I had a really stressed out week because of some personal stuff going on which peaked on Wednesday with all out off-the-charts anxiety. I always forget how bad anxiety can be until I’m thrown into it again. If it wasn’t for keeping a diary I’d never remember just how bad it can get, but more importantly that it does pass again just like a bad 2-3 day thunderstorm. So yesterday the migraine headache began at a low level and today I’ve had one of the worst headaches in a very long time – the sort where your eyes burn, neck is on fire, and you can’t think straight … of course it had to coincide with two back-to-back meetings today. I swear migraine “knows” when to get you.
Anyway, I was hunting around online to remind myself of the biochemistry behind why this occurs and came across a good explanation. Do you guys get hit badly a day after a stressful event? Does it bring on a pain-type headache/migraine? Here’s an explanation I found which gives me some solace. I know it will pass but it’s always nice to have a good explanation for it all and help to know that it’s a reaction and will go. The thing about all of this migraine MAV bullsh*t is that while your in the thick of it, you never think you’ll get out of it no matter how many times you have been there.
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The stress stage is followed by the brain recovery stage – the brain goes into a protective phase to preclude the increase in adrenergic drive from blowing up the brain’s vascular system. Recovery stage leads to vascular vasodilation causing blood vessels to get larger and consequently putting irritation on the trigeminal nerve of the brain. This irritation is experienced as the migraine headache. The reason for an early morning headache after a night’s sleep is due to stress – like a day after an alcohol binge – called the hangover. The migraine headache is the norepinephrine hangover as a result of prior adrenergic over-drive. Interestingly, this is how the brain protects itself from adrenergic over-stimulation after the assault by catecholamines a day before. Findings by Capman L.F., Arch of Neurology 3:223, 1960 reported large amount of catecholamine metabolites in the urine of patients suffering from migraine headache. These findings support the hypothesis that the patient’s brain might have been subjected to increase in adrenergic drive of catecholamines prior to the onset of migraine. Although people experience vascular vasodilation, the trigger mechanism is not known. Perhaps this mechanism is similar to the way baro-receptors function in the heart – firing as soon as they notice a transient increase in blood pressure to bring about normotension. The Varatrum alkaloids (previously used to treat hypertension) trick the heart this way to reduce blood pressure.
Sumatriptan helps to relieve the symptoms of migraine because of its selective serotonergic agonist effect on the serotonin receptors (serotonin subtype 5-HT-1d). The effect causes a vasoconstriction leading to the relief of the migraine symptoms. According to the Briefing Report by the Society of Neuroscience, Feb. 1998, it is believed that sumatriptan targets both the trigeminal nerve and the blood vessels that serve the head and other parts of the body including the heart. Rizatriptan (Maxalt) is the new anti-migraine drug acting at the same receptors and same actions as sumatriptan. Maxalt is said to be more effective in smaller doses than Sumatriptan.
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I’m not sure how accurate the above information is but a “norepinephrin hangover” makes sense. I’ve never tried a triptan before but wonder if it would be effective in situations like this? Has anyone with MAV ever tried a triptan for this part of the condition?
Cheers … Scott