It is estimated that the UK population loses 25 million days from work or school each year because of migraine – a complex condition with a wide variety of, mostly, incapacitating neurological symptoms.
This week is Migraine Awareness Week, an annual campaign to draw attention to migraine and educate the wider public. This week’s blog takes a look at the different stages of migraine attacks, some of the causes associated with this debilitating condition, and nutritional support that could be considered to help alleviate the symptoms.
What is migraine?
Migraine is a complex condition with a wide variety of symptoms. The main symptom for most sufferers of migraine is a painful headache. Other symptoms include disturbed vision, sensitivity to light, sound and smells, feeling sick and vomiting. Migraine attacks can be very frightening and may result in having to lie still for several hours (in darkness).
The symptoms vary from person to person and individuals may have different symptoms during different attacks, with attacks also differing in length and frequency. Migraine attacks usually last from 4 to 72 hours and most people are free from symptoms between attacks. Migraine can have an enormous impact on work and social life.
Causes of migraine
Although the understanding of migraine pathophysiology has improved in recent years, the exact cause is not yet well established. However it has been found that migraine symptoms are usually triggered by a number of different factors, including:
- Increased inflammation that affects normal blood flow, and the blood vessels, reaching the brain
- Oestrogen: Clinical evidence links oestrogen to migraine headaches.(5) Many women report incidences of migraine that relates to the onset of menstruation each month and the use of oestrogen containing oral contraceptives.(6)
- Changes in nerve signals and neurotransmitter levels that cause pain: This includes low serotonin levels and changes in the trigeminal nerve, which releases substances called neuropeptides. Serotonin is a chemical necessary for communication between nerve cells. It can cause narrowing of blood vessels throughout the body.(7)
- Mitochondrial dysfunction (mitochondria are the energy powerhouses of the cells) leading to impaired oxygen metabolism is also speculated to play a role in migraine physiology. Researchers have shown that migraine patients have a reduction in mitochondrial energy production between attacks, which has fuelled further research around nutritional supplements that may enhance mitochondrial function for use during an attack or to prevent migraines.(8)
- Caffeine can cause issues in some migraine sufferers, but does not appear to in all. Caffeine has both excitatory and vasoconstrictive effects on the central nervous system. Caffeine is present in coffee, tea, chocolate, certain soft drinks and energy drinks and some pain killing medication often marketed for headaches. One study found that total cessation of caffeine from any sources dramatically improved migraine treatment when administering Triptan medication to control migraines.(9)
- Alcohol: Particularly red wine is reported by many migraine patients to trigger an attack within 3 hours of ingestion, or sometimes the next day. Wine contains tyramine, sulfites, histamine, and the phenolic flavonoids, all of which can theoretically trigger migraines. Approximately 1/3 of all migraine sufferers note alcohol as a trigger.(10)
- Tyramine: An amino acid that occurs naturally in some foods especially fermented or aged foods such as cheese, soy sauce, sauerkraut.
- Food additives such as nitrates, aspartame and MSG appear to be trigger foods in some individuals. The use of a food and symptom diary for at least 30 days may be a useful tool to determine if there is a particular food or additive that triggers attacks.(11)
- People with a diagnosis of Coeliac disease appear to be four times more prone to migraines than non-coeliac’s, whether this effect is found in non-coeliac gluten sensitivity remains to be researched.(12)
- Weight issues: A recent review found that being either under weight or over weight may increase the risk of migraine.(13)
- Stress as a trigger for migraine attacks is highly reported, additionally high levels of stress are reported in migraine patients, particularly in those suffering from chronic daily migraine.(14)
- Skipping meals resulting in low blood glucose levels has been observed as a migraine trigger.(15)
- Other possible triggers reported amongst migraine patients include: exposure to certain light or smells, fatigue and changes in sleep patterns, weather changes and glaring or flickering lights.
Studies indicate that mutations on the MTHFR gene play a role in migraine.(16) An Italian study in 2007 reviewed all of the published studies on MTHFR gene mutations and migraines. The studies looked at nearly 3000 people with migraines and found that people who had migraine with aura were significantly more likely to have the mutation. People who had migraine without aura had no significant difference from the control group.(17) The MTHFR gene codes for an enzyme that catalyses the final step in the conversion of food folate and folic acid to 5-methyltetrahydrofolate (5-MTHF), the biologically active form of folate which is critical for the methylation cycle. People with this mutation have reduced enzyme efficiency and the mutation is linked with a number of health conditions and potentially high homocysteine levels.
Any persistent and severe headaches should be assessed by a medical doctor who may wish to rule out tumours, abnormal brain structures and stroke. Migraines are usually diagnosed through a combination of symptom description, medical and family history and the ruling out of other causes often by CT or MRI scans.
It is also important to consider that people who experience migraines may also be more likely to experience stroke, sub-clinical vascular brain lesions, coronary heart disease, hypertension, patent foramen ovale (hole in the heart), psychiatric diseases (depression, anxiety, bipolar disorder, panic disorder, and suicide), restless legs syndrome, epilepsy and asthma.(4)
Migraine attack stages and phases
It is often difficult to predict when a migraine attack is going to happen. However, there are well defined stages and it is these stages and their symptoms which distinguish a migraine from a headache.
A migraine attack can be divided into four or five stages that lead on from each other:
- Premonitory or warning phase
- Aura (not always present)
- The headache or main attack stage
People may suffer from one, all, or a combination of these stages, and the combination of stages may vary from attack to attack. Each phase can vary in length and severity.
This describes certain physical and mental changes such as tiredness, craving sweet foods, mood changes, feeling thirsty and a stiff neck. These feelings can last from 1 to 24 hours.
The aura of migraine includes a wide range of neurological symptoms. This stage can last from 5 to 60 minutes, and usually happens before the headache. Migraine without aura does not include this stage.
In some people, changes in the cortex area of the brain causes changes in their sight, such as dark spots, coloured spots, sparkles or ‘stars’, and zigzag lines. Numbness or tingling, weakness, and dizziness or vertigo (the feeling of everything spinning) can also happen. Speech and hearing can also be disturbed, and sufferers may report memory changes. These neurological symptoms are called the ‘aura’ of migraine.
The headache or ‘main attack’ stage
This stage involves head pain which can be severe, even unbearable. The headache is typically throbbing, and made worse by movement. The headache is usually on one side of the head, especially at the start of an attack. Some sufferers get pain on both sides of the head, or over the forehead, but not usually at the back of the head. Nausea and vomiting can happen at this stage, and the sufferer may feel sensitive to light or sound, or both.
Most attacks slowly fade away, but some stop suddenly after the sufferer is sick.
Recovery or postdrome stage
This is the final stage of an attack, and it can take hours or days for a ‘hangover’ type feeling to disappear. Symptoms can be similar to those of the first stage, and often they are mirrored symptoms.
Keep a food and symptom diary
Keeping a food and symptom diary may help to identify possible food and environmental triggers.
Eat regular meals
Eat a meal 3 times a day and avoid fasting for long periods. To avoid blood sugar highs and lows reduce or eliminate refined carbohydrates, eat protein and fat with vegetables at meals and consider the client’s unique carbohydrate tolerance and whether some support is needed with this.(15)
Coenzyme Q10 is a potent antioxidant and is important in mitochondrial energy production. Researchers have found that organs with high metabolic rate, such as the heart and brain, appear to quickly deplete CoQ10 stores, which may lead to a deficiency.(18).
Feverfew (Tanacetum parthenium) is a daisy-like flower with a strong, bitter odour and contains analgesic properties. Mixed effects have been found in studies on the effectiveness of Feverfew for migraine relief and prevention with further research needed.(20)
Magnesium supplementation has been found to support a reduction in the frequency of menstrual migraines, as well as the severity of pain.(21) Further research also supports the use of supplementary magnesium in reducing attack frequency, duration and severity.(22) Magnesium in high doses can cause loose stools, so dosage needs to be tailored to the individual. Magnesium L-threonate is a form of magnesium that is less likely to cause loose stools and has been shown to cross the blood brain barrier.
Alpha Lipoic Acid
Alpha lipoic acid is a potent antioxidant that is both water and fat soluble, and therefore capable of crossing the blood brain barrier. It has been found to play a role in preventing insulin resistance and supporting healthy blood glucose levels. More recent research shows that it has a beneficial effect on migraine incidence, particularly in people with insulin resistance.(23)
5-HTP is the direct building block for serotonin. It can help with vasoconstriction during an attack and may help to stop a reoccurrence after the primary attack.
If you have any questions regarding the topics that have been raised, or any other health matters please do contact me (Lucy) by phone or email at any time.
firstname.lastname@example.org, 01684 310099
Lucy Patterson and the Cytoplan Editorial Team
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References available on request.