Migraine Triggers and Comorbidities: Autoimmune Disease

It’s been estimated that the second leading cause of illness in the United States is autoimmune disease. As a result, autoimmune disease may be expected to be found in a large number of Migraine patients, and it is. Although a comorbid condition is a disease or disorder that is present at the same time as, but doesn’t cause the other disease, they can certainly have profound — and sometimes unique - effects on each other.

What is Autoimmune Disease?

• Auto = self
• Disease = deviation from the normal structure or function, recognized by specific set of symptoms and signs

Autoimmune disease can be described basically in a simplified analogy:

Your immune system is the army that protects their country/your body from foreign terrorists or invaders such as viruses, bacteria etc we call pathogens which seek to do you harm and make you sick. They also protect our bodies from home grown terrorists like cancer.

As in any army, there are generals and soldiers. The generals (specialized educated cells) tell the army what to do, and the soldiers (antibodies) do as they’re instructed. Their job: to eliminate foreign invaders and terrorists and to help the body heal itself. Its goal: a healthy body.

The pathogens or terrorists start out as the predators in this story. Your body suffers as the prey. However, that quickly changes when the generals are notified of the invader, your immune system kicks in and it becomes the predator seeking out the bad guys. The pathogens and terrorists are the prey!

There are three basic parts of the immune system:

• The immunity you were born with is called your Innate Immune System
• The immunity you acquired is called your Adaptive Immunity
• The immunity you *borrowed* from something else is called Passive Immunity

In autoimmunity, the generals that are supposed to direct the soldiers either fail their job, or get confused. The soldiers run amok and, although they know they are supposed to be fighting something, they aren’t sure what it is. Without appropriate instruction, they sometimes begin to identify the body’s own cells as bad guys and begin to try to destroy them.

In war this is known as friendly fire.

There is an organ in the top of your chest that was very large when you were born. It is called the thymus, and its job is to teach your immune system how to fight the bad guys/pathogens. As we age, the thymus shrinks significantly. As the teacher shrinks, our bodies are more likely to begin to get confused and mistakenly identify our own tissue as a foreign invader that needs to be killed. This is called the aging paradox and is thought to be one of the reasons that autoimmunity becomes more common as we age.

Autoimmunity simplified, is a condition in which the body’s immune system begins to attack the body’s own cells and organs, damaging or even killing the cells, organs and potentially, the patient.

Diagnosing autoimmunity

It can be extremely difficult to diagnose an autoimmune problem. While some patients exhibit symptoms and lab work as bold as a neon sign, others do not. Their autoimmunity is hiding, often disguising itself as other diseases or disorders.

In addition to regular blood work, autoimmune screening tests usually include an ANA (antinuclear antibody test), tests that check for markers of inflammation such as ESR (erythrocyte sedimentation) rate aka SED rate, and CRP (C-reactive protein). When an ANA is elevated, an ANA Profile is often then ordered to determine if the patient has one or more of the more common autoimmune antibodies. Sometimes a test called a complement test is also helpful. Other tests which allow the doctor to get a better feel for the entire picture will often follow too. Patients should be aware that some tests will be performed to rule out more serious conditions, not because the physician is looking for a dire disease.

Exacerbating the problem of diagnosis, autoimmunity can often *come and go*in periods of increased disease activity called flares. Like Migraine, autoimmune disease flares can be triggered by physiologic stressors including disease or illness, infection, emotional stress, pain and injury. Depending somewhat on the specific disease and antibodies present, anything that can cause inflammation in the body can trigger an autoimmune flare which can then trigger Migraine. This includes diet, travel, UV exposure (sunlight, fluorescent lighting, air travel), vaccination and some medications.

Diagnosis is based on a combination of the patient’s symptoms and physician testing results which must be interpreted by a doctor who understands the subtleties of autoimmunity. While autoimmunity can be genetic and great leaps have occurred in our knowledge of specific autoimmune related genes and antibodies in the recent past, some patients are sero-negative (antibodies are not found in blood work). It is unknown why some patients exhibit these diseases. It is thought to be initially triggered by such things as viral infection and environmental or other toxins.

Sero-negative patients often search for years before finding a correct diagnosis, an unfortunate result of the wide misunderstanding of autoimmunity.

Autoimmune Diseases

Autoimmunity may sometimes be thought of as a disease category. There are many autoimmune diseases. In all cases the root of the problem is with the immune system, but because different antibodies are formed in each disease, we have given them names that more accurately describe the patient’s symptoms or the physicians who discovered them. Autoimmune patients frequently find that they eventually suffer from multiple autoimmune diseases. A complete list may be found here on the American Autoimmune and Related Diseases Foundation, but common examples are:

• Multiple Sclerosis
• Systemic Lupus Erythematosus (SLE) aka Lupus
• Sjogren’s Syndrome
• Rheumatoid Arthritis
• Grave’s Disease
• Hashimoto’s Disease
• Ankylosing Spondylitis
• Giant Cell Arteritis
• Meniere’s Disease
• Psoriasis
• Vitiligo
• Diabetes type 1
• ALS (Lou Gehrig’s Disease)
• Celiac Disease
• Crohn’s Disease
• Endometriosis
• Addison’s Disease

As yet, there is *no such thing* as an autoimmune specialist. The specialist who helps autoimmune patients is usually a rheumatologist, although most autoimmune patients find the need for multiple specialists to manage their disease throughout their lives. One specialist frequently called on by the autoimmune patient as well as Migraineurs, is a neurologist.

Like Migraine, there is no cure for autoimmune disease. Yet.

Autoimmune Disease Treatment

There are two theories why autoimmunity happens and how it should be treated. Although some genetic markers have been found to be associated with specific diseases, most physicians feel that the reason for autoimmunity is an overactive immune system. Depending on the exact disease, these physicians choose to treat most of their patients with drugs that includes anti-inflammatory medicines like NSAIDs and steroids, anti-malarials like Plaquenil, Biologic medications (genetically engineered compounds designed to interfere with cell action) and Disease Modifying Anti-Rheumatic Drugs (DMARDs). These DMARDs include potent chemotherapy medications used in cancer patients, and anti-rejection drugs designed to lower the body’s errant immune response. This often leaves the patient open to other opportunistic infections as well as cancers. Unlike cancer patients who may someday eliminate their disease, most autoimmune patients must remain on DMARDs and other drugs for the duration of their lives. Remission is possible, but uncommon.

Other physicians have recently put forth the controversial theory that it is an underactive immune system which causes the autoimmunity, because there aren’t enough “generals” to instruct the army. These physicians are trying to treat specific autoimmune diseases by modulating/re-balancing the immune system, hoping to increase the number of generals who will then be more able to instruct the soldiers how to appropriately act.

Fortunately for autoimmune patients, both methodologies often are helpful to patients, but close monitoring and management of these drugs are necessary.

Antibodies, Medications and Migraine

While autoimmunity and Migraine are both primary disorders (not caused by anything else), patients who suffer from both conditions often find themselves in a difficult place trying to manage them simultaneously, feeling much like the conductor of an orchestra playing a song they’ve never heard before. Doctors too often feel this way too, because each specialty is struggling to treat what they know as well as understand aspects of the disease with which they are unfamiliar.

Migraine often adversely affects autoimmune disease, and autoimmunity often adversely affects Migraine. Both frequently exacerbate each other. The interaction between autoimmunity and Migraine has been so long standing and strong, that some autoimmune diseases include Migraine and Headache as symptoms, causing much controversy within both rheumatology as well as headache medicine specialists.

For more information on the implications and comorbidities of autoimmunity in Migraineurs, please see these posts:

• Medication Triggers in Autoimmune Migraineurs
• Migraine Triggers and Co-morbidities — Thyroid Disease