Originally Published in the
American Naturopathic Medical Association Monitor

Natural Interventions for Migraine Sufferers
Robert Thiel, Ph D., Naturopath, Director of Research, Doctors' Research, Inc.

Dr. Thiel runs a clinic in Arroyo Grande, County of San Luis Obispo, California.

He can help you or a loved one.  Call 1-805-489-7188 to schedule an appointment.  

Abstract: The purpose of this preliminary trial was to determine how often individualized natural interventions, used prophylactically, could result in symptomatic improvement for people with migraine headaches. Interventions included dietary restrictions and nutritional supplementation. 44 of the 45 participants (97.7%) reported improvement within 90 days (P <0.01). Possible food intoleranceswere found in 84.4% of the participants, with caffeine being the substance most frequently implicated.

Thiel, R. Natural Interventions for Migraine Sufferers. ANMA Monitor 2(3):5-9, 1998

INTRODUCTION

Migraine headaches cause severe pain. This pain seriously affects the quality of life of migraine sufferers. Migraines seem to occur as the result of functional disturbances of cranial circulation [1-3]. The head pain seems to be due to dilation of the scalp arteries, whereas prodromal (preceding) symptoms such as flashes of light and paresthesias are probably due to intracerebral vasoconstriction [2]. Women are more likely than men to suffer from them [2]. Migraines may be preceded by a short period of depression, irritability, and/or restlessness. The preceding symptoms may be gone before the migraine occurs or may merge with it. Pain can be unilateral or generalized. Some have attacks daily while others only have attacks once a month. With untreated attacks, nausea, vomiting, and photophobia are common. Extremities tend to be cold. Sufferers tend to be irritable and seek seclusion when an attack is present. Scalp arteries tend to be prominent during an attack. Diagnosis is usually based upon symptom pattern if there is no evidence of intracranial pathological changes [2, 4].

Migraines can cause problems other than just pain. Migraines often result in the loss of productivity [4]. They often affect family relatlionships. Studies have shown that those who get migraine headaches (with and without auras) are at increased risk of ischemic stroke [5,6]; this risk is increased substantially for migrainous women if oral contraceptives or heavy cigarette smoking are involved [6]. Natural health practitioners have long worked with migraine sufferers [7-10]. Nutrition, including diet, has been found to affect migraine headaches [4, 7-12]. A clinical trial was performed to determine how often individualized natural interventions, used prophylactically, would result in symptomatic improvement for people with headaches.

SELECTION CRITERIA

Adults were elegible for inclusion in this trial if they came to our office, agreed to provide (and did provide) feedback, signed a consent agreement, and indicated that they suffered from migraine headaches. 45 people were eligible and participated: 39 were female and 6 were male. Ages ranged from 23-73; the mean participant age was 43.3 years.

METHOD

After completing the selection documentation, all subjects were interviewed for approximately 45 minutes. All subjects were then assessed using Reflex Nutrition Assessment (RNA). RNA is a non-invasive technique used to assess nutrition status and possible food intolerances by observing the responses of muscles under externally provided human force [10]. Participants who appeared to be intolerant to one or more foods were advised to avoid them. Participants were advised to consume an average of three tablets per day of one or more nutritional supplements. Although the actual supplements varied by individual, they tended to include various herbs (such as dong quai, feverfew, kelp), vitamins (such as riboflavin), minerals (such as magnesium), fatty acids (from seeds), and /or bovine glandulars (primarily thyroid and adrenal). Subjects were interviewed at approximately three week intervals to determine changes.

RESULTS

44 participants (97.7%) orally reported improvement within 90 days; the P value of improvement (using a binomial Fisher's extract test) was <0.01. Improvement was noted for reduced pain, duration, and/or frequency. The degrees of improvement ranged from 44% to 100%; the mean improvement was 83.3%. Age and gender were not found to be significant factors affecting improvement.

Possible food intolerances were found in 84.4% of the participants with caffeine the most prevalent (57.8%), followed by bovine dairy (28.9%), whole wheat (6.7%), oats (6.7%), chocolate (4.4%), eggs (4.4%), white sugar (2.2%), spices (2.2%) and soy products (2.2%). 6.7% of participants also seemed to be bothered by various household chemicals.

Reflex assessment revealed that the overwhelming majority of participants in this study (73.3%) had some need for nutritional thyroid support. It also revealed that yeast (15.5%) and parasitic infections (22.2%) were suspected in 37.7% of the participants (these participants were also provided with additional herbs, digestive enzymes, and other nutrients to help the body deal with them[10]).

DISCUSSION

Low thyroid function appears to play a role in migraine headaches [9]. Interestingly, both migraine headaches and thyroid problems are much more common in women than in men [2,13]. The thyroid produces hormones which speed metabolism (such as thyroxine) and affect concentrations of calcium (calcitonin) [13, 14]. Thyroid problems, clinical and/or subclinical, are exceptionally common [9, 15-18]. The fact that between 10-48% of senior citizens are suspected of having subclinical hypothyroidism [16, 17] and 11% of the population appears to have a clinical thyroid condition [15], suggests to this investigator that thyroid problems in migraine sufferers are often missed, even when they have been medically tested for. In other words, since thyroid blood tests do not always reveal that thyroid may be involved, actual symptoms can be much more significant factors in determining whether a nutritional intervention may be effective; other doctors have reached similar conclusions [9,18].

Cold extremities, depression, and menstrual disturbances which can be a symptom of low thyroid function [13] are also associated with migraines [2, 4]. Oral contraceptives (birth control pills) can trigger and even be the cause of migraine headaches [9, 19]. This investigator believes this is because they raise estrogen levels to the point they negatively affect estrogen-thyroid hormone balance (these hormones seem to work together in a manner which affects behavior [20]) and that this subsequent imbalance ultimately results in migraine headaches. Headache expert, Dr. Cass Ingram (D.O.), has written that synthetic approaches to thyroid problems (such as Synthroid), have little, if any, effect on headaches; he prefers natural glandulars [9]. Herbs, such as dong quai and kelp, have been found to help low thyroid function [21]; when used in this study, they appeared to play a role in reducing the suffering associated with migraine headaches (one popular book specifically states that dong quai is helpful for "male migraines" [22]. Another herb, feverfew, though not directly involved with thyroid function, appears to improve vasodilation and has historically been used to help migraine sufferers [7, 9].

Caffeine was suspected to play more of a role in this study than any other single food substance. Dr. Alex Duarte places caffeine first in his list of foods which can cause migraine headaches[8]. Just like thyroxine [13, 14], caffeine increases the metabolic rate [23]. A military study concluded that caffeine intoxication usually occurs with consumption in excess of 250 mg[24]; this investigator believes it takes much less caffeine to affect women. This investigator also speculates that people who need nutritional thyroid support will often tend to use caffeine in an attempt to compensate for the positive feeling increased metabolism often gives. Perhaps not surprisingly, caffeine is the most widely consumed pyschotrophic drug [25]. In the U.S., most (around 75%) caffeine is consumed through coffee, followed by tea and sodas [26]. Caffeine is in many commonly consumed "foods" as follows [27]:

5 ounces of ground roasted coffee . . . . . 85 mg
5 ounces of instant coffee . . . . . . . . . . . .60 mg
5 ounces of decaffeinated coffee . . . . . . . 3 mg
5 ounces of tea (1 leaf bag) . . . . . . . . . . 30 mg
5 ounces of instant tea . . . . . . . . . . . . . . 20 mg
5 ounces of hot chocolate . . . . . . . . . . . . 4 mg
6 ounces of cola . . . . . . . . . . . . . . . . . . 18mg
6 ounces of chocolate milk . . . . . . . . . . . 4 mg
1 ounce of chocolate candy . . . . . . . 1.5-6 mg.

Interestingly, caffeine seems to have an antioxidant effect [28]. This is probably one of the reasons that caffeine seems to relieve headaches in many [4] (another could be that caffeine may irritate the nervous system which results in temporary dilation). This investigator, though, suspects that the consumption of caffeine becomes a vicious cycle -- it probably temporarily relieves, but ultimately contributes to additional migraine headaches. Its consumption also probably delays sufferers from seeking nutritional help for thyroid issues, since this investigator believes that caffeine may mask certain hypothyroid conditions. Withdrawal reactions occur in 25-100% of coffee consumers and includes severe headaches, depressed mood, anxiety, and fatigue [24]. Caffeine withdrawal headache symptoms usually occur between 13 to 23 hours of discontinuing caffeine and it occurs most frequently with heavy consumers of caffeine [29]. More money is spent promoting caffeine and performing research in support of caffeine than is spent to warn consumers about caffeine [30].

Since 28.9% of subjects were advised to avoid bovine dairy, most of them were advised to take supplements containing calcium. This investigator suspects that many individuals who are sensitive to these substances often have difficulty absorbing calcium from dairy products. Calcium has been shown to help some women with migraine headaches [31]. Dr. Sheldon Hendlor has written that calcium can function as a natural tranquilizer, can calm nerves, and relieve leg cramps [32]. As calcium tends to be lost during periods of stress [33] (and since migraines increase stress [4]), it appears logical that many migraine sufferers should have at least nutritional benefits from taking supplemental calcium.

Although it has been reported that reducing fat consumption while increasing consumption of carbohydrates resulted in the reduction and intensity of headaches [34], it seems to this investigator that the types of fats consumed is more important than the quantity of fats. It has been found that prophylactic use of foods high in gamma-linolenic and alpha-linolenic acid can, after several months, reduce the severity and frequency of migraine headaches [35]. This may be because gamma-linolenic acid competes with arachidonic acid for the active site of cyclooxygenase and it appears to reduce the production of inflammatory leukotrines [36] Various seeds are high in these oils [36].

Reduced brain concentrations of magnesium can result in migraine headaches [12]. Reduced amounts of magnesium in mononuclear blood cells has been found in patients while experiencing migraines or auras associated with their occurrence [12]. It has been speculated that migraines may respond to magnesium because decreases in serum ionized magnesium appear to 1) increase the affinity for serotonin cerebral muscle receptors, 2) potentate cerebral vasoconstriction induced by serotonin, and 3) facilitate tryptophan release from neuronal storage sites[37]. Many others have found that magnesium can reduce the frequency and duration of migraine headaches [38,39]. Magnesium has been found to be helpful for headaches associated with PMS [40]. Interestingly, one study found that one of the leading symptoms in certain hypomagnesemic children was recurring headaches [41].

In a study headed by Dr. Jean Schoenen at the University of Liege it was found that daily high dose (400mg per day) consumption of riboflavin (vitamin B2) improved average headache scores for migraine sufferers by about two-thirds, which was the same as aspirin [42]. When riboflavin was involved in this study lower dosages were used (lmg-300mg). This investigator believes that riboflavin tends to be indicated for certain people who wake up with headaches. Dr. Schoenen concluded that it took at least three months for the riboflavin to have its full effect [42].

The total incidence of possible yeast and parasitic agents suspected (37.7%) was somewhat of a surprise, even though it was known that giardia lamblia (a parasite) and Candida albicans (a yeast) can cause these types of headaches [43,44]. Medical and natural interventions for Candida albicans have been found to reduce the frequency and severity of migraine headaches when patients also had elevated titers of Candida antigen [44]. Candida antigens can stimulate macrophages to produce prostaglandin E, which induce headaches; Candida may affect platelet glycoproteins and may result in platelet aggregation and headaches [44]. Interestingly, caffeine consumption may increase the risk of Candida overgrowth [45].

Migraine headaches can be induced in those who are exposed to cigarette smoke, air pollution, hair sprays, perfumes and other pollutants [3,46]. This was the case for three of this study's participants. Although monthly hormonal changes can influence the tendency towards migraines in female migraine sufferers, this is not universal [47]. In our small sample, this pattern seemed to affect less than 1/3 of menstruating participants. Low thyroid function has been speculated to play a role in such cases [9]. Supplemental calcium, vitamin D, and magnesium have sometimes been found to be helpful in menstrual-cycle related migraines [31,40]. Since migraine attacks are often frequent, some traditional health professionals believe that they require management with prophylactic agents to reduce their occurrence [1,4]. While this investigator concurs with this belief in many cases, is it necessary that these agents be synthetic?

Although there is no doubt that some medical intervention can be helpful, there is no medical cure for migraine headaches [4]. This investigator is concerned that some migraine medications (such as Cafergot and several types of Excedrin) contain caffeine[19]. This investigator is also concerned that most of the other medicines used to treat headaches (migraines or otherwise) have potentially serious side effects and are generally not recommended for long term use (a helpful summary of headaches medicines and possible side effects can be found in the Standards of Care for Headache Diagnosis and Treatment [4]). Thus it seems clear that other interventions should be considered, at least as an adjunct.

Prophylactic use of natural substances such as magnesium [38-40], riboflavin [42], fatty acids [35], glandulars [9] and herbs have been shown to be effective to reduce the severity and frequency of migraine headaches (although it takes several months for some of them to work, even when they are appropriate [35,42]. Natural interventions administered by properly trained professionals tend to have fewer negative consequences (pregnancy and other cautions, though do apply) than the synthetic counterparts offered by some practitioners [4]. Food and nutritional problems do contribute to causing migraine headaches [4,7,9,35,38-40,42]. Migraines have negative effects on those that suffer from them [4-6] and on those associated with migraine sufferers (such as loved ones and employers) [4]. This researcher encourages doctors and health researchers to be willing to challenge long-standing misconceptions regarding migraines and to work toward cooperative interventions to help these people improve and lead as normal lives as possible.

References
[1] Goadsby PJ. How do currently used prophylactic agents work in migraine. Cephalgia 1997; 17(2):85-92
[2] The Merck Manual of Diagnosis and Therapy, 14th ed. Merck & Co: Rahway (NJ), 1982
[3] Meggs WJ. Neurogenic inflammation and sensitivity to environmental chemicals. Environmental Health Prospectives 1993 101(3):234-238
[4] Mishkin, G. Standards of Care for Headache Diagnosis and Treatment. National Headache Foundation: Chicago,1996
[5] Buring, J, et al. Migraine and subsequent risk of stroke in physicians' health study. Archives of Neurology 1995; 52:129-134
[6] Tzourio C, et al. Case-controlled study of migraine and risk of ischemic stroke in young women. British Medical Journal l995; 310:830-833
[7] Murray M and Pzzomo J. Migraine in Encyclopedia of Natural Medicine. Prima Publishing, Rocklin (CA):410-421, 1991
[8] Duarte A. Health Alternatives, Mega Systems, Morton Grove (IL), 1995
[9] Ingram C. Who Needs Headaches? Literary Visions: Hiawatha (IA), 1991
[10] Thiel R. Serious Nutrition for Health Care Professionals. California Health Group: Arroyo Grande (CA), 1994
[11] Brook G and Guldenpfennig WM. Migraine: Treatment by personalized elimination programme. Neurological Congress, Abstract, March 1994
[12] Gallai V, et al. Magnesium content of mononuclear blood cells in migraine patients. Headache 1994; 34:160-165
[13] Robinson J, Rall JE, Gordon P. The Thyroid and Iodine Metabolism. In: Duncan's Diseases of Metabolism, 7th ed. WB Sauders. (Phil:1009-1104,1974
[14] Luciano DS, Vander AJ, Sherman JH. Human Anatomy and Physiology. McGraw-Hill, NewYork 1983
[15] Many thyroid conditions are underdiagnosed. Medical Tribune, Jan 25, l996;2
[16] Sawin CT.Subclinical hypothyroidism in older persons. Clincs in Geriatric Medicine 1995; 11(2) 231-238
[17] Woeber KA. Subclinical hypothyroid disfunction. Archives of Internal Medicine 1997; 157: 1065-1068
[18] Bakke J. Rethinking thyroid guidelines. Cortlandt Forum 1991; 46-20:79
[19] Physician's Desk Reference, 48th ed. Medical Economics, Montvale (NJ), 1994
[20] Dellovade TL, Shu YS, Krey L, Pfaff DW. Thyroid hormone and estrogen interact to regulate behavior. Proceedings of the National Academy of Science 1996; 93:12581- 12586
[21] Scalzo R. Naturopathic Handbook of Herbal Formulas. Kivaki Press, Durango (CO), 1994
[22] Tenny L. Herb Handbook. Woodland Books, Provo, 1987
[23] Spiller GA. Metabolism and physiological effects of methylxanthines. In:Caffeine CRC Press: New York 225-231, 1997
[24] Iancu I and Dolberg OT. Is caffeine involved in the pathogenesis of combat-stress reaction? Military Medicine 1996; 161(4):230-232
[25] Smith BD and Tola K. Caffeine effects on Psychological functioning and performance In: Caffeine. CRC Press: New York: 251-259, 1997
[26] Lundsberg LS. Caffeine consumption In: Caffeine. CRC Press: New York: 199-224, 1997
[27] Roberts HR, et al. Caffeine consumption. Food and Chemical Toxicology, 1996; 34(1):119-129
[28] Shi X and Dalal NS. Antioxidant behavior of caffeine: Efficient scavenging of hydroxyl radicals. Food & Chemical Toxicology 1991; 29 (1):6
[29] Caffeine-withdrawal headache in post-operative patients. Family Practice Recertification, 1991; 14(8):47
[30] James JE. Caffeine, health and commercial interests: Responding to Golding. Addiction 1995; 90: 985-990
[31] Thys-Jacob S. Vitamin D and calcium in menstrual migraine. Headache, 1994; 34(9): 544-546
[32] Hendlor S. The Doctors Vitamin and Mineral Encyclopedia. Simon and Schuster, New York, l990
[33] Whitney EN and Nunnelley EM. Understanding Nutrition, 4th ed. West Publishing, New York, 1987
[34] Bates B. Low-fat, high-carbohydrate diet averts migraines. Family Practice News August l, l996:16
[35] Wagner W and Nootbaar-Wagner U. Prophylactic treatment of migraine with gamma-linolenic and alpha-linolenic acids. Cephalgia 1997; 17(2): 127-130
[36] Bollet AJ. Nutrition and Diet in Rheumatic Diseases. In Modern Nutrition in Health and Disease, 8th ed. 1994, Lea and Febiger, Philadelphia:1362-1373
[37] Kahn J. Low ionized magnesium linked to migraine headaches. Medical Tribune May l8, l995:7
[38] Peikert A, et al. Prophylaxis of migraine with oral magnesium: Results from a prospective multi-center, placebo-controlled and double-blind randomized study. Cephalgia 1996; 16:257-263
[39] Mauskop A, et al. Intravenous magnesium sulfate relieves migraine attacks in patients with low serum ionized magnesium levels: A pilot study. Clinical Science 1995; 89: 633-636
[40] Boschert S. Magnesium can curb premenstrual migraine. Family Practice News March l, l997:33
[41] Schimatschek HF and Classen HG. Epidemiologic studies on the frequency of hypomagnesemia and hypocalcemic children with functional disorders and neurasthenia. Magnesium-Bulletin 1993; 15(3) 85-104
[42] Schoenen J, et al. High-dose riboflavin as a prophylactic treatment of migraine: Results of an open pilot study. Cephalgia l994; 14:328-329
[43] Galland L, et al. Giardia Lambia infection as a cuase of chronic fatigue. Journal of Nutritional Medicine 1990; 1:27-29
[44] Heuser G. Candida albicans and migraine headaches: A possible link. Journal for the Advance of Medicine, 1992;5(3):177-187
[45] Vaginal yeast infections: Patient guide. The Female Patient 1991; l6:67-68
[46] Anthony M. Platelet superoxide dimutase in migraine and tension-type headaches. Cephalgia l994; 14:181-183
[47] Lokken C, Holm JE and Myers TC. The menstrual cycle and migraine: a time-series anaylsis of 20 women migraineurs. Headache 1997;37(4):235-239

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Copyright 1999/2000 by Robert Thiel, Ph.D., Naturopath All rights reserved.