Are you one of the 36 million Americans who suffer from migraine each year? If you are, or if you know someone who suffers from migraines, then you understand how debilitating they can be. A migraine is much more than just a bad headache. It is a collection of neurological symptoms that may include throbbing pain on one side of your head, neck pain or stiffness, nausea, vomiting and visual distortions called aura. The severity of migraine symptoms can make it impossible to function, or they can be limited to minor visual changes without pain or just a generalized feeling of unwellness. The symptoms can last anywhere from a few hours to a few days.
What can you do to prevent a migraine headache? There are three steps that you can take avoid getting a migraine, or at least to lessen frequency and severity of your migraines.
1) Pinpoint What’s Triggering YOUR Migraines. The exact chain of events leading to a migraine is still not fully understood. Experts believe migraine headaches are caused by abnormal brain activity, including dilation and constriction of the blood vessels within the brain. Although the neurological pathway is still unclear, typically, a migraine is precipitated by one or more stimuli, commonly called “triggers.” Each person has their own individual trigger or triggers; the most common ones include stress, lack of sleep, hormone fluctuations, and a wide range of foods, from caffeine to artificial sweeteners.
a) Keep a Migraine Journal: One of the most effective ways of identifying your specific triggers is to keep a “migraine journal.” Keeping a record of when and where you get a migraine will help you figure out the foods, events, or other stimuli that typically precede your migraine headaches. Besides buying a notebook to record these details, there are great online resources to help you keep a thorough migraine journal, including printable forms and a smartphone application.
b) Get a Thorough Physical Exam: Even if you keep a meticulous journal, there are common migraine triggers such as nutritional deficiencies, hormone imbalances, and other underlying or co-existing medical problems, that without medical testing may go unnoticed. So, if you suffer from migraines, make sure that you get a comprehensive physical exam. Your physician may want to consider testing you for nutritional deficiencies or other coexisting conditions that may be contributing to your migraines.
Nutritional Deficiencies. For example, having low magnesium, Vitamin-D, Vitamin B, or Co-enzyme Q10 levels can predispose a person to suffering a migraine attack.
• Magnesium — The most common way to test magnesium levels is with a blood serum test. Unfortunately, this test misses all but the worst cases of magnesium deficiencies because less than 2% of the body’s magnesium is stored in the blood. Red blood-cell and buccal smear magnesium tests are far more accurate. Oral supplements of magnesium of 250g/day can address deficiencies, but for chronic deficiency, intravenous magnesium supplementation is the most effective treatment.
• Coenzyme Q10 (CoQ10) — This enzyme works as an antioxidant and enhances the energy production within the cells. We recommend 100g/day as a preventive supplement.
• Riboflavin — Riboflavin is a B vitamin that, in higher doses (400 mg/day), has been found to reduce the frequency of migraine headaches.
• Vitamin D — A Vitamin-D deficiency can contribute to chronic pain conditions, including migraines headaches; therefore, addressing this nutritional deficiency is a sensible step to help you avoid migraines.
Other underlying or co-existing conditions. Sometime migraines are related to underlying or co-existing medical conditions that have remained undiagnosed for years. In these cases, addressing the migraine symptoms can at best help temporarily. The only truly effective approach is to take a comprehensive medical history that includes a detailed description of all of your symptoms and what treatments have and haven’t worked for you in the past. On this basis, your doctor may order laboratory testing and, ideally, will offer you an individualized prevention and treatment plan. Serious medical problems that may trigger migraines include Lyme Disease, Mercury Toxicity, eye disease, Celiac disease, Temporomandibular joint disorder (TMJ), concussion, thyroid disorders, and other hormone imbalances.
2) Avoid Your “Personal Migraine Triggers”: Once you’ve identified what sets off your migraine headache, the next step to make a commitment to avoid your personal triggers. For you, this may be as simple as not eating certain foods. It may be necessary, however, for you to make more substantial changes, such as radically modifying your diet, eliminating or taking new medications, getting more sleep, or reducing your stress level through exercise and meditation. For most of us, making lifestyle changes isn’t easy, but migraine pain offers superb motivation. You can also ask your physician for advice and support.
Remember, the best way to lessen the frequency of migraines is to identify and avoid your personal migraine triggers.
3) Explore Your Migraine-Prevention Treatment Options. There are wide range of clinically proven preventive treatments that can help reduce the number of migraine that you suffer. So make an effort to explore your options! Perhaps acupuncture, manual therapies, injection therapies, herbal remedies or prescription medications or combination of these treatments can help you become migraine-free. The important thing is to stay open-minded so you can determine what actually works for you.
• Manual Therapies — Osteopathic Manipulative Treatment (OMT), Physical Therapy, and Craniosacral Therapy can be effective in relieving tense muscles, tendons and ligaments, allowing the body to work more efficiently and without pain.
• Acupuncture — According to a review of 22 clinical trials studying more than 4,000 migraine sufferers, acupuncture was found to be as effective as medication – and sometimes even more effective than medication – for preventing migraines.
• Herbal Remedies — Herbal remedies are most effective when are incorporated into a comprehensive acupuncture treatment. An herbalist with advanced training can help you determine what herbal supplements will benefit you most. Note: Herbal remedies can interact with the prescription and over-the-counter medications, so make sure to inform your physician about the herbs you take.
• Nutritional Supplements — In addition to their role in treating nutritional deficiencies (described above), CoQ10 (100 mg/day) and Riboflavin (400 mg/day) can provide a protective effect against migraines.
• Prolotherapy — Sometimes, head pain can be caused or worsened by referred pain from the neck. If this is the case, prolotherapy can be very effective in resolving trigger points in the neck and back, and thereby reducing the incidence and severity of migraines.
• Prescription Medication — There are several FDA-approved medications that can help prevent migraine attacks. These medications are typically used for individuals who have severe or frequent migraines.
What to Do if You Do Suffer a Migraine Attack: In spite of our best efforts, sometimes a migraine sets in, so it’s also important to have some treatment strategies at the ready.
• Sleep — Many individuals find that sleep helps to resolve their migraine pain. Also, light sensi- tivity is a common symptom, so remain in a dark room to relieve the discomfort.
• Medication — For those who suffer with migraines less frequently (less than 3-4 per month), over-the-counter medications, such as Tylenol, Advil, or Excedrin can be effective, especially when taken at the first sign that a migraine is developing. For treating more frequent or severe migraines, a class of prescription medications known as “triptans” is usually preferred.
Be aware, however, that taking medications more than three days a week for an extended period of time can cause “rebound headaches” or “a chronic headache,” conditions that are even more difficult to resolve.
• Ergotamine IV — If you’ve been suffering with a migraine headache for more than 72 hours, and it’s been unresponsive to treatment, it is categorized as a “status migraine.” In these cases, ergotamine (a vasoconstrictor), provided intravenously, can be quite effective in “breaking” a prolonged migraine.
Migraine symptoms and triggers vary from individual to individual, so it is not surprising that various prevention and treatment options may be more or less successful according to each individual’s medical condition, history and needs. Take the time to identify your own migraine triggers, get a comprehensive medical evaluation, and learn about your prevention and treatment options. Your head will thank you!
2011 Copyright: Kaplan Center for Integrative Medicine