Migraines: More than just a headache

Migraines are a common and often debilitating form of headache. They affect 1.16 billion globally. ⁽¹⁾ They can severely disrupt daily life, and understanding the causes, triggers, and treatment options for migraines is essential for both prevention and management.

What are migraines?

Migraines are classified as primary headaches. This means they occur independently, rather than as a symptom of another condition. They typically involve intense, throbbing pain, often on one side of the head, and are frequently accompanied by nausea, vomiting, and heightened sensitivity to light and sound. The duration of a migraine attack can vary from hours to days, and the frequency of occurrence can also differ from person to person.

Physiological processes in migraines

Migraines are a complex and multifactorial neurological condition. While their exact cause remains unknown, various physiological processes contribute to the initiation and progression of a migraine.

Some of the primary processes involved in the onset of a migraine include:

Serotonin dysregulation

One of the key players in migraine pathophysiology is serotonin, a neurotransmitter that regulates mood, pain perception, and vascular tone. In individuals with migraines, serotonin dysregulation is commonly observed. Under normal circumstances, serotonin helps stabilise blood vessels and regulate pain signals in the brain. However, low serotonin levels in migraine sufferers lead to the release of other neurochemicals such as calcitonin gene-related peptide (CGRP), which induces inflammation and pain. ⁽²⁾ This imbalance can trigger vascular changes and hypersensitivity in the nervous system, paving the way for a migraine attack. Elevated serotonin levels can also promote platelet aggregation, further complicating the migraine process by increasing blood vessel constriction and contributing to the pain response. ⁽³⁾

Vasomotor instability

Another critical factor in migraine onset is vasomotor instability, or abnormal changes in the blood vessels of the brain. Migraines typically begin with vasoconstriction, where blood vessels constrict, reducing blood flow to certain areas of the brain. This is followed by vasodilation, where blood vessels rapidly expand, leading to increased intracranial pressure. These vascular changes are thought to be responsible for the headache pain and may also contribute to aura symptoms, such as visual disturbances or sensory changes, that some individuals experience before a migraine attack.The widening of blood vessels results in pressure and pain, which is characteristic of the throbbing nature of migraines. ⁽⁴⁾

Sensory hyperexcitability

Migraines are also linked to sensory hyperexcitability, a phenomenon in which the brain becomes overly sensitive to stimuli. In migraine sufferers, normal sensory input, such as bright lights, loud noises, or certain smells, can trigger a migraine attack. This central sensitisation is thought to involve the brain's sensory processing pathways, making them more reactive and less capable of filtering out non-threatening stimuli. ⁽⁵⁾

 

Hormonal changes

Hormonal fluctuations, especially in women, play a significant role in migraine frequency and intensity. Oestrogen, a hormone that fluctuates during the menstrual cycle, pregnancy, and menopause, is often implicated as a major migraine trigger. Many women report an increase in migraine attacks around menstruation, when oestrogen levels drop sharply. ⁽⁶⁾

This hormonal shift can lead to changes in serotonin and other neurotransmitters, contributing to migraine onset. Oestrogen also influences vascular tone, making blood vessels more susceptible to dilation and contraction, which can further exacerbate migraine symptoms. ⁽⁶⁾ As a result, women are more likely to experience migraines during times of significant hormonal change.

Food sensitivities and intolerances

Certain foods and beverages have long been associated with triggering migraines in susceptible individuals. Common dietary culprits include aged cheeses, fermented foods, processed meats, alcohol, and chocolate, all of which contain dietary amines like tyramine and histamine. These compounds can influence serotonin and other neurotransmitter systems, promoting migraines. ⁽⁷⁾ Additionally, food sensitivities or intolerances, such as gluten or dairy intolerance, can provoke migraines by activating immune pathways that increase inflammation and neuroexcitability in the brain. ⁽⁷⁾

Liver function

The liver plays a crucial role in detoxifying the body, including processing and excreting toxins, hormones, and other metabolic waste products. Compromised liver function, whether due to disease, diet, or alcohol consumption, can impair this detoxification process. When the liver fails to effectively break down and eliminate toxins and excess hormones, they can accumulate in the body, potentially triggering migraine attacks. ⁽⁸⁾ For instance, an impaired liver may struggle to process oestrogen properly, leading to hormonal imbalances that can precipitate migraines. Furthermore, the accumulation of metabolic waste products can contribute to neuroinflammation and exacerbate migraine symptoms. ⁽⁸⁾

Heavy metal exposure and mould

Environmental factors such as heavy metal exposure (lead and mercury) and mould can also increase the risk of migraines in individuals prone to sensitivities. These toxins can interfere with the normal functioning of neurotransmitters and other cellular processes involved in migraine development. For example, heavy metals may disrupt brain chemistry, impair vascular function, and increase neuroinflammation. ⁽⁹⁾ Similarly, mould exposure can lead to the release of mycotoxins, which can affect the immune system and increase susceptibility to migraines. ⁽¹⁰⁾

Platelet aggregation

Migraines have been linked to platelet dysfunction, particularly in individuals with increased platelet aggregation (clumping) and adhesion. Platelets play an important role in blood clotting, but in the case of migraines, they can contribute to vascular changes by promoting blood vessel constriction. Elevated levels of serotonin are thought to exacerbate this process, leading to increased platelet aggregation and contributing to the vascular changes seen during a migraine attack. This interaction between serotonin and platelet function may also play a role in the initiation and persistence of migraine pain. ⁽¹¹⁾

Histamine

Histamine, a key mediator in immune responses, also plays a significant role in the development of migraines. It is involved in regulating blood vessel dilation and neurotransmitter release, both of which are critical in migraine mechanisms. Studies have shown that histamine intolerance, where the body fails to adequately break down histamine, may contribute to the frequency of migraines in individuals prone to sensitivities. ⁽¹²⁾ Histamine intolerance decreases diamine oxidase activity, an enzyme required for the breakdown of histamine, leading to an accumulation of histamine in the body. Elevated histamine levels can lead to vasodilation, which increases intracranial pressure and intensifies the pain associated with migraines. Histamine contributes to neuroinflammation and increases sensory sensitivity in the brain, making individuals more susceptible to triggers such as light, sound, or touch, which can exacerbate migraine pain. ⁽¹³⁾ Managing histamine levels through dietary adjustments or supplementation may provide a potential strategy to reduce the frequency and intensity of migraines in susceptible individuals.

GIT integrity

Emerging evidence has highlighted a significant connection between gastrointestinal (GI) disorders and migraines, suggesting that individuals with migraines are more likely to experience GI dysfunction. This link is particularly evident in conditions such as irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and gut dysbiosis in migraine sufferers. ⁽¹⁴⁾ One potential mechanism behind this connection is gut hypermobility, a phenomenon where the movement of the intestines becomes irregular or excessive, which can contribute to both GI symptoms and migraine attacks. Additionally, the gut-brain axis (the bidirectional communication pathway between the gut and the brain) plays a pivotal role in this relationship. Disruptions in this communication pathway, due to factors like altered gut microbiota, may trigger neuroinflammation and increased sensory sensitivity, both of which are implicated in migraine pathophysiology. ⁽¹⁴⁾

What triggers a migraine?

While triggers can vary from person to person, the common migraine triggers include:

• Stress or emotional strain
• Sleep disturbances or lack of sleep
• Certain foods (eg chocolate, caffeine, aged cheese)
• Bright lights or flickering lights
• Strong smells (eg perfumes, chemicals)
• Weather changes or barometric pressure changes
• Hormonal fluctuations, especially in women (eg menstrual cycle).

Identifying personal triggers can help reduce the frequency and severity of migraine attacks. ⁽¹⁾

 

Herbal remedies for migraines

While pharmaceutical treatments like triptans are commonly prescribed to alleviate migraine symptoms, many individuals turn to herbal remedies. Research suggests that certain herbs may offer natural relief by targeting various mechanisms involved in migraine pathophysiology, including inflammation, muscle tension, and neurovascular dysfunction. Herbs for migraine relief:

• Feverfew (Tanacetum parthenium): Feverfew is one of the most studied herbs for of migraine relief. Numerous studies have shown that feverfew can help reduce the frequency and intensity of migraines. Its main active parthenolide inhibits aldose reductase activity and relaxes vascular smooth muscle. ⁽¹⁵⁾ The active compounds in feverfew are believed to work by reducing inflammation and inhibiting the release of substances such as prostaglandins and serotonin, which play a key role in migraine pain. ⁽¹⁶⁾
• Peppermint (Mentha piperita): Peppermint oil has long been used for headache relief, particularly in the form of topical application. When applied to the temples and forehead, peppermint oil has been shown to reduce migraine severity and alleviate tension headaches. The cooling effect of peppermint is thought to have analgesic properties, while its menthol content can also improve blood circulation and relieve muscle tightness, which often accompanies migraine attacks. ⁽¹⁷⁾
• Jamaican Dogwood (Piscidia erythrina): Known for its calming and analgesic effects, Jamaican dogwood has been used traditionally to treat muscle spasms and nerve pain, making it potentially beneficial for individuals suffering from tension headaches and migraines. Its active compounds are thought to act as a natural muscle relaxant and sedative, providing both headache relief and a sense of calm. ⁽¹⁸⁾
• Lavender (Lavandula angustifolia): Lavender oil is herb that has been found to help with migraine relief. Studies suggest that the inhalation of lavender essential oil can significantly reduce the severity and duration of a migraine attack. Lavender’s calming and anti-inflammatory properties may help alleviate the stress and tension that often trigger migraines, while its scent is thought to provide a soothing effect that can reduce the perception of pain. ⁽¹⁹⁾
• Ginkgo (Ginkgo biloba): Ginkgo biloba is widely known for its cognitive-enhancing properties, but it may also play a role in migraine relief. Research has shown that ginkgo improves cerebral circulation, which may help alleviate some of the vascular changes associated with migraines. Additionally, ginkgo's antioxidant properties help reduce oxidative stress, a factor believed to contribute to the development and worsening of migraine symptoms. ⁽²⁰⁾

Always consult with a healthcare provider before incorporating herbal remedies into your migraine management plan, especially if you're already taking prescription medications.

 

When to seek professional help

While many migraines can be managed at home, there are situations when you should see a health professional including:

• Your migraines change in intensity or frequency, especially if they become more severe or occur for the first time after age 50.
• You experience neurological symptoms (eg vision changes, weakness, or difficulty speaking) that could indicate a more serious underlying condition.
• Your migraines are not responding to over-the-counter medications or other treatments.

 

Conclusion

Migraines are complex, multifactorial conditions and a lot is unknown. Understanding what causes migraines and identifying personal triggers can go a long way in reducing their frequency and severity. By adopting a comprehensive approach that includes lifestyle adjustments, trigger identification, and herbal treatments, migraine sufferers can take control of their condition and reduce the impact of migraines on their quality of life.

 

 

 

 

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