Health

Migraine Treatment

As headaches go, migraines are in a class by themselves. They don’t just hurt. They pound, they throb, they incapacitate. When a migraine comes on, it can knock you off your feet for hours, possibly days.

Some 24 million Americans-about 18 million women and 6 million menget migraines. They account for 31 percent of all doctors’ appointments for headaches, making them the second most common type of headache. (Tension headaches rank number one.)

Scientists still aren’t certain what causes migraines. But they have identified one culprit: the blood vessels in your head. These vessels contract and expand in response to foods, drugs, hormones-all sorts of things. If these changes happen to aggravate nearby pain nerves, you may get a migraine.

Also to blame are your platelets, the blood cells involved in forming clots. If you’re prone to migraines, your platelets are more likely than normal to clump together-a process that triggers the release of the brain chemical serotonin. And serotonin, in turn, plays a role in triggering migraines.

Migraines often strike in the morning. In about 20 percent of cases, they announce their impending arrival with peculiar smells or visual disturbances-flashing lights, blurred vision, blind spots. These unusual symptoms, called auras, usually begin about 20 minutes to an hour before the onset of a migraine.

Whether or not you experience an aura, the migraine itself is unmistakable. It produces severe pounding, throbbing pain, usually.on one side of your head. You may also experience nausea and vomiting. These symptoms can last anywhere from a few hours to a couple of days.

How often migraines occur varies from one person to the next. Most people get between two and five migraines a month. But for some poor souls, migraines occur almost daily.

If you’re prone to migraines, you’re probably a woman. About 75 percent of all migraine sufferers are female. Some two-thirds of these women get their headaches around the time of their periods, according to endocrinologist Ivy Fettes, M.D., Ph.D., assistant professor of medicine at the Sunnybrook Health Science Center at the University of

Toronto.

Why do so many women develop menstrual migraines? As Dr. Fettesauthor at www.howtogetrid.org explains, the hormone estrogen causes the blood vessels in the head to expand. So when estrogen levels fluctuate over the course of the menstrual cycle, the blood vessels respond by contracting and expanding. This is what triggers migraines.

Gender isn’t the only factor that influences your risk of migraines. For instance, family history appears to playa role. While no clear genetic link has been identified, migraines tend to run in families.

Age is another factor. Most people experience their first migraines during their childhood or teenage years, often after years of motion sickness. The headaches typically peak by age 35, then gradually decline-one of the nicer benefits of getting older.

Many mainstream M.Do’s prescribe medications that can not only stop migraine pain but also minimize the frequency and severity of recurrences. But because these medications have side effects, many people prefer to explore other treatment options first. That’s where blended medicine can help.

Best Choices

Nutrition

Reduce dietary fat. At least one study suggests that switching to a low-fat diet can reduce the frequency, severity, and duration of migraines. The easiest way to cut your fat intake is to steer clear of meats, dairy products, snacks, and desserts. Replace them with naturally nutritious grains, beans, fruits, and vegetables-except for those that are known migraine triggers. (More on migraine-causing foods in a bit.)

Eat less meat, more fish. Meat is one of the top sources of fat in the typical American diet. Much of that fat is saturated, the kind that makes-platelets more likely to clump together and trigger migraines, says Joseph Pizzorno Jr., N.D.

On the other hand, fish-especially salmon and other cold-water species-contain an abundance of essential fatty acids. These “good fats” help keep platelets from clumping.

Get to know tofu. If you’re a woman who’s prone to menstrual migraines, Susan M. Lark, M.D., director of the PMS and Menopause Self-Help Center in Los Altos, California, suggests eating more tofu. Tofu contains plant estrogens, or phytoestrogens. They’re weaker than your own estrogen, but they have similar effects on your body. So by eating tofu, you raise your body’s estrogen level naturally. This counteracts the hormonal fluctuations that cause blood vessels in your head to contract and expand, triggering migraines.

Head off pain with garlic and onions. Both garlic and onions as well as their close relatives shallots, chives, and leeks make your platelets less likely to clump. “You don’t want to knock out your platelets altogether because then your blood won’t clot,” says James A. Duke, Ph.D. “But making them a little less active helps prevent migraines, and garlic and onions do that.” Increasing your intake of garlic and onions is easy: Use the two as ingredients in your cooking as often as possible.

Supplements

Make magnesium your medicine. According to Alan Gaby, M.D., magnesium has many of the same effects as the drugs main­stream M.Do’s use to treat migraines. It makes platelets less likely to clump together. It helps minimize the contraction and expansion of blood vessels. And it inhibits the release of compounds involved in pain and inflammation. Dr. Gaby recommends taking 200 milligrams of magnesium one to three times a day.

Experiment with riboflavin. One of the B vitamins, riboflavin plays a role in certain cellular processes that don’t work quite right in those who are migraine­prone, Dr. Gaby says. To find out whether supplemental riboflavin could help treat migraines, researchers asked 49 people to chart their headaches. Then the participants began taking 400 milligrams of riboflavin every morning at breakfast. After 3 months, the average number of migraines fell 67 percent.

The findings of this study have yet to be confirmed by further research. Still, Dr. Gaby says, riboflavin is a safe and inexpensive supplement. It may be worth a try. Use the same dosage as in the study: 400 milligrams every day at breakfast.

Grow fond of fish oil. If you’re not especially fond of fish, you can get those migraine-fighting essential fatty acids from fish-oil supplements, Dr. Gaby says. In one study, 15 migraine-prone people who had not responded to mainstream drugs reported significantly milder migraines while taking fish oil. If you want to try fish oil, take 5 grams three times a day, as done in the study.

Elimination Diet

Get rid of food triggers. “There is little doubt that food intolerances are the major cause of migraines,” Dr. Pizzorno says. “Several studies show that eliminating offending foods greatly reduces migraine symptoms.” To discover which foods may be triggering your migraines, Dr. Pizzorno recommends an elimination diet. (Consult with a doctor or practitioner for guidance.)

Weed out the primary offenders. If you’d rather not follow a true elimination diet, you can simply cut out the foods with the nastiest reputations for triggering migraines, Dr. Gaby says. The leading offenders include cow’s milk, cheese, wheat and bread products, corn, rice, beef, eggs, oranges and other citrus fruits, chocolate, and alcohol (especially red wine). Other possible food triggers include shellfish, tomatoes, bananas, figs, nuts, lunchmeats, fermented or pickled foods, and foods containing artificial sweeteners (such as saccharin or aspartame), monosodium glutamate (MSG), or sulfites.

Turn to a rotation diet. If you give up the common food triggers and still get migraines, you may have low-level sensitivities to other foods. In this case, Dr. Pizzorno suggests trying a 4-day rotation diet. This means that you don’t eat any food more than once every 4 days.

Visualization

See yourself migraine-free. Dawn Marcus, M.D., assistant professor of neurology at the University of Pittsburgh School of Medicine, recruited 44 pregnant women with migraines, tension headaches, or both. Thirty of the women enrolled in a class in which they learned a combination of deep breathing, muscle relaxation, and visualization. The rest of the women received no treatment. By the time the class ended, 80 percent of the participants reported less headache pain, compared with just 43 percent of the women who received no treatment.

Martin L. Rossman, M.D., has produced many relaxation tapes that combine music and visualization exercises to help prevent migraines. For a free catalog, write to the Academy for Guided Imagery at P. O. Box 2070, Mill Valley, CA 94942-2070.

Herbal Medicine

Have fewer migraines with feverfew. Israeli researchers gave either feverfew or a placebo to 57 people with migraines, none of whom had ever tried the herb. After 2 months, everyone switched treatments, so those who had been taking feverfew were on the placebo, and vice versa. All of the participants reported significantly fewer headaches while taking the herb.

Feverfew is believed to stop migraines in several ways. It discourages blood vessels from constricting and dilating in response to certain things. It prevents the release of serotonin from platelets. And it reduces the production of prostaglandins, leukotrienes, and thromboxanes, compounds that play roles in your body’s pain response. Most studies involving feverfew have used 82 milligrams of dried, powdered leaf, taken once a day.

Try herbal aspirin. The herb willow bark contains salicin, which is the natural precursor to aspirin. “Any pain problem that you treat with aspirin you can also treat with willow bark tea;” Dr. Duke says. Commission E, the German expert panel that evaluates the safety and effectiveness of herbal medicines, also endorses willow bark for headaches, including migraines. The commission recommends taking the herb as a tea. Simmer 1 to 1 1/2 teaspoons of powdered willow bark in 1 cup of boiling water for 10 minutes, then strain. Drink up to three cupfuls of tea a day.

Take ginger. like garlic and onions, ginger helps prevent platelets from clumping. The herb also relieves nausea, a common symptom of migraine. “There aren’t any good studies of ginger as a treatment for migraines,” Dr. Gaby says. “But there are good reasons to use ginger. It can’t hurt.” He suggests taking 500 milligrams of ginger every 4 hours during a migraine episode.

Chiropractic

Manipulate migraine pain. Australian researchers asked chiropractors to perform spinal manipulation on 85 migraine-prone people. Meanwhile, another group received head and back massages from doctors. After 6 months, both groups experienced fewer and briefer migraines. But only the people who received chiropractic manipulation reported less pain.

Homeopathy

Get a personalized prescription. French homeopaths evaluated 60 people with migraines, then recommended homeopathic medicines based on each person’s specific symptoms. Half of the participants took the prescribed medicines every 2 weeks for 2 months. The rest took a placebo for the same amount of time. Seventeen percent of the placebo takers reported significant relief from migraine pain. Among those taking homeopathic medicines, that figure rose to 93 percent.

The medicines used in the study were Belladonna, Cyclamen, Gelsemium, Ignatia, Lachesis, Natrummuriaticum, Silicea, and Sulfur. To find out which of these medicines might benefit you, consult a homeopath.

Chinese Medicine

Revive your Blood. The classic Chinese herbal formula for treating headache is called Chuan Xiong Cha Piao. It contains quite a few herbs, including ligusticum, angelica, asarum, and peppermint. It breaks up the stagnation of Blood, which causes the sharp, stabbing, localized pain that characterizes migraine, says EfremKomgold, O.M.D.,L.Ac. If you want to try Chuan Xiong, you need to consult an oriental medicine practitioner.

Take care of your Liver and Gall­bladder. The irritability and light sensitivity associated with migraines points to a problem in the Liver and Gallbladder. To prevent migraines, you want to nurture these organ networks by eliminating dietary fat, spicy foods, alcohol, and stimulants (the pharmaceutical variety as well as caffeine) and avoiding strong odors, Dr. Korngold says.

Let your fingers provide relief. A number of studies suggest that acupuncture is an effective treatment for headaches, including migraines. In fact, it works so well that it has won the endorsement of both the United Nations World Health Organization and the National Institutes of Health.

Of course, if you want to try acupuncture, you need to consult a trained acupuncturist. If you prefer a do-it-yourself approach, you can use acupressure instead, says Michael Reed Gach, founder and director of the Acupressure Institute. He suggests applying steady, penetrating finger pressure to each of the following points for 3 minutes.

  • Large Intestine 4, located on the back of your hand where the bones of your thumb and index finger meet
  • Governing Vessel 25, located between your eyebrows, where the bridge of your nose meets your forehead
  • Bladder 2, located on either side of your nose, where the bridge of your nose meets the ridge of your eyebrows
  • Governing Vessel 16, located in the center of the back of your head, in the hollow at the base of your skull
  • Stomach 3, located at the base of your cheekbone, directly below your pupil
  • Liver 3, situated on top of your foot in the webbing between your big toe and second toe

If acupressure doesn’t seem to relieve your migraine pain, you may want to consider seeing an acupuncturist. Professional needle stimulation of the points above may help even when finger stimulation doesn’t.

Home Remedies

Migraine Treatment

Use caffeine to control your pain. Studies dating back to the 1970s show that 65 milligrams of caffeine-about the amount in a cup of instant coffee or a half-cup of brewed-boosts the effectiveness of aspirin and other over-the-counter pain relievers by about 40 percent. Scientists believe caffeine helps ease migraine pain because moderate, occasional consumption constricts the blood vessels in your head.

Steer clear of offenders. According to Jerome Goldstein, M.D., director of the San Francisco Headache Clinic, certain lifestyle and environmental factors can cause migraine pain. Among the potential triggers: emotional stress, hunger, fatigue, changes in sleep habits, sex, flashing lights, sun glare, loud noises, changes in the weather, and strong smells.

To help you identify what may be behind your migraines, try keeping a migraine diary, advises Anne Simons, M.D. Whenever you have a migraine episode, write down the date and time that it occurs as well as all of the foods and beverages you consumed within the previous 12 hours. Also note any physical, psychological, or environmental factors that may have contributed to your migraine. Over time, you may see a pattern that you can change.

Over-The-Counter Drugs

Take half an aspirin a day. In the late 1980s, a Harvard study involving 22,000 American male doctors made headlines by showing that low-dose aspirin-one standard tablet every other day-cuts heart at­tack risk by 44 percent. When the researchers examined their data more carefully, they made another startling discovery. Among the doctors who were prone to migraines, taking low-dose aspirin reduced migraine frequency by 20 percent. Aspirin prevents migraines by making platelets less likely to clump together.

If you want to try aspirin, take half a pill every day. This dosage has the same effect as the every-other-day regimen.

Keep Excedrin on hand. The Food and Drug Administration has approved Excedrin as the first over-the-counter drug treatment for mild to moderate migraines. You can take either regular Excedrin or Excedrin Migraine. Both contain a combination of aspirin and caffeine. As mentioned earlier, caffeine boosts the pain-relieving power of aspirin by about 40 percent.

Rely on NSAIDs. According to Dr. Gold­stein, mild migraines sometimes go away with help from over-the-counter nonsteroidal anti-inflammatory drugs (NSAlDs). This category of medicines includes aspirin, ibuprofen, and naproxen (Aleve). Whichever one you choose, follow the dosage recommendations on the label.

Other Good Choices

Medical Measures

Mainstream M.D.’s treat migraines with some 200 different medications. Some of these drugs help relieve pain. They include prescription-strength NSAIDs, ergot derivatives, lidocainenosedrops, antinausea drugs, and medications that constrict blood vessels-notably sumatriptan (Imitrex) and zolmitriptan (Zomig). Other drugs help prevent migraine episodes. Among them are beta-blockers, calcium channel blockers, antidepressants, and anticonvulsants.

Depending on your medical situation, you may not be able to use one or more of these medications. Before you start taking any migraine medication, ask your physician or pharmacist to explain all of the possible side effects.

For menstrual migraines, your doctor may prescribe an estrogen gel or patch. You apply the estrogen 2 days before the time in your cycle when you get your migraines, then continue using it for a week. Research has shown that estrogen decreases the frequency and severity of menstrual migraines.

According to Dr. Goldstein, certain prescription drugs can actually cause migraines. If you’re taking any drug and you’re experiencing migraines, talk to your doctor about switching to another pharmaceutical.

Because migraines and other headaches are so common, special clinics have sprung up around the country that focus exclusively on treating them. To find a practitioner near you, contact one of the following organizations.

  • The American Council for Headache Education, 19 Mantua Road, Mount Royal, NJ 08061-1006
  • National Headache Foundation, 428 West Saint James Place, Second Floor, Chicago, IL 60614-2750

Red Flags

If you experience any of the following, see your doctor right away.

  • An unusually severe headache
  • A headache that lasts longer than 3 days, despite home treatment
  • Headaches that recur more often or get worse over time
  • A headache accompanied by a fever of 102°F or higher
  • Head pain that increases when you bend your chin to your chest
  • Headache accompanied by slurred speech, blurred vision, or numbness or weakness in the arms or legs
  • Head pain that results from a head injury.
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