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Migraine Triggers and Comorbidities: Thyroid Disease – Part 2

Continued from Migraine Triggers and Comorbidities: Thyroid Disease – Part 1

Migraine is a primary headache and is not *caused* by another disease or disorder.

Thyroid disease however is a condition that is a frequent Migraine trigger for those patients unlucky enough to have both conditions — called a co-morbidity. Thyroid dysfunction can be diagnosed and treated, but patients MUST have the correct information and be proactive so they don’t suffer needlessly.

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 be an indicator that you may have thyroid dysfunction.
  • Check your neck — is there noticeable swelling which 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.

T4 is 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 are able to 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.


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 better, 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 as a natural product. 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 yourself, 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. You cannot notice these things or show them to your doctor if you don’t keep copies of your test results.

 

Some important things to do if you have thyroid dysfunction and Migraine:

  • Have your thyroid labs taken at the same time of the day each test. 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 brands of medication as this can cause fluctuations that might trigger a Migraine attack.
  • Get frequent testing. Every 6 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. It’s possible for the autoimmune antibodies to affect your brain and other body parts, causing from 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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Yamihere
    3 years ago

    I have Hashimoto’s disease as do all my maternal grandkids do (and their moms before them). The frustration of trying to find TWO specialists who know than the people here know about migraine or the members of StopTheThyroidMadness know about Hashimoto’s is unbelievable. All those asinine remarks made to you about migraine from someone who managed to get a license to practice medicine which demonstrate a serious lack of knowledge? Just substitute the diagnosis of Hashimoto’s (or any thyroid condition) and the doctor’s specialty and you’ll have the total picture.

    So: since I’ve been off work for 5 months because of these two problems and their attendant symptoms, add the fact that I’ve been to FIVE ENDOCRINOLOGISTS THIS YEAR, and my primary care physician doesn’t want to deal with it anymore and the result? HE** YES I’m stressed, depressed, anxious, angry and have mood swings! My employer (one of the biggest Catholic healthcare providers in the country, who stopped being “Catholic” years ago) has horrible insurance plans which not only restrict my choice of doctors, but my choice of PHARMACIES! Walgreens “can’t” supply the dose of Natural Dessicated Thyroid (NDT) prescribed. Of course they CAN. They just don’t want to. They no longer carry the pain killers I use. No network pharmacy does – I now pay cash at the pharmacy I always used before my employer changed the insurance options in June 2014. Nice huh? THEY can change whatever they want to change whenever they want, EMPLOYEES can only change during open enrollment. And if you have to purchase a PRESCRIBED med outside the network? You won’t be re-imbursed, it doesn’t count toward your deductible. It doesn’t even have to be something doctors have been forced to worry about, like opioids. I’m allergic to ALL statins. They won’t cover the concentrated fish oil Lovaza in generic form which was controlling the elevated cholesterol caused by Hashi’s, not my diet or lifestyle. After months of calls, faxes and letters, during which I used the doctor’s samples, it was approved for one month. When my lab results came in the next month, I got a letter: You’re fine now. Approval is revoked. You will not receive approval ever, unless YOUR TRIGLYCERIDES ARE 500/dL OR GREATER. When I showed that to my PCP, his jaw literally dropped. “But you’d be dead by that time!” Yah, I think that’s what they hope. It’s just like the VA, except you’re PAYING for this “care” every two weeks.

    I’ve had viral meningitis, contracted it at work from a patient. Employer said: Prove it. I had an episode in the military which had to be viral meningitis, and hospitalizations for status migrainosus or Hashi’s encephalitis (no virus or bacteria in sample from spinal tap. And THIS IS IMPORTANT: if you have EVER had meningitis, you are at far more risk than people who haven’t. Like the effects of allodynia, once the blood/brain barrier has been breached by meningitis, it’s much easier for a germ to cross it.

    Please log on to to StopTheThyroidMadness. You’ll find actions YOU can take today to improve your treatment.

  • Anne
    4 years ago

    thank you so much for this! I’ve had migraines since I was 12 (am now 45) but they’ve only gone chronic in the last three years. I have been so incredibly tired all the time – I could sleep all day every day. I’ve been really depressed. I thought it was just the migraines and my neurologist NEVER connected my thyroid to my chronic migraines. I am so annoyed. I am currently awaiting the results of my blood work – but when my doctor examined my thyroid I jumped in pain. I am really irritated that a neurologist, who is supposedly a migraine specialist, did not check for this! I think because no one knows what causes migraines,certain doctors approach treatment in an unpragmatic and unscientific manner.

  • Edith
    5 years ago

    Where can I read more about this potential relationship between thyroid and migraine? I’d like to bring it up with my doctors, but I’d also like to have more background before I do so. I’m not finding much online.

  • SED
    5 years ago

    I had 1/2 of my thyroid out in November and my migraine symptoms have been getting more severe since them- they are still in the process of tweaking my thyroid meds, but I feel lousy at least 85% of the time… Trying to get in to see a neurologist- looks like perhaps I need an endocrinologist as well?

  • Rparker
    6 years ago

    I have suffered with mograines for the past 30 years, the last 3 years they have become daily? I was recently dignosed with hypothyroidism and this monday will see the doctor regarding this. Can you please tell me the name of the medication that would be “best”.

    Thank you so very very much for this information!

  • Ellen Schnakenberg author
    6 years ago

    Renee,

    There is no medication that is the best for everyone. For those with Migraine, I see them quite often doing better once they are switched to a combination therapy that gives them supplemental T4 and T3. This can be done with natural dessicated pig products, or with a combination of lab created supplements. Personally, I am taking a combination of lab created supplements as it allows us to more precisely tweak the amounts that work the best for me.

    I hope this information is helpful to you …

    ~Ellen

  • Dizzy1i
    6 years ago

    Your comments about the difference between T3/T4 treatment protocols in Europe vs USA are compelling. I wish I had reference to a journal article or two to discuss with my doc. He is the sort who sits up and listens when he sees such stuff.

    Nevertheless, thanks o much for this actionable article.

  • Ellen Schnakenberg author
    6 years ago

    Dizzy1i- If you let me know exactly what you’re looking for I can probably help you with that 🙂

    ~Ellen

  • Tara
    6 years ago

    Very good read. I keep saying to my doctors that the migraines started at the same time I was diagnosed with hypothyroid and other hormonal issues. Every time I go to the dr, they say I wonder what is causing the migraines? I get so frustrated, because it’s right there in the lab work. It’s not surprising there is a book called “Screaming to be Heard: Hormonal Connections Women Suspect, and Doctors Still Ignore”. Unfortunately, with all the medical advances there have been, investigating the underlying causes of things has been mostly ignored because the drug companies make so much money off of treating our migraine and thyroid issues with medications. The other problem that thyroid patients have is that many of us end up with adrenal issues because of the T4 only medication we’re on or because of stress which caused both the thyroid and the adrenal issues. For many of us to alleviate all of our symptoms, we need to be on T3 as well, but we can’t because our adrenals won’t support the T3. It’s very important to test adrenals with a 24 hr cortisol saliva test before starting on thyroid meds. I’m in this situation now and I really wish more doctors were informed and proactive about looking out for these issues with their patients.

  • carly
    6 years ago

    Well, I don’t know how to begin to get at my actual Q? w/o writing a book. I am now 51. Had hormone headaches/migraines that turned into chronic daily/intractable migraine over 20 years ago. I do have a pain mgt. specialist and hormone specialist (I stopped seeing my endocrinologist about 4years ago as he was anti-armour thyroid.) I had a partial hysterectomy 6 years ago at age 45(due to severe bleeding..they could not stop it w/ hormones and my hemoglobin was at the transfusion level). At that time I only had my ob/gyn and endocrinologist. I had recently began the headache journey in 2000.I don’t want to bore you w/ all the years of this journey..Dr’s and med.’s, ER visits etc. to get to where I am now. My Q is thyroid related. I am calling today for bloodwork results. I do hormone therapy 75mg progesterone and a estrogen/testosterone pellet..which I am due for another one. I am feeling terrible, sluggish, very foggy, unable to concentrate or process efficiently, muscular weakness and pain. I am recovering from Shoulder surgery (labral and bicep tendon tear) so about the only thing I can do is computer, so I am researching and preparing for my next hormone/thyroid appt. I am going to request my past labs…do you think it is necessary to get all labs since my pit. tumor was diagnosed or even my hysterectomy? Or just since I last felt better? My thyroid dosage has been reduced from 90mg to 30mg in the last 18mos. and I am progressively having more daily headaches and just feeling icky despite excellent pain/headache mgt. that includes botox injections, C2/3 rizotomy, intermittent facet injections. Physical pain as a result of musculoskeletal dysfunction and Chronic nerve root irritation in the high cervical region (resulting from past injury and cervical fusion C5/6) is a big contributor to my pain cycles but, the thyroid and hormone issues play a big part too. It took years of suffering b/f and lots of trial and error b/f all the pieces of my headache puzzle started coming together and I got to a place where pain no longer was my daily dictator and completely controlled my life. Right now during this surgery recovery I am quite flared daily headache wise but, I know the thyroid/hormone component has significantly declined from “optimal for me” and I am doing my current due diligence w/in the current online thinking to be better prepared for my appt. I know that was a lot but, can you help me pull together the right details to figure this out again. The brain fog, worsening depression (60mg Cymbalta/50mg TRAZADONE @ BED) and no motivation, plus the secxual dysfunction are my priorities currently. thanks Carrie

  • Emily
    7 years ago

    This makes me wonder if it’s possible to transition to T3, or at least a combination of T3 and T4, after being on just the artificial T4 for a few years. I’m hypOthyroid with migraines that *were* chronic, and then decided that wasn’t often enough – now I have maybe a few hours every couple of days where I *don’t* have a headache/migraine of some level. It’s not surprising that I’m hypothyroid – a lot of the risk factor list applies to me: female, autoimmune disease (Sjogren’s), exposure to radiation (although hopefully not THAT much – annual dose totals have never been much), fibro, depression/anxiety, and relatives (my mom, and on her side of the family: [only] aunt, [only female] cousin, grandmother, grandfather – my sister refuses to get checked because she’s afraid of taking medication)

    I’m planning to go see an endocrinologist once I get settled with a few of my other doctors (I just moved, and with several different conditions, I’m sure many other migraineurs can appreciate). Since nothing seems to be *neurologically* wrong with me, and everything that’s been tried in the standard and non-standard treatments of migraines hasn’t worked, my chiropractor thinks there might be something weird going on, hormonally.

  • Ellen Schnakenberg author
    6 years ago

    Emily, yes, it is possible. The most difficult part is often convincing your doctor to give it a 3 month trial to see if it is helpful! Good luck 🙂

  • taralane
    7 years ago

    Thanks for making this so understandable. I have had hypo-thyroid disease since I was 24 (when it was diagnosed), and my migraines started around age 19. I was always tired in my teens, a bit overweight, and just had so little energy. My periods came only 4 times a year, and it was only when someone I knew was trying to have children and was seeing an OBGYN to help her and her husband with this, that I went to this doc, and found out I has hypothyroid disease and was put on a 4 mg/day dose. Over the years this has been reduced to .088mg/day, but I now feel I need to see someone more specific for full testing. The most any of my internist’s have done is a Free T3, T4 and TSH when checking. The other two test are never done.

  • Ellen Schnakenberg author
    7 years ago

    hangingbyathread – it is really important to understand your antibody status. The fact is, there are different causes for hypOthyroid conditions, not all are autoimmune. For example, if your cause is iodine deficiency, simply supplementing the missing iodine will usually fix the problem. The only way to know your antibody status is to test for it. I encourage patients to talk to their doctors about testing for TPOabs and for an antibody called TSI.

  • kjdodson
    7 years ago

    This article really explains a lot of symptoms I’ve been experiencing. I can’t believe my neurologist doesn’t make the same connection with thyroid disorder. It also might explain why I periodically notice “swelling” bumps in my head that nobody has ever figured out. Will be following up with him on this! Thank you!

  • MeghanZ
    8 years ago

    I feel like this is the first post/article or anything I’ve read in years that finally validates my personal claim. And that is “Yes, my migraines began the same time I found out I was hypothyroid.” Yet my neurologist and endo never agreed or really acknowledged this. Reading this makes me feel less crazy! Thank you!

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