Migraines and Low Level Light Therapy
Migraines are a Complex Neural-Vascular Syndrome and More than Just a Headache
Migraine is more than just a headache; it is a complex neural-vascular pain syndrome (this means that the nervous system, as well as the blood vessels of the brain, is involved in the pathogenesis of this syndrome); which evolves through multiple phases.
Migraine is a recurrent disorder affecting approximately 12% of the population. It frequently starts in childhood, particularly around puberty; and affects women more than men (3:1 female-to-male ratio).
Genetically speaking, migraine is a complex familial disorder, meaning that multiple genes are involved. An individual’s genetic factors (many related to alterations in ion channels and/or regulation of glutamate neurotransmission), coupled with certain hormonal and neuro-chemical stimuli, interact and result in dysregulation of brain cortical and brainstem excitability. This dysregulation leads to activation of the neurons and glia of the cerebral cortex of the brain, which in turn alters the individual’s pain perception pathway, and subsequently leads to changes in the blood vessels of the brain, including enhanced blood-brain barrier permeability. The pain of migraine is due to both blood vessel dilation in the meninges (membranes which cover the brain) and neurogenic inflammation.
Migraine is a major cause of world-wide disability. More than 3/4 of migraine suffers can’t function normally during an (untreated) migraine attack. The impact of the burden of migraine, however, is not limited to the migraine attacks themselves. Migraine sufferers have an increased risk for other physical and psychiatric conditions. Migraine is a truly devastating condition for many people.
This is especially true since migraine most commonly affects individuals during a highly productive period of their lives (attacks are most frequent between the ages of 22 and 55). Perhaps even more devastating is the fact that migraine afflicts a significant percentage of children. Half of all migraine sufferers have their first attack before the age of 12.
There are four migraine stages: prodrome, aura, headache, postdrome. Not every migraine consists of all four stages.
- Prodrome: warning signs that a migraine is beginning; also called the premonitory phase. The prodrome typically precedes the headache by several hours or even several days. Approximately 1/3 of migraineurs experience a prodrome. Prodromal symptoms/warning signs are myriad and include: fatigue, depression, irritability, food cravings, yawning, muscle tenderness, neck stiffness, photophobia, phonophobia, osmophobia, anhedonia, sleepiness, increased frequency of urination, difficulty speaking, hyperactivity, constipation or diarrhea.
- Aura: transient focal neurological perturbations which originate from the hypothalamus, brainstem, and/or cortex. Migraine aura typically lasts 5 – 60 minutes. Approximately 1/4 of migraneurs experience an aura. Aura is caused by cortical spreading depression (CSD), a slowly propagating wave of depolarization/excitation followed by hyperpolarization/inhibition in cortical neurons and glia. Aura symptoms include: hypersensitivity to feel and touch (allodynia), aphasia (impairment in language), auditory hallucinations, confusion, dizziness and/or vertigo, decrease in hearing, temporary paralysis or weakness of one side of the body (hemi-plegia or hemi-paresis), olfactory hallucinations, tingling/paresthesias, numbness, burning sensations of the body.There are numerous visual aura symptoms including: presence of wavy lines, blind spots, blurry vision, partial loss of sight, flashes of light that streak across the visual field (phosphenes), scotoma (regional loss of vision), hemianopsia (loss of half of the visual field). There is even a rare aura symptom known as “Alice in Wonderland” syndrome, in which there is metamorphosia. This means that an individual experiences a visual distortion of body image and perspective (the migraineur knows that the distortion is not real). This aura symptom most often occurs in children. Lewis Carroll, the author of Alice’s Adventures in Wonderland, was himself a migraine sufferer.
- Headache: begins with activation of meningeal nociceptors (pain receptors) at the origin of the trigemino-vascular system. Pain throbs and intensifies with increase in intracranial pressure with associated nausea, vomiting, abnormal sensitivity to light (photophobia), sound (phonophobia), and smell (osmophobia). Also abnormal skin sensitivity (allodynia) and muscle tenderness. Routine physical activity may aggravate the pain of migraine. The headache phase of migraine typically lasts from 4 -72 hours (if left untreated).
- Postdrome: may last up to 24 hours after the attack. You may feel drained and washed out. Other symptoms experienced in the postdrome phase include: confusion, moodiness, dizziness, weakness, sensitivity to light and sound, or sometimes even elation.
The premonitory/prodromal symptoms of migraine are largely of hypothalamic origin. (The hypothalamus, which is the region of the brain responsible for linking endocrine system and nervous system functions, is the brain structure in control of maintaining the body’s internal homeostasis). Many of the potential prodromal symptoms of migraine, such as food cravings and sleepiness, are related to alterations in the body’s homeostasis.
The initiation of the aura phase of migraine is thought to involve ion channel alterations which lead to cortical spreading depression. There is subsequent trigeminal nerve activation with consequent release of neuro-peptides; including calcitonin-gene related peptide (cgrp), vasoactive intestinal peptide (vip), pituitary adenylate cyclase activating polypeptide-38 (PACAP-38), and substance p. Presynaptic release of these peptides leads to migraine headache pain (headache phase of migraine) via mechanisms of meningeal vasodilation and neurogenic inflammation.
The profound changes in brain activity and cerebral blood flow that occur during the aura phase and headache phase of a migraine attack often persist even after head pain has ended; this is regarded as the postdrome phase of migraine.
Medications/Treatments for Migraine:
- Elimination of Triggers
- Acetaminophen or Non-Steroidal Anti-Inflammatory Agents (such as ibuprofen) are utilized for mild migrainous attacks.
- Two classes of medications, Triptans (such as Sumatriptan) and Ergots (such as Dihydroergotamine), are serotonin receptor agonists. These medications prevent release of cgrp, reverse cgrp-induced vasodilation, and consequently interrupt pain signals from periphery to brainstem.
Low Level Light Therapy Can Help.
Low Level Light Therapy can help alleviate the symptoms of migraine. Not only does LLLT diminish inflammation in the body (which is linked to the pain of migraine); it is also utilized to treat many of the co-morbid features of migraine (such as sleep deprivation). A significant percentage of migraine sufferers do not seek treatment for their condition.
Some of these individuals are concerned about medication side effects; others are unaware of the multiple options that are available to help prevent and treat migraine pain. If you are a migraine sufferer and want to learn more about how LLLT may help alleviate some of the pain and suffering associated with your migraine, then please call Dr. Candice Perkins for a free phone consultation.
Potential Migraine Triggers:
- Red wine
- Skipping meals
- Changes in weather and/or barometric pressure
- Sleep disturbances (sleep deprivation or sleep excess)
- Hormonal factors (e.g. menarche, menstruation, post-partum, menopause, oral contraceptive use)
- Certain foods (e.g. aged cheeses, salty foods, processed foods)
- Sensory overload (e.g. flashing lights, strong odors, loud sounds)
- Intense physical exertions, including sexual activity
- Headache is usually unilateral (one side of the head is involved); however bilateral headaches may occur as well (involving both sides of the head)
- Headache is throbbing or pulsating in nature; moderate-to-severe in intensity
- Headache frequently affects the peri-orbital area (region around the eye) and the eye itself.
- Because the trigeminal nerve becomes inflamed during a migrainous attack, pain may also occur in the sinus area, and the teeth and jaw.
- Photophobia (light-induced exacerbation of pain)
- Phonophobia (sound-induced exacerbation of pain)
- Osmophobia (smell-induced exacerbation of pain)
- Allodynia (abnormal skin sensitivity)
- Muscle tenderness
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