The metabolic face of migraine | Hacker News Reader

The metabolic face of migraine

nature.com

Fascinating work, thank you for sharing. Here's a link to the full paper:

https://orbi.uliege.be/bitstream/2268/247255/1/Gross%20et%20...

Thanks for the link! I must have been logged in via my institution and didn’t realize the article wasn’t public.

Translation: People with highly sensitive nervous systems get migraines because they are overstimulated. It can also be caused by mutations in mitochondria which reduce energy output. Both of these cause mismatches in the amount of energy being consumed and the amount of energy being expended.

I can confirm that my migraine frequency has doubled since having children.

Tests for that mutation?

I have a condition that could be caused by mitochondrial energy problems. I also have horrific migraines. Also an extremely hypersensitive nervous system. Some pills I take at 1/10th the lowest dose and still can barely handle the side effects.

My current pet theory is a low level infection of the mitochondrial. I have enormous rebounds on antibiotics.

Would love to explore other avenues.

Which is why ketogenic diets are so effective against such "diseases of overstimulation", ketone bodies have a stabilizing effect and gaba/glutamate balance normalizes. My personal conviction is the ketotic state is the default state for humans, in part given this stark contrast

I was a migraine-per-year person as a kid and migraine-per-quarter person for much of my adult life.

I kept a food log and identified that a caffeine and chocolate combo to be a consistent trigger.

In addition if too bright of a light shined in my eyes(let’s say a car door shut and the sun reflected off of the door’s window as I looked at it) it would also trigger a migraine.

After working to limit those triggers I’ve found that I don’t get migraines much anymore. Adding in sumatriptan when they do come on has been helpful.

If you find yourself with migraine symptoms I definitely recommend trying to identify the triggers, food, stress or otherwise.

This is good advise. The list of possible triggers is endless. A complete elimination diet is a good starting point. FL-41 migraine glasses are amazing sight. Eliminate all “scents” candles, perfumes, fancy soap, etc.

Can be shocking as you introduce things back in what you find is a trigger.

I rarely get the headache side of migraines, but I do get the visual aura fairly often. If over-stimulation is a factor, then certainly they are a bit self regulating since I have to just stop using the computer, stop reading, stop looking at my phone, etc. until it's gone.

If you've not had the visual migraine effect before, the impact is a bit like if you looked a bright light, then tried to read something.

Very very interesting topic.

I was also used to suffer from the visual migraine as you describe it.

For another exemple, it is like looking at the phone in complete darkness with the phone brightness set to the maximum; but that effect in daylight with the screen set to low/normal brightness level.

Maybe I'm wrong, but the deductions I did from my issues was that it might be related to work conditions. For example, I used to have the computer screen at 90° of a window. And there was probably constantly a little bit of light reflexion on my screen. So it is not so much to be noticable or annoying, but for a full day it will exhaust my eyes and brain. And I would regularly have the issue at the end of the day.

Then, I changed of work and of light conditions, and I almost never got the issue anymore. (Still once in a while, but very very rarely compared to before)

Also, I discovered that there are a lot of good advice regarding the work environment that you should try to respect:

- no excessive room temperature (>21)

- no sun or light directly in front. No light reflexion from the back or side.

- room ambiant light the closest possible to the brightness of the screen

But, a point that could support the theory of this publication is that, when the issue arrived, it was often that I was feeling hungry for sweets and desperately looking for a snack.

Sounds like Ocular Migraines. I've gotten them now for about 10 years. Usually I get them in clusters after not having them for a few months.

Wish I knew if it were something more controllable.

For me it's a bright, shimmering little thing that grows over my entire vision over 30-45 minutes. When it finally subsides, I get a pretty awful headache for 1-2 hours. Ibuprofen fortunately does help with the headache, at least.

I had an occular migraine once. Scared the hell out of me. 95% of my field of view became blurred, and almost as if I was looking through extremely cracked glass. No pain or headache but I had an incredible sensation of pressure centered behind my eyeballs. By the time my wife drove me to the ER, it had subsided completely. Maybe an hour after the onset.

At the time, I was 4 weeks deep into a 6 week crunch (the worst of my career) where I was pulling successive 90+ hour work weeks. Have never worked over 40 hours since moving off of that project. Have never had an occular migraine since. Truly hope I never experience that again. I can't imagine going through them every few months...

My wife recently suggested that mine may be brought on by my seasonal allergies. I get them infrequently, but thinking back the timing is about right. I wish I’d kept a log.

I am not a doctor, but if I start to get one of those I chug a coke or two. Reading the paper, it seems this was one of their findings (one coke is 39g of caffeine). It says you need caffeine and glucose:

"Corticosteroids that stimulate gluconeogenesis, are amongst the most effective drugs for abortion of prolonged migraine attacks and status migrainosus148. Caffeine (>100 mg), on the other hand, has a beneficial (though small) analgesic effect, at least when used in conjunction with common analgesics149. Besides its suppression of transient receptor potential A1 (TRPA1) activity150, caffeine also stimulates cortisol secretion151,152 and, consequently, gluconeogenesis153. In addition, caffeine increases levels of free fatty acids and decreases insulin responses152, effects that are similar to the metabolic changes that occur during a migraine attack81."

Taking caffeine and sugar for a migraine is like taking cocaine for a tooth infection.

I do not usually get the headache part either but the visual part is epic.

The first time I got it, a few years ago, I thought I was having a stroke.

The visual area gets ripped in two by the diagonal, the two pieces move away and are replaced with a silver band. The picture stays more or less complete, but broken in two. The image kind of pulsates, or rather waves.

I was terrified the first time, then visited the ophthalmologist, did a tomography of my head and ended up at a neurologist. He was a specialist of migraines and told me that about 30% of migraines are without headaches.

My father has migraines, my younger brother too and both have headaches.

I had some other extasy-like migranes and I am usually exhausted afterwrds and sleep 10 to 12 hours straight.

I am lucky to have only a few cases a year.

I think the visual aura part can be different for many people. I also thought I was having a stroke -- in my case the entire center of my vision in both eyes disappears.

But the brain is used to that behaviour (center-dead-spot from optic nerve) and has a prebaked solution: average/blend the inputs from around the dead-spot.

However my migraine-visual-aura center-dead spot is about the size of a 12" laptop screen, which results in horrifically nauseating visual "blending" happening nonstop. I tried to look at a book once and the only words I could read were the first & last words on each line. I tried to read a car license plate and could only read the last letter.

When the rate at which I got them increased from 1/6mo to 1/6week, I got a prescription & haven't had one since.

> The first time I got it, a few years ago, I thought I was having a stroke.

That was my reaction as well.

It reminded me of looking through a kaleidoscope.

Luckily I’ve only had it occur a couple of times.

When I first had one many years ago, I thought detached retina, as my sister had them.

An interesting observation RE: the visual aura. My mother has had migraines for years, and just had some surgery involving anesthesia. Afterwards she had very frequent visual migraine auras along with a certain amount of post-anesthesia brain fog, which both lasted about 24-36 hours.

I tend to find that I first notice the visual aura because reading becomes significantly more difficult. I can still make everything out, but focusing on the words takes additional effort. This sometimes comes with some sort of visual artifacts, often things moving within my vision.

Unfortunately stopping my activity at the time is rarely enough to stop the onset, and this progresses into a severe headache. Taking ibuprofen and paracetamol, preferably with a caffeinated drink, at the first sign can reduce the intensity but I don't think I've ever managed to avoid it entirely.

I recently learned about ocular migraines, and what you’re describing could be that. https://www.mayoclinic.org/diseases-conditions/migraine-head...

I have the exact symptoms as you - no headache but visual aura.

I think my triggers are a lack of food/hydration and bright lights.

I’ve seen a doctor for this and he mentioned stress and foods containing tyramine (pickled and fermented foods, preserved meats and aged cheeses, asparagus, red wine, chocolate) as possible triggers.

See: https://www.webmd.com/migraines-headaches/tyramine-and-migra...

This is fascinating, I've suffered occasional migraines for 15 years, and while I've found over time that it's highly connected to my diet combined with other stressors (like intense exercise, lack of sleep, high stress, etc...), I've never seen the mechanism described so clearly as "a mismatch between the brain’s energy reserve and workload."

I wonder if the "migraine hangover" is also part of the brains process to "restore brain energy homeostasis" or is just an unfortunate side effect.

One of my relatives suffers from migraines and they are seriously debilitating with sensitivity to light and intense nausea. There are strong meds that can help prevent them but they always intrinsically knew that certain foods were a trigger for them. It seems over the years that the connection between migraines and nutrition has been strengthening. I could not access the journal but I would have loved to know what their conclusions and recommendations were. Especially the part related to diet modification.

Full text: https://orbi.uliege.be/bitstream/2268/247255/1/Gross%20et%20...

Lots of excellent recommendations starting from page 6 onward ("Theraputic studies")

An incomplete list of long term strategies presented in the paper:

- aerobic exercise

- b-vitamin supplementation (several different ones are mentioned), and magnesium supplementation

- ketogenic diet (train the brain to use non-glucose sources of energy)

- sleep management (are you getting enough?)

Given the root-cause analysis of migraines presented in the paper, there's one additional treatment which I'll experiment with: milk thistle supplementation. Milk thistle boosts levels of glutathione in the liver, which appears to have a bearing on migraines.

I do too; they have at times been debilitating. I’ve found no prescription drug works better than marijuana.

There is also a significant hormonal component to migraines. Women have 2-4x as many migraines as men — an effect that is also seen in trans women who are taking estrogen, which indicates that it’s probably hormones rather than genetic. Not ruling out a dietary component, but it’s obviously a complex set of symptoms with likely dozens of contributing factors.

After trying some prescription drugs I've also found Marijuana works the best for me. It's the difference between lying on the bathroom floor waiting to throw up and being semi-functional (I am pretty stoned, so not totally functional) around the house.

I don't think it's a cure so much as a great way to manage the pain while the migraine is at its peak, unfortunately the migraine hangover still lasts for days.

I'm triggered by sulfates and pistachios. I found this out through a combination of pure luck and semi-structured observation. I haven't had one in several years.

I consider myself very fortunate to have found these, and I encourage anyone who experiences migraines to keep a food diary (write down what you ate and drank the day before, including all ingredients). You may be able to find trigger ingredients at some point, and then avoid them the rest of your life.

I had severe migraines in high school through my early 20's, in addition to a 1 month bout of cluster headaches (you don't want those!), my triggers were MSG (yes I know people say its perfectly fine, but I experimented and was able to show it affected me, all those years of studying Chemistry...) and bright sunshine reflections. I made sure I ate food with little or no MSG, and always wore strong sunglasses outside, which helped reduce them a lot.

The connection to MSG is clearly controversial given how much the food industry loves using it to smooth out taste in prepared foods, but it seems to not affect most people, so it didn't bother me as long as I could identify its inclusion.

In the the past 30+ years they have decreased in frequency and severity; now other than the aura (20 minutes of weird vision) the headache is at most a simple Tylenol one.

Triggers can be almost anything that affects the brain in some way; given this research it's clear that what affects people with migraine potential does not affect those with different genetics. Very often genetics plays a large role in how your body reacts to stimulus and food and diseases, but also that many genetic adaptations have both good and bad sides, so perhaps migraines gave our ancestors some benefit, and we pay the price lying on the couch in the dark.

MSG was the first taste bud science was able to isolate on the tongue because MSG is a messaging enzyme in neurochemistry and it turns out that the taste bud very physically resembles the brain receptors. In a similar way to caffeine, the brain requires a moderate amount of MSG to function, but can easily be over-stimulated.

The reason for all the "perfectly fine" "controversy" with MSG is that there's still no known allergy to it, and the early proponents of "MSG allergies" were quacks using bad science for racist reasons (despite it being a naturally occurring substance, and a required enzyme in the brain).

So overall it is much less controversial to say that MSG is a known migraine trigger in some people. It's still "safe", migraines so far as we know are rarely life-threatening even if sometimes you do feel like you are going to die. You mostly just need to acknowledge that as a trigger it varies greatly among people.

The analogy to caffeine is an extremely useful one as caffeine is also "generally recognized to be fine/safe/not an allergy", but too little caffeine and too much caffeine (and caffeine withdrawal) can all be migraine triggers or migraine relievers depending on what side of it you are on. (Most over-the-counter "migraine medication" if you check the ingredients is just a dose of generic Tylenol and a shot of caffeine because the most common migraines in America are often the withdrawal state or the too little state and it isn't likely to make it worse if you are in the too much state already, unless too much is on the edge of a caffeine OD and you have more life threatening problems.)

It plays the other way sometimes too: sometimes I crave foods high in MSG when I have a migraine and that will settle the migraine some.

> bout of cluster headaches (you don't want those!)

Oh, now you tell me...

"Cluster headache is among the most severe pains known to mankind." [1]

Cluster headaches to generally thought to be neurological compared to migraines which are generally considered vascular. I guess by this article, indirectly vascular.

Cluster headaches are significantly rarer than migraines. Only a very very few get both. You should have gotten a lottery ticket that month. Glad it faded.

[1] https://www.practicalpainmanagement.com/pain/headache/cluste...

Are you triggered by foods that naturally contain msg?

Hey, seriously, check out riboflavin and see my other comment!

https://onlinelibrary.wiley.com/doi/full/10.1111/jcpt.12548

The nausea is most likely from high serotonin which cannot be metabolized by MAOA when in riboflavin deficiency.

I’m a man and had occasional but regular migraines until I got low testosterone diagnosed and treated. Just throwing it out there, even though I might be a unique situation.

Next to what other users said it gives very specific supplement recommendations, riboflavin (B2) far above the daily recommended value, as well as Q10 and Magnesium. I’ve made some good experiences with the latter and will give the others a shot too.

They recommend ketogenic food too (I never noticed an effect on my migraines though).

One medical scientist I know has been banging on for over 25 years that the liver always plays a role in headaches & migraines.

This also helps explain why hormones, especially oestrogen, can be a problem for migraine sufferers, as it's the liver-gut-gallbladder axis that detoxifies hormones from the body.

I get a devastating headache every few weeks lasting a few days from the base of my skull inside, and it feels like the type of headache that you get from drinking something cold too fast, a bit milder, and lasting a few days. It seems to be triggered from sitting in front of the PC (I try to always stand), doing something dumb at the gym (benching and pushing my neck into the bench so I no longer bench), sitting awkwardly for too long (like a train seat), or looking at a slight angle down while working. It feels like nerve impingement and it travels sometimes to just one side of my face, and even hurts above my eye. Sometimes I feel nauseous too. I've had this for many years. It's more likely to happen if I've slept poorly or get stressed.

What's the difference between that and migraine? I hear people all the time saying they suffer from migraines, and I'm told it's connected to a 'quadrant' type of pain. Are people being diagnosed with migraines maybe suffering from a similar nerve issue that I have? And by the way, that I have a nerve impingement is purely my own hypothesis, and difficult to prove/disprove I think.

This sounds similar to something I had for years. I would get a left side migraine every couple months for 3-4 days. Other times I would have a regular headache in various areas, like behind the left eye. The occasional nausea was a symptom too.

I would also get pin prick pain somewhere on my face, usually cheek or nose. It ended up being one of the cervical vertebrae were out of place, and once it was put back I never had an issue again. So I wouldn't be surprised if it's a pinched nerve or similar neck issue in your case.

What type of doc found that ? And was it found with an MRI or X-Ray, or just by feel?

I had an MRI that showed nothing unusual. I've never seen a chiropractor.

If someone found something out of place and put it back, and solved my issue, I would be the happiest person on Earth for a while.

So I actually went to tons of doctors, my GP, neurologist, cardiologist (also had chest spasms). I got an MRI of my head, but not my neck, as the docs thought it was a head issue with all the headaches. I got an x-ray eventually as well but they didn't see anything they thought would matter. I did have a little misalignment in the x-ray but the doctors thought it was nothing.

My neck also felt unstable. Like my head would "slide off" if I tilted it wrong. My cervical vertebrae also would click in certain positions.

It was actually a physical therapist that fixed it. I had gone to them to "stabilize" my neck. They noticed that I couldn't turn my head to the left as far as I could to my right. We did ~2 months of exercises and one day they tried manipulating one of my cervical vertebrae and it was like night and day. I felt a rush of blood up into the left side of my brain and that night I slept great. It took a couple more weeks of exercises to stabilize the new position (other things started to move now that it was better aligned). And I haven't had any issues since.

I hope it's the same for you! I understand what it's like and it's awful. I think in my case it was more of a rotation problem so that might not show up as well on x-ray. Idk what other imaging would be better (if any). It might be worth getting a physical therapist to check out your neck mobility and see if there's anything noticeable. Best of luck.

I wouldn't bother with chiropractors. Whilst most are well-meaning, and some have tried to modernise their practice. chiropracty is anti-scientific, and its core principles have been thoroughly disproven.

I also agree, don't go to a chiro. Physical therapy works much better. I tried one out of desperation and I think it hurt more than helped.

Also you might need to try more than one physical therapist. Some are much better than others.

Not a doctor but I have seen a neurologist for migraine before and my understanding is that migraine causes a pretty unique constellation of symptoms. If someone has repeated episodes of moderate to severe throbbing one-sided headache that builds up over 1-2 hours, lasts 4-72 hours, is intensified by physical activity, is lessened by lying in a dark quiet room, and causes nausea, sometimes vomiting, and sensitivity to light and sound then they almost definitely suffer from migraines. Because pretty much nothing else causes that combination of things. Sort of a "looks like a duck, swims like a duck, and quacks like a duck" situation, if you will.

Of course the experience isn't exactly the same for everyone - personally the headache I experience during a migraine isn't throbbing, but it is very much one-sided and concentrated behind my eye (which is common for migraines). But I think basically from the diagnosis perspective, if connecting the dots (symptoms) results in a picture of a duck (migraine), then it is a duck. If connecting the dots doesn't result in a duck picture because there aren't enough dots, or if connecting some of the dots creates a duck picture but there are left over dots that don't connect - that's when from the doctor's perspective further work up might be needed because it's not clear what the cause is.

For me at least, how I distinguish between other headaches and a migraine is that with migraine the headache is just one of the reasons I feel terrible. It's similar to having a concussion in a lot of ways and more severe migraines can be a little bit like having the flu as well. I'm kind of dazed, struggle to remember things, and trying to think feels akin to running on sand. Sometimes music starts to sound like random noise without any musical quality. Beyond just physical activity making the headache worse, I feel physically weak and tired. During more severe migraines, I often experience rapidly alternating chills and hot flashes. Sometimes NSAIDs will help with only the headache and, even though my head doesn't hurt that much anymore, sitting upright can still be unbearable. Merriam Webster defines malaise as "an indefinite feeling of debility or lack of health" and that's the best description I can come up with for the feeling of having a terrible migraine even when the headache itself is better. All in all, during a migraine I get the distinct impression that my brain is not functioning properly.

If a lot of that resonates, then you're probably also experiencing migraines. And if not, then that's the difference between what you described and migraine. "Cervicogenic headaches" also might be a thing that can cause headaches similar to a migraine and sound kind of like what you're describing. But I believe there's some debate in the medical community about whether migraine-like "cervicogenic headaches" are actually a separate condition or if it's just a way that migraines can present.

Suffered exertion headaches for years. On top of migraines and strokes.

Turned out my cranial pressure was too high. Had some fluid drained off, and symptoms resolved that night and lasted a year.

Diamox helps me now. But lots of side effects.

It will be interesting to see the next phase of migraine treatments - psilocybin, CRGP inhibitors, etc. It really feels like we're getting close to understanding what a migraine truly is.

I believe "cortical spreading depression" is a fairly recent discovery and has opened up a lot of avenues of research vs the past belief that migraine was purely vascular.

This video was a pretty good update on state-of-the-art treatments, including those in trial: https://www.youtube.com/watch?v=LB9nYDvpfbA

everyone always makes it complicated. How about riboflavin?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447943/

I have seen the effect of this first hand.

Riboflavin and the other nutraceuticals are in this paper. Co Q10, magnesium, etc all have promising prophylactic effects.

We still need research and treatments for those who get migraines despite the prophylactics.

Migraine sufferer here. Know your triggers!

I used to suffer migraines at least once a months, and head aches at least once or twice a week. But then I found my triggers...

So the Philae Lander landing on a comet on a Wednesday night, at sometime like 3am, and the next morning I had a really bad migraine. It was right then and there that I realised I only ever got migraines on Saturday and Sunday. Why did I all of a sudden get on then? Lack of sleep! I started experimenting, and eventually found that if I had under 4 hours of sleep for 3 days in a row, surely enough on the fourth day I would most likely have a migraine! It was an awesome epiphany.

I’ve also managed to dramatically reduce headaches too - by having at last 6 hours sleep, I will have most likely staved away my usual tension head aches.

I’m also under the suspicion that my headaches are effected by a lack to serotonin, but haven’t had my bloods checked for that yet.

I suffered from migraines for many years, always after a night's sleep. I had sleep studies and they determined I was not getting enough oxygen. I had surgery for a deviated septum and tissue in my nasal passages and throat was scoured back. I continued to get migraines and was given a CPAP. The headaches continued. I was in my 40s when my dentist asked me if I got headaches in the morning. She said I was grinding my teeth and I needed to start wearing a mouth guard at night or I was going to crack a molar. I still get migraines but they are much less frequent than they used to be.

This leads me to ponder if the cause of the tooth grinding could be resolved, would the frequency of migraines reduce further still?

Have you tried taking a magnesium di-glycinate based magnesium supplement. Magnesium can help relax the small fast twitch muscles in the jaw.

what's your resting jaw position? at rest, teeth shouldn't touch, there should be a small gap, and your tongue is usually touching the upper palate, just behind front teeth. Your resting breath-rate and heart-rate shouldn't be too high, relaxation and exercise will help (at any age!), try breathing deeply a few times, then exhale all the air, empty lungs and hold this for 20s and more

They talk of how migraine might be adaptive. But isn't it possible that migraine is a side-effect of another adaptive gene for a different effect? Nature doesn't care if we're miserable. Just that we survive (as an individual or community) and reproduce.

Imagine if miserly consumption of some chemical was calorie-adaptive or saved for emergencies, but the same gene meant migraines at other times. The gene would still proliferate, with no need to explain the negative effects as adaptive?

If have a bad enough migraine can't go hunt or gather food.

Though sex or orgasm can help with headaches in my experience so maybe that's a driver :)

In my experience an orgasm only makes a migraine go away for 3 or 4 seconds. It’s like a brief moment of relief then you feel the pain come rushing back.

Ouch. I don't think i've experienced a migraine so debilitating as to some who suffer it sounds awful.

This was a good podcast on the subject of migraines that I listened to last week:

"Throbbing head, nausea, dizziness, disturbed vision – just some of the disabling symptoms that can strike during a migraine attack. This neurological condition is far more common than you might think, affecting more people than diabetes, epilepsy and asthma combined.

While medications, to help relieve the symptoms of migraine, have been around for some time, they haven’t worked for everyone. And what happens in the brain during a migraine attack was, until recently, poorly understood.

Peter Goadsby is Professor of Neurology at King's College London’s Institute of Psychiatry, Psychology & Neuroscience and is a true pioneer in the field of migraine.

Over the course of his career, he has unravelled what happens in the brain during a migraine attack and his insights are already benefiting patients - in the form of new medications that can not only treat a migraine, but also prevent it from occurring.

Peter shares this year’s Brain Prize, the world's largest prize for brain research, with three other internationally renowned scientists in the field."

https://www.bbc.co.uk/programmes/m000vp2z

There are a bunch of recently approved new migraine medicines that block CGRP instead of serotonin. I have suffered migraines since my teens and while Sumatriptan provides some relief, it is not great and has to be taken as soon as I get an auora to be at all effective. Stress and high fructose corn syrup, which is in EVERYTHING, are my triggers. I have not yet tried the new meds, but I am hopeful. https://cureheadaches.org/2020/07/15/new-migraine-medication...

Serotonin is metabolized by MAOA, witch needs riboflavin (FAD) work effectively.

https://ars.els-cdn.com/content/image/1-s2.0-B97804446412500...

I once got a migraine with aphasia. I was noticing that the visual alligator crack rainbow lightning stuff was finally going away and I decided to check Facebook. I found that while the letters snd words looked normal, it was all gibberish. I tried saying something out loud and I found that all that came out was a mess of random phonemes. It lasted about half an hour.

It looks like this if you want to see:

https://youtu.be/IG7NuH5QTdE

In retrospect I probably should have gone to a doctor once I realized I was unable to speak..

Exercise would increase the "potential" of the brain and lessen migraines then? Not necessarily DURING a migraine, but as a preventative measure?

Or are measures of "expenditure" vs "reserve" measured in other ways than oxygen consumption / energy production?

I started getting Migraine headaches in the late spring at age 17 and continued to get them in the spring/fall weekly for about two decades[0]. I remember the age and the season because, up to that point, I had headaches. What happened that day resulted in a trip to the emergency room, on my insistence; I thought my brain was bleeding[1]. After 4 hours, I was sent home with a note to take two extra strength Tylenol. And for the 20 years that followed, that was about the quality of treatment I received.

Everything, for me, is solved with a medication that is very rarely prescribed for Migraine. My issue is that I cannot take the usual medications (imitrex, etc). They are effective, but I lack a gene that is required to flush them from my system correctly. So 30 minutes after taking the pill I'd be the happiest I've ever been in my entire life, and about 1.5 hours later, I'd be miserable. It was comical-if-they-weren't-happening-to-you mood swings, which almost killed me[2].

I've seen several doctors for this. After a mess of semi-unrelated circumstances around that event which almost killed me, I ended up on a prescription for Depokote. It's a very old medication, originally prescribed for seizures and I now commonly used off-label for bipolar. It was prescribed to me with the endorsement of "a few of my patients responded well to this, none of them had side effects, and this is where we're at on the list of choices" ... basically, the guy had no confidence it would work, so I didn't either. It was prescribed mid-summer, and I noticed after about a week that I felt like I was carrying around zero anxiety[3], and a number of other fantastic side-effects[4]. By the end of the following spring, I was convinced it worked -- completely. It was the first year I had gone any season without a single Migraine headache. Interestingly, I'd get the "aura", on occasion, but it would never melt into horrifying pain.

The whole time, regardless of specialist, there wasn't anyone who could give me a really good idea of just what the hell was really going on in my skull. I'll admit, after reading this, I'm wondering if I really have Migraine or if I don't have some other thing (cluster was ruled out). My triggers are seasonal; and I have bad days when there has been a large shift from high->low or low-> high. Interestingly, though, if I get a migraine, I am pretty much insulated from getting another one for about a week, which implies some sort of biological process that is serving some function, since multiple repeats of that trigger, or even much stronger ones, will not cause a second migraine for several days after one already landed.

[0] Varying lengths but until I learned to cope with the symptoms, it at least destroyed the entire rest of the remaining day once it hit. Often remained a day after, as well.

[1] I really, really, hated hospitals as a kid. My parents took me on my insistence because they knew I would only demand to go if I seriously thought I was dying ... even though it was a headache.

[2] A combination of medications related to Migraine which I took during an attack (as prescribed) resulted in my serotonin levels sending me to the hospital. It. Was. Bad.

[3] I never thought of myself as anxious, and it's never been an issue in my life -- that I know of -- that has held me back. But, holy cow, the difference was stark.

[4] For medications with "brain affecting" side-effects, I do not read the label. My wife takes that responsibility. My thinking is: (1) placebo/nocebo effect is really strong when the thing it effects is emotional/personality. (2) I can't trust my brain to evaluate what is happening to itself -- it's compromised by the medication.

I had no headaches for a straight year on strict low carb diet

I honestly had the opposite; I tried Keto and had headaches for a month. They went away about 15 minutes after I ate a chocolate bar.

That was probably because of electrolytes. Magnesium supplementation would have been a good idea, and still is.

Riboflavin!

https://onlinelibrary.wiley.com/doi/full/10.1111/jcpt.12548

The link to the mitochondria is through FAD, a metabolic derivative of Riboflavin, which is used in the electron transport chain.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447943/

Didn't work for me. I think it's easy to come up with a pet theory ("migraines are caused by X, and therefore prevented by Y"), especially when there is some science to support you. But when you dig into it, you learn that while some treatments are wildly effective for a few people, no treatment is widely effective. If it were, migraines wouldn't be such a thing in the developed world.

So by all means, let people know that Riboflavin might help them, but be wary of prescribing it to all and sundry when in truth, it will only help a minority.

How much, how long, and what type? You’re not being scientific about it at all.

This shouldn’t be downvoted, B2 / riboflavin is mentioned in the article too, next to Magnesium and Q10. Note that the recommended amount (100mg+) is far above the daily recommendation (~2mg).

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