This post is complementary to my May 2008 Newsletter Article Thyroid Dysfunction and Migraine

The quest for Migraine triggers is the odyssey Migraineurs find themselves living each day. The fear of the intense pain of another attack has the migraineur second guessing every morsel of food, and every activity in which they participate. Indeed, each thing in their environment becomes suspect. While many migraineurs easily find a correlation with reproductive hormonal fluctuations, many do not, leaving them to assume that the trigger is coming from outside their own bodies.

It’s important that migraineurs understand that the diagnosis of Migraine may not always be a complete diagnosis and that they may have other underlying co-morbidities influencing their attacks-– an Inside Trigger-- that may not yet have been recognized.

Almost any of the hormones our bodies produce can trigger migraine if they are unbalanced or unstable. One of these common, under-diagnosed co-morbidities of migraine is thyroid dysfunction. Physicians acknowledge there is a connection between thyroid and migraine disorders, but like migraine alone, have yet to fully understand it.

Though thyroid dysfunction can have its root in abnormal growths, tumors, or outside influences such as excess fluoridation, the most common cause is autoimmune thyroid disease. An extremely common symptom of thyroid dysfunction is headache, especially migraine, new daily persistent headache and chronic migraine.

In Autoimmune thyroid disease (generally considered a dominant genetic trait similar to Migraine), the immune system has gone awry and developed antibodies to self. It is not ‘normal’ to have antibodies to self, and when this happens the antibodies begin to attack the parts of the body it considers foreign.

The problem is not a sick thyroid, but a sick immune system. Simplified- the antibodies act on the thyroid. They begin either to block the TSH receptors in the gland (TBAb or TSBAb), or stimulate them (TSAb or TSI). Blocked receptors result in a hypO thyroid, and stimulated receptors result in a hypER thyroid. TPOAbs result when there is thyroid tissue destruction.

Many people have antibodies that both block and stimulate, resulting in a rollercoastering effect between the two, and undiagnosed disease. Some antibodies go awry and attack other cells in the body including the skin (pretibial myxedema), the eyes (graves ophthalmopathy) and the brain (Encephalopathy associated to autoimmune thyroid disease .

Thyroid is the hormone responsible for the metabolism of every cell in the body. Too much and it is like driving a car with the accelerator on the floor. Too little and it is like trying to drive a car with the brake pedal to the floor. There are several hormones produced by the thyroid, but it is T4 and T3 that are usually referenced, tested and treated.

T4 is the storage hormone- the grocery warehouse. T3 is the hormone the cells use-- think your dinner table. When the body is working properly, T4 is converted to T3 in the organs as needed in addition to the small amount of T3 produced by the thyroid. If the conversion from T4 to T3 isn’t happening sufficiently (often treated with Selenium 200 mcg’s daily or T3) the brain isn’t getting the gasoline it needs to work.

Thyroid hormones are easily bound to other chemicals or hormones such as estrogen, so the most frequently used tests for the total amount of (Total)T4 or T3 do not give a true picture of what is available to the body. The most accurate test is Free T4 and Free T3, but this is less available than Total testing.

TSH is the hormone the pituitary gland (thermostat) sends to the thyroid to turn it on. A suppressed or elevated TSH can mean a thyroid problem. Antibodies and other outside influences can affect these results however, so TSH testing is not always a reliable indicator of imbalance. It takes several weeks for the TSH levels to stabilize after a T4 or T3 alteration, so a test may indicate only the average of your T4 and T3 fluctuations.

Antibodies may be tested and most conscientious physicians order them in addition to FT4, FT3 and TSH to help determine diagnosis, treatment and to gauge progress and determine remission.

Many symptoms of Thyroid disorder are often nearly identical for hypO and hypER conditions, and in rare cases can include encephalopathy or death. This link (http://graves.medshelf.org/Special:Search?search=graves+encephalopa... ) helps reveal how widespread these symptoms are. One of the key symptoms found in those with thyroid dysfunction is headache and migraine.

Because of a recent change in the accepted ‘normal’ values (2003- see this link on the TSH controvery http://thyroid.about.com/od/gettestedanddiagnosed/a/garbertsh.htm ) of TSH, many people who previously were tested as borderline or negative for thyroid illness may have been missed. Non-thyroid specialists may not be aware of the change, and many labs have not yet made the adjustments to the new values and will not flag low levels.

Fortunately, treatment with either synthetic T4 and/or T3 hormones usually stabilizes hypO patients, and anti-thyroid medication can be used indefinitely for those with hypER thyroid symptoms. Sometimes a combination of the two medicines are used for optimal results. Over or under treatment by any of these medications may result in headache. When synthetics are not working or desired, natural hormones are also available and have an excellent record of consistency and shelf life.

Some doctors prefer to treat based on labs alone, while others treat symptomatically as we know that optimal levels vary considerably from one patient to another. Avoidance of foods and chemicals that influence autoimmunity and thyroid disease (such as goitrogens and excess/deficient iodine) is a key to wellness for many.

As in any chronic disease/disorder, the patient needs to take an active role for optimal results of their treatment. Getting and keeping copies of all labs and test results in a binder for reference can reveal even more to the patient than his/her physician. No one knows you like you, and you may catch trends your doctor may miss.

For those who find that they have thyroid triggered Migraine, treatment offers the potential for relief from their attacks, as well as overall better health. Like Migraine, Thyroid disorders are much more about time and patience than anything else. Perseverance often yields the bounty of relief for Migraineurs and thyroid patients who are stubborn enough to continue with the treasure hunt until the gold is found!