Living in the Land of Black Hawk
Rock Island, IL

Migraine Headaches and Related Chemistry

One of my favorite subjects of research is plants and their chemical activity. I have migraine headaches and have been working on determining whether they are actually migraines or cluster headaches. I'm currently leaning towards migraine. Interestingly enough, the drugs used to treat both migraines and cluster headaches are part of a class of drugs known as tryptamines which include LSD, Psilocybin and other hallucinogens. toward which I gravitated in my youth. Ah, the wonders of massaging the The serotonin (5-hydroxytryptamine, 5-HT) receptor sites.

For the record, I have suffered from these headaches since I was very young, long before I used those "other tryptamines". I believe the headaches started in my seventh year as the result of a head injury which caused a concussion. I could be wrong about this since my mother also had migraine headaches.

I believe that these are in fact migraine since the nausea associated with them generally does not accompany cluster headaches.

What is a migraine?

Migraine is a neurological syndrome characterized by altered bodily perceptions, headaches, and nausea. Physiologically, the migraine headache is a neurological condition more common to women than to men. The word migraine was borrowed from Old French migraigne(originally as "megrim", but respelled in 1777 on a contemporary French model). The French term derived from a vulgar pronunciation of the Late Latin word hemicrania, itself based on Greek hemikrania, from Greek roots for "half" and "skull". The typical migraine headache is unilateral and pulsating, lasting from 4 to 72 hours; symptoms include nausea, vomiting, photophobia (increased sensitivity to bright light), andhyperacusis (increased sensitivity to sound); approximately one third of people who suffer migraine headache perceive an aura, an unusual visual, olfactory, or other sensory experiences that are a sign that the migraine will soon occur.

See; wikipedia: Migraine

Migraine Triggers

The most common migraine triggers are:

• Stress (either during a stressful time or right after stress subsides).
• Menstrual cycle in women.
• Too much or too little sleep.
• Fasting or skipping meals.
• Changes in barometric pressure and weather.
• Bright light or reflected sunlight.
• Foods such as chocolate.
• Excessive caffeine or caffeine withdrawal.
• Smoking or being around someone who smokes.

Other migraine triggers include:

• Strong emotions, such as depression or anxiety.
• Physical exercise.
• Alcohol, such as red wine and port.
• Aspartame, an artificial sweetener that is found in diet sodas, light yogurts, and other sugar-free foods.
• Monosodium glutamate (MSG), a seasoning that is often found in Chinese food, meats, and other foods.
• Nitrates, which are found in cured meats such as hot dogs, bacon, and cold cuts.
• Tyramines, which are found in pickled or marinated foods, aged cheeses, and yeast.
• Birth control pills and hormone therapy.
• Certain medications, especially those that dilate blood vessels.
• Overuse of headache pain medications, leading to rebound headaches.
• Bright lights, glare, reflected sunlight, or other intense visual stimuli.
• Odors such as perfume, paint, dust, and certain flowers.

Tyramine or Phenylethylamine: Chocolate, aged or fermented cheese, soy foods, all nuts and most seeds, citrus fruits, vinegar (red and balsamic), along with other foods containing tyramine or phenylethylamine.

Leftovers tyramine levels increase over time. The longer they sit the more likely they are to trigger a migraine

Personally, I've had migraines triggered by anything from chocolate to orgasm.

Hypoglycemic episodes in the early morning cause most of my migraines. These are precipitated by staying up too late and eating too many cookies after having a few Guinness.

Substance P

In the field of neuroscience, substance P (SP) is a neuropeptide: an undecapeptide that functions as a neurotransmitter and as aneuromodulator which alters the excitability of the dorsal horn ganglion (pain responsive neurons).[1][2] It belongs to the tachykininneuropeptide family. Substance P is released from the terminals of specific sensory nerves. Substance P and its closely related neuropeptide neurokinin A (NKA) are produced from a polyprotein precursor after differential splicing of the preprotachykinin A gene. The deduced amino acid sequence of substance P is as follows:

Arg Pro Lys Pro Gln Gln Phe Phe Gly Leu Met

It is a protein found in the brain and spinal cord, and is associated with some inflammatory processes in the joints.[citation needed] Its function is to cause pain, particularly in arthritis, low back pain and fibromyalgia.[citation needed] Release of substance P has also been associated with migraine headaches.

What Migraines Feel Like to Me

I feel really very good the next day. When the headache breaks it's like being in heaven. Small payment if you ask me for feeling like jumping out a window for 24 hours.

A migraine usually starts in the morning for me. It feels like a very large knitting needle is being rammed through my eye all the way through my head and out the back on my neck. Meanwhile, there is this Axe embedded in the top of my head on either the left or right side.

Anyone who has migraines should watch the movie "Pi". The main character suffers from migraines. The way it is depicted in the movie will resonate with migraineurs.

Treatments for Migraine

It is pretty clear that there is a connection between low serotonin and migraine so of course tryptamines are quite interesting and promising.

Tryptamines

The most well-known tryptamines are serotonin, an important neurotransmitter, and melatonin, a hormone involved in regulating the sleep-wake cycle. Tryptamine alkaloids found in fungi, plants and animals are commonly used by humans for their psychotropic effects. Prominent examples include psilocybin (from "magic mushrooms") and DMT (from numerous plant sources, e.g. chacruna, often used in ayahuasca brews). Many synthetic tryptamines have also been made, including the migraine drug sumatriptan and its relatives.

The tryptamine backbone can also be identified as part of the structure of some more complex compounds, for example: LSD, ibogaine and yohimbine. A thorough investigation of dozens of tryptamine compounds was published by Ann and Alexander Shulgin under the title TiHKAL.

Tryptophan (abbreviated as Trp or W)[1] is one of the 20 standard amino acids, as well as an essential amino acid in the human diet. It is encoded in the standard genetic code as the codon UGG. Only the L-stereoisomer of tryptophan is used in structural or enzyme proteins, but the D-stereoisomer is occasionally found in naturally produced peptides (for example, the marine venom peptide contryphan).[2] The distinguishing structural characteristic of tryptophan is that it contains an indole functional group.

Indole is an aromatic heterocyclic organic compound. It has a bicyclic structure, consisting of a six-membered benzene ring fused to a five-membered nitrogen-containing pyrrole ring. The participation of the nitrogen lone electron pair in the aromatic ring means that indole is not a base, and it does not behave like a simple amine.

Indole is a solid at room temperature. Indole can be produced by bacteria as a degradation product of the amino acid tryptophan. It occurs naturally in human feces and has an intense fecal odor. At very low concentrations, however, it has a flowery smell, and is a constituent of many flower scents (such as orange blossoms) and perfumes. It also occurs in coal tar.

The indole structure can be found in many organic compounds like the amino acid tryptophan and in tryptophan-containing protein, in alkaloids, and in pigments.

Indole undergoes electrophilic substitution, mainly at position 3. Substituted indoles are structural elements of (and for some compounds the synthetic precursors for) the tryptophan-derived tryptamine alkaloids like the neurotransmitter serotonin, and melatonin. Other indolic compounds include the plant hormone Auxin (indolyl-3-acetic acid, IAA), the anti-inflammatory drug indomethacin, and the betablocker pindolol.

The name indole is a portmanteau of the words indigo and oleum, since indole was first isolated by treatment of the indigo dye with oleum.

Trace amines are endogenous compounds structurally related to classical biogenic amines, such as catecholamines, serotonin and histamine. Trace amines include p-tyramine, Beta-phenylethylamine, tryptamine, octopamine, and 3-iodothyronamine, and are found in the nervous systems of animals from insects to mammals.

Trace amines overlap substantially with classical biogenic amines neurotransmitters regarding to chemical properties, synthesis, and breakdown; trace amines commonly colocalize in neurons with these neurotransmitters.

Psychiatric disorders such as depression and schizophrenia have been linked to irregular levels of trace amines.

The serotonin (5-hydroxytryptamine, 5-HT) receptors are a group of G protein-coupled receptors and ligand-gated ion channels found in the central and peripheral nervous system. They mediate both excitatory and inhibitory neurotransmission. The serotonin receptors are activated by the neurotransmitter serotonin, which acts as their endogenous ligand. The serotonin receptors modulate the release of many neurotransmitters, including glutamate, GABA, dopamine, epinephrine/norepinephrine, and acetylcholine, as well as many hormones, including oxytocin, prolactin, vasopressin, cortisol, corticosterone, corticotropin, and substance P, among others. The serotonin receptors influence various biological and neurological processes such as aggression, anxiety, appetite, cognition, learning, memory, mood, nausea, sleep, and thermoregulation. The serotonin receptors are the target of a variety ofpharmaceutical and illicit drugs, including many antidepressants, antipsychotics, anorectics, antiemetics, gastroprokinetic agents, antimigraine agents, hallucinogens, and entactogens.

A link between food and serotonin?

Just what is the link between food and serotonin, and can a change in your diet make a difference?

Serotonin is a neurotransmitter, which has gotten a lot of attention in the last few years. The reason is that low serotonin levels have been linked to depression, lack of concentration, obesity, sleeplessness, and, of course, migraine.

But the food and serotonin link is more complicated than just eating foods containing serotonin. Your body doesn't get serotonin from foods, butmakes serotonin from tryptophan. Tryptophan is an amino acid which is essential for the body to get. It is the precursor to more than one neurotransmitter.

You may be able to increase levels of tryptophan by eating foods like breads, pastas, candy ... but wait! That's no good. It may temporarily help if you're depressed (or it may not!), but it's not going to really help anything in the long run. Is there another way?Yes, there are a couple other ways. You can find the food and serotonin link in items that are somewhat healthier. Try turkey, black eyed-peas, black and English walnuts, almonds, sesame or pumpkin seeds, and cheddar, gruyere or swiss cheese. Also helping to a lesser extent are whole grains, rice, and other dairy products (grandma was right, drink a glass of warm milk before bed!).

Examples of food with tryptophan:
wheat germ - 0.4g/1cup
granola - 0.2g/1cup
cottage cheese - 0.4g/1cup
egg - 0.1g/1
duck - 0.4g/quarter lb
turkey - 0.37g/quarter cup
chicken - 0.28g/quarter cup

* list from The Healing Nutrients Within by Dr Eric R Braverman.

How much this may help to raise your serotonin levels is uncertain, but eating healthy foods is going to help with migraine, obesity, depression and sleeplessness anyway, so you can't lose!

If you have Migraine Headaches and the Foods you Eat by Hartnell and Tyler, some recipes that may increase your serotonin levels include: Turkey Quiche (pg 148), Wild Rice Casserole (pg 186), and Rice-Stuffed Squash (pg 92).

In The Migraine Cookbook (Sharp) - for some food and serotonin recipes try... Almond Crescents (pg 144), Roast Duck with Spiced Honey (pg 75), and Bulgur and Green Bean Salad (pg 108) to name a few.

The other method is to give your body a 5-HTP supplement. 5-HTP is the next step after tryptophan to help your body naturally produce serotonin. Drugstore.com has 5-HTP in 50mg capsules.

Special note for the ladies:

Food and serotonin may be especially important for you, because estrogen levels are linked to serotonin levels. When estrogen levels fall, so do serotonin levels, and that may be just what it takes to trigger a migraine. So why not pay close attention to the food and serotonin link, and make sure that you're eating healthy foods especially when you know your estrogen levels are falling.

Once again, remember that eating healthy all the time is a great cure for more than you think! :-)

Tryptophan supplements and EMS

Although currently available for purchase, in 1989 a large outbreak (1,500 cases of permanent disability including at least thirty-seven deaths) of a disabling autoimmune illness calledeosinophilia-myalgia syndrome (EMS) was traced by some epidemiological studies[38][39][40] to L-tryptophan supplied by a Japanese manufacturer, Showa Denko KK.[41] It was further hypothesized that one or more trace impurities produced during the manufacture of tryptophan may have been responsible for the EMS outbreak.[42][43] The fact that the Showa Denko facility used genetically engineered bacteria to produce L-tryptophan gave rise to speculation that genetic engineering was responsible for such impurities.[44][45] However, the methodology used in the initial epidemiological studies has been criticized.[46][47] An alternative explanation for the 1989 EMS outbreak is that large doses of tryptophan produce metabolites which inhibit the normal degradation of histamine and excess histamine in turn has been proposed to cause EMS.

Most tryptophan was banned from sale in the US in 1991, and other countries followed suit. Tryptophan from one manufacturer, of six, continued to be sold for manufacture of baby formulas. At the time of the ban, the FDA did not know, or did not indicate, that EMS was caused by a contaminated batch,[49][50] and yet, even when the contamination was discovered and the purification process fixed, the FDA maintained that L-tryptophan was unsafe. In February 2001, the FDA loosened the restrictions on marketing (though not on importation), but still expressed the following concern:

Since 2002, L-tryptophan has been sold in the U.S. in its original form. Several high-quality sources of L-tryptophan do exist, and are sold in many of the largest health food stores nationwide. Indeed, tryptophan has continued to be used in clinical and experimental studies employing human patients and subjects.

In recent years in the U.S., compounding pharmacies and some mail-order supplement retailers have begun selling tryptophan to the general public. Tryptophan has also remained on the market as a prescription drug (Tryptan), which some psychiatrists continue to prescribe, particularly as an augmenting agent for people who are unresponsive to antidepressant drugs.

Read all about Tryptophan

Read all about Eosinophilia Myalgia Syndrome

http://www.faqs.org/faqs/medicine/migraine/natural-cures/

Vitamins, Mineral Supplements and Herbs

Vitamin B2. In a randomized controlled trial of 55 migraine patients, those who received 400 mg daily of riboflavin for 3 months had a 68% reduction in the frequency, severity, and duration of migraine attacks, which was significantly better than the placebo patients.[16] These results have been replicated in other studies.[17,18] Typical recommendations are to take riboflavin (200 mg) twice daily with meals. Riboflavin is well tolerated; the only notable effect is intensely colored yellow urine.

Vitamin B6. Vitamin B6 is essential in metabolizing tryptophan to serotonin. Pyridoxine has been used as a remedy for headaches triggered by menstruation, but there are few studies evaluating its effects in treating migraine.[19] Side effects of excessive doses of vitamin B6 include: nausea, vomiting, abdominal pain, anorexia, headache, somnolence, lower B12 levels, and sensory neuropathy. The latter typically occurs with doses over 1000 mg daily but can occur with lower doses.

Minerals

Calcium. Small studies suggest that calcium supplementation may benefit women with PMS-related depression and possibly also menstrual migraines.[20-22] Most adolescent girls do not meet their minimum daily requirement for calcium through diet alone. According to the Continuing Survey of Food Intakes of Individuals (1994-1996), the following percentages of American children and adolescents do not meet their recommended intake for calcium:

44% of boys and 58% of girls aged 6-11 years; and

64% of boys and 87% of girls aged 12-19 years. It is important for clinicians counseling adolescent girls with migraines to address adequate calcium intake (optimally 1200-1500 mg daily) to ensure bone health and reduce the risk of headache throughout the menstrual cycle.

Magnesium. Many migraine sufferers, particularly those with menstrual migraines, have low magnesium levels.[23-26] Migraine attacks are associated with platelet aggregation and serotonin release; magnesium can reduce platelet aggregation and decrease the affinity of serotonin for vascular sites.

Administered intravenously, 1 g of magnesium sulfate helps about 50% of patients with acute migraine symptoms.[27] However, most often magnesium supplements are taken by mouth to prevent migraines.[28-30] In one study, magnesium supplementation was associated with a 40% decrease in headache frequency by the ninth week of treatment.[31] In another study of women with menstrual-associated migraine, 360 mg daily was more effective than placebo in reducing migraine symptoms.[32] A controlled trial also found that magnesium supplements were helpful in reducing the frequency of migraine headaches in pediatric patients.[30]

The diet of the typical American teenager is relatively deficient in magnesium-rich foods. Dietary sources of magnesium include: dark green leafy vegetables, beans and bean products (such as soybeans, black beans, and tofu), seeds, soybeans, nuts, whole grains (such as brown rice and millet), shellfish, and citrus fruits.

Typical doses of supplements used in studies of patients with migraine headache ranged from 350 to 500 mg daily. Although some patients take a calcium/magnesium combination, absorption is improved if magnesium is not taken at the same time as iron or zinc supplements. Several months of supplementation may be required before clinical effects are observed. Magnesium supplements are generally safe; excessive doses can cause diarrhea. Clinically, it is prudent to ensure that patients consume a diet rich in vitamins and minerals and, if they are deficient, that deficiencies be corrected through supplementation.

Other Supplements

Coenzyme Q10. Coenzyme Q10, also known as ubiquinone, plays an important role in mitochondrial energy production. In an early open-label trial, 31 patients with migraine received 150 mg daily in a single dose for 3 months; 62% of these patients had more than a 50% reduction in the number of headache days without significant side effects.[33] In a double blind randomized controlled trial, 100 mg of coenzyme Q10 taken 3 times daily led to a significant decrease in headache frequency.[34] Coenzyme Q10 is well tolerated but it can be expensive.

Alpha Lipoic Acid. One small Belgian randomized trial of 600 mg daily of supplementation with alpha lipoic acid (also known as thioctic acid) for 3 months showed a significant reduction in headache frequency and severity.[17] Alpha lipoic acid is widely used as a supplement by patients with diabetic peripheral neuropathy. It is well tolerated. Larger studies are needed before it becomes a routine recommendation for prevention of migraine headaches.

5-Hydroxytryptophan (5-HTP). 5-HTP is a precursor to serotonin. Plasma levels of 5-HTP are lower in migraine sufferers than normal patients[35]; older, small case series and controlled trials suggest that 5-HTP supplements may help reduce the severity of migraine headaches.[36-39] Again, larger controlled trials are needed before routinely recommending 5-HTP supplements as prophylactic therapy for migraine headaches.

Fatty Acids

Fish Oil Supplements. Fish oil supplements rich in the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have become popular approaches to decreasing inflammation. Anecdotes and an open-label study have suggested that omega-3 fatty acids could offer significant benefits in preventing migraine headaches.[40,41] However, in a small controlled trial of adolescents, 2 months of supplementation with fish oil was associated with significant reductions in headache frequency and severity, but these improvements were not significantly better than improvements noted among control patients who took olive oil.[42] Similar studies also found effects no better than olive oil placebo supplementation, though most have noted a very strong placebo effect.[43] Newer research suggests that olive oil itself may have anti-inflammatory effects and may not be a suitable placebo.[44,45]

Fish oil supplements are generally well tolerated, particularly the newer formulations that are molecularly distilled (minimizing the fishy taste and belching associated with older formulas). Product testing has revealed no significant contamination with mercury, dioxins, or other contaminants in molecularly distilled fish oil products. However, as always, clinicians should exercise caution when recommending this product.

Herbs

Herb for headache #1: Feverfew

Feverfew, also called bachelor's button, is a popular folk remedy for headache. This herb is a member of the daisy family, and many people grow the plant themselves and then harvest the leaves. For a long time feverfew was thought to relieve fever symptoms (hence the name), but that didn't turn out to be the case. Today it's mainly used as a preventative for migraines.

Migraine relief is supposed to be achieved by taking a controlled amount of feverfew on a daily basis. In one study, over 2/3 of migraineurs experienced relief by taking feverfew regularly. Unfortunately, the successful studies of feverfew have often been poorly controlled, and the more scientific studies have failed to see the positive results that some people have claimed. So it may still be a while before we find out if feverfew migraine relief is a reality.

Read more about feverfew here.

Herb for headache #2: Peppermint (mentha piperita)

For hundreds of years peppermint has been used as a headache remedy. From tea to extract, there are lots of ways to enjoy peppermint. Be warned that peppermint is not the thing to take if you have heartburn or similar stomach acid problems.

Peppermint is just as useful for it's aroma and cooling properties as an essential oil. Read more about this herb for headache on our home remedies page.

Herb for headache #3: Passionflower (Passiflora alata)

Passionflower is a calming herb. Taken as a tea before bed, it can help you sleep. At least one clinic trial has found it to lower anxiety. It is also believed to have anti-inflammitory and pain killing properties. Great for migraine!

Herb for headache #4: Ginko (ginko biloba)

The leaf of the ginko tree is an extremely popular herb for headache, but the medical evidence is still hotly disputed. Ginko is said to improve the flow of blood and get more oxygen to the brain, hence not only relieving headache but improving memory and alertness as well. There are some nice teas sold with ginko and peppermint, so why not give it a try?

Note that Ginko is one of those herbs that can cause side effects when taken with headache medications, including aspirin and lithium.

Herb for headache #5: Cayenne (capsaicin)

Yes, that's right, the pepper! Many peppers have an ingredient called capsaicin, which among other things seems to raise the pain threshold. It's gained attention in the medical world in recent years especially for its treatment of cluster headaches, and it's often given in the form of a nasal spray.

Cayenne pepper is an excellent spice to have on hand (well, don't put too much ON your hand or you may burn it!), and may lessen your migraine.

Herb for headache #6: Willow (salix . . .)

White willow bark is an especially popular herb for headache because it works much like an aspirin, relieving your headache pain and causing the inflammation to go down. Like any painkiller, it should not be taken long term. Once again, be very careful about taking willow with other painkillers and medications - check with your doctor!

Other herbs for headache:

Meadowsweet, valerian (excellent if you can't sleep), skullcap, chamomile (also common for relaxation).

Recent studies point to butterbur extract (petasites hybridus root) as a migraine treatment. Butterbur has been recommended for migraine before, but now the scientific evidence is starting to catch up. The dosages in recent studies for both children and adults range between 50mg and 150mg. It is recommended that you use a reliable standardized and safe form of butterbur. In a recent German study, Petadolex was used, which is a butterbur extract.

Butterbur (Petasites Hybridus). A large, 3-arm, randomized, controlled trial of butterbur (50-100 mg twice daily) showed a significant reduction in frequency of migraine headaches.[46] Another study confirmed the benefits of butterbur in preventing migraines in pediatric patients.[47] Positive studies have used a product at doses of 100 to 200 mg daily.[48,49] Butterbur is well tolerated[50]; due to the natural variability of herbal products, patients should be advised to use brands that have been tested in controlled trials and are imported from countries in which herbs are regulated like medications rather than like foods.

Feverfew (Tanacetum Parthenium). Feverfew is a member of the daisy family. Taking as little as 25 mg twice daily of feverfew has helped prevent migraine headaches in clinical trials.[51,52] In one randomized controlled trial, feverfew use was associated with a 70% reduction in headache frequency.[53] It is sometimes combined with riboflavin, ginger, and other natural products in over-the-counter preparations. The maximum effect is generally observed after 4-6 weeks.

Side effects of feverfew include aphthous ulcers and upset stomach in 5% to 15% of patients. Withdrawal symptoms of rebound headache can also occur in patients who suddenly stop taking feverfew supplements. Healthcare providers should also consider the great variability in herbal products; American-grown feverfew appears to be less potent than British feverfew in some studies.

Ginger. Ginger is an herbal medicine that is traditionally used in Ayurvedic and Tibetan systems of medicine to treat neurologic disorders including migraine headaches.[54] It has undergone extensive study as an antiemetic[55-58] and may be useful for patients who are troubled by nausea and vomiting with their migraines. It is sometimes combined with feverfew in over-the-counter remedies.[59]

TigerBalm Ointment (Haw Par Healthcare Limited, Singapore). This fragrant ointment is typically used to treat sore muscles. In a randomized trial of adult headache sufferers, applying the ointment to neck muscles helped relieve headache more effectively than placebo ointments[60]; it worked about as well as acetaminophen to relieve tension headache pain. It is very safe but should not be used in or near the eyes (it stings).

Last but certainlty not least is;

Cannabis in addition to prevention, is also known to relieve pain during the onset of a migraine. Associated symptoms of nausea are relieved by cannabis. Citation below.

Herbal Medicinals

Herbs for migraine and other headaches can be very helpful, but there's lot of bad and even dangerous information out there. If you really want to look into natural herbal alternatives, get a good guide that tells you the scientific facts. An excellent comprehensive guide to herbs isThe Herbal Drugstore by Linda B White MD and Steven Foster. Another handy guide is The Complete Herbal Companion by Elizabeth Burch, MD.

Other Migraine Treatments

Surgical Treatment of Migraine Headaches have recently been used and innovative surgical techniques have been developed to help patients with migraine headaches. Migraine headaches affect an estimated 10% of the worldwide population annually, and cause significant loss of workdays and billions of dollars in productivity. It is well documented that migraine headaches cause significant disability, and reduce of quality of life that is as dire, if not worse than, debilitating chronic diseases. There have been major pharmacological advances for the treatment of migraine headaches, yet patients must still endure migraine headache symptoms until the medications take effect. Furthermore, often they still experience a poor quality of life despite an aggressive regimen of pharmacotherapy.[1] Elimination of trigger sites (TS) which was introduced to the public after successful clinical trials has been revolutionary in providing significant improvement and/or long lasting relief from symptoms in appropriate candidates. [2]

Conditions that might lead to migraine

PFO, or patent foramen ovale, is a heart valve in humans that usually closes off at or shortly after birth. The valve's function is to let the circulating blood bypass the lungs, which the body doesn't rely on until a newborn starts breathing air.[1] Tissue flaps in the heart usually fuse and close the hole, but complete closure never occurs in about 20 percent of the U.S. population.[2] According to Dr. Thompson, division chief of pediatric cardiology at Inova Fairfax Hospital in Merrifield, "Approximately twice as many people with migraine headaches have PFO compared to the general population."

Problems occur when the valve is not completely fused and allows unfiltered blood returning to the heart from other parts of the body to bypass the lungs. Normally, the blood picks up oxygen to circulate directly to organs, including the brain [4] Without the needed oxygen, the proper amount of oxygen does not reach the brain. Cardiologist Dr. Pranav Loyalka, of the Texas Heart Institute, explained it as a "trap door" that "opens when the person strains, such as during a cough or sneeze." [5] Air bubbles and dissolved chemicals can also slip through the one-way shunt rather than ride to the lungs, where they'd be exhaled or broken down. [5] Wilmhurst, a cardiologist at the Royal Shrewsbury Hospital in England, speculated that the PFO permits a substance that would be filtered in the lungs to get to the brain." [1] He and some other researchers suspect the peptide serotonin, which is neurologically active and doesn't usually circulate in blood heading from the heart to the brain.

A major effect of the opening is that occasionally blood clots escape through the valve and can trigger strokes. [6] According to the research of Lois Collins, a writer for the Deseret News, half a million cryptogenic strokes worldwide every year are directly attributed to PFOs. [7] Because of the association of strokes and PFO, many stroke patients commonly undergo a procedure to test for an opening of the PFO. Stroke patients who are found to have the opening often undergo surgery to close the PFO valve and prevent the possibility of future strokes. Patients have related a disappearance of their migraines to their surgery.

PFO closure has not only been used for stroke patients. A cardiologist of Royal Shrewsbury Hospital in England found that scuba divers with PFOs were unusually susceptible todecompression sickness, a disorder that can occur when bubbles of nitrogen form in the blood and don't get expelled by the lungs. After closing the heart defects of professional divers, several also reported the disappearance of their migraines.[6] Roman Szatajzel, a neurologist at the University Hospitals of Geneva, performed a PFO valve surgery on a stroke patient. As a result of the surgery, the patient reported a disappearance of her migraines.[1] Even though the migraines disappeared after surgery, not all migraines are associated with an opening in the PFO valve. As related by the Journal of Head < Face Pain, "the relationship between migraine and patent foramen ovale may be stronger in patients suffering from migraine with aura compared to patients with common migraine."[8] Because of the many causes of migraines, studies are now beginning to take place to determine the relation between migraines and an opening of the PFO valve.

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