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Migraine 101

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

A migraine attack is more than a “bad headache”. Apart from severe pain, a migraine often includes intense sensitivity to light, sound, and/or smell, as well as nausea and vomiting.

Beyond physical symptoms, migraine can also cause negative psychological and social effects including feelings of loss of control, low quality of life, and social isolation.

The development of migraine is governed by multiple factors including genetics. A genetically predisposed individual must also be exposed to environmental
triggers for migraine genes to be expressed.

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

Energy Metabolism

Energy Metabolism

Living organisms including humans, have the ability to extract energy (calories) from their environment and convert it into a usable form.

The most energy-hungry organ is the brain. However, the brain cannot store energy effectively and is therefore highly dependent on the body.

Another challenge for the brain’s high energy needs is the protective blood brain barrier, which blocks 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

Migraine and Metabolism

Since the brain orchestrates most behavior, a constant energy supply is essential. Any shortfall in the ATP levels required, can cause severe consequences. When levels are low, the brain sends signals forcing behavior change. A migraine attack is probably the most potent of these signals.

Neuroimaging studies, which can directly quantify brain ATP, show a 16% decrease between non-aura migraine attacks in sufferers, compared to healthy controls. This supports 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 referred to as the “powerhouse of the cell” because this is where the bulk of energy (ATP) is produced. Thus, when mitochondria are functioning sub optimally, so too is cellular energy production. Increased oxidative stress, a lack of micronutrients, oxygen or any
other substance required for mitochondrial functioning can all impair cellular energy production. Micronutrient deficiencies or an increased demand for these micronutrients, as well as increased oxidative stress or a decrease capacity to neutralize 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 an inadequate supply of energy to the brain and/or mitochondria dysfunction stemming from lack of proper nutritrion. Both render the brain vulnerable to an energy deficit. This can create stress for the brain, causing symptoms of migraine, which in turn forces you to rest and conserve energy.