A Medical Irony: Migraine may actually prevent brain pathway damage caused by oxidative stress.

Here’s a new way to think about migraine. The chemical and physiologic changes that occur in and around the brain during an attack may actually be good for you! I know that may be hard to believe, because migraine is so incapacitating for so many

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people. But a lot of evidence from clinical and laboratory based research is starting to suggest that such is the case. Scientists call the phenomenon “neuroprotectivity”. And the concept is framed very nicely in an article by Jonathan Borkum, PhD, from the University of Maine, in this month’s edition of the Journal of Headache (Headache 2018;58:118-135). Several scientists over the last decade or more have postulated that migraine might provide “an evolutionary advantage as a defense against threats to the nervous system” or “a neural protection system”. And new thinking and research tend to support the notion. So, can there be a silver lining associated with migraine? At first glance it seems non-intuitive. But dig a little deeper and it just might start to make some sense.

Here is how the “migraine silver lining” possibly works. During migraine attacks, a lot of microscopic, chemical events with weird scientific sounding names take place. Things like serotonin release, CGRP release, plasma protein extravasation, and nitric oxide synthesis, to name a few. As it turns out, these events which are responsible for the head pain, nausea, light sensitivity, and other symptoms of migraine, are ironically suspected to also provide protection of brain cells from over-stimulation, burn out, and what we call oxidative injury. Pretty fascinating to say the least, huh? It is currently well accepted that the migraine brain is vulnerable or sensitized to activate certain pathways, even at a restful baseline state. These overly active or alerted brain cells, when stimulated by trigger conditions, become revved up even further and produce metabolism by-products called oxidants that cause oxidative stress. If exposed to oxidants for too long, those cells can be injured and they can even undergo something called apoptosis, or a sort of “burn-out death” of the cell. Fortunately, the aforementioned migraine chemistry changes provide anti-oxidant and other protective effects and may ultimately help preserve the health and function of neurons or brain tissue. It is very interesting to think of migraine as an auto-regulatory loop that protects the brain from over-stimulation due to migraine triggers. And that it does this by increasing anti-oxidant activity to protect brain cells and by causing the sufferer to withdraw from further stimulation. Every migraine sufferer has had headaches that make them want to lie down and get still in a dark, quiet place. This happens when the brain wants to withdraw from the world and protect itself from over-stimulation in order to recover from the attack. The whole thing starts to make a little more sense when you think about it in this way.

So what’s to be done about it? That is a great question. Migraine triggers are part of everyone’s life. Stress, hormones, weather changes, some foods, lack of sleep, dehydration, things that knock you out of your routine, etc. So these triggers can’t be completely eliminated from life. But perhaps with new understandings and better research, new medications and other interventions will be able to deliver the best of both worlds: reducing the migraine suffering without reducing the protective effects.  That would be the best way to improve quality of life and productivity for people with migraine and other disabling headache disorders. Being a researcher, I hope people will be motivated to get involved, support research, spread the word, and even volunteer if they are so inclined. Without research participants, we wouldn’t have any medicines at all. Either way, I would appreciate your ideas and feedback. We would love to know what you think about the concepts we bring to you with our blog.

Until next time, allow me to will leave you with a wise instruction I received a long time ago and strive to live by: “Use things, not people. Love people, not things.” Let’s all try to do our part to make the world a healthier place. So long for just a while…

Tim

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