Thursday, September 07, 2006

Migraine or Periodic Paralysis

Many patients with periodic paralysis, suffer from migraines as well. As with all ion channel disorders, the science behind migraines has expanded considerably over the last ten years.  Migraines tend to run in families. They have many causes. Many of my family members suffer from migraines. We have found that they can have different causes. We have noticed that those who have HKPP, generally have migraines and depression as well. My mother and her sister went to the University of Washington and described all of their symptoms including muscle weakness and migraines. Dr. Bird loudly announced that migraines and muscle weakness could never have the same cause. It turns out he was wrong.

I have had migraines since I was 18. They started after I was in a car accident. When my children hit puberty, they started having migraines. Only the ones with HKPP seemed to have the headaches. They  suffered increased anxiety, and sensitivity to sounds and light. These symptoms increased prior to their headaches. These symptoms are called prodrome or premonitory symptoms. By the time my youngest two children started having HKPP symptoms and migraines, I'd read a great deal about magnesium. I learned it is important in calming nerves and muscles. I did not want them to take prescription medication so we tried taking magnesium, when they started having a headache. Taking 250 mg of magnesium oxide with ibuprofen seemed to stop a migraine before it started. With HKPP, there is a loss of potassium after an attack. This can lead to lower magnesium and B vitamin levels. It is important to replenish these through diet or supplementation.

Long ago I noticed there was a connection between HKPP and migraine. Familial Hemiplegic Migraine is an ion channel disorder
"Mutations in the CACNA1A, ATP1A2, and SCN1A genes have been found to cause the three known types of familial hemiplegic migraine. Each of these genes provides instructions for making a protein that is involved in the transport of charged atoms (ions) across cell membranes. The movement of these ions is critical for normal signaling between nerve cells (neurons) in the brain and other parts of the nervous system."


As you can see, this is the same type of mutation that causes periodic paralysis.

There are different types of migraines that are associated with periodic paralysis. First is Abdominal Migraines. There might be a link with serotonin and histamine. But the greater link may be increased calcium or hypercalemia. This is occasionally seen in some rare variants of Periodic Paralysis. High calcium levels will  cause nausea and the other symptoms associated with abdominal migraines. Migraine with Aura is another related to HKPP. Some patients have found relief by following a low-sodium, low-carbohydrate, diet with acetazolamide, which was once used as a migraine medicine. (Always see your doctor for medical advice)
There is a very strong link of low magnesium levels in patients with migraines. Of course. Migraines have many causes. The final two causes are structural. Migraines can be associated with reduced blow flow due to problems in the neck or at the base of the skull. Cardiac issues should always be considered - high blood pressure or arrhythmia. (If you suffer from migraines, request that all possibilities are addressed before you are prescribed strong medication. The medication can trigger worse problems if the migraine is caused by chemical or structural issues. Consider all lifestyle changes first. Especially, do not smoke.)

There is still a great deal that is unknown about migraines. Research never seems to go in the direction that would benefit most patients. Much of the research is in developing new high cost and highly profitable drugs. We should demand that additional research be done in the following areas:
Na,K+-ATPase in neurons and skeletal muscle
Ryr (Ryanodine receptor) calcium-sensing
KATP channels - glucose and insulin
TRPM7 - Transmembrane uptake of magnesium, specifically extracellular to intracellular uptake

You can read about Migraine variants at:
http://emedicine.medscape.com/article/1142731-overview
CVS: Cyclic Vomiting syndrome can be found at the same website

A Clinical Approach to Common Electrolyte Problems
a good read

If you suffer migraines, consider trying to increase magnesium and decrease calcium and sodium in your diet.
Be aware of what you eat and what triggers your pain. Chart symptoms that may be unusual or unrelated prior to the start of a migraine.

I discuss magnesium a great deal because it is critical in many aspects of our health. Without it we can't produce ATP (cellular energy), we develop arrhythmia, can't deal with stress, and many other problems. As I have said many times:
Low potassium cannot be replenished until hypomagnesemia has been resolved. Low magnesium cannot be resolved until B12 deficiency has been resolved. Add in Taurine with potassium and magnesium and you can   finally find a balance. Taking medications that help you retain magnesium and potassium, like amiloride, may reduce paralysis or migraine attacks. I went from having three to five migraine attacks per month to one every two or three years. These are quickly resolved with magnesium, extra fluids, potassium and ibuprofen.

But as with all advice. Check with your doctor. Make sure your kidneys are functioning and can handle potassium, magnesium, or anything else. Do not take any advice found on the internet as fact. Check other sources.

Here is research linking low magnesium with menstrual Migraine:

Magnesium Prophylaxis of Menstrual Migraine: Effects on Intracellular Magnesium
  1. Fabio Facchinetti,Grazia Sances3,Paola Borella2,Andrea R. Genazzani,Giuseppe Nappi3
Article first published online: 20 MAY 2005

SYNOPSIS
The effects of oral Magnesium (Mg) pyrrolidone carboxylic acid were evaluated in 20 patients affected by menstrual migraine, in a double-blind, placebo controlled study. After a two cycles run-in period, the treatment (360 mg/day of Mg or placebo) started on the 15th day of the cycle and continued till the next menses, for two months. Oral Mg was then supplemented in an open design for the next two months. At the 2nd month, the Pain Total Index was decreased by both Placebo and Mg, with patients receiving active drug showing the lowest values (P<0.03). The number of days with headache was reduced only in the patients on active drug. Mg treatment also improved premenstrual complaints, as demonstrated by the significant reduction of Menstrual Distress Questionnaire (MDQ) scores. The reduction of PTI and MDQ scores was observed also at the 4th month of treatment, when Mg was supplemented in all the patients. Intracellular Mg++ levels in patients with menstrual migraine were reduced compared to controls. During oral Mg treatment, the Mg++ content of Lymphocytes (LC) and Polymorphonucleated cells (PMN) significantly increased, while no changes in plasma or Red Blood Cells were found. An inverse correlation between PTI and Mg++ content in PMN was demonstrated. These data point to magnesium supplementation as a further means for menstrual migraine prophylaxis, and support the possibility that a lower migraine threshold could be related to magnesium deficiency.

Additional research about magnesium and Migraines:

Migraine headaches

Individuals who suffer from recurrent migraine headaches have lower intracellular magnesium levels (demonstrated in both red blood cells and white blood cells) than individuals who do not experience migraines (42). Oral magnesium supplementation has been shown to increase intracellular magnesium levels in individuals with migraines, leading to the hypothesis that magnesium supplementation might be helpful in decreasing the frequency and severity of migraine headaches. Two placebo-controlled trials have demonstrated modest decreases in the frequency of migraine headaches after supplementation with 600 mg/day of magnesium (42, 43). However, another placebo-controlled study found that 485 mg/day of magnesium did not reduce the frequency of migraine headaches (44). More recently, a placebo-controlled trial in 86 children with frequent migraine headaches found that oral magnesium oxide (9 mg/kg body weight/day) reduced headache frequency over the 16-week intervention (45). Although no serious adverse effects were noted during these migraine headache trials, the investigators did note adverse effects such as diarrhea and gastric (stomach) irritation in about 19% to 40% of the individuals taking the magnesium supplements.