The Institute for Optimum Nutrition

Coping with Migraine

Complementary Resources for Headache Sufferers
(Part two of a two-part Newswire series)

By Jeremy Appleton, ND

Healthnotes Newswire (July 27, 2000)?Migraine costs American employers about $13 billion a year because of missed workdays and impaired work function.¹ Among children, migraine headaches occur with equal frequency in girls and boys. By adulthood, however, the groups diverge and females outnumber males three to one. Women account for nearly 20 million of the 26 million adult Americans who suffer from episodes of migraine headaches.

In addition to the drugs discussed in Part One of this article (see Healthnotes Newswire?July 20, 2000), several complementary and alternative therapies for migraine have been studied, many with promising results.

Herbs

Feverfew (Tanacetum parthenium) is the most frequently used herb for the long-term prevention of migraine. Feverfew inhibits the release of some mediators of inflammation in the brain and some researchers believe inflammation may be part of the problem causing migraine.^{2 3} Double-blind studies have shown that regular use of feverfew leads to a reduction in the severity, duration, and frequency of migraine headaches.^{4 5 6 7} Studies suggest that taking standardized feverfew leaf extracts that supply a minimum of 250 mcg of parthenolide per day is best. Results may not be evident for at least four to six weeks. Although there has been recent debate about the relevance of parthenolide as an active constituent,⁸ it is best to use standardized extracts of feverfew until research proves otherwise.

Research on other herbs for migraine is sparse. Ginger is sometimes recommended as a tincture in the amount of 1.5?3 ml three times daily for migraine and the accompanying nausea. Ginkgo biloba extract may also help because it inhibits the action of a substance known as platelet-activating factor,⁹ which may contribute to migraine. There is preliminary evidence that capsaicin, the active component of cayenne, can be applied inside the nose as a treatment for acute migraine.¹⁰ However, intranasal application of capsaicin can burn and should only be used under the supervision of a doctor familiar with its use.

Nutritional Supplements

The cause of migraine headaches is thought to be related to abnormal serotonin function in blood vessels,¹¹ and 5-hydroxytryptophan (5-HTP, which is converted by the body into serotonin) may help correct this abnormality. In several double-blind trials, supplementation with 5-HTP (200?600 mg per day) has improved migraine, often producing results comparable to those achieved with antimigraine drugs.^{12 13 14 15 16 17 18} However, one earlier study showed that 5-HTP was no more effective than a placebo for children with migraine.¹⁹

Compared with healthy people, individuals with migraine have been found to have lower levels of magnesium in their blood and brain.^{20 21 22 23} Preliminary research in a group of women (mostly premenopausal women) showed that supplementing with magnesium (usually 200 mg per day) reduced the frequency of migraine in 80% of those treated.²⁴ At least two double-blind trials have found that magnesium supplementation (360?600 mg per day) was helpful in reducing the frequency of migraine occurrence.^{25 26} One double-blind trial found no benefit from 486 mg per day of magnesium for three months. However, that study defined improvement according to extremely strict criteria, and even some known antimigraine drugs have failed to show benefit when tested using those criteria.²⁷

The frequency and severity of migraine has been significantly reduced with 400 mg per day of riboflavin (vitamin B2).²⁸ These results were confirmed in a follow-up three-month double-blind trial.²⁹ The effects of riboflavin were most pronounced during the final month of the study.³⁰ This is a very large amount of riboflavin and should be used under the supervision of a qualified healthcare provider.

Other nutritional supplements have been studied for migraine prevention as well, with promising albeit preliminary results. These include fish oil,^{31 32} calcium,^{33 34} S-adenosylmethionine (SAMe),³⁵ and melatonin.^{36 37}

Diet and Lifestyle Considerations

Control blood sugar: Some migraine sufferers have an abnormality of blood-sugar regulation known as reactive hypoglycemia. In these people, improvement in the frequency and severity of migraine has been observed when dietary changes designed to control the blood sugar were implemented.^{38 39}

Identify and eliminate problem foods: Migraine can be triggered by allergies and most trials have found that a majority of migraine headaches can be relieved by identifying and avoiding the problem foods.^{40 41} Some migraine sufferers have an impaired ability to break down tyramine, a substance found in many foods (e.g., aged cheeses, red wine, beef and chicken liver, sauerkraut) that is known to trigger migraine in some people.⁴² Monosodium glutamate (MSG), a flavoring agent used in many foods, has been reported to provoke migraine headaches. The artificial sweetener aspartame has also been reported to trigger migraine in a small proportion of people.^{43 44} Foods that contain nitrates and nitrites, such as preserved meats, are commonly reported triggers of migraine headaches. Contrary to the commonly held belief of many doctors, chocolate does not appear to play a significant role in triggering migraine headaches.⁴⁵ Some individuals with migraine have been reported to improve after removing all cow?s milk protein from their diet. The presence of lactose intolerance was found to be a strong predictor of improvement on that diet.⁴⁶ Some people who suffer from migraine also react to salt, and reducing intake of salt is helpful for some of these people.⁴⁷

Cigarette smoking and birth control pills: Some doctors have found that reactions to cigarette smoking and birth control pills can be additional contributing factors in migraine.

Ulcers and migraine: Infection with Helicobacter pylori (an organism that causes peptic ulcers) may predispose individuals to migraine headaches. In a preliminary trial, 40% of migraine sufferers were found to have H. pylori infection. Intensity, duration, and frequency of attacks of migraine were significantly reduced in all participants in whom the H. pylori was eradicated by treatment with antibiotics.⁴⁸ Controlled clinical trials are needed to confirm these preliminary results.

Chiropractic

A controlled clinical trial demonstrated that chiropractic manipulations of various spinal segments resulted in statistically significant improvements in migraine frequency, duration, disability, and medication use when compared to those not receiving the treatment.⁴⁹ A review of three previous trials, with a total of 202 subjects, found that spinal manipulation produced fair to very good outcomes for migraine.⁵⁰

Acupuncture

Acupuncture treatment has been shown to have a significant therapeutic effect in the treatment of migraine. In one recent study, the cure rate was 75%, compared to 34.4% with no treatment.⁵¹ Acupuncture has also been shown to be as effective as the drug metoprolol at preventing migraine attacks.⁵² Other controlled trials have also found acupuncture, including electro-acupuncture,⁵³ to be an effective therapy for migraine.^{54 55 56}

Hypnosis

Among children and adolescents, hypnosis techniques have been shown to be an effective intervention for migraine. In a small study, five half-hour sessions of hypnosis or self-hypnosis given at weekly intervals were more effective at controlling migraine attacks than a similar regimen of counseling sessions.⁵⁷ Hypnosis has also been compared to the drug propranolol in children with classic migraine. In a trial involving 28 children aged 6 to 12 years with migraine, self-hypnosis was significantly more effective than propranolol or placebo in reducing headache frequency.⁵⁸

Relaxation and Temperature Biofeedback

Both relaxation techniques and temperature biofeedback techniques have proven equally effective at managing migraine headaches in two studies.^{59 60 61} Relaxation and stress management training has reduced the frequency and intensity of migraine episodes in children aged 6 to 18 years.⁶² Similar results have been observed in adults who received behavioral counseling.⁶³ Physical therapy, while not useful on its own, has proven effective in combination with temperature biofeedback and relaxation training for the treatment of migraine.⁶⁴

Homeopathy

Homeopathic remedies are sometimes used to treat migraine headaches. They have been evaluated for this purpose in two double-blind trials. In the first trial, there was no significant overall benefit of individualized homoeopathic treatment compared to placebo (both groups improved equally).⁶⁵ However, a more recent trial found a statistically significant advantage of individualized homeopathic treatment over placebo in reduction in attack frequency.⁶⁶ Other trends also favored homeopathic treatment, but did not reach statistical significance (i.e., there was greater than a 5% probability that the observed effects were simply due to chance).

Reflexology

Two hundred twenty patients with migraine or tension headaches were treated with reflexological methods (pressure point techniques applied to the feet). At the three-month follow-up evaluation, 81% of patients reported that they were helped or cured by the treatments.⁶⁷

References

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Jeremy Appleton, ND, is a licensed naturopathic physician, writer, and educator in the field of evidence-based complementary and alternative medicine. Dr. Appleton is Chair of Nutrition at the National College of Naturopathic Medicine and Senior Science Editor at Healthnotes.

Copyright © 2000 Healthnotes, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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