FAQ Episode 69: Traumatic Brain injury and Migraines

Frequently Asked Questions about Natural Migraine Relief

You wouldn’t have to be a neuroscientist to predict that getting smacked upside the head might predispose to headaches. This post explores the relationship between head injury and headaches, specifically migraines, and will explore strategies for managing the overlap between the two.

The conventional view is that a concussion is a head injury which results in a “bruise on the brain.” Traumatic brain injury (TBI) is a very broad term for any degree of impact and damage to the head region. It can range from “I saw stars for a moment, but I’m fine now” to post-impact loss of conciousness for seconds to minutes. In any given year ~one percent of us have some form of head impact and TBI.

Your brain: complicated can mean vulnerable

The average brain weighs around three pounds and contains some 80-100 billion neurons. As each of these neurons can have up to 1000 connections to other neurons, an adult brain can have up to 500 trillion neuronal synapses. That’s about 10 trillion connections per ounce. That’s an incredibly dense network of connections! Even though the brain is surrounded by a fluid layer to cushion a blow, an impact to the head which sends a shockwave of pressure through the brain can disrupt millions or even billions of neuronal connections. Because the brain has multiple redundant circuits, most of the time the neurological deficits are more generalized than specific. For instance, instead of a post- impact loss of the motor function of an arm, or a leg, it is more likely to see symptoms like:

• headache (for 70-90% of those with even mild TBI), including migraine varieties

• transient blurred or double vision

• persisting low grade nausea or impaired appetite

• difficulty in concentrating, remembering, learning, reasoning, or judgment

• feeling more emotional, sad, nervous, anxious, angry, or aggressive than usual

• changes in sleep habits, especially experiencing excess fatigue or sleepiness

• feeling lightheaded or dizzy, or having sensory impairment like ringing in the ears, a bad taste in the mouth or sensitivity to light or sound

You can imagine that after even a mild TBI event, that there will be a long list of required repairs. On the microscopic level there are torn capillaries, disrupted neural circuits, local tissue edema, a drawdown of antioxidant defenses, and altered energy production that can take weeks to repair. Some brain damage or areas of scarring may never function quite the same.

Several studies show that TBI results in a higher rate of migraine after the event.¹ A study of 755,000 people in Taiwan showed that the risk of migraine went up 1.48 times after a TBI.² Unfortunately, that goes both ways, in that those with migraine who then suffered TBI had a 7.3 times greater risk for extended recovery time for headaches as compared to non-migraine suffering TBI patients.³ You already knew that life ain’t fair, and this verifies how the damage with a TBI adds up even faster for those with migraine headaches.

Why those with migraine and TBI need to understand the common insults of these overlapping problems

In both chronic disease and trauma, the injury inflicted is cumulatively greater than the patient’s reparative capacity. In the former case, like migraine, it can be a gradual process getting to the point of symptom presentation. In the latter case, like TBI, the damage occurs quickly and the cause and effect relationship is quite obvious. Of course, one of these on top of the other can be even more dramatic. If you have migraine headaches and then go on to have a TBI, understanding WHY you had migraines in the first place will be critical to your TBI recovery. Read that again. I cannot emphasize that relationship strongly enough. If you already have root cause factors that set you up for migraines, those same root cause factors are the potential obstacles that will ALSO get in the way of your TBI recovery. You can learn more through the free FAQ posts on this Substack page, which cover many of these root cause factors, and also at the Natural Migraine Relief course where you can individualize the impact of ten key root cause factors on migraine headaches in much more detail. The more you know about the WHY of your story, the more likely you are to find effective interventions for recovery.

Obviously, if you already have migraine headaches, its even more important than average to consider prevention when it comes to TBI. I’m adverse to telling people how to live their lives, but if you’re prone to recurrent migraines, you may want to reconsider regular exposure to high impact or fall prone recreational activities. At the very least make sure to use the requisite protective gear, including a helmet. For older adults, choosing exercises like Pilates and Tai Chi can help to build balance and core strength to assist in “fall proofing.”

Migraine specific therapy that can also help TBI

If you already have underlying conditions that make you more prone to migraine as a brain specific ‘call for help’, a TBI can bring that out. Consider addressing the following root cause factors that can apply to both migraine and TBI (for paid subscribers, review Lesson 5: Theories about Migraine and the role of Root Cause Factors). These include:

• balanced hormone support therapy for deficits or imbalances in the reproductive, thyroid, adrenal and pineal glands. Some of the FAQ articles addressing these can be found at:

  -FAQ Episode 18: Hysterectomy and Migraines

  -FAQ Episode 59: Migraines and "pellet" HRT therapy

  -FAQ Episode 66: Endometriosis and Migraine: Common cofactors

  -FAQ Episode 63: Migraine and "The Pill"

  -FAQ Episode 43: Is impaired brain drain a factor in migraine?

  -FAQ Episode 30: Low Thyroid and Migraines & FAQ Episode 30b: Checking Basal Body Temperatures to assess the Thyroid/Migraine connection

  as well as in the Natural Migraine Relief for Women course for subscribers in Lessons 11-18. The use of progesterone for brain repair is right at the top of the hormone list, so focus on the discussion about its use in Lessons 11-14.

• raising cellular energetics. I go into great detail on both the roots of the problen and therapy options in the Natural Migraine Relief course’s Lesson 9 Cellular Energy deficits as a Migraine Root cause: Part I Basic Concepts & Lesson 10 Cellular Energy deficits as a Migraine Root cause: Part II Practical details for implementing Therapy. This is a specific root cause for around 50% of those with migraine and are without a doubt a recovery component in 100% of those with a TBI.

• supporting nutrient deficits. There are multiple nutrients that have been found to be deficient in those with migraine. See FAQ Episode 13: How assisting brain repair can limit the recurrent cycle of damage in migraine & Episode 40: Vitamin Deficiencies predict migraine risk. Also see my advice on the “Basic Four” nutrients everyone with migraine should consider. I’ve posted part of my paid course Lesson 6: Integrative Therapy for Migraines for you to give some background and details on that “Basic Four.” Click the Lesson 6 link just above and after reading the first~10 paragraphs you will see the dosing details for those four key nutrients.

  Subscribers should also review Lesson 19: Nutrient deficits as a root cause factor in migraines.

• reducing inflammatory factors. There are multiple factors that can add to the inflammation that provokes a migraine. Some examples I’ve discussed in these posts include:

  -FAQ Episode 39: Is there a relationship between Migraine and Alzheimer's type dementia?

  -FAQ Episode 9: How does histamine formed in the gut affect migraines?

  -FAQ Episode 20: How do food sensitivities promote migraine headaches?

  Paid subscribers will find more details and action recommendations on this topic at Lesson 7: Inflammatory Factors as a root cause of Migraines: Part I & Lesson 8: Inflammatory Factors as a root cause of Migraines: Part II

TBI specific therapy that can also help migraines.

• Hyperbaric oxygen: For many years my practice offered hyperbaric oxygen therapy (HBOT), and treated many patients with TBI. I saw a number of these patients also see an reduction of their underlying migraines during a course of HBOT therapy. Fortunately, traumatic brain injury is one of the conditions for which U.S. insurance companies will cover the expenses of HBOT.

• CBD: CBD has been used as therapy for both TBI and migraine. You can buy CBD everywhere, although the THC/CBD combination is limited to states with medical marijuana dispensaries. See my article FAQ Episode 25: Using Cannabis for Acute and Chronic Migraine Relief for more information that can apply to both migraine and TBI.

• Transcranial direct current stimulation (TDCS): This unit uses a portable, wearable set of scalp electrodes to deliver a low current flow to specific brain regions. It is a neuromodulation technique that can produce changes in brain function at the cellular level by strengthening transmission between neurons during the repair process. My experience with this therapy for TBI and/or migraines is that if its going to help, you will see results in the first few weeks. Currently TDCS has the FDA status of “investigational” which means the FDA has not issued a final opinion yet. Doctors in the United States are allowed to provide “off-label” treatment with TDCS, and you can also rent or buy a unit, typically in the $100-300 range for consumer use.

• Melatonin therapy for TBI⁴,⁵ has shown significant neuroprotective and anti-inflammatory effects. Studies typically used in the 3 to 6 mg/day dosage range, although short term benefits may be derived from doses up to 50 mg/day. I’d advise professional advice in the use of those higher doses. Subscribers can read more about the role of melatonin in migraine at Lesson 18: Hormone Root cause in Migraine: The Pineal gland

• Omega-3 fatty acids: supplementation of omega-3 can reduce the oxidative stress developed in a brain injury like TBI. Find out more at FAQ Episode 41: When is extra fat good for your migraines? Typical doses are in the range of 1200+ mg/day of the total DHA + EPA components.

• Vitamin D3: adequate Vit D3 levels are critical to down regulate the neuroinflammation involved in both TBI⁶,⁷and migraine. Learn more from the post FAQ Episode 11: Migraine prevention: Make sure you don’t ‘fall back’ on your Vitamin D3 level. Find out your Vitamin D level and aim to get yourself into the upper third of the “normal range.”

• methylene blue: this is a non-rx supplement that can enhance oxygen consumption, mitochondrial respiration and ATP production which can all help with brain repair after acute injury. If you would like to research this further, see either Dr. Joseph Mercola’s article at The Surprising Health Benefits of Methylene Blue or check out the book The Ultimate Guide to Methylene Blue by Mark Sloan.

• creatine: while creatine is best known for its use in augmenting response to strength training, its also the basis for a therapeutic intervention in the treatment of TBIs. A primary hallmark of TBI is the uncoupling of energy supply and demand due to altered cerebral energy availability and injury induced cerebral blood flow. Additionally, a TBI reduces brain creatine content, partially due to increasing its drawdown in the repair process. An increase in brain creatine level through supplementation has been shown to enhance recovery following TBIs.⁸ Typically this would use a dose in the range of 5 grams of creatine monohydrate three times daily for the first 4-8 weeks after injury.

• ketone therapy: Ketones can help combat post-traumatic cerebral energy deficits while also reducing inflammation, oxidative stress, and neurodegeneration. Experimental models of TBI suggest that administering ketones to TBI patients may provide significant benefits to improve recovery. Taking ketones can also provide an additional energy source that can reduce the odds of hypoglycemia triggering a migraine event. Applying a ketogenic diet with intermittant fasting can also achieve a similar result, although such a regimen is harder to apply consistently, especially in the aftermath of a TBI. Using a direct ketone product daily, like Ketone IQ as 2 tablespoons oral twice daily, or for those with migraine, the medical food known as Migraket can supply ketones as well as a broad support of nutrients specific to metabolic energy and brain repair support.

• LDN: Low dose naltrexone therapy has utility for several types of central nervous system disorders, including migraine and TBI. Read more at FAQ Episode 6: Low Dose Naltrexone and Migraine, or look for the “LDN Book: Volumes I - III with Linda Elsegood, editor (Amazon or similar booksellers.)

Whichever routes of brain healing you use, always seek to understand YOUR underlying root cause factors that have left you vulnerable to brain dysfunction, be that from migraine or a traumatic brain injury. The more of your root cause factors you successfully identify and manage, the better your TBI recovery and the higher your preventive ‘pre-migraine’ reserve capacity.

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4. Brian Blum et. al. Melatonin in Traumatic Brain Injury and Cognition Cureus. 2021 Sep 6;13(9):e17776. doi: 10.7759/cureus.17776

5. Nicole Osier et.al. Melatonin as a Therapy for Traumatic Brain Injury: A Review of Published Evidence Int J Mol Sci. 2018 May 22;19(5):1539. doi: 10.3390/ijms19051539

6. Ajay Choudhary et. al Chapter 10 - Vitamin D level and the outcome after traumatic brain injury. Vitamins and Minerals in Neurological Disorders 2023, Pages 157-170 https://doi.org/10.1016/B978-0-323-89835-5.00009-0

7. Kiana Saadatman et. al Benefits of vitamin D supplementation to attenuate TBI secondary injury? Transl Neurosci . 2021 Dec 15;12(1):533–544. doi: 10.1515/tnsci-2020-0195

8. Darren G. Candow, Scott C. Forbes, et. al. Heads Up for Creatine Supplementation and its Potential Applications for Brain Health and Function. Sports Medicine (2023) 53 (Suppl 1):S49–S65 https://doi.org/10.1007/s40279-023-01870-9