I have a PhD in NeuroEconomics. My work had less to do with the economics side of this degree and more to do with the neuroscience. As I was working through my PhD, I had migraines, but with the demands of school, two kids and a husband, I neither had the time nor the understanding to attempt a scientific study for finding the cause of migraines. I did what everyone else with migraines does: I took pain killers. When the pain killers didn’t work, I took triptans (serotonin medications). When those medications didn’t work, I went to the emergency room (ER) to get an IV with electrolytes and injections of heavy narcotic medications.
Eventually, nothing worked and I had to find something to help with my migraines. I applied the knowledge I gained from my education to find a cause for my migraines. What I learned was that the cause was right in front of me all along. Migraines could be triggered by dehydration and sodium or salt deficits. Although this is not a theory that has been tested yet, consider the first treatment a migraineur receives in the ER – IV fluids with electrolytes. This is an important clue that in hindsight should have tipped me off. Let me explain.
Neuron Activity and Migraines
In order to understand the connection of electrolytes to migraines, looking at an individual brain cell (neuron) is critical. The image and the function of cells is in every biology 101 book. I realized though, that the basic necessity of the neuron’s survival itself had not been examined by scientists in the context of migraines. Most migraine research begins with the pain of migraine. Scientists often consider that pain to be the cause, so they look for pain relief as their solution. But pain is a symptom rather than the cause. In fact, migraine itself is a symptom of something out of balance in the brain. The real cause is a biochemical imbalance in and around the neurons. Amazingly, ER nurses who use IV electrolyte treatments for migraine have been trained to do the right thing without realizing the importance of what they were doing. Why exactly do nurses start migraine treatment with electrolytes? I asked one nurse interaction and she said: “you are dehydrated.” Interesting, I thought, since I drink plenty of water. How can I be dehydrated?
What is Hydration?
Being hydrated and drinking water are only partially connected. “Hydrate, a term used to indicate that a substance contains water” implies that water is only part of hydration. Electrolytes that I received for my migraines were not just water but brine containing many essential micro nutrients, minerals, and, most importantly, salt. If you look at a cell, it has a membrane that separates it from the external environment with bumps and pores on it. Anything that wants to go into the cell or come out of it must do so on the demand of the cell or by osmosis via channels. This indicates that drinking only water can dehydrate since it can enter the cells via osmotic channels through the membrane but larger elements cannot. However, there are many elements inside the cell, such as sodium (Na+) and potassium (K+) among other things. Via osmosis, K+ may leave the cell if the K+ concentration outside of the cells is smaller than on the inside, thereby dehydrating the cells but NA+ is too large to leave or to enter. This can lead to a very dangerous health condition called water toxicity in which all nutrients leak through the osmotic gradient leaving too much water behind.
Salt Deficiency, Hydration and the Neuron
NaCl (salt) breaks up into ions and separate based on polarity in the body. Na+ (sodium) is inside the cells and its job is to attract and hold onto water, thereby hydrate. The job of Cl- is to maintain optimal hydration fluid levels outside of the cell. Note that Na is positively charged (+) and Cl is negatively charged (–) and these polarity differences result in voltage differences. Cells without proper quantity of Na+ and Cl- are not capable of voltage generation of the right magnitude. One of the functions of this specific voltage magnitude is the enabling of the sodium-potassium pumps that are located on the membrane of the neuron. Without proper voltage for the pumps, they may not be able to open to the outside or to the inside of the neuron. When a cell cannot open to the outside or to the inside, no exchange of nutrition can take place. Cells without sodium cannot retain water and remain dehydrated. Could malfunctioning pumps, brought on by low salt concentrations, be one of the triggers of migraine?
Sodium Potassium Pump
Low Salt Initiates a Cascade of Problems
We have several other issues without the proper electrolyte fluids inside the cells. Electrolytes carry magnesium, for example. Magnesium is used by the cells like a key to open the pumps. If there is no magnesium inside the cells, even if there is plenty of water and salt, the pumps cannot open. Phosphates provide the energy for the magnesium to open the pumps and so phosphates are also needed inside the cell. There are high voltage calcium channels in neuron membranes as well. Without high voltage, the calcium channels cannot work. Thus, even if there is enough voltage to hydrate the neuron and to create neurotransmitters, they are stuck without functioning high voltage calcium channels. Lack of calcium is not a serious problem since our bones are calcium storage sites from which calcium can always be drawn. Of course, osteoporosis is the outcome of low calcium availability to the cells. The brain also often swells in response to neural biochemical imbalance. The swelling itself has a variety of explanations, but not yet a coherent scientifically proven reason.
Migraines and Dehydration Triggers
Let me connect dehydration, lack of voltage, lack of sodium-potassium pump functioning, osmotic leakage, calcium channels, and migraines all together into one picture so you can see the connection.
Neurons without electrolytes in their environment cannot function. They are idle, dying, or dead—this is defined by new research just published in the Journal of Neuroscience as “brain depression”. Neurons are connected to communicate with each other. When neurons in a region don’t function, neighboring neurons try to awaken them—this is referred to as the spreading of electricity in the parts of the brain that are not in depression in the same scientific article. This is seen as aura in those with migraines in the occipital lobe of the brain. For migraines in other regions, the healthy neurons signal pain sensing nerves located in the meninges, a tissue separating the brain from the skull (there is no pain sensing nerve inside the brain). Migraine is pain signaled by pain-sensor neurons in the meninges and so the location of where we feel pain is not necessarily connected to the location that causes pain. If migraines occur seldom, they are not concern for alarm. If migraines are frequent, over 15 a month for several months, they are considered to be chronic. Chronic migraines may change the shape and function of the brain as well as make it more prone to strokes.
Salt Deficient Migraines
Currently, there are no published studies linking low salt to migraine onset and to my knowledge, there are no studies underway to investigate the effect of salt deficient diets on migraine. The evidence I have supporting this hypothesis first evolved by connecting the common clinical practice of IV electrolytes for migraineurs to the physiology of sodium-potassium pumps on the neurons. Next, I tested it on myself. It worked. Subsequently, others who have applied electrolyte hydration protocol have found that they can prevent or treat their migraines without medicines. After 20 years of migraines, I have been migraine free for four years now as a result of proper and regulated hydration, assisted by apps on my smart phone.
There is nothing like migraine free and medicine free life. While this may not be the only cause of migraines, it is physiologically likely that salt deficiency and dehydration can initiate a migraine. Together, with the theory and applied evidence by the many who use the hydration protocol, it is my belief that salt deficiency and dehydration ought to be considered as a possible cause and the hydration protocol be applied as the first line of treatment for migraine pain instead of medicines. Clinical trials with salt and hydration versus placebo may be an option albeit giving placebo to a person with migraine may not pass ethical committees’ scrutiny for experimenting.
About the author. Dr. Stanton received her BSc at UCLA in mathematics, MBA at UCR, MS in Management Science and Engineering at Stanford, PhD in NeuroEconomics at Claremont Graduate University, and fMRI certification at Harvard University. Follow her on Twitter at: @MigraineBook.
- Altered Hypothalamic Functional Connectivity with Autonomic Circuits and the Locus Coeruleus in Migraine, Eric A. Moulton et al. PLOSOne; April 17, 2014
- MRI shows brain abnormalities in migraine patients, March 26, 2013, Radiological Society of North America
- The Cerebellum and Migraine, Maurice Vincent, MD, PhD and Nouchine Hadjikhani, MD,
- Headache. Jun 2007; 47(6): 820-833.doi: 10.1111/j.1526-4610.2006.00715.x
- Parenchymal spin-lock fMRI signals associated with cortical spreading depression
- Joonas A Autio et al., Journal of Cerebral Blood Flow & Metabolism 34, 768-775 (May 2014) | doi:10.1038/jcbfm.2014.16
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