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Conventional Management of migraine headaches should begin with identification and removal, if possible, of factors that consistently provoke migraine attacks. Some of these triggers may include environmental factors such as cigarette smoke, loud noise, and bright or flickering lights; psychological factors including stress, anxiety, or depression; dietary factors such as alcohol, chocolate, caffeine, or tyramine containing foods, food additives, or citrus fruit; or life-style factors such as inadequate or excessive sleep, fasting or dieting, fatigue, skipping meals, or strenuous exercise.
A higher incidence of migraine is also seen during menstruation, while generally a decrease is seen during pregnancy. A number of medications have been associated with drug-induced migraine. Some of these are cimetidine, cocaine, ethinyl estradiol, fluoxetine, histamine, hormone replacement therapy, indomethacin, mestranol, nicotine, nifedipine, nitroglycerin, oral contraceptives, and reserpine.
The use of medications in management of migraine may be targeted in two ways, either to alter the attack once it is underway (abortive therapy) or prevention of the attack altogether. Abortive therapy must begin at the onset of the attack to achieve its full potential. Once an attack is fully developed, treatment is much less likely to be effective.
Simple analgesics, such as aspirin and acetaminophen, should be used in individuals with infrequent and mild forms of migraine. Aspirin is considered the drug of choice in these people, unless contraindicated or not tolerated. There are also combination medications, with additives such as caffeine, for increased GI absorption, bultalbital, to aid in sleep, and other narcotics for additional pain relief. These should be used with caution since rebound headache may occur when the effects wear off, leading to additional medication consumption.
Nonsteroidal anti-inflammatory drugs (NSAID's) have been used with some success in treating migraine headaches. Inhibition of prostaglandin synthesis by NSAID's may prevent neurogenic inflammation in the trigeminovascular system and alleviate migraine pain.(1) Those with a rapid onset of action such as ibuprofen or naproxen may be superior to those with a slower onset of action. Migraines that occur before, during, or after menstruation may respond well to NSAID therapy. The injectable drug, ketorolac, has been used in patients unable to tolerate oral therapy due to nausea and vomiting, and in patients with drug-seeking behaviors.
Ergotamine has been used for years as a treatment for migraine, and as theories of the pathophysiology of migraine have changed, so have proposed mechanisms of action for ergotamine and its derivatives. Currently, it is believed that antimigraine action occurs as a result of stimulation of presynaptic 5HT1 receptors. Ergotamine is available as an oral tablet, a sublingual tablet, and a suppository.(2)
Nutritional Supplementation Additional information (Precautions) is available by clicking on the underlined supplement. Magnesium
Magnesium's role in the pathogenesis of migraine headaches has been clearly established in numerous clinical and experimental studies. However, the precise role of how and why low levels of magnesium increase the risk of migraines remains to be discovered.
Examples of studies reporting on the relationship between magnesium and migraine headaches include the following: Patients with migraines have low brain magnesium levels(3) and in a study of 3,000 women, 80 percent responded well to magnesium supplementation.(4) Magnesium was also found to be effective in the prophylaxis of menstrual migraines. In a double-blind trial, women taking 360 mg/day of magnesium for two months reported a reduction in the number of days with headaches in addition to overall improvement in premenstrual complaints.(5) In addition to reducing the incidence of menstrual migraines, the authors of this study suggest that low levels of magnesium could actually act as a trigger to induce migraine headaches. Vitamin B2
High-dose riboflavin therapy has proven to be remarkably effective in the treatment of migraine headaches.(6) In an open study, 55 patients took 400 mg of vitamin B2 daily for three months. Riboflavin was far superior to placebo in reducing the frequency of migraine attacks and the number of days with headache. The number of patients who improved by at least 50% (responders) was 59% for riboflavin compared to 15% for the placebo patients. At this high dosage level, only two patients reported minor side effects of diarrhea and excess urination.(7) Vitamin D and Calcium
Two studies report that a combination of vitamin D and calcium were effective in reducing the frequency and duration of migraine attacks. One was a case study of two postmenopausal women who developed frequent and excruciating migraine headaches (one following estrogen replacement therapy and the other following a stroke). These women were treated with a combination of vitamin D and calcium. This therapeutic supplementation resulted in a dramatic reduction in the frequency and duration of their migraine headaches.(8)
The second study is a report of two premenopausal women with a history of premenstrual syndrome coupled with menstrually-related migraines. Each woman was treated with a combination of vitamin D and elemental calcium for late phase symptoms of PMS. Both cited a major reduction in their headache attacks as well as premenstrual symptomatology within 2 months of therapy.(9) The results of these two small case studies that vitamin D and calcium therapy should receive consideration as a possible treatment of migraine headaches. Omega-3 Fatty Acids and Omega-6 Fatty Acids
In an open-label uncontrolled study, 129 migraine patients completed a 6-month trial in which they were administered a combination of gamma-linolenic and alpha-linolenic acids. 86% of the patients experienced reduction in severity, frequency, and duration of their migraine attacks, 22% became completely free of migraines, and more than 90% reported a reduction in nausea and vomiting. Most of the participants reduced their self-medication to simple analgesics, while only 14% of patients experienced no improvement.(10)
Herbal Supplementation Additional information (Precautions) is available by clicking on the underlined supplement. Feverfew
Feverfew has gained immense popularity because of its effectiveness in relieving migraine headaches.(11, 12) It can take time for this herb to work, so staying on it for a minimum of a month is recommended for proper activity. It is also used for inflammatory conditions such as rheumatoid arthritis,(13) relaxing smooth muscle in the uterus,(14) inhibiting platelet aggregation and blood clotting,(15, 16) and fever.(17) Turmeric
In Ayurvedic medicine (traditional Indian medicine), turmeric rhizome has been used for centuries internally as a tonic for the stomach and liver and as a blood purifier, and externally in the treatment and prevention of skin diseases and in arthritic complaints.(18) The laboratory and clinical research indicates that turmeric and its phenolics have unique antioxidant and anti-inflammatory properties.(19) The anti-inflammatory strength of turmeric is comparable to steroidal drugs such as indomethacin.(20) Turmeric has been reported to be anti-rheumatic, anti-inflammatory, and antioxidant.(18) Many of these pharmacological factors contribute to the supportive use of turmeric in migraine headaches.(21) Kava
Decreasing and managing stress may also play a key role in relieving and preventing migraine headaches. The herb kava has been used for centuries by South Pacific natives. The root is used in the preparation of a recreational beverage known by a variety of local names (kava, yaqona, awa) and occupies a prominent position in the social, ceremonial, and daily life of Pacific island peoples as coffee or tea does in the Western cultures. In European phytomedicine, kava has long been used as a safe, effective treatment for mild anxiety states, nervous tension, muscular tension, and mild insomnia.(22, 23) Evening Primrose
Evening primrose oil (EPO) is rich in gamma-linolenic acid which is an omega-6 fatty acid.(24, 25) Omega-6 fatty acids reportedly reduce the arachidonic acid cascade and decrease inflammation through inhibiting the formation of inflammatory mediators in this process. Fatty acids are an important part of normal homeostasis. The human body can produce all but two fatty acids - omega-3 and omega-6 fatty acids. Both must be obtained through the diet or by the use of supplements. Obtaining a balance of these two fatty acids is essential. Essential fatty acids are needed for building cell membranes and are precursors for production of hormones and prostaglandins. Modern diets tend to be lacking in quality sources of fatty acids. Gymnema
In the instance where migraines may be related to sugar metabolism, the herb Gymnema may be useful. Gymnema is a rain forest vine found in Central and Southern India which has a long tradition in the treatment and management of diabetes. The Indian name is Gurmar, which means “sugar destroyer.” Its use has been documented in Ayurvedic medical texts for over 2000 years in the treatment of “sweet” urine. Gymnema is gaining popularity with clinicians utilizing natural therapy protocols in the management of diabetes, hyperinsulinemia, and impaired glucose tolerance. The leaves of gymnema are thought to increase insulin secretion, and several studies report control of hyperglycemia in moderately diabetic laboratory animals.(26, 27)
Homeopathy Iris versicolor
Typical Dosage: 6X or 6C, 30X or 30C
Headache starts with blurred vision;
Sharp, throbbing pain mostly located above the eyes;
Especially on the right side Lachesis mutus
Typical Dosage: 6C
Congestive headaches;
Especially left-sided;
Menopausal headaches;
Worse from heat and alcohol Natrum muriaticum
Typical Dosage: 6X or 6C, 30X or 30C
Pounding in the head;
Especially in the morning;
Worse from moving the eyes or head Spigelia anthelmia
Typical Dosage: 6X or 6C, 30X or 30C
Intense, neuralgic pain above left eye or left side of head;
Worse from noise and in the morning Thuja occidentalis
Typical Dosage: 6X or 6C, 30X or 30C
Boring;
Pressing pain;
Especially left-sided
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