PATIENT ENQUIRY

How to Treat Migraine


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What Is?
What is Migraine
How to Treat Migraine
Natural Treatments for Migraine/Headaches

What is migraine?

Migraine is characterised by the sudden recurrence of a severe headache, which is often on just one side of the head. Theses intense headaches are accompanied by systemic distress, including nausea and vomiting, diarrhoea, faintness, chills, sweating, marked lethargy, and a desire to avoid light and sound.

Migraine headaches affect approximately 8% of the population. The pain is often severe enough to hamper daily activities and may last from four hours to three days, if left untreated.

Problems often begin during childhood, with initial episodes occurring prior to age 15 years of age, in approximately 50% of migraine patients. Similar headaches are commonly reported in blood relatives suggesting a genetic contribution to the disease. Women are two times more likely to suffer with migraine compared with men.

The way a migraine resolves varies greatly from person to person and can even differ for each episode. Most people get relief through sleep. Vomiting can make a person feel much better afterwards, in particular children. For a few, nothing works except letting the headache burn out.

Lethargy and a feeling of being completely drained of energy may last for about 24 hours after the migraine resolves. Some people feel energetic or even euphoric, once a migraine resolves.
Signs and symptoms of migraine
Approximately one in three people who get migraine experience warning symptoms called aura, which last on average one hour. A ‘classic’ migraine is accompanied by aura, but a ‘common’ migraine is not.

Typical aura symptoms:

  • Visual disturbance – flashing lights, zigzag sight, double vision, temporary loss of vision
  • Paresthesia – numb or prickling sensation (pins and needles) in the face, hands, arms
  • Difficulty speaking, slurred speech
  • Inability to concentrate
  • Uncoordinated movement.

Migraine can occur at any time. Occasionally a person will sense a migraine is imminent. These sensations are different to aura and may include irritability, inability to concentrate, food cravings, and fatigue.
Migraine symptoms:

  • Headache (moderate to severe) that lasts from four hours up to 72 hours
  • Pulsating, throbbing head pain, often on just one side of the head
  • Nausea or vomiting
  • Increased sensitivity to light and noise
  • Headache that may ease with bed rest.

A person with these symptoms should see a doctor when:

  • Migraines become worse or more frequent
  • Person more than 50 years of age when migraines start
  • Aura symptoms last more than one hour
  • Migraine lasts more than 72 hours.
Is your headache a migraine?

Is your headache a migraine?

18 signs and symptoms associated with migraine:

  • Visual disturbance – flickering lights, zigzag vision, spots or lines
  • Depression, irritability, or excitement
  • Lack of restful sleep – lack of restorative sleep correlates with frequency and intensity of migraines
  • Stuffy nose or watery eyes – often mistaken for sinusitis
  • Food cravings – often chocolate
  • Throbbing head pain on one or both sides
  • Eye or neck pain
  • Frequent urination
  • Excessive yawning
  • Numbness or tingling (pins and needles) from fingertips, through the arm, across the face
  • Nausea or vomiting
  • Light, noise, or smells trigger or worsen pain – person seeks refuge in dark, quiet place
  • Physical exertion triggers or worsens pain
  • Slurred speech or jumbled words
  • Weakness on one side of the body
  • Dizziness, disturbed or double vision – basilar migraine can cause dizziness, vision loss, double vision
  • Post-headache lethargy – feeling lethargic, weak, dizzy, light headed, unable to concentrate after migraine resolves.

Because some of these signs and symptoms occur during stroke, which can also be a complication of migraine, knowing the common signs of stroke can help save a life. Seek urgent medical help at any sign of a stroke. In Australia, call triple 000 and ask for an ambulance. In the US call 911.

Us the acronym FAST to remember the warning signs for stroke.

Face – ask the person to smile. Does one side of the face droop?
Arms – ask the person to raise both arms. Does one arm drift downward?
Speech – ask the person to repeat a simple phrase. Is his or her speech slurred or garbled?
Time is of the essence. If you observe any of the signs, in Australia call triple 000 and ask for an ambulance.

Migraines facts and statistics
Migraine headaches are the most common type of headache in adults, affecting approximately two million Australians. Women are two times more likely than men to develop migraines and the headaches usually begin under 40 years of age. Roughly half of the people who get these recurrent, severe headaches have a family history of migraines.

Types of migraine

Types of migraine

In ‘common’ migraine episodes usually consist of three (3) clinical stages:

  • A prodromal (early) stage with cerebral or hypothalamic symptoms – lethargy and frequent yawning or euphoria and unbridled energy, with occasional food cravings or food distaste
  • Headache – usually unilateral, severe and throbbing or pulsating, often against a background non-specific headache that builds quickly and lasts for up to 48 hours
  • Post-migraine phase of lethargy and tiredness that commonly lasts 1 to 2 days.

In ‘classical’ migraine, the onset of the headache begins with an aura that consists of visual disturbance, with flashing lights, balls or filaments of light and may be accompanied by visual fragmentation, jigsaw vision, or partial vision impairment. Migraines with aura account for less than 20% of all migraines.

A prickling or burning sensation, called paresthesia, of the face and limbs occasionally occurs. In ischaemic migraine, which is rare, unilateral muscle paresis, which means partial loss of movement on one side of the body.

Many other terms are used to distinguish the type of migraine.

Facial migraine or hemicranalgia is a common migraine variant that covers one-half of the face involving the nostril, cheek, and jaw.

Migraine aura without headache describes attacks when the headache of migraine with aura becomes less severe over time.

Status Migrainosus is used to describe an episode where the symptoms of nausea and light sensitiviy resolve after a few days but the headache persists longer than 72 hours.

Basilar artery migraine is a rare migraine with giddiness and loss of balance and fainting, visual disturbances, and slurred speech, followed by aching in the back of the head.

Hemiplegic migraine resembles a stroke and may progress until the arm and leg on one side are completely paralysed for a few hours. Repeated attacks may result in residual weakness.

Ophthalmoplegic migraine results when the muscles moving the eyes are affected resulting in double vision because the eyes can’t focus properly.

Retinal migraine means loss of sight in one eye, but the other eye retains normal vision.

Migrainous infarction describes a migraine attack that results in a permanent blind spot or ischaemic stroke. Inadequate blood supply results in the death of part of the brain.

What causes migraine headaches?

The precise cause of migraine headaches remains ill defined. Medical researchers believe that a lowered hypothalamic threshold to a variety of physiological stimuli causes a wave of electrical activity across the brain cortex when triggered. This results in spreading cortical neuronal depression, which induces reduced blood flow in the small blood vessels in the brain (oligaemia) releasing inflammatory pain-producing chemicals and peptides, such as Substance P, calcitonin G-related peptide and neurokinin A.

In turn, these mediators trigger blood vessel dilation, Mast cell degranulation, white blood cell activation and increased capillary permeability (neurogenic inflammation). These inflammatory events in the brain irritate the perivascular trigeminal nerve sensory fibres, activating the trigemino¬-vascular reflex, thereby increasing vasogenic amine release and blood vessel distension, causing severe, pulsating headache.

Moderate to severe depression increases the risk of episodic migraines becoming chronic.

Physiological stimuli that may trigger the initial hypothalamic response:

  • Catecholaminergic-mediated stress
  • Bright or wavering light
  • Shifting hormonal balance (particularly oestrogen)
  • Starvation and hypoglycaemia
  • Dietary amines and chemicals
  • Food allergy
  • Dehydration

How to prevent migraines

Avoiding the triggers you know could start a migraine is an important part of managing the problem. Keep a food and pain diary so that you can work out which foods or activities trigger your migraines.

Common, well-recognised migraine triggers:

  • Emotional stress
  • Missed, delayed, or inadequate meals
  • Inadequate sleep
  • Certain odours
  • Drinking alcohol – certain wines, beers, or spirits
  • Eating trigger foods
  • Hormone fluctuations
  • Taking certain medicines
  • Overusing pain-relief medicines.

Foods that commonly trigger migraine include cured meats, chocolate, caffeine, citrus fruits, nuts, pickled foods, monosodium glutamate (MSG), aged cheese, yogurt, onions, brown vinegar, and chicken livers.

Environmental triggers that are known to trigger migraine:

  • Bright or flickering lights, strobe lighting, bright sunlight
  • Strong odours – perfume, gasoline, chemicals, smoke-filled rooms, food odours
  • Travel – travel-related stress or high-altitude flying
  • Weather fluctuations – changes in barometric pressure
  • Decompression after deep-sea diving
  • Loud sounds
  • Watching movies on a cinematic-size screen
  • Overuse of computers or poor posture while using a computer.

These hormonal fluctuations are known to trigger migraines in women:

  • Menstruation
  • Oral contraceptive pill
  • Pregnancy
  • Hormone replacement therapy (HRT)
  • Menopause.

Physical and emotional stresses known to trigger migraine:

  • Inadequate sleep or oversleeping (afternoon nap)
  • Medication to treat a viral infection or common cold
  • Back and neck pain, stiff and painful muscles of face, shoulders, neck, upper back
  • Sudden, excessive or vigorous physical exertion
  • Emotional stress – arguments, excitement, stress, muscle tension
  • Relaxation after stress – occurs during a holiday or weekend.

Source: Headache Australia, an initiative of the Brain Foundation

Keeping physically active by exercising for at least 30 minutes five or more days each week and eating nutritious foods will assist migraine control and prevention.
Migraine is a recognised medical disorder of recurrent headache. The headache can be severe and debilitating, but there are ways to beat the pain and prevent recurrence.

Conventional medical treatment for migraine

A classic migraine follows a set of warning symptoms collectively called aura. Migraine with aura is a migraine preceded or accompanied by flashes of light or blind spots, or by tingling in the hands or face. Foods, stress, and hormones can trigger a migraine. Women are particularly susceptible to migraine, because of hormonal fluctuations.

The throbbing pain typically occurs on one side near the temples, forehead, and eyes. Migraines can make a person extremely sensitive to light, sound, or physical exertion. Nausea, vomiting, or vision problems usually accompany migraine episodes. The pain can be so debilitating that the sufferer has to remain in bed, take time off from work, or miss out on other activities.

Migraine medication works best if treatment begins as soon as symptoms are noticed. Effective medication can significantly reduce the frequency, intensity, and length of migraines.

Several types of migraine medicines are prescribed to reduce intense pain:

  • Beta-blockers – Inderal (propanalol) and Toprol (metoprolol), which relax blood vessels
  • Calcium channel blockers – Cardizem (dilatizem) and verapamil, which reduce the amount of narrowing (constriction) of the blood vessels
  • Antidepressants – amitriptyline and nortriptyline are tricyclic antidepressants effective in preventing migraines
  • Anticonvulsants – Depakote (valproic acid) and Topamax (topiramate)

The FDA has approved Botox to treat chronic migraine, which is defined as “distinct and severe neurological disorder characterized by patients who have a history of migraine and suffer from headaches on 15 or more days per month with headaches lasting four hours a day or longer.” Botox is injected around the head and neck at 12-week intervals in an attempt to dull future headache symptoms.

Commonly used acute migraine treatments

Commonly used acute migraine treatments

If a person suffers infrequent, less severe migraines, acute-phase treatment of symptoms can provide some relief. Acute medications fall into four classes of medicines – analgesics, NSAID drugs, ergotamines, and triptans.

A person can tell if treatment is working if he or she answers ‘yes’ to these questions.

  • Are you pain free in 2–4 hours?
  • Are you functioning normally in 3–4 hours?
  • Does your headache respond to treatment consistently at least 50 % of the time?
  • Are you comfortable with taking the treatment prescribed and still able to plan your day?

Source: American Headache Society, ACHE

Affordable, over-the-counter, non-specific pain tablets, such as aspirin or paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Nurofen, Brufen), naproxen (Naprosyn) can be used to treat acute episodes.

Prescription medications that may be prescribed for more severe migraine:

  • Ergotamine compounds (Cafergot)
  • Triptans – sumatriptan (Imigran), naratriptan (Naramig), zolmitriptan (Zomig)
  • Stronger NSAID drugs
  • Stronger narcotic-type analgesics
  • Metoclopramide (Maxolon), prochlorperazine (Stemetil), domperidone (Motilium) to increase absorption and reduce nausea.

Source: Headache Australia, an initiative of the Brain Foundation

Preventative treatment medication for migraine

Preventative treatment medication for migraine

Preventative treatment medication is taken daily, regardless or whether a headache is present, in order to reduce the incidence of severe or frequent headaches.

  • Beta-blockers block the beta-receptors of the central nervous system and blood vessels, in order to prevent a response to adrenalin – propranolol (Inderal), timolol (Blocadren), atenolol (Tenormin) and metoprolol (Lopresor, Betaloc)
  • Serotonin antagonists block the action of serotonin – methysergide (Deseril), pizotifen (Sandomigran), cyproheptadine (Periactin)
  • Sodium valproate or valproic acid – anti-epileptic drugs
  • Calcium-channel blockers – verapamil (Isoptin) prevent blood vessel constriction
  • Antidepressants such as amitriptyline (Tryptanol) prevent headaches independent of their antidepressant action
  • Feverfew – herbal remedy that contains parthenolide, which appears to prevent migraines and reduce symptoms
  • Riboflavin – vitamin B2 in high dosage (400mg/day).

According to Headache Australia, all of these treatments are effective, but all have side effects and, except feverfew and riboflavin, require a doctor’s prescription. Many were initially introduced for some other problem and observed to reduce headache.

Source: Headache Australia, an initiative of the Brain Foundation

Complications of migraine headaches
Status migrainosus describes a migraine that lasts for more than 72 hours. A person with status migrainosus needs to see a medical doctor, who will prescribe appropriate treatment.

A person who gets migraine 15 days or more during one month for an average of three months in one year has chronic migraine. A doctor can assess for triggers and prescribe appropriate medication, in order to reduce the frequency and severity of headaches.

A person who suffers migraine with aura is at greater risk for ischaemic and haemorrhagic stroke

A person with chronic migraine has an increased risk of depression, anxiety, panic disorder, and cerebral stroke, which is why seeing a doctor about the best treatment options is so important.

If you are pregnant and suffer migraine headaches
Many of the medications used to treat migraine are not safe to take when a woman is pregnant. A doctor will need to review your migraine medication when you fall pregnant and adjust the type of medication to a combination of treatment that is safer for both mother and baby.

Nutritional medicine treatment for migraine

As migraine is so variable regards causation and trigger factors, effective treatment requires careful assessment of nutritional and hormonal factors that may contribute to neuronal excitability and lowering of the hypothalamic threshold to ‘normal’ stimuli.

An integrated program is required to improve digestive capacity, balance food intake, stabilise neuronal membrane function, improve cell metabolism, reduce inflammatory mediators, enhance neurotransmitter balance, and stabilise hormone balance.

Nutritional treatment aims to improve digestive capacity, to ensure complete digestion of foods consumed, reduce activation of the gut associated lymphoid tissue (GALT), and prevent immuno-reactive oligopeptide formation.

Food nutrient intake needs to be balanced to control hypoglycaemia. Frequent smaller meals with only low-GI carbohydrates ensures a stustained supply of sugar for energy.

Food allergens and amine exposure need to be identified and removed from the diet. A person who suffers migraines must be screened for both IgE and IgG antibodies to foods.

High amine foods should also be excluded until migraine control is established. Biogenic amines are formed by the breakdown of dietary proteins. Usually the enzyme MAO renders amines harmless but if MAO levels are low or zero then amines build up in the body, causing aggression, bad behaviour in children, depression, migraines, and eczema.

Freshness is a key factor in avoiding amines as the amine content of foods varies with processing, age, ripeness, handling, storage, varietal, and cooking method. While the vacuum packing or meat, fruit, and vegetables can inhibit the growth of bacteria this does nothing to retard the development of amines. Cold tablets, decongestants, nasal drops or sprays, some pain relievers, general and local anaesthetics and some antidepressants contain amines.

Neuronal cell membrane function can be stabilised by balancing essential fatty acid and the calcium/magnesium ratio. Balancing the essential fatty acid ratio and correcting antioxidant capacity will minimise inflammatory mediator release.

Vitamins B6, B3, and zinc are required to optimise cell metabolism and neurotransmitter synthesis. Recent studies indicate that high-dose vitamin B2 also aids in migraine control.

Neurotransmitter precursors may be required, particularly tryptophan or 5-hydroxy-tryptophan, while DL-phenyl-alanine may be useful to increase brain opioid levels. Cholinergic agents, such as choline, phosphatidylcholine, and acetylcarnitine, may be useful in selected cases. Magnesium and dimethylglycine downregulate glutamate activation of NMDA receptor activity and may also be clinically beneficial.

Vitamins E, C, and B5 are essential to normal oestrogen synthesis, while pregnenelone may be useful in improving hormone production and the stabilisation of neuronal membrane activity. In menopausal and perimenopausal women, DHEA and progesterone supplementation are beneficial in improving hormonal status.

Glossary

Glossary

Acetylcarnitine – broken down into carnitine, which is used by the body to transport fatty acids into the cell mitochondria for energy

Aura – symptoms that happen immediately before migraine headache

Calcitonin G-related peptide – a potent peptide vasodilator and can function in the transmission of pain

Catecholaminergic-mediated stress – stress caused by catecholamines

Choline – essential nutrient of the B-complex group of vitamins, found in cauliflower and other cruciferous vegetables

Cholinergic agents – act as agonists and initiate responses at
actetylchonine receptors

Cortical neuronal depression – a crest of hyperpolarisation followed by depolarisation

Dimethylglycine – derivative of glycine, an amino acid

DL-phenyl- alanine – an essential amino acid, changed in the body into tyrosine, which is used to make neurotransmitters and thyroid hormone

5-Hydroxy-tryptophan – needed to make neurotransmitters serotonin and melatonin from tryptophan

Gut associated lymphoid tissue (GALT) – mucosa-associated lymphoid tissue that acts as the digestive system immune system

Magnesium (Mg)– a chemical element and essential mineral nutrient. ATP must be bound to magnesium to remain biologically active for Kreb cycle

Mast cell degranulation – when antimicrobial cytotoxic molecules of the mast cells are released

Neurogenic inflammation – inflammation arising from the local release of inflammatory mediators from afferent neurons

Neurokinin A – a neurologically active peptide translated from the pre-protachykinin gene

NMDA – N-methyl-D-asparate receptor is a glutamate receptor and the key device for memory to function

Oligaemia – low blood volume in the peripheral circulation

Oligopeptide – more than one and up to 20 amino acids

Paresthesia – commonly called pins and needles, a prickling or burning sensation of the skin

Paresis – temporary loss of ability to move one limb, or weakness

Perimenopausal – around the time a woman enters menopause

Perivascular trigeminal sensory fibres

Phosphatidylcholine – is a major component of cell membranes, a type of phospholipid and member of the lecithin group that slows oxidative damage and aging process

Pregnenelone – an endogenous steroid hormone used to create natural steroids

Substance P – a substance that functions as a neurotransmitter and neuromodulator

Trigemino-vascular reflex – a parasympathetic reflex where stimulation of nerve cells in the brain stem to increases blood flow to the scalp and face

Vaso-active algogenic peptides – peptides that affect blood vessel diameter and increase sensitivity to pain

Vasodilation – dilation of blood vessels