WHAT ARE MIGRAINES?
Migraines are very much misunderstood by scientists, physicians, and everyday people. Migraines are either considered to be vascular disease1, neurological disease2, or the combination of to two3 or “mental disease”4. Research also suggests that migraineurs often suffer from Hypertension is more commonly known as high blood pressure…. and metabolic syndrome5. Some of these may serve as migraine symptoms or comorbidities but don’t define what migraine is. Migraine is not a headache either; migraine need not even be accompanied with pain in the head, though the majority of migraine sufferers do get pain.
Migraine can only be generated by a genetic-variant-brain. This type of brain poses metabolic limitation and homeostatic challenges of what a migraineur can safely eat and drink without generating a migraine. To comply with the demands of such a brain is not easy in our modern nutritional world. Take the Standard American Diet (SAD) away from a migraineur, replace it with a diet that is appropriate for her metabolic limitations, and migraines and comorbidities disappear. Scientific studies are close to impossible to fund without the promise of a medicinal solution that can be readily monetized.
Over 15% of the global population has migraines6; it is too large of a percentage to consider it accidental.
Migraines have three distinct stages:
- Prodrome – it can start from a day to minutes before the migraine and may contain one or more of the following: nausea, vomiting, diarrhea, dizziness, vertigo, anxiety, heart palpitations, feeling very cold, yawning, one eye becomes very small, edema, irritability, euphoria, full of energy, emotional crash, craving of salt or sweets, forgetting words and names, tingles under the skin anywhere, RLS, fight-or-flight, ataxia, coma, convulsion, muscle twitching, electrical shocks, auras, blurred vision, inability to read, inability to talk, pain in the eye area, Meniere’s disease, tinnitus, IBS, changes in urination frequency, changes in urine color, sound, light, or odor sensitivity, feeling exhausted and beat up, thirsty, puffy eye lid over one eye, black circle under one eye, edema, loss of body functions on one side of the body, stroke-like symptoms, etc. A prodrome can be almost any change from the norm, a highly individualized condition, that the migraineur has to learn to recognize.
- Migraine – usually lasts 48-72 hours, in some cases even longer
– classic: severe pain on one side of the head—often the same side and same spot; steady dull pain, no throbbing and no change in intensity upon moving the head.
– complex: may or may not have pain but has visual aura. There are over 30 different types of visual auras
- Postdrome – usually lasts 24-48 hours; extreme exhaustion, brain fog, memory block, speech difficulties.
Migraine is the symptom of a biochemical imbalance in electrolyte mineral density. Migraineurs have hyper sensory organ sensitivities7 and more sensory neuronal connections than typical,sup>8. The cascade of events that follows excess stimulus depletes sodium chloride (salt) that is important for neuronal voltage generation and communication. As a result, some regions become unable to generate action potential. Migraineurs use more energy for voltage generation9-12 as a result of their hyper sensitive sensory organs. They pass 50% more sodium in their urine than normal, showing extra sodium use13. A brain in need of higher sodium concentration is not a sick brain; it merely needs a different nutritional regimen with higher sodium for the necessary electrolyte density.
Voltage is generated by voltage dependent ionic pumps in neuronal membranes, facilitating ionic exchanges between the intracellular and interstitial space. The inability of the ionic channels to respond to electrolyte imbalances are often referred to as ionic channelopathy, albeit this has not yet been recognized in association with migraines14,15. Moreover, migraineurs become deficient in those neurotransmitters that neurons with reduced electrolyte mineral concentrations cannot make. An under-supply of some electrolyte mineral sets off changes in the brain that can lead to migraines. Where in the brain those changes occur determines the type of symptoms a migraineur experiences. What may cause such electrolyte homeostasis dysfunction in a migraine brain?
THE ROLE OF CARBOHYDRATES
Carbohydrates convert to glucose via metabolic processes. As glucose enters cells, it removes water and sodium from the cell16, causing electrolyte disruption. Migraineurs have genetically reduced abilities to use exogenous glucose and have an exaggerated response to when glucose enters the cells. This is suggestive that migraineurs may have a Carbohydrates are the primary source of energy for the body as they can be broken down into glucose (sugar) more readily than either protein or… intolerance. Voltage generation requires 6 key elements to be present in ample amounts in electrolyte: sodium, chloride, What it does: Enables nutrients to move in and waste products to move out of cells, promotes healthy nerves and muscles, maintains fluid balance in…, What it does: Promotes a healthy heart, clots blood, promotes healthy nerves, contracts muscles, improves skin, bone and dental health, relieves aching muscles and bones,…, What it does: Strengthens bones and teeth, promotes healthy muscles by helping them to relax, also important for PMS, important for heart muscles and nervous…, and ATP.
Water must also be present in the right amount. Migraineurs have higher than normal serum calcium17, which has important role in the hyperactive brain, releasing neurotransmitters in greater amounts than normal. Any form of carbohydrates (simple or complex) disrupt electrolyte homeostasis because excess glucose dehydrates18. While glucose removes sodium and water from everyone, migraineurs are much more sensitive to the ensuing imbalance as a result of genetic variances that prevent the resetting of electrolyte homeostasis (see ATP1A2, 3 (ATPase Na+/K+ Transporting), CACNA1A (Voltage-gated Calcium channel), SCN1A (Voltage-gated Sodium Channel). KCNK18 (Potassium Channel), SLCxxx (all solute carriers in several GLUT families), etc.,)19.
THE ROLE OF SODIUM
Since many studies established the hyperactive nature of migraine brain, the extra neuronal connections it possesses, the increased sodium-use (as it is seen in excreted urine), and the more frequent and larger amplitude action potentials, the consumption of plentiful sodium chloride plays a significant role in securing electrolyte homeostasis. Anecdotal evidence, based on the past nearly five years with thousands of migraineurs in my dedicated Facebook group, has shown that a protocol of reducing carbohydrates and increasing sodium chloride is capable to prevent all migraines, even while the migraineurs titrate off their medicines and after they are medicine free.
A MIGRAINE PROCESS
Academic literature is lacking in the proper description of migraines. After years of work based on my study of thousands of migraineurs, I was able to create a coherent picture of the cascade of steps it takes to a migraine. As a scientist, who is also a migraineur, I am in an unusual position of being able to describe these events and find their relationships to the cause and symptoms of migraine. A migraine, be it with aura or pain or both, always starts with one particular event and proceeds from there like falling dominos until the outcome is a migraine. In hyper alert mode7, the slightest odor or sound difference, motion of a leaf, etc., imply the subconscious possibility of danger. Thus, the first domino in the chain is anxiety, though the migraineur may not feel anxious. Anxiety’s function is to alert the body to release stress hormones, which initiate an increase of glucose in muscles,sup>20, increase heart rate21, and as a result, the migraineur starts yawning in order to get more air into her lungs.
The fight-or-flight mode kicks in and as digestion stops; if there is anything undigested in the stomach, it will be vomited up, or if in the intestinal tract, a very urgent bowel movement (often diarrhea) will follow22. This is the IBS-like step in the cascade leading to a migraine. Next, given the impeding danger ahead, the released Adrenaline is a hormone produced by the adrenal glands during high stress or exciting situations. This hormone is part of the ‘fight or flight’ response…. and the increased heartbeat and oxygen supply enhance the ability for either a confrontation with the perceived danger or running away from it. This is the fight-or-flight response. Since a migraineur today does not proceed to run during a prodrome, restless legs syndrome (RLS), dizziness, and irritability are the typical consequences. Everything I have just described is an integral part of “getting away from danger”23. Migraineurs also see better in the dark, an aid to get away from danger24. Most migraineurs have very vivid dreams and restless sleep that is not associated with anxiety, perhaps also as a result of being partially awake and listening for danger25.
The adrenaline release of the fight-or-flight response is an evolutionary response to some real danger. In our modern world, this reaction is most often elicited by a perceived danger. When a migraineur senses a perceived danger, it is not any different in her brain’s reaction from that of a real predator. Given the large percent of the population with migraines26, the evolutionary nature of this special brain is the genetic foundation of migraines. All of these steps are present in all migraineurs before a migraine appears—though not all are noticed by them all the time. Sadly, many migraineurs are medicated for each independent cascade-step as if these were independent diseases27.
Food craving (without hunger) is another classic cascade step. Many migraineurs crave sweets before a migraine, even if they are fully stuffed. The brain, in most cases, uses glucose for energy but glucose cannot get into the neurons without functioning voltage dependent ionic channels and the proper amount of sodium. Thus craving represents shortage of voltage energy, and if sodium is not increased, some neurons will run out of fuel and stop generating action potential. Studies point to the importance of magnesium, a critical element providing energy for all cells, including neurons, since it is the “key” to opening the voltage gated pumps28. Voltage gated calcium channels are high-voltage channels that require more sodium-rich electrolyte and more calcium—migraineurs are endowed with more calcium than normal29 and hence they need a higher sodium-rich diet.
Voltage leaks are a hallmark of many health conditions and migraines as well. Voltage leaks occur as a result of damage to the myelin sheath that provides insulation for the electrical communication between neurons. Voltage leaks prevent neuronal communications. Due to the increased voltage activity of a migraine-brain, the potential for myelin sheath damage is high. We can prevent this by supporting the greater cholesterol and There are many different types of fats; polyunsaturated, monounsaturated, hydrogenated, saturated and trans fat. The body requires good fats (polyunsaturated and monounsaturated) in order to… requirements of the brain30,31. Myelin damage is also caused by glucose and Insulin is a hormone made by the pancreas. It is responsible for making the body’s cells absorb glucose (sugar) from the blood….32,33.
Much blame has been placed on the influence of female hormonal variations as the cause of migraines. If migraines have a direct correlation with the presence and fluctuation of female hormones alone, one would assume that anyone who lacks such hormonal changes—men, or small children, or women who are post menopause—would not have migraines, but they do.
UNDERSTANDING THE NUTRIENT-MIGRAINE CONNECTION
There are three macronutrients and two of the three have essential role in our body. The macronutrients are:
- carbohydrates (not essential)
- fats (essential)
- Proteins are large molecules consisting of chains of amino acids. Proteins are essential nutrients for the human body – they are a building block of… (essential)
Of the three macronutrients, carbohydrates are not essential—meaning the human body can make all the nutrients they provide from other sources. Fats (fatty acids) and protein (Amino acids are commonly known as the building blocks of protein. There are 20 standard amino acids from which almost all proteins are made. Nine…) are essential nutrients and so we must eat them. Over 50% of proteins also convert to glucose during Metabolism is a term that is used to describe the chemical reactions that take place within the body’s cells. The body gets the energy it…, based on the protein’s amino acid composition. Macronutrients convert to Acetyl CoA, the “food” mitochondria use to generate energy.
It makes no difference to the mitochondria what we eat. However, there is a huge difference in what happens to the food we eat in the process of conversion to Acetyl CoA. Most migraineurs have chronic insulin resistance or diabetes mellitus type 234. Migraineurs should reduce the consumption of carbohydrates by quitting grains, starches, all sweeteners, juices, smoothies, tropical fruits, milk substitutes, and processed foods.
HOW TO PREVENT MIGRAINES
The greater need for salt by migraineurs needs to be met all day and all night long. Migraineurs need to hydrate properly with salt and water all through the day and need more water and salt than the general population. The minimum water need is weight dependent: 55% of the weight (lbs) in ounces.
Example: 60 kg weight => 132 lbs => 132 * 0.55 = 73 ounces (2 litres) or 9 glasses of water minimum a day.
- Drinking one glass (8 oz) water at once all the time is essential.
- Sipping all day long doesn’t hydrate sufficiently. Migraineurs on the Stanton Migraine Protocol® start the day with an 8 oz glass of water and 1/8th teaspoon salt [henceforth salt]; eat low carb, high fat (LCHF) meals that are always balanced in potassium and sodium at 1:1 ratio in mg (use of nutrition database is essential).
- A LCHF diet is defined as 50-70 net carb grams for women and 65-100 net carb grams for men35. After each meal with 12g net carbs, salt is taken with just a sip of water—no water should be drunk for 30 minutes.
- Every second glass of water should be taken with salt and every 4th glass of water with a handful of potassium rich unsalted nuts/seeds. Finish the evening with a glass of water and salt.
Once the migraine has started, to test if salt or potassium is needed, place a tiny amount of salt (salt test) under tongue; a few salt crystals. Don’t drink, swallow, or talk. As it absorbs, it will make the migraine better (reduce aura, nausea, pain, etc.,) if you need more salt. If so, take salt with only a sip of water. If this makes the symptoms worse, spit it out and eat an avocado or similar high potassium containing food without salt. Feel free to drink water at this time.
1 Schottstaedt, W. W. & Wolff, H. G. Studies on headache: Variations in fluid and electrolyte excretion in association with vascular headache of migraine type. A.M.A. Archives of Neurology & Psychiatry 73, 158-164, doi:10.1001/archneurpsyc.1955.02330080036011 (1955).
2 Lipton, R. B. & Pan, J. Is migraine a progressive brain disease? JAMA 291, 493-494, doi:10.1001/jama.291.4.493 (2004).
3 Fabjan, A., Zaletel, M., #x17d & van, B. Is There a Persistent Dysfunction of Neurovascular Coupling in Migraine? BioMed Research International 2015, 11, doi:10.1155/2015/574186 (2015).
4 Antonaci, F. et al. Migraine and psychiatric comorbidity: a review of clinical findings. The Journal of Headache and Pain 12, 115-125, doi:10.1007/s10194-010-0282-4 (2011).
5 Guldiken, B. et al. Migraine in Metabolic Syndrome. The Neurologist 15, 55-58, doi:10.1097/NRL.0b013e31817781b6 (2009).
6 WHO. Headache Disorders. (World Health Organization, 2012).
7 Schwedt, T. J. Multisensory Integration in Migraine. Curr Opin Neurol, 248-253 (2013).
8 Tso, A. R., Trujillo, A., Guo, C. C., Goadsby, P. J. & Seeley, W. W. The anterior insula shows heightened interictal intrinsic connectivity in migraine without aura. Neurology, 1043-1050 (2015).
9 Liu, H. et al. Resting state brain activity in patients with migraine: a magnetoencephalography study. The Journal of Headache and Pain 16, 42, doi:10.1186/s10194-015-0525-5 (2015).
10 Tessitore, A. et al. Abnormal Connectivity Within Executive Resting-State Network in Migraine With Aura. Headache 55, 794-805, doi:10.1111/head.12587 (2015).
11 Pietrobon, D. Insights into migraine mechanisms and Ca(V)2.1 calcium channel function from mouse models of familial hemiplegic migraine. The Journal of Physiology 588, 1871-1878, doi:10.1113/jphysiol.2010.188003 (2010).
12 Ambrosini, A., De Noordhout, A., Sándor, P. S. & Schoenen, J. Electrophysiological studies in migraine: a comprehensive review of their interest and limitations. Cephalalgia 23, 13-31, doi:10.1046/j.1468-2982.2003.00571.x (2003).
13 Campbell, D. A., Tonks, E. M. & Hay, K. M. An Investigation of the Salt and Water Balance in Migraine. British Medical Journal, 1424-1429 (1951).
14 Catterall, W. A., Dib-Hajj, S., Meisler, M. H. & Pietrobon, D. Inherited Neuronal Ion Channelopathies: New Windows on Complex Neurological Diseases. The Journal of Neuroscience 28, 11768-11777, doi:10.1523/jneurosci.3901-08.2008 (2008).
15 Kullmann, D. M. & Waxman, S. G. Neurological channelopathies: new insights into disease mechanisms and ion channel function. The Journal of Physiology 588, 1823-1827, doi:10.1113/jphysiol.2010.190652 (2010).
16 Longo, D. L. et al. Harrison’s Manual of Medicine 18th Edition. (McGraw Hill Medical, 2013).
17 Yin, P. et al. Serum calcium and risk of migraine: a Mendelian randomization study. Human Molecular Genetics 26, 820-828, doi:10.1093/hmg/ddw416 (2017).
18 Polozkova, V. Dehydration & Hyperglycemia
19 Science, W. I. o. The Human Gene Database
20 McCowen, K. C., Malhotra, A. & Bistrian, B. R. Stress-Induced Hyperglycemia. Critical Care Clinics 17, 107-124, doi:10.1016/S0749-0704(05)70154-8 (2001).
21 Fuller, M. D., Emrick, M. A., Sadilek, M., Scheuer, T. & Catterall, W. A. Molecular Mechanism of Calcium Channel Regulation in the Fight-or-Flight Response. Science signaling 3, ra70-ra70, doi:10.1126/scisignal.2001152 (2010).
22 Tarbell, S. E. & Li, B. U. K. Anxiety Measures Predict Health-Related Quality of Life in Children and Adolescents with Cyclic Vomiting Syndrome. The Journal of Pediatrics 167, 633-638.e631, doi:10.1016/j.jpeds.2015.05.032 (2015).
23 Adeniyi, P. O. Stress, a Major Determinant of Nutritional and Health Status. American Journal of Public Health Research 3, 15-20, doi:10.12691/ajphr-3-1-3 (2015).
24 Tedeschi, G. et al. Increased interictal visual network connectivity in patients with migraine with aura. Cephalalgia, doi:10.1177/0333102415584360 (2015).
25 Lin, Y.-K. et al. Associations Between Sleep Quality and Migraine Frequency: A Cross-Sectional Case-Control Study. Medicine 95, e3554, doi:10.1097/md.0000000000003554 (2016).
26 Baigi, K. & Stewart, W. F. in Handbook of Clinical Neurology Vol. Volume 131 (eds Lotti Marcello & L. Bleecker Margit) 447-463 (Elsevier, 2015).
27 Yavuz, B. G., Aydinlar, E. I., Dikmen, P. Y. & Incesu, C. Association between somatic amplification, anxiety, depression, stress and migraine. The Journal of Headache and Pain 14, 53-53, doi:10.1186/1129-2377-14-53 (2013).
28 Mauskop, A. & Varughese, J. Why all migraine patients should be treated with magnesium. Journal of Neural Transmission 119, 575-579, doi:10.1007/s00702-012-0790-2 (2012).
29 Xue, M. & Rosenmund, C. The Headache of a Hyperactive Calcium Channel. Neuron 61, 653-654, doi:10.1016/j.neuron.2009.02.015 (2009).
30 Martín, M. G., Pfrieger, F. & Dotti, C. G. Cholesterol in brain disease: sometimes determinant and frequently implicated. EMBO reports 15, 1036-1052 (2014).
31 Vance, J. E. Dysregulation of cholesterol balance in the brain: contribution to neurodegenerative diseases. Disease Models and Mechanisms 5, 746-755 (2012).
32 Tomlinson, D. R. & Gardiner, N. J. Glucose neurotoxicity. Nat Rev Neurosci 9, 36-45 (2008).
33 Cermenati, G. et al. Diabetes-induced myelin abnormalities are associated with an altered Fats, oils, waxes and sterols are collectively known as lipids…. pattern: protective effects of LXR activation. Journal of Lipid Research 53, 300-310, doi:10.1194/jlr.M021188 (2012).
34 Casucci, G., Villani, V., Cologno, D. & D’Onofrio, F. Migraine and metabolism. Neurological Sciences 33, 81-85, doi:10.1007/s10072-012-1047-4 (2012).
35 Marksteiner, K. The 3-Step Process to Determining Your Ideal Carbohydrate Intake,