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Migraines: We all Agree to Disagree With Certainty that There is Uncertainty

Cameron Braswell

What do Julius Caesar, Cervantes, Sigmund Freud, Ulysses S. Grant, Lewis Carroll, Vincent Van Gogh, and approximately 23 million Americans all have in common? (1)(3) What medical condition is so unknown yet frequently common simultaneously? Migraine headaches, of course, win the prize for answering the above questions, but there are so many people that lose every day to this condition. I, as one of those 23 million, who suffer infrequently from migraines, know how debilitating an attack can be and readily recognize the most common symptoms. Splitting pain on one or both sides of the brain, muscle tension, sensitivity to light and sound, nausea, and a general inability to move are all general characteristics of a migraine headache that vary in intensity and/or length for each migraine sufferer. The symptoms aforementioned, as well as mood changes, fatigue, diarrhea, and increased urination are typical of common migraine headaches, and can last from 4 to 72 hours. (2) Unfortunately, some people suffer from the classic form of migraine lasting 1-3 days and consisting of the other maladies, "speech difficulty, weakness of an arm or leg, tingling of the face or hands, and confusion," and vision problems known as "aura."(2) Either type of this paroxysmal disorder can strike as often as every day or as infrequent as 2 or 3 times in a lifetime, though for many people there are ways to predict the timing based on diet, lifestyle, or genetics. (4) The profile of someone who suffers migraines often includes an above average intelligence, and a hard-working, driven, "type A" personality. (11) (Which means many Mawrtyrs probably suffer such dreaded headaches.) A migraine sufferer is often one who works hard during the week, is under much stress, sleeps too late on the weekends, and does not have time for a proper diet. In addition, many scientists agree that "migraineurs" have an inherited abnormality in the regulation of blood vessels, in other words, an abnormally sensitive nervous system with faulty neurotransmitter connections at blood vessel sites. (6) This condition or the predisposition to migraines, in many cases is inherited, which is true in my particular case.

One common question is "How do I know I have a migraine and not some other type of cluster or tension headache?" If someone experiences most of the above symptoms at the same time or is a young female, under tremendous stress, or has poor posture, it is highly likely that the cause is migraine. (7) As stated above there are also dietary triggers, if consumed by those predisposed to migraines under above conditions, mild to severe migraine pain is sure to ensue. Some such dietary triggers from an in-exhaustive list include: chocolate, bananas and cheese (which activate mast cells responsible for changes in neuro-vascular systems) (8), eggs, wheat products, nuts, citrus fruits, tomatoes, red meat & shell fish, alcohol (especially red wine and spirits). (4) Each of these triggers do not effect everyone all the time but in conjunction with another trigger can result in a migraine that effectively shuts down normal activity. Other triggers associated with females include coincidence with hormonal imbalances and menstrual cycles, as well as taking birth control. (4) Rapid changes in blood sugar level, Candidiasis or other gastrointestinal disorders, increased intestinal permeability (leaky gut syndrome), magnesium deficiency or other vitamin, mineral, or protein deficiencies have also been proven to play a role in triggering migraines. (11)

Furthermore, there is some research specific to Americans that states we have a higher blood toxicity in general from "whipping our endocrine system" with coffee, other caffeine, or alcohol to produce a certain "feeling" or effect. This effect over-stimulates the adrenal gland and some of the "toxins" reach the blood stream. When carried to the brain this toxicity can trigger migraines. (9) This same observer, along with several other studies, maintains that aspertame found in artificial sweeteners and flavorings causes many of the migraines that otherwise healthy Americans suffer. (9)

This is all useful knowledge but it is knowledge that has been proven many times. There is no debate that the aforementioned is what a migraine is in the physical sense, and the causes. The two main controversies and the meat of the story come from within. There are many things about what happens in the brain when a person has a migraine that are unknown, but two main theories have risen from the ashes. The second controversy has to do with the many methods of treatment for one condition.

In one theory, undeniably the neuro-transmitting chemical serotonin is a key substance responsible in migraine pain onset. Interestingly enough, migraine, depression, and insomnia all have similar mechanisms and pathways, resulting from a loss of serotonin and norepinephrine. (11) In sufferers "there is a defect in a specific type of serotonin receptor that normally causes blood vessels to constrict." (10) All the triggers above do their damage by causing vessels supplying blood to the brain to expand (dilate). (10) Within the blood stream a trigger travels to the brain, typically at the base of the brain where the blood vessels in the neck start getting smaller as they enter the brain, and cause electrical activity and serotonin release as a response to the stimulus (trigger). (12) This causes the blood vessels that receive this trigger to constrict and then, later, expand when faulty receptors cannot retrieve the lost serotonin. (12) This expansion irritates the nerve endings connected to the blood vessels being triggered and this irritation causes the sensation of pain. (10) If there is not enough serotonin uptake going on in the system, as with faulty receptors, to control the enlarging vessels and keep them from over-expanding, the sense of great pain is transmitted from the area of the brain experiencing serotonin depletion. (11) Depending on where this takes place is where the headache is "located." Aura happens when the constriction/expansion takes place in the visual area of the brain. Hearing problems occur if the "headache" takes place in the auditory area, and so forth.

The second, more recent, theory comes from a small pilot study using a new imaging technology called SPECT that insists migraine pain comes from activity in the meninges. (13) Migraine sufferers do have faulty transmitters and leak important molecules but these leaks occur in the meninges at the exact site each patient complains of pain. Using SPECT images during the inflammation of a migraine headache the leakage of important molecules such as albumen in the meninges link this brain area with migraine pain. (13) Further study is needed to define the meninges' role or how serotonin might play into this theory.

The second controversy started about 3,000. BC with the type of treatment offered for this longstanding condition. (1) Though treatment has always been based on a trial and error principle, some of the more notorious historical treatments for migraines now seem quite absurd. These include drilling a hole in the skull to free "evil spirits" and relieve pressure, purges, bloodletting, applying a hot iron to the site of pain, inserting a clove of garlic through an incision in the temple, (1) or drinking "the juice of elderseed, cow's brain, and goat's dung dissolved in vinegar." (2)

Fortunately, modern treatments do not include such drastic measures, but there is just as much variety in effort to appeal to all types of relief seekers. The most common homeopathic remedies of migraine headaches entail: lie down to sleep in a dark room, massage the area where the pain is projected or the back of neck at the pressure points to release pain-reducing endorphins, (4) self-hypnosis, meditation/biofeedback, acupuncture, and chiropractic relief of muscle tensions causing the headache. (2) For those who suffer severe or regular migraine pain there are several drugs available to quiet sensitive nerve pathways, reduce the inflammation, (7) inhibit loss of serotonin, or prevent migraines altogether. Simple analgesics, ibuprofen, Excedrin and the like are good at relieving minor pain at the onset of an attack. Ergot derivatives, or Sumatriptan work in either preventative measures or for a stronger on-the-spot fix for migraine pain. (6) "Divalproex sodium is an important advance in the prophylactic treatment of migraine," says Stephen Silberstein, M.D. (3) One specific study touts the "curing" effects of 2500 mg. pantothenic acid and 2500 mg. Vitamin 'C' administered at the onset of migraine. (5) There are, however, a couple of treatments that mainstream science do not accept, but seem equally effective in irradicating migraine headaches, according to their own studies. Once such treatment has been proven in women who receive small doses of botulism toxin to rid their faces of wrinkles. According to a study conducted by a plastic surgeon these treatments also stave off migraines in these women for months after each treatment. (14) Another treatment that is fascinating just by the fact that it has been tested is use of cannabis, or marijuana.(15) Marijuana was most commonly used to be an effective symptomatic and prophylactic treatment of migraines by the most prominent physicians between 1874 and 1942, and had continuing usage until later twentieth century. (15) This treatment in particular is so controversial that even if studies prove it works it is socially unacceptable to use. Just as with any other substance, however, in moderation marijuana even has its good uses.

In conclusion, with all the knowledge about migraines that is available at this time there is much that has not been pinned down. The general agreement is that there is common uncertainty about how migraines work and effect the brain. There are no known permanent side effects of migraines to date but even that has an air of speculation. The best science has to offer is a set list of characteristics of migraines, an open-ended list of triggers, and a wide array of treatments. Migraine are still fascinating to scientists for these reasons however because there is still room for discovery of what exactly is happening in the brain that is defined as a "migraine", and new and better treatments. Like with many neural disorders and conditions, scientists agree to disagree (question) with certainty that there is always uncertainty in their answers.

WWW Sources

1)Historical Overview, Migraine awareness group with a historical overview of the treatment of migraines through the ages. 1999.

2)Migraine Headaches, Site from the National Institute of Neurological Disorders and Stroke with information on vascular headaches. 1999.

3)Depakote, Medical journal on new drugs for migraine headaches.1996.

4)Migraine, General information about migraine causes and treatments, encyclopedia format.

5)I Cured my Miagraine Headaches, personal article by James Lamb on how he cured his migraines.1996.

6)Migraine Headaches, Medical journal article about migraines in general. 2000.

7)Migraines, AMA health insight on migraines and nervous system causes. 1998.

8)Kids' imagination help migraine headaches, information about mast cell's role in migraines and the triggers. 1996.

9)Migraine, avant-garde article by "the juice guy" of the detrimental effects of aspertame and how to not have migraines.2000.

10)Secrets of Serotonin, chapter from a book about serotonin and its effects on the brain and migraines, by Carol Hart. 1996.

11)Understanding Migraine Headaches, Less technical paper for consumers on understanding migraines by Dr. John Allocca, 1999.

12)What Causes Headaches?, Source for exact mechanism of migraine from foundation for better healthcare.1997.

13)Migraine Pain Not Mainly in the Brain, Site for info on new theory about where migraine is located in the brain and new studies on the matter. Apr. 1999.

14)Headaches-Migraines, Wrinkle removing toxins make migraines vanish. 1999.

15)Cannabis for Migraine Treatment, By the Science of medical marijuana about the positive effects of marijuana on the brain by Ethan B. Russo, MD, 1998.




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