Migraines: energy shortages in the brain?

Groundbreaking discoveries are being made all the time in migraine research. One such discovery happened in 2016 when scientists found various sites in the DNA with genetic variations linked to migraine risk. Yet, despite this progress, much remains unknown about the exact causes and processes underlying migraine. One thing researchers widely agree on is the pivotal role of brain energy supply in triggering migraine attacks. This understanding has led to the development of preventive measures that target this aspect, often leading to noticeable improvements. Recent findings have unearthed differences in a specific energy production process in the brain that might have a lot to do with causing migraines.

Mitochondria: powerhouses of our cells

In the body’s energy game, mitochondria take center stage. These tiny powerhouses in our cells are responsible for making ATP (adenosine triphosphate). ATP is the key carrier of energy in our bodies, the 'energy currency’ powering all life processes. Maintaining a balanced energy equation is key. We don’t want to use up more ATP than we produce. But if that happens and lasts for a long time, and we run short of energy, it’s bad news for our brain. The brain uses up more energy than any other organ but has no energy stores of its own, making it particularly vulnerable to energy shortages.

Ailing powerhouses - cells under stress

An energy shortage puts stress on the brain, increasing the likelihood of a migraine attack. Researchers today believe that a migraine attack is a kind of protective mechanism. As the brain becomes overwhelmed by the energy shortage, oxidative stress builds up. Cell detoxification processes are unable to cope, potentially leading to cellular dysfunction. Migraine attacks act like a brain ‘emergency brake’, forcing the entire body to rest and giving it time to restore its energy balance and allow energy reserves to replenish.

Mitochondria have a remarkable feature: they possess their own DNA. The only other cell component that has its own DNA is the cell nucleus. Like cell nucleus DNA, mitochondrial DNA can develop tiny changes, also known as mutations. Some of these mutations are harmless. Others can lead to disorders and diseases.

Numerous DNA sites in our mitochondria and in the cell nucleus have been identified as containing mutations that may cause illness. When our cellular powerhouses malfunction, a condition known as mitochondrial disease can result. This condition means our cell powerhouses cannot produce ATP (the body's energy transporter) as effectively as usual. The resulting symptoms can be incredibly diverse, typically affecting organs with high energy demands, such as the brain, heart, and skeletal muscles. Mitochondrial diseases are some of the most commonly inherited causes of illness.

Detecting sick mitochondria

To diagnose mitochondrial disease, a thorough family medical history is first done, which may provide clues to inherited risk factors. Specialized laboratory tests focusing on energy metabolism follow, along with stress tests and neurological examinations. If suspicions arise, sophisticated modern molecular biology techniques are used to determine the exact composition of mitochondrial and muscle DNA (this is called ‘sequencing’). Other methods may include PCR (polymerase chain reaction), which gained fame for COVID-19 testing. Screening also includes carefully examining the function of all organs that might be affected by mitochondrial disease.

Mitochondrial disease and migraine

Recent research has shed light on the significant link between impaired energy metabolism due to mitochondrial dysfunction and migraine development. When oxidative stress overwhelms nerve cells’ ability to counteract it, the delicate energy balance collapses, triggering a migraine attack.

Scientific studies reveal that individuals with mitochondrial diseases are more likely to get migraines. While migraines affect 11–14% of the general population, this figure doubles in people with mitochondrial diseases. Depending on specific genetic factors, the prevalence can soar to over 50%. These findings confirm earlier suspicions from the 1970s that mitochondrial diseases might play a pivotal role in migraine development.

Prevention through secure energy supply

If your migraines stem from mitochondrial dysfunction, understanding preventive strategies is crucial. Based on this understanding, you can try a number of lifestyle modifications to see if they work for you. Avoiding energy shortages in the brain, mainly through proper nutrition, is key. Regular carbohydrate intake and adequate hydration (drinking enough fluids) will help ensure that the brain – as the top energy consumer without its own energy stores– gets the energy it so badly needs.

Research is also being done into the effects of micronutrients (vitamins and minerals our bodies need in very small amounts) on mitochondrial performance. Research results show that a good supply of vitamin B2 (riboflavin), coenzyme Q10 (ubiquinone) and magnesium can support and stabilize the work of the mitochondria. Nevertheless, further scientific research is needed in this area, which will hopefully provide doctors and patients with more options for migraine prevention in the future.