Migraine Brain

11 August 2021

This Is Your Migraine Brain. On A Roller Coaster.

Yes, this is indeed a serious article about a clinical trial that was published in the journal Neurology this summer. What happens when migraine patients go on a (virtual) roller coaster?

You may be thinking – why would someone with migraine go on a roller coaster anyway? You can set your mind at ease. Not of these patients was actually having a migraine attack at the time. Which is the whole point.

Migraine brains are simply different – even between attacks.

This was a small study with 40 people, 20 of whom suffer from migraine. During the roller coaster ride, migraine patients did experience more discomfort. They were:

far more likely to experience motin sickness
far more likely to be dizzy

…and their symptoms were more intense and lasted longer than the control group.

Researchers also measured brain activity of the people in the clinical trial and found that they were able to “see” differences in brain activity between the migraineurs and the controls. Some of the differences in brain activity matched what we already have seen in migraine, and parts of the brain that regular movement were also affected.

Study author Dr. Arne May discussed the purpose of the study:

People with migraine often complain of dizziness, balance problems and misperception of their body’s place in space during migraine. By simulating a virtual roller coaster ride, our study found that some of these problems are not only magnified in people who experience migraine, but they are also associated with changes in various areas of the brain. By identifying and pinpointing these changes, our research could lead to a better understanding of migraine which could in turn lead to the development of better treatments.
Arne May, MD, PhD quoted in ScienceDaily

We’ve already seen connections between motion sickness and migraine, and dizziness and migraine – and of course there’s vertigo and cyclic vomiting syndrome. Motion sickness may be a warning sign for other conditions later in life, and should never be ignored. And, of course, we’ve talked about vestibular migraine before.

This study is another reminder that migraine affects all of life, not just those times when the patient is having a migraine attack. It also strengthens the link between migraine and other motion-related conditions.

For those who do suffer from dizziness, or motion sickness, but not from migraine – be sure to talk to your doctor. These symptoms may be a sign that you’re more susceptible to migraine. Paying attention and even finding treatment early on may be a major help later in life.

For more, read the study abstract here: Brain Processing of a Visual Self-Motion Study in Patients With Migraine: An fMRI Study

15 November 2013

Are Migraine Researchers Preoccupied with Pain?

James Discoveries & Stats 13

There’s no doubt that, for most people with migraine, pain is a big concern. But the truth is, pain is not the only symptom of migraine. And it could be that our focus on pain is hindering research.

Dr. Peter Goadsby of the University of California San Francisco Medical Center, is one of the researchers who is concerned that too many are focused on pain, thinking that the pain of migraine is simply causing other symptoms.

Of course, many migraine sufferers will realize that this idea is suspect. After all, what about the symptoms that typically appear before the pain?

But another question is, what about the symptoms that often go with the pain? Is pain simply causing nausea, or is the nausea simply caused by an underlying problem? What about the feeling of heaviness some patients describe, or sensitivity to light?

There is a lingering supposition that pain is simply causing problems in the head – changes in blood vessels, for example. But if there’s an underlying condition of the brain that leads to most migraine symptoms – we must find a treatment for that condition.

Dr. Goadsby’s Study: A Disorder of the Brain

In a study presented earlier this year, Dr. Goadsby believes he has confirmed yet again that migraine symptoms come from a disorder of the brain. In his words:

This is an important step in solidifying our ideas that migraine is fundamentally a disorder of the brain, not a disorder of structures outside the brain. We were able to address the question that people have wondered about for many, many years, that is, what is the degree to which pain is driving the initial symptomatology â€” and we got clear answers to that.

The study used brain scans, but did something that is rare in migraine research. Brains were scanned before the headache hit. This allowed researchers to study migraine symptoms that were present before there was any pain.

So were there changes in the brain before headache? You guessed it – the answer is yes. And we have been able to get a glimpse into which parts of the brain change in the “early stages” of an attack.

For example, the hypothalamus. Just above the brainstem, the hypothalamus is known to be key in cluster headache. It’s key for functions like sleep and mood.

The midbrain was also involved, confirming earlier studies.

The visual cortex was active in patients with visual problems. And the medulla in the brainstem was active in patients experiencing nausea.

This may all seem rather obvious, but the key here is that these patients had not yet experienced migraine headache. So in the case of nausea, for example, it could be that it’s not dependent on the pain, but simply another result of the changes in the brain that cause migraine. Dr. Goadsby explains:

…it’s entirely plausible that those areas are activated by the migraine process and that’s why nausea and vomiting are so common in migraine; it’s not simply a response to the pain … It was thought that nausea and pain were highly linked, but that doesn’t seem to necessarily be the case.

A New Research Manifesto?

Treating symptoms is very important – but we want a cure to migraine – a cure that will end all migraine symptoms.

Research and treatment need to be dealing with the brain. The other symptoms of migraine need to be taken seriously, so that we’re not just stopping pain (often that approach doesn’t work anyway), but stopping migraine.

Patients also need to be cautious of “treating pain” with “painkillers”, and instead look to a complete and targeted migraine treatment plan.

Dr. Goadsby hopes that there will be a shift in thinking when it comes to migraine. “From a big picture treatment perspective, this says to me that we probably won’t get away with developing drugs that don’t get into the brain to have substantial effects on migraine prevention”.

The Migraine Brain: A Review

James Resources 0

One of the biggest challenges a migraineur faces is the feeling of being out of control. You don’t know where to turn next, you don’t think you can do anything to feel better – you feel like there’s no way to get out of the maze of pain you’re in.

If I could suggest a strength of The Migraine Brain by Carolyn Bernstein MD and Elaine McArdle, it would be just that – it’s an attempt to give control back to the patient, the person who wonders if there’s anything else that they can do.

After an overview of some of the most common headache types in chapter one, the authors get into the "title chapter" – how is the migraine brain different? The book addresses some of the most recent research and news about migraine.

(You’ll notice this book was one of the resources I used in my article What is Migraine? (the scientific story). Of course, you’ll read things in my article that aren’t in the book. The problem with writing things down is that they can go out of date very quickly!)

I won’t go through every chapter, but from there on the book goes on to talk about the stages of a migraine, migraine triggers and other key issues.

Then in part 2, the book gets more practical, answering questions such as:

How can I find a doctor?
Which medicines work?
What about alternative treatments?

Finally in part 3, we’re guided through a "personal wellness plan" – eight steps to wellness for the migraineur.

It’s about Control

I mentioned at the beginning of this review that The Migraine Brain is all about giving control back to the migrianeur. Why? Because the book is full of practical advice on things to do – tips, lists, worksheets, and step by steps.

For example, quite a bit of space is dedicated to dealing with migraine attacks at work. First, there are 16 tips for avoiding attacks in the first place.

Next is the "Emergency Work Plan" to put into action if a migraine attack starts. Here’s what the authors suggest: notify someone at work, take a break, put your phone on voice mail and turn away from your computer screen, take your abortive medication, use an ice pack, take slow, deep breaths, use self massage (if it helps you), dim the lights and put your head down, take a short walk outside (if the attack isn’t severe), drive a caffeine drink, and if all else fails, go home (asking someone to drive you if necessary)!

Many of these things may seem obvious, but having it on paper step by step can be a great help.

Other practical features of the book include: creating a migraine travel kit, things your partner should know about migraine, 9 things to bring to your first doctor’s appointment, 14 ways to get better sleep, and making a kit of things to take to the emergency room.

A matter of Emphasis

Of course everyone has their own opinions about migraine treatment, and it’s understandable that you or I aren’t going to agree with everything in any book.

Still, at times I was surprised at the things that were emphasized in the book. There were times when it seems like a well proven treatment got very little air time, when another with little evidence of success had more.

For example, the authors spend very little time on herbs, and issue a host of warnings. They have little confidence even in well researched herbs such as feverfew.

On the other hand, there is very little warning about drugs such as topiramate (Toapamax). And there is almost as much time taken talking about "energy healing" as there is talking about all herbs for migraine put together!

The bottom line

That aside, I think this is an all-in-one book that will be valuable for people that need to make migraine treatment a significant part of their lives. (It may not be helpful for the person who has an attack a year, although they too would probably be interested to learn more about what migraine is) It really will help to put you back in the driver’s seat and make real improvements to your life.

At 333 pages, the book has a significant scope of information, and there’s something for everyone to learn. Topics such as breastfeeding, domestic violence, sex and migraine and migraine tips for partners of migraineurs are not topics you’ll find in every book on migraine! 🙂

So in spite of the book’s weaknesses, the scope of information and the truckload of tips make this, in my opinion, a welcome addition to the migraine library. It also has the advantage of being one of the newest books on the block (September 2008).

I’ll close by letting the book speak about its own goals:

You and I are going to face every aspect of your migraine disability. We’ll address each facet of your life – your family, job, healthy history, personal goals – to devise an individualized treatment approach that works for your body, your personality, and your lifestyle.

That’s the idea behind The Migraine Brain.