The emotional turmoil of migraine: Are we doing all the right research to prevent it?

As some of you reading this may know, people who experience migraines often describe the condition using phrases such as “more than just a headache” or “not just a headache”.  In one recent article the author, Victoria Stokes opened it by stating that “Migraine can be debilitating — not just in the physical sense, but in an emotional sense, too.” (https://www.healthline.com/health/migraine/the-emotional-impact-of-migraine). Then earlier this year Dr Luisa Dillner, writing in the Guardian, posed the brave and challenging question “Are my emotions giving me migraines?” (https://www.theguardian.com/lifeandstyle/2016/apr/18/are-my-emotions-giving-me-migraines

Photo by Aarón Blanco Tejedor on Unsplash

While some will argue that migraines are due to ‘abnormal brain activity’ and not emotions, surely the question should then be: What causes the abnormal brain activity?  In my view, and with my Lifestyle Health Foundation ‘hat on’ plus a combination of neuroscience training and lived experience, there must be a trigger for that ‘activity’. 

I wonder how many of you reading this, whether you are a person living with migraines, are aware of the research linking them to a disconnect between mind and body; a disconnect that may have been triggered when the person suffered significant emotional ‘hurt’ or ‘acquired mind injury’, which is perhaps more commonly referred to in the scientific and medical literature as ‘trauma’ or ‘abuse’. 

It was only back in 2016 that Gretchen E Tietjen and colleagues published the research paper, “Emotional Abuse History and Migraine Among Young Adults” in Headache, the journal of the American Headache Society. In that paper they conclude that “Emotional abuse during childhood contributed more than physical or sexual abuse in the development migraine.” They then state that “There is a dose-response relationship with increased number of abuse types associated with rising odds of migraine”, which for me strengthens the association between emotional turmoil (disrupting the mind-body connection) and migraine. There is now a growing evidence-base in the literature to support this association. You only need type into Google Scholar “childhood abuse trauma and risk of migraine” and you will be presented with several relevant papers. 

When I completed my PhD, back in 2003, which was in the field of nerve injury and neuro-immunology, I hadn’t heard of the book “Molecules of Emotion”, which was originally published in 1997 by the leading neuroscientist, Candace Pert.

Now that I have read it (and in which she describes the brain as being “like a bag of hormones” with “messenger molecules”) suddenly the research that formed my PhD seems to strengthen this association between emotions, physical and mental hurt, and migraine. 

In short, the key observations from that were:

  • Messenger molecules also known as neuropeptides (the one I studied was Calcitonin Gene-Related Peptide (CGRP)) travel up and down nerve fibres (axons) including the sciatic nerve, in the body. 
  • CGRP binds to different cells including those that are part of the immune system as well as cells of the nervous system and relays a message into the cells and for the cells to then respond.
  • When the nerve fibre is physically hurt (cut or crushed) the transport of CGRP up and down the axon is stopped, causing it to accumulate at the damaged site and then seep out into the environment which becomes inflamed, due to the injury. 
CGRP activity in the sciatic nerve

Now, I suspect you may be wondering what the relevance of these observations are to migraine and its prevention. I hope it will now become clear. 

In an announcement earlier in 2021 from the Migraine Trust, the leading charity working to support and provide patient care, Professor Goadsby, one of their trustees, was congratulated (along with 3 other scientists) for winning this year’s Brain Prize. “This award is for four decades of research that paved the way for the development of an entirely new class of migraine drugs which are transforming the lives of many people with migraine. These are calcitonin gene-related peptide (CGRP) monoclonal antibodies (MABs), which are the first preventive medicines specifically developed for the treatment of migraine.”

My basic interpretation of this ground-breaking research is that they have created antibodies, which are molecules that bind to and essentially reduce the availability of CGRP, which send messages into the cells that it can bind to. Those cells will then respond. 

The significance of this research becomes even more apparent when combined with three further observations from research: 

  • Back in 1979, Professor Moskowitz showed that attacks of migraine were triggered when nerve fibres in the face released neuropeptides causing the blood vessels of membranes that surround the brain to dilate, resulting in inflammation and pain. 
  • Professors Goadsby and Edvinsson, identified the key neuropeptide involved in triggering these attacks to be calcitonin gene-related peptide (CGRP).
  • Prof Jes Olesen showed that when CGRP was given to migraine patients it could trigger an attack

Despite this very significant research, which has received very considerable funding, there remains one very vital question that in my opinion also deserves and requires an answer; one that relates to the 1979 observation along with my own PhD research, connected with physical trauma, plus, because of my lived experience, the research literature on ‘acquired mind injury’. It is:

Why is CGRP getting released, inappropriately, in the first place? In other words, what’s the event or events that trigger(s) the release? I suspect it relates to the earlier statement concerning abnormal brain activity.

You’ll remember that one of the observations from my research was that physical trauma leads to blockage of CGRP transport and where is seeps out at the site of injury, sending messages into those cell that it can bind to, which as in and around the injury site. So, the logical thought and question for me is, can an emotional trauma do the same? Could the trauma lead to the release of CGRP by the nerve fibres in the face? I’m confident of what the answer would be, especially when you add in the results of the paper by Gretchen E Tietjen, which, if you remember concluded “Emotional abuse during childhood contributed more than physical or sexual abuse in the development migraine”. However, to be able to conclusively say that this is the trigger for “the abnormal brain activity” mentioned earlier and the release of CGRP, the appropriate research needs funding. 

This draws me to raise and ask, perhaps a more poignant and challenging question: What will it take to stimulate the investment need to research how best to prevent “acquired mind injuries“. Whilst research that leads to a drug making it easier for a person to live their life in the knowledge that they have migraine, we desperately need funding for research could help prevent it happening in the first place. If some of that funding was to come from the millions that companies make from pharmaceutical drugs, perhaps there would be less cynicism concerning pharmaceutical drug development.

It was only a couple of months ago, in a LinkedIn post, that I reacted to a published paper that first asked the question “Does psychological stress cause cellular stress?” but then stated that the research “…may provide novel therapeutic targets for future drug developments”.

I couldn’t quite believe what I had just read, and at the time I responded by saying: “Why, why why? By putting that statement in at the very end, what this paper seems to be implying, to me anyway is (and you can read it for yourself if you like at https://lnkd.in/gtZ2wve) we should look to develop a drug at the expense of leaving the psychological stress to wreak havoc through the person, and even worse, it implies that we should develop this new “wonder drug” so the person can remain exposed to the stress.” That in my world seems to be unethical. 

If, like me, you want to help redress this balance, researching how, through lifestyle health (which recognises the significance of social and emotional health, especially in children) we can help secure a more healthy life, then please visit the home of the Lifestyle Health Foundation, www.lifestylehealth.org.uk. There you will be able to learn more about our vision and mission and leave your details with us, and who knows we can convince the pharmaceutical industry to support us as well.