Sunday, February 7, 2010

Does Anyone Really Know What Causes Migraines?

Your Guess is as Good as Mine

Heather at War On Headaches stated in a comment to a recent post (MRI Results)

I'm beginning to think that headache pain is simply headache pain, and there may not be an explanation. Don't get me wrong - I'm not giving up on trying to get better; I'm just thinking that trying to find the source may be a wild goose chase!

This got me to thinking, and since my brain is on permanent circuit overload status that can be a dangerous thing. What would I find in PubMed if I did a simple search on 'causes of migraine headache'? Surely I would find some consensus, especially with the plethora of imaging techniques and genetic tests and new drug studies. Instead of consensus, I found no unified field theory of causation, and much disagreement on disease mechanism.

I only went through a few pages (sorted by most recent relevant contributions to journals) and came up with a short list. After review I wonder if what we call "migraine" is actually a catch all for several disparate diseases which all cause similar symptoms by different mechanisms. Perhaps that is why it is so difficult to manage, because there is no real "it"...rather migraine is a loose definition of a entire spectrum of disorders

A couple of surprises were a link to a specific pesticide, association with high levels of air pollution, and mitochondrial damage associated with medication, including acetaminophen. I had migraines BEFORE acetaminophen was ever marketed, so I definitely know in my case there is no correlation to that one. Here's the list I compiled:

1. Patent foramen ovale
2. Metabolic Syndrome
3. Obesity & dysfunction in the orexins pathways
4. Changes in extracellular sodium and potassium levels in spinal fluid and the brain
5. Air pollution
6. Dilation of dural vessels
7. Exaggerated or abnormal neurotransmitter responses to normal cyclic changes in the ovarian hormones
8. vasodilatation provoked by calcitonin gene-related peptide
9. Neurogenic inflammation of meningeal vessels provoked by peptides released from trigeminal sensory neurons
10. Pituitary adenylate cyclase activating peptide-38 (PACAP38)
11. Mutations in ion channels causing imbalance in the activity of excitatory and inhibitory neurons
12. Dysfunctions in the neuronal networks in the brain stem (especially in the serotoninergic nuclei) or the hypothalamus (SCN)
13. Medication induced mitochondrial damage; offending medications include acetaminophen and psychotropic drugs
14. Cortical activation, which disinhibits craniovascular sensation through the nucleus raphe magnus (NRM)
15. Inflammation of the meninges, particularly the dural membranes that surround the brain
16. Mutations of the voltage-gated K+channels of the K(V)7 (KCNQ) family
17. Pesticide Antracol Combi WP 76
18. Cytokine and immune system modifications
19. Nitric oxide and the transcription factor nuclear factor-kappaB (NF-kappaB)
20. 5-HT(1F) receptors and/or 5-HT(7) receptors

See what happens when I take pain medication and I can't sleep? I come up with simplistic suppositions of semi-scientific speculation and can't stop the alliteration bandwagon for the life of me!!!

On a personal note, no nausea today so far, so ate a small but real supper (dinner for you city folk). The Belly protested with pain, so I took a Percocet. The pain decreased slightly and I don't feel drugged at all AND so far no hives!! Woohoo! My PCP said this is a low dose, so maybe this is something I will be able to take and still be able to work.

I worked today for about six hours helping look at conversion data for a client, and working on testing some programs. It was very difficult for me as I have no energy and am very very shaky feeling (this was way before I took the Percocet). My boss announced yesterday they have hired someone as a trainer, bless his sweet heart!! I am so relieved; although I have communicated with my bosses about my illness, I have not been honest with them or myself about how difficult it is for me to work. After the last couple of weeks have been afraid that I may not be able to continue and they would not have anyone to do what I have been doing, so I am relieved they have found someone!

Working is almost more than I can do, and the last two weeks have made this even more clear. I love the work I do and the people I work with and the company I work for. I am more fulfilled at this job than any I have had in years. No matter how difficult it is to go to work, I just can't envision my life with out this, but I want to be fair to my bosses too. They have a right to a worker who can actually get through a day without getting so ill she can't continue. I am trying my best to get better, but its not happening fast enough for me.

My mother and family are wanting me to quit and apply for disability. In all practicality, even if I wanted to apply for disability, there is no way for me to survive financially while I wait 18 months to two years for a disability determination hearing. In the U.S.A. [note: opinion not fact] you have a 99.9% chance you will be denied disability on initial application. I wonder what this administrative intensive process costs us as taxpayers compared to the miniscule savings it initiates by discouraging fraudulent claims? A false economy that was implemented by Ronald Reagan for political mileage in the 1980's. Time for this regulating rule to be revisited! And at the same time, make disabled citizens immediately available for Medicare, no 18 month waiting period.


  1. 18 months!!!! Holy crap. That's just wrong.

  2. The idea I think was to force people to use all their worldly possessions in order to receive healthcare, especially those with illnesses bad enough to be disabling, before the government would help. But maybe I'm just cynical???

    At least you live somewhere the government actually cares enough to provide health coverage for all. sigh.

    Hope you are feeling better tonight Sue. Praying your head pain is able to be better controlled!

  3. Very interesting post, Winny. Thanks for the shout out!

  4. The sad thing Heather, is I was thinking that maybe in the 32 years since I was diagnosed with migraines (at that time it was thought that the muscles of the veins/arteries were having seizures causing restrictions in blood flow) that medicine in all its advances would have found a real cause and a real cure. Guess not.

    Am I just being cynical again, or if this was some disease that affected mostly wage earning men instead of women that more resources would have been used to find effective management?

    There is still literature out there about the "migraine personality" as if it is a self-induced disease. Gripes me to the max.

  5. Agree completely...on the sexist thing and the self-induced crap. I don't know if "Migraine Brain" implies those things, but I've avoided that book because it seems like it might. I may read it one day, but now is not the right time. I need to chill a bit first! :)

  6. Interesting post!

    My last day at work was 11/26/2006. The Office of Personnel Management has yet to resolve my claim.

    I haven't even started on the Social Security part yet.

    My personal situation is a bit different. My mother and I live in the same house but still, I have no more money left. None.

    We had a good laugh that she might qualify to claim me as a dependent on her 2010 tax return.

    There is no fairness about this or anything. That's for the life to come, I'm afraid. I consider myself employed full-time at the job of getting well, and I begrudge Meniere's and Migraine and my other issues when they take even one of my six-days-out-of-seven work week.

    I am so sorry. I left a job I loved too. I was our department lead, earned straight-5's on my last three annual evaluations. They say you have to walk on water to get straight 5's where I worked.

    I can't blog like I used to, but I'd love to continue your thoughts because mine run similarly. I simply cannot believe that the Migraine I have is the same as the Migraine of someone who has one or two attacks a year.

  7. PS - no there is no fairness. I do think there are levels of headaches, and some people like you and I are on the bad end of the spectrum.

    I think disability law is far behind the times in recognizing the severity of the disability because most people have experienced a headache, and so they think "Oh they are just having headaches - I know what that is - it can't be disabling".

    There is no diagnositic criteria that says PS has these terrible awful dizzy spells and migraines and THIS is what it does. Do they think we would just quit doing what we love to do if we didn't have to??? Migraine covers such a spectrum of illness it seems like just a bucket they are putting everyone in because they don't have anymore buckets!!!