Migraine and cognitive decline among women: prospective cohort study

Dear Editor,

May we be allowed to lay out another view and a possible management technique for migraine, that is quite effective, and allows freedom from migraine and its prophylactic drugs. So, let’s look at migraine once again. With its penchant for running in families and genetic predilection, and usually confined to one side, could this possibly be another passing gift to our ancestor for having gained an erect posture, the Homo erectus, like the already identified hemorrhoids and varicose veins? Possibly this hypothesis can generate some extra imagination and interest in migraine, and maybe this could also lead to some breakthrough in effecting a change in the way we manage migraine, that could also be making the management easier.

Plenty is perhaps already known about migraine. It is also known that migraine activity begins in the brainstem, and ends with distension and inflammation of meningeal vessels. Can we just for a while deviate from migraine and consider instead a patient’s symptoms who suffers from varicose veins in lower extremities? It is known that every person does not get affected by varicose veins, and it is some special persons who might be prone for it, where many a times valve defects have been the starting point for this problem, and that this problem keeps worsening over a period of time. Common symptoms are tiredness or aching, along with swelling over legs on prolonged standing. Repeated such occurrences are possibly capable of letting it be known that with some rest, the tiredness eases off, alas only to return later after prolonged standing.

We already know that migraine effects are by and largely confined and limited to the cranium, and mostly to one side of the head, without usually crossing over to other parts of the body or involving the whole body. Could it be possible that the sufferers of migraine might have some genetic propensity or a structural birth defect within the cranial microcirculation, something similar to factors that lead up to varicocoele or varicose veins, but perhaps not to that magnitude so as to be easily overlooked all this time? Could the erect posture that we have inherited from homo sapien erectus has a role to play, along with the interplay of gravity in prone individuals with as yet unidentified minor deformity or derangement within cranial microcirculation. If this were anyway correct, then this minor defect in microcirculation within the cranium could perhaps hinder continuous, regular and uniform distribution and dissipation of various hormones and other circulating products, via this internal microcirculation, allowing some inadvertent storage in possibly a narrow-necked pitcher of sorts, albeit temporarily.

Given that migraine is usually to one side, the defect causing formation of such a makeshift ‘pitcher’, as explained afore, would also be lying to that particular side. Migraine could be a result of a build-up of collections in this make-shift ‘pitcher’ that could exert its effect either by behaving like a rapidly expanding intracranial space occupying lesion (ICSOL), or by spilling all of its contents suddenly within the microcirculation effecting a sudden surge and a change in the internal neuro-endocrinal milieu, or possibly by combining both these possible scenarios, or through some such similar event. Triggering factors for migraine are very well known, and those could trigger the release of the contents from this ‘pitcher’ suddenly and simultaneously, thus overwhelming the internal milieu of the circulation, so much so as to be precipitating an acute attack of migraine, if a threshold is suddenly crossed.

Sudden release of inflammatory products in an enclosed space may perhaps exert their short lived effect maximally on the structures in that particular enclosed space. If analyzed carefully, this could perhaps also be a pointer to the location of this “pitcher”, as every patient has different manifestation with special predilections, aura, intensity, duration, etc. Since the intracranial microcirculation also has internal ramifications as well as cross connections with the other half. In certain severe cases, this could possibly have the potentials to engage the whole cranium, and not remain confined just to a one half of it. If one were to consider the cranial capacity, which in any adult is as such more or less fixed with no scope of expansion, it will follow that any little expansion will result in raising the intra cranial tension (ICT), that will be manifested variably, but basically the structures in immediate proximity of this expansion might have to face the maximum brunt.

As the brain weight, size and its volume decrease after menopause, this would provide more space for expansion within the cranium, and would therefore delay the fireworks, or may decrease the effects. On the other front, post menopause hormonal secretions are also reduced, which might not be able to fill up those pitchers anymore, or for that matter so frequently or so regularly anymore, this therefore would allow the migraine to tone down its intensity, duration and frequency, and gradually fade out completely. With all of this, maybe there could be a shift in the way we look and deal with migraine.

During the III International Conclave of Family Medicine, held at Chennai, INDIA, in September 2012, we had showcased our new modality of managing migraine. It is quite effective, but requires lots of further research that perhaps may be done by international agencies and research groups. This is a non-invasive technique, requiring four or five sittings of an hour each, and we have used a combination of electro-medical gadgets like TENS, ultrasonic therapy unit, infra red apparatus, etc, in varying proportions and combinations, depending on the symptoms that a patient has. The wife of our first author was the first patient, who herself suggested that something new should be tried for her, as it was getting very sickening for her. We don’t really know the nitty-gritty of how it works, and are really short of explanations, but then she has found marked relief and is almost cured. She does not have migraine attacks so frequently, and the severity has also reduced considerably. There have been some other acquaintances, who we could not refuse, and they too have benefited considerably. We have named this technique as “DHAMNA TECHNIQUE” for managing migraine, and we present this to the world through you BMJ, to spread smiles all across the world.

Best regards.