Migraine Headaches May Cause Brain Damage, Mouse Study Shows (2007)

This is an old article which I came across today - but I found it very interesting - I am sure that HM causes some kind of damage, which can not yet be seen on the scans. Otherwise why does it take so long to get over the damn things..... They can see the wave move across the brain during an attack, how do they know if the brain goes back to normal after the wave has passed............. for example - I had a big HM on Friday and I am sure the wave has stopped moving............. yet I am still slow, fragile and numb on my left side...........

What do you all think?

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ScienceDaily (Apr. 30, 2007) — Migraines may be doing more than causing people skull-splitting pain. Scientists have found evidence that the headaches may also be acting like tiny transient strokes, leaving parts of the brain starved for oxygen and altering the brain in significant ways.

The scientists say the work makes it crucial for migraine sufferers to do everything they can to prevent their headaches. While avoiding severe pain has long been a motivating factor, the scientists say the risk of brain damage makes it imperative to prevent the headaches, by avoiding a person's triggers for the headaches and by using medications prescribed by doctors to prevent them.

"Normally, the focus of migraine treatment is to reduce the pain. We're saying that migraines may be causing brain damage, and that the focus should be on prevention, which will stop not only the pain but also minimize potential damage," said Maiken Nedergaard, M.D., Ph.D., the neuroscientist who led the research team. She is a professor in the Department of Neurosurgery and a member of the Center for Aging and Developmental Biology and worked closely with Takahiro Takano, Ph.D., research assistant professor, who is first author of the paper.
By combining two recently developed imaging technologies, Nedergaard's team was able to get an unprecedented look at the events that happen in the brain of a mouse as a migraine unfolds. The team uncovered a complex, unexpected tale of supply and demand regarding blood flow and oxygen.

In short, the team found that the brain develops a voracious demand for energy as the organ attempts to restore the delicate chemical balance that is lost in the initial throes of a phenomenon known as cortical spreading depression, which is thought to underlie many migraines.

Even though the brain's arteries expand dramatically and make a great deal more oxygen-rich blood available to meet the demand for energy, some parts of the brain still wind up experiencing severe oxygen shortage, or hypoxia. This causes parts of brain cells' sophisticated signaling structures to disintegrate, similar to what occurs when a person has a mini-stroke, or after a severe injury, or when blood flow to the brain is completely stopped, such as during a heart attack.

"In mice, the damage from these episodes looks exactly like the damage that occurs to the brain from repeated TIAs, or transient ischemic attacks," said Takano. "It's long been known that patients having a migraine attack are functionally impaired from the pain. It's also been shown recently that with repeated migraines, a person's cognitive abilities decrease. But actually doing damage to the brain -- that is a surprise."

Deborah Friedman, M.D., a neurologist who was not involved in the study, says that a few studies have found that people who get auras with their migraines are at increased risk for vascular problems like heart attack and stroke. The Women's Health Initiative, for instance, found that such women had a 50 to 70 percent higher risk of stroke compared to other women. And a study led by Michel Ferrari of Leiden University in the Netherlands showed that in women under the age of 45, those who suffered from migraines were much more likely to have the type of brain damage done by a stroke, even though they had never reported symptoms of stroke.

Friedman, a member of the board of directors of the American Headache Society who has treated thousands of headache sufferers, echoes Nedergaard's call for a greater emphasis on prevention.

"It's astounding just how many migraine sufferers do not see a doctor and are not on a medication to prevent a recurrence," said Friedman, professor of Ophthalmology and Neurology. "It's estimated that less than 20 percent of people who should be on preventive treatment receive such treatment. Doctors and patients need to be diligent and rigorous about using preventive medications for migraine."

The work puts the visual disturbances known as auras that many migraine sufferers report in a different light. The aura that precedes the headaches for at least one out of four migraine sufferers might involve floating black spots, flashing light, or some other visual changes. Nedergaard says those disturbances might actually be a visual sign that parts of the brain are short of oxygen.

In the work described in Nature Neuroscience, Nedergaard studied a phenomenon known as cortical spreading depression, or CSD. The process is now considered by many scientists as the basis for some migraines, particularly those involving an aura. CSD is an electrical event that initially involves a burst of intense activity among the neurons on the surface of the brain, followed by a gradually spreading wave of suppressed brain cell activity.

Many scientists believe that the phenomenon contributes to injury from stroke and from traumatic brain injury as well as migraine.

While it's been widely recognized that CSD underlies some migraines, Nedergaard's team linked the phenomenon for the first time to both severe hypoxia and to damage to brain cells. As a result of CSD, the team found changes to the synapses, the connections between brain cells known as neurons. The team observed that nerve cells swell and begin to disintegrate, with neurons shedding important connections known as dendritic spines -- the tiny extensions of an individual neuron's body that usually number in the thousands within a synapse. Mice in the grasp of a migraine lost up to three-quarters of these important cellular components.

Ironically, the team found that during CSD, even though blood flow in the brain overall increases dramatically, some parts of the brain still suffer from a lack of oxygen.

The problem begins as the brain tries to recover from CSD, which throws the proportion of crucial ions like potassium and sodium out of balance, taking away the brain's ability to function efficiently. This change in the proportion of chemicals gradually sweeps across the brain like a slowly spreading wave.

The brain, in turn, is under tremendous stress, developing a voracious appetite for oxygen as it works frantically to restore the proper chemical balance. Oxygen-rich blood pours into the area to allow brain tissue to work overtime; the team found that the brain's arteries expand by more than 50 percent to keep up with the demand.
It's at this stage that Nedergaard observed the unexpected: While blood flow increased, bringing more oxygen overall to the brain, there were still pockets of severe hypoxia. The brain was working so hard to restore the chemical balance and to resume normal cellular function, using so much oxygen, that the brain simply couldn't keep up with the demand.

"Basically, even though the body has really stepped up the availability of oxygen, the brain's demands for oxygen are suddenly so great that the blood vessels in the brain can't keep up," said Nedergaard. "It's a mismatch between supply and demand."

Brain tissue closest to the oxygen-rich blood vessels soaks up the oxygen as fast as they can, leaving tissues further away with a diminished supply. It's like a pride of lion cubs fighting for their mother's milk -- a few may get nudged away, go without, and will eventually die. In a brain in the midst of cortical spreading depression, brain cells closest to oxygen-rich blood vessels survive, while cells further away don't get access to the oxygen and are in jeopardy.

"People have always thought that in order to treat a migraine, you treat the pain. We're going beyond that. Migraines could be dangerous. The focus should be on prevention," said Nedergaard, who notes that by the time a person feels pain or notices a visual disturbance, the changes to the brain are already well underway.To make the finding, the team used a sophisticated laser system known as two-photon imaging to look at the activity of live cells in the intact brain of a mouse. They combined that with a new technique to precisely measure how brain cells allocate and use energy.

http://www.sciencedaily.com/releases/2007/04/070430102025.htm

i agree with you tee , i never come fully right after a severe migraine , i have learning difficulties and memory problems , im on a soft diet still after 4 months . any trauma to the brian is serious , and i dont think drs take it seriously enough.

I dont have anything like that at all.
I have pain, when it is gone, I am back to my usual myofascial pain.
No ill effects from the migraine at all.
But then I dont get aura, is this the difference?

It could well be Fron - I think migraines are clumped together and in time they may show that different things cause different types.... still a lot we do not know...

Hi!

I agree with Tee and Fron- it takes me several days to recover from a migraine: I tend to find that my cognitive skills are slower, I feel spaced out and find social contact hard as a result. The accompanying word finding difficulties that I sometimes get, don't help, either!!

At the risk of digressing from the topic, here is a little about me. I have suffered from migraines since my teens. I have recently been diagnosed with "Atypical migraine" by my current neurologist. I was diagnosed with Basilar migraine 13 years ago from a different neuro. I do sometimes wonder if I might have HM as I get weakness on my left side (sometimes during an attack- I notice it especially with my arm (e.g. on lifting my son) and my leg (walking with a limp). Guess diagnosis does not matter too much now as I am taking migraine prophylaxis (nortriptyline 10mg, verapamil 180mg at night). This treatment has reduced the frequency and severity of the attacks and allowed me to return to work. Very relieved!!

Hi Rosie and welcome

I am so pleased to read you have found a preventative that works for you

Re the diagnosis - There is quiet a difference between basilar and HM and since you have left side weakness it might be worth asking your nero about this - btw you can have more than one type - but if you have HM then you have to go careful with triptans - that is if your taking them - so it might worth mentioning it.

Was it just the medication which helped you or have you done others things aswell?

Tee

Hi Tee

Great to get your reply so quickly. Nice to meet you.

Re: meds: certainly was a relief to get something that at least reduces the severity and frequency of them but it took about six months before the meds fully kicked in (including about eight weeks off work). I also reduced my caffeine intake and tried to regulate my sleep time. Just wish the migraines would fully disappear as they certainly make work/ childcare/homelife hard at times.

AS for diagnosis, I know what you mean about BM and HM being quite different. I was told about ten years ago by an American neuro that although my most frequent migraine presnetation was BM, I also presented with several other types of migraine (but was not informed of which). I do seem to get different types- I have noticed that i don't get the dizziness/tinnitus/back of head headache (BM) when I get my left sided weakness- instead the left of my head/face aches etc..I've had common migraines, too. Classic migraine and common migraine run in the family. I think my migaines are changing as I get older. They almost disappeared when I first had my children but then came back with a vengeance several years later.

I think your warning re triptans is important. I was advised to avoid triptans by my frst neuro due to vaso constriction/stroke risk, so have never taken them, luckily!

Really good to 'talk' to you.

Rosie

What you have said is quiet normal - migs can change over the years and you can have more than one type and often they go when you are pregnant (why I have 4 kids lol)

Do you keep a diary - you sound like you have made such great progress - I know it has taken time - but it does - but you have found something that works and that is the important thing........... now its a bout fine tuning it and getting it even better...

Hence why I mention a diary - they can help spot triggers - or do you know your triggers?

this might help - https://migrainetalk.forumotion.co.uk/t330-types-of-triggers

Also have you ever tried any supplements? A few on here (including myself) have found magnesium to help?

tee

Hi Tee

I've tried complex vitamin B in the past which seemed helpful, but not magnesium. My main triggers seem to be interrupted sleep (children!!!), bright/flickering light, hormones, stress mainly. Most of these are hard to control unfortunately.

Thanks for the information!

Rosie

- I totally understand ....

Sleep is a big problem - have a look at the conversation running between Pav and Kala -

https://migrainetalk.forumotion.co.uk/t765-status-migrainosus

Thanks, Tee. Will do.

Rosie

Great article! Thanks for sharing it!

I have HMs as well as Migraine with Aura. I was one of those people who has a very sharp mind that can figure out just about anything. I co-authored 3 technical books on computers in the late 90's, before the migraines became such an issue. Since 2005, I have watched my sharp, astute mind deteriorate into into something I do not recognize. I don't remember most of the books I have read, I don't remember movies I have seen, TV shows that I loved. I completely forgot how to do math (I was a math major for part of my college days).

I am at my worst after an HM and it can take weeks for me to come back. I don't really seem to come back all the way any more. The MRIs and CT scans show nothing, but I really think that there is something happening in the brain that does not show up on the scans.

BTW ... it took me about 2 hours to write this. That is how badly my mental process has been impacted by the migraines.

Have a lovely weekend,

Scarlett