What is Migraine?
What is TRUE Migraine
The International Classification of Headache Disorders (ICHD) defines migraine as a type of headache that typically affects one side of the head and is characterized by a pulsating sensation. The intensity of pain is usually moderate, but it can vary from person to person. While this definition might sound complex, it underscores the importance of classification in ensuring accurate diagnoses and effective treatment options. There's a wealth of information to explore regarding migraines, including their triggers, symptoms, and potential management strategies, so let's delve deeper into this intricate subject.
According to updated research (2017-19), MIGRAINE is a genetic brain condition, one where the brain is sensitive or hyper-excitable and predisposed to specific pathophysiology that creates migraine symptoms. Symptoms commonly include:
Unilateral pulsating,
throbbing head pain starting over one or both EYES,
headache, nausea,
light and sound sensitivity
Migraine is the most common neurological disorder in the USA, affecting about 38 million people, most of whom are women. The prevalence of migraines concerning 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 it is 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 occurs LESS than 14 times per month,
usually over 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
A PROGRESSIVE disorder that generally starts in the teens and 20s as episodic and gets chronically worse as the years move on. Someone who is 50 years old who gets their “first migraine ever, and it lasted for 2 months” … probably does not 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 date back to 1867, when it was referred to as a "nerve storm" or "neuronal seizure." In the 1940s, research began to suggest that the causes of migraine are more vascular in nature, leading to the cranial blood vessel theory. Current research indicates that while blood vessels do play a role, they are not the primary cause of migraines. In fact, studies using MRA (magnetic resonance angiography) have shown that blood vessels do not even dilate during acute migraine attacks.
Moving away from the cranial vessel theory, data from the 1990s suggested a possible cause of migraine related to "neurogenic inflammation," which postulates that inflamed nerves create pain. However, up-to-date research shows that while the brain and its associated neurological structures are involved in the overall migraine process, they do not become inflamed.
This brings us to the timeline of approximately 2017-2019, during which a significant study and review of existing migraine literature developed an updated working theory regarding the causes and mechanisms of migraines. According to this theory, Migraine is an altered genetic brain state that leads to an “overly sensitive” brain. This altered brain state theory encompasses previous theories, as we now understand that both brain vasculature and nerves are involved, but not from a single perspective. Migraine is now recognized as a multifactorial disease with four primary components.
The 4 Components of Migraine
All migraine sufferers have a unique combination of the following 4 components:
Neurological
Hormonal
Musculoskeletal
Dietary
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 are 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 toward the top of the bucket … and eventually spills over. Then, you experience a migraine. Similarly, 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 pretty simple and easy!). If the most considerable amount of fluid in the bucket is nutritional dysfunction, then intake modification, dietary adherence, and blood sugar stabilization will be the most important.
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 varied, but we’ll focus on the most common ones and mention a couple of extremely promising emerging ones.
Without a doubt, the most common treatment for Migraine is a prescription medication, usually in the form of topiramate, lisinopril, and now CGRPs. I 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. 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 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.
BOTOX is a promising treatment that has been effective for many. It is a botulin toxin used to “turn down the noise” from the muscles injected. That’s it. BOTOX does NOT cure; it only masks. Typically, BOTOX treatments comprise 150 units, over 30 sites around the head and neck, and, on average, cost 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 works 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 might think, and the research points towards a higher ratio of THC: CBD is 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 complicated 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. A whole host of research exists that supports all of these approaches. One can argue that the most exciting part is the 2018 research that compared BOTOX to Low-Level Laser and found that the LLL was just as effective as BOTOX. This is massive! It is one of the treatments that Keystone Upper Cervical Spine Clinic uses for clients suffering from chronic migraine, and we have found great success utilizing this promisingly innovative technology.
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Alright, we’re going to wrap up this month's Migraine Blog! Stay tuned for next month's installment, tackling the Neuropathophysiology of Migraines… I promise it won’t be a snooze fest! -------------------------------------------------------------------------------------- This blog is provided for informational purposes only. The content is not 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.
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