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Migraine 101

According to the World Health Organization, migraine is the third most common disease overall and the most common neurological disease worldwide.

A migraine attack is not simply a “bad headache”. On the contrary, apart from severe pain, a migraine often includes intense sensitivity to light, sound, and/or smell, as well as nausea and vomiting.

Beyond the physical symptoms migraine also means loss: loss of control, of the ability to plan, of quality of life, independence and, perhaps, of a job, hobbies or even friends and family who might distance themselves from you due to a lack of understanding or an inability to cope.

The development of migraine is governed by multiple factors and most likely a huge number of different genes. In practice, what this means is that a genetically predisposed individual must also be exposed to an environment that triggers those genes to be expressed.

Migraine is considered a spectrum disorder. Clinical and pathophysiological features may progress over time, with episodic migraine on one end of the spectrum and chronic migraine on the other. Chronic migraine, which affects 1.4%-2.2% of the population worldwide, is defined as fifteen or more headache days per month, out of which eight must meet the criteria for migraine. It’s worth noting that each year, approximately 3% of episodic migraine attacks become chronic.

Energy Metabolism

Living organisms, such as us humans, are unique in that they can extract energy from their environment and convert it into a form that they can use. 

Metabolism - in simple terms - is the process by which your body converts what you eat and drink into energy. During these complex chemical reactions, the energy generating nutrients found in food and beverages is combined with oxygen to create the energy currency ATP that your body requires to function.

Mitochondria are the powerhouses that supply all organs and cells with ATP. Thousands of coordinated, multi-step metabolic reactions happen at all times and in parallel to keep our cells and hence our organs (such as the brain) healthy and working. All the chemical reactions that take place inside of a cell are collectively called the cell’s metabolism.

The most energy-hungry organ is our brain. Yet it cannot store energy very well and is therefore highly dependent on energy sources from the rest of the body. 

Like a laptop without a battery, it quickly dies once it’s ‘unplugged’. Another challenge for the brain’s high energy needs comes in the form of the protective blood brain barrier, which excludes the passage of large, energy-dense molecules, such as long-chain fatty acids. 

In fact, only three molecules can feed the brain in sufficient quantities: 

  • Glucose
  • Lactate
  • Ketone bodies

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Migraine and Metabolism

Since the brain orchestrates most behavior, it’s essential that it has a constant energy supply. Any shortfall in the ATP levels required to sustain the body’s reactions and organs properly, will have severe consequences. However, your brain cannot tell you that it needs more food, or to stop expending energy. What it can do is send signals that force us to change our behavior, to prevent harm. A migraine attack is probably the most potent of these signals.

Neuroimaging studies, which can directly quantify brain ATP, show a decrease of 16% between attacks in patients with migraine without aura, compared to healthy controls. This is one of the pieces of evidence supporting the hypothesis that a mismatch between energy availability and energy utilization could be a cornerstone of migraine pathophysiology. In short, the brain gets hungry but there’s not enough food in the cupboard! 

Mitochondria are often called the “powerhouse of the cell” because this is where the bulk of our energy (ATP) is produced. Thus, when mitochondria are functioning sub optimally, our cells are generating suboptimal amounts of energy. A lack of micronutrients, oxygen or any other substance required for mitochondrial functioning as well as increased oxidative stress are all factors that can impair the capacity of mitochondria to produce energy for us. Micronutrient deficiencies or an increased demand for these micronutrients, as well as increased oxidative stress or a decrease capacity to neutralise this oxidative stress, as well as general mitochondrial dysfunction have all been linked to migraine and can be addressed through dietary management.

In essence, it is likely that migraine attacks are due to the brain not receiving an adequate supply of energy and/or mitochondria not functioning due to lack of proper nutrients, rendering the brain vulnerable to an energy deficit. This can create stress for the brain, ultimately promoting symptoms of migraine, which in turn forces you to rest and conserve energy.