Migraine Triggers and Comorbidities: Thyroid Disease - Part 2
Thyroid disease is a migraine comorbidity
Migraine is a primary headache and is not *caused* by another disease or disorder.
However, thyroid disease is a frequent migraine trigger for those patients unlucky enough to have both conditions — called a comorbidity. Thyroid dysfunction can be diagnosed and treated, but patients MUST have the correct information and be proactive, so they don’t suffer needlessly.
How do I know if I have thyroid disease?
Some things you can do yourself to help see if you might have a thyroid problem include:
- Take your temperature in the morning before moving or rising for the day. A low or high temperature can indicate that you may have thyroid dysfunction.
- Check your neck — is there noticeable swelling that may look like a fatty deposit below your Adam’s apple and above your collar bone? If so, see a physician and ask for specific further testing.
- Check for symptoms of hypothyroid (low) or hyperthyroid (high) conditions. Write them down and ask your physician for appropriate testing.
Should you be diagnosed with thyroid dysfunction, you will most likely be told you need to take medicine. If you are hypOthyroid, the treatment is usually supplementation of thyroid hormones. The most frequently prescribed type of thyroid hormone is T4. There is another type of hormone that many with migraine find helpful in eliminating a thyroid-related trigger. It is called T3.
T3 and T4 hormones
T4 is a storage hormone. The body makes T4, so it is available to organs when they need it. T4 itself is not an active hormone. The organs (and brain) can remove an iodine molecule which creates T3. This smaller T3 hormone is what the body actually uses for metabolism, not the inactive T4. Many people can convert T4 to T3 effectively enough that they don’t need additional T3 supplementation. This conversion requires specific amounts of selenium and Vitamin B12 to be converted to selenomethionine to happen.
Migraine and thyroid hormones
Many — especially migraineurs — do not convert T4 to T3 very well. When this happens to a migraineur, migraine attacks are a frequent result because their brains are essentially starving — they cannot metabolize the energy they need to function correctly. A clinical trial of T3 hormone given twice daily is often warranted to see if the patient’s migraine frequency or severity responds.
Selenomethionine is used in other more thyroid savvy countries to help patients convert their T4 to T3, often resulting in remission from Hashimoto’s (autoimmune hypOthyroid) disease. The United States remains behind the learning curve where this is concerned, choosing instead to continue treating with T4 and prematurely considering the thyroid a “lost gland.”
T4 and T3 hormones are available as lab-created compounds and natural products. Natural products are usually the thyroid glands of pigs that have been dried, ground to powder, then tested for potency, and put into pill form. The T4 to T3 ratio of the pig thyroid is different from a human’s; however — the pig thyroid contains more T3 than a human’s - so some people will have problems with the natural product. Artificial T3 used in concert with artificial T4 leaves the patient with more options, but it is not a natural product and doesn’t contain some of the other hormones the normal thyroid produces. Natural products appeal to many patients, but the inability to change the T4 to T3 ratio, as well as occasional problems in getting it, may be an issue.
Once you are tested and know your thyroid status, do your thyroid, and your doctors a favor and keep paper copies of all your labs in a notebook or file folder. The truth is that nobody knows your body better than you. You also have more time to pay attention to it than your doctor. You may notice changes that your doctor misses. You may see patterns your doctor misses. If you don't keep copies of your test results, you cannot show them to your doctor.
What can you do?
Some important things to do if you have thyroid dysfunction and migraine:
- Have your thyroid labs taken simultaneously. Try to use the same lab for each test to minimize variations in results.
- Take care not to have thyroid testing done within a few hours of taking your medicine.
- Always take your thyroid supplement on an empty stomach at the same time each day, and with 8 ounces of water. Wait an hour before consuming anything — other meds, food, or drink.
- Do not switch medication brands as this can cause fluctuations that might trigger a migraine attack.
- Get frequent testing. Every six months is average once your levels are stabilized on your medicine, but it might sometimes be better to consider testing more frequently, especially if you are not yet stable.
- Find an endocrinologist who will treat you based on how you are feeling and doesn’t get hung up on lab values alone. You are looking to find your personal optimal level, not someone else’s “normal.”
- Tell your doctor you want to avoid major fluctuations and ask if a rise or fall in thyroid supplementation or anti-thyroid drugs might be taken more slowly to minimize migraine attacks.
- Remember that — should you experience side effects — you can ask your doctor to take your medicine at lower doses, more frequently. This is one of the most frequent mistakes made when a patient is on ATD’s (anti-thyroid drugs) for hypERerthyroid.
- Understand that — when hyperthyroid — many patients can remain on ATD’s for many years if taken properly and conscientiously in split doses throughout the day. Having your thyroid ablated or removed does nothing to help your antibody levels.
In closing, it’s interesting to mention that it is not only the dysfunctional thyroid that can cause a problem for us — meaning the hormones - but also the antibodies themselves. The autoimmune antibodies can affect your brain and other body parts, causing mild to serious complications, which may include:
- Hashimoto’s encephalitis (antibodies cause brain swelling and neurologic symptoms)
- Graves’ encephalitis (antibodies cause brain swelling and neurologic symptoms)
- Graves’ ophthalmopathy (antibodies cause bulging eyes and sometimes changing eyesight)
- Pretibial myxedema (antibodies cause a severe rash on the lower leg
Think you might have thyroid dysfunction? Tell us about it here. Then, use this post to become educated and begin a conversation with your doctor. Remember, the person with the most to lose gets to choose.
How much has your migraine disease changed or evolved over time?