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Migraines

 

Migraine Headache Introduction

:migraine.jpg Migraine headaches are recurrent episodes of head pain. These particular headaches are characterized by pulsatile and unilateral pain, long durations, and are often associate with nausea, vomiting, and/or a sensitivity to light (photophobia). [1]

It is theorized that migraine headaches are caused by the vasodilation of the blood vessels in the head. Although its exact mechanism of action is unknown, platelet aggregation, serotonin metabolism, inflammatory prostaglandins, and histamine production are all thought to play a role in the development of this condition. [2]

Migraines can be classified into three types: common, classic, and complicated.

  • Common migraines: account for 80% of migraines, last 1-3 days, have frontal and one-sided pain, and no other symptoms.
  • Classic migraines: account for nearly 10% of all cases, last 2-6 hours, are unilateral, have an aura, and may present with nausea, vomiting, and pallor.
  • Complicated migraines: account for 10% of cases also, last for an extended period of time, pain can be present anywhere and may even be absent. Additionally, there is an aura, vertigo, faintness, and mild neurological impairment, such as temporary loss of speech and paralysis. [3]

Migraine Symptoms and Statistics

Migraines may be preceded by a prodromal period of depression, anorexia, irritability, and restlessness. 10-20% of migraines also present with conditions caused by prodromal auras. An aura is an irreversible change in vision, motor, or language skills perceived by the patient and others. The aura usually appears 1 hour before the onset of the migraine.

Migraines usually follow a pattern, but can present on different sides of the head. Attacks can be a daily occurrence or be sporadic in nature, only affecting persons 3-4 times per year. Pain is described as a throbbing or pounding sensation that can last from hours to days. [4]

Besides pain, individuals with migraines may be subject to nausea and vomiting. They may also experience vertigo (dizziness), fainting, double vision, and numbness or tingling in a limb. In extreme cases, individuals can have speech deficits, limb paralysis, and palsy’s of the cranial nerve III. [5]

Migraine Statistics:

  • It is estimated that 28 million Americans suffer from migraines. This equates to 1 in 9 persons suffering from a specific form of migraine headache; or 1 out of every 4 households..
  • It is also estimated that as many as 14 million cases of migraine remain undiagnosed. 75% of individuals ( 21 million) suffering from migraines are women. [6]
  • The most common ages of occurrence are between 10 and 40, while most migraines usually resolving by age 50. This fact may be, in large part, due to menopause in women (with women being the largest group affected). 50% of individuals with migraines have a strong family history of the condition. [7]

Migraine Headache Treatment

Conventional drug treatment for Migraine Headaches is focused on three primary goals:

  1. Prophylaxis: Prophylaxis treatment is used for individuals who experience more than one Migraine Headache a week and comorbid illness. Drugs used for prophylactic treatment include beta-blockers, calcium channel blockers, and anti-depressants.
  2. Abortive treatments: Abortive drugs are used for acute treatments of Migraine Headache. Standard medicinals used in this form of treatments include, triptan drugs (Sumatriptan or Rizatriptan) or ergot alkaloids (ergotamine or dihydroergotamine).
  3. Analgesic treatment: Drugs focused on analgesic treatments, analgesics, should be used sparingly. NSAIDs are used first for mild to moderate pain, with treatment of opioids being reserved for those experiencing severe pain. [8]

Alternative treatment has been equally successful in the treatment of Migraine Headaches, both for its prevention and subsequent treatments of acute attack. Most of the treatment recommendations are based on hypothesis concerning the mechanism of Migraine Headache, and are focused on impacting biochemical pathways in the brain.

Supplements helpful for Migraine Headaches

Riboflavin (Vitamin B2)

Vitamin B2 has shown the greatest efficacy in the prevention of Migraine Headaches. The proposed mechanism is the defect in mitochondrial energy metabolism in the cerebral vessels of migraine sufferers. This deficient energy state causes vasodilation. B2 increases energy efficiency in the mitochondria.

One study found that Vitamin B2 supplementation for 6 months decreased the frequency of Migraine Headaches by nearly 50%. There was no change in the duration or intensity of headache, but patients did report a decreased use of analgesic medications. [9] Another study found that supplementation for 3 months caused a decrease in the frequency and reduction of total headache days. 59% of the participants responded to the B2 versus only 15% in the placebo group, which is statistically significant.

Vitamin B12

Vitamin B12 is a nitric oxide scavenger. Vitamin B12 is thought to block the nitric oxide pathway. Nitric oxide causes vasodilation, a proposed mechanisms for Migraine Headaches.

In a study using intranasal B12 for 3 months, 53% of participants saw a reduction in frequency, duration, number of headache days, and number of medications used. [10] Intranasal B12 is administered because of poor the vitamin’s poor absorption in the GI tract. B12 is also considered more efficient if taken sublingually or intramuscularly.

5-htp

5-HTP is a precursor to serotonin, a neurotransmitter in the brain. One of the hypothesized causes of Migraine Headaches is abnormal serotonin metabolism. Supplementation with 5-HTP can increase the serotonin levels in the brain.

In one study, supplementation of 5-HTP reduced the occurrences of Migraine Headaches, a result comparative to the drug methysergide. However, unlike methysergide, it also reduced intensity and duration of the Migraine Headaches without any harmful side effects. [11]

Magnesium

Low magnesium is found in the brain tissue of individuals who suffer from Migraine Headaches. Magnesium helps to maintain tone in the blood vessels. Magnesium is a natural relaxant to both muscle and nerve cells. It is also believed that magnesium affects serotonin receptors in the brain, and decreases nitric oxide synthesis. In one particular study, 50% of participants with an acute Migraine Headache attack had low magnesium levels in plasma. [12] Another comparative study concerning women who suffered from menstrual Migraine Headache attacks, used magnesium supplementation to provide an effective reduction in pain from caused migraine attacks. [13] Intravenous magnesium is of great benefit for treating acute Migraine Headache attacks, and in some cases will cause instant relief from symptoms.

Polyunsaturated Fatty Acids (PUFA’s)

It is understood that certain prostaglandins are increased in individuals who suffer from Migraine Headaches. Prostaglandins are thought to increase platelet aggregation in vessels, thereby leading to a pro-inflammatory state. The harmful prostaglandins are producst of arachadonic acid metabolism. By taking polyunsaturated fatty acids (PUFAs), like omega 3 and omega 6 oils, the arachadonic acid pathway can be bypassed. NSAIDs are prescription drugs which provide similar mechanisms of action.

The prostaglandins that are produced by the omega 3 and omega 6 fatty acid pathways are anti-inflammatory and prevent anti-platelet aggregation. One study in adolescents with Migraine Headaches given omega 3 fish oils found a 87% decrease in frequency, a 74% decrease in duration, and a 83% decrease in severity of pain associated with attacks. [14] After PUFA supplementation for six months, 87% of individuals in another study reported a decrease in the severity, frequency, and duration of migraine headaches. 22% of these patients also became Migraine Headache free, and also indicated a 90% decrease in symptoms associated with the Migraine Headache, including nausea and vomiting. [15]

Coenzyme Q10

In an preliminary study, supplementation with CoQ10 for 3 months resulted in 61% of individuals having 1/2 the number of headache days, and 53% of these individuals experienced 1/2 the frequency of Migraine Headaches. [16] The exact mechanism is not known, and further double blind studies are being conducted.

Feverfew (Tanacetum parthenium)

Feverfew is an effective prophylactic treatment for Migraine Headache. It has been shown to inhibit the release of specific chemical agents that cause vasodilation. Feverfew also inhibits inflammatory pathways and helps to maintain blood vessel tone. In one study, feverfew was taken for 4 months. This supplementation resulted in a decrease in the number and severity of attacks, as well as a decrease in vomiting. Although the duration of the attacks was not altered, feverfew was also effective at decreasing the occurrence of visual disturbances, like aura and double vision. [17] In another study, 70% of participants reported a decrease in the severity and frequency of Migraine Headache attacks after taking feverfew every day for prolonged periods. [18]

References

[1] Beers M and Berkow R. Migraine. The Merck Manual 17th Ed. Pp: 1376-1377.

[2] Pizzorno J, Murray M, Joiner-Bey H. Migraine Headache. The Clinician’s Handbook of Natural Medicine. Churchill Livingstone New York. Pp: 332-343.

[3] Pizzorno J, Murray M, Joiner-Bey H. Migraine Headache. The Clinician’s Handbook of Natural Medicine. Churchill Livingstone New York. Pp: 332-343.

[4] Beers M and Berkow R. Migraine. The Merck Manual 17th Ed. Pp: 1376-1377.

[5] Pizzorno J, Murray M, Joiner-Bey H. Migraine Headache. The Clinician’s Handbook of Natural Medicine. Churchill Livingstone New York. Pp: 332-343.

[6] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[7] Beers M and Berkow R. Migraine. The Merck Manual 17th Ed. Pp: 1376-1377.

[8] Beers M and Berkow R. Migraine. The Merck Manual 17th Ed. Pp: 1376-1377.

[9] Boehnke C et al. High dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care center. Eur J Neurol. 2004 Jul; 11(7): 475-477.

[10] Van der Kuy PH et al. Hydroxycobalamin: a nitric oxide scavenger in the prophylaxis of migraines: a pilot study. Cephalgia. 2002 Sep; 22(7): 513-519.

[11] Titus F et al. 5-hydroxytryptophan versus methysergide in prophylaxis of migraine: a randomized clinical trial. Eur J Neurol. 1986; 25(5): 327-329.

[12] Mauskop A and Altera BM. Role of magnesium in pathogenesis and treatment of migraine. Clin Neuro Sci. 1998; 5(1): 24-27.

[13] Facchinetti F et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache 1991 May; 31(5): 298-301.

[14] Harel Z et al. Supplementation with omega 3 polyunsaturated fatty acids in the management of recurring migraines in adolescents. J Adolesc Health. 2002 Aug; 31(2): 154-161.

[15] Wagner W and Nootbaar-Wagner V. Prophylactic treatment of migraine with gamma linolenic and alpha linolenic acids. Cephalgia 1997 April; 17(2): 127-130.

[16] Rozen TD et al. Open label trial of coenzyme Q10 as a migraine preventative. Cephalgia 2002 Mar; 22(2): 137-141.

[17] Murphy JJ, Hepinstall S, and Mitchell JR. Randomized double blind placebo controlled trial of feverfew in migraine prevention. Lancet. 1998 Jul; 23(2): 189-192.

[18] Pizzorno J, Murray M, Joiner-Bey H. Migraine Headache. The Clinician’s Handbook of Natural Medicine. Churchill Livingstone New York. Pp: 332-343.