AAN 2024 | Metabolic dysfunction and migraine
Elizabeth Leroux, MD, FRCP, University of Calgary, Calgary, Canada, discusses the potential relationship between metabolic factors and migraine, with emerging evidence suggesting that migraine may be a protective reaction of the brain to a mismatch between excessive energy demand and insufficient energy availability. Dr Leroux highlights that almost all triggers leading to migraine attacks are related to oxidative stress, and it is necessary to consider metabolic factors as key players in the triggering of the cascade that leads to the onset of migraine. Additionally, Dr Leroux suggests that a poorer response to calcitonin gene-related peptide (CGRP) blockade is often observed in patients with obesity, vascular disorders, and traumatic childhood events. This interview took place at the American Academy of Neurology (AAN) Annual Meeting 2024 in Denver, CO.
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Transcript
Metabolism is the way that our brains and bodies stay alive and adapt to the environment. So if you focus on the brain, the idea is to match the energy that we have to the demands that we have; namely sensory input, mental load, focusing, exercise, etc… There’s been research in the past wondering about migraine as a protective reaction of the brain to a mismatch between excessive demands and insufficient energy, and that’s what we think about when we think about metabolism...
Metabolism is the way that our brains and bodies stay alive and adapt to the environment. So if you focus on the brain, the idea is to match the energy that we have to the demands that we have; namely sensory input, mental load, focusing, exercise, etc… There’s been research in the past wondering about migraine as a protective reaction of the brain to a mismatch between excessive demands and insufficient energy, and that’s what we think about when we think about metabolism. Key aspects of this go beyond only the brain. You have to look at the whole body. For example, maintenance of blood sugar levels is key. One other factor that is very important is sensory overload, so for example excessive lights or sounds. Air pollution is also something that influences our metabolism. Interestingly, almost all triggers that will lead to a migraine attack coalesce to increase something called oxidative stress, which is the result of this kind of excessive energy spending or higher demands. The only trigger that doesn’t really increase oxidative stress is neck pain, for example, but all the rest coalesce there. We now know, thanks to the calcitonin gene-related peptide (CGRP) era (which has been a key advancement in neurology in migraines for the past decade), the end of the cascade results in inflammation triggering the attack. But what triggers this cascade? Could that be metabolic factors? We also know that some people do not respond very well to CGRP blockade. Could that be because of metabolic factors? If you look at certain people who are very refractory to treatments, they are either obese, some of them have a very significant adverse childhood events that also increase the metabolic load in future adverse events, some have vascular disorders that also cause problems. So one could wonder is that a path to treatment, maybe?
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Disclosures
Elizabeth Leroux has engaged in consulting, advisory boards, and/or participated as a speaker in events organized by Allergan, Eli Lilly, LinPharma, Lundbeck, McKesson Canada, MedScape, Paladin, Teva, and Novartis.
