The Science of Migraine: “It’s All in Your Brain” – Part 1

0:00 [Music]
0:22 hello everyone
0:23 and welcome to this first webinar of
0:25 migraine canada
0:27 addressing the causes of migraine my
0:29 name is dr elizabeth larue i’m a
0:31 headache specialist and i work in
0:33 montreal quebec
0:34 i hope you will enjoy this video and
0:37 welcome
0:38 [Music]
0:42 so why am i giving this talk well one of
0:46 the reasons is because uh over 10 years
0:48 of practice it’s not rare
0:50 that i meet someone who’s been living
0:52 with migraines
0:53 since the age of 12 and when i asked
0:56 this person you know what do you think
0:57 migraine is exactly what is going on
0:59 during a migraine attack
1:01 um they tell me nobody ever told them
1:03 that
1:04 and they’ve been living with this
1:05 condition for years and years
1:07 without really understanding what is
1:09 going on
1:11 migraine as we will see is actually
1:13 invisible
1:14 and this contributes to the stigma that
1:17 is an additional suffering for people
1:19 who live with migraine and the stigma
1:22 also leads to a lack of treatment or a
1:25 lot of misconceptions about treatment
1:28 so by discussing the science of migraine
1:30 today
1:31 i really hope that i can help you
1:33 understand better what migraine is
1:35 and that you can share that with your
1:37 networks and your healthcare providers
1:42 if you live with migraine probably
1:44 you’ve heard those things before
1:45 you know you should drink more water you
1:47 should manage your stress
1:49 you should give up on chocolate and god
1:51 forbid we would have to give up on
1:53 chocolates it’s so good isn’t it
1:55 so what about these advices are they
1:58 helpful
1:59 what are they based on of course it’s
2:01 reasonable to be hydrated
2:02 of course it’s reasonable to manage
2:04 stress but is it enough
2:06 to control migraine another thing that
2:09 can actually happen if you have migraine
2:11 is you will start looking for
2:13 improvement and then you will meet a lot
2:15 of different professionals or different
2:18 firms and companies who pretend that
2:21 they know the unique cause of migraine
2:23 and they have a perfect tool or a
2:25 perfect thing to address it
2:27 they have the migraine cure so that
2:29 might be a miracle diet
2:31 that might be a procedure a person that
2:34 might be
2:35 a special supplement and
2:38 sometimes uh these these people are
2:41 these companies uh really want to help
2:43 of course
2:44 but some of them are actually more
2:46 interested in the profit they can make
2:48 um so it’s not always easy to understand
2:51 what those treatments are based on
2:53 and i think as a person with migraine
2:55 every time you hear something like
2:57 miracle cure or works 95 percent of the
3:00 time
3:01 you should be very careful and put that
3:03 in the same list
3:04 as you know lose weight without doing
3:08 any change to your diet or make money
3:10 while staying at home
3:12 so be very careful about these but as we
3:14 will discuss
3:15 it doesn’t mean that all our alternative
3:18 medicine options are
3:20 are not fitted for you it just means
3:23 that be careful when someone
3:24 tries to sell a perfect option for
3:27 migraine
3:29 it’s also very important to talk about
3:32 migraine because it’s so
3:34 common in the human race a lot of my
3:37 patients say that they feel alone
3:39 they feel that no one understands them
3:43 which is funny really because migraine
3:45 is the third most common problem
3:47 or disease in the whole world so bring
3:49 it malaria
3:51 tumors cancer everything
3:54 migraine is the third most common um the
3:56 third the first one
3:58 if you’re curious is dental caries
4:01 the second one is tension type headache
4:04 which is closely related
4:06 uh on it’s also a headache disorder so
4:08 it’s kind of related to migraine as well
4:11 so migraine is common and but you could
4:14 say well a lot of people with migraine
4:16 have a few migraines per year and
4:18 they’re not that disabled
4:20 it might be true but one to two percent
4:23 of the whole world
4:25 lives with what we call chronic migraine
4:27 which is having migraine or some related
4:30 headache
4:31 more than 15 days per month so that’s
4:33 very disabling
4:34 and that’s one to two percent of the
4:37 world’s population
4:38 so we we definitely should talk about
4:40 migraine more
4:42 in this society okay so topics for today
4:46 i will not talk about particular
4:49 treatments today
4:50 i really want to start at the root of it
4:53 at how your brain works and why migraine
4:56 occur so we’ll talk about genes and the
5:00 migraine software
5:01 we’ll talk about the migraine pain and
5:03 the cascade of migraine
5:05 we also will discuss the pink what i
5:08 call the ping pong theory
5:10 it’s how the migrant brain interacts
5:12 with the environment and then we’ll talk
5:14 about
5:14 triggers and thresholds then we’ll
5:17 just put all this together and and then
5:20 move to
5:21 an overview of treatment so now that we
5:24 will understand what migraine is
5:26 well how could we treat it um we will
5:29 have an introduction to the migraine
5:31 tree which is our key resource
5:33 for information on our migraine canada
5:35 website and then
5:36 we’ll finish with just a little note
5:38 about how important it is
5:40 to change the system in canada to serve
5:42 people with migraine and
5:44 other headache conditions better are you
5:46 ready
5:47 are you curious let’s get started
5:52 society should get this
5:55 um nobody in their right minds would say
5:59 that
5:59 coughing or being a bit out of breath is
6:02 the same thing as living with asthma
6:04 so i really hope that someday people
6:07 will get that having a headache
6:09 is not living with migraine coughing and
6:12 a headache are symptoms
6:13 they can be caused by gazillion things
6:16 asthma
6:16 and migraine are chronic conditions that
6:20 can be disabling and may require medical
6:23 therapy
6:24 so hopefully every time i go in the
6:25 media i’m asked the same thing what’s
6:27 the difference between a headache and a
6:29 migraine
6:29 and i hope someday people will get it
6:32 and understand that a headache is a
6:34 symptom
6:35 and migraine is actually a medical
6:37 diagnosis
6:39 so what is a migraine attack well
6:42 when you see a doctor for a headache
6:44 well the doctor will
6:46 start by ruling out dangerous things by
6:48 different questions and
6:50 about your symptoms and how it happened
6:52 and then
6:53 if to diagnose migraine they will start
6:56 with questions to see if your symptoms
6:58 fit into a migraine attack
7:00 but the key thing is that a migraine
7:02 migraine should be
7:04 recurrent if you have for the first ever
7:07 time
7:07 a headache even if this headache comes
7:10 with nausea or light sensitivity
7:12 which are typical symptoms from migraine
7:15 our first ever headache should never be
7:16 diagnosed as a migraine
7:18 because it can be something else can
7:20 tumor can be an infection
7:22 so if you have or if you live with
7:24 migraine and you have a new headache
7:26 just be wary
7:27 and seek medical advice all right so you
7:30 have recurrent attacks
7:31 and then you have a bunch of symptoms
7:34 depending on which
7:35 you know part of the brain becomes
7:37 affected
7:38 so the typical migraine headache may
7:41 start on the one side
7:42 and might be pulsating but a lot of
7:45 people
7:46 actually have headaches in the end on
7:48 both sides
7:49 and not all of them report that the
7:51 headache has to be throbbing
7:53 so it’s possible to have a migraine
7:55 that’s both sides
7:56 especially in kids uh but and not from
7:59 it
7:59 though and then the migraine has to be
8:02 moderate to severe
8:03 so it has to slow you down or to be
8:05 somewhat disabling but there are
8:07 different severities of migraine some of
8:09 them are terrible flamboyant they put
8:10 you on your back for days
8:12 others are maybe more moderate it has to
8:15 last more than four hours
8:17 so the key point here is to
8:19 differentiate between a tension headache
8:21 which is super common
8:22 a little headache like a helmet or a
8:24 cask you don’t have any other symptoms
8:26 with it
8:27 it goes away usually and it’s not
8:29 usually disabling
8:31 and then you have the other symptoms of
8:33 migraine we call them sometimes the
8:35 cardinal symptoms of migraine
8:37 gastrointestinal stuff nausea vomiting
8:40 some of my patients complain of diarrhea
8:42 something going on with the gut in the
8:44 stomach
8:45 sensory hypersensitive is huge
8:48 sensitivity to light
8:49 to sound to smells very typical
8:53 and then to movements and touch having
8:56 the skin hypersensitive
8:58 and then some of people with migraine
9:00 actually live
9:01 have auras i will talk about them a
9:03 little more
9:04 and then there are symptoms that are
9:06 less common maybe
9:08 but or less official but a lot of people
9:10 talk about them
9:12 dizziness feeling unstable vertigo
9:16 and then all the other pains neck pain
9:18 sinus pain
9:19 jaw pain we’ll talk about that skin
9:22 hypersensitivity
9:23 and then everything that relates to the
9:25 what we call the higher brain functions
9:28 that’s what your brain does when it has
9:31 to compute information
9:32 so having difficulty focus finding words
9:35 having difficulty uh concentrating
9:38 um and some people sometimes call about
9:40 talk about
9:41 brain fog to kind of
9:44 define this irritability and
9:47 fatigue is big especially after the
9:49 migraine attack people
9:50 may feel exhausted so it doesn’t mean
9:53 that
9:54 everyone with migraine has all of these
9:56 but they mix and match and usually
9:58 people
9:59 may have two or three different types of
10:01 attack and may have those symptoms so
10:04 we’re really more than a headache here
10:07 so migraine the problem is it’s
10:10 invisible on ct scans and mris
10:12 medicine relies a lot on imaging these
10:15 days
10:15 we do imaging for everything for the
10:17 heart for the kidney for the brain
10:19 name it you just mri the problem is that
10:23 it works well if you have a brain tumor
10:25 so this here you see the big bad tumor
10:28 and it relates to the computer that is
10:30 visibly broken
10:32 but with migraine we’re talking about a
10:34 software problem
10:35 so it’s all about a computer that seems
10:38 to work
10:39 you know it looks nice but then you
10:40 start it and it might actually
10:42 um be slow the programs might not run
10:46 and it looks like a normal brain uh it
10:48 looks just fine
10:49 but it doesn’t work very well so
10:53 can you imagine something else that you
10:54 can’t see but does exist
10:57 uh i would say the wi-fi is a good
10:58 example it’s also a kind of an
11:00 electromagnetic thing
11:02 um we use the wi-fi every day i’m using
11:05 it right now
11:06 um and we don’t see it but it still does
11:09 exist
11:09 right so i think we should just go a bit
11:13 beyond
11:14 saying that if you can’t see it it
11:16 doesn’t exist remember all in old days
11:18 epilepsy was supposed to be a demonic
11:21 possession
11:22 because we couldn’t see it until the eeg
11:25 um
11:25 and in the old days there was a lot that
11:27 couldn’t be seen like infections and
11:29 bacteria and viruses and people thought
11:31 it was in the air
11:32 so we really have to be careful before
11:34 discarding something just because you
11:36 can’t see
11:38 so okay so what is the cause of migraine
11:40 then what can we
11:42 actually scientifically say about it
11:45 to understand that we have to discuss
11:47 what is a gene and what is a protein
11:49 we have to understand how the brain
11:52 works
11:53 um so a gene is a bit like a cookbook a
11:56 recipe from a cookbook
11:58 to build proteins a bit like legos all
12:01 our bodies are made from proteins
12:03 and those proteins are encoded by genes
12:06 all humans have similar genes but
12:08 different versions just like recipe you
12:10 know
12:11 your recipe for spaghetti sauce is not
12:13 the same exact recipe as your grandma’s
12:16 so genes are really ways to build
12:20 proteins in our body how does the brain
12:24 work
12:24 we could you know some people spend
12:26 their lives on this but just let’s make
12:28 it very simple
12:30 our neurons who talk together uh that we
12:33 have like gazillion
12:34 trillion trillion neurons they speak
12:36 together and they determine
12:38 how we behave how we perceive they
12:40 integrate tons of information
12:42 how do they communicate they communicate
12:45 through electricity
12:46 and chemistry for chemistry we have what
12:50 we call
12:51 neurotransmitters that are little
12:53 molecules that
12:54 bind to a receptor so it’s a bit of a
12:57 message that
12:57 that finds the right mailbox
13:01 um to make the other neuron um
13:04 do something or behave differently so we
13:07 have chemical substances
13:09 binding to receptors and influencing the
13:11 way that the neuron behaves
13:13 the electrical current may actually lead
13:16 to the release
13:17 of those molecules those
13:18 neurotransmitters and they may also
13:21 influence that
13:22 neurons can also communicate directly
13:24 just with electrical messages
13:26 and all of this is not visible to the
13:28 naked eye or even the mri
13:31 okay so we have our genes our proteins
13:34 and that determines our
13:36 neurotransmitters our receptors
13:38 but also how our blood vessels work and
13:41 blood vessels
13:42 are very important to keep our brain
13:44 well fed
13:45 and well functioning so blood is a bit
13:47 like the fuel
13:49 or the electricity if you want that
13:50 keeps the computer
13:52 working so that’s how your brain works
13:56 but it’s it gets very complex i’m just
13:58 showing this slide here
14:00 to see that we actually get a lot of
14:03 information about the brain
14:04 and a lot of proteins there so the level
14:08 of complexity of a neuron it’s not like
14:10 an
14:10 a or b switch it’s like a little town
14:13 with all kinds of people talking
14:15 together to make a decision
14:17 so neurons are very very complicated uh
14:20 structures
14:21 okay so how can we observe the brain and
14:24 understand what’s causing migraine so
14:26 that’s the thing right
14:28 um so we just said that the mri and the
14:30 ct scan is not very helpful we just see
14:33 a normal
14:34 appearing brain we can look at the genes
14:36 and there’s been a lot of genetic
14:38 studies
14:39 um we can look at chromosomes and so on
14:42 and this
14:43 tells us which genes are linked with
14:45 migraine so we actually know some genes
14:46 that are linked with migraine
14:48 we can also look at the electric
14:50 activity of the brain with different
14:52 recordings
14:53 we can look at the chemical activity of
14:55 the brain by dosing
14:57 products measuring different substances
14:59 like neurotransmitters
15:01 those that’s what we call biomarkers
15:03 that we can measure
15:04 and we can also do something pretty cool
15:06 which is functional mri
15:08 so that’s putting someone in the mri
15:10 machine
15:11 and then ask this person to do or think
15:14 about something
15:15 and then we see that a zone in the brain
15:17 lights up
15:18 uh gets more blood and that should mean
15:21 that something is going on
15:22 during that time uh that necessitates
15:25 the blood
15:26 requires the blood in that zone so by
15:28 doing this
15:29 we can say okay that that zone must have
15:31 something to do with whatever is going
15:33 on
15:34 okay so what is going on around the
15:36 world to study migraine
15:38 well many teams use those techniques and
15:41 become
15:41 expert at using them one example is the
15:45 human model that they use in denmark
15:47 so in denmark they actually have a
15:49 center where they can take volunteers
15:51 people with migraine or people without
15:53 migraine and they
15:55 inject them with different substances
15:57 that can trigger a migraine attack
16:00 and then the um they kind of record all
16:03 kinds of things
16:04 so the blood vessel reaction the blood
16:06 pressure reaction
16:07 and they can also put them in the fmri
16:09 machine
16:10 and see if they get a migraine attack so
16:12 that’s a very interesting way
16:14 of proceeding okay so we said that the
16:17 migraine brain
16:18 is different from other brains and this
16:21 is what the researchers found out
16:23 for example in the chemical world we
16:26 know that the migraine brain
16:27 has a lower serotonin state and that
16:30 during a migraine attack serotonin
16:32 actually just just spikes
16:36 uh on the electrical thing uh electrical
16:38 side of things
16:39 we know that migraine brain does not
16:42 have weight what does that mean
16:44 it means that if you take a normal brain
16:47 and you flash a light uh to this person
16:52 the brain will eventually say okay i’ve
16:54 seen you
16:55 light it’s okay i’m gonna dim that out
16:57 because it’s not relevant i’m going to
16:59 ignore it
17:00 the migrants brains do not do that very
17:02 well they keep
17:03 responding responding responding light
17:06 reaction
17:06 light reaction so that’s what we call a
17:09 low habituation
17:11 and that probably has a consequences
17:14 on how the brain works of course because
17:17 everything is always very important you
17:19 know lots of uh input
17:21 and no moderation it might also
17:23 influence the way the brain
17:25 manages energy let’s talk
17:28 about the aura some of you might have
17:32 what we call an aura uh an aura might be
17:35 a symptom of vision seeing zig zaggy
17:38 lines
17:38 flashes of colors losing vision uh
17:41 usually it’s progressive sauce starts
17:43 small and then grows bigger
17:46 i’ll see a bit more about the symptoms
17:47 in a sec but
17:49 the cause of the aura is a wave of
17:52 electricity on the surface of the brain
17:54 so on this slide you can see in red
17:57 that’s kind of the wave where the
17:58 neurons just
17:59 fire and fire and fire and that moves
18:02 you know the neurons kind of it’s like
18:04 dominoes it communicates
18:06 and then after the wave passes the
18:08 neurons are stunned you know they just
18:10 fired a lot and so they stopped working
18:12 they’re a bit in the days if you want
18:15 so during that phase those neurons stop
18:18 working
18:18 and that leads to symptoms so where the
18:21 wave goes
18:22 the symptoms occur so typically an
18:26 aura is often a visual thing and i’ll
18:28 show you some example
18:29 but it can be for some people this
18:32 crawling numbness or tingling that goes
18:34 along your arm
18:36 and face uh it can be for some people
18:39 difficulty
18:40 speaking difficulty um understanding
18:43 and in extreme cases uh people can even
18:47 paralyze with an aura if the wave goes
18:49 to the
18:50 zone of movement in the brain uh that’s
18:53 what we call hemiplegic migraines very
18:55 rare
18:56 it’s usually genetic and and that can
18:59 actually be very very scary
19:01 so think of the aura as a wave of
19:03 electricity
19:04 causing symptoms um here here are some
19:07 drawings
19:08 a visual symptoms of the aura is very
19:11 diverse
19:12 because the visual part of our brain is
19:14 very very complicated
19:16 so it can be one side or two sides can
19:18 be
19:19 colored it can be black and white can
19:21 these lines can be dots
19:23 so if you have auras you can discuss
19:26 with your physician
19:27 usually they look alike and they repeat
19:30 um but some people have
19:31 auras and they never have migraines so
19:34 the aura is something that can exist
19:36 even in non-migraine people in their 50s
19:39 often
19:39 so the aura is something that’s very
19:41 genetic it’s a wave of electricity we
19:44 understand it
19:45 but not everyone with migraine has it so
19:48 now we get back to this idea that genes
19:50 produce proteins and that every brain
19:54 works a little bit differently
19:56 um and that actually influences also the
19:59 susceptibility to aura
20:00 there’s a lot of people with aura in
20:02 their families they
20:04 there are others that have aura so the
20:06 aura is
20:07 very very uh genetically influenced
20:10 okay the nice thing with the aura is
20:12 there’s actually
20:13 studies uh where we can see the
20:15 electrical wave we can actually observe
20:17 it
20:18 so can we see the migraine attack not
20:21 the aura just a migraine attack
20:23 and i’m delighted to say that now we can
20:25 actually see
20:27 things happening in the brain with
20:29 advanced techniques
20:40 [Music]
20:56 you