Post COVID Migraine in a Six Day Cycle

After COVID infections and three vaccinations (AZx2 + Modx1), I now have a cycle of inflammation causing migraines which lasts six days. The inflammatory episode lasts three days so that means three days on and three days off. With ME CFIDS related PEM (post exertion malaise) all the time. 

Previously my ME CFIDS involved a recurring virus cycle which started at about 30 days long in 1986 and either caused or was a result of whatever was causing ME CFS. 

Subsequently I caught other viruses and some appeared to become recurrent e.g. recurring swine flu after 2009 whenever my head got cold. In about 2017 I caught something I cant identify but may be an enterovirus like echovirus as it caused rib cramps (Bornholm symptoms) and headaches recurring every two weeks odd. 

Every time I caught a new recurring virus the cycle got shorter. My best guess is its like a ratchet because whichever virus is quickest to recur triggers my immune response first. The others are held at bay by the immune response to the quickest repeater, but some are still there and show themselves from time to time.

The new six day cycle has been accompanied by a new degree of intolerance for some foods, especially maize, in addition to all my other intolerances, which make the headaches much worse. This started to be a problem around the swine flu epidemic in 2009. I found eating tortilla chips, which I used to love, gave me an intolerable headache.

This new phase of 6 day cycle began after a dose of suspected COVID-19 and caught me off guard. At first the migraine was very intense and I honestly feared for my health and wellbeing. 

I noticed it varied in intensity and tried to work out why. After much observing, thinking and experimenting on myself, I have found several factors which all reduce the severity a little. Primarily, during an inflammatory episode my migraine is much worse if I eat any protein, animal or vegetable and also any food high in manganese or vitamin K. 

I can now usually survive the entire cycle with minimum migraine pain as long as I stick to what helps. I score my headaches 1-10 and the worst I got to was 8, which I felt was approaching life threatening due to the sensation of compression inside my head and the fear of aneurism. 10 I think would be very dangerous, probably coma. Right now I can usually manage to keep it below 1, with the worst being 2. This is a big improvement and relief for me so I wanted to share.

Details below, in the hope it might help others in a similar situation and save them some pain.

During the three day migraine phase ...

• I need a low protein diet excluding both animal and plant protein. i.e. no meat, no eggs, no rice, no lentils or other legumes as these all have more than 5g protein per 100g. I live on assorted vegetables, spices, oils and fats and (not too much) white cassava gari. - I use eatthismuch.com for looking up food data. https://www.eatthismuch.com/food/browse/?q=&type=food
• I have to avoid foods or supplements rich in vitamin K or manganese (Mn) or the pain increases significantly. (Implicated in blood clotting.)
• Taking moderate amounts of magnesium (Mg) supplements helps to reduce head pain as well as heart arrhythmia.
• Head pain is also reduced by taking linseed oil for omega 3 lipids, vitamin D and turmeric extract (Solgar), which are commonly recommended as anti-inflammatory supplements and turmeric is a blood thinner.
• I have to restrict sugars or the pain can get worse, sugars are considered proinflammatory.
• I need to relax and avoid using my brain too much or it starts to hurt. I drink hop tea herb tea to help as it is mildly tranquilising. I usually add marigold and bucchu to this, sometimes lavender. (UPDATE I have to be careful with any green plants like hops as they tend to have VitK which can exacerbate migraine, possibly via microclotting.) 
• I often feel sleepy in the inflammatory phase and do better if I sleep when I feel the need. It feels like there is inflammation in my brain affecting my cognition and in my experience it is best not to fight it. Best to sleep, somewhere warm and let one's body heal.
• Heat treatment for the neck and back can promote vasodilation which helps reduce head pain. Likewise hot showers or short hot baths.
• I have to avoid getting exhausted by activity and my ability is even less than usual. Otherwise I get post exertion malaise (PEM) which makes the migraine worse.
• It helps to drink plenty of fluid.
• Sometimes the inflammatory phase is accompanied by a symptom which causes my mind to race, involuntarily and to an excessive degree, which feels like a vicious spiral, as though my brain is on fire. This is exacerbated by too much onion (quercetin). At these times, when hop tea does not work but Mg usually helps a little, I have also found a wee medicinal dram of alcohol and I mean wee, about a quarter measure, damps this down, which I ascribe to the way alcohol acts as a depressant of brain activity, hence its effect when taken in larger quantities. In this situation the benefits significantly outweigh the mild proinflammatory drawbacks. 

Outside a migraine phase...

I cannot tolerate any maize corn as this always causes a migraine.

It looks like I cannot tolerate eating any meat from an animal which has been fed maize either. I have tested this and now order regeneratively farmed meat, like 100% pasture fed beef and lamb which I can eat outside a migraine phase without ill effect. If I buy meat from a supermarket from animals which have been fed standard animal feeds containing maize then it sets off a food intolerance headache lasting 12-18 hours which occurs even when not in a migraine phase and can significantly exacerbate a migraine phase.

I am not eating any nuts now. Anything with hazelnuts in causes headache and other nuts like walnuts or pecans seem to cause itching skin around my fingers.

When eating high protein food like meat, at any time, it is helpful to take digestive enzymes including proteases and also DAO (diamine-oxidase) which reduces histamine absorbtion by oxidising it in the digestive system. These reduce the likelihood and severity of any headaches arising from eating protein.

It helps to take B vits complex, B12, also minerals excluding manganese. Also I have beetroot juice in my omega 3 heavy salad dressing every morning (helps vasodilation).

I still have to avoid even very light exertion causing PEM.

My other preexisting dietary constraints.

I am avoiding wheat gluten all the time based on doctors advice. It does seem to exacerbate headachey patches.

I do not eat any dairy, palm oil or coconut oil as they contain high levels of MCTs (medium chain triglycerides) which are proinflammatory as I addressed in a previous blog.

I do not eat any nightshade vegetables as they cause me mouth ulcers along with inflammation of the skin inside my mouth causing me to bite my cheeks (I get the ulcers even if I don't bite myself accidentally) and it also causes a body wide malaise of ache and weakness. This means no potato, tomato, aubergine (egg plant), chili peppers (paprika), sweet peppers, blueberries. I dont know if that is just me but its what I need to do to avoid getting iller.

Good news is... 

By avoiding these common but problematic foods and taking anti-inflammatory supplements, I can turn three days of excruciating headache into three days of being an airhead, which believe me is much better. 

Discussion.

To recap: I get headaches if I eat the wrong foods (anything with maize in or which has been fed maize, any supplement with manganese in). I also get headaches in a regular cycle and these are exacerbated by high protein foods and anything with high levels of vitamin K or manganese in.

Outside the migraine phase of the inflammatory cycle I can eat limited portions of protein without getting headaches and low levels of vitamin K and manganese containing foods, (not supplements though) without getting headaches. 

My method for reaching this conclusion was based on applying scientific logic to personal experience. 

Observations of my condition were recorded in my diary, alongside foods I eat. I tried to make sense of these to see if there was anything I could do to reduce my pain, by painstakingly tabulating them in spreadsheets.

I ran experiments to test foods which seemed to cause problems at one time to see if they caused a problem at different times.

It was confusing at first because there were too many things going on at the same time. I could not tell the inflammatory cycle headaches from the food triggered headaches and just seemed to be getting headaches all the time whatever I did but with inconsistent triggers.

I learned to avoid a lot of foods and ended up only able to tolerate stewed beef short ribs from among supermarket meats and good quality eggs as long as I only ate one per serving and only one serving of protein per day. One serving of short rib stew for example contained half a short rib worth of beef at around the 100g mark and I could not have more protein like an egg on the same day without getting a headache.

I also realised that whatever I ate or didn't eat, there was also an underlying cycle of inflammatory episodes, three days on and three days off and that during the migraine phase, foods which would not normally cause a headache could cause one or compound a migraine making it more severe. 

That meant any protein at all was out in the inflammatory phase, even from vegetable sources like rice or lentils. Though I could eat these and either short rib stew or an egg (but not both) on the other three days in the less inflammatory phase.

I also noticed that supplements containing manganese caused headaches and so did very green vegetables, both of which I thought would be healthy for me but were making my headaches worse.

Deductions.

The key observation though, was realising that if I took a hot shower it helped relieve my migraine.

It took a while to twig but the implication was that vasodilation was helping to reduce the head pain, as heat causes vasodilation, i.e. the blood vessels relax and get wider.

I tried it out several times and it usually worked unless I had one of those headaches brought on by onions where my mind was racing and which responded  well to medicinal alcohol. 

I then began to experiment with supplements which could assist vasodilation including magnesium, which also helped. I also noticed that taking calcium supplements sometimes triggered a migraine. 

Calcium (Ca) is an antagonist for magnesium (Mg), to be clear we need them both but they need to be balanced. My deduction was that too much calcium was lowering magnesium and impairing vasodilation and possibly encouraging vasoconstriction during headaches. 

My conclusion was I needed more magnesium in headachey patches, which did help a little. The problem then was that sometimes I would get muscle cramps from taking too much Mg all the time and it occurred to me the inflammatory cycle seemed to cause Ca/Mg balance to change quite dramatically at one point  in the cycle (which coincided with the onset of the headache) and then change back. So I had to dose the Mg to coincide with the point where my body was acting as if it had just had a dose of Ca, then ease off the Mg dose, which worked. 

Other vasodilation promoters include Coenzyme Q10 and B12 which is also anti-inflammatory. I also find Kirkman B complex and zinc (Zn) supportive. 

(UPDATE 9/8/23 the above struck through are not always helpful actually, depending on timing and I think it is because CoQ10 has a structure similar to VitK which promotes microthrombosis, while B12 interacts in complex ways with the nitric oxide based control of vasodilation/constriction and may not be particularly influential on its own, while Zn is implicated in clotting and may not always be helpful. B vits complex I still consider moderately supportive though containing B12 as these include niacin aka vitamin B3 which is known to cause vasodilation.) 

Manganese and VitK cause headaches or make them worse and since they are known to be implicated in blood clotting it seems possible that my headaches result from vasoconstriction exacerbated with a tendency to blood thickening or even microthrombotic tendency, as these have been recorded in conjunction with longCOVID. 

Its possible my 6 day cycle is caused by recurring COVID just like the other recurring viruses I have. I had an aching right kidney after initial infection which lasted over two years and may have been acting as a refugium for the virus and may still be though the ache is less obvious now, as it is a site for the expression of ACE2 receptor, as is the endothelium of blood vessels and many other locations in the body.

The fact that reducing protein intake reduces the severity of headaches is consistent with this scenario as protein is the type of molecule involved in blood clotting mechanisms (fibrin) and when being digested can contribute to the levels of proteins and amino acids in the blood plasma adding to viscosity and perhaps reacting to increase the size and or frequency of microclots and protein agglomerations.

ME patients have long been known for having slower ESR (erythrocyte sedimentation rates) than normal and lower blood volumes.

It stands to reason that thicker blood in thinner, possibly vasoconstricted and possibly inflamed, blood vessels will not flow as well.

So IMHO that is the long and the short of it and the key facts I managed to untangle to save myself from the worst effects of an ongoing migraine cycle.

This is a WIP (work in progress) which I am publishing while working on it to get the facts out for others to read. Will try to polish it up and add links etc later. 

Hope it helps.

UPDATE 9/8/23 I have seen a pattern in the 3 day migraine which can be described as M shaped, appropriately enough, the migraine pain is worst (peaks) on the first and third day and is almost not detectable on the second day as long as I dont eat any protein. 

UPDATE DISCUSSION 9/8/23 Regarding protein, it strikes me as a possible hypothesis that the symptoms of headache due to vasoconstriction might be explained by the periodic blocking of ACE2 receptors by SARS-2-COV spike protein, leading to vasoconstriction due to the inhibition of angiotensin conversion to the vasodilatory form. 

The M shaped curve of migraine intensity might be a result of my immune system interacting with the spike protein itself and whatever is producing spike protein. There are more than one candidates for this but first among them must be the virus variants themselves and given my experience with other recurring viruses this is likely. 

Given my predisposition for one day migraines before COVID and after a recurring infection resembling enterovirus since 2015-7, it may be that the post COVID M shaped curve is composed of two types of migraine with different but interrelated causes. These one day migraines used to occur predictably after any recurring infection bout as my immune system was clearing up the aftermath, the timing of which was most evident with bouts of HSV2 as the symptoms are so marked. 

So it seems possible that the second phase or hump of the M shaped 3 day migraine is immunological mop up inflammation migraine, following on from a viral infection recurrence which causes the first hump of migraine directly by releasing spike protein which blocks ACE2 and vasodilation causing vasoconstriction headaches. 

That is my current working hypothesis for management, it follows that each phase of the migraine needs appropriate treatments. The first phase needs vasodilation therapy like heat treatment and possibly B3 (niacin) though this is not good for your liver in large amounts. The second phase needs anti-inflammatory treatments like Vitamin D, Turmeric and Linseed oil for Omega 3 lipids. This approach seems to help.

Will update again if there are further changes to my condition or perspective.

Coconut - the downside for ME CFIDS patients - possible TH2 shifting.

Further to my previous on problems with food. I have recently chanced upon a research paper which describes a phenomenon which may explain the symptoms I have been getting.

The experiment involved mice being fed coconut oil, which made a significant percentage of them vulnerable to TH2 shift and inflammatory reactions including anaphylaxis.

Dietary medium-chain triglycerides promote oral allergic sensitization and orally induced anaphylaxis to peanut protein in mice.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563838/?report=classic
J. Li et al.

CONCLUSION

Dietary MCT promote allergic sensitization and anaphylaxis by affecting antigen absorption and availability and by stimulating Th2 responses.

MCT stands for medium chain triglycerides. In this case derived from coconut oil, which is considered a health food and often recommended for ketogenic dieting. The evidence applies only to mice but...

Over the last 5 years I have been suffering from summer headcolds which included severe oedemas in the upper respiratory tract. These may be an exacerbation of a previous tendency to TH2 shift in the summer since ME onset in 1986. The difference between these limited inflammations and the whole body response of anaphylaxis is that these oedemas were localised to tissues where an immune response was ongoing. If a virus is involved it remains unidentified but this condition was accompanied by intercostal cramps and tendency to hives, possibly headaches too and these lesser symptoms are apparently recurrent for me, fit the diagnosis of enterovirus, possibly echovirus which may be recurring like another repeatedly diagnosed virus does for me (HSV2 diagnosed by PCR still recurs 6 to 12 times a year, 32 years after infection, which triggered ME in the context of previous diagnosed EBV). This may be a result of the D in CFIDS (chronic fatigue immune dysfunction syndrome) which causes atypical things to happen with my immune system.

The colds with oedema typically produced pronounced nasal polyps and completely blocked my right ear once as well. The oedemas involved in these headcolds were greatly exacerbated by eating honey and lime and also coconut oil which I construed indicated salicylates, as I mentioned in my previous blog.

Honey and lime drink, which I unthinkingly took for a cold remedy, contains a lot of salicylates from honey but also lime has caused me problems with photsensitivity since and I cant rule that out as a factor and lime and all citrus have been added to my foods-to-avoid list. Honey is also reputed to contain pollen including grass pollen to which I am allergic as proven by a skin test.

Coconut oil, which I was eating regularly over the years this happened, contains salicylates but also MCTs, so this makes it difficult to be sure what has happened, as the MCTs may have exacerbated the oedema by another route as per the paper above, which I may have confused with the effect of salicylates.

I felt the salicylate sensitivity was further corroborated by the fact that I did end up having to avoid green vegetables during oedemas and also afterwards a string of headaches appeared to be triggered by green veg. All low salicylate foods seemed to be more tolerable for me. But green veg may contain potential allergens in the form of lectins which is something I am trying to understand and the headaches were often accompanied by mild asthma which suggests an inflammatory basis but by what route the inflammation occurs I cannot be sure.

So to be honest I would not call this a conclusive level of proof for the salicylate theory. An alternative hypothesis is that I was allergic to the honey and the green veg due to increased absorption of allergens induced by MCTs. However this is why testing food intolerance needs to be based on results and not solely on theory and I continue to test the bounds of my diet to check I am not being neurotic without good reason or making my life harder than it needs to be through lack of awareness.

If a thing makes me ill I need to avoid it, I just need to understand what it is so I can apply the knowledge effectively. There are some things I wont test any more like nightshades and coconut, because the evidence is sufficient for me, the years I ate coconut I got oedema and since I stopped eating coconut the oedemas stopped. Salicylates/lectins sensitivity I will continue to test, albeit very carefully, because it is variable and not as severe if I am not eating coconut.

A reaction to allergens does not rule out exacerbation by salicylates either, which are known to promote oedemas in some people. This is probably not an allergic reaction in itself IMHO, possibly a result of the way salicylates can interfere with prostaglandin pathways etc. This is odd because salicylate is normally regarded as an anti-inflammatory, but salicylates do have a wide range of effects and there are close connections to the inflammatory pathways, not all of which are beneficial. It remains a mystery but if coconut MCTs played a part and altered my reaction to allergens and salicylates combined, then if I do not eat coconut MCTs any more I may be able to tolerate salicylates better.

For me a breakthrough came after noting the long term coincidence in timing of these oedema attacks and my use of coconut oil in cooking, in a concerted attempt 5 years ago to improve my dietary intake of healthy lipids. I decided to stop eating coconut oil last year and this year the headcold with oedema attacks have not recurred, unlike the previous 4 years.

I am still having problems with vegetables and headaches but I found reducing gluten and including apple cider vinegar in my diet seemed to help.

It is my belief that somehow MCT coconut oil was setting me up for inflammatory reactions by some effect comparable to the observed TH2 shifting in mice (TH2 stands for T-helper cell type 2, which is the pro-allergic pathway,) and increased allergen absorption at Peyer's patches and this was behind my apparently new food intolerances.

TH2 shifting is known to be a vulnerability for ME CFIDS patients. Dr Paul Cheney identifed this clinically a long time ago and a recent paper from Maddy Hornig et al corroborates this diagnosis.

Cytokine network analysis of cerebrospinal fluid in myalgic encephalomyelitis/chronic fatigue syndrome.
https://www.ncbi.nlm.nih.gov/pubmed/25824300

M. Hornig et al.

Our results indicate a markedly disturbed immune signature in the cerebrospinal fluid of cases that is consistent with immune activation in the central nervous system, and a shift toward an allergic or T helper type-2 pattern associated with autoimmunity.

It occurs to me at the time of writing that its not impossible that the TH2 shift which may apply in my case due to ME CFIDS exacerbated by coconut MCT  might create a situation in which I developed an allergy to a latent virus, hence the strange mix of symptoms I experienced.

Hopefully avoiding coconut will mean I can avoid oedema reactions in future. Though if it is MCTs then its not just coconut as palm oil also has a high fraction of MCTs, though palm oil's capacity for allergic sensitisation has not been specifically tested and probably ought to be. Dairy also has them but I dont eat dairy anyway due to previous problems with it exacerbating summer allergies which I put down to casein at the time but on reflection may have been the same phenomenon.

I count myself lucky the oedemas caused, apparently by infection, when eating coconut were only in my upper respiratory tracts and not in vital organs. But this is a potentially dangerous phenomenon and something I feel its my duty to bring to other peoples' attention, despite the fact my understanding of it is incomplete.

I have now recovered from those episodes but coconut is definitely off the menu.

FYI