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Migraine and vitiligo

MagazineDecember 2013 (Vol. 24 Issue 9)Migraine and vitiligo

addresses your most pressing health issueswith promising alternative treatments and those proven to work

WDDTYaddresses your most pressing health issues with promising alternative treatments and those proven to work

Migraine

Q

Are there any natural treatments that work for migraines, which I suffer from at least once a month? When I get one, the only thing that helps is going to sleep, but that's not always an option! I'd love to be able to prevent them, but I don't know where to start.

M.G., Hove

A

Migraine has been rated among the top-20 most disabling chronic lifetime conditions by the World Health Organization-not surprising considering the symptoms: severe headaches often accompanied by nausea, vomiting, abdominal pain, and increased sensitivity to light and noise.

Migraine is thought to happen when blood vessels in the brain tighten and then suddenly expand. But precisely what causes this pattern of vascular constriction and relaxation remains a mystery. Doctors usually blame it on heredity and treat the condition with prescription drugs like prochlorperazine, sumatriptan and ergotamine. But these don't get to the root of the problem and come with a myriad of side-effects.

Some can even cause rebound headaches-that is, headaches brought on by the medication itself.

You stand a much better chance of long-term relief if you try to work out what's causing your 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 trigger these headaches-and uncovering your triggers could be the key to beating migraines for good.

You'll need to do some detective work, though, as the causes can vary from person to person and you'll likely have multiple triggers.1 Here are some likely culprits.

Food

Certain foods can trigger migraines, so keep a food diary to record any patterns and see if avoiding potential triggers makes any difference. Usually, it's the chemicals in foods that are most likely the culprits. Chemicals such as tyramine (found in cheese), phenylethylamine (found in chocolate), tyrosine (found in high-protein foods), monosodium glutamate (MSG), aspartame, caffeine, sulphites, nitrates (found in processed meats) and histamine (found in wine and beer) can trigger the condition by altering the physiological processes associated with migraine attacks.2

A study of nearly 600 migraine sufferers found that sensitivity to cheese, chocolate, red wine and beer had the most clear-cut association with migraine attacks.3 There's also evidence that gluten sensitivity may play a role in migraines, and migraine is a common feature in patients with coeliac disease. One study found that a gluten-free diet can help. When four patients with migraine and coeliac disease were put on a gluten-free diet for six months, one patient was cured of migraines, while the other three experienced improvements in migraine frequency, duration and intensity.4

Other types of anti-allergy diets have also worked. In a controlled trial of children with frequent severe migraines, an elimination diet led to full recovery in 93 per cent of them. Their symptoms recurred when the suspect foods were reintroduced into their diets.5

Sleep problems

If you suffer from any sort of sleep problems, sorting this out could help with your migraines. Sleep disturbances seem to be much more common among migraine sufferers than headache-free people.6

One study found that overnight headaches or having a headache first thing in the morning reflected a sleep disturbance in more than half of patients. When their sleep problems were addressed, 65 per cent saw their headaches completely resolve, while all patients enjoyed some improvement.1

Infection

It may be worth getting testing for infections such as Helicobacter pylori (the bug that causes peptic ulcers), which is thought to 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 migraine attacks were significantly reduced in all participants who were completely cleared of the bacteria.7

H. pyloriinfection is most common in people with migraines not triggered by hormonal fluctuations (such as during menstruation) and in those with no family history of migraine.8

Deficiencies

If you've ruled out food, sleep and infections, consider getting tested for nutritional deficiencies. Not getting enough magnesium, for example, has been linked to migraine, and taking around 600 mg/day has been found to significantly reduce the frequency of attacks.9

Another study found that just 200 mg/day of magnesium could reduce the frequency of migraines in 80 per cent of those taking the supplements.10 This is something you could try before getting tested to see if it makes a difference.

It's thought that magnesium plays a role by counteracting the sudden contraction of blood vessels, inhibiting platelet aggregation and stabilizing cell membranes-all involved in migraine.

Stress

This is the factor listed most often by migraine sufferers as a trigger for their attacks. Plus migraine attacks themselves may be a cause of stress, leading to a vicious cycle. Stress-reducing techniques such as meditation, yoga and regular massage may help.11

Environment

Could your home or workplace be giving you headaches? 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 well be a plausible explanation for chronic headache in some cases.1 Bright sunlight, flickering lights, air quality and odours can also be migraine triggers.12

Alternative treatments

Keeping a headache diary and trying to work out what's triggering your migraines is the best way to beat them. And addressing your triggers with the help of an experienced practitioner may reduce the frequency of attacks or even eradicate the problem completely. But if this doesn't work, there are a number of tried-and-tested natural ways to treat migraine.

Supplements

Riboflavin (vitamin B2).

A German study found that supplementing with riboflavin reduced the number of migraine attacks by half, although once an attack had started, the vitamin had no effect on either its severity or duration.13 Riboflavin is generally safe, although some people taking high doses may develop diarrhoea.

Dosage: 400 mg/day

Coenzyme Q10.A significant proportion of migraine sufferers seem to be deficient in this vitamin-like antioxidant, and one study suggests that CoQ10 may cut migraine frequency by more than half.14

Dosage: 150 mg/day

Fatty acids.Polyunsaturated fatty acids (PUFAs) like omega-3s are worth trying. When 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 attacks, 22 per cent became migraine-free, and more than 90 per cent had less nausea and vomiting.15 Although one trial found no significant differences between treatment with omega-3 supplements and a placebo, this might have been because the placebo was olive oil, which is itself a source of beneficial PUFAs.16

5-Hydroxytryptophan.This amino acid, also known as 5-HTP, has proved to be just as effective as two commonly used drugs-propranolol and methysergide.17

Dosage: 400-600 mg/day

Manual therapies

Spinal manipulation/mobilization can effectively treat migraine. One study found that spinal manipulation was on par with drugs for reducing migraine suffering-and had fewer side-effects.18

Exercise

Physical activity can trigger headaches in some, although recent evidence suggests that exercise may be beneficial 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.19

Acupuncture

This traditional Chinese therapy can treat a range of different kinds of headaches, including migraines. According to a review by the prestigious Cochrane Collaboration, acupuncture is "at least as effective as, or possibly more effectivethan, prophylactic drug treatment, and has fewer adverse effects".20

Biofeedback

This technique uses special machines to feed back information related to your specific internal physiological states. Numerous studies have shown that biofeedback can reduce the frequency and severity of headaches, but it can also be expensive and time-consuming.21

Homeopathy

A two-year study in Germany suggests that homeopathy can ease the symptoms of migraine, and also reduce the use of conventional treatments and health services.22 Contact a qualified practitioner for a personalized treatment.

Herbs

A number of herbs can work against migraines, including butterbur, ginger and Ginkgo biloba, but you'll need to take them for a number of weeks to experience any improvements.

Dosages: 50 mg/day alkaloid-free butterbur; 500-600 mg/day dried ginger; 40 mg three times/day Ginkgo standardized to 24 per cent heterosides

Vitiligo

Q

I'm 49 and have recently developed vitiligo that so far just affects my hands. My GP has suggested topical corticosteroids, but I'm concerned about the side-effects and would prefer to try natural treatments first. I'd also like to stop the condition from getting worse. Can you recommend any natural remedies that work?

T.R., Surrey


AVitiligo is a puzzling, often progressive, condition that causes depigmentation (skin whitening) in patches. It happens when melanocytes, the cells responsible for the pigments that give colour to the skin, die or are unable to function normally. An estimated 100 million people are affected worldwide.

For mild vitiligo, the usual treatment is topical corticosteroids, which can be effective but at a cost, especially when used long term. The drugs can have the same side-effects as their oral cousins, including thinning of the skin, growth problems and hormone disorders.1

For more extreme cases, the most accepted standard treatment is to attract more pigmented cells to the surface of the skin through phototherapy using ultraviolet (UV) A or UVB radiation-as seen naturally when you lie in the sun to get a tan-either on its own or in combination with other treatments such as psoralen drugs. Concerns have been raised, though, over side-effects like phototoxic reactions and blistering, and there is a lack of data on the risks of skin cancer with long-term UV irradiation.2

Happily, there are a number of natural treatments showing great promise for vitiligo. Your best plan of action is to work with an experienced naturopath who can suggest the relevant tests and recommend appropriate supplements and dosages, but here are some pointers.

Try antioxidants

What causes vitiligo is still a mystery, but the leading theory is that it's an autoimmune disorder in which the immune system targets the body's own pigment cells and tissues.3 Gaining in popularity, however, is the idea that vitiligo is caused by the body's reduced ability to fight free radicals like hydrogen peroxide, which can accumulate in the skin and damage melanocytes.

Our cells are normally able to defend themselves against free-radical damage through the actions of antioxidant enzymes like superoxide dismutase (SOD)and glutathione, but studies have shown that this defence system is impaired in vitiligo sufferers, leading to 'oxidative stress'.4

migraine references

1.Aust Fam Physician, 2005; 34: 647-51

2.Pediatr Neurol, 2003; 28: 9-15

3.Headache, 1995; 35: 355-7

4.Mov Disord, 2009; 24: 2358-62; Am J Gastroenterol, 2003; 98: 625-9

5.Lancet, 1983; 2: 865-9

6.J Headache Pain, 2010; 11: 197-206

7.Hepatogastroenterology, 1998; 45: 765-70

8.J Headache Pain, 2007; 8: 329-33

9.Altern Med Rev, 1999; 4: 86-95

10.Headache, 1990; 30: 168

11.Headache, 2009; 49:1378-86

12.Headache, 2009; 49: 941-52

13.Eur J Neurol, 2004; 11: 475-7; Neurology, 1998; 50: 466-70

14.Headache, 2007; 47: 73-80; Cephalalgia, 2002; 22: 137-41

15.Cephalalgia, 1997; 17: 127-30

16.J Adolesc Health, 2002; 31: 154-61

17.Schweiz Med Wochenschr, 1991; 121: 1585-90; Eur Neurol, 1986; 25: 327-9

18.Chiropr Osteopat, 2010; 18: 3; J Manipulative Physiol Ther, 1998; 21: 511-9

19.Headache, 2009; 49: 563-70

20.Cochrane Database Syst Rev, 2009; 1: CD001218

21.Pain Physician, 2009; 12: 1005-11

22.J Altern Complement Med, 2010; 16: 347-55

vitiligo references

1.Am Fam Physician, 2009; 79: 135-40

2.BMC Dermatol, 2008; 8: 2

3.Autoimmun Rev, 2010; 9: 516-20

4.Indian J Dermatol Venereol Leprol, 2009; 75: 268-71

5.Indian J Dermatol, 2009; 54: 357-60

6.Clin Exp Dermatol, 2007; 32: 631-6

7.Invest Clin, 2007; 48: 21-31

8.Clin Exp Dermatol, 2003; 28: 285-7

9.Cutis, 1992; 50: 39-42

10.Yonsei Med J, 1991; 32: 79-81

11.N J Med, 1989, 86: 377-80

12.Dermatologica, 1982; 165: 136-40

13.Arch Dermatol, 2000; 136: 393-9

14.Int J Dermatol, 2002; 41: 482-7


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