Ehlers-Danlos Syndromes (EDS) are inherited disorders affecting connective tissues throughout the body. These conditions cause a wide range of symptoms, including migraines. This article explores the relationship between EDS and migraines, examining why they often co-occur and what factors contribute to this connection. Understanding this link is important for effective management.
Ehlers-Danlos Syndromes and Migraines Explained
Ehlers-Danlos Syndromes (EDS) are genetic conditions that weaken connective tissues like collagen, which supports joints, skin, blood vessels, and organs. This tissue fragility leads to widespread symptoms, including joint hypermobility, stretchy skin, and easy bruising. While there are distinct types of EDS, all involve altered connective tissue integrity.
Migraines are complex neurological events, not just headaches. They cause intense, throbbing pain, often on one side of the head. Attacks can include nausea, vomiting, and heightened sensitivity to light and sound. Migraines can significantly disrupt daily activities, sometimes lasting for hours to days.
The Connection Between EDS and Migraine Headaches
A recognized association exists between Ehlers-Danlos Syndromes and migraines. Research indicates migraines occur more frequently in individuals with EDS, especially the hypermobile type (hEDS), compared to the general population. While about 14% of the general population experiences migraines, estimates suggest 40% to 75% of people with hypermobility may experience them.
Migraines in individuals with EDS are often more severe and frequent. Studies show those with hEDS may have more migraine days per month and report more intense pain. Migraine onset can also be earlier in life for people with EDS. This difference points to a complex relationship, with multiple biological factors contributing to migraine development and persistence in this population.
Why EDS Can Lead to Migraines: Underlying Factors
The compromised connective tissue in EDS can impact various bodily systems, creating several pathways that might contribute to migraine development.
Autonomic Dysfunction (POTS)
One significant factor is autonomic dysfunction, often seen as Postural Orthostatic Tachycardia Syndrome (POTS). In POTS, the autonomic nervous system does not regulate blood pressure and heart rate effectively, especially when changing positions. This dysregulation can lead to fluctuations in cerebral blood flow, potentially triggering migraine attacks. Dysautonomia affects 31% to 94% of individuals with EDS.
Cervical Instability
Connective tissue laxity in EDS can also affect the stability of the cervical spine, particularly the upper neck region (C0-C2). This cervical instability allows for excessive movement of the vertebrae, which can strain surrounding nerves, blood vessels, and even the spinal cord. Such mechanical stress can contribute to chronic headaches and migraines, sometimes termed cervicogenic headaches. Conditions like atlantoaxial instability (AAI) or craniocervical instability (CCI) are more common in EDS and can directly lead to head pain.
Mast Cell Activation Syndrome (MCAS)
Another contributing factor is Mast Cell Activation Syndrome (MCAS), a condition where mast cells release excessive amounts of inflammatory chemicals. These mediators, including histamine and prostaglandins, can cause widespread inflammation and vasodilation (widening of blood vessels), particularly in the brain’s lining. This inflammatory response is a known trigger for migraines and is frequently observed in individuals with EDS.
Vascular Issues and Chronic Pain
Vascular issues stemming from fragile connective tissue may also play a role. Some types of EDS, like vascular EDS (vEDS), are associated with delicate blood vessels that can be prone to tearing or structural abnormalities. These issues can impact blood flow to the brain, potentially contributing to headache development. The generalized chronic pain and systemic inflammation common in EDS can lower an individual’s pain threshold, making them more susceptible to migraine attacks and increasing their frequency and severity.
Strategies for Managing Migraines with EDS
Managing migraines in the context of Ehlers-Danlos Syndromes often requires a comprehensive and individualized approach, given the multiple underlying factors involved. It is beneficial to seek guidance from healthcare professionals who understand both EDS and headache disorders. A thorough medical evaluation can help identify specific contributing factors, such as dysautonomia or cervical instability, allowing for more targeted treatment strategies.
Pharmacological interventions include acute treatments to stop a migraine attack, such as triptans, non-steroidal anti-inflammatory drugs (NSAIDs), and anti-nausea medications. Preventive medications, like beta-blockers, certain antidepressants, or newer calcitonin gene-related peptide (CGRP) inhibitors, may also be prescribed to reduce migraine frequency and severity. However, clinicians consider potential sensitivities to medications and the risk of medication overuse headache, which is common in chronic pain conditions.
Non-pharmacological strategies can also support migraine management. Physical therapy, particularly focusing on neck stability and posture, can alleviate pain originating from cervical issues. Lifestyle adjustments, including consistent sleep hygiene, stress reduction techniques like meditation, maintaining proper hydration, and adopting an anti-inflammatory diet, can help reduce migraine triggers. Some individuals find benefit from supplements such as magnesium, CoQ10, and riboflavin. Addressing underlying EDS-related conditions, such as managing POTS symptoms or stabilizing mast cell activity, can often lead to a significant reduction in migraine burden.