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How To Reduce Frequency and Severity of Migraine Headaches

Posted on: 06/11/2009
Anyone who suffers from migraine headaches or knows someone who does will be interested in the information presented in this article. The authors (two physicians from The New York Headache Center) review the known or suspected pathology behind this painful condition. And they discuss the role of foods as triggers and supplements as treatment for migraines.

Migraines can be inherited but they can also be caused by environmental factors. The exact way in which these two factors bring on a migraine isn't known yet. The bits and pieces we do know suggest that in genetically-linked migraines, there is a lowered resistance to certain triggers such as skipping meals, certain foods, changes in weather, or caffeine intake.

When exposed to these triggers, the nervous system hits the panic button. A cascade of chemicals is released that ultimately results in pain perceived by the brain. There's even some evidence to suggest that improper use of oxygen at the cellular level plays a role in migraines. This helps explain why some nutritional supplements can prevent migraines.

Although it is difficult, giving up certain trigger foods can really help prevent these very disabling headaches. Everyone has different triggers, so it's a good idea to keep a food diary to identify specific individual triggers. The most commonly reported food triggers include alcohol, chocolate, cheese, caffeine, and monosodium glutamate (MSG).

It may take several months (even several years) to track foods that trigger migraines. That's because the reaction can be delayed by hours to several days -- AND the triggers can change over time. Sometimes it takes a while before the person has been exposed enough times to the substance before the body loses its tolerance and a new food becomes an offending trigger.

Some detail is known about how and why these triggers bring on a migraine. For example, phenylethylamine in chocolate causes the release of neurotransmitters in the bloodstream that vasodilate (open up) blood vessels in the brain. Too much vasodilation puts stretch and tension on the pain receptors of the blood vessels. The result is a vascular migraine.

In some people, caffeine in the chocolate is the trigger. Caffeine is present in chocolate, but also in coffee, tea, soda pop, and many over-the counter or prescription drugs. Many people have a love-hate relationship with caffeine. The very same symptoms that caffeine reduces (headache, irritability, tremors) can be reversed by sudden caffeine withdrawal (alertness becomes insomnia, energy becomes anxiety, headache pain comes back).

Alcohol as a trigger for migraines or a separate type of headache called alcohol hangover headache (AHH) may be caused by a variety of substances in the alcohol. Some people react to the sulfites in red wine. But white wine can also trigger a migraine, which suggests the tyramine, flavonoids, and histamine as potential triggers. Tyramine is a substance that is also found in aged cheese, cured meats, smoked fish, beer, fermented food (anything with vinegar in it) and yeast extract. Any of these foods can also trigger headaches.

AHH seems to occur more often after drinking dark-colored alcoholic beverages (e.g., bourbon or whiskey). These drinks are the natural byproduct of alcohol fermentation (conversion of carbohydrates into alcohols). But exactly why they have this effect is still being studied.

No matter what your trigger(s) are, lifestyle modifications and the use of nutritional supplements may be the answer. Eating small meals evenly spaced and avoiding foods known to be triggers heads the list of lifestyle modifications.

Limiting (even gradually eliminating) foods and beverages with caffeine may be necessary. Anyone who develops alcohol-induced headaches should eat before drinking, drink in moderation, and stay hydrated with non-alcoholic beverages, especially water or other noncaffeinated, clear liquids.

Vitamins and other recommended supplements include magnesium, Petadolex (Butterbur), Feverfew, CoQ10, vitamin B2 (riboflavin) and alpha lipoic acid. Nutritional counseling with a specialist is advised when choosing the right supplement and determining the correct dosage. More study is needed but valerian root and ginger may also have beneficial effects.

Women with migraines who are sexually active or who could get pregnant must avoid feverfew and butterbur as these can harm the developing baby. There are nondrug, nonsupplemental treatments approaches that might help instead. These include biofeedback, regular exercise, and avoiding known triggers. Magnesium supplements to prevent or treat migraines are safe during pregnancy and while breast-feeding. Again, appropriate medical guidance is advised under these circumstances.

In summary, the reported studies on the effectiveness of oral supplements for the prevention and treatment of migraines open up new options for patients who suffer from this problem. Changing diet and altering lifestyle often takes a lot of discipline. Even the threat of a painful headache doesn't always keep someone from indulging in certain foods or drinking problem beverages. Having nutritional supplements as a fallback option or even as a main prevention/treatment strategy is a welcome relief for many migraine sufferers.

Christina Sun-Edelstein, ME, and Alexander Mauskop, MD. Foods and Supplements in the Management of Migraine Headaches. In The Clinical Journal of Pain. June 2009. Vol. 25. No. 5. Pp. 446-452.

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