Migraine Headaches

Definition: Migraines are very painful headaches that usually begin on only one side of the head only, are frequently associated with nausea, vomiting and may made worse with exposure to light, sound or movement.

The cause of migraine headaches is believed to be related to a deficiency of Serotonin, an excess of Norepinephrine, or abnormal functioning of Serotonin Receptors in blood vessels of the brain.31  

Various triggers, including stress, hunger, fatigue, hormones, sensory stimulation, and certain foods, can cause a central destabilization of the Serotonin / Norepinephrine ratio and/or delivery system of the brain and blood vessels of the brain. Excessive amounts of the stress hormone Norepinephrine causes dilation of the blood vessels of the brain leading to pain and often visual and other sensory disturbances. ( Saxena PR, Ferrari MD. 5-HT(1)-like receptor agonists and the pathophysiology of migraine. Trends Pharmacol Sci. 1989 May;10(5):200-4) Serotonin, the natural counterbalance to Norepinephrine, is often deficient in migraine sufferers. (Bucci L. Migraine, insomnia, reactive depression due to brain serotonin deficiency. Br J Psychiatry. 1988 Jun;152:867-8)

Syptoms: Migraines are commonly preceded by warning symptoms (prodrome), that may include

Recommendations

Diet: Diet can play an important role in the cause of migraine. Dietary triggers affect phases of the migraine process by influencing release of serotonin and norepinephrine, causing vasoconstriction or vasodilatation, or by direct stimulation of trigeminal ganglia, brainstem, and cortical neuronal pathways. The list of foods, beverages, and additives that trigger migraine includes cheese, chocolate, citrus fruits, hot dogs, monosodium glutamate, aspartame, fatty foods, ice cream, caffeine withdrawal, and alcoholic drinks, especially red wine and beer. Tyramine, phenylethylamine, histamine, nitrites, and sulfites found in these foods are involved in the mechanism of food intolerance headache.

Migraines can be triggered by allergies and may be relieved by identifying and avoiding the problem foods.3 4 5 6 Uncovering these food allergies with the help of a doctor is often a useful way to prevent migraines. In children suffering migraines who also have epilepsy, there is evidence that eliminating offending foods will also reduce the frequency of seizures.7
Some people who suffer from migraines also react to salt, and reducing intake of salt is helpful for some of these people.8 Some people with migraines have been reported to improve after removing all cows’ milk protein from their diet. The presence of lactose intolerance was found to be a strong predictor of improvement in that study.9 In addition, some migraine sufferers have an impaired capacity to break down tyramine, a substance found in many foods10 that is known to trigger migraines in some people.11 People with this defect are presumably more sensitive than others to the effects of tyramine.12 Ingestion of the artificial sweetener, aspartame, has also been reported to trigger migraines in a small proportion of people.13 14

Lifestyle: Some doctors have found that reactions to smoking and birth control pills can be additional contributing factors in migraines.

Supplements (see below for more info on each supplement): L-tryptophan, 5HTP, omega-3 fatty acids, Vitamin B3 (Niacin), Magnesium, Vitamin B2 (Riboflavin), SAMe (S-adenosyl-L-methionine), Melatonin, Tanacetum parthenium (Feverfew), and Petasites hybridus (Butterbur)

More Information:

An estimated 5% to 12% of the total population in a study of 5 different countries were classified as suffering from migraine headaches, with most attacks categorized as fairly severe to very severe. Between 23% and 42% of migraine sufferers reported greater than24 attacks in the previous 12 months. Approximately one-half of all migraine sufferers did not seek medical advice. In all countries, the most commonly used current treatment was simple analgesics (22% to 54%). Of those who did consult a physician, 3% to 19% were prescribed triptan drugs (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan) that activate Serotonin Receptors. Only 21% to 50% of patients were satisfied with their current treatment. Many sufferers supplement their prescription therapy with alternative management strategies, including herbal and homeopathic remedies, stress management, relaxation therapy, avoidance of trigger factors, and bed rest. (MacGregor EA, Brandes J, Eikermann A. Migraine prevalence and treatment patterns: the global Migraine and Zolmitriptan Evaluation survey. J Neural Transm Suppl. 2003;(64):35-63)

More Info On Supplements

L-tryptophan, an amino acid found in 100% whole-wheat foods, is converted to Serotonin, which has been found to relieve migraines. In a small double-blind trial, four of eight people had marked improvement in their migraine symptoms while receiving L-tryptophan (500 mg every six hours).17

5-hydroxytryptophan ( 5-HTP), which is made in the body from L-Tryptophan and converted into Serotonin may correct this dysfunction. In one study, 40 people with recurrent migraines received either 5-HTP (200 mg per day) or methysergide (a drug used to prevent migraines) for 40 days. Both compounds reduced the frequency of migraines by about 50%.32 Larger amounts of 5-HTP (600 mg per day) were also found to be as effective as medications for reducing migraine headache attacks in adults in two double-blind trials.33, 34 Migraine attacks were reduced in frequency, severity, and duration in 90% of those taking 400 mg per day of 5-HTP in a double-blind placebo-controlled trial,35 though another trial found no benefit of 5-HTP.36 In another controlled study, 400 mg of dl-5-HTP (another form of 5-HTP) led to reduced consumption of pain-killing drugs and pain scores after one to two months.37 Children who suffered from migraines and had problems sleeping responded well to a daily amount of 5-HTP equal to 20 mg for every 10 pounds of body weight in a controlled trial,38 though an earlier study showed 5-HTP had no better effect than placebo for children with migraines.39

Fish oil containing omega-3 fatty acids: Twenty-seven adolescents suffering from frequent migraines for at least 1 year (mean 4 +/- 1 years since migraine onset) participated in a randomized, double-blind, cross-over study consisting of 2 months of taking daily doses of omega-3 containing fish oil supplements. Patients' ratings of treatments revealed that 87% experienced reduction in headache frequency, 74% experienced reduction in headache duration, and 83% experienced reduction in headache severity during treatment with fish oil.
Taking Omega-3 containing fish oil daily for 18 days has been shown to double the level of the critical neurotransmitter, Serotonin in the brain of animals. Omega-3 fatty acids are polyunsaturated oils that cannot be made by the body and are derived primarily from seafood.

The fatty acid with most direct influence on brain development and function is DHA.
"The DHA is highly concentrated in the brain," said Dr. Joseph Hibbeln, a senior clinical investigator at the National Institutes of Health., "and it's concentrated in the brain right where the neurons communicate with each other and all the signals pass back and forth." The DHA from omega-3 makes up the walls of neurons, Hibbeln said. "The body cannot manufacture DHA so it has to get it from our diet."

At Sheffield University in England, Dr. Malcolm Peet gave omega-3 fatty acids to 70 depressed patients who had not been helped by drugs such as Prozac. After 12 weeks, 69% of the patients showed marked improvement compared with 25% given placebos. (Peet M, Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry. 2002 Oct;59(10):913-9)

The amount of omega-3 containing Fish oils reported to reduce the symptoms of migraine headaches in a double-blind trials was 1 gram of fish oil per 10 pounds of body weight.40 41


Vitamin B3 (Niacin): Low plasma levels of Serotonin have been implicated in migraine pathogenesis, and niacin may act as a negative feedback regulator on the kynurenine pathway to shunt tryptophan into the serotonin pathway, thus increasing plasma serotonin levels. Sustained-release niacin merits further study as a potentially useful preventive therapy for migraine headache. (Velling DA, Dodick DW, Muir JJ. Sustained-release niacin for prevention of migraine headache. Mayo Clin Proc. 2003 Jun;78(6):770-1)

Magnesium: Compared with healthy people, people with migraines have been found to have lower blood and brain levels of magnesium.19 20 21 22 Preliminary research in a group of women (mostly premenopausal) showed that supplementing with magnesium (usually 200 mg per day) reduced the frequency of migraines in 80% of those treated.23 In a double-blind trial of 81 people with migraines, 600 mg of magnesium per day was significantly more effective than placebo at reducing the frequency of migraines.24 Another double-blind trial found that taking 360 mg of magnesium per day decreased the number of days on which premenstrual migraines occurred.25 One double-blind trial found no benefit from 486 mg of magnesium per day for three months. However, that study defined improvement according to extremely strict criteria, and even some known anti-migraine drugs have failed to show benefit when tested using those criteria.26 Intravenous magnesium has been reported to produce marked and sometimes complete symptom relief during acute migraines, usually within 15 minutes or less.27

Vitamin B2 (Riboflavin): One group of researchers treated 49 migraine patients with large amounts of vitamin B2 (400 mg per day). Both the frequency and severity of migraines decreased by more than two-thirds.28 In a follow-up three-month, double-blind trial, the same researchers reported that 59% of patients assigned to receive vitamin B2 had at least a 50% reduction in the number of headache days, whereas only 15% of those assigned to receive a placebo experienced that degree of improvement.29 The effects of vitamin B2 were most pronounced during the final month of the trial.30

SAMe (S-adenosyl-L-methionine): Preliminary research also suggests that oral supplements of SAMe (S-adenosyl-L-methionine) may reduce symptoms for some migraine sufferers.44 A deficiency of SAMe can lead to a build up of Norepinephrine and a depletion of Epinephrine.

Melatonin: The function of the pineal gland and its cyclic secretion of melatonin may be disturbed in people with migraine headaches.45 Preliminary evidence suggests that 5 mg per day of melatonin, taken 30 minutes before bedtime, may reduce symptoms of migraine headaches.46

Tanacetum parthenium (Feverfew): The most frequently used herb for the long-term prevention of migraines is feverfew.47 Three double-blind trials have reported that continuous use of feverfew leads to a reduction in the severity, duration, and frequency of migraine headaches,48 49 50 although one double-blind trial found feverfew to be ineffective.51

Studies suggest that taking standardized feverfew leaf extracts that supply a minimum of 250 mcg of parthenolide per day is most effective. Results may not be evident for at least four to six weeks. Although there has been recent debate about the relevance of parthenolide as an active constituent,52 it is best to use standardized extracts of feverfew until research proves otherwise.

Petasites hybridus (Butterbur): A standardized extract of butterbur (Petasites hybridus) was shown in a double-blind trial to reduce the incidence of migraine attacks for three months.55 People in the study took 50 mg of the extract twice per day. Note: Research has shown that certain butterbur products contain pyrrolizidine alkaloids (PAs), which are thought to be potentially harmful to the liver and possibly linked to cancer. The only PA free Butterbur product available on the market is Petadolex® Patented brand of Petasites hybridus.

Infection
Helicobacter pylori (H. pylori) is an organism that causes peptic ulcers may predispose people to migraine headaches. In a small clinical trial, 40% of migraine sufferers were found to have H. pylori infection. Intensity, duration, and frequency of attacks of migraine were significantly reduced in all participants in whom the H. pylori was eradicated.18

References:
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