Migraines are very painful headaches that usually begin on only one side of the head and may become worse with exposure to light.
What are the symptoms of migraine?
Migraines are commonly preceded by warning symptoms (prodrome), that may include depression, irritability, restlessness, loss of appetite, and a characteristic “aura”—usually a visual disturbance such as flashing lights or a localized area of blindness that follows the appearance of brilliantly colored shimmering lights. Migraines may also involve nausea, vomiting, and changes in vision.
Medical treatments for migraine headache
Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin (Bayer®, Ecotrin®, Bufferin®), ibuprofen (Motrin®, Advil®), and naproxen (Aleve®), may help provide pain relief in mild cases. Excedrin Migraine®, which contains acetaminophen, aspirin, and caffeine, might also help with migraine pain.
The most commonly used prescription drugs are the serotonin receptor agonists, such as sumatriptan (Imitrex®), naratriptan (Amerge®), rizatriptan (Maxalt®), and zolmitriptan (Zomig®). Less frequently used agents include isometheptene-acetaminophen-dichloralphenazone (Midrin®), dihydroergotamine (DHE®), and ergotamine-caffeine (Cafergot®). Many different drugs have been prescribed for migraine prevention, such as propranolol (Inderal®), verapamil (Calan®, Isoptin®), and amitriptyline (Elavil®).
Treatment might also include avoidance of certain triggers, such as alcohol and specific foods. Some individuals might benefit from the correction of vision, while others might benefit from biofeedback.
Dietary changes that may be helpful for migraine headache
Some migraine sufferers have an abnormality of blood-sugar regulation known as reactive hypoglycemia. In these people, improvement in the frequency and/or severity of migraines resulted from dietary changes designed to control the blood sugar.1 2 For the treatment of reactive hypoglycemia, many healthcare practitioners recommend strict avoidance of refined sugar, caffeine, and alcohol, and eating small, frequent meals (such as six times per day).
Migraines can be triggered by allergies and may be relieved by identifying and avoiding the problem foods.3 4 5 6 Uncovering these food allergies with the help of a doctor is often a useful way to prevent migraines. In children suffering migraines who also have epilepsy, there is evidence that eliminating offending foods will also reduce the frequency of seizures.7
Some people who suffer from migraines also react to salt, and reducing intake of salt is helpful for some of these people.8 Some people with migraines have been reported to improve after removing all cows’ milk protein from their diet. The presence of lactose intolerance was found to be a strong predictor of improvement in that study.9 In addition, some migraine sufferers have an impaired capacity to break down tyramine, a substance found in many foods10 that is known to trigger migraines in some people.11 People with this defect are presumably more sensitive than others to the effects of tyramine.12 Ingestion of the artificial sweetener, aspartame, has also been reported to trigger migraines in a small proportion of people.13 14
L-tryptophan, an amino acid found in protein-rich foods, is converted to serotonin, a substance that might worsen some migraines. For that reason, two studies have investigated the effect of a low-protein diet on migraines; in these studies some people experienced a reduction in migraine symptoms.15 16 However, in a small double-blind trial, four of eight people had marked improvement in their migraine symptoms while receiving L-tryptophan (500 mg every six hours).17 Moreover, some preliminary evidence discussed below suggests that 5-hydroxytryptophan, a supplement related to L-tryptophan, may reduce symptoms in some migraine sufferers. Therefore, the idea that a low-protein diet would help migraine patients due to its low L-tryptophan content appears doubtful.
Lifestyle changes that may be helpful for migraine headache
Some doctors have found that reactions to smoking and birth control pills can be additional contributing factors in migraines.
Infection with Helicobacter pylori (H. pylori, an organism that causes peptic ulcers) may predispose people to migraine headaches. In a preliminary trial, 40% of migraine sufferers were found to have H. pylori infection. Intensity, duration, and frequency of attacks of migraine were significantly reduced in all participants in whom the H. pylori was eradicated.18 Controlled clinical trials are needed to confirm these preliminary results.
Nutritional supplements that may be helpful for migraine headache
Compared with healthy people, people with migraines have been found to have lower blood and brain levels of magnesium.19 20 21 22 Preliminary research in a group of women (mostly premenopausal) showed that supplementing with magnesium (usually 200 mg per day) reduced the frequency of migraines in 80% of those treated.23 In a double-blind trial of 81 people with migraines, 600 mg of magnesium per day was significantly more effective than placebo at reducing the frequency of migraines.24 Another double-blind trial found that taking 360 mg of magnesium per day decreased the number of days on which premenstrual migraines occurred.25 One double-blind trial found no benefit from 486 mg of magnesium per day for three months. However, that study defined improvement according to extremely strict criteria, and even some known anti-migraine drugs have failed to show benefit when tested using those criteria.26 Intravenous magnesium has been reported to produce marked and sometimes complete symptom relief during acute migraines, usually within 15 minutes or less.27
One group of researchers treated 49 migraine patients with large amounts of vitamin B2 (400 mg per day). Both the frequency and severity of migraines decreased by more than two-thirds.28 In a follow-up three-month, double-blind trial, the same researchers reported that 59% of patients assigned to receive vitamin B2 had at least a 50% reduction in the number of headache days, whereas only 15% of those assigned to receive a placebo experienced that degree of improvement.29 The effects of vitamin B2 were most pronounced during the final month of the trial.30
In a preliminary trial, administration of 1 mg of vitamin B12 per day (by the intranasal route) for 3 months reduced the frequency of migraine attacks by at least 50% in 10 of 19 people with recurrent migraines.31 A placebo-controlled study is needed to determine how much of this improvement was due to a placebo effect.
The cause of migraine headache is believed to be related to abnormal serotonin function in blood vessels,32 and 5-hydroxytryptophan (5-HTP, which is converted by the body into serotonin) may affect this abnormality. In one study, 40 people with recurrent migraines received either 5-HTP (200 mg per day) or methysergide (a drug used to prevent migraines) for 40 days. Both compounds reduced the frequency of migraines by about 50%.33 Larger amounts of 5-HTP (600 mg per day) were also found to be as effective as medications for reducing migraine headache attacks in adults in two double-blind trials.34 35 Migraine attacks were reduced in frequency, severity, and duration in 90% of those taking 400 mg per day of 5-HTP in a double-blind placebo-controlled trial,36 though another trial found no benefit of 5-HTP.37 In another controlled study, 400 mg of dl-5-HTP (another form of 5-HTP) led to reduced consumption of pain-killing drugs and pain scores after one to two months.38 Children who suffered from migraines and had problems sleeping responded well to a daily amount of 5-HTP equal to 20 mg for every 10 pounds of body weight in a controlled trial,39 though an earlier study showed 5-HTP had no better effect than placebo for children with migraines.40
Fish oil containing EPA and DHA has been reported to reduce the symptoms of migraine headache in a double-blind trial using 1 gram of fish oil per 10 pounds of body weight.41 42 Fish oil may help because of its effects in modifying prostaglandins (hormone-like substances made by the body).
Taking large amounts of the combination of calcium (1,000 to 2,000 mg per day) and vitamin D has been reported to produce a marked reduction in the incidence of migraines in several women.43 44 However, the amount of vitamin D given to these women (usually 50,000 IU once a week), can cause adverse reactions, particularly when used in combination with calcium. This amount of vitamin D should be used only under medical supervision. Doctors often recommend that people take 800 to 1,200 mg of calcium and 400 IU of vitamin D per day. However, it is not known whether theses amounts would have an effect on migraines.
In a preliminary trial, supplementation of migraine sufferers with 150 mg per day of coenzyme Q10 for three months reduced the average number of days with migraine headaches by 60%.45 A placebo-controlled trial is needed to rule out the possibility that this improvement was due to a placebo effect.
Preliminary research also suggests that oral supplements of SAMe (S-adenosyl-L-methionine) may reduce symptoms for some migraine sufferers.46
The function of the pineal gland and its cyclic secretion of melatonin may be disturbed in people with migraine headaches.47 Preliminary evidence suggests that 5 mg per day of melatonin, taken 30 minutes before bedtime, may reduce symptoms of migraine headache.48
Are there any side effects or interactions with migraine headache?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful for migraine headache
The most frequently used herb for the long-term prevention of migraines is feverfew.49 Three double-blind trials have reported that continuous use of feverfew leads to a reduction in the severity, duration, and frequency of migraine headaches,50 51 52 although one double-blind trial found feverfew to be ineffective.53
Studies suggest that taking standardized feverfew leaf extracts that supply a minimum of 250 mcg of parthenolide per day is most effective. Results may not be evident for at least four to six weeks. Although there has been recent debate about the relevance of parthenolide as an active constituent,54 it is best to use standardized extracts of feverfew until research proves otherwise.
Anecdotal evidence suggests ginger may be used for migraines and the accompanying nausea.55 Ginkgo biloba extract may also help because it inhibits the action of a substance known as platelet-activating factor,56 which may contribute to migraines. No clinical trials have examined its effectiveness in treating migraines, however.
A standardized extract of butterbur (Petasites hybridus) was shown in a double-blind trial to reduce the incidence of migraine attacks for three months.57 People in the study took 50 mg of the extract twice per day. It should be noted that butterbur contains pyrrolizidine alkaloids (PAs)—constituents that are potentially harmful to the liver. The extract used in this study lowered the amount of PAs to a level deemed safe by the German health authorities.
There is preliminary evidence that capsaicin, the active constituent of cayenne, can be applied inside the nose as a treatment for acute migraine.58 However, as intranasal application of capsaicin produces a burning sensation, it should be used only under the supervision of a doctor familiar with its use.
Are there any side effects or interactions with migraine headache?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful for migraine headache
Many reports have shown acupuncture to be useful in the treatment of migraines. In a preliminary trial, 18 of 26 people suffering from migraine headaches demonstrated an improvement in symptoms following therapy with acupuncture; they also had a 50% reduction in the use of pain medication.59 Previous preliminary trials have demonstrated similar results,60 61 62 which have also been confirmed in placebo-controlled trials.63 64 Improvement has been maintained at one65 and three66 years of follow-up. In preliminary research, patients suffering from chronic headaches of various types (including migraine, cluster, or tension headaches) have also experienced an improvement in symptoms following acupuncture treatment.67 In a trial comparing acupuncture to traditional drug therapy, a significantly greater cure rate was achieved in the acupuncture group relative to the drug treatment group (75% vs. 34%).68
Dry needling is a form of acupuncture that does not utilize traditional Chinese medicine diagnosis or traditional acupuncture points for treatment. Instead, acupuncture needles are inserted into painful muscle areas (trigger points). A study of 85 patients comparing dry needle acupuncture to conventional drug therapy found a similar reduction in frequency and duration of migraine attacks in both treatment groups.69
Percutaneous Electrical Nerve Stimulation (PENS) is an electrical nerve stimulation technique that has become increasingly popular in the complementary and alternative management of pain syndromes. PENS involves insertion of needle probes, similar to acupuncture, at specific therapeutic points and then applying low levels of electrical current. In one study, PENS was significantly more effective than needles alone at relieving pain in migraine headaches (tension headaches and post-traumatic headaches were also improved).70
Practitioners of manipulation report success in treating migraine with manipulation.71 Migraine sufferers are reported to often have neck pain, tenderness of the spinal joints of the neck,72 and limited ability to move the neck,73 all of which suggest the presence of neck problems that could respond to manipulation. Two preliminary trials reported significant benefit to 75–80% of migraine patients treated with manipulation,74 75 while a third preliminary trial reported reductions in headache frequency and duration, nausea, and sensitivity to light one year after the completion of a two-month course of manipulation.76 A controlled trial compared three types of manipulation and found all three provided significant improvement in headache frequency, severity, and duration.77 78 Another controlled trial compared two months of manipulation to sham (fake) manipulation and to placebo treatment with a non-functioning electrical unit. People in the manipulation group had significantly more improvement of headache frequency and duration, and of ability to function in daily life; they also used less medication.79 The largest controlled trial to date compared eight weeks of manipulation, drug therapy, or both treatments in combination. Manipulation was as effective as the medication in reducing an overall score of migraine suffering, but had fewer reported side effects.80