The Honest Migraine is pleased to share an exclusive, three-part interview with highly respected expert, Dr. Nancy Klimas, who holds multiple noteworthy positions including Director, Institute for Neuro-Immune Medicine, Nova Southeastern University.
Klimas specializes in myalgic encephalomyelitis – chronic fatigue syndrome (ME/CFS), which commonly results in migraines, “brain fog,” and other crippling conditions.
Chronic fatigue syndrome patients suffer an ongoing feeling of exhaustion. “The key feature of CFS is the relapse that happens after a person exerts [energy],” Klimas says. “That’s a very weird symptom. It doesn’t happen in very many illnesses and it only happens in neuro-inflammatory illnesses.”
Multiple sclerosis and myasthenia gravis are other illnesses where exercise can “drive [a person] into a relapse,” Klimas says. “It is a neuro-immune disease.” She says some of the key biologic features of ME/CFS are neuro inflammation and oxidative stress in the brain and body. In clinical terms, Klimas says, “It’s a brain disease with systemic inflammation.” This is the sector that features symptoms such as headaches and cognitive problems, like “brain fog.” This is caused by the patient exercising their brain and running out of capacity.
Women are more commonly affected than men. Klimas says that the average age people get ME/CFS is when they are in their early 30s. She has found that more than half of the individuals she has treated developed it after battling a viral condition. One of the more common viruses that can induce ME/CFS is Epstein-Barr Syndrome.
While some experts say the exact cause of ME/CFS is unknown, experts also say they find links to environmental and genetic factors as well.
A large number of migraine sufferers have made their way into her chronic illness clinic. As a result, she reports that patients who have ME/CFS and also suffer from migraine headaches, which is not unusual, can have “better days and worse days, but not fabulous days.” Those with chronic fatigue must manage their energy and not over-stimulate their system or will pay the price.
In comparison, Klimas says individuals who suffer with migraines alone, not ME/CFS, are much more fortunate. “I have found that a lot of migraine-only patients, between their episodes of migraine, are very, very healthy. They are functional. They can exercise.”
The common denominator between ME/CFS and migraines seems to be rooted in the fact that they are both neuro-inflammatory conditions. Migraine sufferers are very familiar with how their neuro-inflammatory symptoms causes light to bother their eyes (photophobia). They can have trouble sleeping and experience long periods of fatigue.
“It’s one of the consequences of severe periods of pain,” Klimas says. “Pain is a terrible thing. It can absolutely cause fatigue. [With migraines], you have to break the headache cycle as well as the fatigue cycle. They interplay a lot.”
With her ME/CFS patients, Klimas says migraines add an additional level of pain to their condition and “you better deal with the pain, because they are not going to get out of the ME/CFS cycle unless you deal with the migraine.”
With ME/CFS patients, Klimas describes them as “individuals who have an energy system that is like a bucket less than half-full.”
She says as those patients go through their day, their “bucket” slowly empties until their energy is fully depleted. “[They] have to wait for it to fill back up again,” says Klimas. “Or, [they] can go about [their] day, tapping a little bit of [their] reserve and not emptying the bucket.” This allows the patient to get through the day easier. Essentially it’s a strategy of using a little bit of energy [at a time] and taking breaks.
“You have to fill the ‘bucket’ back up; if you let it go to the bottom, you’re done,” Klimas says.
Fatigue resulting from pain and debilitating health conditions doesn’t just affect the body, Klimas underscores. As mentioned above, many people are finding they are experiencing a condition referred to as “brain fog,” also known as cognitive exhaustion.
“Cognitive energy is a different thing,” Klimas explains. “Your brain is making more energy and using more energy than any of your muscles. You’ve got more mitochondria (energy production units) per cell in your brain by 100-fold than in your muscles. Using a lot of this energy makes more oxidative stress. If you are using your brain, you need little mental breaks as well. You have to deliver oxygen and glucose, but also take away the oxidative stress stuff (lactic acid).”
“Oxidative stress in the brain and body are vicious cycles, they drive each other,” Klimas explains. “The more oxidative stress, the more inflammation, they go push-push. Those two are circular.”
The best and easiest way to help alleviate cognitive exhaustion? “The most effective way to rest your brain is to be flat,” says Klimas. “When you’re upright, more blood flow goes to the legs and feet. When you’re lying flat, you’re actually getting more blood flow to your brain than when you are upright.”
Thus, rest breaks pertain to the body and the mind. “Take mental breaks; lie down for a minute; then come back and function again,” Klimas advises. “Brain fog is basically driving the brain into higher levels of inflammation and oxidative stress.”
Klimas says there is “a lot of fibromyalgia associated with ME/CFS.” She estimates between 60 and 70 percent of patients have both conditions.
In addition to pain and fibromyalgia, autonomic dysfunction is a common systemic symptom of ME/CFS. Autonomic dysfunction includes irritable bowel syndrome, racing heart, blood pressure fluctuations (especially drops), migraines, and a host of other things.
When dealing with chronic illness, it is easy for patients to feel overwhelmed, but Dr. Klimas gives sound advice.
“Learn to co-exist with [your] illness,” she encourages. “Give it the respect it deserves, but carry on. Find a way to carry on.”
“Psychologists call it ‘positive denial,’” Klimas explains. “The positive side is ‘I’ve learned to adapt.’ ‘I take my medicine, but I’m not allowing [the] disease to drag me down into a black pit of despair.’ I think positive denial is a great thing to try and achieve.”
In addition to being the Director, Institute for Neuro-Immune Medicine at Nova Southeastern University; Dr. Nancy Klimas is the Director, Clinical Immunology Research at Miami Veterans Affairs Medical Center; a member of the VA Research Advisory Committee for Gulf War Illness; and the immediate past president of the Internal Association for CFS and ME (IACFS/ME).
Coming next: Botox® success and learning about migraine “triggers”