Migraine Triggers and Comorbidities: Thyroid Disease - Part 1
Migraine is an often misunderstood and much maligned disease. If I had to pick another that comes close to the misdiagnosis and stigma of Migraine, it would be autoimmune thyroid disease.
Unfortunately, there are probably more undiagnosed people with thyroid disease walking around wondering why they don’t feel well than there are Migraineurs without an appropriate diagnosis.To make matters more confusing, thyroid dysfunction is a frequently co-morbid disease with Migraine, as well as acting as a frequent trigger for Migraine attacks.
When episodic Migraine transforms into chronic Migraine, or a patient presents to a physician with a case of new daily persistent headache (NDPH) a frequent cause or trigger is thyroid disease or dysfunction. Like Migraine, thyroid disease is most often found in women, and can be influenced by levels of reproductive and other hormones.
What is the thyroid?
The thyroid is a small, butterfly shaped gland in your neck between your adam’s apple and collarbone. It is a gland that responds to hormonal instructions by the brain. The part of our brains called the hypothalamus senses the need for thyroid hormone. It secretes TRH (thyrotropin releasing hormone) and the pituitary gland responds by secreting TSH (thyroid stimulating hormone) which turn the thyroid’s hormone production plant on. The thyroid in turn secretes a number of hormones which are vital to the way every single cell in our bodies function. When it underproduces hormone, we say the patient is hypOthyroid. When it overproduces thyroid hormone, we say the patient is hypERthyroid.
The thyroid gland utilizes mainly dietary elements as fuel to create thyroid hormones, especially iodine and tyrosine. The most important of these hormones are called T4 and T3. The T stands for tyrosine and the number stands for the number of iodine molecules attached to it. Knowing these facts are important as we learn how thyroid hormones function and why they can be so important to Migraineurs.
Left untreated, thyroid disease often becomes disabling, and can eventually be fatal. Just 100 years ago, myxedema (hypothyroid) was a frequent cause of death. HypERthyroid conditions often also resulted in death, often by heart attack.
Our knowledge re: thyroid disorders is fluid and changes constantly as we learn more about these problems and get better at testing for them and treating them. It used to be assumed that children rarely if ever had thyroid dysfunction. Most of these children actually suffer through their childhoods without a diagnosis. For them, feeling bad becomes their normal. Although the chance you suffer thyroid dysfunction rises with age, we now know that lab ranges for children vary from those of adults, and that they do suffer thyroid dysfunction. Endocrinologists who specialize in pediatric thyroid care are the best resources for children who may have a thyroid disorder as their diagnosis and treatment may be more difficult. Finding a good doctor is a vital key for these patients.
Thyroid dysfunction can happen at any age, but estimates range from 1/3rd to 2/3rds of women over the age of 50 suffer from some type of thyroid dysfunction, and the percentage of men affected by thyroid dysfunction rises with age as well. More than half are undiagnosed. Why then do very few doctors take the time to screen their chronic Migraine patients for thyroid dysfunction or even have the ability to visually identify a goiter (swollen thyroid gland)?
Indeed, the average physician is not even up to date enough on thyroid protocol to know which tests must be run to find a thyroid condition. Thyroid conditions are sometimes not taken seriously and patients suffer stigma from families, friends and unfortunately, sometimes their physicians. This is why it is very important for Migraineurs — especially chronic Migraineurs — to understand these conditions and be proactive with their doctors so they can receive the right testing to correctly diagnose thyroid dysfunction that may be complicating their Migraine disease.
The most frequent reasons a person may be suffering from a thyroid disorder include:
- Autoimmune disease
- Dietary deficiency or malabsorption problem
- Thyroid nodules
- Injury or radiation exposure
- Over-consumption of iodine or goitrogenic foods such as soy, cruciferous vegetables, etc
There are several things that may put you at increased risk for thyroid dysfunction including:
- Female gender
- Having a relative with thyroid disease
- Having an autoimmune disease
- Having another endocrine (hormone) disorder
- Pregnancy or recent childbirth
- Exposure to radiation, chemicals, certain medications or surgeries
- A diagnosis of Fibromyalgia or Chronic Fatigue Syndrome
- A diagnosis of depression or anxiety
Although there are many tests for thyroid function, many are old, outdated and no longer as useful as current testing. The main and current screening tests include:
- Free T3 (not total)
- Free T4 (not total)
- TPO antibodies
- TSI antibodies
If you have a nodule (growth, or bump within the gland) or goiter, ultrasound is usually used to locate and measure the gland and any growths found within it. A baseline is usually noted so it can be monitored over time. Nodules may be further tested with a nuclear uptake scan that will determine if it is ‘hot’ (produces too much hormone) or ‘cold’ (produces insufficient hormone). Needle biopsies are usually considered if cancer is suspected.
Next: Migraine triggers and co-morbidities: Thyroid Disease - Part 2
When it comes to planning vacations or other events where travel is required, how much does migraine factor into your decision-making?