Migraines: What a Headache!

Migraine headaches are painful and frustrating.  36 million Americans suffer from them, or 12% of the population.  Yet they remain largely a mystery in terms of how they are triggered and how they should be treated.

Unfortunately I've been learning a little too much about migraine headaches recently, as my teenage son has been suffering from them.  You'd think by now the medical profession would know everything there is to know and have an exact cure, but that certainly isn't the case.

Entire research studies and many books have been written on the subject, but hopefully my notes here will give you some insight if you're suffering or know someone who is.

What is a migraine?
A migraine is a type of headache. It may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head.  Some people who get migraines have warning symptoms, called an aura, before the actual headache begins. An aura is a group of symptoms, including vision changes. An aura is a warning sign that a bad headache is coming.  (source:  US National Library of Medicine)

What causes a migraine?
Migraines have many different causes, also called triggers.  Unfortunately, triggers are numerous and vary widely depending on the person.  Many people go for years or even a lifetime without knowing what causes their migraines.  Here are some leading causes of migraines:

• Food. Salty foods or aged foods, such as cheese and salami, may cause migraine headaches. Highly processed foods can trigger a migraine, too.
  
• Skipping meals. People with a history of migraines shouldn’t skip meals or fast unless it is done under a doctor’s supervision. Missing a meal can cause a migraine.
  
• Drink. Alcohol and caffeine may cause headaches.
  
• Preservatives and sweeteners. Some artificial sweeteners, such as aspartame, can trigger a migraine. The popular preservative monosodium glutamate (MSG) can, too. Read labels to avoid them.
  
• Sensory stimulation. Unusually bright lights, loud noises, or strong smells may set off a migraine headache, as can flashing lights or bright sun. Strong scents, such as perfume, paint, and cigarette smoke, are common triggers.
  
• Hormonal changes. Hormone shifts are an especially common migraine trigger for women. Fluctuating levels of estrogen may trigger headaches. For example, many women report developing migraine headaches right before or even during their period. That’s because estrogen levels fall dramatically during that time. Other women may develop hormone-induced migraines during pregnancy or menopause.
  
• Hormone medications. Medications, such as birth control and hormone replacement therapies, can trigger or worsen a migraine. However, in some cases, these medicines can actually reduce a woman’s migraine headaches.
  
• Other medications. Vasodilators, such as nitroglycerin, can trigger a migraine.
  
• Stress. Constant mental stress can cause migraines. Home life and work life are two of the most common sources of stress. Stress damages your body and your mind if you aren’t able to control it effectively.
  
• Physical stress. Extreme exercise, physical exertion, and even sexual activity can trigger migraine headaches.
  
• Sleep cycle changes. If you’re not getting regular, routine sleep, you may experience more migraines. Don’t bother trying to “make up” for lost sleep on the weekends, either. Too much sleep is just as likely to cause a headache as too little.
  
• Weather changes. What Mother Nature is doing outside may affect how you feel on the inside. Changes in weather and shifts in barometric pressure can trigger a migraine.  (source:  www.healthline.com)
  

How do I determine what causes my migraines?
If you are a migraine sufferer, it is critical for you to keep a migraine journal.  A migraine journal is a way for you to document the days leading up to a headache.  By documenting activities and specific foods that were eaten, the hope is that you can determine what triggers your particular migraines.  Here are some questions to answer:

• What times did I go to sleep and wake up?
• What did I eat and drink?
• What were my activities?  
• Did anything in particular bother me or cause me stress?
• What was the weather like?
• What medications or supplements did I take?
• Could it have been a time of month when I was more hormonal (especially for women)?

How do I treat my migraines?
It turns out that prevention is a lot better tactic than treatment.  In other words, it is best to try and stop the migraine from happening in the first place.  The best approach is to ensure that you are living a healthy lifestyle.  Ask yourself "am I doing everything possible in my power to live a healthy and balanced life so that hopefully these migraines can be prevented?"  

Living a healthy and balanced life includes:

• Getting enough sleep (see my blog post on sleep)
• Drinking enough water (see my blog post on drinking water)
• Managing stress in your life (see my blog post on taking care of your mind)
• Eating healthy (see my blog post on food planning)
• Exercising (see my blog post on making time for exercise)

These kinds of adjustments will in many cases diminish or even cure migraines.  You might say "but all of those things sound hard, and what if I did them and still have migraines?"  The answer is yes, you might still have migraines, but good health is its own reward.  

Don't jump straight to pescriptions
The medications doctors prescribe are potent and you run the risk of incurring potentially scary side-effects.  For example, one common migraine prevention medication that doctors prescribe is called Topomax.  

Let's look at its common side effects:  vision problems, especially blurred vision, double vision, eye pain, or rapidly decreasing vision, burning, prickling, or tingling sensations, clumsiness or unsteadiness, confusion, continuous, uncontrolled back-and-forth or rolling eye movements, dizziness, drowsiness, eye redness, generalized slowing of mental and physical activity, increased eye pressure, memory problems, menstrual changes, menstrual pain, nervousness, speech or language problems, trouble in concentrating or paying attention, and unusual tiredness or weakness. 
Less common side effects include abdominal or stomach pain, fever, chills, or sore throat, lessening of sensations or perception, loss of appetite, mood or mental changes, including aggression, agitation, apathy, irritability, and mental depression, red, irritated, or bleeding gums, and weight loss.  
Rare side effects include blood in the urine, decrease in sexual performance or desire, difficult or painful urination, frequent urination, hearing loss, loss of bladder control, lower back or side pain, nosebleeds, pale skin, red or irritated eyes, ringing or buzzing in the ears, skin rash or itching, swelling, and trouble breathing.

Other prescription medications aren't any better.  I know that you're suffering and just want a pill to make it better.  But consider whether you're trading one set of problems for another.  I know in the case of my son, even a little increase in dosage of the medication has aggravating side-effects.  So we minimize prescriptions and emphasize healthy lifestyle changes.  And more natural remedies.

What are some natural remedies?
The neurologist we are working with is great, because she is open and willing to try anything she or we have discovered that might help my son, including more natural remedies.  You might say "natural remedies by definition are ones that don't have any scientific research behind them and are probably just placebos."  This isn't the case at all. Consider the following remedies that actually have some well-tested, proven research behind them:

• Butterbur.  According to Life Extension Magazine, studies suggest that a standardized extract of butterbur (Petasites hybridus) is a powerful migraine-preventive agent.  Butterbur has been used for more than 2,000 years for conditions ranging from gastric disorders to allergies.  A specialized butterbur root extract has been available in Germany as a prescription remedy since 1988. More than half a million German citizens have used this remarkable plant extract for health concerns such as migraine prevention and allergies.  The good news is that this standardized butterbur extract is now also readily available in the United States as a dietary supplement.  Butterbur’s headache-preventive capabilities likely stem from its anti-inflammatory and spasmolytic (muscle-relaxant) effects. It contains active components known as isopetasin, oxopetasin, and petasin, which induce smooth muscle relaxation, particularly in cerebral blood vessel walls. Research indicates that petasin inhibits the proinflammatory lipoxygenase (LOX) enzyme, while both petasin and isopetasin exert highly potent anti-inflammatory effects by inhibiting leukotriene synthesis.  Butterbur extract has also been reported to inhibit cyclooxygenase-2 (COX-2) activity, which relieves pain and inflammation. In addition, butterbur petasins decrease the intracellular concentration of calcium, thus offsetting calcium-induced vasoconstriction, which also helps explain the herb’s anti-inflammatory and spasmolytic effects.
• Feverfew.  According to the Migraine Trust, Feverfew is used as a preventative (or prophylactic) treatment for migraine. A number of people have reported that after taking feverfew their migraines have gradually become less frequent and in a few cases have stopped altogether.  Until recently only a few scientific studies into the use feverfew had been conducted, and those few had been small in scale. However a well designed trial published in 2005 has attested to the efficacy of feverfew as a viable preventative treatment for migraine.
• Coenzyme Q10 (CoQ10).  According to Migraine.com, Coenzyme Q10 is found inside the body’s cells. It is key to cells proper functioning. Coenzyme Q10, also called CoQ10, can reduce damage to cells caused by the environment and other factors.  Coenzyme Q10 is similar to a vitamin and is needed inside of each of the body’s cells for the cells to produce energy.  A small study found that out of 31 patients who suffer from migraines, 19 of them reported the number of days they had migraines cut in half. Another small study of 42 migraine sufferers compared Coenzyme Q10 to an inactive placebo. In that study, of CoQ10 and migraine, the supplement was three times more likely than placebo to reduce the number of migraines.  A larger study of 1,550 patients ages 3 to 22 with migraine measured their Coenzyme Q10 levels. Of those migraine sufferers, 33 percent had low levels of CoQ10. Those with low levels received Coenzyme Q10 supplements and had fewer migraines.
• Lavender.  According to one widely-publicized study, Lavender essential oil has been used as an anxiolytic drug, a mood stabilizer, a sedative, spasmolytic, antihypertensive, antimicrobial, analgesic agent as well as a wound healing accelerator. The researchers said "We have studied for the first time the efficacy of lavender essential oil inhalation for the treatment of migraine in a placebo-controlled clinical trial.  Forty-seven patients with definite diagnosis of migraine headache were divided into cases and controls. Cases inhaled lavender essential oil for 15 min, whereas the control group used liquid paraffin for the same time period. Patients were asked to record their headache severity and associated symptoms in 30-min intervals for a total of 2 h. We matched the two groups for key confounding factors.  The present study suggests that inhalation of lavender essential oil may be an effective and safe treatment modality in acute management of migraine headaches."
• Peppermint. According to Headache and Migraine News, reports that a new study confirms that the oil of peppermint, and the active ingredient that comes from mint and peppermint oils – menthol – has long been used to fight migraine. And it’s a natural remedy that continues to be confirmed by the evidence, according to a study published in the International Journal of Clinical Practice in February 2010.  This was a small study, however it was a randomised, triple-blind, placebo-controlled, crossed-over study (that’s good).  The study covered 118 migraine attacks, and patients were given the menthol solution during the attack.  The side of the head with the most pain was washed with tap water, and then the 10% menthol solution was applied.  Patients receiving the menthol solution were more often pain free after two hours, and also were more often in less pain or pain free/in less pain over a longer time period.  Better yet, patients using the menthol had less nausea/vomiting, and less sensitivity to light or sound.
  
• Magnesium (200 - 600 mg per day).  According to the University of Maryland Medical Center, people with migraines often have lower levels of magnesium than people who do not have migraines, and several studies suggest that magnesium may reduce the frequency of migraine attacks in people with low levels of magnesium. In one study, people who took magnesium reduce the frequency of attacks by 41.6%, compared to 15.8% in those who took placebo. Some studies also suggest that magnesium may be helpful for women whose migraines are triggered by their periods. Side effects from magnesium can include lower blood pressure and diarrhea. Magnesium can interact with medications including heart medications, diuretics or water pills, some antibiotics, and muscle relaxers.
• Vitamin B2 (riboflavin, 400 mg per day).  According to the University of Maryland Medical Center, a few studies indicate that riboflavin may reduce the frequency and duration of migraines. In one study, people who took riboflavin had more than a 50% decrease in the number of attacks. Not all studies have found riboflavin to be effective, however. More research is needed. 

• Acupuncture.  According to a study published in the Canadian Medical Association Journal, almost 480 adults were treated with either traditional Chinese acupuncture or a sham treatment in which acupuncture needles were inserted in nonspecific points. The acupuncture treatment points were previously used to study migraine. Participants did not know which type of acupuncture treatment they were receiving during the four-week study.  After completing the study, all of the participants -- including those in the sham group -- reported fewer days with migraines than before the study began. Prior to the study, most suffered monthly migraines, on average six days of migraines a month. After the completing the study, they reported migraines on an average of three days in the month.  In the month following the treatment, all of the participants also reported improvements in the frequency and intensity of migraines.

• Neurostimulation.  A device called Cefaly has recently been approved by the FDA for treatment of migraines in the US.  Cefaly is a drug-free method for treating migraine pain and preventing migraine headaches from ever coming on. Cefaly treats migraine pain with neurostimulation. A stimulus that limits pain signals from the nerve centre by working on the trigeminal nerve where migraine headaches start. The patented Cefaly treatment changes the trigger threshold of migraine headaches. As the pain threshold becomes harder to reach, migraine headaches are less frequent, less painful, and simply disappear.  Cefaly offers patients suffering from migraine pain and headaches an efficient electrotherapeutical system delivered via an extremely comfortable, ergonomic and simple-to-use medical device.

All of the above more natural remedies are much safer and in many cases just as effective as prescription medications without the horrible potential side-effects.  I know that this sounds a bit too good to be true, but with so much potential benefit and little downside, these are all worth more of your time to research and understand better.

Prescription Remedies
If living a healthy lifestyle and trying natural remedies don't work, then it does make sense to working with a doctor to look for help in prescription medication.  As I mentioned above, the side-effects can offset their positive effects, but some people tolerate medication better than others.  Some over the counter medications can help as well, but be careful there as well, since over-use can sometimes make migraines worse.

• Triptans.  These medications are often the first ones prescribed to relieve pain, nausea, and sensitivity to light and sound. They work by constricting the blood vessels in the brain. 
  
• Ergots.  Ergots also work by constricting blood vessels, but tend to have more side effects than triptans. 
• Isometheptene, dichloralphenazone, and acetaminophen (Midrin).  Midrin combines a pain reliever (acetaminophen) and sedative (dichloralphenazone) with a medication that constricts blood vessels (isometheptene) to prevent migraines.
• Acetaminophen, aspirin, and caffeine (Excedrin Migraine) is an FDA-approved over-the-counter treatment for migraine.
  
• Ibuprofen (Advil Migraine, Motrin Migraine) is also an FDA-approved over-the-counter migraine medication.
  
• Narcotics, such as codeine, are sometimes used for people who can't take triptans or ergots; however, they can cause dependency and rebound headaches.  (source:  University of Maryland Medical Center)
  

Bottom line
Despite all the research that has been done and all of the evidence that has been collected, there is no magic cure-all for migraines.  People still suffer.  Some have found a combination of remedies that work for them, but it is still a very individual journey and a painstaking process to try different things to see what works.  

Speaking of process, it might be tempting to try everything you can at once, hoping that something helps.  But if you can be more patient and try one thing at a time, you'll be able to better understand what might help and what might not.

In summary, first make changes to live a more well-balanced, healthy life.  Then look to natural remedies, and as a last resort look to prescription medication.  I wish you good luck in your own journey towards pain relief.