What is a Migraine?
What is TRUE Migraine
According to the International Classification of Headache Disorders (ICHD), Migraine is a one-sided, headache disorder, with a pulsating quality that must be moderate in nature. An ambiguous mouthful, I know. But, classification is important for standardization, especially when it comes to diagnosis and treatment. Now, there’s a whole lot more that can be going on with this, so we’ll dive right in.
According to updated research (2017-19), MIGRAINE is a genetic brain condition, one where the brain is sensitive or hyper-excitable and predisposed to certain pathophysiology that creates migraine symptoms. Symptoms commonly include:
throbbing head pain starting over one or both EYES,
light and sound sensitivity
Migraine is the most common neurological disorder in the USA, affecting about 38 million people, mostly of whom are women. The prevalence of migraine with regard to sex is about 3:1, Female to Male, with the
range of years of incidence being in the “productive years.” This translates into about 20-40 years old,
roughly. The financial burden in the USA alone is upwards of $10+ BILLION dollars, so its safe to say that
MIGRAINE is NOT just a “bad headache.”
An important distinction to make when it comes to Migraine, especially from a diagnosis and treatment
standpoint is Episodic vs Chronic. Episodic migraine is one that occurs LESS than 14 times per month,
usually over a period of about 3 months. As you can now surmise, Chronic migraine is MORE than 15
migraines days per month. There’s an important point to make here in that migraine is commonly a
PROGRESSIVE disorder, in that it generally starts in the teens and 20’s as episodic and gets chronically worse as the years move on. Someone who is 50 years old who gets their “first migraine ever and its lasted
for 2 months” … probably doesn't have TRUE migraine.
What’s the History of Migraine
Headaches have been around since, well, forever. That’s documented as far back as Roman-type eras. Migraine, is a little bit “newer” so to say.
The first known writings about migraine come from the year 1867, in which it was referred to as a “nerve storm,” or “neuronal seizure.” Round about the 1940s, new research and data pointed toward migraine causes being more vascular in nature, with the cranial blood vessel theory. Current research shows that the vessels are indeed involved, however, are not the CAUSE of migraine. In all actuality, a study of MRA (angiogram) showed that the vessels didn’t even dilate at ALL during acute migraine attacks!! Anyways, moving away from the cranial vessel theory, data from the 1990s pointed more toward a possible “neurogenic inflammation” cause of migraine, in that the nerves are inflamed, creating pain. Again, with up-to-date research, we know now that brain and associated neurological structures are definitely involved in the overall migraine process, but they don’t get “inflamed.”
So, this puts us timeline wise up to about 2017-2019, where a landmark study and review of all migraine literature created an updated working theory about why and how migraine occurs. According to this, Migraine is an altered brain state, a genetic one, creating an “overly sensitive” brain. This altered brain state theory combines all the previous ones, as we know that brain vasculature and nerves ARE involved, but not solely from a single lens perspective. Migraine is now a multifactorial disease, with 4 primary components.
The 4 Components of Migraine
All migraine sufferers have a unique combination of the following 4 components:
In some instances, it may be 98% coming from the musculoskeletal system. This, for example, is when you hear of folks who went to a chiropractor or acupuncturist and were “cured” by the treatment they received. Conversely, if a female is having horrible migraines around their menstrual cycle, and oral contraceptive prescriptions “cure” the migraines, there's a high likelihood that their migraines were over 90% hormonal. The folks who usually end up in our office are the ones who have a combination of all 4 that haven't been addressed optimally by other providers.
Think of these 4 components of migraine like fluids in a bucket. As dysfunction continues in the body, the “fluid” rises towards the top of the bucket … and eventually spills over. Then, you experience a migraine. Similarly as above, if neurological dysfunction is the primary fluid that makes up the bucket, then the best method of improvement is going to be brain rehab strategies (sounds scary, but it’s actually pretty simple and easy!). If the largest amount of fluid in the bucket is nutritional dysfunction, then dietary modification and adherence, as well as blood sugar stabilization, is going to be the most important thing.
An important point to make here is the “size” of the bucket. Some migraine folks are blessed with a large bucket, and only experience a migraine once a year or so. It takes a LOT of “fluid” to spill over. On the flip side, you have the folks with a bucket the size of a Dixie Cup,” and experience a migraine 4x a week. Regardless, the goal with any treatment should be to decrease the AMOUNT of “fluid” in the bucket, as well as increase the SIZE of the bucket (creating resilience to future migraine attacks). And yes, this can be done.
Common Migraine Treatments
Migraine treatments and approaches can be all over the map, but we’re going to focus on the most common treatments, with a couple extremely promising emerging ones.
Without a doubt, the most common treatment for Migraine is prescription medication, usually in the form of topiramates, lisinoprils, and now CGRPs. I personally think there is nothing wrong with utilizing these medications, as long as one, the patient understands that these are for symptom MANAGEMENT and not for the root cause for the migraine, and two, if there is enough benefit to justify using them. The downside of these medications is that most create side effects that require more medication to mitigate. For example, medication overuse headache is very common with migraine prescription users. Another road bump with medications is that in most cases, for insurance carriers to cover the cost, you have to be at an extreme level of suffering to “justify” the use of the medication. And, even if they do cover a portion of the cost, statistics show that a single medication for a year will cost upwards of $13,000 out of pocket … again, that's every single year, assuming that you only take one medication.
Moving onward, a promising treatment that has been effective for many is BOTOX. BOTOX is a botulin toxin that is used to “turn down the noise” from the muscles injected. That’s it. BOTOX does NOT cure, it only masks. Typically, BOTOX treatments comprise of 150 units over 30 sites around the head and neck, on average costing about $1,000 per cycle. As I’m sure you’ve read or heard somewhere, CBD has been the rage for quite a few conditions, and Migraine is of course one of them. The great thing about CBD is that the basic compound of the endocannabinoid receptors work on the SAME synapse as TRIPTANS. Yes, you read that correctly. Now, I’ve heard some folks say that CBD didn't work for them. This is more common than you’d might think, and the research points towards a higher ratio of THC:CBD being more effective (usually 2:1). In pretty much all states in the US, this is right at the level of illegal, so until things change, this will still be a difficult approach to take.
Lastly, we have CAMs, which stands for Complementary and Alternative Medicines. This typically includes Chiropractic for Migraine, Acupuncture for Migraine, Massage Therapy, Neurofeedback for Migraine, Cognitive behavioral Therapy, Low Level Laser Treatment for migraine, and supplements for Migraine. There’s a whole host of research out there that supports all of these approaches. Personally, I think the most exciting is research from 2018 that compared BOTOX to Low Level Laser and found the LLL was JUST as effective as BOTOX. This is massive! LLL is one of the treatments that we use here at Keystone, and have found great success with it.
Alright, we’re going to wrap this months Migraine Blog up! Stay tuned for next months installment, tackling the Neuropathophysiology of the Migraine … I promise it won’t be a snooze fest! -------------------------------------------------------------------------------------- This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that we might see and do not describe the circumstances of a specific individual.