[HN Gopher] The metabolic face of migraine - from pathophysiolog...
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The metabolic face of migraine - from pathophysiology to treatment
Author : DanielleMolloy
Score : 76 points
Date : 2021-05-07 14:13 UTC (8 hours ago)
(HTM) web link (www.nature.com)
(TXT) w3m dump (www.nature.com)
| yolobouquet wrote:
| I suffered from migraines for many years, always after a night's
| sleep. I had sleep studies and they determined I was not getting
| enough oxygen. I had surgery for a deviated septum and tissue in
| my nasal passages and throat was scoured back. I continued to get
| migraines and was given a CPAP. The headaches continued. I was in
| my 40s when my dentist asked me if I got headaches in the
| morning. She said I was grinding my teeth and I needed to start
| wearing a mouth guard at night or I was going to crack a molar. I
| still get migraines but they are much less frequent than they
| used to be.
| TheSpiceIsLife wrote:
| This leads me to ponder if the _cause of the tooth grinding_
| could be resolved, would the frequency of migraines reduce
| further still?
|
| Have you tried taking a magnesium di-glycinate based magnesium
| supplement. Magnesium can help relax the small fast twitch
| muscles in the jaw.
| JoeAltmaier wrote:
| They talk of how migraine might be adaptive. But isn't it
| possible that migraine is a side-effect of another adaptive gene
| for a different effect? Nature doesn't care if we're miserable.
| Just that we survive (as an individual or community) and
| reproduce.
|
| Imagine if miserly consumption of some chemical was calorie-
| adaptive or saved for emergencies, but the same gene meant
| migraines at other times. The gene would still proliferate, with
| no need to explain the negative effects as adaptive?
| dillondoyle wrote:
| If have a bad enough migraine can't go hunt or gather food.
|
| Though sex or orgasm can help with headaches in my experience
| so maybe that's a driver :)
| fallingfrog wrote:
| In my experience an orgasm only makes a migraine go away for
| 3 or 4 seconds. It's like a brief moment of relief then you
| feel the pain come rushing back.
| svcrunch wrote:
| Fascinating work, thank you for sharing. Here's a link to the
| full paper:
|
| https://orbi.uliege.be/bitstream/2268/247255/1/Gross%20et%20...
| DanielleMolloy wrote:
| Thanks for the link! I must have been logged in via my
| institution and didn't realize the article wasn't public.
| lazypenguin wrote:
| One of my relatives suffers from migraines and they are seriously
| debilitating with sensitivity to light and intense nausea. There
| are strong meds that can help prevent them but they always
| intrinsically knew that certain foods were a trigger for them. It
| seems over the years that the connection between migraines and
| nutrition has been strengthening. I could not access the journal
| but I would have loved to know what their conclusions and
| recommendations were. Especially the part related to diet
| modification.
| TheSpiceIsLife wrote:
| One medical scientist I know has been banging on for over 25
| years that the liver _always plays a role in headaches &
| migraines._
|
| This also helps explain why hormones, especially oestrogen, can
| be a problem for migraine sufferers, as it's the liver-gut-
| gallbladder axis that detoxifies hormones from the body.
| wayoutthere wrote:
| I do too; they have at times been debilitating. I've found no
| prescription drug works better than marijuana.
|
| There is also a significant hormonal component to migraines.
| Women have 2-4x as many migraines as men -- an effect that is
| also seen in trans women who are taking estrogen, which
| indicates that it's probably hormones rather than genetic. Not
| ruling out a dietary component, but it's obviously a complex
| set of symptoms with likely dozens of contributing factors.
| nickclaw wrote:
| After trying some prescription drugs I've also found
| Marijuana works the best for me. It's the difference between
| lying on the bathroom floor waiting to throw up and being
| semi-functional (I am pretty stoned, so not totally
| functional) around the house.
|
| I don't think it's a cure so much as a great way to manage
| the pain while the migraine is at its peak, unfortunately the
| migraine hangover still lasts for days.
| AuryGlenz wrote:
| I'm a man and had occasional but regular migraines until I got
| low testosterone diagnosed and treated. Just throwing it out
| there, even though I might be a unique situation.
| podgaj wrote:
| Hey, seriously, check out riboflavin and see my other comment!
|
| https://onlinelibrary.wiley.com/doi/full/10.1111/jcpt.12548
|
| The nausea is most likely from high serotonin which cannot be
| metabolized by MAOA when in riboflavin deficiency.
| binarymax wrote:
| I'm triggered by sulfates and pistachios. I found this out
| through a combination of pure luck and semi-structured
| observation. I haven't had one in several years.
|
| I consider myself very fortunate to have found these, and I
| encourage anyone who experiences migraines to keep a food diary
| (write down what you ate and drank the day before, including
| all ingredients). You may be able to find trigger ingredients
| at some point, and then avoid them the rest of your life.
| coldcode wrote:
| I had severe migraines in high school through my early 20's,
| in addition to a 1 month bout of cluster headaches (you don't
| want those!), my triggers were MSG (yes I know people say its
| perfectly fine, but I experimented and was able to show it
| affected me, all those years of studying Chemistry...) and
| bright sunshine reflections. I made sure I ate food with
| little or no MSG, and always wore strong sunglasses outside,
| which helped reduce them a lot.
|
| The connection to MSG is clearly controversial given how much
| the food industry loves using it to smooth out taste in
| prepared foods, but it seems to not affect most people, so it
| didn't bother me as long as I could identify its inclusion.
|
| In the the past 30+ years they have decreased in frequency
| and severity; now other than the aura (20 minutes of weird
| vision) the headache is at most a simple Tylenol one.
|
| Triggers can be almost anything that affects the brain in
| some way; given this research it's clear that what affects
| people with migraine potential does not affect those with
| different genetics. Very often genetics plays a large role in
| how your body reacts to stimulus and food and diseases, but
| also that many genetic adaptations have both good and bad
| sides, so perhaps migraines gave our ancestors some benefit,
| and we pay the price lying on the couch in the dark.
| WorldMaker wrote:
| MSG was the first taste bud science was able to isolate on
| the tongue because MSG is a messaging enzyme in
| neurochemistry and it turns out that the taste bud very
| physically resembles the brain receptors. In a similar way
| to caffeine, the brain requires a moderate amount of MSG to
| function, but can easily be over-stimulated.
|
| The reason for all the "perfectly fine" "controversy" with
| MSG is that there's still no known allergy to it, and the
| early proponents of "MSG allergies" were quacks using bad
| science for racist reasons (despite it being a naturally
| occurring substance, and a required enzyme in the brain).
|
| So overall it is much less controversial to say that MSG is
| a known migraine trigger in some people. It's still "safe",
| migraines so far as we know are rarely life-threatening
| even if sometimes you do feel like you are going to die.
| You mostly just need to acknowledge that as a trigger it
| varies greatly among people.
|
| The analogy to caffeine is an extremely useful one as
| caffeine is also "generally recognized to be fine/safe/not
| an allergy", but too little caffeine and too much caffeine
| (and caffeine withdrawal) can all be migraine triggers or
| migraine relievers depending on what side of it you are on.
| (Most over-the-counter "migraine medication" if you check
| the ingredients is just a dose of generic Tylenol and a
| shot of caffeine because the most common migraines in
| America are often the withdrawal state or the too little
| state and it isn't likely to make it worse if you are in
| the too much state already, unless too much is on the edge
| of a caffeine OD and you have more life threatening
| problems.)
|
| It plays the other way sometimes too: sometimes I crave
| foods high in MSG when I have a migraine and that will
| settle the migraine some.
| Tarragon wrote:
| > bout of cluster headaches (you don't want those!)
|
| Oh, now you tell me...
|
| "Cluster headache is among the most severe pains known to
| mankind." [1]
|
| Cluster headaches to generally thought to be neurological
| compared to migraines which are generally considered
| vascular. I guess by this article, indirectly vascular.
|
| Cluster headaches are significantly rarer than migraines.
| Only a very very few get both. You should have gotten a
| lottery ticket that month. Glad it faded.
|
| [1] https://www.practicalpainmanagement.com/pain/headache/c
| luste...
| ses1984 wrote:
| Are you triggered by foods that naturally contain msg?
| DanielleMolloy wrote:
| Next to what other users said it gives very specific supplement
| recommendations, riboflavin (B2) far above the daily
| recommended value, as well as Q10 and Magnesium. I've made some
| good experiences with the latter and will give the others a
| shot too.
|
| They recommend ketogenic food too (I never noticed an effect on
| my migraines though).
| svcrunch wrote:
| Full text:
| https://orbi.uliege.be/bitstream/2268/247255/1/Gross%20et%20...
|
| Lots of excellent recommendations starting from page 6 onward
| ("Theraputic studies")
|
| An incomplete list of long term strategies presented in the
| paper:
|
| - aerobic exercise
|
| - b-vitamin supplementation (several different ones are
| mentioned), and magnesium supplementation
|
| - ketogenic diet (train the brain to use non-glucose sources of
| energy)
|
| - sleep management (are you getting enough?)
|
| Given the root-cause analysis of migraines presented in the
| paper, there's one additional treatment which I'll experiment
| with: milk thistle supplementation. Milk thistle boosts levels
| of glutathione in the liver, which appears to have a bearing on
| migraines.
| mdip wrote:
| I started getting Migraine headaches in the late spring at age 17
| and continued to get them in the spring/fall weekly for about two
| decades[0]. I remember the age and the season because, up to that
| point, I had headaches. What happened that day resulted in a trip
| to the emergency room, on my insistence; I thought my brain was
| bleeding[1]. After 4 hours, I was sent home with a note to take
| two extra strength Tylenol. And for the 20 years that followed,
| that was about the quality of treatment I received.
|
| Everything, for me, is solved with a medication that is very
| rarely prescribed for Migraine. My issue is that I cannot take
| the usual medications (imitrex, etc). They are effective, but I
| lack a gene that is required to flush them from my system
| correctly. So 30 minutes after taking the pill I'd be the
| happiest I've ever been in my entire life, and about 1.5 hours
| later, I'd be miserable. It was _comical-if-they-weren
| 't-happening-to-you_ mood swings, which almost killed me[2].
|
| I've seen several doctors for this. After a mess of semi-
| unrelated circumstances around that event which almost killed me,
| I ended up on a prescription for Depokote. It's a very old
| medication, originally prescribed for seizures and I now commonly
| used off-label for bipolar. It was prescribed to me with the
| endorsement of "a few of my patients responded well to this, none
| of them had side effects, and this is where we're at on the list
| of choices" ... basically, the guy had no confidence it would
| work, so I didn't either. It was prescribed mid-summer, and I
| noticed after about a week that I felt like I was carrying around
| _zero_ anxiety[3], and a number of other fantastic side-
| effects[4]. By the end of the following spring, I was convinced
| it worked -- completely. It was the first year I had gone any
| season without a single Migraine headache. Interestingly, I 'd
| get the "aura", on occasion, but it would never melt into
| horrifying pain.
|
| The whole time, regardless of specialist, there wasn't anyone who
| could give me a really good idea of just what the hell was really
| going on in my skull. I'll admit, after reading this, I'm
| wondering if I really have Migraine or if I don't have some other
| thing (cluster was ruled out). My triggers are seasonal; and I
| have bad days when there has been a large shift from high->low or
| low-> high. Interestingly, though, if I get a migraine, I am
| pretty much insulated from getting another one for about a week,
| which implies some sort of biological process that is serving
| some function, since multiple repeats of that trigger, or even
| much stronger ones, will not cause a second migraine for several
| days after one already landed.
|
| [0] Varying lengths but until I learned to cope with the
| symptoms, it at least destroyed the entire rest of the remaining
| day once it hit. Often remained a day after, as well.
|
| [1] I really, _really_ , hated hospitals as a kid. My parents
| took me on my insistence because they knew I would only demand to
| go if I seriously thought I was dying ... even though it was a
| headache.
|
| [2] A combination of medications related to Migraine which I took
| during an attack (as prescribed) resulted in my serotonin levels
| sending me to the hospital. It. Was. Bad.
|
| [3] I never thought of myself as anxious, and it's never been an
| issue in my life -- that I know of -- that has held me back. But,
| holy cow, the difference was _stark_.
|
| [4] For medications with "brain affecting" side-effects, I _do
| not_ read the label. My wife takes that responsibility. My
| thinking is: (1) placebo /nocebo effect is really strong when the
| thing it effects is emotional/personality. (2) I can't trust my
| brain to evaluate what is happening to itself -- it's compromised
| by the medication.
| mancerayder wrote:
| I get a devastating headache every few weeks lasting a few days
| from the base of my skull inside, and it feels like the type of
| headache that you get from drinking something cold too fast, a
| bit milder, and lasting a few days. It seems to be triggered from
| sitting in front of the PC (I try to always stand), doing
| something dumb at the gym (benching and pushing my neck into the
| bench so I no longer bench), sitting awkwardly for too long (like
| a train seat), or looking at a slight angle down while working.
| It feels like nerve impingement and it travels sometimes to just
| one side of my face, and even hurts above my eye. Sometimes I
| feel nauseous too. I've had this for many years. It's more likely
| to happen if I've slept poorly or get stressed.
|
| What's the difference between that and migraine? I hear people
| all the time saying they suffer from migraines, and I'm told it's
| connected to a 'quadrant' type of pain. Are people being
| diagnosed with migraines maybe suffering from a similar nerve
| issue that I have? And by the way, that I have a nerve
| impingement is purely my own hypothesis, and difficult to
| prove/disprove I think.
| podgaj wrote:
| Riboflavin!
|
| https://onlinelibrary.wiley.com/doi/full/10.1111/jcpt.12548
|
| The link to the mitochondria is through FAD, a metabolic
| derivative of Riboflavin, which is used in the electron transport
| chain.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447943/
| boffinism wrote:
| Didn't work for me. I think it's easy to come up with a pet
| theory ("migraines are caused by X, and therefore prevented by
| Y"), especially when there is some science to support you. But
| when you dig into it, you learn that while some treatments are
| wildly effective for a few people, no treatment is widely
| effective. If it were, migraines wouldn't be such a thing in
| the developed world.
|
| So by all means, let people know that Riboflavin might help
| them, but be wary of prescribing it to all and sundry when in
| truth, it will only help a minority.
| mmastrac wrote:
| It will be interesting to see the next phase of migraine
| treatments - psilocybin, CRGP inhibitors, etc. It really feels
| like we're getting close to understanding what a migraine truly
| is.
|
| I believe "cortical spreading depression" is a fairly recent
| discovery and has opened up a lot of avenues of research vs the
| past belief that migraine was purely vascular.
|
| This video was a pretty good update on state-of-the-art
| treatments, including those in trial:
| https://www.youtube.com/watch?v=LB9nYDvpfbA
| podgaj wrote:
| everyone always makes it complicated. How about riboflavin?
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447943/
|
| I have seen the effect of this first hand.
| mmastrac wrote:
| Riboflavin and the other nutraceuticals are in this paper. Co
| Q10, magnesium, etc all have promising prophylactic effects.
|
| We still need research and treatments for those who get
| migraines despite the prophylactics.
| gadders wrote:
| This was a good podcast on the subject of migraines that I
| listened to last week:
|
| "Throbbing head, nausea, dizziness, disturbed vision - just some
| of the disabling symptoms that can strike during a migraine
| attack. This neurological condition is far more common than you
| might think, affecting more people than diabetes, epilepsy and
| asthma combined.
|
| While medications, to help relieve the symptoms of migraine, have
| been around for some time, they haven't worked for everyone. And
| what happens in the brain during a migraine attack was, until
| recently, poorly understood.
|
| Peter Goadsby is Professor of Neurology at King's College
| London's Institute of Psychiatry, Psychology & Neuroscience and
| is a true pioneer in the field of migraine.
|
| Over the course of his career, he has unravelled what happens in
| the brain during a migraine attack and his insights are already
| benefiting patients - in the form of new medications that can not
| only treat a migraine, but also prevent it from occurring.
|
| Peter shares this year's Brain Prize, the world's largest prize
| for brain research, with three other internationally renowned
| scientists in the field."
|
| https://www.bbc.co.uk/programmes/m000vp2z
| alexreds wrote:
| There are a bunch of recently approved new migraine medicines
| that block CGRP instead of serotonin. I have suffered migraines
| since my teens and while Sumatriptan provides some relief, it
| is not great and has to be taken as soon as I get an auora to
| be at all effective. Stress and high fructose corn syrup, which
| is in EVERYTHING, are my triggers. I have not yet tried the new
| meds, but I am hopeful.
| https://cureheadaches.org/2020/07/15/new-migraine-medication...
| podgaj wrote:
| Serotonin is metabolized by MAOA, witch needs riboflavin
| (FAD) work effectively.
|
| https://ars.els-
| cdn.com/content/image/1-s2.0-B97804446412500...
| plutonorm wrote:
| Translation: People with highly sensitive nervous systems get
| migraines because they are overstimulated. It can also be caused
| by mutations in mitochondria which reduce energy output. Both of
| these cause mismatches in the amount of energy being consumed and
| the amount of energy being expended.
|
| I can confirm that my migraine frequency has doubled since having
| children.
| nickclaw wrote:
| This is fascinating, I've suffered occasional migraines for 15
| years, and while I've found over time that it's highly connected
| to my diet combined with other stressors (like intense exercise,
| lack of sleep, high stress, etc...), I've never seen the
| mechanism described so clearly as "a mismatch between the brain's
| energy reserve and workload."
|
| I wonder if the "migraine hangover" is also part of the brains
| process to "restore brain energy homeostasis" or is just an
| unfortunate side effect.
| fallingfrog wrote:
| I once got a migraine with aphasia. I was noticing that the
| visual alligator crack rainbow lightning stuff was finally going
| away and I decided to check Facebook. I found that while the
| letters snd words looked normal, it was all gibberish. I tried
| saying something out loud and I found that all that came out was
| a mess of random phonemes. It lasted about half an hour.
|
| It looks like this if you want to see:
|
| https://youtu.be/IG7NuH5QTdE
| pugworthy wrote:
| I rarely get the headache side of migraines, but I do get the
| visual aura fairly often. If over-stimulation is a factor, then
| certainly they are a bit self regulating since I have to just
| stop using the computer, stop reading, stop looking at my phone,
| etc. until it's gone.
|
| If you've not had the visual migraine effect before, the impact
| is a bit like if you looked a bright light, then tried to read
| something.
| greatgib wrote:
| Very very interesting topic.
|
| I was also used to suffer from the visual migraine as you
| describe it.
|
| For another exemple, it is like looking at the phone in
| complete darkness with the phone brightness set to the maximum;
| but that effect in daylight with the screen set to low/normal
| brightness level.
|
| Maybe I'm wrong, but the deductions I did from my issues was
| that it might be related to work conditions. For example, I
| used to have the computer screen at 90deg of a window. And
| there was probably constantly a little bit of light reflexion
| on my screen. So it is not so much to be noticable or annoying,
| but for a full day it will exhaust my eyes and brain. And I
| would regularly have the issue at the end of the day.
|
| Then, I changed of work and of light conditions, and I almost
| never got the issue anymore. (Still once in a while, but very
| very rarely compared to before)
|
| Also, I discovered that there are a lot of good advice
| regarding the work environment that you should try to respect:
|
| - no excessive room temperature (>21)
|
| - no sun or light directly in front. No light reflexion from
| the back or side.
|
| - room ambiant light the closest possible to the brightness of
| the screen
|
| But, a point that could support the theory of this publication
| is that, when the issue arrived, it was often that I was
| feeling hungry for sweets and desperately looking for a snack.
| davmar wrote:
| I have the exact symptoms as you - no headache but visual aura.
|
| I think my triggers are a lack of food/hydration and bright
| lights.
| mjklin wrote:
| I've seen a doctor for this and he mentioned stress and foods
| containing tyramine (pickled and fermented foods, preserved
| meats and aged cheeses, asparagus, red wine, chocolate) as
| possible triggers.
|
| See: https://www.webmd.com/migraines-headaches/tyramine-and-
| migra...
| auslegung wrote:
| I recently learned about ocular migraines, and what you're
| describing could be that. https://www.mayoclinic.org/diseases-
| conditions/migraine-head...
| BrandoElFollito wrote:
| I do not usually get the headache part either but the visual
| part is epic.
|
| The first time I got it, a few years ago, I thought I was
| having a stroke.
|
| The visual area gets ripped in two by the diagonal, the two
| pieces move away and are replaced with a silver band. The
| picture stays more or less complete, but broken in two. The
| image kind of pulsates, or rather waves.
|
| I was terrified the first time, then visited the
| ophthalmologist, did a tomography of my head and ended up at a
| neurologist. He was a specialist of migraines and told me that
| about 30% of migraines are without headaches.
|
| My father has migraines, my younger brother too and both have
| headaches.
|
| I had some other extasy-like migranes and I am usually
| exhausted afterwrds and sleep 10 to 12 hours straight.
|
| I am lucky to have only a few cases a year.
| tonyedgecombe wrote:
| > The first time I got it, a few years ago, I thought I was
| having a stroke.
|
| That was my reaction as well.
|
| It reminded me of looking through a kaleidoscope.
|
| Luckily I've only had it occur a couple of times.
| alfiedotwtf wrote:
| Migraine sufferer here. Know your triggers!
|
| I used to suffer migraines at least once a months, and head aches
| at least once or twice a week. But then I found my triggers...
|
| So the Philae Lander landing on a comet on a Wednesday night, at
| sometime like 3am, and the next morning I had a really bad
| migraine. It was right then and there that I realised I only ever
| got migraines on Saturday and Sunday. Why did I all of a sudden
| get on then? Lack of sleep! I started experimenting, and
| eventually found that if I had under 4 hours of sleep for 3 days
| in a row, surely enough on the fourth day I would most likely
| have a migraine! It was an awesome epiphany.
|
| I've also managed to dramatically reduce headaches too - by
| having at last 6 hours sleep, I will have most likely staved away
| my usual tension head aches.
|
| I'm also under the suspicion that my headaches are effected by a
| lack to serotonin, but haven't had my bloods checked for that
| yet.
| juskrey wrote:
| I had no headaches for a straight year on strict low carb diet
| wayoutthere wrote:
| I honestly had the opposite; I tried Keto and had headaches for
| a month. They went away about 15 minutes after I ate a
| chocolate bar.
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