Updated: Apr 1, 2020
Migraines are incredibly common with a prevalence that appears to be on the rise. They affect over a billion people worldwide, making them the third most common disease in the world behind dental caries and tension-type headaches. Along with the severe throbbing head pain, which can last up to 72 hours, 25% of individuals also experience visual disturbances (“aura”).
Every day in the UK there are over 190,000 migraine attacks, and more than half involve severe impairment. Over 90% of migraine sufferers are unable to work or function normally during an attack. Astonishingly, migraine sufferers spend on average 5.3% of their lives with migraine pain, making them one of the most debilitating health conditions and the leading cause of disability among all neurological disorders. Anxiety and depression are also a lot more common among migraineurs.
Most sufferers are females aged between 35 and 45 years old. The gender differences are quite pronounced with females experiencing 3 times as many migraines as males. Following puberty the rate almost triples for females, which suggests a very strong association with the female sex hormones.
What Causes Migraines?
Despite being so common, the exact cause of migraine headaches is still poorly understood. The only widely accepted facts are that migraines are both individual and multi-factorial, and most likely have a genetic basis with certain environmental triggers.
Physiologically, migraineurs may have a specific anatomical variant in the brain (thicker posterior insular and precuneus cortices). Vascular and/or neuronal abnormalities, muscular tension and mitochondrial dysfunction have also all been implicated in the pathogenesis of migraine.
Historically, migraines have been considered a vascular disorder caused by constriction followed by sudden dilation of the blood vessels supplying the neck, brain and scalp. The subsequent abnormal release of the neurotransmitter serotonin, which further constricted the arteries to the brain was then thought to cause the throbbing pain.
However modern neurology has disproven this theory, proposing that electrical “hyperexcitability” in the brain region is to blame. Migraine sufferers are thought to have hypersensitive nervous systems, making them susceptible to these headaches, and certain lifestyle or environmental triggers such as hormonal fluctuations or exposure to particular foods or chemicals then provoke an attack.
Despite the unconfirmed biochemical basis of migraine headaches, migraine pain is best prevented and treated at its onset so it’s important to try and recognize individual triggers.
The increased frequency of migraines after female puberty and with hormonal contraceptive use, along with observed improvements during pregnancy and post-menopause, indicate quite clearly that the female sex hormones, and in particular falling levels of oestrogen, play a crucial role in migraine pathophysiology.
Particular foods are also known migraine triggers. Studies have shown the most common trigger foods to be wheat, chocolate, cow’s milk, cane sugar, cheese, wine, beer, food additives (particularly MSG), sweeteners (aspartame and sucralose/Splenda), eggs, tea and coffee.
Heavy metal toxicity should also be considered as migraine sufferers often have significantly higher levels of cadmium, iron, lead and manganese in their bodies. Other potential triggers include dehydration, hypoglycaemia, caffeine consumption/withdrawal, medication overuse and environmental toxins.
Treatment for Migraines
Most migraine sufferers do not seek proper medical care for their pain, and although many would benefit from preventative treatment, very few receive it. The majority self-medicate with over-the-counter drugs or natural therapies.
Conventional medicine offers few effective options for migraines and GPs have very little training in headache management, which explains why most migraine patients are dissatisfied with their current treatments. It is reported that 75% of the undergraduate medical schools in England do not have headache teaching on their curriculums, and worldwide only 4 hours are spent learning about headache disorders in formal undergraduate medical training. There are also only about 12 trained headache specialist nurses in England.
With increasingly more science becoming available confirming the efficacy of natural therapies for both the prevention and treatment of migraines, the combination of avoiding migraine triggers while using natural therapies is a well-proven strategy to help manage migraines. Natural therapies offer effective treatment options without the adverse side effects that come with pharmaceutical drugs, and they can also be used to reduce the dosage requirements of these drugs. It is essential that you consult with a well-qualified health practitioner though before changing or combining treatments since there are contraindications in some cases.
Menstrual migraines are a particular sub-type of migraine, directly related to the female menstrual cycle, and are definitely a topic unto themselves so I have written a separate blog post about menstrual migraines and their natural treatment options.
Natural Treatment Options for Migraines:
1. Magnesium; deficiency of this essential mineral is very common in migraine sufferers and often goes undetected since routine blood tests do not provide an accurate reflection of the body’s magnesium levels (most is stored in the bone, and also inside body cells). Magnesium calms the nervous system, reduces inflammation, stabilises serotonin receptors and also prevents the release of substance P (the neurotransmitter that promotes migraine pain). Supplementation with highly bioavailable forms of magnesium powder can alleviate both the frequency and intensity of migraines, and is recommended as a first-line treatment option.
2. Coenzyme Q10; CoQ10 is another common deficiency with migraines, and plays a central role in mitochondrial energy production. Several studies have shown that supplementation can be effective at preventing migraines, with no side effects.
3. Herbal Remedies; Butterbur (Petasites hybridus), Feverfew (Tanacetum parthenium) and Ginkgo biloba are all effective treatment options for preventing migraines.
- Ginkgolide B, a component of the herb Ginkgo biloba is able to reduce migraine frequency and duration. Gingkolide B modulates the action of glutamate acid, the main excitatory neurotransmitter of the central nervous system, to reduce the aura and pain associated with migraines. The herb’s anti-platelet activating factor (PAF) inhibitor also counteracts the strong pro-inflammatory and nociceptive agents released during the inflammatory process.
- Feverfew inhibits the release of two inflammatory substances; serotonin from platelets and prostaglandin from white blood cells, both of which can contribute to the onset of migraine attacks. By also inhibiting the production of histamine, the herb modulates the constriction of blood vessels in the head to reduce pain-causing spasms. Feverfew is thought to suppress the production of several inflammatory mediators and inhibit platelet aggregation to reduce migraine pain.
- Butterbur has been found to be effective in the prophylaxis of migraines in multiple studies leading both the American and Canadian Headache societies to give the herb a level A recommendation and declare it to be effective in the prevention of migraine headaches. The herb's active components include the sesquiterpenes, Petasin and Isopetasin, which exhibit anti-inflammatory effects through the inhibition of COX-2. The Petasites also inhibit the opening of calcium channels to reduce the vasoconstriction of blood vessels and excitation of neurons.
4. B Vitamins; migraines have been closely associated with high homocysteine levels, which are caused by vitamin B9 and B12 deficiencies, so supplementation with these B vitamins has been well studied as a treatment option for migraines. The combination of folic acid, vitamin B6 and vitamin B12 effectively reduce homocysteine levels and in turn can reduce headache frequency and pain severity. High-dose riboflavin (vitamin B2) can also help to prevent migraines by normalising serotonin production and improving the function of the MTHFR enzyme, which has been linked to migraines.
5. Hydration; dehydration is a trigger for migraine headache so optimal hydration (at least 2.1L of hydrating fluid each day) should be maintained. Studies have shown that the simple measure of increasing water intake can lead to a significant reduction in migraine incidence. Aim to sip water throughout the day as opposed to drinking large quantities at once.
6. Gluten-Free Diet; several studies have found that a significant proportion of migraineurs have gluten intolerance or Coeliac’s disease. Following a 6-month gluten-free diet, the individuals studied experienced a significant improvement in the frequency, duration and intensity of migraine attacks so avoiding gluten may help to prevent migraines for some individuals by reducing the inflammation that drives migraines.
7. Acupuncture; used in China for centuries to treat migraine headache, (real) acupuncture offers safe and effective pain relief for migraines, as well as preventing their recurrence. Several studies have shown (real) acupuncture to be more effective and safer than conventional drug treatments, just make sure that you seek out a traditional acupuncturist.
8. Bodywork Therapies; massage therapy, chiropractic and osteopathy can all help to prevent and relieve migraines, as well as assist with better sleep and overall stress management, which is important since stress is a major cause of migraine attacks.
Posture and head/neck alignment have a significant impact on the occurrence of several types of headache. Chronic headaches, including migraines, can be a sign that the body’s architecture is misaligned so regular bodywork therapies along with strength and alignment training such as yoga or Pilates, and being aware of how you move through life every day can be very effective at preventing headaches.
9. Exercise; aerobic forms of exercise and yoga in particular can help to improve migraine symptoms, with studies demonstrating significant reductions in migraine pain intensity following these forms of exercise.
10. Relaxation & Stress Management; mindfulness exercises, including meditation and breathing techniques, can lessen the frequency and severity of migraine headaches by promoting relaxation and better stress management. Cognitive behavioural therapy (CBT) is also very effective for reducing migraines.
11. Sleep Hygiene; dysregulated circadian rhythms have been observed with migraineurs, and evidence shows that migraines can improve with the implementation of strategies to restore and regulate sleep. Supplementing with melatonin (the body's sleep hormone) has been shown to be as effective as commonly used drugs for migraine prevention.
12. Reduce Environmental Toxin Exposure; exposure to occupational and environmental toxins, particularly dangerous ‘endocrine-disruptors’ can trigger migraines. The World Health Organization have warned that new/refurbished commercial offices contribute to headaches due to the high levels of volatile organic compounds (from paints, plastics, glues etc.) as well as poor or excessive lighting and air conditioning. Other environmental toxins including mould and chemicals from domestic products, such as scented candles, air fresheners, cosmetics, cleaning products and soaps can trigger migraines so should be avoided.
1. Food Allergy & Intolerance; a comprehensive food allergy test or well-controlled elimination diet should be conducted especially since multiple intolerances tend to exist with migraines.
2. Regular Eating; skipping meals can cause hypoglycaemia, which is a known headache trigger so migraineurs should consume small, frequent meals with sufficient fibre and protein.
3. Caffeine; excess consumption is a common migraine trigger, as is caffeine withdrawal. All caffeine sources (energy drinks, coffee, tea, chocolate) must be reduced gradually. Activated vitamin B3 and vitamin C supplements can assist the withdrawal process.
4. Alcohol; as another common migraine trigger, alcohol and particularly red wine (due to higher amounts of histamine and phenolic flavonoids) should be avoided. Alcohol can also cause magnesium deficiency and dehydration, both of which can contribute to headaches.
5. Aspartame; all artificial sweeteners are potential migraine triggers however aspartame is well proven to trigger migraines so all foods/drinks containing aspartame should be avoided.
6. Nitrites; these migraine-causing food preservatives are used to inhibit the growth of botulism-causing bacteria, and to give food a smoked/cured flavour. Tinned and delicatessen meats such as smoked ham, salami, sausages, hot dogs and bacon should all be avoided.
7. Amines; tyramine and phenylethylamine in particular have been identified as migraine triggers. Common foods containing amines include chocolate, aged cheese, cured meats, smoked fish, beer, wine, fermented food and yeast extract.
8. Histamines; a high intake of histamines, allergic reactions, histamine sensitivity, DAO enzyme deficiency and antidepressant use can all cause histamine-induced headaches, which are thought to result from neuroinflammation, blood brain barrier dysregulation and dilation of blood vessels supplying the brain so all histamine-containing foods should be avoided.
By following the above guidelines and focusing on proper nutrition, along with identifying and avoiding individual triggers, and living a healthy lifestyle, both the frequency and intensity of migraines can be reduced, and even eliminated! Further support, particularly with choosing high-quality and relevant supplements, including natural hormonal support if needed, can be sought from your natural health practitioner. 😊
Allais G, Chiarle G, Sinigaglia S, Benedetto C. Menstrual migraine: a review of current and developing pharmacotherapies for women. Expert Opin Pharmacother. 2017;19(2):123-136. doi:10.1080/14656566.2017.1414182. Allais G, D’Andrea G, Maggio M, Benedetto C, 2013. ‘The efficacy of ginkgolide Bin the acute management of migraineaura: an open preliminary trial’ Neurol Sci 34 Suppl 1 S161-3.
Ambrosini A, Di Lorenzo C, Coppola G, Pierelli F 2013. ‘ Use of Vitex agnus-castus in migranous women with premenstrual syndrome: an open- label clinical observation.’ Acta Neurol Belg 113(1):25-9.
Astin J. Why patients use alternative medicine: results of a national study. JAMA 1998;279:1548-53.
Bryant M, Cassidy A, Hill C, Powell J et al 2005. ‘ Effect of consumption of soy Isoflavones on behavioural, somatic and affective symptoms in women with premenstrual syndrome’ Br J Nutr 93(5):731-9.
Burke BE, Olson RD, Cusack BJ. Randomized, controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine. Biomed Pharmacother. 2002;56(6):283–288.
Calhoun AH, 2012 ‘Menstrual migraine:update on pathophysiology and approach to therapy and management’ Curr Treat Options Neurol 14(1):1-14.
Chai, N. C., Peterlin, B. L., & Calhoun, A. H. (2014). Migraine and estrogen. Current opinion in neurology, 27(3), 315–324. doi:10.1097/WCO.0000000000000091
Din L, Lui F. Butterbur. [Updated 2020 Jan 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK537160/
Ferrante F, Fusco E, Calabresi P, Cupini LM 2004 ‘Phyto-oestrogens in the prophylaxis of menstrual migraine’ Clin Neuropharmacol 27(3):137-40
Feverfew Monograph. UC Denver. www.ucdenver.edu › nutr_monographs › Monograph-feverfew
Goadsby PJ et al. Neurobiology of migraine. Neuroscience 2009; 161(2): 327-41.
Headache Disorders – not respected, not resourced. All-Party Parliamentary Group on Primary Headache Disorders. 2010.
Hechtman, L. (2012) Clinical Naturopathic Medicine. Elsevier Australia
Helmut L. Haas, Olga A. Sergeeva, and Oliver Selbach. Physiological Reviews 2008 88:3, 1183-1241. Histamine in the Nervous System
House of Commons. Headache Services in England. All-Party Parliamentary Group on Primary Headache Disorders. 2014.
Karakurum Göksel B. (2013). The Use of Complementary and Alternative Medicine in Patients with Migraine. Noro psikiyatri arsivi, 50(Suppl 1), S41–S46. doi:10.4274/npa.y6809
Karli, N, Baykan, B, Ertas,M, Zarfoğlu, M et al 2012. ‘Impact of sex hormonal changes on tension-type headaches and migraine: a cross-sectional population-based survey in 2,600 women’ J Headache Pain 13(7):557-65.
Kernick D and Goadsby PJ. Headache: a practical manual. Oxford University Press 2009.
Loder E, Rizzoli P, GolubJ. 2007. ‘Hormonal management of migraine with menses and the menopause: a clinical review.’ Headache 47(2):329-40.
Maasumi K, Tepper S, Kriegler J. Menstrual Migraine and Treatment Options: Review. Headache: The Journal of Head and Face Pain. 2016;57(2):194-208. doi:10.1111/head.12978.
Martin VT, 2014, ‘Migraine and the menopausal transition’ Neurol Sci 35 Suppl 1:6-9.
Melhado, EM, Bigal, ME, Galego, AR, Galdezzani, JP et al, 2014. ‘Headache classification and aspects of reproductive life in young women’ Arg Neuropsiquiatr 72(1):17-23.
Natoli JL et al. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2010 May;30(5):599-609.
Pavone E et al. Patterns of triptans use: a study based on the records of a community pharmaceutical department. Cephalalgia. 2007;27(9):1000-4.
Pfaffenrath V, Diener HC, Fischer M, Friede M et al 2002. ‘ The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophlaxix- a double-blind, Multicentre, randomized placebo-controlled dose-response study’ Cephalgia 22(7):523-32.
Shapiro RE and Goadsby PJ. The long drought: the dearth of public funding for headache research. Cephalalgia. 2007;27(9):991-4.
Shuster LT, Faubion SS, Sood R, Casey PM 2011. ‘Hormonal manipulation strategies in the management of menstrual migraine and other hormonally related headaches’ Curr Neurol Neurosci Rep 11(12):131-8.
Steiner TJ et al. Migraine: the seventh disabler. The Journal of Headache and Pain 2013, 14:1.
Steiner TJ et al. The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity. Cephalalgia. 2003;23(7):519-527.
Tepper, DE, 2014. ‘Headache toolbox: menstrual migraine.’ Headache 54(2):403-8.
Usai S, Grazzi L, Bussone G, 2011. ‘Gingkolide B as migraine preventative treatment in young age: results at 1 year follow-up’ Neurol Sci 32 Suppl 1:S197-9.
Vetvik KG, Macgregor EA, Lundqvist, C, Russell, MB 2014. ‘Prevalence of menstrual migraine: a population based study.’ Cephalalgia 34(4):280-8.
Witteveen H, van den Berg P, Vermeulen G. Treatment of menstrual migraine; multidisciplinary or mono-disciplinary approach. J Headache Pain. 2017;18(1). doi:10.1186/s10194-017-0752-z.
World Health Organization. Atlas of headache disorders and resources in the world 2011.
World Health Organization. Headache disorders. 2016.