[embodiment] adventures in pharmacology
Aug. 11th, 2021 09:51 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
kaberettSo. Migraines. We don't really know what they are, but there's probably a component of neurovascular disorder. Our best guess about how triptans work is by (tl;dr) causing constriction of blood vessels in the brain. Per my zolmitriptan Patient Information Leaflet:
Alright, fair enough, thinks I. But... caffeine? Why does caffeine help me so much? What's the mechanism of action here? Isn't caffeine a vasodilator? (I stopped consuming caffeine after my first term at university when I finally twigged that "a soothing cup of tea" was absolutely consistently making everything Worse, and that if I timed it wrong so would "two squares of dark chocolate". But was I... making up the panic attacks? Could I have been drinking proper tea all this time?)
It turns out (and please forgive my somewhat sketchy citations here) that caffeine causes vasodilation in smooth muscle (indirectly, e.g. review of Echeverri et al. 2010), but vasoconstriction when it comes to blood supply to the brain (e.g. Addicott et al. 2009).
Which I looked at and went !!! because -- while my grasp on the details of the biology here might charitably be described as shaky -- it looks to me as though This Explains Everything (about my personal experiences, sample size of 1, etc).
Like so: if we accept that one factor in migraines is vasodilation, and that the mechanism by which triptans work (when they do) is restricting of blood supply to the brain, then: caffeine (in the form of two mugs of weak tea), to which I am both highly sensitive and unhabituated, is a plausible explanation for the part where my last migraine lasted less than 24 hours instead of three days, and I was genuinely back to normal by the next day, instead of gritting my teeth through a miserable hangover.
In contrast, if I do not have an Active Neurovascular Event In Progress, the effects of caffeine are:
... which is to say, a panic attack.
In very slightly more detail: physiology and psychology are interacting and interdependent systems, and you can influence the one by manipulating the other. Thus the positive contributions of "slow exhales" and "gentle stretching" and "cold water" and "strong sensory input" in managing anxiety or panic or distress, and, similarly, the ability to induce psychological distress via physical arousal. If my body acts enough like it's having a panic attack, my mind will get in on the action.
So, in conclusion: I still shouldn't be drinking tea when I don't have a migraine, but given I'm getting two migraines a month with monotonous regularity, it's time for me to buy myself small quantities of all the fancy teas I've spent the past thirteen years missing. I am very glad I took the nice NHS 111 doctor's advice to try caffeine, on the basis that it couldn't possibly render me any more miserable than I was already, and only a little petulant about the inadvisability of drinking highly caffeinated and absolutely delicious alcohol -- normally off-limits because of the caffeine -- to "treat" a headache...
Migraine symptoms may be caused by the widening of blood vessels in the head. Zolmitriptan is thought to reduce the widening of these blood vessels. This helps to take away the headache and other symptoms of a migraine attack.
Alright, fair enough, thinks I. But... caffeine? Why does caffeine help me so much? What's the mechanism of action here? Isn't caffeine a vasodilator? (I stopped consuming caffeine after my first term at university when I finally twigged that "a soothing cup of tea" was absolutely consistently making everything Worse, and that if I timed it wrong so would "two squares of dark chocolate". But was I... making up the panic attacks? Could I have been drinking proper tea all this time?)
It turns out (and please forgive my somewhat sketchy citations here) that caffeine causes vasodilation in smooth muscle (indirectly, e.g. review of Echeverri et al. 2010), but vasoconstriction when it comes to blood supply to the brain (e.g. Addicott et al. 2009).
Which I looked at and went !!! because -- while my grasp on the details of the biology here might charitably be described as shaky -- it looks to me as though This Explains Everything (about my personal experiences, sample size of 1, etc).
Like so: if we accept that one factor in migraines is vasodilation, and that the mechanism by which triptans work (when they do) is restricting of blood supply to the brain, then: caffeine (in the form of two mugs of weak tea), to which I am both highly sensitive and unhabituated, is a plausible explanation for the part where my last migraine lasted less than 24 hours instead of three days, and I was genuinely back to normal by the next day, instead of gritting my teeth through a miserable hangover.
In contrast, if I do not have an Active Neurovascular Event In Progress, the effects of caffeine are:
- vasodilation in most of my body, resulting rapidly in readily observable flushing, increased surface temperature, and clamminess, as well as (presumably) increased oxygen and glucose delivery to my muscles; and
- cerebral vasoconstriction, resulting in reduced delivery of glucose and (circuitously) oxygen to my brain; and
- hyperventilation and increased heart rate, in an attempt to increase the oxygen available for my brain, which apparently results in a counterintuitive drop in oxygen availability to specifically the brain (the term for which appears to be "paradoxical effects of hyperventilation")
... which is to say, a panic attack.
In very slightly more detail: physiology and psychology are interacting and interdependent systems, and you can influence the one by manipulating the other. Thus the positive contributions of "slow exhales" and "gentle stretching" and "cold water" and "strong sensory input" in managing anxiety or panic or distress, and, similarly, the ability to induce psychological distress via physical arousal. If my body acts enough like it's having a panic attack, my mind will get in on the action.
So, in conclusion: I still shouldn't be drinking tea when I don't have a migraine, but given I'm getting two migraines a month with monotonous regularity, it's time for me to buy myself small quantities of all the fancy teas I've spent the past thirteen years missing. I am very glad I took the nice NHS 111 doctor's advice to try caffeine, on the basis that it couldn't possibly render me any more miserable than I was already, and only a little petulant about the inadvisability of drinking highly caffeinated and absolutely delicious alcohol -- normally off-limits because of the caffeine -- to "treat" a headache...
(no subject)
Date: 2021-08-11 09:15 pm (UTC)Fascinating.
(no subject)
Date: 2021-08-12 08:38 am (UTC)(We have Earl Grey in. I have also really missed jasmine, which goes well with the kinds of foods I consider Actually Foods mid-migraine. And while I'm buying myself jasmine I'm also contemplating a sample pouch of fancy rose-and-marzipan black tea...)
(no subject)
Date: 2021-08-11 09:36 pm (UTC)(no subject)
Date: 2021-08-12 08:37 am (UTC)(no subject)
Date: 2021-08-11 10:14 pm (UTC)enjoy the fancy teas!
(no subject)
Date: 2021-08-12 08:39 am (UTC)(no subject)
Date: 2021-08-11 11:32 pm (UTC)It is frequently so odd what helps in a migraine and doesn't during non-migraine times! Normally, you hand me a bag of ice to put behind my neck and I am Very Much Made of Nope, however during a migraine it's the best. So good. Mmmmm.
(no subject)
Date: 2021-08-12 08:39 am (UTC)(no subject)
Date: 2021-08-11 11:50 pm (UTC)About 20 years ago, I was having persistent migraines, and a doctor suggested I try a blood pressure med for a month. In some number of people, this turns out to be helpful (and it's basically a very safe thing to try as long as you don't have low blood pressure problems). The idea was that you did it for a month, and in some people it lets the constriction habits of your blood vessels - especially in your head - reset.
It definitely helped me - I went from pounding headache, had to be in a dark room doing nothing else to my migraines being a fog of neurological glitchiness, but one where I could do some things (especially if I was in a mostly dark room, wasn't dealing with background noise that's a trigger, etc.) Which is, frankly, a vast improvement in the situation.
I've also gotten the advice (which again, works well for me, and may not for anyone else) that one way to head off a migraine is caffeine + two ibuprofen taken as soon as you feel the very first twinge of the headache. (If you miss that window, which is a few minutes, it probably won't work.)
My previous doctor also recced a magnesium and B2 migraine supplement (the one she recced is called Migrelief in the US, also has feverfew which may or may not be any help. Whatever their processing does, it works better for me than other magnesium or B2, or maybe it's the proportion that helps.) Anyway, the magnesium part is because a lot of people are magnesium deficient, and magnesium has a lot to do with contraction and relaxation of a lot of the passive muscle stuff. (I take a half dose compared to the bottle: magnesium is a 'take to GI tolerance' dosage, and a half dose is about where I hit the tolerance.)
All of that said, I not only have a good tolerance for caffeine, but also do much better when I have a moderate daily intake (2 cans of diet coke and some chocolate covered coffee beans in the evening to modulate just enough to give me focus for writing time.)
Bodies, so very very weird.
(no subject)
Date: 2021-08-12 08:41 am (UTC)Noted, re magnesium...
(no subject)
Date: 2021-08-12 09:41 am (UTC)and magnesium seem to have reduced both the frequency and the severity of my migraines
[tho not 100%!]
(no subject)
Date: 2021-08-12 01:26 am (UTC)I once had a nurse tell me that taking paracetamol washed down with caffeine would do more to help my headache
than caffeine + paracetamol taken several hours apart...
(no subject)
Date: 2021-08-12 08:41 am (UTC)(no subject)
Date: 2021-08-12 01:49 am (UTC)(no subject)
Date: 2021-08-12 08:42 am (UTC)(no subject)
Date: 2021-08-12 07:14 am (UTC)(My own least favourite "physical arousal -> panic attack" pathway: combining core work with cardio, for extra credit while also ruminating on how unfit I am and how ludicrously easy most people would find this exercise. Makes my vagus nerve so angry. It goes all Jörmungandr on me.)
(no subject)
Date: 2021-08-12 08:42 am (UTC)(no subject)
Date: 2021-08-12 09:10 am (UTC)Enjoy the fancy teas
(no subject)
Date: 2021-08-12 10:19 am (UTC)(no subject)
Date: 2021-08-12 10:56 am (UTC)(no subject)
Date: 2021-08-13 03:02 pm (UTC)(no subject)
Date: 2021-08-20 12:24 am (UTC)I live for physiological/psychological feedback connections, but I think I sometimes overrely on them---maybe it's not *always* true that I feel bad emotionally because I feel bad physically? (Sounds fake, I know.)