Serotonin- whats the deal people?

I don’t understand the relationship between serotonin and migraines. I read some reports that say increased serotonin promotes migraines (for example, feverfew works by decreasing serotonin levels) and other reports that say serotonin inhibits migraines, for example, my doctor prescribes lexapro as part of my migraine regime and the ever popular effexor also promotes serotonin in the brain.

I don’t think there is a definitive answer for this, I think there are various theories but I’d love to hear some of yours!

thanks,
Selena

Selena,

I remember reading the same thing about Feverfew which is why it sits on my shelf. However, I just pulled out my ppt slides of Hain, Carey and Jen and Hain says that the reason Effexor works is not clear. He does not say that it is because of it’s effect on serotonin. He also claims that Zoloft **does not ** work for migraines. So if Hain is correct, it is not a question of being more serotonin or less serotonin.

i know that this may seem elementary, but there are research scientists, yes, believe it or not, who do realize that we are only assuming **at best **that the reasons that SSRIs work for depression is because they inhibit the reutake of serotonin. it’s only an assumption. They could very well have something else in common. ADs work with 3 neurtransmitters and the last time I read, which was long ago, the count was well over 100. It could be that the ADs we are taking are hitting sites other than we know ??? This again may seem elementary, but hard scientists publish data that supports their assumptions, and that allows pharmaceutical companies to develop and sell drugs based on those assumptions, but they realize that they are only assumptions. It’s what makes the world go round.

Sorry for the lecture, but Hain states clearly in his latest ppt slides that the reason Effexor works is unclear.

Hain is also famous for always updating his webpages. As he gains new experience and new knowlege he updates the new pages and often does not delete the old. It doesn’t surprise me that his website it a bit disorganized (in my opinion) beause he had NO idea how to transfer me back to his front desk.

Julie

In fact, here’s how complex the brain is and the many ways it can be approached. Tianeptine is a drug which is documented in Julien’s Primer of Drug Action:

Tianeptine is a novel antidepressant compoud. In contrast to SSRIs, it increases the presynaptic neuronal uptake of serotonin in he brain and thus decreases serotonin neurotransmssion. However, tianeptine appears to reduce sress-induced atrophy of neuronal dendrites, exerting a neuronal protective effect against stress…and restroing intracellular mechanisms adversely affected by stress and other insults…Its efficcacy against major depression is well documented…

Boslee and I were talking - we wish there were as much funding for migraine drugs as there were for antidepressive drugs. all we get is those that fall to us off label and feel lucky for that.

JJ

FROM ANOTHER SITE ANOTHER PERSONS PERSPECTIVE
motion intolerance , mdds symptoms migraine Mav and seratonin???

Hi …i am trying to recall back in February what Baloh said to me.
First of all he said that when he diagnosis someone with MAV or
Migraine Eqivalent he basis it on all his/her history and also a
process of elimination. It’s also a Theory of what he believes is
going on with the brain (chemical Imbalance)…lacking Serotonin. He
said that many people who have Painful Migraines, Silent Migraines,
Migraine Equivalent tend to (not all) be Motion Intolerance as a child
and never outgrows it even when they are an Adult. He is not speaking
for everyone, but a sizeable portion as i recall. Dr. Baloh said that
Migraines are in the same ballpark as Anxiety Disorders, Panic
Disorder and Depression. It all boils down to lacking Seratonin.
Remember…it’s only his theory…but it makes alot of sense, atleast
for my condition. Also, genetics play a role in this.

ALSO THIS:

As i recall, Dr. Baloh believes that MDDS and MAV are…including

Panic Disorder, Anxiety Disorders, Depression and Migraines are all
in a similar family of disorders. Most likely our brains are lacking
Serotonin. Depression & anxiety is in my mom’s side of the family.
My head does not have a painful pounding headache…rather…i have
this throbbing like sensation, which evolves into a rocking motion
and most of this is felt mostly inside my head. Xanex helps to make
me feel more stationary. My condition became Chronic when i was 40
and i’m now 53. Betweene 38-40 yrs old i would have approx 2
nightime vertigo attacks (wake me up from sleep) and i would vomit.
Remember…Dr. Baloh giving the diagnosis “Migraine Equivalent” or
MAV is trying to be as accurate as possible. It’s only a theory
about our brains lacking serotonin…but it makes alot of sense. My
mother suffered from depression/anxiety, sister suffers from
anxiety/migraines and my late brother also had some nasty headaches,
although he never said they were migraines.

What is inderal? Have you tried any anti-anxiety medications like
Klonopin, xanex, ativan or valium? I never became addicted and
although its like putting a band-aide on, atleast it helps me to
have a semi-decent life and i’m able to do most things.

NEXT EMAIL:

thanks for asking. Based on my health history that i shared
with Dr. Robert Baloh, he said there is a possiblitly it started out
as BPPV (Benign Positional Veritgo) and evolved into Migraine
Eqivalent. But only a possibility… If someone is lacking
Serotonin in their brain (chemical imbalance), the symptoms (rocking
sensation) will most likely continue. The Xanex is an anti-anxiety
medication and it is only a band-aide (no cure)…it doesnot
increase Serotonin like anti-depressants do. Dr. Baloh said they
call it “Migraine Equivalent” because the symptoms are equivalent to
a Migraine even though it is for the most part Silent. I feel the
throbbing, rocking motion in my head, but very little pain. My mind
doesnot feel relaxed and there is some tension and that is where the
Xanex helps to keep me stationary and decrease the tension and
motion in my head.

In 1992 when this condition started to become Chronic, my therapist
first thought i had “Panic Disorder”…then a few years later it was
changed to “Inner-ear Dysfunction with Anxiety”. Another doctor
thought i might have Menieres disease and a Neurologist thought i
could very well have a stubborn case of Benign Possitional Vertigo.
Having "Migraine Equivalent’ the inner-ear is In-directly involved
because the symptoms are brought on from the Brain instead of having
an inner-ear problem that symptoms come directly from the Inner-ear.
Of all the diagnosis i have recieved, i believe Dr. Baloh is the
most accurate one. My mother suffered from depression, my sister
suffers from Anxiety and Classic Painful Migraines, and my late
brother had headaches. I am presently taking Elavil (anti-
depressant) and since i am very senstive to medications, my doctor
has decided to take it very slowly as far as increasing the med. In
a couple of weeks my doc will be increasing the elavil to 25mg up
from 20mg. If you have any questions, feel free to ask.

NEXT: EMAIL

Did Dr. Baloh ever share any research with you? And if so can you share
it with us. It sounds like there are so many things going on, migraine,
seratonin, motion, anxiety, stress,hormones, etc. How does one even
know where to begin? Thanks.

NEXT:EMAIL

Do you know if there is a test for seratonin levels?

NEXT EMAIL:
If i’m not mistaken, i asked my current doctor(Dr. Chunkich) at the
VA hospital the same question and he said there isnot. Sure would be
great if there was.I mean, if there was such a test you would think
Dr. Baloh from UCLA would have suggested it.

P:S
There isnt Any such test as of yet!
When it happens , it will stop the confusion wont it! :mrgreen:

This email has names deleted for privacy issue’s,
Thank you.

jen

Hmm, I’m with Boslee on this one. It all just seems weird.
I’ve had my fair share of serotonin-increasing meds (two SSRIs, Remeron and amitriptyline (Elavil, Endep)) with NO change for the better whatsoever. This whole deal got way worse when I added two of those meds, though! :shock:

And if it were as simple as an SSRI or a TCA, why wouldn’t one be just as good as another? Hain swears by Effexor and claims Zoloft is worthless. Furman swears by Zoloft, etc.

Hain says he’s not clear why Effexor works.

Did Boslee post? if he did, it gone!!! :shock:

I don’t remember posting a follow-up in this one. He could be talking about something we discussed on a PM, and thought it outloud perhaps lol? I personally don’t understand the serotonin relationship with migraine either, but I HAVE spoken to quite a few mav’rs both on this forum and on others, and SSRI’s other than effexor DO work in their experience, but it would seem that most of the time, anxiety was a major factor in the cases where the SSRI’s made a difference in the dizziness. Hain says SSRI’s do not work for migraine. I believe him. But if the condition falls more under “MARD”, as in the article Scott posted, it would appear that the SSRI category would have a major influence in the condition. This is backed up in the “MARD” article and the MARD concept is also indirectly referenced in an article I posted via the name “psychogenic dizziness”. They called it “chronic subjective dizziness” in this article however.

I may be wrong about this, but based on what I’m reading (unless I’m interpreting it wrong, which is entirely possible on Topamax lol), it would seem that SSRI’s make the most difference when anxiety is the primary factor and work the least when migraine is the primary factor. But then again, I have spoken to many people who would say otherwise lol, so go figure. :slight_smile: I can’t claim to have any better handle on understanding this than anyone else researching this. But I think there is something to the MARD vs Migraine concept, and this COULD influence which drugs are given initially which COULD help to lessen experimentation and help to hit the nail on the head a bit sooner by having the proper mechanisms of action nailed down before treatment. (the following is just an example not an established protocol)If this turns out to be right, treatment could look something like this maybe… If it’s MARD, treat with SSRI/benzo first, and if not getting full results, add perhaps verapamil or another migraine preventative to take care of the secondary migraine disorder. If primary migraine, start with any migraine preventative, if no results, add second migraine preventative, if insufficient, add third category, if insufficient, add klonopin, if insufficient, add effexor (which covers anticonvulsant, calcium channel blocker, benzo, and anti-depressant). There’s not too much else one can do beyond that, but it does eliminate someone with MARD starting with say topamax first or verapamil first, where the primary problem is being left untreated. The same would hold true for a true migraineour who is started on say paxil first, with THEIR primary problem being left untreated. Sounds nice in theory anyway lol.

I forgot what the heck we were talking about after writing this. My goodness lol. I had to go back to the first post and read it again. wow. oh, yeah serotonin!!! I think the reason serotonin PROMOTES headaches in some and RELIEVES headaches in others might be due, in part anyway, to the MARD vs Migraine idea, or if not that, something to that effect. Or, it could just be that in some people, serotonin promotes headaches, end of story, and in some people, serotonin relieves it. Not sure really. But I don’t think it’s important to know this. I think it’s more important to know what is currently working, and if anything, maybe try to gain an understanding WHY it may be working instead HOW, so that the SSRI’s can be applied a little more methodically. So far, i can’t find a better reason for why SSRI’s work in some, and not in others, than the MARD vs Migraine idea. To me, that seems to sum it up. We all know that SSRI’s do work for anxiety, which according to the MARD article, make migraine many times worse. It would seem that as long as PRIMARY anxiety disorders continue, migraine just continues to go on. It’s kind of like having a house that is WAY too hot (migraine), and so you get this huge industrial air conditioner to clean up the job (migraine preventative). However, ALL the windows are open in the house (anxiety) so no matter how much cold air you blast (migraine preventative), you can never cool the house (migraine). However, if you simply close the windows (kill the anxiety), then the exact same about cooling power (migraine preventative) now does the job and knocks out the hot air (migraine). But, even if you get 2 or 3 air conditioners, as long as the windows are open, the house will continue to be hot. Simple little analogy lol but it really got me thinking about how much anxiety plays into this, for some people anyway. And for those people, it seems the SSRI’s might be a very good choice. Anyway, I’ll stop here because I’m saying a whole lot and I’m not sure if any of it is making any sense or if it is even relevant to what we are talking about here lol. I am really up in the air about what to do about my topamax dosage. It has me saying and doing all sorts of whacky things :oops:

Boslee

Oh Boslee that was a fantastic explanation, thankyou.
I understood it and I’m dyslexic, good one!

It makes a lot of sense to me that migraine could present in someone as a permanent problem regardless of what type,
If someone were stressed out or had underlying anxiety issues,

Now, until just recently I had no idea how full of anxiety I really am.
And how much of a roll it has been playing in my Mav.
I kept saying wow, this cant be so,
I have a fantastic husband, and beautiful daughter and a great life, why would this Migraine be driven by anxiety?
They must be wrong these stupid Dr…………. bla bla bla.
It wasn’t till “very recently” that I’ve have realized that I have very bad anxiety from, issues in my past OK.
:twisted:

Now, “psychogenic dizziness” OR MARD…………… I get confused as to whether they are the same thing,
I thought that “psychogenic dizziness” ………… didn’t have aura…… right?

I’ve read the MARD article 3 times and still don’t see understand the difference. :oops:
maybe Scott could explain it to us,
But hey! it doesn’t matter.
That’s not important. right?

It seems to me, if I had MARD, that a big part of MY therapy, would be to have psychotherapy,
in conjunction with meds to help remove the underlying cause
and in turn The real issues causing the initial problem.
Learning techniques and strategies for coping?
Mine possibly being molestation, as a 9 year old.

I’ve wondered if this would help me at all
What do you think Bos?
Thanks.

Jen.

also just found this tid bit, from another dizzy site, on Elavil (endep)
Elavil prevents the reuptake of seratonin and norepinephrine

which cause vasoconstriction of the blood vessels. Vasoconstriction
causes an increase in blood pressure. I’m not certain if Elavil by
preventing the reuptake into the nerve acts as a calming effect or
if it is a stimulant. Maybe by preventing these two excitatory
neurotransmitters from being taken back into the nerve cell it acts
as a calming effect. I’m not a biochemist so if there is anyone out
there that understands this please provide an explanation!

vasoconstriction for a maver is a no no, maybe this is why some of us get worse on elavil?
I wonder?

jen

— Begin quote from "jennyd"

also just found this tid bit, from another dizzy site, on Elavil (endep)
Elavil prevents the reuptake of seratonin and norepinephrine

which cause vasoconstriction of the blood vessels. Vasoconstriction
causes an increase in blood pressure. I’m not certain if Elavil by
preventing the reuptake into the nerve acts as a calming effect or
if it is a stimulant. Maybe by preventing these two excitatory
neurotransmitters from being taken back into the nerve cell it acts
as a calming effect. I’m not a biochemist so if there is anyone out
there that understands this please provide an explanation!

vasoconstriction for a maver is a no no, maybe this is why some of us get worse on elavil?
I wonder?

jen

— End quote

Hmm odd, many dizzy docs use it as first- or second-line for migraine prevention. Although, I have to admit, it hasn’t helped me at all! It might have helped the first few weeks, but I got worse after that.

Yea Hi Tran , I stuck with it for 3 months and it nearly did me in. :shock:

Okay guys, get ready for another boring one, but for those of you who didn’t feel like reading the entire article, it really is filled with some gems:

**migraine is characterised by interictal alterations in neurochemicals (including serotonin, norepinephrine (noradrenaline), and dopamine) **and cutaneous allodynia, representing aberrant neurophysiology during migraine.11

These changes in monoaminergic activity due to vestibular activation may both trigger migraine related symptoms and
modulate activity in both pain related and anxiety related pathways.

Numerous studies have confirmed that anxiety and dizziness are interrelated.6 32 For example, among 268 patients
recruited from a tertiary otolaryngology clinic, panic disorder was identified in 17.2% and major depressive disorder in
11.2%.33

Based on a retrospective chart review of 132 (77%) of 172 patients at a tertiary dizziness clinic who had been referred for psychiatric evaluation, Staab et al40 classified patients into three groups: (a) psychiatric disorder causing dizziness,
(b) primary otoneurological disorder with secondary anxiety, and © preexisting anxiety or prodromes escalating
as a result of the neurotological disorder.

Anxiety seems to be a particular problem in patients with acute vestibular disorders. In a recent study,41 17
(57%) of 30 patients with acute vertigo reported that anxiety symptoms seemed disproportionate to the seriousness of
the disorder. Only 23% had no anxiety. The increase in anxiety was not just a general reaction to having an acute
illness, because the comparison group of patients with other acute neurological conditions without dizziness reported
significantly less anxiety (17%).

**The actions of selective serotonin reuptake inhibitors (SSRIs) have provided compelling evidence for a role of serotonergic transmission in vestibular function. **Recent evidence indicates that SSRIs are efficacious in the treatment of vertigo;18 32 72 furthermore, the beneficial effect of benzodiazepines such as clonazepam on both dizziness and anxiety
may be mediated by their serotonergic effects. 73–75 In addition, the vestibular manifestations of the SSRI discontinuation
syndrome (acute onset of dizziness, vertigo, and uncoordination) are exacerbated by head and eye movements, 76 77 which is consistent with direct effects on vestibular information processing.

**The link between migraine and balance disorders and the link between anxiety and balance disorders suggests that a subgroup of such patients will manifest migraine, anxiety, and a balance disorder. **MARD is unlikely to be simply the
chance combination of a balance disorder, migraine headache, and anxiety. This notion is supported by the increased prevalence of panic disorder in migraine patients with and without aura. In a recent study, the lifetime prevalence of panic disorder was 19.6% in migraine patients with aura and 14.3% in migraine patients without aura.84 In addition, the presence of anxiety in patients with migraine suggests a worse prognosis.85

The clinical implications of the overlap between migraine, anxiety, and balance disorders in MARD relate to diagnosis,
clinical course, and treatment. Because the care of these patients tends to be distributed among primary care physicians,
neurologists, otolaryngologists, and psychiatrists, the initial diagnosis may reflect the background of the examining doctor in addition to the symptoms of the patient. Furthermore, patients may self select to a particular specialist depending on which component predominates. Patients with MARD may be misdiagnosed if one or more components go unrecognised. In
our experience, balance symptoms in patients with a clinically significant anxiety disorder are most likely to be overlooked, as their symptoms are often attributed entirely to anxiety. An awareness of the existence of MARD will enable physicians not only to appreciate the predominant complaint but also stimulate them to look for the other components.

A common feature in MARD is visual dependence—that is, an excessive reliance on visual cues for balance. Visual
dependence and its symptomatic expression, SMD, affect many patients with migraine, anxiety, or a balance disorder. Patients with SMD often have discomfort in visual environments that are overly complex or devoid of visual orientation cues.

In certain anxiety disorders, particularly in height phobia, patients have an increased tendency to manifest discomfort in certain visual environments. As noted in figs 224, visual dependence and SMD may be seen in patients with migraine related or anxiety related dizziness, and in MARD.

if MARD represents a disorder in which the three manifestations constitute different symptomatic expressions of the same pathological substrate, a treatment directed at that underlying common pathological substrate should result in improvement of all three components. However, treatment directed at a component that constitutes a superficial manifestation of the condition (symptomatic treatment) should result in improvement of that component but not the others.
Although empirical information on the simultaneous effects of treatment on the three components of MARD is lacking, studies that focus on two of the three components have been conducted. With respect to the combination of dizziness and anxiety, several drugs, including antidepressants and benzodiazepines, are used to treat both conditions. Treatment with SSRIs may reduce both dizziness90 and posturographic abnormalities in agoraphobia.91 Dizziness limited to panic attacks in
panic disorder (psychiatric dizziness)92 resolves as panic frequency is reduced with treatment of this condition. In our
laboratory, we have found that vestibular rehabilitation therapy can be of value for patients with agoraphobia with
vestibular dysfunction who did not respond to behaviourally oriented therapy. 93 With respect to the combination
of dizziness and migraine, both abortive and prophylactic migraine medications effectively control headache and balance
symptoms in patients with both migraine and balance complaints.94 Reploeg and Goebel found a reduction of at least 75% in the frequency of attacks of dizziness in 72% of patients with migraine related dizziness who were treated with either a tyramine restrictive diet alone or diet in combination with nortriptyline or atenolol.95

In our experience, patients with MARD in whom balance symptoms predominate should be treated with a combination of an antidepressant, such as imipramine, and a benzodiazepine, such as clonazepam. Sertraline and diazepam are alternates. For patients in whom vertigo is considered a migraine aura or migraine equivalent, a triptan may be beneficial94 for acute
attacks. Patients with MARD in whom migraine predominates may also benefit from treatment with an antidepressant.
Our preferred medication is imipramine. This type of patient may also benefit from treatment with an anticonvulsant
such as topiramate or a calcium channel blocker such as verapamil. Note that in our experience, beta blocking agents do
not appear to be helpful for patients with MARD. Rescue therapy includes short term benzodiazepines. For patients with MARD in whom anxiety symptoms predominate, an SSRI such as paroxetine98 99 or sertraline90 is preferred. Benzodiazepines such as clonazepam are valuable, particularly for those patients with both prominent anxiety and pronounced balance symptoms

all patients with MARD, especially those with SMD, may benefit from vestibular rehabilitation therapy.

So Jen, can you top this one? :mrgreen:

Bitch!!! :mrgreen:
no ! no I can’t
thanks jules thats a goodie, just what I was looking for.
xxxxx
your a good researcher.

You mean I WIN!!! ???

:smiley:

ph…ttt

what eva…
yea you can have this one K :shock:
your very compedetive Julie :?:
arent you
heeeeeeeeeeeeee

nah, not me :wink:

heeeeeee
8)