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Homocysteine and Migraine

Homocysteine and Migraines – What Does It Mean?

Homocysteine and Migraine

 

Headaches are very common and almost everyone has experienced one at one point in their life. They can be painful and disabling, which cuts into your focus, productivity, and quality of life. Headaches come in different types such as tension, cluster, and migraine. The migraine type headaches are the third most common disease in the world and effect about 14.7% of the worlds population. That’s around 1 in 7 people who will experience a debilitating headache that will put that person down for the count, locked up in a room with the lights off, and a trash can near by. It is not a pleasant way to spend your day.

When you have a migraine you look for any way to get rid of them. People have asked what’s the relationship of homocysteine to migraines after hearing about methylation problems in the body.

Homocysteine is an amino acid found in the blood, but if found in high amounts has been shown to cause inflammation leading to an increased chance of stroke or cardiovascular disease. Migraine headaches are severe throbbing or pounding headaches that usually occur on one side of the head. People may experience a sensitivity to light, sounds, and smells. Some experience nausea or vomiting. Some migraine patients experience what is called an aura before the onset. An aura is a visual disturbance, such as a blind spot or flashing light.

Homocysteines are a major player in chronic inflammation.

Homocysteines are a major player in chronic inflammation.

The question being studied is, “does an increase in homocysteine in the blood directly relate to an increase in migraines?” There have been a lot of studies to answer this question and the results appear to be conflicting. On one side, many studies show no significance between the two. On the other side, some do show significance that an increase of homocysteine in the blood does correlate to an increase in migraine headaches. There seems to be no sound conclusion when it come to levels in the blood.

However, a study out of Headache tested homocysteine levels in the cerebrospinal fluid (CSF) in the spine and showed a very significant increase. It showed that migraine patients with auras had a 376% increase in the CSF and patients without had a 41% increase. What this means is an increase of inflammation in the CSF for people with migraines.

What is Special About Cerebrospinal Fluid

CSF also acts an a cushion and protector of the nervous system. It should flow normally through out the system without being stagnant. In recent years, CSF has been identified as a fluid that helps to remove waste products from the brain’s normal metabolism, and that failure in CSF movement from things like lack of sleep may contribute to the pathology of Alzheimer’s disease.

Why Is CSF Important to Us?

Sometimes when a segment in the spine shifts out of place it can not only put pressure on the disc, nerves, and bloods vessels around that segment, but it can also effect the flow of CSF through that area. When this happens this can cause CSF in areas in the head and spine to be stagnant because a segment has shifted out of place affecting the normal flow. When the CSF is stagnant you can have a pooling where it can collect homocysteine causing inflammation.

As a structural chiropractor that focuses on the craniocervical junction, the interaction between the neck and cerebrospinal fluid is an important area  of interest. A study by the Upper Cervical Research Foundation showed that a correction of the atlas vertebra shows significant improvement in migraine symptoms and potential changes in venous drainage patterns. This allows things to function better, including the CSF to flow better.

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Rheumatoid Arthritis and Fibromyalgia

Why Does Fibromyalgia Occur in Rheamatoid Arthritis – a Neurological Perspective

Rheumatoid Arthritis and Fibromyalgia

When working with a large number of patients with chronic pain and illness, you begin to notice patterns in relationship to certain illnesses. One of the more common trends I see today is the association between having an inflammatory illness like rheumatoid arthritis along with widespread body pain like fibromyalgia.

Rhumatoid arthritis and fibromyalgia share some commonalities in that they disproportionately affect women more than men, are associated with flare ups of increased pain intensity, and are chronic illnesses with no cure. Although they are separate and distinct health issues, it seems that if you have an inflammatory illness like rhematoid arthritis, 10-15% of these patients are likely to report the widespread body pain of fibromyalgia. Let’s see if we can break this phenomenon down.

Rheumatoid Arthritis and Inflammatory Illnesses

Rheumatoid arthritis falls into a class of inflammatory disorders where flare ups of inflammation can create damage to joints throughout the body. The pain from these flare ups can be debilitating, and the damage done to the joints can be quite severe when left untreated.

CanStock Photo

Notice the deformity of the thumb and index finger on the right hand. CanStock Photo

The damage to these joints is caused by an autoimmune reaction. Autoimmune disease is a condition where the body’s own defenses inadvertently create harm to the body itself. In the case of rheumatoid arthritis antibodies can build up in the joint spaces and cause other immune cells to create an inflammatory reaction in the area. This is where people can feel the heat, swelling, and pain that is known to occur in flare ups.

Patients with rheumatoid arthritis tend to have arthritic flare ups affect joints like the hands, toes, and neck. However, they are also more prone to wide spread pain in other regions not associated with arthritic breakdown. Why would pain exist in an area that is not associated with inflammation and destruction of the joint?

Chronic Pain: Central  Mechanisms

Pain is an extremely complex phenomenon. We generally think of pain having a direct relationship to tissue damage. When we get a cut, sprain an ankle, or break a bone we expect that pain will occur because of the injury. Therefore it’s not surprising that the pain and destruction from a rheumatoid arthritis attack to be very painful.

However, we also know that pain can occur long after an injury has healed, and even in the absence of injury whatsoever. This is what happens in patients with the widespread pain of fibromyalgia. People with fibromyalgia often have nothing to point to as a cause of their pain. It’s an enigma that makes chronic pain syndromes so frustrating because they have no test or image to prove why they feel so poorly.

Many suspect that this widespread body pain may be from dysfunction at the level of the central nervous system. In normal circumstances, the brain has a few ways of controlling how much pain it will feel.  This ensures that our bodies don’t overreact to normal everyday stimuli and interpret as painful.

One mechanism is by pain inhibition. Pain inhibition involves the brain using it’s own pharmacy of pain killing chemicals to stop a pain signal from going up the spinal cord.

Pain can be inhibited by chemical pathways inherent in the brain.

Studies on patients with rheumatoid arthritis have shown that the brain’s ability to inhibit pain becomes compromised leading to an increase in pain with normal stimulation. [Source]

Pain Inhibition broken

When your brain has difficulty inhibiting pain, then you begin to feel it in places where there’s no injury

Another way that the brain can modulate pain is through a concept known as the pain gate. The pain gate operates on the idea that pain has to hit a certain threshold for it to be consciously perceived in the brain. In this way, it allows the brain to ignore things that aren’t causing much damage or risk.

In a perfect system, you would only feel pain when you have actually created injury or are under imminent threat of injury. However, this appears to be another mechanism that gets disrupted in chronic pain patients. When people have chronic pain, it probably means that the gate that is meant to block most of your pain is letting everything in.

Pain Gate Theory

 Does Rheumatoid Arthritis Break This System Down?

The main treatment for inflammatory arthritis focuses on managing inflammation. Most patients with this type of arthritis will take a wide variety of anti-inflammatories that cover a wide spectrum. They include drugs that specifically target the inflammation associated with RA like Trexall, immune modifying biologics like Humira, and go all the way down to non-steroidal anti-inflammatories like ibuprofen.

In many of these cases, the inflammatory pain of arthritis is under control by these drugs, yet the widespread body pain persists. We don’t really know how or why these inflammatory disorders can lead to pain sensitization, but studying other acute pain conditions may give us some clues.

Studies done on patients with acute pain from a traumatic injury and post-surgery pain issues. When someone suffers from the pain of a major injury, the neurons associated with the pain response start to fire more frequently to guard against the area of injury. This is only supposed to be a short term response to significant injury, but in some cases these changes become persist through a phenomenon known as plasticity. When these spinal cord neurons stay hypersensitive, it means that a person’s nervous system will become hypersensitive to the pain response. [Source]

While inflammatory arthritis isn’t necessarily an injury in the classic terms, make no mistake that inflammation can create a significant amount of tissue damage when it goes unchecked.

Making Your Nervous System Less Sensitive

If the nervous system can be made more sensitive by persistent pain, can it work in the opposite direction? A lot of the research on pain has been focused on targeting these mechanisms which has lead to a higher usage of opioid medications. The obvious problem is that opioids are highly addictive and has become a major public health issue.

There is a growing need for non-pharmacologic interventions to address these chronic pain issues, and fortunately there are some that can be really effective. In cases of chronic pain, the best approach is one that addresses a person from a mental and physical standpoint rather than chasing after a holy grail treatment.

When you look at the pain gate theory image, you can see that the factors that impact your pain threshold include brain and spinal input which exercise and chiropractic adjustments can play a major role. Things like memories, emotions, expectations, and attention are all factors that can be changed with neuropsychological therapy. Out of that entire list, everything except your genes are modifiable factors.

Our approach to chiropractic is focused on the head and neck, which has been shown in at least one study to improve long term outcomes in patients with fibromyalgia syndrome when combined with exercise and cognitive based therapy. You can read more about that in a previous article below:

Fibromyalgia and the Atlas

Conclusion

At the end of the day, there is no cures for rheumatoid arthritis or fibromyalgia yet. There may not be cures for years to come. However, many people with these illnesses can see their quality of life improve by addressing some of the neurological consequences of the disease.

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