Have Migraines? Try these approaches. This article was written by a professor of mine in graduate school, Dr. Debora Khoshaba.
It may seem strange that an article on migraines is appearing on a psychology publication page. But, the effects of migraines on mental health and behavior make this neurological disorder an important consideration in diagnostic evaluation of psychotherapy patients. Migraines can negatively affect stability of mood, relationship, sleep and parenting behavior, and lifestyle habits that contribute to mental health. Skilled psychological clinicians strongly consider the role that migraines may play in the presenting symptoms of a psychotherapy patient.
I got to recognize the effects of migraines way back in childhood, as my mother, brothers, sisters and I suffer from them. Indeed, suffer is the word most migraineur’s use to describe the debilitating effects of their symptoms. Migraines can be so painful that it can lead a person under the throes of pain to say, “Please, someone put me out of my misery!”
When my siblings and I were young, there was no specific medical treatment for migraines. Migraineur’s had to just wait the migraine out. This was usually a two to three day period of lying in bed in a darkened room and only getting up to vomit. I can recall many days that my mother would drag herself out of bed with a migraine to prepare our lunches for school and for her to go to work. What a trooper she was. But, by noon, she was so ill that my father would have to bring her home. Vomiting often relieved the pain and stopped the migraine. But, like all migraineur’s know too well, this respite does not last long, as another migraine is sure to appear several days later.
My siblings and I knew to keep very quiet, when my mother had a migraine. The house felt like a morgue, at such times. Back then, migraines took important chunks of time out of a person’s life. Workdays cut short, less quality time with family, canceled outings and vacations spent in bed all characterized a migraineur’s life. Also, you never knew when they were coming or how hard they would hit you. It is easy to see why people called them migraine attacks.
It was also common for migraineur’s to be prescribed antidepressants, like Elavil (A tricyclic psychiatric medication) that did little to treat the neurological basis of the migraine and also worsened the migraine and caused it to ricochet into a new migraine episode.
Thank goodness the medical, nutrition, psychological and sport sciences have come a long way in understanding the nature and triggers of a migraine headache.
What is a Migraine?
Migraines affect about one in ten people worldwide, with women getting it about 3 to 4 times more often than men. It is a debilitating neurological disorder that alters the normal way the arteries, nerves and capillaries (blood vessels) usually work. Migraines do not result from a nervous personality condition; rather, people have a genetic predisposition for migraines. That is—they are genetically predisposed to a nervous system that has a specific way of responding to changes affecting their bodies.
Migraines run in families. Research has found at least three genetic mutations that are linked to an increased risk of migraine in the general population (Medical News Today) and four genes that predispose people to migraines without the symptom of aura; visual, sensory, motor or verbal disturbances that are distinct signs that a migraine is about to happen (Migraine Gene Found By Scientist Inspired By Her Own Illness, MNT, 2013).
Inflammation of blood vessels
Although science can describe a pattern of neurological changes in the body’s blood vessels that result in a migraine, the roots of a migraine vary, so they are referred to as triggers rather than due to a single cause. A change of weather, shift in hormones, sensitivities to certain food and drink, inadequate sleep, eating too much or too little in one sitting, or skipping meals altogether, a strong odor, light or sound, environmental allergies, pollutants and irritants, and emotional stress can precipitate a migraine attack. These migraine triggers activate the release of histamine from the nerve fibers that are coiled around the brain’s arteries and veins that narrow and constrict these blood vessels beyond their normal size. Vascular constriction activates the release of the enzyme Nitric Oxide (NO) that expands the size of the brain’s blood vessels so that we don’t stroke out. It is the expansion of the arteries and veins that actually causes the brain inflammation and the arterial pain that we feel in our temples. This entire process stresses the body to the point that sets off a fight-or-flight stress response in us, which makes us nauseous, causes diarrhea and vomiting, delays stomach emptying and food absorption and decreases blood flow and circulation (leading to symptoms of cold hands and feet and sensitivity to light and sound) (Medical News Today, Nov. 2013).
But, even more debilitating to our physical health and behavior is that expanded blood vessels cause our brain to dysfunction. The parts of the brain depend upon the right amount of chemicals, blood sugar and oxygen to carry out their operations. This requires that the brain and body’s blood vessels have just the right amount of tension (not to little or too much) so they can act like a pump and carry essential nourishments to the brain. But, the enlarged blood vessels of a migraine attack do not permit them to carry what is needed for the brain parts to operate and interact with each other, so that problems of reasoning, information processing, mood, and behavior result.
I always knew when I was about to get a bad migraine, because my speech would start to slur (an aura sign that is verbal). I’d stop processing information, become irritable, emotional and teary-eyed. A migraine is so debilitating to thinking, reasoning, visual and auditory processing of information, and mood stability that it can seem like one is having a mini-stroke (Trans-ischemic attack or TIA).
For some time, scientists thought migraines did little harm to the long-term integrity of the brain. But, recently, researchers from the University of Copenhagen in Denmark found a link between migraines and brain lesions, silent abnormalities, and brain volume, especially in people who have migraine with an aura, as part of their symptoms. They have a 68% increased risk of white matter brain lesions, compared with a 34% risk such brain lesions in migraineur’s without auras. Thesestroke-like, infarct-like abnormalities in the brain (areas of the brain in which tissue is dead) showed a disruption in blood flow to the brain (blood flow decrease increased by 44% in migraineur’s with auras as compared to those without). Additionally, brain volume changes were more prevalent in both groups of migraineur’s (with and without aura) than in a non-migraine population.
These studies show that we migraineur’s need to do all we can to lower the frequency of our migraines by understanding our triggers.
Reducing Migraines:
A Five-Step Approach
Fortunately there’s much you can do to reduce the number of migraines that you have. But, you have to become your own scientist and investigate the triggers of your migraines. Identifying what triggers a migraine is an important first step in preventing future attacks.
1. Food and Environmental Sensitivities:
Diet: The neurotransmitter called histamine plays an important role in migraine activation. Food, drink, and environmental toxins to which a person is allergic to can trigger high histamine levels in the brain and body that starts the migraine process. Numerous studies evaluating the relationship between histamine and migraine show that “histamine and other immune responses are part of the body’s response system to a perceived threat from the environment and how the brain responds to this threat is at the heart of migraine” (Stanford University Blog on Migraines and Headaches).
Migraine triggers activate the release of histamine from the nerve fibers that are coiled around the brain’s arteries and blood vessels that constrict the blood vessels beyond their normal size. This activates the release of the enzyme Nitric Oxide (NO) that is responsible for biochemically expanding the size of these blood vessels so that we don’t stroke out. It is the expansion of the arteries and veins that causes the brain inflammation and the pain that we feel. Researchers have been able to show the importance of histamine to the migraine process, by inducing headaches in migraine and non-migraine sufferers through histamine dosing (Link between Allergies and Migraines).
Getting to know the food, drink, and environmental pollutants, toxins and other irritants that you are sensitive to can significantly help you to lower the frequency of your migraines.
Sugar: There is a relationship between sugar intake, blood sugar levels and some migraine attacks. It has to do with the close relationship between the blood sugar hormones (glucose and insulin) and the enzyme Nitric Oxide (NO) that causes changes in the vascular system. Rises in blood sugar level through ingestion of too much sugar, or sugar released through the body due to fight or flight, causes the blood sugar storing hormone, insulin, to store the excess sugar in our bodies so that we do not stroke. It’s this storing process that activates Nitric Oxide that over-expands the blood vessels to the point of a migraine. Quick rises in blood sugar by eating too much sugar or too much food can result in a migraine through this process. But, low blood sugar can also result in a migraine. When blood sugar drops too low our bodies try to help us by stimulating the release of excitatory chemicals through the body so that we can think and function. This can cause a fight or flight stress response that activates the migraine process.
To better manage a migraine, it’s best to keep blood sugar at normal levels throughout the day. Migraineur’s often address the problem of blood sugar and their migraines by using the Glycemic Index to evaluate how much sugar is in the food and liquid they consume. Diets that emphasize moderation in daily intake of sugar and carbohydrates are excellent in this regard (The Carbohydrate Addict’s Diet; Dr. Mark Hyman, The Blood Sugar Solution Diet and Mayo Clinic on Blood Sugar, Diet and the Glycemic Index).
2. Sleep: Lack of sleep or poor sleep habits can trigger migraines and also cause them to become more frequent. Being deprived of REM sleep (stage of deep sleep in which we dream) changes how key proteins involved in the pain process are expressed. It seems that the lack of REM sleep raises the levels of these proteins that arouse the nervous system and cause pain (WebMD, Lack of Sleep Triggers Migraine Proteins).
3. Exercise: There are numerous health benefits that come with regular exercise. “Regular physical activity is shown to improve our health and to reduce the risk of high blood pressure, diabetes, depression and obesity.” It also improves sleep and reduces stress. But, some people who are prone to migraine find that strenuous exercise can bring on a migraine attack and start to think of exercise as a trigger. (Fact Sheet on Exercise and Migraine; The Migraine Trust).
Don’t give up on exercise. Just choose the type of exercise that doesn’t overly stress your body and produce a migraine. For example, if you choose yoga, you may want to avoid the Bikram form of it to avoid high heat temperatures that can over-stress your biology.
4. Psychotherapy: Therapists can help us to manage aspects of our lifestyle that are triggers for a migraine, especially relevant here are health psychologists and cognitive-behavior therapists. They train you in body awareness and stress management techniques that help you to become more aware of your migraine triggers. Behavioral therapists can also help you to construct a program for eliminating migraine triggers and for measure outcomes of your efforts (Migraines: Can Therapy Help?).
5. Medication: Today, there are medications that are solely used to treat migraines. These medications (Imitrex, Zomig, Maxalt) treat the affected blood vessels that result in a migraine. That is, they restore the blood vessels to normal size. These new medications are so much better than over the counter medications that only block pain receptors and do little to return the blood vessels to normal size and function.
If you are a migraineur, you have to keep in mind that your nervous system is sensitive to changes. But, if you follow through on some of these recommendations, you can reduce the number of migraines you have and bring more balance and well being into your life. From time to time, you’ll get a migraine. But, you’ll have far more control over them than before. I know, for example, if I eat popcorn or dairy, especially two days in a row, I will definitely get a migraine. I have learned about the foods that trigger my migraines and know how to control their onset by when and how much I will indulge in that food.