagnosed with Type I Chiari Malformation. Her neurologist told her, “Your brain is constricted and requires decompression. Your symptoms of dizziness, migraines, gait imbalance, limb numbness, and various others are caused by this compression.” If you, or anyone you know has lived experience with this rare diagnosis, please reach out to her on her blog post (Chiari Who?) and share your feedback and support. Thank you!!

Stay well peeps. xox