FAQ Episode 10: "What if you have both migraines and interstitial cystitis. Is there a relationship between them?"
FAQs for Natural Migraine Relief for Women
Welcome again to Frequently Asked Questions about Natural Migraine Relief for Women. Today’s episode is an answer to a question from a member of the Natural Migraine Relief class. As we’ve discussed in previous FAQ episodes, sometimes you can have two medical conditions that have underlying root cause factors in common. This is also the case for migraines and a problem known as interstitial cystitis.
Interstitial cystitis (IC) is a chronic bladder condition that may cause scarring and stiffening of the bladder walls. IC causes a frequent urge to urinate, sometimes up to 60 times in 24 hours. It also causes pain and pressure in the bladder. It can be highly disabling, and only half of those with the disorder are able to work full-time. One study found the quality of life in those suffering from IC was lower than that of individuals going through chronic dialysis for renal failure.
Demographically, it is estimated that more than 1 million in the U.S. suffer from this condition, the median onset of IC is 40 years of age and 90% of those with IC are women. Interestingly, this age group correlates with the early 40’s, where:
-the incidence of migraine is at its peak
-we see the progression of perimenopause, where ovarian hormone output begins an ongoing state of decline toward eventual menopause.
Currently, the underlying triggers for IC are not fully understood, and the diagnosis is made by excluding other similar conditions. Initial testing is needed to rule out infections, bladder stones, multiple sclerosis, and sexually transmitted infections, among others.
18%-25% of those with IC also have migraine headaches, as well as an enhanced likelihood to have irritable bowel syndrome (3X that of normal controls)1, fibromyalgia, fatigue (10X)1, other chronic pain disorders (3X)1, underlying sleep disorders (2X)1, Raynaud’s syndrome (3X)1 or allergies.
IC could be termed a ‘hypersensitive bladder’ in the same way that a migraine could be considered a “hypersensitive brain’. It may be instructive to ask whether these two disorders could have root cause factors in common. Here are three to consider:
Inflammation
1. Certain foods trigger symptoms in the bladder, as do stress and anxiety since both increase muscle tension. Similarly, increased muscle tension in the head and neck can also be a triggering factor for vascular headaches like migraines. Dietary modification is a crucial first step in taking charge of these conditions, and helping to protect your bladder or brain. Some foods that commonly aggravate both IC and migraine include caffeinated beverages, alcoholic beverages, spicy or salty foods, processed foods, acidic foods like citrus or tomatoes, and foods with additives such as artificial flavorings like aspartame or monosodium glutamate (MSG). Cutting them out of your diet could reduce the pro-inflammatory effects on both IC and migraine. In either case, removing one or more such trigger foods from the diet for 2-3 weeks can reveal if they are a player in your symptoms.
Three additional anti-inflammatory measures that have been found to help both IC and migraine include:
-the use of the citrus bioflavonoid quercetin helps by reducing histamine release and its secondary inflammation. 3,4
-the antioxidant benefit of melatonin supplementation. 5,6
-stopping smoking. Each cigarette includes more than 600 chemical ingredients and when smoked these create over 7000 chemical products that are pro-inflammatory irritants in blood vessels, and in the case of IC, especially when they are concentrated in the urinary bladder.
2. Excessive levels of plant-derived oxalates and their acidic metabolites can promote inflammation in many organ systems. Oxalates are organic acids found in many plants. Inflammation from excess oxalates can target the bladder lining in interstitial cystitis and the endothelial (blood vessel) lining in vascular problems like migraine.
The highest levels of oxalates are found in leafy green vegetables, nuts, especially almonds and dark chocolate, wheat, and rice bran. You may be getting too much of the oxalates as cumulative excess if green smoothies, almond milk, nut snacks, or beet root extract supplements are part of your diet. The first step is to trim excess oxalate intake. Then, a simple measure to assist both problems is to take magnesium citrate to both reduce oxalates in IC and also to augment whole-body magnesium levels, which are suboptimal in most individuals with migraines.
For more information on oxalic acid and how to manage it, see the very informative review 2 by nutritionist Sally Norton at https://sallyknorton.com/oxalate-science/oxalate-basics/
3. Reproductive hormone imbalance or deficits
The perimenopausal time frame involves a gradual drop in hormone levels, including estrogens, progesterone, and female-appropriate testosterone. One can have enough ovarian hormonal signals during these years to enable a menstrual cycle, yet be declining to a degree where many organs do not receive optimal hormone support. Interestingly, the late 30s to mid-to-late 40s is a common time frame to see either IC or migraine headaches emerge or worsen, and this peri-menopausal time frame correlates with how these problems are far more common in women than men (9 times more common in IC, 3 times more common in migraine).
The use of bio-identical hormone support during the peri-menopausal years can help with both problems, although the focus is slightly different in these two cases. In migraines, you can have both estrogen deficiency and estrogen dominance-which is better understood as a progesterone deficiency problem. In IC, the gradual but progressive drop in estrogen, progesterone, and testosterone can result in gradual pelvic atrophy changes. This can have a vaginal and sexual impact but is less understood to also allow for bladder atrophy changes, which can be a co-factor in the development of interstitial cystitis. I have found that vaginal use of estriol support therapy can be a useful adjuvant in addressing the IC symptom complex.
In either case, find an integrative physician who can address this for you. If you have a nearby compounding pharmacy, they can help you find a knowledgeable practitioner.
4. Hydration
Water is the simple and wonderful solvent of life. When there is too little, almost every medical problem is vexed, sometimes to a breaking point. Within reason, drinking more water helps both IC and migraine through some simple but powerful mechanisms:
In Interstitial Cystitis, extra water is helpful by:
-reducing the concentration of the urine, and thus diluting the contact of filtered irritants to the inflamed lining of the bladder.
-hydrating the mucous lining, also known as the glycosaminoglycans layer of the interior bladder, which helps to reduce its permeability to toxins and their inflammatory promotion of the IC vicious cycle.
Unfortunately, when the IC-plagued bladder muscle is triggered by increased volume, the ‘urge to go’ can be multiplied, increasing the number of voids per day. Finding a middle ground on ‘enough fluid to dilute, but not too much to trigger’ can be a narrow piece of real estate. Find your version while working all the other angles that can clear root cause factors for your IC.
In migraine, we should remember that the brain is ~80% water. Even as little as a 2% decrease in brain hydration can cause obvious cognitive deficits. Too little water outside the cells reduces blood circulation in the brain and can change the anatomical relation of the brain within the skull. Too little water in the cell reduces the efficiency of key cell repair and energy production capabilities. Staying hydrated can reduce the frequency and intensity of migraine headaches.7 Aim for 80-100 oz minimum per day, including both food and beverage sources. If you have a headache coming on, and you sense recent dehydration is a factor, aim to drink 16-32 ounces in the coming 30 minutes to assist in resolution.
Common Action Items list for both IC and Migraine:
1. Find and avoid your pro-inflammatory trigger foods, including foods with excess oxalates. It's no small thing to do, but it's overwhelmingly worth the effort. In this process, also consider taking:
-magnesium citrate 250-500 mg/day
-quercetin 500 mg/day
-melatonin 3-10 mg in the 1-2 hours before sleep
2. Consider assessing the role of reproductive hormones in the case of either IC or migraines. If you are in the late 30-plus age group, consider intravaginal bio-identical hormone support therapy to revitalize and protect the pelvic area, especially within the bladder complex.
3. Every day, give thought to your hydration status and how to optimize it. Hydrate well in advance of known trigger factors like exercise or weather extremes.
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As is almost always the case, problems like IC or migraine arise from the combination of several root cause factors, which cumulatively push you over the “here comes my (fill in the symptom)” threshold. If you would like to know more about how inflammation, reproductive hormones, lifestyle, diet, and many other root cause factors affect migraine, as well as practical strategies to individualize a migraine prevention plan, I’d recommend that you take a look at my online course “Natural Migraine Relief for Women”.
References
1 Co-morbidities of interstitial cystitis Front. Neuroscience, 10 August 2012 Volume 6 - 2012 | https://doi.org/10.3389/fnins.2012.00114 https://www.frontiersin.org/articles/10.3389/fnins.2012.00114/full
2 https://sallyknorton.com/oxalate-science/oxalate-basics/
3 https://www.ncbi.nlm.nih.gov/pubmed/11272677
4 Quercetin Attenuates Nitroglycerin-Induced Migraine Headaches by Inhibiting Oxidative Stress and Inflammatory Mediators Nutrients. 2022 Nov; 14(22): 4871. Published online 2022 Nov 17. doi: 10.3390/nu14224871 https://pubmed.ncbi.nlm.nih.gov/36432556/
5 Melatonin improves bladder symptoms and may ameliorate bladder damage via increasing HO-1 in rats. Qing-hua Zhang, et. al. 1, Inflammation 2013 Jun;36(3):651-7. doi: 10.1007/s10753-012-9588-5. https://www.ncbi.nlm.nih.gov/pubmed/23250825
6 Therapeutic role of melatonin in migraine prophylaxis: A systematic review. Rujin Long, MD et. al. Medicine (Baltimore). 2019 Jan; 98(3): e14099. https://pubmed.ncbi.nlm.nih.gov/30653130/
7 Dehydration and Headache Arca, K.N. et.al. Current Pain Headache Rep. 2021; 25(8): 56. https://pubmed.ncbi.nlm.nih.gov/34268642/
This blog article should not be construed as a definitive review of either migraine or interstitial cystitis and is not intended to serve as personal medical advice for any particular reader.