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Migraine misery: triggers and treatments

MagazineDecember 2010 (Vol. 21 Issue 9)Migraine misery: triggers and treatments

If you suffer from these severe chronic headaches, it's useful to know that there's a wide range of safe alternative treatments you can takeMore than just a headache, migraine is a chronic condition that can have a huge impact on people's lives

If you suffer from these severe chronic headaches, it's useful to know that there's a wide range of safe alternative treatments you can take

More than just a headache, migraine is a chronic condition that can have a huge impact on people's lives. In fact, the World Health Organization has rated migraine amongst the top-20 most-disabling chronic lifetime conditions.

Besides a severe headache, sufferers may experience a range of other symptoms that include nausea, vomiting, abdominal pain, and an increased sensitivity to light and noise. What's more, recent evidence suggests that people with migraine have a higher risk of stroke, particularly those who suffer from migraine with aura-sensory, motor or visual disturbances that can precede or accompany the headache. Smoking, oral contraceptive use and being a woman can increase the risk even further (Neurol Sci, 2010; 31 Suppl 1: S127-8).

Migraine is thought to occur when the blood vessels in the brain constrict and then suddenly widen. But precisely what brings about this pattern of vascular constriction and relaxation remains a mystery.

Doctors usually blame it on heredity, and treat the condition with prescription drugs such as prochlorperazine, sumatriptan and ergotamine. But these agents do nothing to cure the condition and, worse, come with a myriad of side-effects. Some can even cause rebound headaches-that is, headaches brought on by the medication itself.

Sufferers stand a much better chance of long-term relief if they try to work out what's causing their migraines in the first place.
Although it's not clear why some people have migraines and others don't, studies have identified a number of factors that can precipitate such headaches. These can vary from person to person and, in most cases, the sufferer is responding to multiple triggers (Aust Fam Physician, 2005; 34: 647-51).

Migraine triggers

o Food allergies/sensitivities. One factor known to bring on migraines-particularly in children and teenagers-is food. Usually, it's the chemicals within foods that are thought to be the culprit. Chemicals such as tyramine (found in cheese), phenylethylamine (found in chocolate), tyrosine, monosodium glutamate (MSG), aspartame, caffeine, sulphites, nitrates (found in processed meats) and histamine (found in wine and beer) appear to trigger the condition by altering the physiological processes associated with migraine attacks (Pediatr Neurol, 2003; 28: 9-15).

A study of 577 migraine sufferers found that sensitivity to cheese, chocolate, red wine and beer had the most clear-cut associations with attacks (Headache, 1995; 35: 355-7).

There's also some evidence that gluten sensitivity may play a role in migraines. Indeed, it appears that migraine is a common feature in patients with coeliac disease (CD) (Mov Disord, 2009; 24: 2358-62), and one study found that a gluten-free diet can help. When four patients with migraine and CD were put on a gluten-free diet for six months, one patient subsequently had no migraine attacks, while the other three experienced improvements in the frequency, duration and intensity of their migraines (Am J Gastroenterol, 2003; 98: 625-9).

Other types of anti-allergy diets have also proved effective. In a double-blind controlled trial of 88 children with severe, frequent migraines, an elim-ination diet led to full recovery in 93 per cent of them. Their symptoms recurred when the suspected foods were reintroduced into their diets (Lancet, 1983; 2: 865-9).

o Sleep problems. Several studies have found an association between sleep patterns and migraine. In a recent Norwegian study, severe sleep disturbances were five times more common among migraine sufferers than headache-free individuals (J Headache Pain, 2010; 11: 197-206). Another study found that overnight headaches, or headaches first thing in the morning, reflected a sleep disturbance in 55 per cent of patients. Treatment of the sleep disorder varied, but the results showed an improvement in headache symptoms in 100 per cent of the participants, and complete resolu-tion in 65 per cent of cases (Aust Fam Physician, 2005; 34: 647-51).

o Infection. Helicobacter pylori (the microorganism that causes peptic ulcers) infection can predispose some people to migraine. In one trial, 40 per cent of migraine sufferers had H. pylori infection, and the intensity, duration and frequency of attacks of migraine were significantly reduced in all participants in whom the bacteria were eradicated (Hepatogastroenterology, 1998; 45: 765-70). More recently, researchers discovered that H. pylori infection is most common in people whose migraines are not triggered by hor-monal fluctuations (such as during menstruation) and in those without a family history of migraine (J Headache Pain, 2007; 8: 329-33).

o Magnesium deficiency. Compared with non-sufferers, people with migraines have lower blood and brain levels of magnesium. However, taking around 600 mg/day was found to significantly reduce the frequency of migraine attacks (Altern Med Rev, 1999; 4: 86-95). But lower doses of magnesium can also be effective. Another study found that just 200 mg/day could reduce the frequency of migraines in 80 per cent of those treated (Headache, 1990; 30: 168). It's thought that magnes-ium plays a role by counteracting the sudden contraction of blood vessels, inhibiting platelet aggregation and stabilizing cell membranes-all of which are involved in migraine.

o Stress. This is the factor listed most often by migraine sufferers as a trigger for their attacks. There's also evidence that stress may even help to initiate migraine in those predisposed to the disorder and that migraine attacks themselves may be a stressor, thus leading to a vicious cycle of chronic migraines. This suggests that stress-reduction techniques-such as medita-tion, yoga or regular massage-or even a relaxing hobby may help to prevent and manage migraines (Headache, 2009; 49:1378-86).

o Environment. Bright sunlight, flickering lights, air quality and odours are known to trigger migraines (Headache, 2009; 49: 941-52). Moreover, headache is a common symptom of 'sick building syndrome' (SBS), a condition thought to result from factors such as volatile organic compounds (found in paint, lacquer, plastic and glue), moulds, electromagnetic radiation, lighting, noise, air conditioning, excessive heating and poor ventilation. According to one review, SBS may indeed be a plausible explanation for chronic headache in some patients (Aust Fam Physician, 2005; 34: 647-51).

Alternative treatments

A variety of other factors-ranging from drugs to hormones to dehydration-can bring on migraines, so the best course of action is to keep a headache diary to help to determine your potential triggers. Addressing these triggers-with the help of an experienced practitioner-may reduce the frequency of attacks or even eradicate the problem entirely. How-ever, if this approach doesn't work, there are a number of tried-and-tested natural ways to treat migraine.

Supplements

The following nutritional supplements may be beneficial for migraine.

o Riboflavin (vitamin B2). A German study found that supplementing with 400 mg of riboflavin reduced the number of migraine attacks by half, although once an attack had occurred, the vitamin had no effect on either its severity or duration (Eur J Neurol, 2004;

11: 475-7). Similar results have been reported in earlier studies (Neurology, 1998; 50: 466-70). Riboflavin is generally safe, although some people taking high doses may develop diarrhoea.

o Coenzyme Q10. A significant propor-tion of migraine sufferers may be deficient in this vitamin-like antioxi-dant (Headache, 2007; 47: 73-80). Placebo-controlled trials are lacking, but 150 mg/day of CoQ10 may cut migraine frequency by more than 50 per cent-without any side-effects (Cephalalgia, 2002; 22: 137-41).

o Polyunsaturated fatty acids (PUFAs) may also be useful. When 129 migraine sufferers were given gamma-linolenic acid (an omega-6 PUFA) and alpha-linolenic acid (an omega-3 PUFA), 86 per cent saw reductions in the severity, frequency and duration of their migraine attacks, 22 per cent became migraine-free, and more than 90 per cent had reduced nausea and vomiting (Cephalalgia, 1997; 17: 127-30). In contrast, a randomized double-blind placebo-controlled trial-considered the 'gold standard' for scientific evaluation-found no significant differences between treatment with omega-3 supplements and placebo. However, the placebo was olive oil, which is itself a source of beneficial PUFAs (J Adolesc Health, 2002; 31: 154-61).

o 5-Hydroxytryptophan (5-HTP) can be just as effective as two commonly used migraine drugs-propranolol and methysergide (Schweiz Med Wochenschr, 1991; 121: 1585-90; Eur Neurol, 1986; 25: 327-9). In general, dosages of 400-600 mg/day are taken.

o Manual therapies. According to a review of the scientific literature, spinal manipulation/mobilization is effective for migraine (Chiropr Osteopat, 2010; 18: 3). One study found that spinal manipulation was on par with drugs
for reducing migraine suffering-and had fewer side-effects (J Manipulative Physiol Ther, 1998; 21: 511-9).

o Transcranial magnetic stimulation (TMS). This non-invasive technique, which uses a fluctuating magnetic field to stimulate neurons in the brain, shows promise as a migraine treatment and preventative. Indeed, a portable device called Neuralieve was found to be significantly better than placebo at alleviating migraine attacks (Lancet Neurol, 2010; 9: 373-80).

o Exercise. Physical activity has been reported to trigger headaches in some people, yet recent evidence also suggests that exercise may be bene-ficial for migraines. When Swedish researchers studied 26 patients at a local headache clinic for 12 weeks, they found that regular exercise (indoor cycling three times a week) led to significant improvements, including fewer migraine attacks, less intense symptoms and less use of medicines, and better quality of life (Headache, 2009; 49: 563-70).

o Acupuncture. This traditional Chinese technique can treat a range of different sorts of headaches, including migraine. According to a review by the Cochrane Collaboration, acupuncture is "at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects" (Cochrane Database Syst Rev, 2009; 1: CD001218).

o Biofeedback. This technique uses special machines to feed back information related to your specific internal physiological states. In fact, numerous studies have shown that biofeedback is effective for reducing the frequency and severity of head-aches. However, such treatment can
be expensive and time-consuming (Pain Physician, 2009; 12: 1005-11).

o Homeopathy. A two-year study carried out in Germany suggests that homeopathy may be useful against migraine (J Altern Complement Med, 2010; 16: 347-55). A qualified practitioner will be able to prescribe personalized treatment.

Joanna Evans

WDDTY VOL. 21 ISSUE 4


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