Solving the Mystery of the Migraine

Taken from the July/August 2015 issue of the Women's Health Activist Newsletter.

These approaches often fail because they do not address migraine’s root causes. Like other pain, migraine is best thought of as a warning signal — an alarm bell. Potential triggers, of which there are many, range from the biochemical to neuromuscular and vascular problems, often arising from structural distortions and other stressors.

“Chemical imbalances” behind migraine can be as simple as poor quality food, water, air, light and sleep. Women’s migraines may be due, in part, to hormonal fluctuations of the menstrual cycle, to endocrine disruptors in personal care products,2 and to vitamin and mineral deficiencies that impact their nerves and muscles.

Muscular triggers of migraines have long been dismissed, although poor posture alone can strain muscles and impinge on neurovascular supply. Traditionally, pain starting at the back of the head or neck was diagnosed as “tension” (even if it converted to a full-blown vascular migraine). But, consider the 1995 discovery that tight neck muscles can pull directly on the lining (dura) of the brain and upper spinal cord.3  This 20-year-old link between muscles and migraine is thoroughly documented,4 but has yet to appear in standard medical textbooks or popular articles on migraine.5

The old notion that the brain does not feel pain is partly true: neurons do not feel pain, but blood vessels, connective tissue (fascia) and the dura do.

The pain-sensitive dura is supplied by the trigeminal nerve that controls constriction and vasodilation of the brain’s blood vessels — the hallmark of true migraine. This nerve is also the link between migraines that hurt right down to your teeth or are triggered by Temporomandibular Joint Dysfunction (TMJ). It also underlies the 1998 discovery that Botox injections relieve lifelong migraines.6 The target is the corrugator supercili, a muscle that, in frowning, can irritate a branch of the trigeminal nerve. In the medical literature, this nerve has been linked to migraine for over 40 years. In what you've read, have you ever heard of it?

Women suffer from migraines at a rate three times that of men; in addition to the horrific pain and disability, they also die from suicide and strokes from migraines that are improperly diagnosed, but profitably treated by the drug industry. While we wait for standard medical practice to catch up with migraine research, see the box for ways you can identify the causes and possible treatments for your migraines.

Self-Help for Migraine

Here are approaches that address migraines’ actual causes and can help break the cycle of pain and dysfunction.

  1. Eliminate the obvious. Make sure you get good food, water, air, and sleep. Avoid known trigger foods,7 MSG, artificial sweeteners, and physical and emotional stressors. Maintain a regular schedule and good posture. Breathe, and don’t frown!
  2. Rule out infections and disease. Migraine can be symptomatic of everything from gluten sensitivity, to viral and bacterial infections, including ulcers caused by the Helicobacter pylori bacteria (a common side effect of antacids). Include a dental checkup to assess cavities and/or damaged teeth.
  3. Make a detailed pain map. There’s a big difference between a headache that starts in the back of the head and one that starts in front. Notice where it starts, where it goes, and what happens next — throughout the body. 8 If your fingers ache or tingle, which fingers and where? If your head hurts right down to your teeth, which teeth hurt? Head pain can come from a calf muscle (soleus)9 and symptoms of Carpal Tunnel Syndrome are linked to rates of migraine 34% above controls.10  These patterns have meaning for knowledgeable eyes.
  4. List falls, fender benders, and head or neck trauma. Migraines are extremely common after such injuries. Many symptoms date back to childhood falls that happened while learning to walk or ride a bike.
  5. Get appropriate tests.  
    • CT/MRI can check for cysts / tumors, hematoma, bleeds, and structural problems. Note if the cervical curve is normal (A), straight (B), or reversed (C) — abnormal curves can cause severe pain and herniated discs. (See photo.) Are vertebrae rotated out of place? The pain-sensitive dura attaches to the upper three vertebrae. Is the first rib elevated?11 This entraps nerves and blocks circulation; a first sign is intractable migraine and symptoms of Carpal Tunnel Syndrome. Range-of-motion testing evaluates related muscular issues.12
    • Take your temperature. Migraineurs’ cold hands and feet are usually attributed to autonomic dysfunction, but can come from compression of blood vessels from strained or shortened muscles. Learning to relax muscles and raise peripheral temperatures can calm the autonomic nervous system. Practice with a digital biofeedback thermometer. Once you can raise hand temperatures to 95 degrees, practice with the probe taped to the big toe.  Persistent cold suggests thyroid dysfunction, so testing should include reverse T3 for thyroid resistance.
    • Do a sleep study. Even home observation with a watch and inexpensive oxygen dosimeter can provide valuable information. “Apneas” are pauses in breathing lasting several seconds or more, occurring five or more times per hour, reducing oxygen levels and starving the brain.
    • Measure electrolytes. The Exa Test is far more accurate than traditional blood tests and has revolutionized electrolyte research, especially for magnesium, a key factor in menstrual migraine.13,14 It also reveals imbalances created by years of women being told to overdose on calcium.

C. M. Shifflett, a former migraineur, is the author of Migraine Brains & Bodies: A Comprehensive Guide to Solving the Mystery of Your Migraines, and co-author of Conquering Concussion. 


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References

1. Egger J, Carter CM, Wilson J et al.,  “Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment,” Lancet 1983, Oct 15;2(8355):865-9. Available online at:  http://www.ncbi.nlm.nih.gov/pubmed/?term=6137694. Several follow-up articles on larger studies are also available, including Carter CM, Soothill JF, Wilson J, “Oligoantigenic diet treatment of children with epi­lepsy and migraine,” J of Pediatrics, 1989, 114:1, 51-58.  Available online at: http://www.ncbi.nlm.nih.gov/pubmed/?term=2909707.

2. Malkan S, Not Just a Pretty Face: The Ugly Side of the Beauty Industry, Gabriola Island, BC: New Society Publishers, 2007.  This provides the long lists of allergens and toxins in personal care products. Estrogen is strongly linked to women’s migraines, and consider the potential impact of hair straightener made out of placenta from pregnant cattle. Both men and women trigger migraines with vasodilating hair restorers. See: http://www.ewg.org/skindeep.

3. To learn more about the powerful anatomical link between neck muscles and the brain, see: Hack GD, Koritzer RT, Robinson WL, et al., “Anatomic relation between the rectus capitis posterior minor muscle and the dura mater,” Spine, 1995; 20:23, 2484-2486. Available online at: http://www.ncbi.nlm.nih.gov/pubmed/8610241.

4. Humphreys BK, Kenin S, Hubbard BB, et al., “Investigation of connective tissue attach­ments to the cervical spinal dura mater,” Clinical Anatomy, 2003; 16:2, 152-159. The “dural bridge” between the rectus capitus posterior minor muscle and the dura mater of the brain has been found to be standard, sturdy, and readily visible on MRI. Available online at: http://www.ncbi.nlm.nih.gov/pubmed/?term=12589671.

5. Wheeler AH, “Botulinum Toxin A, adjunctive therapy for refractory headaches associated with per­icranial muscle tension,” Headache, 1998; 38:6, 468. This article provides case histories of intractable migraines that are unresponsive to medications and successfully treated with Botox A (BXTA).

6. Egger J, Carter CM, Wilson J, et al., “Is migraine food allergy? A double-blind con­trolled trial of oligoantigenic diet treatment,” Lancet, 1983; 2:835, 865-869. This landmark paper showed that the standard lists of food to avoid have been outdated for more than 30 years; specifically, problems occur from cow’s milk cheese (rather than all dairy or cheese), peanuts (rather than all nuts), and wheat (rather than all breads). Patients in the study experienced relief from migraines, eczema, and seizures. For a follow-up report, see also Carter CM et al. (1989).

7. See template example of headache origin and progression here: http://round-earth.com/Migraine_Pain_Info.html

8. Travell JG, Simons DG, Myofascial Pain and Dysfuncton: The Trigger Point Manual, Vol 2, The Lower Extremeties, Baltimore: Williams & Wilkins, 1992, page 430.

9. Law HZ, Amirlak B, Cheng J, et al., “An Association between Carpal Tunnel Syndrome and Migraine Headaches-National Health Interview Survey,” Plast Reconstr Surg Glob Open 2015; 7:3(3):e333. doi: 10.1097/GOX.0000000000000257. PMID: 25878944. See also http://www.medpagetoday.com/Neurology/Migraines/51548.

10. Lindgren KA, Manninen H, Rytkönen H, “Thoracic outlet syndrome — a functional disturbance of the thoracic upper aperture?”, Muscle Nerve 1995; 18:5, 526-530.

11. Shifflett CM, Migraine Brains and Bodies: A Comprehensive Guide to Solving the Mystery of Your Migraines, Berkeley: North Atlantic Books, 2011. See pages 46-79 for the classic headache pain patterns and ROM tests for evaluating the muscles behind them.  See also http://round-earth.com/HeadPainIntro.html and http://round-earth.com/CervicalTests.html.

12. See http://ExaTest.com.