Headaches are extremely common and often debilitating. In fact, the World Health Organization ranks headache and migraine among the top 10 most disabling conditions. More than 28 million people in the US suffer from migraine headaches, according to a 2001 report from the National Institute of Neurological Disorders and Stroke.
Some experts believe this number may be as high as 40 million by now. If that’s the case, it means there is a migraine sufferer in 25% of all U.S. households—and very likely, there will be one in your office waiting room at some time tomorrow.
The cost to society is also enormous. Migraine headaches add $13-17 billion to our healthcare costs each year (this includes medications, emergency room visits, hospitalization, physician services, laboratory and diagnostic services, and management of drug side effects). Migraines have indirect costs too: headaches are the most frequent pain-related complaint among workers – leading to absenteeism and lost or decreased productivity.
What is a Migraine?
This is an important question to ask, as fully 50% of all Americans who suffer from migraines don’t know it. They think they have tension headaches or sinus headaches, or they think their headaches can’t be migraines because they’re not lying in bed in agony all day and missing work.
The full spectrum of migraine spans all the above – headaches can be mild to severe, associated with nausea, diarrhea, light sensitivity, neck pain, nasal congestion, runny nose, tingling sensations, dizziness and vertigo, and even weakness on one side of the body that mimics a stroke. In order to effectively treat migraines, you must first know that someone has them.
The accepted diagnostic criteria for migraine is defined as at least five episodes of one sided or bilateral moderate to severe pain for at least four hours that includes any two of the following: nausea/vomiting, light sensitivity, worsening with movement, or a family history of migraine. However, many migraine patients do not meet all of these criteria. A simple screening test that works well is to define a migraine as ANY episodic headache that is somewhat disabling, i.e. you can’t go to work, you miss social functions, or you are simply less productive at what you are trying to do during the headache.
Here’s a simple 30-second assessment tool. If someone answers two of the following questions with a “yes,” odds are good that the headaches are migraines:
a. Do you ever miss work or school because of a headache?
b. Do lights or sounds bother you when you have a headache?
c. Do you become nauseous AND dizzy during a headache?
d. Are you completely pain free between headache episodes?
e. Does any immediate family member suffer from migraines?
While pharmacotherapy can help some people with migraines some of the time, the reality is that drug-based therapies are fairly limited. So far there is no definitive drug-based “cure” for migraine headaches. However, there are many non-pharma holistic approaches and self-care techniques that can be quite helpful.
In many cases—between 70-90% of all cases—patients notice that eating specific foods will trigger migraine headaches. The offending food can vary from person to person, however, there several “usual suspects.” Foods like chocolate, cheese, citrus and alcohol contain high amounts of amines, which can trigger migraines in some people. Other common triggers include wheat, egg, tea, coffee, milk, beef, corn, sugar, and yeast, in that order.
Cheese, beer, and wine can induce migraines because they contain histamines and vasoactive compounds that cause blood vessels to expand and platelets to clump; these are two key mechanisms presumed to underlie migraines. Women tend to react to histamine-containing foods more frequently than men do, on account of a deficiency in diamine oxidase, an enzyme that breaks down histamine.
Supplementation with a healthy dose of Vitamin B6 in its active form, pyridoxal 5’-phosphate or P5P, may be helpful in these situations, as it can increase diamine oxidase activity. Patients can usually get 15-20mg of P5P per day as part of a B complex or daily multivitamin.
Nitrites, which are common additives in deli meats and smoked/cured meats, also dilate blood vessels, and may also trigger migraine. For many reasons, it’s good to minimize consumption of these foods.
The food-migraine connection is not always straightforward. While some patients experience symptoms almost immediately after eating a trigger food, others experience more of a delayed response—up to 36 hours later—making it hard to identify the exact trigger. Still, it is important to realize that reactions to food can be a significant contributor to headaches. We’ve found that patients experience major reductions of symptoms, if not complete remissions, if we can help them identify and eliminate problematic dietary items.
Not that this is always easy: it is one thing to explain to someone that they have a certain allergy, and a whole other thing to get them to stop eating or drinking their favorite items! Often, the trigger causing someone’s pain and discomfort is the very thing that he or she eats or drinks on a regular basis.
Various other factors should be taken into consideration, including bowel issues (such as constipation), dehydration, mold/environmental allergies, hormonal imbalances, vitamin and mineral deficiencies (commonly magnesium), mitochondrial imbalances (deficiencies of antioxidants like Coenzyme Q10), hypertension, TMJ misalignment, spinal subluxations, artificial sweeteners (aspartame, Nutrasweet, Equal, Splenda), preservatives, additives & food-borne colorings and toxins (tartrazine, benzoic acid, MSG, sulfites, nitrates; pesticides, GMO foods, herbicides), to name just a few.
Botanical & Nutritional Therapies
Natural headache remedies can be found all around us, and unlike our forbearers several centuries ago, modern day herbal medicines and nutritional supplements have a firm root in science. The following are a few herbs and supplements that have proven clinically effective at treating migraines.
Feverfew (Tanacetum parthenium) has been used for centuries to treat migraine headaches (Diener HC, et al. Cepthalgia. 2005; 25(11):1031-41). In the 1980s, a survey of 270 people with migraines found that more than 70% of them felt much better after taking an average of 2-3 fresh Feverfew leaves daily. Since then, numerous studies have demonstrated the safety and efficacy of feverfew for preventing and decreasing frequency of migraine attacks using a daily dosage of 100-300 mg.
This herb has shown no major safety problems. However, it is important to note that feverfew may increase the risk of bleeding, especially in people taking blood-thinning drugs such as warfarin (Coumadin) or aspirin. Long-term use of Feverfew followed by abrupt cessation may induce rebound headaches, muscle and joint pains in some. Pregnant women should not take Feverfew2. Potential side effects can include abdominal pain, indigestion, nausea, vomiting, nervousness, and allergic reactions but these are rare (Pfaffenrath V, et al. Cephalgia. 2002; 22(7):523-32).
Butterbur (Petasites hybridus) is growing in popularity as a migraine treatment since it helps stabilize blood flow to the brain. Its active constituents (petasin and isopetasin) inhibit the synthesis of key inflammatory chemicals which can trigger migraines. Petasin and isopetasin act as antispasmodic agents on the vascular wall with an affinity for cerebral blood vessels. In a recent double-blind trial, Butterbur reduced migraine frequency by 50 percent after a 12-week period (Lipton, RB, et al. Neurology. 2004; 63:2240-2244).
A safe dose can range from 50-150mg of butterbur per day (Pothmann R, Densch U. Headache. 2005; 45(3):196-203). Some butterbur products may contain pyrrolizidine alkaloids (PAs), which can damage the liver or lungs, so be sure to utilize a PA-free form of butterbur, which is generally well tolerated.
Riboflavin (Vitamin B2) at high doses, can also be effective, especially when used in combination with other nutrients and herbs (Maizels M, et al. Headache. 2004; 44(9):885-90). In one study, daily doses of 400mg were administered for three months yielding a 59% response rate along with decreased headache frequency and severity. Riboflavin can impart a distinct yellowing of the urine which is a normal occurrence, and at this dose, there were no side effects (Boehnke C, et al. Eur J Neurol. 2004; 11(7):475–477).
Magnesium is a powerful reliever of stress and tension-induced migraines. A dosage of 100-200 mg up to three times per day can be an excellent way to help maintain vascular tone while preventing over excitability of nerve cells; both common causes of chronic migraine pain (Peikert A. Cephalalgia.1996;16:257–63).
Magnesium also plays an important role in mitochondrial energy production, cellular communication, skeletal and smooth muscle relaxation and production of serotonin and other neurotransmitters. The only caveat with magnesium is that one must be sure to divide up the daily dose; taking too much at one time can cause loose bowels.
Mindfulness & Self-Care
Self-care is essential for ongoing control of migraines and other chronic headaches; it begins with mindfulness. Rene Descartes, the father of modern philosophy, is famous for telling us that the world we see is interpreted by our brains through the lenses of our eyes – that the world around us exists because we think it. There is mounting scientific evidence that the mind actually has the power to do much more than that; we can actually leverage the power of minds to heal our bodies and our brains.
Self healing is easier than most of us would imagine. The simplest approach is to cultivate the ‘relaxation response.’ Rhythmic breathing evokes this basic state of relaxation. Here’s a very simple technique that you can easily teach your patients. Generally patients should practice this when they don’t have headaches, so they are able to apply the technique and obtain its benefits when they are in the throes of a headache.
• Sit in a comfortable chair, close your eyes and focus on your breathing
• Envision your lungs expanding and contracting with each breath – to the exclusion of all else around you.
• Stick with this for 10 full minutes.
In most cases, people feel immediately more relaxed with a sense of well being or diminished pain.
Remember that pain is perceived. The brain will modify perceptions based on what the mind is telling it. A more sophisticated, and yet easily achievable, form of mindfulness is meditation. The easiest meditations for the beginner are those that involve guided imagery. We have found that encouraging patients to visualize what’s happening in their bodies can be a great help. It goes like this:
• Again, find a comfortable position in your favorite chair or perhaps lying on a bed.
• With eyes open or closed (whichever you prefer) concentrate on your breathing.
• Then, imagine in your mind’s eye your toes and feet. Imagine the bones and muscles; see the blood flowing through your veins.
• Work your way up to your legs, trunk, arms and head, visualizing the blood flowing through the various parts of the body.
Meditating this way for just 10 minutes twice daily, can—over time—greatly reduce anxiety levels, improve energy and diminish pain.
Practices like yoga, biofeedback, Reiki, and cognitive behavioral therapy all have an element of mindfulness built in, and they can be valuable. Yoga is particularly helpful. It is safe, helps people restore balance, increases overall vitality, and engenders an attitude of empowerment.
Commonly practiced alongside meditation techniques, yoga may include any combination of appropriately paced movement coordinated with breathing, active postures based on ancient and well-validated principles of anatomical alignment, restorative postures (seated or lying down with the support of blocks, blankets and bolsters), breathing techniques, deep relaxation, and meditation.
Biofeedback, Reiki and cognitive behavioral therapy are non-pharmacological self-help treatments that can also play a role in migraine self care, but usually require the ongoing assistance of qualified professionals.
There are as many different approaches to treating migraines as there are individuals suffering from them. Our job as clinicians is to help people discover which causes or triggers are most important for them, and then to put together the optimal combination of nutritional, botanical, self-care—and in some cases, drug-based treatments—for them. Each person with chronic headaches has different pieces that form his/her very unique puzzle. Identifying those pieces is the key to a successful outcome.
Anthony P. Geraci, MD, is the founder and director of neurOasis, an integrative neurology clinic in New York City. Board certified in neurology, headache and electrodiagnostic medicine, Dr. Geraci is a member of the American Academy of Neurology, the National Headache Foundation, the American Headache Society, the International Headache Society, the American Telemedicine Association and the American Academy of Electrodiagnostic Medicine. He specializes in headache medicine, electromyography and nerve/muscle disorders, and is the principal investigator for 12 original studies, focusing on a range of neurological and neuropathic issues including migraine, acute, ischemic stroke and acute cerebral infarction and hyperglycemia. Dr. Geraci is the recipient of several prestigious awards, including the Patient’s Choice Award in 2008 and 2009 and recognition as one of the Best Doctors in America from 2004-2010.
Laurie Brodsky ND, HBSc, is a board-certified Naturopathic Doctor with a special focus in neurology, headache and gastroenterology, She utilizes the least invasive measures necessary for symptom improvement or resolution through a variety of lifestyle, dietary and behavioral modifications, and a diverse array of natural supplementation and individualized dietary recommendations. She graduated with high honors from the Canadian College of Naturopathic Medicine in Toronto, and completed an internship program at the Robert Schad Naturopathic Clinic, and the Sherbourne Health Center, Toronto. Dr. Brodsky is an active member on the Board of Directors for the New York Association of Naturopathic Physicians, and is the Medical Advisor for Everlast Sports Nutrition.