Migraine Headache Treatments

Migraines cause severe pounding, throbbing pain usually on one side of your head, and often nausea and vomiting. Frequently, they strike in the morning, and last from a few hours to two days. Some poor souls get migraines almost daily. Others experience them every few weeks or months. Most migraine sufferers get two to five a month. From 20 minutes to an hour before migraines hit, about 20 percent of people experience strange symptoms (auras) such as flashing lights, blurred vision, blind spots, or peculiar smells.

Migraine Treatments

Elimination Diet

• Your key to stopping the throbbing. “There is little doubt, says naturopath Joseph Pizzorno, N.D., president of Bastyr University, the naturopathic medical school near Seattle, “that food intolerances are the major cause of migraines. Several studies show that elimination of offending foods greatly reduces migraine symptoms.” In one, 88 children with migraines were placed on an elimination diet. More than 90 percent experienced significant improvement. In another, 19 of 43 adult migraine sufferers became pain-free or improved substantially on an elimination diet. The researchers concluded: “Migraine is a food-allergic disease.”

To discover your food sensitivities, Dr. Pizzorno recommends an elimination diet. But beware: The first week on an elimination diet, some people get more migraines. Stick with it, Dr. Pizzorno says. This passes, and you soon should experience substantial relief.

• Say no to typical food triggers. If you’d rather not deal with a true elimination diet, you can simply eliminate the foods with the nastiest reputations for triggering migraines, says Dr. Pizzorno’s Bastyr colleague, family practitioner Alan Gaby, M.D. Leading offenders include: cow’s milk, wheat and bread products, chocolate, eggs, oranges and other citrus fruits, alcohol (beer, wine, liquor—especially red wine), cheeses, beef, corn, and rice. Milk and wheat trigger not only migraines, but all sorts of other health problems in those who are sensitive to them. Several of these foods, notably chocolate, cheese, and alcohol, contain compounds (amines) that cause blood vessel constriction.

Other possible food triggers include: tomatoes, shellfish, artificial sweeteners (NutraSweet, saccharin), fermented or pickled foods, figs, monosodium glutamate, coffee, tea, nuts, bananas, deli sandwich meats, and sulfites (in shrimp and boxed mashed potatoes). Many of these also contain amines.

• Less meat, more fish. The saturated fat in meats makes your platelets more likely to clump together, and trigger migraines, Dr. Pizzorno explains. On the other hand, the essential fatty acids in fish, especially in salmon and other cold-water fish, help prevent platelet clumping and migraines. (Substituting fish for meat also helps prevent heart attack, because it prevents platelets from clumping into blood clots in your coronary arteries.)

• Lower you fat. Meat is one of the top sources of fat in the typical American diet. Switching from meat to fish lowers dietary fat. A recent study shows that a low-fat diet reduces migraine frequency, severity, and duration. Glen Blix, Dr.P.H., an associate professor of health promotion at the Loma Linda University School of Public Health in Southern California, monitored the usual diets and headaches of 54 migraine sufferers for four weeks. He then placed them on a low-fat diet—no more than 20 grams of fat a day for eight weeks. Their migraine frequency dropped 70 percent. Headache intensity fell 68 percent. And migraine duration dropped 74 percent.

• Turn to a rotation diet. If you eliminate common food triggers and still get migraines, you may have low-level sensitivities to other foods. You might try an elimination diet. Or Dr. Pizzorno suggests a four-day rotation diet. Don’t eat anything more than once every four days.

• Eat more soy foods. If you’re a woman with menstrual migraines, family practitioner Susan Lark, M.D., of Los Altos Hills, California, suggests eating more tofu. Tofu contains plant estrogens (phytoestrogens). They’re weaker than your own estrogen, but have similar effects on your body. Menstrual migraines are triggered by cyclic estrogen fluctuations that dilate and constrict the blood vessels in your head. Tofu helps raise your estrogen level when it’s low, diminishing your fluctuations.

Lifestyle

• Don’t swallow your drug triggers. Many common drugs can trigger migraines, says Jerome Goldstein, M.D., director of the San Francisco Headache Clinic, among them: calcium channel blockers (Cardizem and many others used to treat angina and high blood pressure), cimetidine (Tagamet, for indigestion), estrogen (birth control pills), fenfluramine (Pondimin, for weight control), nitroglycerin (Nitrostat, for angina), theophylline (TheoDur, for asthma), nonsteroidal anti-inflammatory drugs (Indocin and many others, for arthritis), and overuse of or withdrawal from pain medications.

• Trigger, triggers, everywhere! Dr. Goldstein says other possible migraine triggers include: emotional stress, hunger, fatigue, changes in sleep routine (insomnia or extra sleep), sex, flashing lights, sun glare, loud noises, changes in the weather, and strong smells (perfume, smoke).

• Keep a migraine diary. You may have other migraine triggers. “Every time you get a migraine,” says family practitioner Anne Simons, M.D., an assistant clinical professor of family and community medicine at the University of California’s San Francisco Medical Center, “write down the date and time, all the foods and beverages you consumed within the previous 12 hours, and any psychological, physical, or environmental factors that might have contributed to it. You may see a pattern you can change.”

Supplements

• Munch on magnesium. Magnesium, Dr. Gaby says, has many of the same effects as the drugs mainstream M.D.s use to treat migraines. It makes platelets less likely to clump together. It helps diminish dilation and constriction of blood vessels. And it inhibits release of compounds involved in pain and inflammation. In addition, one study showed that compared to people who are migraine-free, during attacks, migraine sufferers had 19 percent less magnesium in their brain tissue.

Can supplemental magnesium help treat migraines? Several studies support this idea: At the Munich-Harlaching Clinic in Germany, neurologists gave 81 migraine sufferers either a placebo or magnesium (600 mg every morning) for 12 weeks. By the end of the study, attack frequency declined 16 percent in the placebo group, but 42 among those who took magnesium. In another report, Italian researchers gave 20 women with menstrual migraines either a placebo or magnesium (360 mg a day) for two months. By the end of the study, the women taking magnesium reported shorter, less painful migraines.

Dr. Gaby recommends taking 200 mg of magnesium one to three times a day. But if you develop diarrhea, cut back.

• Beat a path to vitamin B2. This vitamin, also known as riboflavin, is involved in cellular processes (the electron transport chain) that don’t work quite right in people with migraines, Dr. Gaby says. This observation led scientists to arrange a pilot study of 49 migraine sufferers, who charted their headaches, and then began taking 400 mg of B2 at breakfast every day for three months. Their average number of attacks fell 67 percent, and their headaches became less painful as well. There was no placebo group in this study, and its findings have not been corroborated, so they must be viewed cautiously. But riboflavin is “inexpensive and safe,” Dr. Gaby says, so it’s worth a try.

• Go fish. Substituting fish for meats helps prevent migraines because fish oil makes your platelets less likely to clump together. If you don’t care for salmon, or just want a little extra migraine-preventive boost, Dr. Gaby suggests taking supplemental fish oil containing omega-3 fatty acids. In one study, 15 migraine sufferers who had not responded to mainstream drugs took either a placebo or fish oil (5 g three times a day with meals) for six weeks. Then the groups were switched: The placebo takers got the fish oil and visa versa. Those taking fish oil reported significantly milder migraines.

Relaxation Therapies

• Bravo for biofeedback. “In my experience,” says stress-management specialist Martin Rossman, M.D., co-director of the Academy for Guided Imagery in Mill Valley, California, “daily practice of a relaxation technique—biofeedback, visualization, meditation—is about as effective in preventing migraines as the most commonly used medications.”

At Ohio University in Athens, researchers analyzed the results of 25 studies that had used biofeedback or other relaxation therapies to prevent migraines, and compared them with 35 studies that had used a standard pharmaceutical (propranolol, Inderal). Both treatments produced the same benefit—43 percent reduction in migraine attacks, compared with 14 percent among those using placebos.

“Biofeedback is an integral part of the comprehensive approach to migraine treatment at my clinic,” Dr. Goldstein says. Why? “Because it works.”

Biofeedback works especially well for headaches in children, notes Paul Winner, M.D., co-director of the Palm Beach Headache Center in West Palm Beach, Florida. Compared with adults who use biofeedback for headaches, kids often get twice the benefit.

• Visualize no more migraines. Speaking of children, Karen Olness, M.D., a professor of pediatrics at Case Western Reserve University in Cleveland, randomly assigned 28 children with migraines to one of three treatments: a placebo, propranolol, or visualization/self-hypnosis. The visualization/self-hypnosis group showed a significant decrease in migraines.

Pregnant women shouldn’t take drugs, including migraine medications. But about 15 percent of pregnant women suffer migraines. Dawn Marcus, M.D., an assistant professor of neurology at the University of Pittsburgh School of Medicine, recruited 44 pregnant women with migraines, tension headaches, or both. She gave 14 no treatment, and enrolled the 30 others in a class that taught them to relax using deep breathing, muscle relaxation, and a visualization of enjoying themselves on a sunny beach. When the class was over, 43 percent of the control group reported less headache pain, but in the relaxation-visualization group, the figure was 80 percent.

Dr. Rossman has produced many relaxation tapes that combine music and visualizations that help prevent migraines. For a catalog, write the Academy for Guided Imagery at P.O. Box 2070, Mill Valley, CA 94942.

• Wake up, and smell the apples. The scent of green apples relieved migraine pain in a study by neurologist Alan Hirsch, M.D., director of the Smell and Taste Research Center in Chicago. He gave 50 migraine sufferers two little capped vials. One contained no scent, the other, the aroma of green apples. Hirsch asked each participant to rate the severity of three migraines. During the first and third, they sniffed the scent-free vial. During the second, they smelled the apple-scented vial—and reported significantly less pain. Previous studies have linked the scent of green apples to relief of anxiety, Hirsch explains, and as anxiety decreases, so does the perception of pain. The scent of lavender has also been shown to be relaxing.

To use aromatherapy for your migraines, herbalists Kathy Keville and Mindy Green, authors of Aromatherapy: A Complete Guide to the Healing Art, suggest filling a small, capped vial with a few chips of rock salt. Add a drop or two of your essential oil. The rock salt holds the oil. When you want a whiff, simply uncap the vial and inhale deeply.

Herbal Medicine

• Fewer migraines with feverfew. Let’s get one thing straight right away: Traditional herbalists did not use feverfew to treat fever. The name is actually a corruption of “featherfew,” a reference to this herb’s feathery leaf edges. Feverfew was used to treat headaches. This traditional use came to the attention of British physician John Hill as early as 1772: “In the worst headaches, this herb exceeds whatever else is known.”

Feverfew remained a part of folk medicine until the wife of the chief medical officer of Britain’s National Coal Board suffered chronic migraines. A miner heard about her problem and told her he’d also been a longtime migraine sufferer—until he started chewing a few feverfew leaves every day. The woman tried the herb, noticed immediate improvement, and after 14 months was free of her headaches.

Her husband brought his wife’s experience to the attention of Dr. E. Stewart Johnson, M.D., of the City of London Migraine Clinic. Dr. Johnson recruited 17 people who claimed that feverfew prevented their migraines, and gave them either a placebo or feverfew (50 mg a day). The group continuing on feverfew reported no change in their migraines, but those who had been on feverfew and then took the placebo in the study reported three times as many.

Then J.J. Murphy, M.D. at the University of Nottingham gave either a placebo or freeze-dried feverfew (82 mg a day) to 72 migraine sufferers. After four months, the two groups switched treatments for another four months. While taking the feverfew, the participants suffered significantly fewer migraines, and the headaches they had were comparatively mild, with significantly less nausea and vomiting.

Most recently, Israeli researchers gave either a placebo or feverfew to 57 migraine sufferers, none of whom had ever tried the herb. After two months, the groups switched for another two months. While taking feverfew, the participants reported significantly fewer headaches.

Feverfew helps stop migraines in several ways: It blunts blood vessel reaction to things that cause them to constrict and dilate. It prevents release of serotonin from platelets. And it reduces production of other compounds in the body involved in pain (prostaglandins, leukotrienes, and thromboxanes).

• Go for garlic and onions. Both of these herbs—and their close relatives: shallots, chives, and leeks—make your platelets less likely to clump. “You don’t want to knock out your platelets altogether,” says Maryland botanist/herbalist James Duke, Ph.D., author of The Green Pharmacy, “because then your blood wouldn’t clot. But making them a little less active helps prevent migraines, and garlic and onions do that.”

• Jump for ginger. Like garlic, ginger helps prevent platelet clumping. It also helps prevent nausea, a frequent symptom of migraine (see NAUSEA AND VOMITING). “There aren’t any good studies of ginger for migraines,” Dr. Gaby says, “but there are good reasons to use ginger, and it can’t hurt.” He suggests 500 mg of ginger every four hours during migraines. Ginger capsules are available at health food stores. To help prevent migraines, Dr. Duke suggests cooking with ginger and drinking ginger tea (1 to 2 teaspoons of grated root per cup of boiling water, steeped 10 minutes).

• Aspirin tea, anyone? You can take aspirin for migraines (see below), or you can try herbal aspirin—willow bark, which contains salicin, aspirin’s natural precursor. “Anything pain problem you treat with aspirin, you can treat with willow bark tea,” Dr. Duke says. Commission E, the German expert panel that judges the safety and effectiveness of herbal medicines for that nation’s counterpart of the Food and Drug Administration, endorses willow bark for headache, including migraines—1 to 1.5 teaspoons of powdered white willow bark per cup of boiling water, simmered for about 10 minutes, and then strained. Two other herbs also are rich in salicin—wintergreen and meadowsweet. But if you’re allergic or sensitive to aspirin, don’t use willow bark, wintergreen or meadowsweet.

• Coffee constricts blood vessels. Studies dating back to the 1970’s years show that 65 mg of caffeine, about the amount in a cup of instant or a half-cup of brewed coffee, boosts the power of aspirin and other over-the-counter (OTC) pain relievers (see below) by about 40 percent. Scientists believe caffeine helps treat migraines because moderate, occasional consumption constricts the blood vessels in your head.

Some OTC pain relievers contain caffeine (Excedrin, Midol, Vanquish Caplets). Or you can simply wash yours down with a cup or two of coffee. In addition, some prescription migraine medicines contain caffeine (Cafergot, Cafatine, Ercaf).

• But java junkies, beware… Coffee is addictive, and if you drink it regularly and then stop suddenly, you’re in for a caffeine withdrawal headache that can last several days, Dr. Duke says. To avoid this affliction, taper off regular coffee slowly over several weeks. The same advice applies to tea, which also contains caffeine, but only about half as much per cup as coffee.

• Got ergot? Ergotamine drugs have been a mainstay of mainstream medical migraine treatment (Cafergot, etc.) since the 1920s. They constrict blood vessels in the head. But few doctors know that ergot is an herbal remedy—a fungus that grows on rye grass. In traditional herbal medicine, midwives used it to promote uterine contractions.

Chinese Medicine

• Revive your Blood. Chinese medicine views pain as stagnation of chi, Blood, or Moisture, says San Francisco Chinese physician Efrem Korngold, L.Ac., O.M.D., co-author (with Harriet Beinfield, L.Ac.) of Between Heaven and Earth: A Guide to Chinese Medicine. Stagnation of Blood produces sharp, stabbing, localized pain, the kind that characterizes migraines. But Dr. Korngold says, many migraines involve stagnation of the other two tree elements as well.

The classic Chinese herbal formula for treating headache is called Chuan Xiong Cha Piao, which contains quite a few herbs, including: ligusticum, angelica, asarum, and peppermint. “It breaks up stagnation,” Dr. Korngold explains.

Beyond treatment, however, the irritability and light sensitivity of migraines points to a Liver and Gall Bladder problem. To prevent migraines, you want to nurture these organ systems by eliminating dietary fat, alcohol, stimulants, and spicy foods, and avoiding strong odors. “Emotions can play a major role as well,” Dr. Korngold says. “Suppression of anger, hurt, or frustration affect the Liver and Gall Bladder and can contribute to migraines. Work on your emotional well-being.”

• Press your way to relief. The United Nations World Health Organization suggests acupuncture for headaches, including migraines, and so does the National Institutes of Health. Why? Because several studies show that it helps.

At University College in London, England, psychologists gave 30 migraine sufferers either real or sham acupuncture. Those who received real acupuncture reported 43 percent less pain, and reduced their migraine medication 38 percent.

At the Pain Clinic of Skodsborg Sanatorium in Denmark, researchers compared the migraine-preventive effects of acupuncture and a standard drug (metoprolol). Half of the 77 participants received real acupuncture plus a placebo pill. The other half received sham acupuncture plus metoprolol. Both treatments prevented migraine equally, showing that acupuncture worked as well as the mainstream drug.

Acupuncture treatment is also long-lasting. In one recent study, researchers asked 26 migraine sufferers to keep a diary of their attacks for five weeks, and then gave them a dozen weekly acupuncture treatments, and followed them for three years by periodically reviewing their headache diaries. Immediately after treatment, 54 percent rated their pain significantly decreased. After three years, 50 percent said the same thing. Use of pain medication feel significantly after treatment, and stayed low for the three year follow-up period.

Several acupuncture points help relieve migraines. You can visit an acupuncturist, or try do-it-yourself finger acupressure, says Michael Reed Gach, director of the Acupressure Institute of America in Berkeley, California. Press each point with steady, boring, penetrating pressure for about three minutes. Dr. Gach recommends:

• Large Intestine 4. Located in the fleshy webbing between your thumb and index finger.

• Governing Vessel(GV) 25. Between your eyebrows in the indentation where the bridge of your nose meets your forehead.

• GV 16. In the center of the back of your head, in the hollow under the base of your skull.

• Bladder 2. In the little indentation on either side of GV 25.

• Stomach 3. At the base of your cheekbones directly below the pupils of your eyes.

• Liver 3. On top of your feet, in the valley between your big toe and your second toe.

For chronic headaches, Dr. Korngold recommends needle acupuncture at the same points. Acupuncture generally provides greater pain relief than acupressure.

Transcutaneous Electrical Stimulation (TENS)

• Zap your migraines. In TENS therapy, electrodes are attached to various points around your body (often acupuncture points), and you get zapped with mild current—enough to feel some tingling, but not enough to cause a shock. Several studies show that TENS can help treat migraines. Recently, Neil Nathan, M.D., medical director of the Shealy Institute, a pain clinic in Springfield, Missouri, gave 50 migraine sufferers either their regular medication, or their drugs plus TENS at 12 acupuncture points, along with a visualization routine, and special exercises to relax their necks. After the three-month study, the drugs-only group reported no change in migraine frequency or intensity. But the TENS group reported 76 percent fewer migraines, and a 56 percent decrease in severity.

Homeopathy

• Try a microdose medicine. French homeopaths evaluated 60 migraine sufferers, recommending individual homeopathic medicines based on their specific symptoms. Half received the recommended medicines every two weeks for two months. The other half took a placebo. As in all double-blind studies, neither the homeopaths nor the participants knew who took what. Seventeen percent of the placebo group reported significant relief. In the homeopathic group, however, the figure was 93 percent. The medicines used in this study (in order of frequency) were: Belladonna (deadly nightshade), Natrum mur (salt), Silicea (silica), Gelsemium (yellow jessamine), Ignatia (St. Ignatius bean), Sulphur, Lachesis (venom of the bushmaster), and Cyclamen (sowbread).

Chiropractic

• Manipulation manages migraines. Australian researchers asked chiropractors to manipulate 85 migraine sufferers. Meanwhile, doctors gave neck and back massages to a control group. After six months, both group experienced fewer and briefer migraines, but one those who received chiropractic manipulation reported less pain.

Over the Counter

• Half an aspirin a day keeps migraines away. In the late 1980’s, a Harvard study of 22,000 American male doctors made headlines by showing that low-dose aspirin (one standard tablet every other day) cuts heart attack risk by 44 percent. When the researchers looked at their data more carefully, they made another startling discovery. In the doctors with migraines, the low-dose aspirin treatment produced a 20 percent reduction in migraine risk. A similar study of British doctors came up with the same finding. Aspirin makes platelets less likely to clump together.

• The doctor said NSAIDs. Dr. Goldstein says mild migraines sometimes respond to OTC nonsteroidal anti-inflammatory drugs (NSAIDs): aspirin, ibuprofen (Motrin, Advil, Nuprin), or naproxen (Naprosyn).

• Keep some Excedrin on hand. Recall that caffeine boosts the pain-relieving power of aspirin by about 40 percent. Recently, the Food and Drug Administration approved Excedrin, an aspirin-caffeine combination, as the first over-the-counter drug treatment for mild-to-moderate migraines. The FDA based its approval on three studies that gave either Excedrin or a placebo to 1,250 migraine sufferers. After two hours, 33 percent of those who took the placebo were pain-free, but in the Excedrin group, the figure was 59 percent. Take either regular Excedrin or the new Excedrin Migraine. They both contain the same aspirin-caffeine formula.

• For tots, try Children’s Tylenol or Motrin. In one recent study, 88 kids (average age, 10) were randomly given one of three drugs for their migraines: acetaminophen (Tylenol), ibuprofen, or a placebo. After one hour, the children who took acetaminophen or ibuprofen were three to four times more likely to report relief.

Other Good Choices

Hydrotherapy

• Heat your body, cool your head. At the first sign of a migraine, Portland naturopath Tori Hudson, N.D., a professor at the National College of Naturopathic Medicine there, recommends taking a hot bath, while at the same time, placing a cold compress on the affected side of your head. For extra benefit, she suggests mixing dry mustard generously into your bath.

• Heat and cool your head. If you can’t jump into a bathtub, Dr. Hudson suggests alternating hot and cold compresses.

Ayurvedic Medicine

• Put your finger in your nose. Don’t cringe: This is nasya, a technique Ayurvedic physician John Douillard, D.C., director of the Invincible Life Spa, an Ayurvedic center in Boulder, Colorado, recommends for migraine: “Place 2 to 3 drops of sesame oil (with pinches of salt and pepper mixed in) into your left hand. Rub your right pinky in the oil, then insert it into your right nostril as far as you can comfortably. Repeat this with your left pinky and left nostril until all the oil is gone. Then hold your nostrils alternately closed and inhale deeply.”

Depending on your constitutional type, Dr. Douillard also recommends various herbs: for Vata people, calamus and valerian (one-half teaspoon three times a day, one hour before meals); for Pitta, sandalwood powder made into a paste and peppermint oil applied to the painful area; and for Kapha, vigorous exercise and red pepper, clove, and trikatu, a combination of pepper and ginger, (one-half teaspoon three times a day).

And Finally…

Doctors treat migraines with some 200 different medications. Some help prevent the headaches, others treat them. Preventive medications include: blood pressure drugs (beta-blockers, calcium channel blockers), antidepressants, and anticonvulsants. Once you have a migraine, mainstream treatments include: nonsteroidal anti-inflammatory drugs (NSAIDs), ergot derivatives, antinausea drugs, lidocaine nosedrops, and medications that constrict blood vessels, notably sumatriptan (Imitrex) and zolmitriptan (Zomig), which often provide rapid relief.

Ironically, some of these same drugs can trigger migraines. Depending on your medical situation, you may not be able to take one or more of these medications—if you have angina, heart disease, or high blood pressure, Imitrex is out. Finally, many of these drugs can cause side effects, including nausea, weight gain, depression, chest pain, insomnia, nightmares, dizziness, dry mouth, and abdominal pain. Ask your physician and pharmacist for information about all the possible side effects of any migraine medication you take.

For menstrual migraines, Dr. Fettes suggests an estrogen gel or patch. Apply it two days before the time in your cycle when you get your migraines, and use it for a week. Research shows that estrogen decreases the frequency and severity of menstrual migraines.

Red Flags

See a physician immediately:

• For any unusually severe headache.

• If your headache lasts longer than three days, despite home treatment.

• If you also develop a fever of 102Ëš or higher, or if pain increases when you bend your chin to your chest. These symptoms suggest meningitis.

• If your headache is accompanied by slurred speech, blurred vision, numbness or weakness in the arms or legs. These symptoms suggest a stroke.

• If your headache was caused by a head injury. There might be internal bleeding.

• Or if your headaches recur more and more often and/or get worse over time.