Mind Zapping Monkeyshines

The Klonopin Must Go

The last few months I have been taking clonazepam in order to sleep better [which in theory will decrease my overall pain levels] starting at .5 mg, then 1 mg, and this last week have been increasing it by .5 mg every other night until I was up to 2.5 mg.  The instructions were to increase it until I got a good night's sleep without waking up at 2 AM and without feeling drugged in the morning when I got up to go to work.

My overall headache pain levels have been increasing all summer long and last night I finally made a correlation between the increased dosage of clonazapam (Klonopin) and the growing pain.  Not only did I have a headache on the bad side of my head but I was starting to get an overall headache all the time.  I stopped the clonazepam last night and woke with much less head pain.  Headache, or a hangover type headache, seems to be a fairly common side effect for this medication.  Just my luck.  If sleep comes in short shrift (like last week) I may try taking it again. 

Got a good day's work done today, even though I had to delay going to work in the AM because The Headache itself was not behaving.  My "entire head" headache was gone, but The Headache decided that this morning was its day to play.  I finally lulled it back to semi-sleep with ice and then drove to work.  It's always a gamble on days like today if I will make it home from work, or just make it to the ER.  Hoping that when the clonazepam totally gets out of my body (which may take a day or two) The Headache will calm itself down, and I won't feel like such a wilted lily.

Have been trying to control my nervous system with my biofeedback CD.  Mostly I am just having trouble controlling the CD player which is wanting to skip.  Of course this is not conducive to being in a meditative state so I guess my nervous system is just railing about out of control wrecking havoc throughout my body.  I did changeup my occipital stimulator settings today to see if that might jog the brain cells to quit colliding.  It's somewhat like a nuclear explosion - when the bouncing brain cells collide enough times I hit critical mass and The Headache explodes.

In the news today was an article about the discovery of a genetic difference that many common migraine sufferers (like me for years and years) share concerning the storage/usage of glutamate. Glutamate and nitric oxide work together, and apparently glutamate can start cascades of neural signalling which effect diseases such as epilepsy and autism.  The article states that an overload of glutamate may be why the migraine begins, essentially sending too many signals to the synapses and starting the migraine process. The researchers hope to find a way to inhibit the overload or to prevent the resulting signals in order to control migraines without aura (common migraine).  Since a lot of research and  many medications are geared to migraine with aura because there is a warning that a migraine is going to occur, new medication options for migraine without aura would be a great stride forward towards controlling this disease.

Interesting Theory About Migraine

Is Migraine a Disease or a Syndrome?

In the May 2010 issue of Neurological Sciences there is an interesting article entitled "Is Migraine A Disease?" by Cortelli, Pierangeli, and Montagna.  This article theorizes that migraines themselves are normal functions of the body to what the primitive brains of our ancestors saw as threats.  When these threats (or triggers) are experienced a cascade of chemical and neurological changes occur as the body attempts to negate the effects of the threat. 

One area directly stimulated by these responses is the hypothalamic region of the brain, which is closely related to the "Fight or flight" response.  In sensitive individuals if the threats/triggers are detected too frequently, the body starts to anticipate the threat, increasing the reaction and shortening the response time.  After many repetitions the condition becomes chronic, resulting in migraine as a malfunction, rather than migraine as a defense mechanism.

Cortelli, et.al., make the point that many of the common triggers for migraine (hunger, lack of sleep or too much sleep, alcohol consumption, light, noise, smell, and stress p. s30) could be seen as threats to brain function.  The brain desires to mitigate these threats, and when overwhelmed creates what Cortelli, et. al., describe as excessive allostatic load.  Allostasis is the body's active response to restore and maintain homeostasis (normal levels of stress hormones and energy), and allostatic overload results in continued heightened response to stimulus, often in excess to the threat offered.

"Four types of allostatic states leading to allostatic load have been identified
(1) repeated challenges,
(2) failure to habituate with repeated challenges,
(3) failure to shut off the response after the challenge is past, and
(4) failure to mount an adequate response." (p. s30)

The theory put forth is that migraine pain, nausea, photophobia, phonophobia, and sensitivity to odors is a normal defense mechanism of the brain.  The abnormal behavior in the migraineur's brain happens when allostatic load is increased frequently and the brain becomes habituated to it and starts to "short circuit".  Perhaps that is why many migraineurs find solace in a dark quiet room, lying very still - all threats are minimized and the overactive circuits are able to stop firing.

The authors speculate that "Migraine attack may not be considered a disease itself but in presence of a failure of the mechanisms controlling an excessive allostatic load, the repeating of migraine attacks may lead to a morbid state (chronic migraine)." Cortellis, et. al state that the migraine spectrum is a syndrome not a disease or dysfunction, and that more research needs to be done to find the exact mechanism that turns the primitive midbrain response into a chronic pain condition. (p. s30- s31).

In a post I did entitled "Does Anyone Really Know What Causes Migraines?"  I wrote "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."  I guess I could modify this thought with this caveat "or a syndrome with varying causes masquerading as a disease".

My headache disorder, hemicrania continua, is mediated by the hypothalamus.  Perhaps my primitive midbrain/hindbrain is in constant alarm state, not able to turn itself off - that could explain the bone weary fatigue that goes with it.  I think I must have hit myself in the head too many times in past lives with a rock and am paying the penalty now.  Guess my primitive bonehead needs more space for the brain!  After all this scientific hoohah babble I have been writing, I think perhaps what brain I have is shriveled up like a raisin.

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.