That Neuroscience Guy - The Neuroscience of Headaches and Migraines with Dr. Marla Mickleborough

Episode Date: May 14, 2022

Have you ever woken up with a pounding headache? Maybe you suffer from frequent migraines that can make it harder to function day-to-day. But what is going on in the brain to cause these things, and what can we do to prevent them? In today's episode of That Neuroscience Guy, we enlist the help of Dr Marla Mickleborough from the University of Saskatchewan to discuss the neuroscience of headaches. 

Hi, my name is Olaf Kregolsen, and I'm a neuroscientist at the University of Victoria. And in my spare time, I'm that neuroscience guy. Welcome to the podcast. Have you ever had a headache? I almost feel like that's like the dumbest question I could possibly ask, is everyone's had a headache. I almost feel like that's the dumbest question I could possibly ask, is everyone's had a headache. And some of us even get that worse. We get what are called migraines.

So what's a headache? Well, a headache basically is a problem within the brain, in a sense, at its simplest level. Well, no kidding, right? But it's basically when you have signals interacting between the brain, the blood vessels, and the surrounding nerves. And these things are activated and pain signals get sent. Now, there's many, many causes of headaches. You can get headaches from tension. They tend to be mild and they're non-throbbing, both sides of the head. You can get cluster headaches where there's little clusters of pain. And you can even get sinus headaches.

And we've experienced headaches and we kind of know the basics about how to deal with them, right? You want to rest, close your eyes, get away from bright lights and things like that. But we go a step further with headaches. There are a special class of headaches called migraines. And to answer this, I brought in a really good friend of mine, Dr. Marla Mikobara, a professor at the University of Saskatchewan. Marla, thanks for coming to the podcast. How are you doing today? I'm great, Olaf. Thank you for inviting me to talk today. Excellent. Well, what we always do is we always dive right into the science and then we can

chit-chat a bit at the end. So you're the expert. how is a migraine different from a headache? Well, the headache is just a part of the migraine. So it's actually a symptom of the migraine. And the migraine itself is actually, I mean, it's a great neuroscience question because it is actually the central nervous system. system, having a hyper excitable or a hypersensitive, or sometimes people will say just an overreaction to things that are in the environment that would normally not cause a headache. So when a person, when a migrainer activates the same system that causes headaches for anybody, you get an activation of the nerves of the face and those nerves can cause basically a reaction in the brain and in the blood vessels of the head

that cause pain. And a migraine might have that reaction to things that shouldn't cause that. So one of the examples I always give is fluorescent lights. The flicker from fluorescent lights can cause a person with migraine to trigger or activate that overreaction in the brain. That's not going to cause that to happen in a regular person. And I said trigger, and that automatically made me think of a recent paper that we submitted where one of the reviewers said we shouldn't use the word trigger anymore. And that's something that we at one of the recent conferences I was at where they were talking about that a lot. And even anybody who has migraines thinks about the triggers that they have that can cause a migraine. But actually now there's some suggestion that it isn't even triggering the

migraine. It's that you've become so sensitive. So you're already in a kind of migraine state and you're becoming really sensitive. And that's actually a symptom of the migraine. And this, I myself am a migraine or so. This is one of those things I always point out to my mom where it's like, no, I can have the chocolate. It's not that the chocolate triggered the migraine for me. It's that I'm craving chocolate because I'm in this pre-migraine state. I see. So I guess the idea, so the conventional idea, if I have this right, is the old assumption, to use your chocolate example, because I love chocolate, the old assumption would be that chocolate gives you migraine. So it's a trigger, right? And that's just a cause and effect relationship and you stay away from that.

But the more modern theory then is that you're in a pre-grain migraine state sometimes and that might set it off. But there's other times if you're not in that state, it doesn't get set off. So you can have a couple of levels. Yeah. I think that's a good way to think of it. And to be honest, when I'm having a bunch of migraines, I back off the chocolate automatically because it's been years of training me that way. But they're even taking it a step further. Some researchers are saying that it's probably not causing. It's like I'm craving chocolate more because whatever's causing the headache is causing

me to also crave chocolate. So some of those are sort of extraordinary symptoms. And you asked about, so when we differentiate migraine from headache, I love that you started off by saying, you know, have you ever had a headache? We, when we first started doing the research, we tried to have a control group for people who didn't have headaches. And it hadn't really occurred to me until I started the research. But of course, it was nearly impossible to find the non-headache group. So we quickly had to change that, you know, and of course, I was new to doing this type of research. Other researchers

had known this for a long time. But you do, you look at people with headaches that are not classified as migraines. So somebody who has, some people might have one or two headaches a year. We are jealous of those people, but they might have one or two headaches a year, mild, you know, pressing type of headache. So people with migraine headaches have pain that's one-sided and it's pulsating or throbbing rather than having like a constriction or constant pain. And the pain should be moderate or severe intensity, not just mild. And it's aggravated by routine activity such as walking or climbing stairs. We're not talking playing basketball or going for a run.

Just walking up the stairs can make it worse. You don't have to have all of those symptoms, but you have to have at least two of those to be considered a migraine. And then one other thing you have to have, either you have sensitivity to light and sound, or you have nausea and vomiting. And you can have all those symptoms, but it's like a cluster of those that makes it a migraine. And so if you have a headache that doesn't have all those symptoms,

then it's not going to be classified as a migraine. I found that fascinating, especially the thing I didn't, I kind of knew about the exercise possibly aggravating a migraine, but I'd never really thought it through because when I have a headache, my first instinct is to get outside and go for a walk. But if you had a migraine, that would be like the worst thing you could do, right? Because you literally are probably bright light and you're exercising. And people who get headaches from sitting in front of their computer for too long studying, because a lot of our participants are students. And so if you get a headache from sitting too long and studying and not moving and maybe keeping your neck muscles tight over your laptop, getting out and going for a walk

is going to help that headache. Whereas if you have a migraine, getting out and going for a walk, it's like what's going to make the headache worse. So I know sometimes people can say they can get their pain down to mild to moderate if they're staying in bed in a dark room. And that's one of their ways of treating it. But getting up and walking around, they would have moderate to severe pain. Gotcha. I could talk for hours about this. I got one more question before we go to sort of our next topic idea, which is if you do something that creates a headache. So, okay, I'll throw myself under the bus. I've been talking a lot about, you know, during COVID and stress, you probably shouldn't consume alcohol. But I like a pint on a Friday.

It comes from my days and living in the UK. So let's say I have a couple of pints of beer and that's something that's going to cause me a headache. Is that going to be even worse than a migraine? So is that like, are you setting yourself up for like an epic hangover or a headache? Well, so if the migraine brain is sensitized, then you can trigger, or I should say again, I use the word trigger, but I got to be careful to do that. But you can have a reaction that's hyper responsive. So the migraine brain might cause a worse headache. And one of the things that I mean, it's interesting you say there, if I have a drink, drinks can be something that can trigger or cause people to have migraines if they're sensitive.

But it's really difficult because the way you line that up, is it if somebody were to get a migraine, they're a migrainer and they get a migraine the next day. Is that because they had a drink? And is it the drink that's triggering it? And this is always the reason it's been difficult with triggers. Or is it because, you know, they worked really hard all week and then on the weekend they stayed up late and had a drink. And so one of the things we know is really effective for migrainers for, like, how do you, how do you prevent migraines in a migrainer? One of the things that's really important is keeping your schedule and your routines in place. So migrainers thrive on routine. So you want to get up at the same time and go to bed at the same time every day.

You want to eat the meals at regular intervals. You want that homeostasis in the body to really stay in balance because it's that getting off that can cause migraines. And a lot of people actually will go all the way through the week and then the migraine is on Saturday morning because they got out of their routine and their body couldn't handle it. Well, that was going to be my next question, which is, so if you are a migrainer, what can you do about it? So obviously one thing that's leaping out at me here is that regularity is crucial, right?

So you regularize your schedule. What other things should migrainers think about doing to try to, you know, alleviate or at least cope with being a migrainer as best they can? So some of my research to date has been looking at attention in migrainers and specifically how do migrainers respond to their environment? And what we found is that migrainers actually have like a, they over respond to environmental stimuli. So if you should be able to ignore, maybe somebody keeps passing by in the hallway outside your office door, or maybe there's a person sitting in front of you in class that keeps tapping a pen or moving their foot. That's a visual distraction. And if it's not doing anything beneficial to you, normally a brain should habituate to that and start to ignore it.

But the migrainers don't have that same habituation response or it's not working as adequately. And so they don't ignore those environmental stimuli. Their brain doesn't ignore them as well. And so then that can cause an overreaction. And so one of the things I was telling people from that is that, you know, you can control some of those things in your environment. So maybe you want to sit at a place in the room where you're not going to be as distracted by other people. I always orient my office so that I'm not looking out the door because I don't ignore

things that go by as well as maybe other people do. So that's some of the research that's sort of new in the field, looking at how actually migrainers, even between headache attacks, their attention, their visual spatial attention is different than people who are non-migrainers. Gotcha. That's so fascinating. So they're literally the way they attend to the world and the way that they allocate resources during attention is just fundamentally different. Yeah. Yeah. And so that's part of what gets me interested about the migraine brain. And so my newest research, actually, what I wanted to do, what I'm really interested in seeing is how does the migraine brain differ just on a day-to-day basis?

What I wanted to do is look at the EEG brain waves of participants on a regular day versus just before they get a migraine. The question was, how do we do that? I had a really great undergrad student in the lab. She's a medical student now. And she thought of sending home this Muse device that records the EEG. So I know you've used this in the past. And so we actually sent it home to record brainwaves in individuals with migraine headache. But the actual research that we're doing is having them do a meditation at home for eight weeks. And so half the people are doing a meditation, half the people are doing a control attention task. the meditation is because, you know, doing a mindfulness meditation can help a person to become more aware of things that are causing stress in their life and help them to calm down. But of course, I was really interested in collecting the brainwaves. What I want to know in the end is, can we see a difference in the brain the day before somebody gets a migraine?

And so that's sort of my long-term interest in looking at that. That would be so cool. You know, if people knew these things were coming on, then they could take advantage of that information and try to, you know, walk it back, right? Yeah. I certainly feel like if I knew that I was going to have a migraine tomorrow, then I'd make some adjustments to my schedule today, you know, and arrange things. So we try to stay grounded, in fact, on the podcast, given our day jobs, but you might, so you might have to speculate on this one, but I'm really curious. Do you think this is a nature or a nurture thing? Do you think migraine nerds are born wired differently? Or do you think that

the product of their upbringing, something about, you know, just things in their life has created a migraine brain? Oh, this is great. I love this question. There is so much stigma around migraine. One of the qualitative studies I'd like to do in the future is looking at movies and how movies and media portray the stigma of migraine. It's like, I think the title of the paper would be mother's lying down with one of her headaches. And it's always a rich, you know, woman who has no job. And that's how it's portrayed in the movies. But that's not really how it is. It is more women than men. In Canada, it's about 15% of women who have migraine

and 8% of men. So I mean, that's true. It is more, the female brain is more susceptible. But I love this question about, is it biological or not? And I think it's comparable to things like, okay, so diabetes runs in my family. Type 2 diabetes runs in my family. Am I more at risk to get diabetes than my husband is who doesn't have it in his family? Yes. But do we know that lifestyle factors will influence that? in his family? Yes. But do we know that lifestyle factors will influence that? Absolutely. I can do things and I should do things knowing that. Migraine also does run in families. And so I mean, I know that I can do things to help prevent that. But that's one of the things I want to look at is, you know, what's the brain like that's different? What causes me who had a concussion when I was two? And then, you know, you look back in your life, it was the 80s, we all had concussions at some point, or a lot of us. But, you know, how come in some people, a concussion can lead a person to get migraines? COVID can trigger or start events for people to have migraines.

migraines. Different factors like that can cause some brains to have migraines and some don't. And that's what I'm most interested in is to find out sort of, you know, do we, are we born with, I would suspect that we're born with a brain that is more susceptible to becoming hyper excited or hyper bothered by environmental stimulus. So I think me and my kids probably have a brain that's going to be more likely to develop that, but it is an environmental stimulus that's going to cause it to get triggered. Fair enough. Well, thank you all for all the cool information.

I didn't mention this at the outset because we've been doing the personal stuff at the end, but I met Marla when I was a postdoctoral fellow at UBC in Dr. Todd Handy's lab. And Marla was a graduate student and we instantly became friends and have known each other since. But I don't think I've ever asked you this. Like, why neuroscience? Like, what got you into neuroscience? So I was in commerce in my first year university.

I entered commerce I was a farm girl and it was like agriculture or commerce were the two things that that seemed realistic for me I did a year of commerce and I didn't love it and so I took a year off and it was you know 1998 and so I had migraines since I was eight years old and I thought, I have nothing to do. I'm going to do some research and find out, you know, what causes my brain to have migraines? What's actually happening in there? And so I started looking at little pamphlets and waiting for the very slow farm speed to internet to load up some answers. And that's where I discovered neuroscience.

to load up some answers. And that's where I discovered neuroscience. I had never heard of it until that moment. And I knew instantly, you know, there's a job where people can just do research about the brain. And that was it. Before that, I'd never had anything that I wanted to be. And then I knew, well, I want to be a neuroscientist. Well, I totally relate to that. I don't think I've shared this on the podcast, but most people assume I was a neuroscientist the whole way through. But what they don't think I've shared this on the podcast, but most people assume I was a neuroscientist the whole way through. But what they don't really realize is when I took my first neuroscience class, I was a master's student at Indiana University. And my declared major was sports marketing. And for whatever reason, I took this neuroscience elective class because it said something about learning in the brain.

And I was just like, okay, I'm not coaching basketball ever again. This is what I'm going to do. As we wrap up here, you run the Brain Health Lab at the University of Saskatchewan. You tell us just a quick couple things about your lab, like what other projects you're working on? Well, yeah, so my research has been primarily looking at people with migraines so far, but then what I'm expanding into is that idea of looking at brain health. So it's kind of what we touched on earlier is what causes somebody's brain to be different so that it reacts and has migraines or in concussion, what causes some people's brain to

go into post-concussive syndrome or have concussions that last longer, or even arguably the same impact can cause a concussion response in some, but no symptoms in another person. And so that's really what I'm interested in looking at is that sort of side of brain health. And a lot of the brain health research labs are looking at aging and brain health, because of course, that's when you start to see the problems breaking down and things like Alzheimer's and Parkinson's. So I'm really interested in kind of looking at like, what about in a 15 year old with migraine, with concussion, with things like that, that can actually happen at a younger age? And what are the things that we can do to take care of our brain to protect it from those types of things? I'm glad you said that because I found myself drifting into that space myself.

Especially, you mentioned the Muse earlier. You know we use the Muse. And as soon as you get into this mobile EEG space, you can ask so many cool real-world questions. In fact, that was the whole point of my TEDx talk was basically saying, hey, here's this technology. It could change the world. Marla, well, thank you so

much for being on the podcast. Totally appreciate it. That was fascinating. When I talk to my colleagues and people like you, I always learn so much. So thank you so much for sharing what you know about headaches and migraines. Yeah, thank you so much for having me. That was awesome to talk to you today. So there you have, everyone, an awesome overview of headaches and migraines and what causes them and what you can do to potentially alleviate the symptoms. Remember, our website is up, thatneuroscienceguy.com.

We got links to Patreon where you can support us. All the money is going to grad students to help pay their tuition bills. None of it's coming back to me or the university. We also have links to our merch. We got our t-shirt up. We got number two launching. I say this every week, but I promise we're going to have a t-shirt up soon, number two. Thanks to

those of you that already bought them. Remember, you can follow me on Twitter at that Neurosag guy. You can DM me for ideas. And in fact, this episode was based on requests to me on Twitter from people following the podcast who want to know about headaches and migraines. So send me your ideas. And of course, subscribe and listen to the podcast. My name is Olof Kregolsen, and I'm that neuroscience guy. Thank you so much for listening, and I'll see you on Wednesday for another Neuroscience Byte.