Stress and the Hypothalamic Pituitary Adrenal Axis (HPA) in Migraine

When people come to see me, they’re desperate for relief from migraine. They are overjoyed to be able to find clear, tangible explanations for the underlying nutritional and physiological causes of their migraine – and to learn which foods, supplements, and especially minerals can support them in their healing. Migraineurs are extraordinarily motivated to change their lifestyle, because migraine is so painful.

These very tangible things that people can do to improve their migraines immediately can be very powerful and effective. But they are also a distraction from what we know to be true: that our stress response is at the heart of our migraine pattern. Yet even though we all know this, managing one’s own stress response still seems far less tangible than taking a supplement. I wrote a bit about these issues in my recent blog post “Healing the Stress Response and Finding Rest.

Perhaps we dismiss stress management as a practical goal because we think that modern life is just inherently stressful – for everyone – and there’s no way around it. For parents of young children like myself, stress seems to go part and parcel with our life stage.

We have become habituated to stress. Many of us rely on the release of stress hormones as a kind of energy that keeps us going in the midst of our deeper core-level feeling of depletion. Stress has become normal, and we may have a hard time remembering what life felt like before the stress of migraine.

A closer look at the elephant in the room

Stress is an unavoidable part of life, experienced by all organisms. Stress, if it is not ongoing and the organism is given the time to rest and recover, can actually be healthy. This is called eustress. It challenges the person, plant or animal to adapt to life. But constant low-grade or high-grade stress – also known as distress – will compromise every level of the bodymind’s functioning.

The nervous system is regulated by the hypothalamic-pituitary-adrenal axis (HPA axis). Dr. David Watts, PhD, one of the early developers of Hair Tissue Mineral Analysis methodology and director of research at Trace Elements Inc, describes how the nervous system and the endocrine system work together to orchestrate so much of our behavior and physical functioning:

This neuroendocrine integration regulates the stress response as well as the immune response, reproduction, digestion, energy production, utilization of nutrients, behavior and survival, and is regulated by the hypothalamus, pituitary and adrenals, termed the hypothalamicpituitary-adrenal axis or HPA. . . (Source: TEI Newsletter May 2018)

Stress is usually categorized into the sympathetic and parasympathetic responses, which are both part of the ANS, or autonomic nervous system. Both of these branches of the ANS are regulated by the HPA axis, and associated with different metabolic and endocrine characteristics.

The sympathetic nervous system is also called the fight-or-flight system. It activates the brain and the muscles and is the “speed-up” system. It causes expenditure of energy and is catabolic. The parasympathetic system is conserving, nurturing, nourishing and restful. It activates the digestive organs. It is anabolic and regenerates the body. . . Many people compulsively fight or run all the time. Others are in a give-up mode. . . Causes of autonomic imbalance include chemical imbalances one is born with, poor diet, use of stimulants, negative thinking, structural imbalances, physical or emotional traumas and exposure to toxic metals and chemicals that affect the hypothalamus and pituitary gland. (Source)

Stress can come from known or unknown sources. Adrenaline (sympathetic fight-or-flight) is released under stressful conditions that are known, while noradrenaline (parasympathetic rest-and-digest) is released under unknown or unexpected stress conditions.

Post Traumatic Stress Disorder (PTSD) and migraine

Acute stress such as trauma is known to cause PTSD, or Post Traumatic Stress Disorder.

[I]n a general population survey of over 5600 participants, the 12-month and lifetime odds ratio of PTSD in episodic migraineurs was noted to be greater than the odds ratio for either major depression or generalized anxiety in episodic migraineurs. Episodic migraineurs had a 3- to 4-fold greater odds of PTSD than those without headache. . .A general population study, using data from the National Comorbidity Survey Replication, reported that irrespective of PTSD status, episodic migraineurs have more traumatic stressors than those without headache. . . . in this same study, 60% of episodic migraineurs with PTSD reported physical or sexual abuse as a traumatic life event. It is also notable that 42% of all episodic migraineurs, irrespective of PTSD presence, reported physical or sexual assault. (Source)

There is increasing recognition that PTSD should not be viewed as a disorder, but rather that it signifies a REordering of the nervous system. Rather than pathologizing everything, we can see this heightened alarm response as an adaptive mechanism that is necessarily created when life circumstances require hypervigilance in order to survive.

Some people are even able to grow from acute trauma. This is known as PTG, Post Traumatic Growth. Regardless of the intensity of your stress response or the cause of it, learning to manage stress is key to healing migraine.

Emotional self-regulation and the stress response

Our emotions can also be viewed through the lense of the autonomic nervous system. Sympathetic dominance is associated with anxiety about the future, faster adrenal and thyroid function, higher blood pressure and higher blood sugar.

Parasympathetic dominance, on the other hand, is associated with fatigue, depression, worry about the past, and emotional suppression.

Repression is a parasympathetic characteristic . . . and the stress of keeping [the emotions] hidden contributes to stress that can manifest physically in fatigue, depression, eating disorders, arthritis, digestive conditions, [etc] . . . (Source: TEI Newsletter May 2018)

So, with our low blood sugar, low blood pressure, history of trauma (for many but not all with migraine), depression, digestive problems, and exhaustion, can you guess whether most migraineurs might be more caught in the sympathetic or parasympathetic stress response?

From what I’ve seen in my practice, I believe that migraineurs’ stress responses overall may be more reflective of a dis-regulated parasympathetic response.

Then again, migraineurs also experience anxiety and sympathetic states. It’s like being revved up and exhausted at the same time. In Hair Tissue Mineral Analysis, we call this an out-of-synch metabolic type – one in which a person has a fast adrenal function but slow thyroid function, or vice versa. Basically, the major endocrine organs are not working at the same pace and tempo in order to harmoniously function in concert. Another term for this is HPA axis dysregulation.

What does all this have to do with mineral balancing and different metabolic types?

To find out, stay tuned for Part 2 of this series coming next week as I explore “Mineral Patterns and Stress”.

About Marya Gendron
Marya Gendron is a biodynamic craniosacral therapist and health coach specializing in chronic migraine headache relief and alleviation of brain fog, indigestion, and histamine intolerance through plant-based solutions and hair mineral analysis. She practices out of White Salmon, Washington.

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