New research suggests that migraine is an energy-deficit syndrome of the brain involving dysregulation of energy metabolism in the mitochondria of nerve cells. This leads to a cascade of neurological symptoms. Magnetic resonance spectroscopy (MRS) has been used to analyze numerous substances involved in energy metabolism, including lactate, magnesium, and adenosine triphosphate (ATP). Studies have identified alterations in the hypothalamus, thalamus, and brainstem, suggesting an endocrine origin of migraine. Taken together, these investigations suggest that the migraine attack itself is a response to an energy-deficit syndrome of the brain.

Oxidative stress levels exceed the antioxidant capacity of nerve cells. A migraine attack may support the restoration of the brain's balanced energy levels by reducing damaging oxidative stress. Nerve cells maintain their ability to neutralize reducing or oxidizing substances by producing and storing these substances. When a cell's normal repair and detoxification functions are overwhelmed, this is called oxidative stress. The result is a malfunction or damage to cell function.

Dysregulation of mitochondrial enzyme function and glucose metabolism, as well as oxidative stress, can be specific responses to external triggers. This leads to migraine attacks in patients who exhibit a cerebral overreaction to external stimuli and consequently suffer from dysregulation of central stimulus processing.

Triggers, therefore, do not act in isolation. Rather, their effect is a consequence of disruptions in the brain's energy metabolism. The crucial factor in the development of a migraine attack is not the attack itself. Instead, it arises from a multitude of events, often weeks before the actual attack occurs. These events then culminate in a migraine attack. The immediate period before the actual attack is therefore not of decisive importance. The advice to avoid triggers is thus generally ineffective. They are effective at certain times and not at others. Triggers culminate in a migraine attack when a certain threshold is exceeded, a threshold determined by the individual's biology, not by the physical properties of the trigger itself. The common factor among triggers is their ability, in aggregate, to cause oxidative stress. Oxidative stress is caused by a deficit in neural energy reserves. The consequence is that the nerve cells can no longer use their energy to defend against oxidative stress, and the antioxidant defense is no longer adequate. These changes are then reset to the normal state by the migraine attack.

These findings lead to a completely new approach to treating migraines. In particular, therapeutic intervention is possible well before the actual onset of a migraine attack through knowledge and adapted behaviors. This challenges the previous notion that the migraine attack is the actual illness that must be suppressed. Rather, the migraine attack is an attempt by the brain to stabilize its energy balance and restore normal physiological function.

This leads to new and essential preventive treatment strategies. Treatments that normalize brain metabolism play a central role. Therefore, measures aimed at stabilizing energy metabolism should be the primary focus of therapy. This applies to adults, but even more so to adolescent patients and children.

Nutrition is also a key focus. It provides nerve cells with the energy they need to function. Nutrition is crucial for ensuring an adequate energy supply to the central nervous system. Regularity and a carbohydrate-rich diet are essential for maintaining a stable energy supply to nerve cells. Stabilizing energy levels can also be important for treating acute attacks. Caffeine activates the conversion of carbohydrates into nerve energy. Corticosteroids can also therapeutically influence nerve cell energy levels through a metabolic effect. All other treatment methods for attacks work by reducing pain generation in the trigeminal-vascular system, which was previously activated by metabolic changes resulting in an energy deficit.

In summary, a migraine attack is a protective reaction of the brain to ward off damage, and not the actual problem. Through the migraine attack, the body attempts to stabilize its energy balance after a massive disruption of the metabolic system resulting in an energy deficit.

Professor Dr. Hartmut Göbel discusses with the well-known NDR nutrition expert Dr. Matthias Riedl, Medical Director of medicum Hamburg, how to actively maintain a balanced energy level through diet and behavior, focusing on living as pain-free a life as possible with migraines.

The expert interview is published in the magazine "Eat Yourself Healthy". Read the attached PDF for details.

Eat yourself healthy: Nutrition for migraines

literature

1. Gross EC, Lisicki M, Fischer D, Sándor PS, Schoenen J. The metabolic face of migraine – from pathophysiology to treatment [published online October 4, 2019]. Nat Rev Neurol. doi:10.1038/s41582-019-0255-4

2. Kokavec A. Migraine: A disorder of metabolism? Med hypotheses. 2016;97:117-130.

3. Akerman S, Romero-Reyes M, Holland PR. Current and novel insights into the neurophysiology of migraine and its implications for therapeutics . Pharmacol Ther . 2017;172:151-170.

4. Borkum JM. Migraine triggers and oxidative stress: a narrative review and synthesis . Headache . 2016;56(1):12-35.