Recently, I analyzed a longstanding problem for a young woman who had been suffering with debilitating migraine pain for almost eighteen years. As with most migraine sufferers, her doctors were of little help finding a solution for her pain beyond prescribing heavy-duty medication that had little or no effect in reducing either the duration or severity of her symptoms. Julie (pseudonym used to preserve privacy) had no recourse beyond retreating to her bedroom every time she experienced a new episode, closing all the blinds and escaping from the world for 3-7 days until the migraine ran its course.
We scheduled a Skype call and spent an hour and a half collecting and analyzing the history of her problem. Our beginning premise was that something was probably triggering these episodes, and that if it was found to be an environmental or lifestyle issue, we should be able to stop the migraines by eliminating the causal link. Various studies have shown that most chronic pain across a broad spectrum of illnesses have an external cause, and as such can be prevented and easily cured by locating and neutralizing the cause rather than just fighting the symptoms. This requires good solid detective work and a careful analysis of the facts—something that is rarely performed in the pressure-cooker modern day managed care office of the traditional physician, who typically takes ten minutes or less to perform a quick examination and prescribe treatment.
The first clue in revealing possible causes for any illness lies in carefully defining both those who have the condition as well as those who do not have the condition. In instances where we can identify more than one person with a similar symptom history who are closely related or who share common traits and activities, these commonalities often provide good clues as to the (common) cause of the condition. In this instance, Julie had a large family, some of whom were similarly afflicted with painful migraines, and others who mysteriously seemed exempt: specifically, her younger brother and one of her three sisters experienced a similar history of migraines.
The other side of the coin can be equally revealing in pointing to possible causes: what related or similar people are not experiencing the problem? In Julie’s case, we had some rich and closely related data: neither her older brother, her other two sisters, nor either of her parents appeared to have suffered with the condition. Although it is always tempting while performing these analyses to immediately begin searching for commonalities and distinctions among and between the affected individuals, there were still two other important problem history aspects to explore before jumping to possible causes. Every problem case is unique, and the smoking gun can be found in any one of the three areas pertaining to Who, Where, or When the problem is experienced—and not experienced.
Defining the full and specific set of symptoms that needs resolution requires much more than a stethoscope to listen for unusual sounds, or palpating a body part to see where it hurts, or performing a scan to look for anatomical irregularities. The most relevant data is usually gleaned by directly leveraging the five senses of the person who is closest to the problem, by simply questioning the patient. I first asked Julie to review a checklist of sensations to have her carefully describe exactly what she felt when she had a migraine. She described a piercing, stabbing, throbbing pain that usually started behind her eyes then radiated to the rest of her brain. She also said she felt pressure around her eyes, disequilibrium (room spinning), and occasional nausea. I then asked her to use her other senses to describe her symptoms: what did she see, hear, smell, or taste that also seemed unusual or uncomfortable at these times? She indicated that she would often experience ‘tunnel vision’ when she felt an episode coming on, accompanied with fuzzy peripheral vision.
The next area to explore that could provide possible clues to the cause was the location where she experienced her problem, both on her body and geographically where she frequented. Julie had already explained as clearly as possible the location on her body where the pain and other sensations were felt: beginning behind her eyes, then radiating to the rest of her brain. I asked Julie where she lived and traveled, both when she experienced migraines and when she did not. She had lived in the Mesa, Arizona area on the south-east side of Phoenix most of life, and this is where she had initially and subsequently experienced frequent and recurring episodes of migraine pain. Oddly however, she indicated that when she lived in Arkansas for six intervening years and also when she occasionally traveled to visit with friends and family outside the Phoenix area, she never experienced migraine pain. This was definitely intriguing and relevant information, but we had one more area to explore before looking for possible causes.
When a health problem has a sudden onset and/or if it varies in severity or frequency over time, these temporal patterns of expression can often be correlated with external events in the environment or with lifestyle habits that can be linked as causal agents. The first important timing question is: when were the symptoms first experienced? Julie remembered clearly when she experienced her first migraine episode: in October 1997, one month after having her first child. Her episodes then continued fairly regularly, if unpredictably, up to the present day—with notable exceptions for those times when she lived or traveled outside the Phoenix area. Each episode would last anywhere from two to seven days uninterrupted, with piercing pain levels reaching 9-10 (excruciating) on the severity scale.
Oftentimes, additional useful and relevant timing information can be discovered by examining a related but slightly different aspect of timing, which is the life history of the patient. In this case, we’re not looking for dates and times when the symptoms are present, rather the events in the life history of the individual. I asked Julie what was happening in her life at the time when she experienced her first migraine, and also what she was doing when she did not experience migraines. She revealed that she had her first child when she was seventeen, and gave the child up for adoption in the first month after birth. Subsequent migraines, although frequent, were worst when she experienced subsequent pregnancies with her second and third child. Interestingly, she never experienced migraines while nursing her second and third child.
The chart below summarizes this problem description information:
I have consistently found that the causes of almost every health problem can be found by examining the differences between the affected people, places, or times when the problem is observed compared to those where it is not observed. However, because every unique case has a unique cause, which of these categories actually reveals the true cause can’t be known until each category is fully explored. The first category to explore related to the individuals both having and not having the illness. In Julie’s case, we had a wealth of rich and relevant data in this category. I asked her what is common about her, her younger brother, and her sister whom all suffered with migraines, that is also different when compared to all her other family members who had never suffered with a migraine? Julie mentioned that the only thing she could think of was that the three afflicted siblings had all lived at one time or another in the Mesa suburb of Phoenix, whereas the other family members either lived on the west side of the city or much further away.
The next distinction category and question was: what was different about the first month after giving birth to her first child? Julie said she was terribly depressed and guilty about having to give her child up for adoption. What else? She was lactating, but obviously not nursing. Among other things, nursing stimulates the production of oxytocin, a known pain modulating hormone, so this was missing during this time in her normal life cycle.
The next IS/IS NOT category and related distinction question was: what was different about the subsequent pregnancies, especially when compared to those times when she nursed her second and third child? Numerous hormonal differences: notably the absence during pregnancy (and presence during nursing) of the hormone oxytocin.
The next category of IS/IS NOT facts prompted the question: what was different about the location behind her eyes, where she normally felt the first pings of migraine pain, which subsequently radiated to the rest of her brain? Julie mentioned that she had been diagnosed while a teenager with a condition called drusen, which is a buildup or deposit of unknown origin on the optic nerve.
Finally, I asked what is different about the location where she lives: Mesa, Arizona—especially compared to the places where her other family members live who are not experiencing migraines? Mesa is on the windward (east) side of Phoenix.
The chart below summarizes this next phase of problem description information.
Armed with this new and highly relevant information, Julie and I were ready to speculate possible causes for her migraines. Since none of her previous doctors and health professionals were able to identify the cause or a permanent cure, we knew we had to think outside the box. I asked her to ‘hallucinate’ everything and anything she could think of, focusing on each of the listed distinctions, that could possibly explain her symptoms.
The first possibility pertained to the unique hormonal changes Julie experienced while pregnant and when nursing. The hormone oxytocin is released during childbirth to produce uterine contractions and also while nursing to promote the flow of milk. Could this be playing a role in the triggering of her migraines? Oxytocin is known to have pain modulating effects, but the presence or deficit of this hormone didn’t explain why Julie also suffered from migraines at times when she was neither pregnant or nursing.
Another possibility related to the drusen condition which showed a buildup of unknown origin on the optic nerves behind Julie’s eyes. This could explain the initial location of the migraine pain that Julie experienced and also her blurred vision, but how did it explain the regular and repeating nature of her migraine symptoms where they would suddenly appear and just as quickly disappear for weeks at a time?
It appeared that stress was likely playing a role at least in the initial expression of her problem, since the symptoms suddenly started around the time of unusual stress and anxiety associated with the adoption of Julie’s first child. The mechanism triggering the reaction could have been via her depressed immune system, which previously may have been fully capable of identifying and neutralizing any toxins that could otherwise trigger a migraine. Stress and depression are known factors compromising immune systems, but how did this explain that Julie is still suffering migraines so frequently, even though she no longer suffers chronic anxiety or depression? It also didn’t explain why she never experienced migraines during her extended residency in Arkansas.
This left the one remaining possible cause pertaining to the common problem of high air pollution in the Phoenix area. This hypothesis fit most of the facts very well, with only a few assumptions necessary: It explained why Julie, her sister, and younger brother got migraines (all lived in Mesa area) and why other family members did not (they lived on west side of Phoenix or further away). The pain Julie felt behind her eyes and the associated impairment of vision could have been from irritation due to the residue buildup on her optic nerve(s). The initial timing of migraines in October 1997 was likely due to impairment of Julie’s immune system from heightened stress, which reduced the ability of her body to identify and neutralize the environmental toxins entering her sinuses. The presence of oxytocin while nursing was likely masking or neutralizing any pain signals from the environment during those periods. Lastly, the Mesa area was likely collecting and concentrating more pollution (i.e. from the prevailing westerly winds) than other parts of Phoenix basin where the rest of her family lived.
The chart below summarizes this final phase of problem description information.
Julie and I were now 95% sure we had identified the clear and direct cause of her migraines, but there were a few simple things she could do to be 100% certain. First, her brother and sister who also suffered with migraines had recently moved away from the Phoenix area. It only took two quick calls to confirm that neither of them had experienced a migraine since moving away. Julie also started to keep a symptom log, where she could track and confirm the timing of subsequent migraine episodes with changes in barometric pressure (low air pressure usually concentrates pollution over the city) and smog levels in her surrounding region.
It appeared that a permanent cure would necessitate moving away from the high concentration of industrial pollution in the Phoenix area. As it turned out, Julie was already considering a job-related move to the North Carolina region, where she would be far from any industrial polluting source, so this recent turn of events would be serendipitous in providing a permanent cure for her long-suffering migraine problem.
The next time you or a loved one suffers with a debilitating migraine, don’t just lie down and accept that it has to be a permanent disability that you have to live with indefinitely. Like Julie, you or they may also be unknowingly exposed to some kind of external signal which is triggering this response. Be a good detective and examine the facts to see if you can uncover the unique distinctions and changes occurring in your environment which is leading your body to react in an uncomfortable way. Remember, most health anomalies are not caused by an internal genetic irregularity, rather by an external environmental irregularity. You can’t change your genes, but you can change your environment. Pain medication only temporarily treats the symptoms—to find a permanent and drug-free cure for your problem you’ve got to find and eliminate the underlying cause of your problem.
If you have a similar experience or a related problem that you think can benefit our readers, please share your insights and comments in the comment thread below. Digital and printable versions of the worksheet template used in this analysis are available for free download at pinpointdiagnostics.net. More examples where similar health problems have been solved using this same analytic process can be found in the blog post archives in the sidebar to the right of this article, and in my book Be Your Own Health Detective, a free sample of which can be found by clicking on the Amazon widget at the top of the right sidebar. Live long and live naturally!