Why Migraine Attacks may make you withdraw Into Darkness (or, Your Brain on the Holodeck)

Migraine attacks often come with a number of unwanted symptoms besides just pain. While some types of headaches may just be annoying, or others may make you want to pace the room, migraine patients generally retreat into darkness. And sometimes a migraine attack warning signal is – yawning! Why is that?

In a small study (Dopamine D2/D3 imbalance during migraine attack and allodynia in vivo), researchers at the University of Michigan discovered that, for these patients, dopamine levels fell during the attack itself.

A little background. These 8 patients had episodic types of migraine, and their brains were scanned both during the migraine attack and in between attacks. During the attack, researchers elicited an allodynia experience (sensitive, painful skin. See so that they could also see changes in dopamine levels when this symptom was present).

Dopamine molecules have a lot of functions in the body, such as influencing movement. But they’re most famous for the way they can make you “feel good” – motivating you to do certain things; rewarding and reinforcing behaviour.

The migraine patients had pretty normal levels of dopamine in between attacks – but when an attack hit, levels dropped.

So when dopamine levels crash, what happens? Well, you can guess. This may partly explain why you want to withdraw, get into a dark room, and stay still (although the pain may keep you moving). And the longer you’ve suffered from migraine, the worse your body seems to get at keeping your dopamine levels up where they should be.

Researchers also discovered that the dopamine levels fluctuated during the attack. When the patients felt the sensitive pain of allodynia, dopamine levels rose – but not back to normal levels. Unfortunately, this probably wouldn’t help you “feel better” – the partial rise would only be a reaction, possibly causing more symptoms, such as nausea.

Changing dopamine levels may actually be telling your body something valid – as Dr. Alexandre DaSilva (one of the researchers) put it: “This dopamine reduction and fluctuation during the migraine attack is your brain telling you that something is not going well internally, and that you need time to heal by forcing you to slow down, go to a dark room and avoid any kind of stimulation.”

In the emergency room, patients are sometimes given dopamine antagonists such as metoclopramide to help stop the wild fluctuations (and stop nausea).

Also, magnesium (taken to prevent migraine, but also given intravenously in emergency) may help keep levels stable.

(By the way – one of the topics of this year’s World Migraine Summit will be Calming the Hypersensitive Migraine Brain with Dr. Todd Schwedt of The Mayo Clinic)

The connection between migraine and dopamine levels isn’t a new discovery. What is new is the increasing ability to accurately see how levels rise and fall.

Your brain on the holodeckAnd that brings us to the fun part of the study.

Here you can see Dr. DaSilva with a floating brain on his “holodeck”. Ok, it’s not exactly a holodeck, but it is an amazing way to see a brain – in this case a collection of responses from a number of brains – in 3D. It’s an incredible way to investigate the results of studies like this one.

For more information, and to see a video of Dr. DaSilva using the 3D brain, check out Brain scans show dopamine levels fall during migraine attacks.

via: Why Migraines Make You Tired and Sad: New Research Points to Role of Dopamine


Yes, it matters which Magnesium supplement you use…

I don’t usually write too many personal notes here at Headache and Migraine News, because, after all, the focus is on the news. Also, because every person is so different, you’ll find that different treatments are more or less helpful for different people.

But when I ran out of “my brand” of magnesium recently, I was reminded that, yes, it does matter which supplement you buy.

For a quick primer on why migraine patients should seriously consider taking a magnesium supplement, read Magnesium: Top of the List for Migraine. For tips on how to take it, read Magnesium for Migraine (graphic).

Anyway, yes, I ran out of the brand I use, but I had some left over of another brand. But – not nearly as good.

You’ll find that some types or brands of magnesium won’t absorb as well. That means they won’t protect you as well from migraine attacks. And they can cause diarrhea.

For the record, I most often recommend (and use) Ultra-Mag Hi Efficiency Magnesium. If you want to see what brands our readers have recommended, see Which Magnesium Supplements Work?

And now, back to our regular programming.


The Unexpected Reason You Should Pay Attention to the Migraine World Summit

There’s a very important event coming up that you need to know about – The Migraine World Summit 2017! Why (you may ask)?

Last year’s Migraine World Summit was a tremendous success! I had the privilege of being both a speaker and a learner. The information was cutting edge and very practical – I’m still going through the material.

But this year is going to be even better!

Migraine World Summit 2017For those of you who don’t know, the summit will be bringing together experts from around the world – and I mean top, world renowned experts. They will be sharing the latest information, and their years of experience, with everyone who attends.

And you can attend, online, for free (as long as you have tickets. Which are free).

Compared to last year, the production quality is going to be raised significantly, and there will be even more great speakers (36 in all) from the forefront of migraine research and treatment.

Now, why should you attend? Of course you want to be on the inside track of information for new treatments and research. But there’s another, maybe even more important reason, why you should get your free tickets.

I spoke with Carl Cincinnato, the host of the Migraine World Summit, via Skype. He has an ambitious vision for the summit and its future.

Imagine if the summit starts getting the attention of more researchers, governments, universities, and other people with major influence. The Migraine World Summit could become more than just a tool for patients and doctors – it could become a movement.

What if people with money started realizing the need for funding migraine research? What if governments started making research a priority? What if more places of learning and research started cooperating?

You can help get their attention just by attending via your computer or smart phone. The more people, the better!

And now for the details: The event is taking place between the 23rd and 29th of April (if you get tickets, you are free to “attend” whichever workshops you would like to). As a bonus, after you sign up, you’ll get to see a free video with highlights from last year (yes – I’m in it!).

To sign up for free, visit this page.

Be a part of the movement – it’s time to fight back!

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Vestibular Migraine: What’s New

Dizzy? Maybe have some migraine symptoms? It could be vestibular migraine.

We’ve been talking about vestibular migraine here for almost 10 years. Back then it was not even recognized by the International Headache Society as a distinct type of migraine. So we talked about it as a manifestation of various types of migraine. In fact, dizziness/vertigo are very common migraine symptoms.

Vestibular MigraineBecause, after all dizziness and vertigo (yes, I know the two are different) are seen in more than just one type of migraine. But today vestibular migraine is much more recognized as a distinct type of migraine.

So what is it, and how are people diagnosed?

First, you need to have a past history of some type of migraine. Second, some of your attacks (at least 50%, say the official guidelines) should include at least one common migraine symptom: sensitivity to light or sound, visual aura, and/or a significant headache, usually one sided and throbbing.

Finally, the vertigo/dizziness. It will be significant enough to interfere with your normal activities. It will last between 5 minutes and 72 hours.

You can probably already see some reasons why there is still so much confusion. If some other types of migraine also may include dizziness (such as migraine with brainstem aura) – not to mention other conditions – and if you already have migraine, and you have these symptoms sometimes, but not all the time – well, it can be a challenge to diagnose.

Even if the vertigo/dizziness accompanies your migraine attacks, your doctor should check carefully for other conditions that may be the underlying cause. And, of course, if you do have a history of migraine, and/or are experiencing any of the symptoms above, your doctor should know that as well. It’s easy to misdiagnose vestibular migraine as something else.

The current research into migraine and dizziness is being put to good use. Take for example recent studies into vertigo in children. It has been discovered that many children with vertigo actually have migraine, and that when the migraine is properly treated the vertigo is also treated. The same, of course, would be true for adults.

And beyond migraine treatment, some patients are finding help in “vestibular rehabilitation”, specific therapy for people with vertigo/dizziness.

Another very common cause of vertigo is benign paroxysmal positional vertigo (BPPV). There is some information and resources here.

Whatever the cause, the symptoms can be very disabling, and do need to be taken seriously.

You can help your doctor come to a correct diagnosis. Take note of how long the symptoms last, and what other symptoms you’re experiencing – such as ringing in the ears, visual aura (eg flashing lights), headache, or hearing loss?

Also, try to be more specific than just “I feel dizzy”. Does the room seem to be spinning? Do you feel like you are moving? Does moving make it worse?

And, as always, make sure your doctor knows your medical/family medical history.

It’s encouraging to see a renewed interest in research of vestibular migraine. However, it is a very difficult condition to study, and we still know very little about it. The good news is that many patients are finally getting an accurate diagnosis, and are finding migraine treatment that works.


PFO Closure for Migraine: An Update

12-14 years ago, there was a lot of discussion about “PFO closure” for migraine.

PFO stands for patent foramen ovale, a hole in the heart between the right and left chambers. A PFO is a common developmental condition, affecting about 1 in 4 people. But you may never know you have it.

patent foramen ovaleSurgery can be done to close the PFO, for example if someone has low blood oxygen levels that may be caused by the defect. But years ago, patients who had the surgery for various reasons began to report that their migraine attacks had also subsided.

And so began the investigations and the trials. The well known MIST trials, originally planned as a series of four trials, were cancelled before the second one was completed. The results were not encouraging.

More studies have been done recently, and results continue to be mixed at best.

So why is PFO closure still being discussed? First, because some patients do experience a reduction in migraine symptoms after PFO closure. Second, it’s clear that migraine and PFO are somehow linked – PFO patients are much more likely to have migraine, and migraine patients are more likely to have PFO.

But a relationship does not mean that fixing one problem will fix the other, as trials have shown.

But there is more. For example, particles that move from one side of the heart to the other (through a shunt) may lead to migraine – not to mention the relationship between stroke, PFO and migraine. These particles in the blood may trigger a cortical spreading depression, a key part of the migraine chain-reaction.

In short, there are good reasons to think that PFO may actually increase migraine attacks.

So why doesn’t everyone with migraine just have the surgery? There are actually good reasons. And this has been one of the downfalls of the trials – patients simply don’t want to have heart surgery – even if it’s fairly simple surgery.

Though the surgery is generally safe, there are risks. In a report published earlier this month, PFO and Migraine: Is There a Role for Closure?, the authors noted that “several potentially life-threatening procedure-related adverse events occurred in the clinical trials”. There are also concerns that the surgery may lead to other health problems down the road.

Researchers remain intrigued by the possible connection between PFO closure and migraine. Although trials have been disappointing, it’s still worth trying to understand the connection, which may lead to other types of treatment. And it could be that we can find a certain type of migraine patient who will benefit from PFO closure, even if those are a small percentage of migraineurs.

But in the mean time, the poor chance of success, and risk of other health issues, and availability of many better treatments, continue to leave PFO closure in the area of research and not in the area of recommended treatments.

As the authors of the above say, although some patients who have the surgery for other reasons may see a decrease in migraine symptoms (either due to the closure or other reasons?), they “recommend against offering PFO closure as a preventive treatment for migraine”.

See also Closing PFO closure for migraine?

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