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Are migraine, fibromyalgia and ME/CFS connected at the hip?

Migraine effects 12% of the population (!) or about 40 million people.  Two studies suggest as many as 75% of people with chronic fatigue syndrome experience migraines and that most migraines in ME/CFS are undiagnosed.  A  recent large fibromyalgia study suggested that 55% of FM patients may meet the criteria for migraines.  WebMD, which has very little to say otherwise about chronic fatigue syndrome, states ME/CFS is one of five disorders with high migraine rates.

If those studies are accurate, ME/CFS and FM may have more in common with migraine than with each other. That’s an astonishing possibility given that migraines were hardly talked about with respect to either disease five or ten years ago.

That makes a recent migraine study highlighting hypoxia (low blood oxygen levels) and increased lactate  – two intriguing possibilities in ME/CFS and FM –  all the more interesting.

A recent blog suggested that increased lactate levels in the brains of ME/CFS patients could set the stage for increased fatigue. Several studies, in fact, suggest that increased lactate levels exist in the brain, muscles and perhaps guts of both chronic fatigue syndrome and fibromyalgia patients.

What is causing these lactate accumulations is unclear but one of the possibilities is hypoxia or low oxygen levels. When oxygen levels are low cells turn to glucose to produce energy via a process called glycolysis.  This process produces pyruvate which, in turn is converted into lactate and released into the bloodstream.  As that happens hydrogen ions also build up causing acidosis.

The Migraine, Hypoxia, Lactate Connection

A recent study exposed people who experience migraines to hypoxic conditions to see if they would trigger a migraine.  They found that low oxygen conditions did, in fact, trigger a migraine in about half the women with a history of migraines but not in the healthy controls.

Migraine induced by hypoxia: an MRI spectroscopy and angiography study.  BRAIN 2016: 139; 723–737 | 723. Nanna Arngrim,1 Henrik Winther Schytz,1 Josefine Britze,1 Faisal Mohammad Amin,1 ark Bitsch Vestergaard,2 Anders Hougaard,1 Frauke Wolfram,2 Patrick J. H. de Koning,3 Karsten S. Olsen,4

The ability of low oxygen conditions to trigger migraines in such a high percentage of women was astonishing. Why? Because until this study showed up it’s been difficult to intentionally trigger a migraine in the lab. The oxygen levels the researchers subjected their subjects to was quite low but it did suggest that hypoxia may play a role in triggering migraines.

How was it doing that? It’s long been known that small dilations of the blood vessels in the brain occur during a migraine. These researchers showed that hypoxia did indeed cause those arteries to dilate – but in both the healthy controls and the migraineurs. Since the amount of dilation was no larger in the migraineurs than in the healthy controls it wasn’t clear that enlarged blood vessels were behind the migraines.

Nor were levels of glutamate, an excitatory neurochemical long been believed to play a role in migraine, increased.

lactate

Lactate levels mushroomed in the migraine patients after hypoxia

Instead, lactate levels significantly increased in the migraine patients brains and blood. Why the migraineurs responded to low oxygen levels by producing higher levels of lactate than the healthy controls was unclear, but it was clear the lactate increases were associated with a migraine and/or the occurrence of unusual visual disturbances.

Some of those visual disturbances may be familiar to people with ME/CFS or FM; they included black spots, “worms” (floaters?), difficulty focusing and blurred vision. (Those visual disturbances technically fulfilled two criteria for migraine. Three of the four people with visual disturbances also experienced a migraine-like headache.)

The high levels of lactate were also sustained for several hours after the hypoxic challenge ended. That suggested that mitochondrial problems may come into play.  A 1998 study, in fact, found increased plasma lactate levels after exercise in migraine, and numerous other studies have shown decreased ATP production in the visual cortex of migraineurs as well.

Conclusions

What do we know? We know that migraine is common in ME/CFS and FM and vice versa, and that hypoxia and lactate accumulations and mitochondrial problems may be involved in each of these diseases.

We also know that as with ME/CFS and FM, women are primarily effected by migraines, and migraines and ME/CFS symptoms are often substantially reduced during pregnancy.  People with severe ME/CFS, in particular, often have significant problems with stimuli – as do migraineurs –  and migraineurs and ME/CFS/FM patients also often seek out low stimuli environments during attacks or crashes.

transmission line

The connections between the three diseases appear to be growing

We know exercise during a migraine is usually impossible. People with migraines often experience ME/CFS-like symptoms of fatigue and cognitive issues for several days following their migraine attack.

In fact, in a 2015 paper Rayhan and Baraniuk proposed ME/CFS/FM patients may exist in a kind of chronic migraine-like state. Given the considerable symptom overlap migraine has with ME/CFS (visual disturbances, sensitivity to light/sound, weakness, pins and needles, speech problems, nausea, vomiting, increased urination, etc) they could very well be right.

It’s not exactly clear how migraines, ME/CFS and FM are related but the connections are growing.

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