My Biggest Frustration with Migraines

chronic migraines as a progressive brain disorder

Chronic migraines as a progressive brain disorder

I have dedicated a significant amount of time to migraines.  From treatment in my office to hundreds of review articles of medical studies to publishing a book on Migraines And Epilepsy, I consider myself quite educated on the topic.

While there have been a few exceptions in my office (literally less than a handful over the past 18+ years), if patients are willing to make the changes I recommend, they get better.  My recommendations range from a course of treatment in the office to exercise to managing stress to major lifestyle overhauls.  If patients are willing to make these changes, I can almost guarantee that migraines will be history.

Why?  How can patients get better with my recommendations versus the neurologist that they’ve been seeing for years and practice out of a very well-known hospital system?

Because the “why” is far more important to me than suppressing the symptoms of a migraine.  It is VERY rare that I have a chronic migraine patients come into my office that has been educated on the underlying cause of his or her migraine headaches.

But before I get into the secret of migraine headaches I need to make a very important distinction.

By the time patients make it into my office they have accumulated multiple types of headaches.  The two biggest classifications are structural and migrainous.  And I can say, with a high degree of confidence, that every migraine patient has aspects of both.

The structural headaches are related to the soft tissues (ligaments, tendons, muscles and fascia) and joints.  While my opinion is strongly biased, these types of headaches HAVE to be addressed by a chiropractor that understands and treats the soft tissues.  Adjusting alone, exercises alone, Botox alone (and yes-if someone responds to Botox it is because they have been improperly diagnosed with migraines instead of a structural headache) or soft tissue work alone is not going to completely fix the problem.

But, as I mentioned, it’s my bias based on almost 20 years of treatment migraine patients who have not responded elsewhere.

The true migraine headaches, however, do not respond well to good structural care.  This is because the true cause is not one that can be addressed from outside the body.

If you experience chronic migraine headaches and you really, really want to get rid of your headaches, you’re going to have to address the health of your blood vessels.


Anything less will not guarantee a fix for your headaches.  And medications?  Not a damn one of them will fix your blood vessels.  Some will actually make it worse.  And even if medications control your headaches, they have not fixed the problem.

Poor blood vessel health, endothelial dysfunction, vascular dysfunction.  It goes by different names depending upon who you are speaking to, but they all mean the same thing.

The blood vessels of a true migraine patient have lost the ability to respond appropriate to changes in demand for blood supply.  This system—where the blood vessels open and constrict based on how much oxygen the tissues need—is an incredibly dynamic process, with changes occurring by the second.  If your blood vessel is no longer able to respond to needs of your brain cells your brain cells are not going to be happy with you and can trigger a migraine.

THIS is the key to understanding your migraines.  THIS is the key to lifestyle changes that will help your chronic migraine headaches.

I have certainly spent time on migraine message boards and there are a lot of headache patients who get pissed off at my suggestion that headaches can be fixed.  These patients, however, have not achieved ideal body weight.  They are stressing too much.  They are not eating the right foods (even if he or she thinks his or her diet is ideal).  They are not exercising.  They are smokers.

I would suggest that, as much as it may be offensive to some, patients with true migraine headaches have not made the correct choices for his or her blood vessels and brain.

The details of these changes are beyond the scope of this article, but are outlined very readily in my book Migraines and Epilepsy that can be purchased by clicking here.

While many migraine sufferers care about getting rid of or controlling headaches, there is a bigger problem looming.  Poor blood vessel health has everything to do with risk of heart attack or stroke in the future.  This is absolutely, unquestionable solidly demonstrated in medical research study after research study.

Most of these research studies, however, have focused on migraine with aura.  Most of the studies that have linked future risk of heart disease or stroke have been on migraine with aura.  This particular study is yet another one in the long list of studies linking heart disease risk and migraines, except this one covered ALL migraines, not just those with aura.  Here’s the details on this large study of 17,531 women with migraines who were followed up for 20 years:

  • Migraine was associated with a 50% higher risk for major cardiovascular disease.
  • They had a 39% higher risk of a heart attack.
  • There was a 62% higher risk of having suffered a stroke.’
  • Sufferers had a 74% higher risk of having chest pain or having had a coronary angiogram.
  • Furthermore, migraines were linked to a 37% higher risk of dying from heart disease.

The relationship is so strong that, in a linked editorial, the suggestion is that migraine should be viewed as a risk factor for heart disease just like high blood pressure and cholesterol.  This is a strong statement and one that is not entertained by the average treating neurologist or primary care doctor.

It also reinforces my concern that the vast majority of true migraine patients are not getting the education needed to understand and improve the condition.  Chronic migraine sufferers HAVE to address the underlying dysfunction of the blood vessels through lifestyle changes geared towards protecting the heart.  This include diet, stress management, exercise and focus on reducing exposure to environmental chemicals that damage the heart and blood vessels.

Anything less is only a band-aid.

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.