Friday, June 15, 2012

#NMAM Blogger's Choice: Strange Behavior - The Physiology of Migraine Mood Swings

Migraines are very interesting things because it's an attack on the whole nervous system. Migraine effects the whole body, and included in that is mood and behavior. One friend of mine became apologetic when he got his migraines. He couldn't stop apologizing for himself and thanking people. Beyond my strange cravings (cigarettes---the real kind---not the e-kind, Red Bull, chocolate, super-sugary candies), I have mood swings from here to Egypt. I can get super creative, sexually aggressive, and love the world (also known as hypomania), I can have panic attacks that freeze all decision making, or I can have deep, suicidal depressions. None of this is controllable through medication. I'll explain some of the reasons why.

One of the functions of migraine is that the body loses all serotonin. It loses its supply in the blood, it loses its supply in the brain. Migraineurs (those people who suffer from/survive migraines) just piss it out. It's measurable in the urine.
"Disturbances in serotonin levels are associated with most headaches. In migraines, serotonin levels increase before onset and then decrease during the headache phase. In chronic tension headaches, serotonin levels remain low all the time. As a result of lower serotonin levels, nerve impulses move along the trigeminal nerve to blood vessels in the meninges, the brain's outer covering. This causes blood vessels in the meninges to dilate and become inflamed and swollen. The result is a headache."
- Phyllis A. Balch, CNC, Prescription for Nutritional Healing, 4th Edition: A Practical A-to-Z Reference to Drug-Free Remedies Using Vitamins, Minerals, Herbs & Food Supplements

The initial burst of serotonin causes hypomania and/or panic attacks. There are short-acting drugs for the panic attacks, but no short-acting medications for hypomania. The subsequent lull in serotonin causes the suicidal depressions. There are no short-acting medications for that either. Additionally, drugs like SSRIs are useless. These drugs try to preserve the brains supply of serotonin by preventing re-uptake of serotonin by the cells. But when the brain is dumping it's supply.... That's like putting a lid on a bucket of water to try and keep the water from splashing out, when there's a hole in the bottom of the bucket. Most migraine abortive medications---the class of drugs known as the triptains---are serotonin-like molecules. They stop the migraine by "resupplying" the brain and the blood with molecules that look like serotonin.

Well, that's not exactly true. The triptains stop part of the migraine, but not all of it. Migraine actually starts deep in the brain stem, and "consistent with previous work, the [brainstem] activation persisted after pain was controlled by sumatriptan," one of the triptains (S. K. Afridi1, M. S. Matharu, L. Lee, H. Kaube, K. J. Friston, R. S. J. Frackowiak and P. J. Goadsby, "A PET study exploring the laterality of brainstem activation in migraine using glyceryl trinitrate," Brain, Volume 128, Issue 4, pgs. 932-939). Meaning, the triptains can take the migraine pain away, but that doesn't mean they've taken the migraine away. Which is why a lot of people experience a "rebound" headache (not really a rebound, since it's the same headache!) once the triptain wears off.
[For some of the best articles on migraines out there, see:
PBS Need to Know: Migraine Headaches
Scientific America: Why Migraine Strikes
Science News: Head Agony
If you can understand those, you can understand migraine.]

It's completely normal to expect with all this wacky brain chemistry going off, that besides the pain, there's going to be an emotional component. (Pain, itself, provides its own emotional components, triggering "fight or flight" emotions such as aggression or apologizing.) There are going to be mood swings as there are brain chemical swings. And since all this also kicks off the autonomic nervous system by causing physical stress on the body, the migraineur's ability to handle external stress is taxed. Now add to this that some people's migraines have tripped over into lasting every day... Sometimes for decades (I'm looking at you Kerrie Smyres)... Then emotional stability becomes something of an Olympic sport!

So goes the strange behavior of migraines. It's like mini-bipolar with pain, nausea, and a host of other symptoms (including, sometimes, loss of language skills and balance). Fun times! @.@

So What Do We Do About It?

First, we have to practice detachment, and remember that feelings are not facts. Just because I feel up or down, doesn't necessarily mean anything more than a brain malfunction. I need to measure the situation against reality and see if things check out. And even if they do check out, that doesn't then mean I get to go running down the field with my emotions. It means I think about the best possible outcome for the situation and taking aim for that. Have I a right to be angry? Sometimes, absolutely! But that doesn't mean it's a good idea for me to get angry; that has negative, physical side effects, plus it clouds my vision to opportunities---they're harder to see when I'm angry and it's easier to slip into self-pity.

We've got to practice positive thinking, daily, to stay strong. I'm not talking Pollyanna-type, sun-shiney, sugary sweet, bullcrap. I'm talking real soul-searching, find the good in this (even if you have to dig a mile down for that diamond) type positive thinking. One: Remember that your suffering can be used to help other people with their suffering. Two: Recognize that you are a survivor, even though you were drafted and didn't have a choice in the matter. Three: Recognize that you are learning to manage something that no one would choose for themselves; this isn't extreme-sports, weekends-only heroics---this is the real deal. Four: We have a unique wisdom about the frailty of human bodies, human minds, human promises, human technologies, and human institutions; we can appreciate when things work, that much more. Five: We have a unique ability to be there for other people like us (there is an understanding---a kinship). These are just a few automatic wins. These are the thoughts we can repeat to ourselves in the dark times so that the suicidal depressions don't end up in suicide. These are some of the reasons we have value as human beings, despite being sick. We have these values as a result of being sick!

Next, we need to use these values to re-frame or thinking about ourselves. We aren't just patients, we're healers, too---healing the hearts of others like us. We're not alone in our suffering, though it may be lonely and isolating. We're diplomats, extending the welcome to others with conditions like ours. We're educators, informing the public of scientific, medical, and political matters. We're activists, raising awareness for people with our condition. We're researchers, spending countless hours on the internet looking up patient information. We're project managers, administrating the near full-time job of records, medications, symptom-tracking, billing, insurance claims, etc., etc. We may be a miserable pile of pain-ridden goo, but we are at the same time, absolutely amazing. Our diseases may limit what we can do, but it doesn't limit who we are.

It's easy for us to lose sight of our worth, especially when migraines are so crippling. So remind yourself of your value from time to time. Be kind and forgiving towards yourself, like you would a sick child. Comfort, but don't spoil. We must be careful today to make a good tomorrow. We must forgive ourselves when we fall short. We must try when we have the strength and rest when we do not. Additionally, don't think that you lose worth from being sick. Our disease is nothing to be ashamed of, period. I don't care if you have migraines from a self-induced head injury. No one says, "Race you to the first neurologist's visit!" It's not the mistakes we make, it's our recovery from them that counts. That we're walking the road of dealing with a chronic illness has merit in itself, regardless of source.

Practicing these thought exercises helps shore up our emotions, so when those big depressive storms come, we can remind ourselves of the good things, and hold on until the storm passes.

"National Migraine Awareness Month is initiated by the National Headache Foundation. The Blogger's Challenge is initiated by www.FightingHeadacheDisorders.com."

27 comments:

  1. Excellent, informative post. Explanations of mood swings and the emotions of illness are hard to find and often difficult to understand. And your suggested coping mechanisms are great too.

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    1. And you even mentioned that before I had the link back set up to your blog!!

      Seriously, tho...Coming from you, that means a lot. Thank you.

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  2. Very helpful. I've been wondering about my emotional symptoms. As my pain gets better in general over the years, it seems often the strange moods are not. I've been wondering if it's "all in my head." ; ) It makes so much sense. The mind and body and spirit and emotions are one; it's just our culture that splits our miraculous (neurological) beings into separate parts. Thanks!

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    1. The body is lazy. It will use the same chemical for multiple different ways. And since serotonin is used up in wound healing, it makes sense to feel emotionally bad when "wounded" (because a migraine is a brain that thinks it's being injured by normal sensory input) so that we avoid wounding behavior. And it even makes sense for some people to be hypersensitive to the environment, like migraineurs are... we're out tribe's early warning system. I don't know about you, but I'm a human barometer. That would be a useful skill, among hunter-gatherer tribes.

      Medicine is unlearning it's mistakes (http://www.uctv.tv/search-details.aspx?showID=13074) but it takes a while for these changes to permeate the system.

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  3. I've been fighting migraines for 20 years - and depression the better part of that. How has no medical professional, ever, told me this ? Thank you. Thank you so much.

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    1. They probably don't know... In my experience, it takes about 10 years for cutting-edge medical theory to trickle its way into a GPs office. I was luck in Seattle, working with some cutting-edge doctors...

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  4. Remarkable article. Thank you. I have done so much research and nothing has made so much sense or been so clear until this. I feel so encouraged as well.

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  5. This is the second time now I've run across this article in my research. I remember crying in relief the first time I read it because it made so much sense and I knew I wasn't crazy. I think I will print it and keep a copy handy to read when I get discouraged. Thank you so much. Nothing else has made so much sense or been so helpful.

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    1. I'm so happy I could help you... I know the pain and frustration that comes with not having control over our own heads, or what goes on in them. I can just remember my teacher saying "I'm sorry, I'm sorry," over and over again when he got his migraines. That's when it finally hit me, and I verified it with my doctor... it's all the brain chemical storm - it's not *us*. Hang in there! And I'm glad to have helped. ^_^

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  6. Wow, so glad I found this. I've been noticing I become forgetful, irritable, nervous & teary for a week or 2 before I get a migraine. I also get visual aura's too.

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    1. A week or two is a *long* prodrome! Have you tried any SSRIs to see if that could help rid you of migraine side-effects? Visual Auras are caused by a lack of oxygen to the visual center of the brain as a result of cortical spreading depression (waves of low activity that move from the brain from back to front). Do they show up 2 weeks in advance too? (My guess would be no, but i want to be sure ;)

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  7. Thank god. how did this information take so long to find. i feel like the pre-migraine mood swings are almost worse than the pain (but i do take a triptan habitually), i get migraines almost every other day, and i was beginning to think i was bipolar along with everything else... So releaved! Still just the one problem, even if it has a milliom symptoms

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    1. They *are* almost worse than the pain, aren't they? It's just so frustrating that there's no medication that can help.

      Oh, and as an FYI, I hope you aren't taking triptains more that 3 times per week. If so, talk to your doctor about a more long-term medication. You don't want to risk going status migrainousis (daily migraine, sometimes lasting years).

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  8. My 10 year old daughter was recently diagnosed with migraine, but she only gets the aura with no pain. Several times a week she gets colored blobs in her vision. I've been getting very concerned about her mood swings lately, and even worried about bipolar. This article definitely gives me something to think about, thank you! I will printing this off for her appointment with the psychiatrist next month.

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    1. Be sure to Google migraine and serotonin. One feature of migraines is that our bodies flush our supply of serotonin from the blood and body. Triptains (rescue migraine medications) are all based off the serotonin molecule for this reason. Injecting a person with serotonin also works, but because of the body's dual use of the molecule as a vasoconstrictor and wound-healing agent, the side-effects are horrendous. Biochemists are trying to engineer a molecule which has the migraine relieving effects, without triggering other body responses.

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  9. Thank you for this--I'm on a hormone so I was blaming the extreme emotional roller coaster solely on that.

    I've had the vision loss in my left eye for about 10 years now before the pain comes, but 3 years ago the entire left side of my body started to go numb before a migraine in addition to the visual aura. Thinking it was a stroke the first time I had this type of migraine, I went to the ER. Nope, just an atypical migraine!

    My left arm is super numb right now and I've been so incredibly irritable and emotional, it dawned on me that perhaps my range of emotions were also a symptom of my migraines. Reading this is a relief on some level, because it confirms my suspicions and I can get a better idea as to how to treat it. Acupuncture is the ONLY relief from my migraines, if you haven't tried it, it is FAR better than the Rx you put into your body, especially because there are no horrible side effects (I'm also the lucky person who gets every side effect listed on the bottle, with the exception of death!)

    Thanks again for this post.

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    1. Acupuncture can be a huge help for those who can use it! I, unfortunately, have other health issues that make acupuncture a bad idea and was told after a few sessions that I shouldn't pursue it further. But it can help others, and I'm glad it's helped you!

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  10. A bit late to the game here, but thanks for a great article. 61 years old, migraine equivalent 40 years now (typically, visual aura with little to no headache, but other neurological syx such as speech aphasia and extremity numbness----negative for TIA). Might go several years w/o one, but recently had a swarm of three in five days.
    Interestingly, yesterday's was probably the most severe ever, and once I'd passed the "hangover" phase today and began to feel better-----I REALLY began to feel BETTER! As in hyponanic-better. Best of my knowledge, never had this happen before, or at least to this extent. But inbetween the 2d and 3d event yesterday, I swear I've never felt better.
    Nice to put some perspective on an otherwise inexplicable emotional state-----if anything, I tend towards mild, chronic depression. But fascinating explanation for all this!
    OK, I'm out, and finished with using exclamation points!

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  11. I am an MD and migraine sufferer who keeps it secret with colleagues because of fear of discrimination. Excellent post, as i have researched the literature and hardly ever found any reference to mood swings. I have mood swings, I am usually a happy person( to the point that someone would define me hypomanic) but before a migraine i get depressed, really really depressed to the point where i have wondered many times if i have either depression or bipolar. I am a person with very good self control, and despite my very short periods of depression and extreme sadness I do not qualify for a mood disorder. I have been given anything on the market, depakote and SSRI for prevention which did absolutely nothing for my headaches, but made my moods worse, triptans that work for the pain but not for the other symptoms, opioids that make me vomit nonstop. I always knew my moods came from the pain but never been able to communicate this to my doc, so I just keep it quiet since I am afraid of the stigma that goes if they should think i have a mood disorder, remember I am a frigging MD so I must be perfect. My aura is weird, all that happens is that i have a hard time articulating speech. Thing that works best beside sumatriptan which is a dangerous drug with many side effects is cannabis but it is illegal here and I cannot use it for that reason. The prescription policy tha rruins my life and also the life of my patients who do not get prtescribed whatever they need because of fear of addiction. I am not biased about pain, mostof my collelagues are, poerhaps because most of the most effective pain meds on the market come from mother nature (oppioids, cannabis) and do not make big money to the farma industry.
    Docs are happy to prescribe SSRIs even TCAs, which have potential for addiction and deadly side effects, because they are manipulated by the farmacologic industry which is Satan. Had they experienced the incredible pain I have they would change their mind.

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  12. Incredible article...Not all migraines are the same and side effects change. Maintain a strategic distance from those things that trigger a migrane. First off, don't smoke. Maintain a strategic distance from anxiety and quickly counsel the specialist in migraines.

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  13. I feel reborn after reading this. Have suffered from this my entire life, both migraine w/aura and "mood swings". How many psychiatrists know about this? Got the migraine dx after the psych; psych drugs/system never helped. Now I know why! Just came off a bad migraine/severe depression followed by relief and my "normal" mood. Lasted one day. Wrote better comment before, but took me hours to figure out how to post on here! Also, of course, some of us can't even have Triptans; I have hemiplegic migraine. Thanks again.

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  14. Here I am discovering a stunning blog once more, and laughing I preferred your depiction. Much appreciated such a great amount for imparting this online journal to us! Specialist in Migraine

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  15. Too good..very well connected how body n mind works n a complete solution.. It works .thanks for educating ..will go through this articale very often

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  16. Too good..very well connected how body n mind works n a complete solution.. It works .thanks for educating ..will go through this articale very often

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  17. The Information given on causes and cure of migraine is quite awesome. Do visit web health network for more information on Migraine it's causes and cure.

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  18. I was diagnosed in my early teens with migraine with aura - little/no pain but I lose 1/2 of my vision. After a recent fender bender, I had speech/comprehension issues that appeared to be a stroke - but nope...just a migraine.

    I left work today because everything was making me furious and I couldn't stop crying. It didn't occur to me until today that it could be related to migraines. I as relieved to find your article and find that it might just be another migraine symptom instead of me going completely crazy.

    Thanks for a great explanation! It's giving me a much better understanding of myself.

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