02:43 1/3 of migraineurs get an aura phase, where they lose vision in part of the visual field, or they see zig/zag lines. Part of the body can become paralyzed, in rare cases.
03:25 It was known that there is a link between energy metabolism and migraines. 50 to 100 years ago migraines were called hypoglycemic headache. This theory was put aside and focus was put on other aspects of the migraine that may respond to pharmacological interventions. Pharma is most times a monotherapy, targeting one pathway.
04:06 Migraine is a multigenic disorder. Many small polymorphisms/mutations in different genes will add up to cause migraines in some way. Chronic civilization diseases don’t have one target.
04:47 Prevention of migraines, until recently, consisted of anti-depressants, anti-epileptics or beta blockers. These may help reduce migraine frequency for a little while. Once the body adapts, the dose needs to be increased. Side effects will increase as well.
05:30 Your migraine continues after the pain is suppressed with triptan drugs.
05:57 Migraine vaccines target one neuropeptide that is involved in pain transmission. It does not look at the root cause of migraine.
07:37 Elena believes that migraines are an adaptive response of the brain to something bad that happens. Everyone has an individual threshold for migraines.
08:31 Migraines are an energy deficit syndrome, an adaptive response to a severe energy crisis in the brain that can be triggered by oxidative stress levels being too high or hypoglycemia/hypometabolism.
08:48 Between attacks, a migraineur’s brain has 20% less ATP on average than a healthy person. It may be more profound during an attack. Hypometabolism means that there is less glucose in the brain.
09:14 Migraineur brains have increased oxidative stress and mitochondrial dysfunction. A healthy brain encodes change. A migraine brain encodes detail continuously, which is much more energy demanding.
10:48 There must have been an evolutionary advantage to migraines. 15% of our population suffers from them. It may be that we have not adapted to our new carbohydrate-rich metabolism.
11:51 Your genetic phenotype may be more susceptible to migraines because of your inherited metabolic milieu. Neanderthals were less adapted to carbohydrate metabolism. Neandertals were better at fat and protein metabolism.
12:38 There is an ancestral advantage to having a hyperexcitable brain. They will be the first alerted to danger. They hear louder, they are sensitive to light and they smell more in the hours before a migraine attack. It takes less of a stimulus to reach the sensory organ to make action potentials.
14:35 Blue light is increases oxidative stress in the eye and through your skin to your mitochondria of even in healthy individuals. Increasing oxidative stress in the mitochondria means you are making less ATP.
14:56 Whenever there is a mismatch between oxidative stress and your antioxidant capacity, you suffer. Your mitochondria will not perform well. This increases your risk for disease. In migraineurs, antioxidant capacity may also be genetically compromised.
15:42 When your brain is in an energy crisis, it turns on the migraine as an alarm, forcing you to rest.
16:40 The brain senses an energy shortage and are taking compensatory action to restore energy homeostasis. Studies from 50 years ago measured ketogenesis, cortisol and glucose at the beginning of a migraine attack found that triglycerides and ketone bodies are elevated.
17:09 You still have an energy deficit in your brain when you take triptans and potent pain killers for a migraine attack to override your body’s warning signal.
17:30 Migraineurs have a higher risk of depression.
18:07 Migraine risk goes down dramatically in diabetics. They have higher blood sugar levels.
18:22 Insulin resistance is a good thing, evolutionarily. It is adaptive. When you are in ketosis, your body preserves the remaining glucose reserve for you brain, heart and blood cells. Insulin resistance means that your muscles become insulin resistant because they can burn fatty acids or proteins.
19:04 Gestational diabetes is a similar mechanism. Nature wants to preserve the glucose during carbohydrate shortage for the demands of a developing baby.
19:24 There is evidence to suggest that a migraineur turns insulin resistant. It may not be the cause of migraine, but an act of preservation of glucose for the brain.
20:03 Migraine triggers are related to oxidative stress increase.
20:11 Teen girls who take oral contraceptives develop migraines 6 months to a year later, or they existing migraines worsen. On average, 6 to 12 months later, oxidative stress increased by 50%. This may be because oral contraceptives are not bioidentical hormones. They do not replace the function of our hormones completely.
21:11 Premenstrual migraine happens when estrogen plummets. With artificial contraceptive pill, endogenous production of female hormones plummets because the body thinks there is enough. Estrogen is highly antioxidant. Lowing estrogen would reflect increased oxidation.
23:37 Migraineurs often have a delayed insulin response, first sending too little insulin and then too much. If you give a migraine patient a glucose tolerance test, 50% develop a migraine within the next 8 hours. A low carb diet can stabilize blood sugar levels.
25:23 If you still have migraines on a low carb diet, try taking out dairy and gluten. It this still does not work, try ketosis.
25:41 Ketone bodies are signaling molecules. In addition to supplying the brain with an efficient energy source, they reduce inflammation. They can reduce hyperexcitability via a number of mechanisms. They shift the balance between GABA and glutamate towards GABA. GABA is the neurotransmitter that relaxes things.
26:04 Ketosis also increases mitochondrial biogenesis. More mitochondria should translate into more energy.
26:16 Ketones reduce oxidative stress. They produce less oxidative stress when they are burned. They are a cleaner source of fuel. Ketones increase the number of glucose transporters being expressed to transport glucose into the brain.
27:10 If your liver isn’t making enough ketones or you are stressed with high cortisol levels, you can add exogenous ketones, like a ketone body salt.
28:53 Exercise is one of the most potent migraine triggers. Exercise increases oxidative stress, which migraineurs cannot buffer, and uses up a lot of energy, so there is not enough for the brain. You must fix your metabolism first.
30:03 Metabolic therapy may be appropriate for you if exercise is a migraine trigger for you. Once you have keto adapted, you may have enough to fuel your brain, especially if you are not doing HIIT. Find what works.
31:05 In a study, migraineurs had glucagon resistance. If you are glucagon resistant, you don’t make energy in a fasted state. Glucagon is the antagonist of insulin. Whenever you are fasting, you are relying on glucagon to instigate ketosis and gluconeogenesis.
35:39 A migraine attack can sometimes be aborted. When you feel a migraine beginning, high dose BHB exogenous ketones with magnesium.
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