Migraines and the Hypothalamus, Part One: Towards a Grand Unified Theory


What Causes Migraine, Part OneIf you’d told me five years ago I’d be writing a book about migraines in the future, I doubt I would’ve believed you. Not that I wasn’t keenly interested in the subject, mind you. It’s just that at that time, though I knew there was still much to learn about migraines, I thought that pretty much everything there was to say about them had been said.

But when I inadvertently happened upon a way to end my own migraines for good, all that changed.

Not only did this discovery vastly improve the care I could provide to my patients, it also forced me to re-examine migraine physiology from a fresh perspective (along with many other aspects of health, for that matter!).

As it turns out, there’s a precedent for this sort of thing. Much of what we know of migraine actually comes from scientist and physician migraineurs observing and analyzing their own symptoms. Psychophysiologist and migraineur Karl Lashley, for example, rightly predicted that his visual aura was associated with a wave of depressed brain activity marching across his cerebral cortex at a speed of 3 millimeters per minute. And he came to this conclusion by doing nothing more than observing and analyzing his own aura.

Sometimes there’s just no substitute for personal experience. And, in this particular case, it’s my own personal experience with migraine that has afforded me a perspective on the subject I could not have otherwise acquired – one that has ultimately led to novel insights about the origins of migraine.

The Need for a Grand Unified Theory

Though in recent years progress has been made in our understanding of the individual components of migraine pathophysiology, the root cause of migraine has remained elusive. As such, our current arsenal of preventative tools have come not by means of a targeted, scientific approach, but rather through a crude process of trial and error. It’s the “throw some stuff at it and see what sticks” approach to migraine research. Not surprisingly, these tools are weak.

Discovering the root cause of migraine, however, would provide us with an unprecedented opportunity to find ways of attacking migraine at its source.

In other words, to make true progress from the current state of affairs, we need a complete theory of migraine.

Up until now, that goal seemed far away. Now, it seems well within reach.

To begin with, the following two previously unexplored observations provide tantalizing clues about the origins of migraine:

  1. An ancestral diet, with deliberate carbohydrate restriction when necessary, is the most powerful means of preventing migraines.
  2. Migraine headaches don’t occur in indigenous hunter gatherer populations. They only occur in humans eating an agriculturally and industrially based modern diet.

From these observations, we can reasonably conclude that migraines are a disease of civilization. In other words, migraines only manifest in human brains when the constituents of our diet and lifestyle (i.e. our “environment”) are outside the bounds of our evolutionary experience.

This then leads to the next question: how does our modern diet and lifestyle provoke migraines? How is this environmental mismatch realized in the brain, and how does that then lead to migraine?

This is the question I’ll be addressing in the next several posts, the answers to which lead to a grand unified theory of migraine.

I know it’s a bold title. But big problems call for bold ambition, right? And I think the pieces are in place to complete the puzzle. With the re-conceptualization of migraine as a disease of civilization combined with knowledge acquired from clinical medicine, molecular biology, functional imaging, animal studies, and evolutionary biology, I believe we can now construct a robust theory of migraine that accounts for all the available evidence, showing us the way stopping migraine at its source.