Weight and migraines

kinny-overweight-just right

Remember the days when your neurologist would tell you to lose weight due to your migraines… after years of preventative treatments that caused the weight gain in the first place? Good times. Because obesity was a risk factor for migraine and migraine chronicfication.

Well, now underweight is added to the list.

So what you are looking for is the Goldilocks zone.

“As obesity and being underweight are potentially modifiable risk factors for Migraine, awareness of these risk factors is vital for both people with Migraine and doctors,” said study author B. Lee Peterlin, DO, of Johns Hopkins University School of Medicine and a member of the American Academy of Neurology. “More research is needed to determine whether efforts to help people lose or gain weight could lower their risk for Migraine.Migraine Again

And here is the clincher… they have no clue if us losing or gaining weight could help with migraines we ALREADY have.

Before you diss the research it was a significant meta-analysis of 12 studies involving 288,981 participants.  Obese individuals were 27% more likely to have migraines than people of average weight. This would be a BMI 30 or higher. People in the underweight area 13% more likely to have migraine. BMI less than 18.5.

“Given that obesity is associated with a variety of pain disorders and with depression, the finding is not surprising but it is important,” he said, adding that it makes sense “because obesity induces inflammation and inflammation contributes to pain.”

What he found surprising, however, was that “the underweight are at risk for migraine and the mechanisms here are less clear.” Medscape

Study limitations are that in some of the studies BMI was self-reported and people tend to lower their BMI.

So it is a matter of keeping the BMI over 18.5 and below 30. Forever. Yeah. With medications that cause a boatload of weight gain. Or people like me with hypothyroidism on top of things, that is always fun. Not to even mention other comorbids.

I know weight has never been a factor for me. But my BMI has always been within 22-29. Currently at 23. It went high when I gained a lot from meds. I was going strong for a bit there. Lyrica I suspect, which long term can cause pretty continuous weight gain. Then I lost 20 pounds on topamax. And then a couple years later lost another 25 due to persistent nausea and lack of appetite.  I was a little underweight when I was 18, but migraines didn’t hit until I was twenty and by then I was right where I should have been weight wise. And I still got migraines and went chronic. So it is a risk factor, but it is one of many. Doctors focus on it a lot, but we have the migraines already do we not? This is a risk factor for Getting migraines.

Although as I said, obesity is also a risk factor for chronification but not sure about the research behind that one since the research for chronification and chronic migraines never seems to be substantial. Others for chronication are life stress, depression, medication overuse, improper use of acute medication, chronic sleep deprivation and having had a trauma in life. I think depression was my risk factor although they did tell me my migraines went chronic due to central sensitization.  Depression did seem to jump in once I was chronic… due to the pain and all.

 

 

Migraine and dopamine levels

12.01.19 _ 8AM.png

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

migraine

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

migraine

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.

 

 

Brain stimulation for migraine

blogs-and-resources-2

There has been an area of research that has interested me a long time for FM and for migraines. Brain stimulation or transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). I was fascinated that we can stimulate certain areas and get a response, but… permanent, no, still as a treatment, maybe.

Well for migraines, this study suggests not. It is a meta-analysis of eight studies, so looking at those studies and reviewing the results. And finding no significant difference between active and sham treatment in controlling migraine pain  (standardized mean difference 20.61, P=0.11), reducing migraine frequency (SMD 20.44, P=0.22), or decreasing the need for pain medication (SMD 20.57, P=0.08) reported online in Headache.

However, they did a sub-analysis of just tDCS and said it could be promising for a non-pharmacological alternative to pain control. “In migraineurs, tDCS was moderately to highly effective in reducing pain intensity (SMD 20.91, P=0.04), decreasing attack frequency (SMD 20.75; P=0.004), and reducing the need for pain medication (SMD 20.64, P=0.03), the researchers said.” Medpage Today

The studies for brain stimulation for migraine pain control often have small sample sizes, definitely, and and high or unlcear risk of bias suggested by Monte-Silva in an interview.Medpage Today “I believe that larger double-blind, multi-site clinical trials with methodological rigor can increase the power of results and demonstrate that NIBS is a promising non-pharmacological treatment for migraine,” she told MedPage Today.

NIBS should also be considered as an adjunct therapy to improve or accelerate the efficacy of medication or other non-pharmacologic treatments, she said.

“Understanding the individual intrinsic factors that cause large variability in NIBS response may help to better define the NIBS protocols and increase its effectiveness in controlling migraine pain,” she added.

While the analysis demonstrated that NIBS for control of migraine pain is safe and well-tolerated, more research is also needed to better understand adverse effects associated with NIBS, the researchers said.

Adverse affects over time is something that needs to be looked at in all areas of this research, because they simply do not know.

People do say it is painless, non-invasive, easy and non-invasive.

Anyway the meta-analysis on non-invasive brain stimulation only demonstrated any use to Transcranial Direct Current Simulations.

 

 

Migraines and mouth bacteria?

people, emotions, stress and health care concept - unhappy afric

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.