Alexandre DaSilva Archives - Headache and Migraine News

Alexandre DaSilva

10 April 2017

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.

And 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

8 January 2013

Zap the Brain? Electric Stimulation and Pain

James Discoveries & Stats, Information, Treatments 7

Ever since Dr. Frankenstein first saw his monster come to life, the world has been fascinated with the use of electricity in medicine.

Though crude methods have been made famous in the movies, in the last few years transcranial direct current stimulation (tDCS) has become a serious science that has helped people with migraine, chronic facial pain, depression, post-stroke rehabilitation, and more.

It could be argued that this form of treatment is still in its infancy. After all, we still know very little about how it works and how to best use it to treat specific patients.

However, it’s a lot less brutal than you might imagine if you’re thinking of a horror film.

Let’s take for example amperes, the measurement of electrical current. A toaster may have anywhere from 9-16 amps. Electroconvulsive therapy (ECT), on the other hand, which is used to treat issues such as severe depression, typically uses 200 to 1600 milliamperes, or .2 to 1.6 amps.

The current delivered for a lot of the pain treatment we’re talking about today is typically in the range of 1-2 milliamps, or about 0.0015 amps.

Amps comparison

Research by Dr. Alexandre DaSilva at the Headache & Orofacial Pain Effort (HOPE) Lab is giving us new insight into how tDCS may fight chronic pain issues such as migraine.

We do know that tDCS treatment can reduce migraine and headache pain. A recent study published in Frontiers In Psychiatry demonstrates how tDCS might work to reduce pain.

Researchers watched what happened during treatment using a specially designed radiotracer and a PET scan. The idea was to measure µ-opioid release.

Without getting into too much detail, you might already be able to guess how this works in the end. Opiates such as morphine impact the same system in the brain, and help fight pain. In short, the plan is to use tDCS to stimulate the natural systems of the body to alleviate pain.

Dr. DaSilva says (as quoted in ScienceDaily):

This is arguably the main resource in the brain to reduce pain. We’re stimulating the release of our (body’s) own resources to provide analgesia. Instead of giving more pharmaceutical opiates, we are directly targeting and activating the same areas in the brain on which they work. (Therefore), we can increase the power of this pain-killing effect and even decrease the use of opiates in general, and consequently avoid their side effects, including addiction.

Dr. James Fugedy has been using tDCS to treat pain for the past few years. He started with fibromyalgia, and has since helped patients with migraine, depression, and chronic daily headache. He writes:

Transcranial direct current stimulation (tDCS) is the most exciting innovation I’ve experienced in 30 years of practicing medicine. … The tDCS procedure itself is simple, but protocols have evolved and results have improved. The numerous but small studies done thus far indicate, but do not yet conclusively prove benefit. Large multi-center studies need to be done to verify outcomes. Still, there is enough evidence at this time to justify clinical use for the treatment-resistant patient, particularly when you consider that there are no negative side effects with tDCS.

Future studies will be designed to provide more solid evidence of benefit, and show us which type of treatment works the best for which type of patient.

We also need to know more about how to help patients long term. How frequent do treatments need to be for patients with chronic headache? For example, could a six-week treatment regime lead to permanent results?

Meanwhile, some doctors are increasingly using tDCS to treat chronic pain. So far, this treatment has an excellent track record. Patients need to start asking their doctors about it, and pushing for further research.