Taming the Chronic Migraine

Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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Taming the Chronic Migraine
“Not tonight dear. I have a headache.” For those who have uttered those words in the throes of a migraine headache, you know how poorly you feel. You also know that stimulus of any kind – bright lights, conversation, smells, even watching TV or listening to music in the background can fuel or worsen the explosion occurring in your head. The attack is dreaded. Migraine disorders are complex and can turn into a debilitating chronic problem. Updated findings with chronic migraine disorders may just help reduce the number of times of having to cancel plans and improve management of this debilitating concern.

Numerous factors can trigger migraines. These include hormone fluctuations, certain foods like aged cheeses, salty foods, processed foods, food allergens/ intolerance like gluten, food additives, alcohol, stress, over-stimulation, and changes in sleep-wake cycle, spinal misalignments, and more. Lymph stagnation and poor detoxification also perpetuate the problem.

[Jump to: Nutritional Options]

Chronic Migraines and Central Sensitization


Migraine headaches that have flared with intensity, frequency and duration, can eventually lead into chronic migraine headaches that are difficult to manage. This debilitating trend leads to central sensitization within the brain. Central sensitization occurs when the nerves in the brain have been chronically overstimulated from the above triggers or wound-up from excess neurochemicals like substance P and histamine. The nervous system becomes unable to handle stimulus which leads to chronic pain and chronic migraines. Wind-up and central sensitization is like repetitive sunburn to the nervous system. Repeated sunburns or injury create the injury and pain, but the tissue changes in response to the “burn” and fails to calm down making it less able to manage “normal” stress. This leads to the development and persistence of chronic pain and chronic migraines.

Several factors can perpetuate central sensitization, but two factors in particular are vital to understand. The two players that affect wind-up and inflammation are related to the methylation defects and changes in the blood brain barrier (BBB). The new findings on methylation roadblocks and improving blood brain barrier health linked with migraines can help offer a deeper understanding of migraine disorders. More importantly, this knowledge can help prevent and better manage migraine disorders.

Migraines Linked with Methylation Problems and Elevated Homocysteine


One of the main lab findings with impaired methylation in general is an elevated homocysteine lab value. This finding is commonly present in patients with migraine disorders. In fact, researchers studying migraine patients who experienced an aura with their headaches, found that homocysteine levels were markedly elevated within the cerebrospinal fluid. Individuals who experience aura symptoms may see flashing or shimmering lights, zigzagging lines, stars or even blind spots. Total homocysteine concentration levels were found to be increased by 376 percent in those with migraine with auras as compared to those with migraines without aura at 41 percent increase. Optimal homocysteine levels are less than 7.2.

It is interesting to note that historical treatment of migraines with nutrition has often been related to the use of B vitamins, specifically B2, B6, B12, and folate. This knowledge was being applied well before methylation defects could be linked to migraine disorders and methylation cycle. Many times the success was attributed to the need for B vitamins related to stress or the need for B vitamins because of how birth control pills strip out vitamins B6, B12, and folate.

Fast forward into the genome project, and one will find several studies linked with impaired gene function and poor methylation leading to migraines. Scientists have found that the MTHFR C677T gene is especially linked with migraine with aura and elevated homocysteine. Those who have the MTRR A66 gene variant are also more apt to have migraine problems with a high level of suffering and disability.

In a six-month, randomized, double-blind, placebo-controlled trial of a daily supplementation with vitamins B6, B12, and folate, results showed reduced occurrence of migraine with and without aura. The study provided evidence that vitamin supplementation could prevent the headaches. A 2015 Australian study confirms that women who had the lowest dietary folate intake had worse problems with migraine frequency, severity, and disability which correlated with the MTHFR C677T variant. The MTHFR and MTRR genes may be tested through your health care professional or through commercial gene testing labs.

Women with migraines during the menstrual cycle may be affected by inflammatory mechanisms other than methylation imbalances. One group of researchers noted that menstrual migraine is associated with increased inflammation or elevated prostaglandin (PG, PGE2) levels in the endometrium or the lining of the uterus. PGE2 reflects inflammation and insufficient balance with PGE1 and PGE3. This balance depends on the good omega-3 and omega-6 oils like EPA/ DHA and GLA, respectively. It is also influenced by vitamins E and C as these compounds quench the inflammatory free radicals induced by excess PGE2. It is possible to have methylation problems and the prostaglandin/ inflammatory imbalance related to the menstrual cycle trigger migraines.

Researchers recently identified the first evidence of migraine disorders linked with low DNA methylation function at the RAMP1 promoter at CpG sites. This is valuable information to the researchers as it confirms the link with a positive family history and female preponderance. Women with migraines and a family history were more likely to have problems with poor methylation linked with the RAMP1 gene.

If there is a methylation defect, it is even more crucial to supplement with the methylated or active forms of vitamin B2, B6, B12, and folate. Other nutrients that assist with methylation include choline, sulfur, and sulfur-rich vegetables and dark green leafy vegetables.

Migraines and Blood Brain Barrier Changes


Scientists have been studying the effects of chronic pain, like chronic migraine, related to the protective barrier that surrounds the brain, i.e. the blood brain barrier (BBB). Studies have suggested that chronic pain changes the BBB permeability, leading to a “leaky brain”. This concept is similar to “leaky gut” (leaky gut syndrome or increased intestinal permeability). The brain needs the BBB intact performing its job of selectively allowing only certain compounds into the brain. The BBB is the gatekeeper of the roads in and out of the brain.

Several studies have explored the relationship of migraine disorders and the change in the BBB. Neurovascular inflammation from substance P and various peptides and interleukins from the migraine triggers a breakdown of the barrier and a spreading of the chronic pain. The spreading is like a wave of chemicals and signals that floods over nerves waking them up. It simultaneously provokes microglial cell activation, a breakdown in the protective blood brain barrier, mitochondrial toxicity, and high levels of oxidative stress.

Blood brain barrier disruption is also induced by a number of inflammatory compounds including homocysteine which is linked with impaired methylation. Animal studies showed that high homocysteine levels provoke high levels of oxidative stress and increase the permeability of the blood brain barrier. In addition, it can lead to injury to nerves and high levels of toxic stress to the nerve synapses.

One animal study confirms that elevated homocysteine levels can activate the mechanisms associated with central sensitization and migraine. The presence of high homocysteine levels like the substance P caused nerve tissue injury within in the brain and in the periphery, cell death, and elevated levels of other toxic compounds creating long-term toxic effects and difficult pain management. High homocysteine levels also promote activation and proliferation of microglial cell activity. The presence of excess microglial cell activity is brain inflammation. Celiac disease/ gluten intolerance is one of the causes for high homocysteine levels and is linked with migraine problems.

Protecting the Blood Brain Barrier and Migraine Prevention


The evidence that we see with chronic migraines and chronic pain disrupting the protective barrier means that we need to be proactive and help repair and prevent further damage. Several nutrients have been shown to be helpful with protecting the BBB. These include acetyl-l-carnitine, pantethine resveratrol, and blueberries. Melatonin, which functions as a powerful antioxidant has also been shown to be helpful for chronic migraines. A recent study found that 4 mg of melatonin taken 30 minutes before bedtime helped reduce chronic migraines. Other studies have demonstrated that melatonin and curcumin help reduce microglial cell activation and protect the BBB from further injury. Many of these same nutrients help reduce excess microglial cell activation and protect mitochondria. Consider combing the nutrients that support balanced methylation (coenzyme B2, B6, B12, folate, choline, sulfur rich compounds) protect the blood brain barrier, and dampen inflammatory PGE2 (vitamin C, E, and DHA/EPA) if you struggle with chronic migraines. You might just find yourself saying “yes, dear” and participating in life events more often rather than withdrawing into a dark room to rest.

Nutritional Options


Acetyl-L-Carnitine (ALC) – ALC helps preserve the blood brain barrier integrity and protect it from breakdown and injury. It also helps protect nerves from stress and inflammation and is a helpful memory nutrient.

Pantethine – Pantethine helps protect the blood brain barrier from breakdown and removes toxic aldehyde that causes brain fog. It helps the brain repair, along with ALC and blueberries, by making the repair compound BDNF. Pantethine also supports the adrenal system.

Resveratrol – Resveratrol is a powerful antioxidant that helps protect the blood brain barrier from inflammation. This vital nutrient also helps support and protect mitochondria that are stressed with migraine headaches and brain inflammation.

Blueberries – Blueberries are well known for protecting the microglial cells and blood brain barrier from inflammation. Blueberries help make BDNF which help the brain repair from day-to-day insults.

Melatonin – Melatonin functions as a powerful antioxidant. It quenches toxic free radicals that occur as a result of the migraine or other inflammatory insults to the brain. It is best taken before bed and also helps sleep.

B Vitamins – B vitamins are needed for healthy methylation and mitochondria function. B vitamins are used up by stress, caffeine, and alcohol. Inadequate B vitamins increases the risk and presence of inflammation within the brain, especially high homocysteine. It is a first-line of therapy for migraines and stress.

Folate – Folate deficiency is linked with high levels of homocysteine that markedly increases the risk for migraine problems. Folate is essential to take with vitamin B6 and B12 for healthy methylation.

Choline – Choline is an unsung hero, vital for methylation and cell membrane health. Insufficient choline leads to problems with memory, blood brain barrier stress, and inflammation. If you don’t eat egg yolks, then add in choline.

MSM Sulfur – MSM sulfur provides the backbone of sulfur and a combination of nutrients to help methylation and detoxification. It helps protect the blood brain barrier and manage inflammation. MSM sulfur is also known as the beauty mineral because it helps strengthen hair and nails.

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