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Conari Press, an imprint of Red Wheel/Weiser, LLC  is the publisher of Sharron's book, Migraine: Identify Your Triggers, Break your Dependence on Medication, Take Back Your Life -  An Integrative Self-Care Plan for Wellness," released June, 2013. Follow Sharron on Twitter @murraysharron, and her page Sharron Murray, MS, RN on Facebook, for tips to help you battle your migraines and achieve wellness.

 

Monday
Apr142014

The Hypothalamus, Homeostasis, and Migraine -"Rock steady down the line"  

 

There is no cure for migraine. However, the more we know about our disease, the more we are able to gain control over our attacks and our lives. 

A number of studies have associated migraine with several areas in the brain including the brainstem, the cortex, the thalamus, and most recently the hypothalamus. In this article, to gain more knowledge about the vulnerability of our "migraine brain" and how this sensitivity to change affects the frequency of our attacks, we explore

  • the hypothalamus and homeostasis, and
  • hypothalamic activity and migraine. 

HYPOTHALAMUS AND HOMEOSTASIS   

The hypothalamus is an endocrine gland located deep within the brain above the brainstem. The main function of the hypothalamus is to regulate homeostasis, or our bodies' equilibrium (balance). To maintain homeostasis, the hypothalamus controls and integrates the functions of our endocrine systems, sympathetic and parasympathetic branches of our autonomic nervous systems (ANS), and multiple other biologic systems. It produces, releases, and is responsive to transmissions from a number of neurotransmitters and neuropeptides. And, it produces a variety of hormones sensitive to a feedback loop from other hormones. 

Through these mechanisms, the hypothalamus regulates a number of our bodies' functions including

  • blood pressure and heart rate, 
  • fluid and electrolyte balance, 
  • body temperature, 
  • metabolism, 
  • digestion, 
  • hunger,
  • thirst, 
  • sleep-wake cycles, 
  • alertness, 
  • ovarian and testicular function, 
  • sex drive, 
  • emotions like anger and joy, and 
  • behaviors such as aggression. 

For example, take hunger. When our stomach is empty it releases the hormone ghrelin, which activates parts of the hypothalamus that makes us feel hungry. When we have eaten, the hormone leptin is released by the body's fat stores and causes the hypothalamus to inhibit hunger and create a feeling of fullness.

Another example of how the hypothalamus maintains homeostasis, and one that is critical to our survival, is our bodies' response to a real or perceived threat (stressor). In this instance, the hypothalamus takes charge and through the sympathetic branch of our ANS and the hypothalamic-pituitary-adrenal axis (HPA), tells our adrenal glands to release a flood of hormones including, but not limited to, epinephrine (adrenaline), norepinephrine (noradrenaline), and cortisol. Our heart rate, blood pressure, and respirations increase, our skeletal muscles tighten and get ready for action, and almost all of our other body systems gear up to fight the challenger. We feel focused, energetic, and alert and sleep is inhibited. We know this as the "fight or flight" stress response. When the threat has passed without harm, levels of our stress hormones, and in turn our bodies' systems, return to normal.

HYPOTHALAMIC ACTIVITY AND MIGRAINE

Recent studies and reports (Denuelle et al, 2007, Charles, 2013 and Maniyar et al, 2013) have shown hypothalamic activation with migraine. This hypothalamic activity is thought to be especially important in the premonitory (prodrome) phase of our migraine attacks and could explain many of the symptoms we experience including 

  • changes in mood,
  • alterations in wakefulness and alertness,
  • fatigue
  • food cravings,
  • yawning,
  • fluid retention, and
  • thirst.

Other arguments for hypothalamic involvement include

  • the circadian rhythmicity of the onset of migraine attacks, with a peak incidence in the early morning,
  • the fact that sleep disturbances like insomnia and prolonged sleep are migraine triggers, and,
  • the correlation of hormonal fluctuations with migraine frequency in females  (Denuelle, 2007).

Triggers

Although more research is necessary to determine where, how, and why our migraine attacks are triggered, it has been suggested that the key may lie in the hypothalamus as migraine is commonly activated by a change in homeostasis (Alstadhaug, 2009 and Maniyar et al, 2013). Given the number of body functions the hypothalamus regulates to maintain homeostasis, some examples of migraine triggers that may fall into this category include

  • magnesium deficiency,
  • hormonal fluctuations,
  • dehydration,
  • hunger- dieting, fasting, skipped meals (hypoglycemia),
  • change in sleep patterns (oversleeping, disrupted, inadequate),
  • fatigue (exhaustion) 
  • emotions,
  • fever,
  • allergies, illnesses like flu and colds, 
  • foods and beverages (Many of these can affect neurotransmiters like serotonin and glutamate. Those with additives, dyes, chemicals, MSG, and other artificial ingredients may cause sensitivities and inflammatory or immune reactions), and
  • stress*.

*Stress may contribute to the initial onset of migraine attacks in those of us with a predisposition to the disease. Other potential effects of stress on migraine are thought to include: can act as a trigger for migraine attacks, increase our susceptibility to other triggers; amplify attack duration and severity; increase attack frequency and the risk for progression to chronic migraine; and, as migraine itself can be a stressor, create a vicious cycle. We should know that recent studies have shown "increasing stress resulted in increasing headache days" and "there is a striking association between reduction in stress and the occurrence of migraine headaches".

Stressors

Given the stress response is an adaptive mechanism regulated by the hypothalamus to maintain homeostasis in the face of a real or perceived stressor, we need to take a closer look at stressors. In an in-depth report from the University of Maryland (Seekers, 2013) on the causes, diagnosis, treatment, and prevention of stress, common stressors are listed as: 

  • noise,
  • video games,
  • cell phones,
  • crowding,
  • loneliness,
  • hunger,
  • danger,
  • infection,
  • pain,
  • work pressures,
  • relationship problems, and
  • financial worries.

Health- related problems

The report goes on to say that if these stressors are persistent (chronic), they can wear out the HPA axis and increase our susceptibility to a number of diseases and disorders like heart disease, hypertension, asthma, obesity, diabetes, cancer, erectile dysfunction, decreased libido in women, menstrual irregularities, sleep disturbances, depression, anxiety and panic disorders, allergies, infections, and immune disorders like colds and flu. 

*For those of us with migraine, we need to be aware that some of these health-related problems can make us more susceptible to our migraine triggers. For example:

  • Persistent emotions like worry and fear related to job pressures, or unhappy relationships, can lead to alterations in our sleep patterns, fatigue,
  • Colds and flu can make us susceptible to dehydration and hypoglycemia, and
  • Menstrual irregularities can aggravate hormonal fluctuations and exacerbate our hormonal migraines.

Conditions and factors that may make us more likely to have health-related problems, influence our response to stress and make us at higher risk for stress

Conditions most likely to produce health-related problems are thought to include:

  • persistent stressors that a person cannot easily control such as work pressures and unhappy relationships,
  • persistent stress after an acute traumatic event, and 
  • persistent stress accompanying a serious illness.   

 Factors  that may influence a person's response to stress are thought to include:

  • people who have been abused in childhood - they may have long-term abnormalities in the HPA axis,
  • people who may over-respond to stressful events,
  • genetic factors that effect the relaxation response of stress, and 
  • immune regulated diseases such as rheumatoid arthritis may weaken the response to stress.

 Factors  that may make individuals at higher risk for stress are thought to include:

  • older age as the stress response may become less efficient, and there may be an increase in stressors like medical problems, loneliness with loss of spouse and friends, change in living situations and financial worries,
  • women, in particular working women whether married or single,
  • financial strain, especially with long-term unemployment and if there is no health insurance,
  • people who are targets of racial or sex discrimination, and
  • people who are less educated, divorced, widowed, isolated, lonely, and those who live in cities.   

*For those of us with migraine, additional conditions and factors to consider include 

  • fear of pain associated with a migraine attack,
  • whether one has enough medication to handle the pain,
  • whether insurance will cover the cost of medication,
  • fear of when an attack may occur, for example the first day of a new job or the onset of a vacation,
  • decrease in productivity because of migraines can increase work pressure,
  • loss of jobs because of the frequency of attacks can not only interfere with relationships, but  lead to persistent financial worries, and 
  • comorbid diseases and disorders.

Rock steady down the line

In an editorial, "Stress and migraine"  by Peter J. Goadsby, M.D., PhD, (2014), he says, "There is an emerging consensus that the migraine brain is vulnerable to change, such as sleep and stress, and therefore best kept stable."  In the study, "Reduction in perceived stress as a migraine trigger" (Lipton et al, 2014), the study co-author Dawn Buse, PhD, says "This study highlights the importance of stress management and healthy lifestyle habits for people who live with migraine". 

As I think about these statements, a quote by Dr. Alvin Augustus Jones comes to mind. "In the Soul Train Life, your daily routine is your rhythm for success. Never permit unscheduled events or unorganized passengers to derail your soundtrack. Rock steady down the line and always stay in beat with your heart."  

While researchers continue to define the exact relationship between the hypothalamus, homeostasis, and migraine, to help me understand my migraine brain, I think of it as the "Soul Train Life". Consistency in my daily routine is paramount to a successful wellness plan. Healthy lifestyle habits (e.g., eating and sleeping patterns, exercise) and stress reduction practices (e.g., biofeedback, meditation, guided imagery, and breathing techniques) help me keep "unscheduled events or unorganized passengers" (triggers and stressors) from derailing my soundtrack, or in other words setting off a migraine attack.

I hope, along with the information in this article, this analogy helps you understand more about your migraine brain, decrease the frequency of your migraines, and experience a more full, happy, and healthy life with migraine.   

Rock steady down the line.

References:

Alstadhaug, K. B. (2009). "Migraine and the Hypothalamus". Cephalalgia.29(8): 809-17. 

Anderson, P. (2013, July 02): 'Migraine Really Is a Brain Disorder". Medscape Medical News.  

Charles, A. (2013). "Migraine: A Brain State". Current Opinion in Neurology 26(3): 235-239. 

Chrousos, G. P. (2009). "Stress and Disorders of the Stress Syndrome". Nature Reviews Endocrinology. 5(7): 374-381. 

Denuelle, M., MD., et al (2007). "Hypothalamic Activation in Spontaneous Migraine Attacks". Headache. 47(10):1418-1426. 

Dougherty, Ph.D. "Chapter 1:Hypothalamus: Structural Organization." Neuroscience Online".  UTHealth/McGovern Medical School. Universityof Texas:Houston 

Goadsby, P.J. (2014). "Stress and migraine". Editorial. Neurology. Published online before print March 26. 

Lipton,R.L., M.D., Buse, D.C., PhD., et al (2014). "Reduction in percevied stress as a migraine trigger." Neurology. Published online before print March 26. 

Maniyar, F.H., et al (2013). "Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks". Brain. 137(1):232-241. doi.1093/brain/awt320. First published online before print November 25, 2013. 

Seekers, J. "Stress". ( 2013, June 26). University of Maryland Medical Center: http://umm.edu/health/medical/reports/articles/stress  

Sharron Murray MS, RN is an author and coauthor CaMEO Study, "Life With Migraine". Currently, Sharron is active in the migraine community as a writer, advocate, American Migraine Foundation Partner, moderator for the American Migraine Foundation "Move Against Migraine" Facebook Group, and member of the National Headache Foundation Patient Leadership Council. 

Follow Sharron on twitter @murraysharron, her FB page, Sharron Murray, MS, RN, and her website, www.sharronmurray.com 

This article is not a substitute for medical advce. If you have specific concerns about your health or nutrition, please contact a qualified professional.

Copyright 2014, Sharron E. Murray 

Updated November 15, 2018 

 

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