Knowing the Beast

Every year nearly 1 billion people suffer from migraines. There’s even this fancy name for them, migraineur. If you say it with an outrageous french accent it sounds so…sophisticated. Except that it is the 6th most common cause of disability on the planet. To put this into perspective, it affects about twice as many people as diabetes or asthma, and in numbers similar to genital herpes.

I don’t suffer from migraines, my husband, Stuart, is one of those 1 billion people who do. So let’s say that each of these 1 billion people has two people that care about them and hate to see them suffering; then this disability, it’s the medical literature’s word not mine, impacts a total of 3 billion people! Let’s not even consider the impact on productivity and the workplace.

I think we can safely say with this back of the envelop calculation that half the people on the planet are impacted by migraines. It’s a massive health problem.

The best practice treatment for migraines is pretty straight forward; (1) avoid your migraine triggers, (2) if you get a migraine, take your medication and (3) wait for previously mentioned medication to break the physiological aspects of the pain cycle. If your migraines are frequent enough you may be placed on medications that might reduce their frequency. Good luck because you are going to get migraines and come back when you need a refill on those prescriptions.

OK, step 1 avoid your migraine triggers. First you go through the tedious process of determining them through the oh so fun method of trial and error. It’s a bit like Russian Roulette where error results in a migraine. Most migraineurs can list their triggers off and a lot of these are foods.

Since a lot of triggers are foods, then there should be some diet recommendations, right? I mean there are dietary recommendations for all kinds of disabilities. Diabetes, FODMAP and SIBO for gut disorders and even genital herpes – all integrate diet as a component of their management. So the scientist in me was amazed to learn that the total extent of the dietary recommendations is to avoid your triggers.

Seriously, #6 on the health disability list can do better than that. There must be enough science out there that some better informed diet choices can be made. Sure enough, when I started to look and pull the story together there was.

Migraines are a complicated beast. They result from a series of physiological responses in the brain that has a very dedicated scientific community working very hard to try and figure out. So the story behind how diet might be able to help manage the frequency and severity of migraines is complicated.

Here in the learn section; I’m going to try and do my best and explain it to you. Each Sunday I’ll make a post, and if you can find 15 minutes and a quiet space, I promise it will be worth it. Remember best practice, it’s up to you to avoid your triggers and I hope that this can help you.

So let’s get started with some things you can do this week to help avoid your triggers. To do that you need to know a few things about how migraines work. I’ll go into this in greater depth in upcoming posts, but here are some basics.

All migraines result from a swelling of blood vessels, vasodilation, in the brain. The swollen blood vessels push on the nerves and that causes the pain. In response to being activated the nerves then release a molecule called CGRP, Calcitonin gene-related peptide, which in turn causes more vasodilation. It’s a cruel feedback loop. She’s a nasty beast.

The primary action of the most common medications to abort migraines, sumatriptan and indomethacin, is to stop vasodilation by inhibiting the physiological pathway that causes it. Vasodilation is mediated by the molecule nitric oxide (NO). NO is a really important molecule and has lots of functions in the body. You can’t live without it. So migraine medications don’t remove the molecule, they just inhibit its uptake by cells. It’s still floating around in your bloodstream looking for a cell that needs it to do something important.

Spoiler alert, it turns out that a lot of the triggers for migraines actually activate the physiological pathway that makes NO, the fuel of the migraine beast. Just as an example, eating something spicey results in the creation of excess NO in your arm which goes into your bloodstream looking for something to do. Let’s hope it doesn’t find those blood vessels in your brain.

So let’s start with the simple premise that we don’t want to feed the beast. Here are three simple lifestyle changes you can make reduce the amount of excess NO:

  1. Cut preservatives out. Preservatives are usually nitrates and nitrites of some sort. Nitrates and nitrites can be used by the body to make NO. You get plenty of the base materials to make NO in your food. You don’t need to throw in some extra chemicals because they will be used.
  2. Remove added MSG in all its forms. You get plenty of glutamate in a healthy diet so you don’t need to add any. Read the label of your food and don’t eat it if it has yeast extract, flavour enhancer, hydrolysed vegetable protein, soy extract or malted flours. These are all MSG by another name. I’m sorry, but no more chicken salt. Don’t be surprised if this one makes you cry.
  3. Quit alcohol and second hand smoke. These two normally go hand in hand for some strange reason, but they act in different ways. The liver detoxifies alcohol using, you guessed it, NO. Second hand smoke causes the lungs to synthesis NO. Excess NO made by these massive organs gets dumped into the bloodstream and well you can take it from there.

Remember to always consult with your healthcare team before undertaking any lifestyle changes.

Informed by science, cooked by you.

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One thought on “Knowing the Beast

  1. Pingback: Migraineur’s Lament of Hidden MSG | Headache Free Foodie

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