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Migraines, often experienced as a painful, throbbing headache and sometimes causing nausea and light sensitivity, affect 1 billion people worldwide. Some studies suggest that one in seven people will experience this severe headache at some point in their life—almost one in five women and one in 15 men. In the United States, management of migraine headaches are believed to cost the healthcare system $78 billion dollars annually.
Migraine headaches are a leading reason patients visit their primary physician and emergency rooms, where one will frequently be exposed to radiation from a head CT scan. However, this is occasionally necessary to ensure there is no blood on the brain, which is a rare cause of a severe headache.
Migraines appear to be triggered by “malfunctioning nerves and blood vessels” in the brain, which inappropriately activates the trigeminal-cervical pain system. While scientifically complicated, understanding how migraines start allows doctors to best prevent and treat them. In addition, there appears to be a genetic component to migraine headaches as mothers and daughters are frequently both affected.
When a person is diagnosed by their physician with a migraine, it is important to try to find the triggers so they can be eliminated from the diet and the migraine prevented.
Medications frequently used to help control migraine headaches include the following:
Other medications used during an acute migraine include anti-nausea medications such as chlorpromazine, ondansetron and promethazine. CGRP receptor antagonists are being studied and may be more common in the future. In addition, ergots such as ergotamine are sometimes used. Caffeine can also be helpful for some.
Prescription drugs are also sometimes used to help prevent migraine headaches. It is estimated that 38 percent of migraine sufferers are candidates for preventive therapy, but only three to 13 percent take a preventive approach. These include propranolol, amitriptyline (Elavil), valproic acid and topiramate (Topamax). The effectiveness of these medications is variable, person to person.
Prevention is truly the best medicine and trying to avoid a migraine from starting is really the best strategy. I usually recommend my patients try diet and lifestyle changes, and natural supplements as the first line before starting pharmaceuticals for prevention. For most, this approach is effective.
Over the last 100 years, thousands of chemicals have been created by companies and discarded into our water supply, air, and even home environments. With many of these chemicals, we still have limited information on how they affect us. However, we do know that many have negative health consequences, and a migraine headache is included. Each person has toxic chemicals in their bodies—there is no way to completely avoid it. However, we can try to minimize the long-term effects of exposure. Detoxifying the body is crucial to healing the body. Learn more about detoxifying the body and fixing a Leaky Gut.
Avoiding processed food is important for those with migraines. Processed foods have chemicals that are foreign to the human body (xenobiotics) and have negative effects on our physiology. These include food preservatives and food dyes. Many migraine sufferers do well when they avoid dairy products and grains, including gluten. Others with migraines are sensitive to corn and soy.
Consuming a diet high in fruits and vegetables is a good place to start. If possible, pesticide-free (organic) fruits and vegetables should be purchased. Familiarize yourself with the "Clean Thirteen", which names produce that is safer to eat conventionally, and "Dirty Dozen", a list of fruits that should be purchased organic. Also, if you consume meat, purchase a grass-fed, antibiotic-free, and hormone-free option. While this may be more expensive up front, there is a potential for cost savings if it helps prevent chronic health conditions and improves one’s quality of life.
After cleaning up one’s diet, adequately hydrating, exercising daily, and optimizing one’s sleep, there are a few natural therapies that scientific studies have shown to be effective in preventing migraine headaches.
Over the last several decades, studies have proven many nutraceuticals to be helpful in the prevention of migraine headaches. As more people search for non-drug approaches, supplements have become a popular alternative.
Riboflavin – Also known as vitamin B2. This vitamin has been shown to be effective in preventing migraines. A 2017 study in the Journal of Clinical Pharmacy and Therapeutics, which evaluated eleven studies concluded: “Riboflavin is well tolerated, inexpensive and has demonstrated efficacy in the reduction of adult patient's migraine headache frequency”. A 2014 study in Canadian Family Physician also demonstrated riboflavin’s usefulness in children with migraine headaches. Suggested dose: Adults - Riboflavin 400 mg daily. Pediatrics - 100 to 400 mg daily.
Magnesium – I have recommended magnesium to patients who are afflicted with migraines for over a decade. In my experience, it works for four in five people in that it helps prevent migraine headaches from starting. The scientific research supports my doctoring experience. A 2017 study in The Journal of Head and Face Pain concluded that migraine headaches could be prevented with magnesium. Other studies show similar findings. Suggested dose: Magnesium chelate -125 mg to 500 mg daily to help prevent migraines. Start low and increase as needed.
Ginger – anti-nausea benefits but also can be helpful in the treatment of a migraine. Its use can be found in Ayurvedic medicine. A 1990 study demonstrated knowledge of ginger’s effectiveness in the treatment of migraines while a 2014 study showed ginger to be just as effective as the pharmaceutical drug sumatriptan when treating a migraine. Drinking ginger tea may also be helpful to minimize symptoms of nausea. Suggested dose: Ginger 250 mg to 500 mg once or twice daily.
Omega 3-Fish Oil – A 2017 study in Nutritional Neuroscience showed that omega-3 fish oils could help reduce the duration of migraine headaches. A 2012 study compared fish oil and valproic acid versus valproic acid use all by itself for migraine prevention. The fish oil and valproic acid combination was more effective in preventing headaches. Lastly, a 2017 study, during which subjects took fish oil and curcumin (turmeric), showed a reduction in migraine headaches. Suggested dose: Omega 3-fish oil 2,000 to 4,000 mg daily. Divide into twice a day dosing.
Coenzyme Q10 (CoQ10) – Studies show CoQ10 can help prevent migraines. A 2017 study concluded “… that CoQ10 might reduce the frequency of headaches, and may also make them shorter in duration, and less severe, with a favorable safety profile.” Another 2017 study and a 2011 study also showed a benefit of CoQ10 supplementation in preventing migraines. Suggested dose: Coenzyme Q10 100 mg to 300 mg daily
Alpha Lipoic Acid – A 2017 study in the Journal of Medicinal Food showed this potent antioxidant, when taken at doses of 400 mg twice per day, could help prevent the frequency and duration of a migraine headache. A 2007 study showed similar benefit. Suggested dose: Alpha Lipoic Acid 600 to 800 mg daily to prevent migraines, okay to take in divided doses.
Melatonin – Melatonin, the “sleep vitamin” has been shown to be effective in preventing migraine headaches. A 2017 study compared 3 mg of melatonin with the prescription drug valproic acid. Melatonin was shown to be more effective and without side effects. A 2017 study showed melatonin reduced CGRP levels and helped prevent migraines. Lastly, a 2017 study in the Journal of Family Practice showed melatonin as effective as the prescription drug amitriptyline in preventing migraines. Suggested dose: Melatonin 3 mg to 10 mg each night 1-2 hours before bed.
Feverfew – Feverfew ( Tanacetum parthenium) is a perennial herb well known for its medicinal properties. It is frequently used to help prevent migraines, and studies show some benefit. A 2017 study showed feverfew, when taken with magnesium and coenzyme Q10 could be effective in migraine prevention. Suggested dose: Feverfew 250 mg once or twice per day.
Butterbur – This supplement can also help prevent migraines. However, it should only be taken if pyrrolizidine alkaloids (PA)-free, as this substance can cause liver problems. Suggested dose: Butterbur 75 mg once to three times daily.
Migraine headaches are a leading reason people miss work and seek medical care. These severe headaches are estimated to affect 1 billion people worldwide. Remember, a healthy diet can play an important role in preventing migraines. Avoiding triggers is also crucial and, for many, this includes dairy and gluten. Pharmaceutical drugs can also be very effective but concerns about side effects result in people seeking alternatives. Fortunately, there are options. Many start with riboflavin as first line. Adding magnesium chelate and ginger should also be considered. If the use of these three supplements are not sufficient, adding additional supplements can be considered. Be patient, it may take a few months before the right combination is found.
Eat healthy, think healthy and be healthy.
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By Dr. Eric Madrid, M.D.
