How to Reduce Your Migraine Headaches
Migraines are a leading cause of disability worldwide [1], and those who suffer with migraine headaches understand how debilitating they can be. Although there are other categories of headaches, the hallmark of a migraine is a disabling headache that is often associated with nausea, sound, or light sensitivity.
The International Classification of Headache Disorders (ICHD) is an important resource for the diagnosis of migraine, but the heterogeneity of migraines can make them difficult entity to diagnose. Attack symptoms and severity can vary from person to person, and also from attack to attack in the same person.
For those who suffer from headaches, any change in the pattern of headache (such as an increase in attack frequency or severity) can indicate a more serious condition. Please see your primary healthcare practitioner for evaluation.
Common Migraine Triggers:
Typically, triggers can be placed within 5 main categories:
EMOTIONAL STRESS
Anxiety, depression
Reduced serotonin levels
MENSTRUAL RELATED
Fluctuating estrogen levels
SLEEP DISTURBANCE
Sleep apnea
Stress or anxiety induced insomnia
FOOD & ALCOHOL
Histamine Intolerance
Food sensitivities
Reactive hypoglycemia & fasting
Caffeine
Aspartame
MEDICATION WITHDRAWAL
Common options for prevention:
This is not an exhaustive list, but it is a snapshot of what therapies may be employed.
Occipital Nerve Blocks: [1]
A local anaesthetic is injected (with or without steroids) on the back of your skull, assisting in calming nerves that may be contributing to your migraines. Occipital nerve blocks are routinely done as preventative therapy and may be most beneficial for those who experience very frequent migraines. You may be a good candidate for these if your pain radiates from the back of the head to the top, in a “C” shape.
Pharmaceutical Preventative Medications: [1,2]
Medications for preventative therapy of migraines has had little change since 2012. Beta blockers, tricyclic antidepressants, anticonvulsants, and botox injections are the common standard of care for migraine prophylaxis. Pharmaceutical prevention choices are chosen based on an individual basis, comorbid conditions, and tolerability.
BOTANICALS: Petasites & Tanacetum [2,3,4]
Both Petasites hybridus & Tanacetum parthenium may be effective in reducing migraine attack frequency. Petasites is a purified extract of the butterbur plant and is generally well tolerated when used for prophylaxis. Keep in mind that herbal supplements are not regulated, and thus it is difficult to gain an accurate estimation of how much therapeutic extract/herb is in the product.
Studies on Tanacetum parthenthium have mixed results but a systematic review of six trials showed reduced headache frequency with Tanacetum parthenium extract compared to without.
ORAL NUTRACEUTICALS: Coq10, Magnesium, Melatonin [2, 4, 6]
Nutraceutical prophylaxis research is limited, and it is difficult to study due to the lack of regulation around natural health products. Nevertheless, some products show promise in supporting migraine prophylaxis without the use of pharmaceutical intervention.
COQ10: Supplementation with Coq10 may have utility in reducing attack frequency (but not severity or duration).
MAGNESIUM: Magnesium use in migraines is based on the vascular theory of migraine development. In one study, oral magnesium showed a reduction in the number of migraine attacks by 22-43%. Intravenous magnesium does seem to be much more effective than oral.
MELATONIN: A study of melatonin use in 32 patients with migraine showed a 78% responder rate with reduction in frequency, intensity and duration of headaches at both 1 and 3 months compared to baseline. [5] It is unclear if migraine markers are improved due to the improvement of sleep, or from melatonin itself.
Hormone Replacement Therapy [2]
HRT for migraines is limited to premenopausal women, as the data on postmenopausal women generally suggests that HRT may worsen migraines in this population. HRT can be in the form of birth control or an estrogen patch, and it is reserved for those who experience menstrual related migraines.
Acupuncture [6]
Acupuncture is a component of Traditional Chinese Medicine (TCM) and involves the insertion of thin needles into specific points along energy meridians. Insertion of needles has been evidenced to increase the activity of the opioidergic system, which may be effective for the relief of pain. Research suggests that acupuncture may be able to reduce the frequency of acute migraine attacks, but the results likely will depend heavily on the expertise of the practitioner, as well as the chronicity of migraine.
Naturopathic Approach to Treatment of Migraines:
Effective treatment and prevention of migraines requires an acute diagnosis of WHY your migraines are occurring.
It is important to understand that there are conditions that often go hand in hand with migraines (comorbidities), such as below. However, even if comorbidities are addressed, it does not necessarily mean migraine frequency, duration or severity will improve.
Sleep disorders
Psychiatric Conditions
Allergic Conditions
Cardiovascular Disease
Irritable Bowel Syndrome
Restless Leg Syndrome
A Naturopathic Doctor can support you in gaining clarity into the root cause of your migraines and what can be done to reduce their frequency, severity, and duration. Once lifestyle and general health have been examined and assessed, labs may be done to rule out underlying conditions. Next, treatment options available can be discussed and a treatment strategy is formulated.
Treatment is always a discussion between you and your healthcare provider. It should be catered to your lifestyle, individual risk factors, and bandwidth for change.
References:
Charles, A. (2018). The pathophysiology of migraine: Implications for clinical management. The Lancet Neurology, 17(2), 174–182. https://doi.org/10.1016/s1474-4422(17)30435-0
Holland, S., Silberstein, S. D., Freitag, F., Dodick, D. W., Argoff, C., & Ashman, E. (2012). Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults. Neurology, 78(17), 1346–1353. https://doi.org/10.1212/wnl.0b013e3182535d0c
Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology. 2004 Dec 28;63(12):2240-4. doi: 10.1212/01.wnl.0000147290.68260.11. PMID: 15623680.
Patel, P. S., & Minen, M. T. (2019). Complementary and Integrative Health Treatments for Migraine. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society, 39(3), 360–369. https://doi.org/10.1097/WNO.0000000000000841
Peres MF, Zukerman E, da Cunha Tanuri F, Moreira FR, Cipolla-Neto J. Melatonin, 3 mg, is effective for migraine prevention. Neurology. 2004 Aug 24;63(4):757. doi: 10.1212/01.wnl.0000134653.35587.24. PMID: 15326268.
Millstine, D., Chen, C. Y., & Bauer, B. (2017). Complementary and integrative medicine in the management of Headache. BMJ. https://doi.org/10.1136/bmj.j1805
