MIGRAINE – PAIN THAT CAN BE PREVENTED New Ideas and Preventive Approaches
The pain of a migraine headache is one of the most excruciating pains that can be felt. A migraine headache is different from a tension headache both in its cause and severity – often intensely throbbing and one-sided. Migraines affect approximately 8% of the Canadian population, females three times more frequently than males, and can cause huge losses in time spent away from work and pleasure. Migraine sufferers (migraineurs), also have to contend with nausea, vomiting, and increased sensitivities to light and sound in addition to the throbbing pain. The headaches can last anywhere from hours to days; and many people end up in the emergency rooms looking for relief. Migraine headaches are vascular - small blood vessels in the brain expand and press on nerves causing the pain; whereas tension headaches are due to muscular contraction.
Although the treatment of migraine has advanced somewhat in recent years with the advent of abortive medications, there is still a huge amount of suffering. As usual, not enough time is spent on creating programs of prevention or alternative methods of treatment other than medication.
From a preventive aspect migraine headaches can be divided into 3 categories:
Allergies/Intolerances Stress Hormonal Some or all of the above
1. Migraines can be triggered by many different substances in the diet. Most commonly these are substances such as sulphites contained either naturally or as a preservative both in wine and some juices, particularly concentrated lemon and lime juice, as well as dried fruits. Here is a partial list of foods that might contain sulphites – check the labels - canned vegetables, pickled foods, dried fruit, potato chips, vegetable juices, grape juice, apple cider, fresh or frozen shrimp, guacamole, maraschino cherries, and dehydrated pre-cut or peeled potatoes. Sulphite-containing ingredients to look for on food labels include: Sulfur dioxide, Potassium bisulphite or potassium metabisulphite, sodium bisulphite, sodium metabisulphite or sodium sulphite. Monosodium Glutamate or MSG, a flavouring used in many prepared foods and often in Chinese food can also precipitate migraines as well as other symptoms.
Migraines can also commonly be triggered by a substance known as tyramine. Tyramine is an amino acid that is often present in larger quantities in aged cheese, fava or broad beans, sauerkraut, pickles, olives dark chocolate and red wine. Any fermented soy products may contain tyramine – for example miso, soy sauce, and teriyaki sauce. Marmite® and Vegemite®, processed fish and meats containing nitrites (such as hot dogs), citrus fruits, and caffeine can also be suspect. Almost any food can precipitate a migraine – I have seen both wheat and diary very specifically bring on a migraine headache.
2. Stress can precipitate migraines as well. Sometimes however, migraineurs do not get their headache until after the stress is over. This paradoxical stress response is common. People with migraines often push themselves to do more than they can comfortably manage, and they do well during the stress itself, and the migraine comes on only after the stressful period is over.
3. The hormonal aspect of migraines is probably the most overlooked aspect. We know that the birth control pill can make migraines worse and that it can also precipitate migraines in those who have not suffered prior to taking it. There is a danger in taking the pill if you have migraine, especially if you have an ‘aura’ before the migraine comes on, as there is an increased likelihood of stroke in migraineurs with auras and those who take the birth control pill. Migraines can occur exclusively premenstrually, coming on 7-10 days prior to the beginning of the cycle, and then magically disappearing a few days after the cycle begins.
4. We all tend to look for a single cause for migraines or any illness for that matter, and more often than not it is a combination of factors that can precipitate any illness, and migraine is no exception. This makes prevention somewhat tricky. It means that you have to consider all of the above elements in prevention. As a start I would recommend the following.
The Bottom Line in Migraine Prevention
1. Diet – eliminate all processed foods and pay special attention to the foods listed above that contain tyramine, sulphites, and MSG. If nothing from this elimination helps, then next eliminate milk and dairy first, and then wheat, rye, oats, and barley (all gluten contain foods) from your diet. If you do this around the time of your expected migraine attacks, you should only have to eliminate these for 1-2 weeks before you know if they are having a negative impact. Do NOT eliminate these staple foods for any long period without assistance from a health care practitioner.
2. Decrease stress through a regular relaxation/meditation program (as usual I recommend my “Learn to Unwind & Enjoy Your Life” CD available at Ste. Anne’s Spa and fromwww.arfe.ca) Above all, migraineurs should pace their lives as much as possible, prevent stress and manage it well, rather than actually getting stressed and then having a migraine, if that is your pattern.
3. No migraineur should be on the birth control pill. If your migraines are related to your menses (i.e. they come on within a week of getting your period on a regular basis), and if they were ever absent during a pregnancy, you have a very good chance of preventing any further attacks by having a program developed by my father, Dr. Nevil Leyton of Harley St. London, UK, using a natural hormone called HCG(human chorionic gonadotropin). This treatment is 80% effective in preventing migraine in hormonally induced situations. More details can be found at www3.sympatico.ca/holodoc and scrolling down to the article "Migraine -a natural preventive treatment for the sufferer of hormonally related migraines”. This treatment must be given by a physician.
4. Consider all of the above as possibilities as well as the following: The use of some herbs has been found helpful – as a preventive feverfew is one found in many health food and drug stores. Recently one vitamin and two notable antioxidants have been found to be useful in prevention. These are important new studies. Two studies have shown that taking a supplement called Coenzyme Q10 in doses of 180 mg/day can reduce attack frequency by 50%. Another study using riboflavin (Vitamin B2) at a dose of 400 mg daily can reduce attack frequency and severity by 50%. Both of these take from 1-3 months to take effect. Nobody has studied these two together, but they both act in the same area of the cell, so they may be synergistic. The other study shows that the antioxidant lipoic acid may have some potential benefit at 600 mg/day, but this is by no means conclusive. Side effects are non-existent in these new treatments.
For those interested in following this research the references to these are below.
Lancet(1942);1:488 Leyton, Nevil. Med. Press and Circ. (1944);11:302 Leyton, Nevil. A New Approach to the Treatment of Migraine. Med. Press and Circ. (1951) 226:46 Leyton, Nevil Migraine and Periodic Headache - A Modern Approach to Successful Treatment by Nevil Leyton MA, MRCS, LRCP. William Heinemann Medical Books Ltd.(1954 - 2nd edition) Headache 2007 Jan;47(1):52-7 Lipoic Acid A randomized double-blind placebo-controlled trial of thioctic acid in migraine prophylaxis Neurology 2005 Feb 22;64(4):713-5. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Cephalgia 2002 Mar;22(2):137-41. Open label trial of coenzyme Q10 as a migraine preventiveRozen T,e t al. Canadian Family Physician 2003 October;49:1291-3 High-dose riboflavin for prophylaxis of migraine Corinne Breen, MD Adrian Crowe, MD Heather J. Roelfsema, MD, MSC Inderpal Singh Saluja, MD Dale Guenter, MD, MPH