Headaches and Migraines

We all suffer from headaches at some or other stage in our lives. Only 4% of the world population claims to never have had a headache. The International Classification of Headache Disorder Committee discovered that there are 14 different categories of headaches, separated into 3 categories:

Primary headaches, such as migraines; tension headaches and cluster headaches (Trigeminal autonomic cephalalgias or TACs). These headaches have no direct of identifiable cause and remains a mystery.

Secondary headaches, such as headaches due to trauma or injury to the head and/or neck; headaches due to cranial or cervical vascular disorder (potentially a serious underlying disorder such as inflammation of blood vessels); headaches due to non-vascular intracranial disorder (simply put, headaches caused by high or low cerebrospinal fluid pressure); headaches caused by a substance or substance withdrawal; headaches attributed to infection; headaches caused by a disorder of homeostasis (heart failure of diabetes); headaches due to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth etc.; and headaches attributed to psychiatric disorders. The abovementioned headaches all have a cause, either infection or tumours.

Other headaches, eg. due to lesions of the cranial nerves and other facial pain and all other headache disorders.

However we look at it, headaches are not fun. Like cluster headaches (or TACs) and migraines, they can be debilitating. Let’s start with TACs, as very few people have ever had cluster headaches. They are considered the worst pain a human can experience and are rare. The main symptom is severe, excruciating pain on one side of the head, often felt around the eye. This pain can last anything from 15 to 180 minutes, sometimes even longer. Unlike migraines, TACs are not triggered by food, hormonal changes or stress, but is thought to be caused by abnormalities in the body’s biological clock (the hypothalamus, which regulates hormones that control blood pressure, body temperature, growth, to name a few). To date, the exact cause of TACs is unknown. Treatments range from injections to nasal sprays, which must be used as soon as the headache starts. TACs are more prevalent among men and usually start around ages 30 – 40. Bouts of frequent attacks (cluster periods) can last weeks, even months, and are followed by remission periods when the headaches stop completely, sometimes for months or years.

Common signs and symptoms of TACs are:

• Excruciating pain in or behind one eye, which may radiate to other areas of your face, head and neck
• One-sided pain
• Restlessness
• Excessive tearing
• Redness of the eye on the affected side
• Stuffy or runny nose on the affected side
• Sweating on the affected side
• Pale skin or flushing of the face
• Swelling around the affected eye
• Drooping eyelid on the affected side

During cluster periods, TACs usually occur every day, sometimes even several times a day. A single attack can last from 15 minutes to 3 hours, often happening at the same time every day. These attacks occur mostly during the night, between 1 and 2 hours after going to bed. The pain usually ends as suddenly as it begins, leaving the sufferer pain-free but exhausted.

The second, most debilitating headaches are migraines. Migraines are among the most puzzling and mysterious ailments, are wholly individual and there are no exact cause for them. Some theories are that migraines may be the result of abnormal brain activity which temporarily alters nerve signals, chemicals and blood vessels in the brain; or it may be because of the accumulation of several stressors over time. These stressors ultimately affect the serotonin metabolism. Serotonin is a neurotransmitter, and can be consider a hormone. The body uses it to send messages between nerve cells. It appears to play a role in mood, emotions, appetite, and digestion. As the precursor for melatonin, it helps regulate sleep-wake cycles and the body clock. (In order to explain serotonin metabolism, I will have to write a whole new blog. I will just mention that serotonin is chiefly metabolized in the liver). These stressors basically release inflammatory substances into the nerves and blood vessels of your head, causing a migraine.

Migraines are characterised as a throbbing pain, typically felt on just one side of the head. There are 4 typical phases or stages of a migraine, though not everyone suffers the same stages. These are:

• Prodrome: This is the first stage, and can last from a few hours to a few days. The sufferer can experience a change of mood, have low energy or low appetite several hours before the attack. Some people can feel wonderful before an attack, while others can feel suicidal. Not everyone experience it the same way, and some may not have the prodrome or preheadache phase.
• Aura: This phase relates to visual problems, for example flashing lights, blind spots or blurred vision. This phase can last anything from 5 minutes to an hour. Most people don’t experience an aura, but some have both the aura and the headache simultaneously.
• Headache: This phase can last from 4 hours to 72 hours. The throbbing, drilling pain in your head typically starts on one side, and spreads to the other side. Typical symptoms that accompanies the pain are feeling nauseous, vomiting, sensitivity to light and sounds, poor concentration, hot and cold flushes, stomach ache and diarrhoea.
• Postdrome: Often called a migrain “hangover”, this stage can go on for a day or two. The headache and symptoms go away, but you feel exhausted for a few days after the migraine.

There are a number of triggers that can set of a migraine. These differ from individual to individual, and migraines affect more women than men. Common triggers are:

Emotional stress – when you are stressed, certain chemicals are released in your brain to combat the stress situation (flight or flight response). This release can bring on a migraine. Anxiety, worry or excitement can increase muscle tension and dilate blood vessels, worsening the migraine.

Sensitivity to specific chemicals and preservatives in food – histamine-releasing food such as alcohol, fermented foods and dairy products, caffeine, chocolates (sorry, ladies!) and food additives like nitrates (found in pepperoni, hot dogs and lunch meats); as well as certain smells like perfume, smoke or cleaning products.

Daily use of pain-relieving medicine – regular use of pain medications can cause rebound headaches.

Hormonal changes in women – women tend to get migraines around the time of their menstrual periods. This is because the drop in estrogen that triggers menses can trigger migraines, as can the hormonal changes brought on by birth control pills and HRT (hormone replacement therapy). Migraines are usually worse between puberty and menopause, as estrogen fluctuations do not occur in prepubescent girls and post-menopausal women. Obviously, hormonal changes do not trigger migraines in men …

Other triggers – flashing lights, fluorescent lights, changing weather conditions (storm fronts, barometric pressure changes, changes in altitude), overexertion, dieting, dehydration, loud noises, and changes in sleeping patterns.

There are several types of migraines (some are duplicated and/or have similar symptoms):

• Migraine with an aura (also called the complicated migraine): appriximately 15% to 20% of sufferers experience an aura
• Common migraine (without an aura): as it suggests, the aura is absent but all other symptoms are the same
• Migraine without head pain (also known as silent migraine or acephalgic migraine): this includes the aura and other symptoms but the typical headache is absent
• Hemiplegic migraine: Hemiplegia means temporary paralysis or lack of control and neurological changes in one side of the body. You may experience temporary numbness, extreme weakness on one side of the body, a tingling sensation, a loss or sensation and dizziness or vision changes at the start of the headache, sometimes with a head ache and sometimes without.
• Retinal or ocular migraine: This means temporary, partial or complete loss of vision in one of the eyes, along with a dull ache behind the eye that may spread to the rest of the head. The loss of vision may last anything from one minute to as long as a month. It is extremely important to report retinal migraines to your healthcare provider, as it may be the sign of more serious issues.
• Chronic migraine: This is a migraine that occurs at least 15 per month, with changing symptoms and severity. Chronic migraine sufferers probably use headache medication more than 10 days a month, which can lead to headaches happening more frequently.
• Migraine with brainstem aura: Here, you will have vertigo, slurred speech, double vision or loss of balance, which occur during the prodrome stage. The actual pain affects the back of your head. The symptoms occur suddenly and can be associated with the inability to speak properly, ringing in the ears (tinitus) and vomiting.
• Status migrainosus: This type of migraine is rare and severe and can last longer than 72 hours. The headache pain and nausea are extremely bad. This migraine can be caused by certain medications or medication withdrawal.

Before I continue, I need to explain why your brain can feel no pain. The brain has no nociceptors (free (bare) nerve endings found in the skin muscle, joints, bone and viscera that detect signals from damaged tissue or the threat of damage), and thus cannot feel pain. Why, then, do our heads ache? Many of the other structures in or head have nociceptors, like blood vessels, muscles, and nerves in the scalp, face and neck. Have you ever experienced brain freeze? This is caused by sudden changes in blood flow in the veins between the throat and brain. The pain you experience during a migraine is thought to be due to the activation of nociceptors in the meninges (the “wrapping” that encases the brain and spinal cord).

(Neurosurgeons often wake a patient from anesthesia whilst operating on their brain to prevent damaging speech, language ability, sight etc. without the danger of the patient feeling any pain. For those who have watched the movie Hannibal , remember where Hannibal Lecter cuts out part of the (fully awake) FBI agent’s brain and serves it to his guests? The agent felt no pain!)

Can we prevent migraines?

Now that we know a bit more about TACs and migraines, here are a number of things you can do to recognise the beginning of these headaches For instance, keeping a migraine(or TAC) diary can assist you and your healthcare provider with the diagnosis process, as you will eventually recognise the prodrome of the headache; the duration of the headache; events that lead up to the headache and the frequency or the headache. This type of diary will be invaluable to you and your healthcare provider. Then diary will help you recognise the triggers that lead to the migraine, for example what you eat and drink, your exercise routine and schedule, the weather, feelings and emotions, medications you take and their side effects, and the times and severity of the headaches.

You can also consider taking a DNA test through a reputable laboratory (eg. Nordic Laboratories), which will help you ascertain whether you have any mineral deficiencies (magnesium deficiency can contribute to the onset of migraines) or whether there are some other issues you are not aware of, that may trigger the migraines.

Herbal medicines and natural supplements can be a great help. For instance, ginger has been used to treat headaches for centuries, and a group of Danish physicians experimented on a migraine sufferer, telling her to mix a quarter of a spoon of powdered ginger in some water and drink it as soon as she feels a headache coming on. Within thirty minutes, the migraine disappeared. The patient followed this advise every time she felt a migraine coming on, with the same results every time. However, one swallow does not a summer make, and in order to make the results official, the physicians did a double-sided, randomised and controlled clinical trial, whereby the compared the efficacy of the ginger for treating migraines to Imitrex, one of the best selling drugs for migraines in the world. The result was amazing – just one-eight of a teaspoon of powdered ginger worked just as well and just as fast as the drug. And the best news? Ginger is cheaper and healthier than the drug, has no side effects, apart from an upset stomach where too much ginger was used! Taking powdered ginger 3 times a day reduced pain from an eight to a six on a scale of one to ten, and down to a three in the second month of taking it regularly.

Herbal medicine can also help in the treatment of the gut. As we all know by know, the gut\brain connection is extremely strong. A healthy gut means a healthy body, means a healthy brain. Ginger helps with digestion by moving food through the intestines to prevent it sitting and fermenting in the gut, causing bloating and pain. Gastro-intestinal disturbance is a very common cause of headaches. When you think about the complexities of the brain, you never think of the gut having exactly the same complexities. The network of nerves in the gut is called the ‘gut-brain’ because it is just as large and chemically complex as our cerebral cortex (or grey matter) in our heads. The vagus nerve, which connects the brain and the gut, is the fastest and most important route between gut and brain and transfers messages to the brain about the functioning of the rest of the body. This enables the brain to form a picture of the health of all bodily functions. Thus, if the gut is unhealthy or inflamed, the brain will not be able to get the correct messages and can result in all types of illnesses, including headaches. Our intestines are responsible for the absorption of nutrients from the food we digest. When the system is put under stress, the permeability of our intestines becomes altered, allowing molecules and toxins to enter the bloodstream and stimulate an immune response. With around 70% of our immune cells located in the gut, their response can cause body-wide inflammation and release signalling chemicals which can stimulate key cranial and facial nerves, and trigger migraine attacks. It is imperative to keep the gut bacteria healthy. The human gut contains trillions of healthy bacteria (microbiota), found naturally within the body, which are essential for our wellbeing. The species of bacteria can vary from person to person, resulting in a unique range of gut bacteria – known as the gut microbiota profile.

Probiotics, often known as Live Bacteria, are gut-friendly bacteria which we can introduce into our bodies through our diet. They can help maintain a healthy gut by increasing the variation in bacterial species as well as replacing any nutritional molecules lost with ‘leaky gut’. These can be found naturally in foods such as yoghurt and kefir, or in supplements such as Activated Probiotics, which contains 4 billion live bacteria, all essential for a healthy gut.

According to the National Migraine Center, recent research has shown that use of live bacteria to supplement the gut can help migraine sufferers. In a 2019 study published in Cephalalgia (3), one of the world’s leading headache journals, it showed that both frequency and intensity of migraines were reduced by up to 40% for patients with episodic migraine who received a live bacteria supplement.

By taking a good probiotic daily, eating the right food (especially foods rich in magnesium and potassium such as dark leafy greens, avocado, tuna and fish rich in omega-3 fatty acids, seeds, bananas and legumes), keeping the body hydrated (eating watermelon is a delicious way to ward off dehydration!) turning to natural herbal medication instead of prescription medicines we can reduce the intensity and frequency of our migraines. Drinking herbal teas like peppermint tea, ginger tea and camomile tea benefits the whole body, especially the brain-gut axis. But if nothing helps and you keep a headache diary, please talk to your doctor or nutritionist. They can advise you on the correct path and supplements. The body is a fine tuned instrument and irregularities like headaches are the body’s way of letting us know something is amiss. Listen to your body, and obey it!

Sources:

Gut – Julia Enders; How Not To Die – Michael Greger, MD; Bill Bryson – The Body: A Guide for Occupants; National Migraine Centre – Migraines and the Gut; IHS Classification ICHD-3 – International Classification of Headache Disorders Committee; Life Lessons from a Brain Surgeon – Dr. Rahul Jandial; 12 Foods to Help Get Rid of a Headache or Migraine Attack Naturally – Everyday Health