Migraines are severe, disabling headaches that affect up to 17 percent of women and six percent of men. The disorder has many variants, often making diagnosis difficult. Migraines can be excruciating for patients, incapacitating them for hours or days at a time. They are also frustrating for doctors, who often find that the condition resists their best efforts at treatment.
Fortunately, conventional management of migraines has improved dramatically over the past 10 years. An integrative approach - combining the best of these conventional techniques with evidence-based natural approaches -- can make a tremendous difference in reducing frequency and severity of attacks.
What are the symptoms of migraine headaches?
The classic, "textbook" migraine is a one-sided severe, throbbing headache, which can be preceded by some sort of "aura" (visual disturbances), and accompanied by nausea and vomiting, along with sensitivity to light and sound. Headache pain worsens with physical activity and usually interferes with normal functioning. Frequency can vary from several times a month to once a year; intensity varies as well. If left untreated, a migraine can last from a couple of hours to several days.
Not all migraine symptoms are the same, and most individuals do not experience auras. Those who do report a variety of visual sensations such as seeing spots or flashes of light, bright zigzagging lines across the field of vision, or blind spots. Other sensations can include numbness and tingling in the extremities, and, rarely, weakness or speech problems mimicking a stroke or transient ischemic attack (TIA).
Before a migraine occurs, a person can experience premonitions or "prodromes" that may include feelings of elation or intense energy, carbohydrate cravings, excessive hunger or thirst, and sleepiness, irritability or depression. These can occur several hours or even a day or two before headaches occur.
What are the causes of migraine headaches?
The exact mechanism of action of migraine headaches isn't fully understood. There are no true nerves for pain in the area where it is experienced. Pain and discomfort of this nature ultimately comes from blood vessels in the head that rapidly dilate and may become inflamed. Exactly how this happens is far from clear, but there are several plausible theories.
Some researchers believe migraines arise from functional changes in the trigeminal nerve, one of the main facial nerves that also houses a major pain pathway. Others think it comes from imbalances in the neurotransmitter serotonin, which plays a regulatory role for pain messages going through the trigeminal nerve.
The vascular instability that is the immediate cause of migraines is influenced by many factors. Food sensitivity often plays a role, since in many sufferers specific foods trigger attacks. Hormonal fluctuations are a factor, at least in women. While pregnancy tends to prevent migraines, birth control pills can elicit them. Stress is clearly involved as well, as is heredity. It may be impossible to disentangle all the elements that lead to migraine in an individual case.
Typical food triggers include aged cheeses and processed meats (particularly pepperoni and hot dogs); peanuts; bread and crackers containing cheese as well as any strong-flavored cheeses; broad beans, peas, and lentils; and beverages containing caffeine and chocolate. Wine is another culprit (red is usually more problematic than white). Fermented foods including soy sauce and miso have been implicated, as have some fish including sardines, anchovies, and pickled herring. Other foods that have been linked to migraines include avocados, bananas, citrus fruits, figs, raisins, red plums, and raspberries.
Food additives that may play a role include nitrates and nitrites (in processed meats), yellow food coloring, and monosodium glutamate (MSG) used in some canned or processed foods, as well as in Chinese foods and in soy sauce.
In addition, watch out for non-food triggers such as fatigue, lack of sleep (or sleeping too much), missing meals, changes in barometric pressure, and changes in altitude. Strong smells, such as those of paint, gasoline or heavy perfumes, and bright flashing lights can also trigger migraine symptoms.
What is the conventional treatment of migraines?
A variety of drugs are available that have been specifically designed to treat migraines. There are also several pharmaceuticals commonly used to treat other conditions that also help relieve or prevent migraines in responsive individuals.
Medications used to address migraines fall into two general categories: those that relieve pain, taken during migraine attacks to stop symptoms that have already started; and those that are taken regularly to reduce the severity or frequency of migraines.
Non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen are still first-line treatments for migraine attacks. Some over-the-counter drugs marketed specifically for migraines contain these compounds in combination with acetaminophen and caffeine. They can be effective for mild or intermittent headaches, but if taken frequently or for long periods of time, can lead to ulcers, gastrointestinal bleeding and "rebound headaches" - a headache that is just as strong, or worse, when the medicine is withdrawn.
A newer class of prescription drugs called triptans is now widely used and is especially effective when taken at the beginning of an attack. They come in oral, intranasal and injectable preparations, and although they are the drug of choice for severe migraines, they do have side effects that should not be discounted, especially in patients with heart disease or hypertension. Triptans act on serotonin levels and cause blood vessels to constrict, which counters the blood vessel dilation leading to migraine. Side effects include nausea, dizziness, muscle weakness and, rarely, if vessels narrow too much, stroke and heart attack can occur in susceptible individuals. It is important to be under close medical supervision when using drugs in this class.
Ergotamine preparations have been used for over 60 years and were commonly employed before triptans became available. They are less expensive with fewer side effects, but are also not as effective as the triptan medications.
Anti-nausea drugs are also commonly used in combination with treatments for other symptoms, and medications that combine the sedative butalbital with aspirin or acetaminophen have been used in the past to treat migraine attacks. Some combinations also include caffeine. These medications, however, have a high risk of rebound headaches and withdrawal symptoms and should be used infrequently.
In addition, medications containing narcotics such as codeine and hydrocodone are often used to treat migraine pain during acute situations (often in urgent care settings) or when people can't tolerate triptans or ergotamines. These drugs are habit-forming, can cause rebound - and should be used only as a last resort.
Preventive medications that help regulate blood vessel tone and activity, like beta blockers, calcium channel blockers and other anti-hypertensives, can often reduce the frequency, severity and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks. Certain antidepressant medications can help prevent migraines as well, as can some anti-seizure drugs, namely Depakote, Neurontin and Topamax. Side effects may include dizziness, drowsiness, lightheadedness, stomach upset, and weight gain or even weight loss (in the case of Topamax). Your doctor may recommend taking preventive medications daily if migraines aren't being adequately treated or if a predictable, but unavoidable, trigger is approaching.
What therapies do I recommend for migraines?
Eliminate coffee (including decaffeinated coffee) as well as all other sources of caffeine from your daily routine. Make sure you are not taking any OTC or prescription drugs that contain it. Once you are completely off caffeine, you can try using coffee or other forms of caffeine as an effective and immediate treatment for migraine. Drink one or two cups of strong coffee at the first sign of an attack, then lie down in a dark, quiet room.
Eliminate dietary triggers of migraine and also avoid all artificial sweeteners, including aspartame (NutraSweet and Equal).
Experiment with the herb butterbur as a preventative. This plant (Petasites hybridus), native to Europe, northern Africa and southwestern Asia has been clinically studied. Results of a small study published in the May, 2000, issue of the journal Headache showed that an extract of butterbur root significantly reduced the frequency of migraine attacks among the 58 patients participating. If you decide to try it, avoid the crude herb, which contains toxic pyrrolizidine alkaloids (PAs). Instead, choose PA-free butterbur extracts standardized to contain a minimum of 7.5 mg of petasin and isopetasin. The adult dosage ranges from 50-100 mg twice daily with meals. Side effects are rare.
You can also try feverfew (Tanacetum parthenium), 100-150 mg daily of a product standardized to contain at least 0.2 percent parthenolides. This herb helps prevent the release of substances that dilate blood vessels in the head. You can stay on it indefinitely.
Another option is coenzyme Q10 (CoQ10). A study published in the February 22, 2005, issue of Neurology found that CoQ10 was superior to a placebo in preventing migraines. Researchers tested CoQ10 among a group of 43 patients, about half of whom received a placebo. Of the patients who took CoQ10, 50 percent reported significantly reduced frequency of headaches compared to only 14 percent of those who took the placebo. Dosage of CoQ10 in the trial was 100 mg three times daily.
Vitamin B2 (riboflavin) can also be helpful, as can magnesium. The recommended dose of riboflavin is 400 mg daily - a high dose, which needs to be prescribed by a physician.
You should first try these therapies individually, and allow enough time - usually six to eight weeks - to experience a change and then judge results before trying the next.
You can also experiment with the mind-body connection by taking a course of biofeedback. With practice, biofeedback can allow you to influence the part of the nervous system that regulates the dilation of blood vessels that contribute to migraine symptoms. Once you master this technique, it can be a tool you can use to abort a headache at the start of an attack.
Finally, if you continue to have attacks, try to change the way you think about the headaches. Migraine is like an electrical storm in your head - violent and disruptive, but leading to a calm, clear state in the end. You may, upon reflection, discover that it is not so bad to let yourself have a headache once in a while. It is a good excuse to drop your usual routine and go inward, letting accumulated stress dissipate. As you come to accept migraines in this way and see them as serving a purpose in your life, you may not have them so frequently.
Andrew Weil, M.D., is the founder and director of the Arizona Center for Integrative Medicine and the editorial director of www.DrWeil.com. Become a fan on Facebook, follow Dr. Weil on Twitter, and check out his Daily Health Tips Blog.
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Heavy sodium in all of these trigger foods:
aged cheeses, processed meats; peanuts (salt);
crackers containing cheese (and lots of salt)
as well as any strong-flavored cheeses (salt);
soy sauce and miso (both lots and lots of salt);
sardines, anchovies, and pickled herring( lots of salt). .
Food additives with sodium:
nitrates and nitrites (in processed meats),
monosodium glutamate (MSG)
Get extra salt out of your diet and enjoy the tast of real food again.
Than you again Dr. Weil. .
weeks or so into my Crystal Light regimen, I had my first
episode of vision loss. [ last week of January ]
This incident was completely different in degree and kind
than the normal visual problems (increased far-sightedness
and visual lability) I had been experiencing.
Rather abruptly, I lost the visual field of the left hemisphere
of my left eye.
The vision loss lasted for about 20 or 30 minutes and after
approximately 15 minutes, I started to develop a crushing
headache which lasted for hours.
I've never had a history of headaches, so the intensity and
duration of this headache was unusual."
recent aspartame (methanol, formaldehyde, formic acid) symptoms in English
professor: Kristi Siegel: Rich Murray 2010.04.17
http://groups.yahoo.com/group/aspartameNM/message/1599
Less chance of getting a drug dependency or side effect with that approach, but as usual, it doesn't work for everybody.
Even my primary care doctors were telling me most of this more than a decade ago,
What is the point of Weill? He positions himself as from innovative guy with special knowledge, but everything he says is such common knowledge.
Well, perhaps, but having had cluster headaches, I really appreciated the forum in all the comments here. So, I found the fact that this post was published to have been of great value and support for me.
All the best,
We treat most migraines successfully with Acupuncture. We don't recommend taking the medications, which while they often initially work, often lead to a "rebound" effect after 1 or more years. The resultant migraines are usually worse that ever - and that is when people usually come to us to spend money, since acupuncture isn't covered by most insurance.
We agree with well documented affects of foods that trigger migraines in people who are already susceptible. There are books on the subject. Dr. Weil didn't discover any of this.
There is nothing new in this story, but I am quite surprised that Dr. Weil, who doesn't do acupuncture himself, wouldn't be more aware of the success that many acupuncturists have obtained with acupuncture treatments.
Or else you should find some different acupuncturists.
One misunderstanding about acupuncture, is everyone does it a little differently.
Chance are its something else going on (Brain, cervical MRI are possible) if we can't get an effect after 5-10 treatments, although in most cases we get results on 1st treatment.
Any type of effect is a good sign, even if it gets worse on one of the treatments.
Cost is usually the only reason why people aren't satisfied, and it is a legitimate reason.
Also its better to try acupuncture as the first, 2nd and 3rd approach. The longer you wait, the more difficult to treat. The same for other neurological problems, such as Bell's Palsy.
We have a saying up here: "If you don't like the weather, wait a few minutes - it will change". That might be a significant trigger for me, and I didn't even know it. I identified the food triggers years ago, and just avoid them (especially microwave popcorn!).
For those who don't understand what Naturopaths are about, I would encourage you to check out the American Association of Naturopathic Physicians website (www.naturopathic.org), or the Institute of Functional Medicine which is an organization that teaches all doctors how to do what Naturopaths are trained to do - to look at the whole person and not just stop at the symptoms. While this is a reductionist definition, it is pretty accurate.
We see migraine patients pretty often and it is amazing how many different causes there are and how many solutions there are to migraine pain. One solution may be a good starting place in diagnosis, but it does not fit all people and in terms of chronic and metabolic illnesses may not be the most effective solution. If you suffer from migraines I encourage you to keep looking for solutions that work for you. It could be IgG food intolerances, it could be neurological, it could be environmental issues, it could be vascular issues. Keep looking.
Here is what I have found that works for me during a migraine: About 400 mg or more of Magnesium Citrate plus 1200 mg of feverfew. This reduces the pain drastically but does not eliminate it entirely. However, the remaining pain is eliminated by 400 mg of Ibuprofen.
The following works for me as a preventive:
Avoiding coffee, cheese, sandwitch meat, banana, chocolate.
Supplement: 200 mg Magnesium Citrate 4 times daily.