Saturday, August 24, 2013

The Migraine Brain

I've been reading a book called The Migraine Brain by Carolyn Bernstein, MD, and Elaine McArdle.

Whoa. Hang on to your hats and glasses, folks.

This book is amazing.

Before I continue, I will say that this book came out in 2008 and I am realizing how far behind I am in my own migraine knowledge and research. There is so much here that could have been helping me for a few years, now, and I am just now finding out about it.


Because I gave up looking a long time ago. I mean, granted, I spent part of 2008 pregnant with twins and the time since then rather occupied, but still. There was information to be had and I didn't have it.

To be honest, I trusted my doctors to have it, or at least to point me toward it. Going to see a doctor was, I felt, holding up my end of the bargain. The things I heard from them never indicated that further research might be fruitful.

But the more I think about it, the more angry I get, because the response I've had from doctors over the years has actually not only been inadequate, it's been largely condescending and dismissive. 

Yellow Wallpaper Syndrome, anyone?  

But I let myself be dismissed, because, as I've said before, because I've felt a lot of really unhelpful things about having these migraines in the first place: guilt, embarrassment, shame. 

So I've taken my inadequate prescriptions and endured the patronizing comments and gone home.

I did go to a headache clinic at the Kaiser hospital near me for a short while in 2006 and 2007, and this was where I was given my first triptan medication (triptans are the most effective treatment for migraine, and something no doctor had thought to prescribe for me during the previous TEN YEARS of chronic migraine). 

So I has what I thought was cutting-edge medication (and maybe it was, then), and I was trying several alternative treatments (rolfing, ozone colonics, spinal network analysis), and I thought I was doing all there was to do.


As it turns out, according to The Migraine Brain, I haven't even understood the nature of what was happening to me.

According to The Migraine Brain, "migraines" are not headaches, but one of many possible symptoms of migraine, a chronic, genetic neurological illness caused by an abnormality in your brain chemistry-- and one of the least-understood and most mis-diagnosed illnesses in medical history.

I'm only a few chapters into this book, and I've already learned that many of the strange symptoms I've always thought were somehow related to my migraines WERE, in fact related, and happen to others besides me. 

I've also learned that children with migraines are often mis-diagnosed with food allergies (yep: dairy and citrus-- two very common migraine triggers), blood sugar regulation problems (yep: hypoglycemia-- another very common migraine trigger), and/or dismissed as hypochondriacs (YEP: I was notoriously "sickly" and was often doubted by parents, doctors, and teachers alike).

In fact, I think that last thing is the source of my shame over this condition now. I don't advocate well for myself with doctors when it comes to my migraines, and in fact I rarely bring them up at all. I fear being seen and treated as a hysteric or a drug-seeker; like I'm making the whole thing up or being deliberately "high maintenance." 

The fact that this is probably what would happen a lot of the time is just a bonus. Ha ha.

Anyway, the book is incredibly enlightening and I'm reading it just in time for my appointment with the Northern California Headache Clinic on Monday. I think this is going to be a major, major, life-changing step for me.

No pressure. 

So... check this out.

As I was reading Dr. Bernstein's description of "the Migraine Brain," I noticed something very, very familiar.

Here, I'll quote her and you can see for yourself. Emphasis mine:
"[The Migraine Brain] is as high-maintenance as they come. Like a thoroughbred or diva, it's hypersensitive, demanding, and overly excitable. It usually insists that everything in its environment remain stable and even-keeled. It can respond angrily to anything it isn't accustomed to or doesn't like....
"A Migraine Brain is always on alert, ready to overreact to any stimulus is find displeasing... The irritants that trigger a migraine vary from one person to the next and can be almost anything, from aged cheese to fluctuating hormones to low blood sugar. These triggers don't merely upset your brain, they can cause it to careen out of control with a biochemical chain reaction that may result in anything from severe head pain to vomiting to dizziness, or, in rare cases, paralysis."

Sound like anyone you know?

Yep, the Migraine Brain is described in a shockingly similar way to the Traumatized Brain as I have discussed it in this very blog:

  • Hypervigilant
  • Intolerant of instability or extremes
  • Easily triggered and unable to regulate its response
In case you didn't click through the links above to see my old posts about trauma theory and the biochemical reaction of a traumatized brain to stimulus, here they are:

The red line indicates the normal charge and discharge of the sympathetic and parasympathetic nervous system. The horizontal lines are the boundaries of normal emotional experience. The jagged line shows the erratic charge/discharge of the traumatized brain, and how it can careen past normal boundaries and into crisis territory.

As PTSR progresses, the sufferer narrows his/her emotional boundaries in response to being triggered, only to make being triggered that much easier.

Years on, PTSR means that even normal emotional charge and discharge falls outside of one's limits of tolerance, let alone the wild ride of the trauma response.
(All images recreated from 
Crash Course: A Self-Healing Guide To Auto Accident Trauma & Recovery by Diane Poole Heller, Ph. D.)

So you can see why that description of the Migraine Brain struck me, right? It sounds suspiciously like my PTSR brain.


I looked through the book to see if there was a mention of a link between PTSD/PTSR and migraines, and look... just look what I found (again, emphasis mine):

A new study of Iraq veterans has documented the migraine-mental health connection more strongly than ever, as well as raising other questions about the genesis of migraines. Soldiers returning from combat in Iraq have more than twice the prevalence of migraines as the general population, and the soldiers with migraine have double the risk for certain mental health issues including depression, PTSD, and anxiety. This report, the first to document a migraine-PTSD connection, is important as we work to understand more about migraine and how to treat it.
Conducted by military doctors at the Madigan Army Medical Center in Tacoma, Washington, and presented at the 2007 annual meeting of the American Academy of Neurology, the study gathered information about headache symptoms and mental health from more than 2100 American soldiers who served in combat in Iraq. The group was 96% male, with an average age of 27.
 Among the findings:
  • At least 19% of Iraq combat veterans suffer from migraines. Only 5% of the soldiers had previously been diagnosed with migraine.
  • 50% of the soldiers with migraine also suffered from clinic depression, compared to 27% of soldiers without migraines.
  • 39% of soldiers with migraines are also suffering from PTSD, compared to 18% of soldiers without migraines.
  • 22% of soldiers with migraines have anxiety disorders, compared to 10% without migraines. 
  •  The migraines continued and often got worse after the soldiers returned to the United States.
  • Only a tiny fraction of soldiers with migraine were using triptans, the most effective migraine treatment.
  • Soldiers with migraine and depression or PTSD-- but not anxiety disorders-- had more frequent migraines. But the pain and duration of their migraines was not different from migraineur soldiers without these disorders.
 Why are these soldiers suffering migraines at a higher rate than the civilian population? The researchers offer various theories including exposure to chemicals, extreme heat, dehydration, lack of sleep, and irregular means, all well-established migraine triggers. The suggest that migraines may lead to psychiatric disorders, and mental disorders may lead to migraine. This is called a bi-directional influence, a theory supported by prior studies of migraine and depression. 
So. I'm no doctor, but man, the connection seems clear to me.

Remember when I told you about the research I found that suggested that PTSR might be a shame disorder? If shame-prone people are more susceptible to a trauma response, the implication is that in those people, there is a pre-established framework that allows PTSR to take root-- a tendency to withdraw, dissociate, self-blame, to name a few examples.

It makes sense to me that someone susceptible and vulnerable to this kind of biochemical imbalance would be more likely to be susceptible to other kinds of biochemical imbalance-- like the one that causes migraine. Or maybe it's the same biochemical imbalance? 

Either way, it strikes me that following this logic means that it isn't that traumatic experiences cause PTSR or migraines, but that some people are predisposed to these responses, and under the right conditions, will be more likely than the average person to have them.

Iraq (or any war zone) being, of course, an extreme example of "the right conditions."

It's difficult to pull the threads apart, here-- these things seem so deeply linked in my own experience that I can't imagine there isn't a profound connection between them. I knew that if I found a mention of PTSD in this book that it would suggest a link between trauma and migraines, and it did.

I want to volunteer to be part of a study, or assist in writing a paper, or write a goddamn book about it myself if no one else wants to, because this feels like a vital clue to figuring out how to treat both conditions, to me.

Am I imagining things? Do you see the link I'm seeing?

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