Migraine. The very word makes those who understand its implications shudder. Changes in vision. Pain that can last for hours to days. Nausea. Vomiting. Extreme sensitivity to light or sound. Loss of ability to function, sometimes for days on end. Yes, for those who suffer from migraines, prevention may be one of the greatest gifts you could ever receive.
Greater than 10% of Americans suffer from migraines, with the prevalence in women being about 3 times more than in men. Although in children the prevalence of migraines is higher in boys than girls, once puberty sets in, the rate of migraines in females nearly triples that in males.
Researchers continue to search for a better understanding of the cause of migraines. Although the exact cause of migraine headaches is still poorly understood, environmental and genetic factors appear to play a role.
Until recently, the most accepted theory for the migraine process was that it was the result of vascular abnormalities in the head. New research, however, has begun to demonstrate that migraines may actually be the result of an underlying disorder of the central nervous system. Certain stimuli, such as foods, smells, lights, etc., may trigger this disorder, which then sets off a chain of biochemical and neurological events which subsequently affects the vascular system of the brain, causing a migraine headache.
A variety of prescription drugs exist to treat acute migraine episode, ranging from serotonin agonists to opioid analgesics, as well as an array of other drugs to prevent recurrences, including beta blockers. Although acute treatments may work in the moment, they may also cause a number of adverse effects ranging from rebound headache to drug dependence and even acute myocardial infarction. With regard to prophylactic drugs, the reduction in mean migraine frequency is no more than 50% with even the most effective medication, and many of these drugs are also associated with significant side effects.
Factors Involved in Migraine Process
Despite years of study, scientists are still searching for one experimental model that can fully explain the migraine process. In the meantime, there are a number of nerve pathways, chemicals, structures, and other factors that are still being investigated for their role in migraine synthesis. The more we understand these factors, the better chance we have of successful prevention and treatment of migraines.
Some of these factors include:
- Serotonin Levels. Neurotransmitters are chemical messengers in the brain. Serotonin is a neurotransmitter famous for its role in the migraine process. Although it’s part is not entirely understood, some researchers have theorized that migraines result from changes in the brainstem, its interactions with the trigeminal nerve, and serotonin. Serotonin helps to regulate nervous system pain. Some researchers have demonstrated that migraine patients have chronically low levels of serotonin. Other studies have shown that levels of serotonin drop during migraine episodes, and some researchers have deduced that this reduction may trigger a reaction in the trigeminal system that results in migraine pain. Researchers have illustrated that serotonin can constrict blood vessels and lead to the stimulation of pain receptors via a constriction and dilation reaction of blood vessels in the brain, leading to migraine pain.
- Fluctuating Estrogen Levels. Women who experience migraines at certain times in their lives, (ie. during their cycle, during or immediately after pregnancy, or during perimenopause) may be suffering as a result of their hormone levels. It is known that the prevalence of migraines in women is three times that of men, and there is strong evidence to support that this is due to estrogen. Such evidence includes the following: boys experience more migraines than girls prior to puberty; the prevalence of migraines increases at menarche; estrogen withdrawal during menstruation commonly triggers migraines; administration of estrogen in hormone replacement therapy can trigger migraines; oral contraceptive use can trigger migraines in some women, while relieving them in others; frequency of migraines typically decreases during the second and third trimesters of pregnancy when estrogen levels are high; when estrogen levels drop post-partum, migraines become common; and migraines typically improve with menopause, although menopause may trigger migraines in others. Research has shown that it is most likely the fluctuation in estrogen, rather than if it is high or low, that triggers migraines.
- Food Sensitivity. Studies have shown that food sensitivities appears to be one of the most common causes of migraines. While medical literature has repeatedly documented food sensitivities as a cause for migraines over the last 70 years, most doctors still remain unaware of this information. What conventional medical doctors do recognize is that certain compounds in foods, such as tyramine, modosodium glutamate, phenylethylamine, and nitrates, are precipitating factors in the onset of migraine. However, it is uncommon for migraine patients to obtain complete relief by avoidance of these substances, which is why understanding what food sensitivities are can be such a crucial component in migraine prevention.
- Reactive Hypoglycemia/Spontaneous Hypoglycemia. The term reactive hypoglycemia is used to describe an exaggerated drop in blood glucose concentration that results from excessive secretion of insulin in response to a meal. Reactive hypoglycemia may also occur as a result of a metabolic or endocrine abnormality. Diet plays an extremely important role in the management of reactive hypoglycemia, which is most commonly caused by excessive consumption of refined carbohydrates. Spontaneous hypoglycemia usually occurs in the fasting state, or in between meals. Abnormal blood sugar appears to be another common cause of migraines. Therefore, it is important to speak with your naturopathic doctor about ways to regulate your blood sugar through proper diet.
- Caffeine. The role of caffeine continues to remain a controversial topic within the treatment of migraines. For some, consumption appears to improve symptoms, but for most migraine patients, avoidance of caffeine seems to cause the greatest benefit. This may be due to the facts that caffeine impairs blood glucose regulation, as well as triggers migraines through a mechanism still being studied by researchers.
- Aspartame. Certain studies have demonstrated a role of aspartame in the onset of migraines. Although research is inconclusive, some experts still consider avoidance of aspartame as a treatment in migraine patients.
- Peptides. Certain factors, such as stress, can trigger the release of inflammatory peptides such as Substance P, calcitonin gene-related peptide, and others. The role of these peptides is to dilate blood vessels and produce an inflammatory response, which may then cause over-excitation of the nerve cells in the trigeminal pathway. The significance of this is that the trigeminal pathway runs from the brainstem to the head and face and also spread to the meninges (the membrane covering the brain).
- Reduced Magnesium Levels. Magnesium deficiencies have been observed in people with migraine headaches. Reduced levels of magnesium could destabilize nerves in the brain, causing them to misfire. Researches have hypothesized that this may account for the auras experienced by many migraine patients.
- Impaired Mitochondrial Energy Production. Research has demonstrated that migraine patients have impaired mitochondrial energy production. Therefore, supplements aimed at treating this have shown to be effective in migraine prevention.
- Abnormal Calcium Channels. Calcium channels seem to play a significant role in the migraine process, with some migraines being the result of the abnormal transport of calcium, potassium and magnesium within cells.
- Nitric Oxide. Some studies suggest that over-excitable neurons release nitric oxide, which may trigger migraines.
- Inflammation in the Maxillary Nerve. Early research suggests that some migraine headaches may be the result of inflammation in maxillary nerve (the branch of the trigeminal nerve that runs behind the cheekbone). Although this theory may not be widely understood, based on my clinical experience, I would consider it in certain circumstances.
- Other factors include stress, alcohol (especially red wine), emotional changes (especially intense emotions and let-down after stress), too little or too much sleep, withdrawal from caffeine or alcohol, poor posture, exhaustion, muscle tension, glare or eyestrain, and weather changes. All of these should be investigated when formulating a migraine prevention program.
Naturopathic Treatment for Prevention:
- Elimination of Food Sensitivities and Non-Sensitivity-Mediated Food Reactions: Elimination of food sensitivities is an extremely important part of a naturopathic prevention protocol for migraine. Therefore, it is important to see a qualified naturopathic physician for assessment of and education about food sensitivities, as they are unique to each person. Otherwise, utilization of supplements may be bandaging an underlying problem, which will greatly increase the risk of your migraines continuing. In addition to food sensitivities, there are a number of foods that have been implemented in the trigger of migraines in a large number of people. These foods include chocolate, cheese, alcohol (particularly red wine), and citrus fruits. These foods appear to cause migraine due to vasoactive substances found in them, rather than to an allergic reaction (i.e. food sensitivity reaction). Certain compounds in foods have also been found to trigger migraines, which include tyramine, phenylethylamine, and possibly phenolic compounds and histamine. People who suffer from migraines after eating these compounds may have an inherent inability to metabolize them properly.
- Avoid Reactive/Spontaneous Hypoglycemia: Although there are a variety of supplements that can be used to treat various types of hypoglycemia, simple dietary changes can make a significant difference. A combination of avoiding refined sugar and other refined carbohydrates, concentrated sugars, alcohol, caffeine, food sensitivities, increasing protein, and eating 6 small meals per day has been shown to make a significant impact on migraine prevention.
- Liver Support/Cleanse: The metabolism of estrogen primarily takes place in the liver through Phase I and Phase II pathways, with its final products being excreted via urine and feces. If liver function is impaired, this can result in improper metabolism of estrogen. Due to the role estrogen plays in the migraine process, it is important to assess the liver when treating migraine patients.
- Estrogen Modulators: As mentioned above, estrogen levels play a crucial role in the migraine process. Although researchers still do not fully understand how changes in estrogen levels affect migraines, naturopathic treatment aimed at modulating estrogen levels has been shown to greatly improve both the frequency and severity of migraines in many women. Examples of such treatments include Vitex Agnus Castus, vitamin B6, magnesium, folic acid, and zinc.
- Tanacetum parthenium (Feverfew): Studies demonstrate the ability of Tanacetum to re-establish proper tone of blood vessels, inhibit production of inflammatory substances and inhibit release of blood vessel-dilating substance from platelets, all of which can significantly prevent migraine formation. The efficacy of this herb depends on adequate concentrations of parthenolide, its active principle.
- Zingiber officinalis (Ginger): Some evidence suggests that the ability of this root to reduce inflammation and platelet aggregation may also help in migraine prevention.
- Riboflavin (B2): As stated above, studies have shown that migraine patients appear to have impaired mitochondrial energy production. Riboflavin is the precursor of flavin adenine dinucleotide (FAD), which is a coenzyme involved in the electron-transport chain. Therefore, riboflavin plays a significant role in mitochondrial energy production and has been found to be an effective migraine prophylaxis in adults.
- Coenzyme Q10: Like riboflavin, coenzyme Q10 (CoQ10) is a component of the electron-transport chain and there plays a significant role in mitochondrial energy production.
- L-Tryptophan and 5-HTP: As explained above, migraines appear to be at least partly caused by abnormalities in the serotonergic system, often resulting in chronically low levels of serotonin in the brain of migraine sufferers. Conventional medicine has demonstrated that serotonin receptor agonists are effective in the treatment of acute migraines, and L-tryptophan is a naturally occurring precursor to serotonin. L-5-Hydroxytryptophan (5-HTP) is a metabolite of L-tryptophan and a direct precursor to serotonin. Although studies have shown that 5-HTP is also an effective preventative treatment for migraines, one expert states that L-tryptophan appears to be preferable in most circumstances. These supplements are best avoided by anyone taking drugs that increase serotonergic activity unless under the strict guidance of a qualified professional.
- Fish Oil: Inflammation has been implicated as a factor in the migraine process and fish oils are well known for their antiinflammatory capability. This may explain why they have been found to effectively prevent migraine in certain people.
- Vitamin B12, Vitamin D, and Calcium: All of these nutrients have been shown to be effective in the prevention of migraine in certain patients.
- Other nutrients to consider include alpha-lipoic acid, vitamin C, niacin and niacinamide.
- Melatonin: Studies have shown plasma levels and urinary excretion of melatonin to be significantly lower in migraine patients than in controls, and supplementation with melatonin has demonstrated the ability to prevent migraine in certain patients.
- Prolo and Neural Prolotherapy: There is much evidence to suggest the use of both prolo therapy and neural prolo therapy in the treatment and prevention of migraine.
- Affirmations: According to Louise L. Hay, author of “Heal Your Body”, migraines are due to the dislike of being driven and resisting the flow of life. Repeating the following affirmations several times a day may aid in the prevention of migraine in some cases: “I relax into the flow of life and let life provide all that I need easily and comfortably. Life is for me.”
- Homeopathy: Finding the right homeopathic remedy through the guidance of a qualified naturopathic doctor or homeopath may also assist in migraine prevention.
Treatment for Acute Migraine:
- Several experts state the efficacy of I.V. magnesium and I.V. Myers Cocktails in the treatment of acute migraine symptoms.
- Niacin: There is some evidence that ingestion of niacin (not niacinamide) may help in the treatment of acute migraine.
Migraines can be a difficult condition to treat. Whether attempting to treat yourself or as a practitioner treating patients, it is important to note that each individual is unique from the next. Try not to lose hope. With a certain amount of patience and creativity, you may at last be able to free yourself and/or your patients from the confines of migraine headaches.
Nutritional Medicine; Alan Gaby
The Clinician’s Handbook of Natural Medicine; Pizzorno Jr, Murray, Joiner-Bey.
Heal Your Body; Louise L. Hay.