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Posted on 03-28-2012

Morning everyone.  An important condition affecting millions of people is MIGRAINE. I've had several patients through the years who have suffered for up to 90% of the week in dark rooms laying in bed.  I even have a couple of patients under 20 years of age who are on social security disability due to the affects of these horrible headaches.  For the record classic migraine and cervicogenic headache are very similar in presentation and intensity.  Migraine however has the classic flashing aura or lights visualized around the periphery.  It is important to note that a really bad headache is NOT necessarily a migraine.  Cervicogenic headache is readily helped with Chiropractic care.  This article from the journal 'Cephalgia' reviews the "G" in "MSG."  That being glutamate and how it can be a potent trigger of migraine.


Both preclinical and clinical data link glutamate to the migraine pathophysiology [or mechanism].

Altered plasma, platelets and cerebrospinal (CSF) glutamate levels have been reported in migraine patients. [CSF is the fluid that bathes the brain and spinal cord]

It has been recently shown that chronic migraine has comorbidity with fibromyalgia.

The objective of this study was to study cerebrospinal fluid glutamate levels in chronic migraine patients with and without fibromyalgia. We studied 20 chronic migraine patients, with and without fibromyalgia, compared to age-sex matched controls.

CSF glutamate levels were measured.

CSF glutamate demonstrated significantly higher levels in patients with fibromyalgia compared to those without fibromyalgia.

Patients overall had higher CSF glutamate levels than controls.
Mean pain score correlated with glutamate levels in chronic migraine patients.

Tender points, the hallmark of fibromyalgia, can be considered as pressure allodynia, and is probably mediated by central sensitization, with increase in CSF glutamate levels.

We postulate chronic migraine patients with fibromyalgia, in addition to have more disabling headaches, suffer from a more severe central sensitization process.

Headache intensity correlate with glutamate levels in chronic migraine patients.


"Glutamate is a major excitatory neurotransmitter in the central nervous system, widely involved in migraine mechanisms."

"Glutamate is implicated in cortical spreading depression, trigeminovascular activation, and central sensitization."

Glutamate is linked to the pathophysiology of migraine.

23% of the general population has chronic migraine (CM).

CM is one of the most debilitating and difficult to treat headaches.

CM is comorbid with fibromyalgia in many patients, and these patients have more debilitating headaches.

Migraine patients and patients with chronic daily headaches have higher CSF and plasma glutamate in levels.

Central sensitization is implicated in both chronic migraine pathophysiology and in fibromyalgia.

In this study CSF glutamate levels were measured following a lumbar puncture.

CSF glutamate levels were significantly higher in CM than controls

Mean pain score correlated with CSF glutamate levels.

"CM patients with fibromyalgia had significantly higher CSF glutamate levels than patients without fibromyalgia."


"Our study shows increased glutamate levels in the CSF of chronic migraine patients compared to controls."

"More important is the new finding of even higher levels of glutamate in chronic migraine patients with fibromyalgia compared to those without fibromyalgia."

Migraine headache sufferers have substantially higher plasma glutamate and aspartate levels than do control patients.
[Ferrari MD, Odink J, Bos KD, Malessy MJ, Bruyn GW. Neuroexcitatory plasma amino acids are elevated in migraine. Neurology 1990; 40: 15826].

"During migraine attacks, glutamate (and to a lesser extent aspartate) levels were even further increased."

There is also a significant increase in CSF glutamate levels in chronic daily headache patients compared to controls.

"Head pain in migraine arises within the trigeminal system."

[areas Chiropractic adjustments have a profound influence on]

"Central trigeminal neurons that receive convergent input from external stimuli [like input from the neck joints] may be sensitized."

"Central sensitization may account for the severe pain of migraine headache, in this study we showed pain intensity correlated with CSF glutamate levels, providing evidence that glutamate levels, central sensitization and pain intensity are linked."

These authors suggest that acute migraine drugs increase CSF glutamate levels, increasing chances of chronic migraine suffering. [WOW!]

It is "hypothesized that migraine is associated with a state of central neuronal hyperexcitability, involving overactivity of the excitatory amino acids, glutamate, and possibly aspartate."

This theory may also be applied in the comorbidity between migraine and fibromyalgia.

[Magnesium blocks the glutamate receptor, reducing the excitotoxicity of glutamate]. [This is an important management tip].

"A low brain magnesium and consequent reduced gating of glutamatergic receptors could be another possible link between migraine, fibromyalgia and the mechanisms of glutamate hyperactivity, neuronal hyperexcitability, and susceptibility to glutamate-dependent spreading depression."

"Sensitization of both peripheral and central trigeminovascular neurons accounts for the intracranial hypersensitivity observed in migraineurs, i.e. the worsening pain during coughing, bending over, rapid head movement, and the throbbing nature of migraine pain."

There is a hyperexcitability in the central trigeminal pathway after in migraine.

Fibromyalgia allodynia also has an increase in CSF glutamate levels.

Migraine patients with fibromyalgia have more disabling headaches and suffer from a more severe central sensitization process.

These patients need more aggressive therapy.


Glutamate (an amino acid) is the brain's primary excitatory neurotransmitter. However, excess glutamate kills brain neurons and is therefore called an "excitotoxin." Too much glutamate literally excites brain neurons to death. Glutamate is commonly added to foods because it makes them "exciting" or taste better. Most of us know glutamate by its salt form monosodium glutamate or MSG. There are dozens of names for glutamate as it is added to foods. A partial list of names seen on food

packaging are listed below, from the website

Have a blessed day guys!


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