Accceptance therapy for migraine?

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Pain Acceptance Linked With Reduced Disability, Pain Interference in Migraine

Migraine sufferers often avoid triggers and activities thought to precipitate migraine. In line with the fear avoidance model of pain, however, some findings have shown that avoidance can lead to headache disability by reducing pain thresholds and preventing pain habituation.2,3 In addition, psychological factors have been found to have a greater influence on the fear-avoidance cycle than symptoms like headache severity, suggesting that targeting such factors in patients with migraine may improve outcomes.4

In contrast to avoidance-style coping, pain acceptance consists of 2 components: pain willingness — the recognition that pain avoidance efforts tend to be ineffective — and activity engagement, consisting of participation in life activities despite being in pain.5

This study was looking at overweight women in particular with a BMI over 25.  There were 126 subjects. They found there was reduced headache disability with acceptance and less disruption there was in their lives. It is limited due to its focus but the idea is that acceptance therapy is beneficial with chronic pain and may very well be with migraines as well.

This is a strategy my psychologist takes. You should engage in life because you will be in pain anyway. You should do all the strategies to manage that pain, but also not avoid interaction, social activities and other things due to pain that will always be there.

I find it a lot more difficult with chronic migraines than say, when I only had fibromyalgia. The Limit is a harder line. You see you can’t exceed your pain limit and push through the pain all the time. For me, that lead to depression and suicidal ideation. Loss of hope. Too much suffering for coping strategies to encompass. For that reason, my pain psychologist acknowledges that working full time is impossible for me. Working part-time is likewise very problematic. When I exceed my pain limits and try to function like that, and fail to function, I cease to want to thrive and exist. Clearly counterproductive to coping. So you have to acknowledge that pain has limits. You can only cope with so much. Only function with so much. Acceptance or not, that is a Hard Line.

But chronic migraines are chronic pain and we do have lives to live. We cannot hide in our cave every time we have a migraine or we would be in there every day. We do have to do things with migraines. Even socialize with them. Do housework with them. Go for walks for exercise with them. Limited errands with them. Just not with pain levels at 8 or above. We are limited by our pain levels and, therefore, the lower functionality that comes with those levels.  Likewise, we can be limited by bouts of vertigo, vomiting, and diarrhea. And we can’t push those limits without risking our mental health. In the 6-7 range with have lower functionality and can do limited housework and limited errands and limited socialization. Not on the same day. But we can. It tends to make the pain worse. Aggravates things. Sometimes so much worse you have to leave early, get home as soon as possible, or immediately stop what you are doing.

Acceptable with Fibromyalgia is a lot easier. You pace, moderate and stay within your limits. Rest on flares. Self-care on flares. But the rest of time just ensure you pace, rest when you need to and never exceed you limits. You can live a well-rounded, mellow and careful life. Mind you mine has gotten worse over the years but I still follow this and it works well. Migraines, daily, on top? A lot harder process. Pacing means nothing to migraines. They come on regardless if you pace. Pacing doesn’t prevent the pain from being worse or better. It just is.

So we can have acceptance and try to live our lives within the capcity we have. It is just limited capacity.

 

Migraine and dopamine levels

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A study in Neurology done by the University of Michigan using PET scans shows that the neurotransmitter dopamine falls and fluctuates with migraines. (Brain scans show dopamine levels fall during migraine attacks)  This could lead to better migraine therapies and also understand our behaviours during a migraine attack. Dopamine is the brain’s ‘feel-good’ neurotransmitter and it is responsible for such things as motivation, mood regulation, and sensory perception.

They looked at the brains of 8 migraineurs and 8 healthy controls during migraine attacks and between the attacks. The migraineurs between attacks had normal and stable dopamine but in an attack it significantly dropped.

“Dopamine is one of the main neurotransmitters controlling sensory sensitivity,” said study co-author Kenneth Casey, U-M professor emeritus of neurology. “Therefore, a drop in dopamine could produce increased sensory sensitivity so that normally painless or imperceptible sensory signals from skin, muscle and blood vessels could become painful.” MedicalXpress

Allodynia:

DaSilva says he was surprised when patients who were resting during their migraine attacks experienced a small dopamine spike and worsening symptoms when researchers applied warmth to their foreheads.

This condition in chronic pain patients is called allodynia—when a stimulus that normally wouldn’t cause pain does. DaSilva says the sudden small spike in dopamine was probably an aversive reaction to environmental stimulation.

This small fluctuation was only a partial recovery of dopamine, but it made the suffering worse because the dopamine receptors were highly sensitive by then, and even a small recovery would induce more nausea, vomiting and other symptoms related to migraine, he says.MedicalXpress

 

 

The Cerebral Cortex – Dr. Todd Schwedt

Fascinating article…by Nancy Bonk on Health Central

“Another study used a white moving dot pattern on a black background to visually stimulate the subjects, showing the Migraine group had a stronger activation in the middle temporal complex (motion sensitive region) compared to the non-Migraine group. These studies support the idea that Migraineurs have enhanced reaction to light and motion stimuli in addition to having thicker cortex in the visual motion processing centers of the brain compared to non-Migraineurs.”

Yep… that relation I can understand since I am really hypersensitive to both light and motion. Both of which persistent beyond the migraine but are obviously worse with one.

“Dr. Schwedt rounded out his session discussing how a Migraineur “co-processes” different stimuli and that Migraine itself is multisensory integration that has “gone wrong.” He went on to explain what multisensory integration is:
“sensory-specific brain responses and perceptual judgments of incoming sensory stimuli which concern one sense may be modulated by relations with other senses.”

This means, our brains can take in many sensory stimuli (visual, olfactory, auditory and somatosensory) at the same time and process them simultaneously – we don’t process one type of stimuli at a time. He thinks this is important because Migraineurs with osmophobia seem to have a higher attack frequency and are found to be photophobic. If Migraineurs are hypersensitive to light they may also be sensitive to odors and have a hyper reactive trigeminal system. One study that measured pain thresholds in a group of Migraineurs who were not experiencing a Migraine and were exposed to bright light, became more sensitive after exposure when their pain thresholds were re-measured. This did not happen in the control group.”

Again, isn’t that interesting to note? How the stimulus gets tangled up? Makes a lot of sense doesn’t it? Certainly, it seems that our senses are hyper-aware during a migraine. That super sense of smell, photophobia, super hearing… too much of everything. And I am definitely photophobic and have been for decades. And odors… Anyway, it is quite intriguing. This was a few years back. I am re-printing it from my brainless blogger blog.

Throbbing: rhythm of the brain

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With a migraine the word Throbbing is definitely a word that is commonly used. And more. But there is throbbing. It feels like our brain is pulsing with our hearts. Like every blood vessel in our brains is throbbing in pain.

But apparently, Throbbing pain has nothing to do with blood flow. And everything to do with the brain.

Throbbing pain is actually connected to the pulsing rhythms of Alpha brain waves. That is right, we are throbbing to the rhythm of our brain.

In the study, researchers examined a patient who suffered from a throbbing sensation that remained even after her chronic migraine headaches had been resolved.

The researchers simultaneously observed the patient’s feelings of throbbing pain as well as her arterial pulse and found that they were unrelated to one another, suggesting that the pulsing of blood from the heartbeat was not connected to the throbbing quality of pain.

Through the use of an electroencephalogram, however, they discovered that the throbbing quality was linked to a type of brain activity — alpha waves.

“We understand very little about alpha waves, but they appear to have an important role in attention and how we experience the world,” Ahn said. “In addition, by analogy to how a radio works, alpha waves may also act as a carrier signal that allows different parts of the brain to communicate with itself.”

Scientists still aren’t sure how just alpha waves cause throbbing pain. But the current research suggests that the experience of throbbing pain is tied to how the brain works and not to the pulsations of blood at the location of pain. PsychCentral

Intriguing. One study doesn’t make fact, but if true then it makes you realize how little we understand some pain, doesn’t it?

 

Dumbified: a study

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I have said, often, repeatedly, that I can’t think through a migraine. One assumes it is the pain level. Or is it the migraine itself?

Well, guess what they did a study on that. How thinking is impacted by a migraine. And we are right… we are dumified by a migraine. Or to put it better there is cognitive dysfunction with migraines, that is not permanent, but certainly feels that way when migraines are way more frequent than not.

The study was on migraine without aura. I would assume it is the same with aura, if not worse given aura symptoms.

Thirty-nine patients with episodic migraine (37 females, average 38 years old) were included and 24 completed the study. Participants performed worse during the attack in the majority of cognitive tests, compared to the headache-free status, and significantly so in word reading speed (p = 0.013), verbal learning (p = 0.01), short-term verbal recall with (p = 0.01) and without (p = 0.013) semantic cueing and delayed recall with (p = 0.003) and without (p = 0.05) semantic cues. Differences found were unrelated to age, gender, literacy, condition order, interval between evaluations, anxiety, pain intensity or duration of the attack. PubMed Cephalalgia.

In the end they conclude “Cognitive performance decreases during migraine attacks, especially in reading and processing speed, verbal memory and learning, supporting patients’ subjective complaints. These findings suggest the existence of a reversible brain dysfunction during attacks of migraine without aura, which can relate specifically to migraine or be a consequence of acute pain processing by the brain.

So either due to the migraine or the pain. Either way, that is a lot of dysfunction. For example, the one damn thing fibrofog doesn’t touch? Processing speed. And migraines do. That is impressive in a bad way. What is processing speed? “Processing Speed is one of the measures of cognitive efficiency or cognitive proficiency.  It involves the ability to automatically and fluently perform relatively easy or over-learned cognitive tasks, especially when high mental efficiency is required.  That is, for simple tasks requiring attention and focused concentration.  It relates to the ability to process information automatically and therefore speedily, without intentional thinking through.ETFO Like reading comprehension and doing simple math. Ever have a problem doing simple math in your head with a migraine? Processing speed issues. Ever read a sentence and not comprehend it? Or delayed comprehension? Processing speed. Fail to recognize an object? Or delayed comprehension?  Processing speed. Copy words and sentences incorrectly? Processing speed. Taking a longer time to respond to a question or respond to written instructions. All processing speed. That system getting glitchy can slow a person right down. I call it having to be really methodical in my steps. Makes my brain feel slower than molasses. Pudding brain, I call it. It can affect how we comprehend in conversations to how overwhelmed we become in by too much information at once. I know with a migraine thinking has to be very This Step and then This Step. So this study is intriguing because it shows the limitations we have cognitively with a migraine. And the frustrations that come with that.

Makes me think it is more than pain when they say it affects processing speed. But that is because I have read the research on FM where pretty much everything from short term, long term and working memory is affected from pain, except processing speed.

 

 

Migraines and mouth bacteria?

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The study that came out about food triggers and mouth bacteria was a pretty fascinating one… to clear it up for us Teri Robert has written Are Migraine Food Triggers and Mouth Bacteria Related? 

The fact is the gut is a fascinating topic and ripe for research. We develop our gut bacteria when we are young… and have it for the rest of our lives. Another fun fact, it is estimated about 90% of our serotonin is made in our digestive system. Chew on that! So it is a largely ignored area that affects a rather massive amount of things. So I actually found this study pretty fascinating, but preliminary and obviously we would have to see where they go with it in the future.

White Matter Lesions and migraines

So I recently discovered I have these migraine brain lesions. Not because I was told, but because I read the letter he sent to my doctor where he said “scan from July 2009 had minimal scattered lesions.”

I suspected as such when my pain doc said he could ‘see’ I had migraines after reviewing my files and that old MRI. I knew you cannot see anything of the sort, other than damage due to stroke, therefore I very likely had some lesions showing at that time.

The research is as interesting as it is confounding. What is going on? Why is it going on? Is there any long term damage from the accumulation of these lesions? Are there any other structural changes going on with the brain we are unaware of? (such as with other forms of chronic pain some atrophy can be seen in certain areas). It puzzles me. Nevertheless is is damage for the migraines. And that is disturbing in itself.

This research in 2011:

 the dBrain white matter hyperintensities are more prevalent in migraine patients than in the general population, but the pathogenesis and the risk factors of these hyperintensities are not fully elucidated. The authors analyzed the routine clinical data of 186 migraine patients who were referred to the Outpatient Headache Department of the Department of Neurology, Medical School, University of Pécs, Hungary between 2007 and 2009: 58 patients with white matter hyperintensities and 128 patients without white matter hyperintensities on 3 T MRI. Significant associations between the presence of white matter hyperintensities and longer disease duration (14.4 vs. 19.9 years, p = 0.004), higher headache frequency (4.1 vs. 5.5 attacks/month, p = 0.017), hyperhomocysteinemia (incidence of hyperintensity is 9/9 = 100%, p = 0.009) and thyroid gland dysfunction (incidence of hyperintensity is 8/14 = 57.1%, p = 0.038) were found. These data support the theory that both the disease duration and the attack frequency have a key role in the formation of migraine-related brain white matter hyperintensities, but the effects of comorbid diseases may also contribute to the development of the hyperintensities.NCBI

At the bottom you can note that study determined disease duration and attack frequency were factors.

Continue reading “White Matter Lesions and migraines”

In-between photophobia

studies have shown migraineurs can have photosensitivity between migraine attacks.

This isn’t a new study but these particular studies have fascinated me so I thought I would write about them again on this blog so that people who have not heard about them have the chance.

We all know light sensitivity is a migraine symptom. But it turns out it can be, to a degree, a symptom between attacks in some migraineurs.

 inBackground Migraine attacks manifest with hypersensitivities to light, sound, touch and odor. Some people with migraine have photosensitivity between migraine attacks, suggesting persistent alterations in the integrity of brain regions that process light. Although functional neuroimaging studies have shown visual stimulus induced “hyperactivation” of visual cortex regions in migraineurs between attacks, whether photosensitivity is associated with alterations in brain structure is unknown.

Methods Levels of photosensitivity were evaluated using the Photosensitivity Assessment Questionnaire in 48 interictal migraineurs and 48 healthy controls. Vertex-by-vertex measurements of cortical thickness were assessed in 28 people with episodic migraine who had interictal photosensitivity (mean age = 35.0 years, SD = 12.1) and 20 episodic migraine patients without symptoms of interictal photosensitivity (mean age = 36.0 years, SD = 11.4) using a general linear model design.

Results Migraineurs have greater levels of interictal photosensitivity relative to healthy controls. Relative to migraineurs without interictal photosensitivity, migraineurs with interictal photosensitivity have thicker cortex in several brain areas including the right lingual, isthmus cingulate and pericalcarine regions, and the left precentral, postcentral and supramarginal regions.

Conclusion Episodic migraineurs with interictal photosensitivity have greater cortical thickness in the right parietal-occipital and left fronto-parietal regions, suggesting that persistent light sensitivity is associated with underlying structural alterations. Sage Journals

 

What is interesting to look at in that last part of the quote is the conclusion where it goes over the structural changes the person with interictal photosensitivity in the structure of the brain. More and more studies are looking at the brain structure and migraines and seeing a migraine brain and structural changes occurring. It is fascinating research.