Natural Relief From Migraines

It pounds, it throbs, it brings life to a halt when it attacks. Each day, tens of thousands of migraine sufferers lose days of productivity. Migraines are poorly understood by conventional medicine, and the treatments are mostly pain relievers or vasoconstrictor drugs such as sumatriptan (Imitrex). However, and Integrative Medicine approach can be effective in lessening or eliminating the need for such drugs.

The first issue to explore with the patient who has migraines is that of diet, and specifically, food sensitivities. Estimates of food allergy and sensitivity as a trigger for migraines have been as high as 70%. Wheat and dairy seem to be the most notable culprits, as they are in many other food-related conditions, and withdrawing both at once seems to be easier than doing one at a time, since many of our common foods (bagel and cream cheese, cereal and milk, pizza, pasta with cheese, etc.) are wheat and dairy based. We ask the patient to completely withdraw wheat and dairy foods for a three week minimum. Then, the patient “challenges” with a wheat or dairy meal. Many times, a migraine will be activated by this challenge, implying that the food is a trigger. Aspartame (NutraSweet„¢)and various preservatives and additives can also effect a migraine history, so a patient should withdraw those, and the common migraine-associated foods (chocolate, red wine, etc.) as well.

The second piece to look for is a structural imbalance. Most patients with a diagnosis of migraine have muscle spasm that makes the pain worse, and some have other musculoskeletal problems such as a misalignment of their neck vertebrae or ligament strains. To find this, we press along and beside the cervical spine, looking for painful areas. We can also find areas of tenderness along the back of the skull, and in the trapezius and shoulder muscles.

Some of these tender points can actually send pain to the areas of the migraine; these are called trigger points. Trigger points were first described by Dr. Janet Travell, who was President Kennedy€™s back physician. These points in the muscles can refer pain to the top of the head and to the temples. The jaw is another area of tightness and pain that can worsen a migraine. Although migraine is thought to be a vascular phenomenon, it is surprising how much the problem can be modified by good body work, chiropractic and/or osteopathic adjustments.

The next area to investigate is whether there is a hormonal variation. Quite commonly, a female patient comes in whose migraines appear at ovulation and at the beginning of menses, or premenstrually. Other symptoms can also occur, suggesting a relative estrogen/progesterone imbalance. Documenting this imbalance can be difficult since standard blood tests give only a single snapshot of the hormones. Recently, salivary assays have been developed to measure estrogen and progesterone over the course of a monthly cycle. Most commonly, it is the progesterone that is relatively deficient. We sometimes treat this with topical progesterone cream, although oral progesterone is also useful and might have more reliable absorption. For relative estrogen deficiency we might use black cohosh extract, soy-based phytoestrogens, or (if other symptoms co-exist) natural estrogen preparations.

Chinese medicine gives a good framework for understanding and treating migraine, and we look for certain patterns in evaluating the patient. These patterns, if present, suggest that the patient is a good candidate for acupuncture and/or Chinese herbs. In Chinese medicine, Wood energy (characterized by the Liver and Gall Bladder channels) is associated with “wind” conditions. Wind is the quality that brings a symptom rapidly and furiously into being, and migraines frequently are associated with wood patterns of imbalance. Patients with wood imbalances tend to have a feeling of frustration, of impatience, and (sometimes) of underlying anger. Physically they can manifest spasm of the digestive organs, abnormal menstrual cycles with crampy periods, and lack of musculoskeletal flexibility. Migraines also tend to be “yang” illnesses, that is, they are sharp, pounding, and hot in nature. Thus a frequent treatment of migraines in Chinese medicine involves “cooling” the Liver Yang which has risen to the head, giving pain in the Gall Bladder channels which run along the temples and parietal areas.

Since symptoms hardly ever happen in a vacuum, we frequently see migraines associated with other signs of a neurological or circulatory system that is hyper-functioning. For instance, there might be high or labile blood pressure, cold hands and feet, palpitations or other signs of nervous system imbalance. The portion of the nervous system that controls these activities is called the autonomic nervous system, and includes the fight-or-flight response. There is a body of literature on using biofeedback to retrain the autonomic nervous system, and on its use in migraines specifically. Commonly, we send patients for biofeedback training after the acute phase of migraine treatment is completed.

Even simple relaxation techniques can be effective in warding off migraine. Yoga, meditation and qigong exercises all can be useful in quieting down a hyperactive nervous system, provided they€™re done regularly.

Several specific therapies are worth mentioning. Magnesium is useful in any condition involving spasm, and migraines can respond to magnesium therapy. However, oral magnesium is limited in its usefulness, since it is dependent on proper stomach acid, and will tend to cause diarrhea if too much is given. Intramuscular magnesium can be useful in an acute attack, and weekly as a preventive. Sometimes an intravenous slow injection of magnesium, usually given in conjunction with vitamin C, B vitamins, and trace minerals, is given. Called a Myers’ Cocktail (named after Dr. John Myers who developed it, and popularized by Dr. Alan Gaby), this infusion seems to deliver nutrients directly into the cells by temporarily changing the concentration in the bloodstream. The Myers€™ Cocktail infusion is used by physicians in a variety of conditions related to fatigue and nutrient depletion. In the case of migraines, the magnesium content of the infusion is increased a bit, and the “cocktail” is repeated weekly as necessary.

The herb we use most commonly for migraine is feverfew, which has been studied a lot for its migraine prevention abilities. Feverfew preparations vary, so a standardized extract is important to look for. Ginger is also useful in dealing with migraines. Frequently, a migraine sufferer is sensitive to caffeine withdrawal, and so they self-medicate with coffee, tea or cola to ward off a headache. In these cases we try to wean the patient off their substance and onto green tea. One of the common Chinese medicine herbal formulas that can be used for migraine, Cnidium and Tea Formula, probably works partially through its tea content.

Ultimately some people with migraines require medications, and our strategy becomes one of lessening the toxic effect of longterm medications on the body. We can do this by giving nutritional substances (usually called lipotropic factors) which provide the liver with the nutrients it requires for proper detoxification. Milk thistle and artichoke are herbs that are particularly useful in protecting the liver from the effects of medications. And, for patients who are on opiate derivatives such as codeine and Percocet, proper attention to bowel cleansing and digestion is essential.

Migraines provide a good demonstration of the ways that the mind and body interact in sickness and in health. With so many options available, we can hopefully shorten or eliminate the days spent in a dark room with a cold rag over the eyes.
To implement a program based on Dr. Rothfeld€™s recommendations, you may order the following supplements:

Lipotropic Factors (take 2 after each meal)

Other supplements that may be helpful for headache relief are:

Valsed(an herbal formula containing relaxing herbs and nutrients) 2 after each meal

SpectraChrome (a nutritional formula for low blood sugar headaches) 2 after breakfast and lunch

If you wish to have more information about salivary hormone testing, click here.

[Please notify your doctor that you are planning on taking these supplements. This program is not a substitute for regular medical care, and does not purport to treat specific medical illnesses.]