FAQ Episode 43: Is impaired brain drain a factor in migraine?
FAQ Episode 43: Is impaired brain drain a factor in migraine?
Frequently Asked Questions about Natural Migraine Relief for Women
Did you know that your brain has its own fluid balance system? The lymph circulation of the brain plays a role in both daily ‘clean up’ as well as the long term preservation of healthy function. In the brain this is known as the glymphatic system, which is a network of spaces in the central nervous system that:
clears neurotoxic metabolic wastes from the brain, including pathogenic proteins like amyloid which is excessive in Alzheimer’s dementia.
distributes nutrient compounds like glucose, lipids, amino acids, growth factors and neurotransmitters through the brain as needed.
acts as a conduit between the brain and the immune system
moves excess fluid cerebrospinal fluid (CSF) out to the vascular system.
This unique drainage system is made up of:
the meninges, the membrane that covers the brain.
the meningeal lymphatic vessels (MLVs), which balance the fluid load, while cleansing and detoxifying brain cells and while circulating nutrients and neurotransmitters throughout the brain.
a constant turnover of cerebrospinal fluid. Around 16-17 ounces of this fluid are made per day, while the brain only holds about five ounces of it at a time. This means this fluid volume circulates, filters and turns over a full three times a day. This filter and flush effect is greatest during deep sleep, where the glymphatic system can expand and contract an extra 60% more than average to pulse the fluid through the perivascular spaces to ‘rinse’ the brain.
If this fluid doesn’t circulate freely:
a change in cerebrospinal fluid pressure can sensitize the meninges to pain signals. Excess pressure from the CSF can activate the trigeminal nerve1, which is a key conduit of pain signals from the brain to the face and head (and vice versa) that is percieved as migraine pain.
neurons may not get a sufficient supply of the nutrients and neurotransmitters that are critical to brain health.
reduced glympatic circulation could allow metabolic wastes to accumulate, and in the process allow a low grade condition of inflammation to persist or build.
the extra brain tissue and chemistry insults of having chronic headache pain and the related emotional stress and sleep deprivation make this glymphatic repair cycle even more critical to health, or potentially, part of a vicious headache cycle when it is dysfunctional.
These concepts are generally new to the understanding of migraine, and they could also partially explain why women are significantly more prone to migraine than men.
How could glymphatic imbalance preferentially affect women?
Estrogen is your dominant hormone and it is a salt retaining hormone. In excess it can cause fluid retention. Anyone who has experienced several pounds of weight gain, ankle edema, tight rings, etc. specifically during the last five to ten days of their cycle intuitively understands this. The main problem, however, is really one of estrogen dominance. Estrogen and progesterone are paired in their gender specific functions for a reason. Progesterone moderates the side effects of estrogen, including that of salt retention —> fluid retention. Estrogen levels can be normal, or even in decline during peri-menopause, yet…no matter your age, if progesterone is too low, the relative ratio can favor estrogen dominance and its side effects. This can be a problem presenting even as early as one’ teens, which is interestingly the time frame where many women first experience the onset of migraine headaches. Some typical symptoms of estrogen dominance include:
-heavy menstrual periods
-breast fullness or tenderness, especially if cyclic
-excessive cramping with periods
-fluid retention and edema
-a history of endometriosis, fibrocystic breast changes, uterine fibroids, or migraine. (See FAQ Episode 5: Endometriosis and Migraine for more details on this)
-late cycle PMS, including mood changes and food cravings.
The excess fluid that may be retained on a monthly cyclic, or even ongoing basis, is distributed throughout the body, including the glymphatic system. This can explain why some headaches have a cyclic basis to them, usually worse in the late cycle leading up the the next period.
Adrenal stress and salt balance. Many women with migraine have some degree of adrenal stress, where the output of two key adrenal hormones, pregnenolone and DHEA can be reduced over time, especially in the late 30’s to early 50’s time frame. Over time, this combination of hormone deficit, stress, inflammation, and headaches becomes a cycle that can be hard to break. Adrenal stress leads to adrenal fatigue, and even on to low grade adrenal insufficiency, where key hormones are still made, but in insufficient amounts. This can lead to fluid and salt level imbalances. If you have salt cravings, you may have some degree of adrenal insufficiency. Adrenal hormones can also be useful building blocks for reproductive hormones and a deficit in one can readily affect the other, especially in the late 30’s and onward through menopause.
Unfortunately, anything short of significant adrenal deficiency is not easily recognized by clinical testing and unless your doctor is looking for clinical indicators in your history and your symptoms it may go unrecognized. A blood test for DHEA can be a proxy for where you on adrenal function and output.
Sleep disorders related to perimenopause. While sleep problems can occur at any age, they are often more prominent in the late 30s-40s decades, especially if you have a heat-exchange problem, often described as hot flashes or night sweats. When this is due to the downward drift of ovarian hormone production during these years, you could still be having regular periods, yet have low enough estrogen levels to affect the quality of your deep-phase “non-REM” restorative sleep. The glymphatic system is most active during these non-REM phases, when glymphatic pulsations and cerebral ‘deep cleaning’ reduces inflammation and clears wastes from the brain.
If this peri-menopausal ovarian drift is reducing your estrogen or progesterone levels, augmenting them with individualized daily bio-identical hormone support to regain deep sleep restoration can be an invaluable support tool.
Conclusion and Action Items:
The glymphatic system rinses, repairs and restores the brain. When functioning optimally this can reduce several root cause factors for migraine. If its off, however, especially in the nightime hours, it can promote those same factors and push you to and through the threshhold for both single and repetitive migraine headaches. Here are some focused action items to consider:
Manage estrogen dominance. The first step is to recognize it. Review the description above. For paid subscribers, the course’s Women’s Assessment Calendar can help you identify or chart symptoms (A-J and S-Y) typical of this state as you go through your month. If you are having menstrual cycles these symptoms are typically most prominent in the last 5-12 days of the monthly cycle. The next step is to consider additional daily progesterone support therapy. You could start with comething as simple as USP pure Progesterone bought over-the-counter, at a heath food store or online. Usually we start with 20-40 mg per day during the symptomatic days of the cycle. You should stop when your period starts, or the day it normally would be expected. More complicated cases may need the attention of an integrative minded practitioner and a compounded hormone support therapy that is phased through your cycle. Course subscribers should review Lesson 24: Getting another opinion: finding an integrative or functional medicine minded practitioner.
Pursue optimal deep sleep by addressing the following factors:
-Manage light exposure. Blue light from screens disrupts melatonin secretion, crucial for sleep regulation. Using blue light filters, minimizing screen time before bed, and creating darker sleep environments support healthy sleep patterns.
-Temperature management. Keeping your bedroom cool to 68 degrees or less can improve sleep. If you are mid to late 30’s or older, you may have declining ovarian hormone production, allowing P.M. heat exchange problems, i.e. ‘night sweats’ which may need to be addressed with individualized hormone support therapy. You don’t have to wait until your periods to quit to benefit from daily baseline support for these peri-menopausal symptoms.
-Avoid late PM intake of caffeine and alcohol which disrupt sleep cycles and impair sleep quality. Also avoid late night eating which can shift blood sugar levels and leave you with bedtime indigestion and potential reflux.
-Respect your circadian rhythms. The body's natural cycle, governed by processes like adenosine buildup and circadian cues, signals when to sleep. Consistency in sleep and waking times is a plus for good sleep hygiene.
-Treat your bedroom as a sleep sanctuary. Minimize TV, computer and tablet use before bedtime. By all means, don’t leave a TV or radio playing while you sleep(!) It will play havic with deep sleep cycles. Have a ‘wind down’ set of bedtime habits that calm your mind and prepares you for sleep transition. For many people, a dark, quiet and cool environment is best for deep sleep.
Support adrenal function. One simple way to do this, especially during phases where you’re experiencing heightened stress is to take herbal adrenal adaptogens, like Rhodiola, Shisandra, Eleuthero or Ashwaganda. One of my favorite versions, with a balance of all four is Adrenasense by Natural Factors. Start with one capsule in the AM, with two caps per day being full dose. If your DHEA level is low, augmenting it with direct DHEA or pregnenelone can help,especially for those with migraine. Course subscribers can find more details on this in Lesson 17: Hormone Root Cause factors in Migraine: Adrenal gland
Consider the CGRP blocking drugs as an adjunct pharmaceutical option. Excess CGRP (a brain peptide) has been associated with a reduction in the amount of cerebrospinal fluid exiting from the brain. This is one pathway by which the CGRP antagonist/blocker drugs may reduce migraine frequency. Discuss this with your personal physician.
The complexity of factors involved in glymphatic related migraine expression also could explain why roughly half of migraine patients get an inadequate response to the CGRP inhibitor class of drugs. This situation underlines the importance of finding and addressing as many interlocking and additive underlying root cause factors for migraine as possible to get optimal relief.
Promoting the health of your brain’s glymphatic circulation can earn benefits now, as it may help reduce your acute migraines. Optimizing ongoing glymphatic ‘brain rinse’ also reduces the risk of future brain aging disorders.
My goal in writing articles like this post is to make the point that because migraine headaches are complex in their underlying causes, they require an understanding of YOUR specific root cause factors to successfully reduce or clear them.
I encourage you to keep researching the uniqueness of you and the plug in parts specific to your story that will earn you relief from migraine pain. There are answers, so stay in the game and find yours!
Trigeminal ganglion neurons are directly activated by influx of CSF solutes in a migraine model. Martin Kaag Rasmussen, et. al. Science 4 Jul 2024 Vol 385, Issue 6704 pp. 80-86 DOI: 10.1126/science.adl054