Migraine remains a poorly understood disease, and with this the management traditionally is frequently unsatisfactory.   Migraine headaches are characterized by a throbbing or pounding pain, and are classically located on one side of the head, although they can occur all over.   The pain is usually severe, and is usually accompanied by sensitivity to bright lights, sounds as well as nausea and vomiting.     The pain may last for hours or even days.

Some migraines are preceded by an “aura” 10-30 minutes before the headache.  Typically, auras can be flashing lights, cracked glass visual change, motor/ speech difficulty, weakness of an arm or leg, or it can be sensory such as with tingling of the face or hands.

The pain is thought to be caused by abnormal dilatation of the blood vessels.    The preceding aura is thought to be vascular constriction of the vessels before they dilate.    This constriction leads to a lower blood flow through the affected part of the brain, and that the transient ischaemia causes the aura.

Certain foods that are “vasoactive” such as red wine, chocolate and aged cheese are well-known triggers.  In women, hormonal changes at the times of menstruation can be a trigger.   Sometimes it can be weather changes, or glare while driving, and the triggers can be obvious, but sometimes they can be very difficult to determine.

Migraine is about inflammation.   Genetic information points to the involvement of transient receptor potential (TRP) channels in pain mechanism.   TRPA1, an ion channel on the trigeminal (and most other sensory) nerves is the major oxidative threat sensor.   It is activated by various irritants and agents releasing the pro-migraine peptide, calcitonin gene-related peptide through this nerve pathway.   TRPA1 agonists release chemicals that cause vascular dilation.

Successful management of migraine is really about “turning off” the processes that are driving the inflammation. Other research at Griffith University has been looking for methylation defects in young women with migraine.  In most (and perhaps all) there appears to be a defect in the gene methylation pathway so most can have their migraine reduced/ removed using appropriate B12 supplementation. Some cannot tolerate the folic acid which is combined with the B12 in most tablets. Sometimes the B12 needs to be changed to a different form, and some need IM B 12. Vitamin B2 (riboflavin) has been known for some time to reduce the frequency of migraine, especially in children, and B2 looks as though it is important in the methylation pathway in enabling vitamin B12 function.

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