Headache Migraine

Migraines are pounding or throbbing headaches that start suddenly last for hours and usually occur with other symptoms such as nausea. The headaches usually occur between ages 10 and 30 often vanishing after age 50 or in women after menopause. More women than men have migraines.

Signs and Symptoms

• Throbbing or pounding pain on one side of your head (or both)
• Nausea and vomiting
• Disturbances in your hearing or vision (such as flashes of light) that often start 10 to 30 minutes before the headache
• Parts of your body may feel numb weak or tingly
• Light noise and movement—especially bending over—make your head hurt worse; you want to lie down in a dark quiet room
• Your feet and hands feel cold and may look bluish

What Causes It?

No one knows for certain what causes migraine. They can run in families. Researchers do know that something triggers blood vessels in the head to tighten and then expand a process that irritates the nerves surrounding those blood vessels. Things that can trigger migraine include the following.

• Abnormal blood levels of the neurotransmitter serotonin
• Medicines for high blood pressure angina and arthritis
• Certain foods and alcohol; missing meals; too much sun; sleeping too little or too much
• Hormones and menstruation
• Certain odors such as perfume or cigarette smoke
• Stress

What to Expect at Your Provider's Office

Your health care provider will ask questions to help identify the cause of your headaches. He or she will teach you how to use painkillers so the medicine doesn't cause a "rebound headache."

Treatment Options

Treatment Plan

Avoid all known migraine triggers if possible. Put an ice pack on your forehead at the onset of a headache. Regular aerobic exercise can reduce the frequency and intensity of migraine episodes. Various drugs are available both to prevent migraines and to relieve their symptoms.

Drug Therapies

Prescription

• Ergotamines—relieves moderate migraines; taken orally or by suppository
• Dihydroergotamine (DHE)—for severe migraines; taken orally by injection or intravenously
• Beta-blockers or calcium-channel blockers—are blood pressure medications that work by controlling expansion and contraction of blood vessels and can also prevent migraines in some people; various side effects
• Lidocaine nasal spray—may give quick relief

Over the Counter

• Aspirin or ibuprofen—may be effective for mild migraines especially if taken early in the attack

Complementary and Alternative Therapies

A combination of drugs for pain relief and complementary therapies to reduce recurrence can offer effective management of migraines. Biofeedback to control vascular contraction and improve stress management may influence the frequency and intensity of attacks.

Nutrition

• Avoid food allergens. Some common allergens are alcohol (especially red wine) cheese chocolate citrus cow's milk wheat eggs coffee tea beef pork corn tomato rye yeast shellfish food additives (preservatives and coloring) and nitrates.
• Avoid caffeine because it is a vasodilator.
• Essential fatty acids (1 500 to 3 000 mg per day) may be helpful. Supplementing with fish oil or flax seed oil (1 to 3 mg twice a day) may also be helpful.
• Magnesium (500 mg per day) increases muscle relaxation.
• Injection of one gram of magnesium by a physician can terminate an acute migraine headache within minutes.
• Injection of folic acid (15 mg) in one study achieved total relief of acute headache within one hour in 60 percent of patients.
• Omega-3 oils (EPA and DHA average dose 14 grams daily) greatly reduce intensity and frequency of migraines.
• Vitamin B₂ (riboflavin) (400 mg/day for three months) has been shown to reduce migraine frequency by two-thirds.
• Vitamin C (2 000 mg per day) vitamin E (400 to 600 IU per day) vitamin B₆ (100 mg per day) choline (100 to 300 mg per day) and mixed bioflavonoids (1 000 mg per day).
• 5-hydroxytryptophan (300 mg twice a day) for migraine prevention enhanced by taking with 25 mg of vitamin B₆.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Feverfew (Tanacetum) can help with both frequency and intensity of migraines. Take two fresh leaves daily 250 to 300 mg dried herb (capsules) twice a day or 30 drops of tincture three times per day. Use feverfew by itself.

Use the following herbs in combination. Put 1 tsp. of each herb in one cup of water; steep for 10 minutes and take two to four times a day. For tinctures use 60 drops of each herb two to four times a day. Jamaican dogwood (Piscidia piscipula); skullcap (Scutellaria lateriflora); gingko (Gingko biloba); ginger (Zingiber officinalis); meadowsweet (Filipendula ulmaria).

Homeopathy

Some of the most common remedies used for migraines are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

• Iris versicolor: for periodic migraines that begin with blurred vision
• Lac defloratum: for a migraine in the front of your head that starts with an aura of dim vision nausea vomiting and chills
• Natrum muriaticum: for migraines that feel like "hammers beating the head that are better when you lie down alone in the dark
• Sanguinaria: for right-sided migraines that begin in your neck and move up, and migraines that make you vomit

Physical Medicine

Chiropractic adjustments or craniosacral therapy may be helpful.

Acupuncture

May be helpful especially if migraines are hormonally influenced.

Massage

Massage may help release chronic neck and shoulder tension and maintain an even blood flow to the head.

Special Considerations

Call your provider if you suddenly develop new symptoms.

Supporting Research

Berkow R. The Merck Manual. 15th ed. Rahway NJ: Merck Sharp & Dohme Research Laboratories; 1987.

De Weerdt CJ Bootsma HPR Hendricks H. Herbal medicines in migraine prevention. Randomized double-blind placebo controlled crossover trial of a feverfew preparation. Phytomedicine. 1996;3:225–230.

Gruenwald J Brendler T Jaenicke C et al eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998.

Minirth F. The Headache Book: Prevention and Treatment for All Types of Headaches. Nashville Tenn: Thomas Nelson; 1994.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993.

Murphy JJ Heptinsall S Mitchell JRA. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet. 1988;2:189–192.

Murray MT. Encyclopedia of Nutritional Supplements. Rocklin Calif: Prima Publishing; 1996.

Palevitch D Earon G Carasso R. Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: a double-blind controlled study. Phytotherapy Res. 1997;11:508–511.

Pryse-Phillips W. Guideline for the diagnosis and management of migraine in clinical practice. Can Med Assoc J. 1997;156:1273–1287.

Walker L Brown E. The Alternative Pharmacy: Break The Drug Cycle With Safe Natural Treatment For 200 Everyday Ailments. Paramus NJ: Prentice Hall; 1998.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.