Migraines are painful, often debilitating headaches and are a common concern in primary care practices.  Up to 17% of women and 6% of men report experiencing a migraine headache in their lifetime, and, in general, women are three times as likely to have them as men.  Migraine pain is typically described as pounding, throbbing and sharp.  Some people report having a warning, or aura, before the migraine comes on and nausea and vomiting are commonly experienced during the headache.  Sufferers generally become sensitive to light and noise and must lie down in a quiet, dark room until the pain resides (usually hours, but these can last days).

 The migraine headache is poorly understood, but it is generally believed that in response to certain triggers the levels of a neurotransmitter called serotonin drop causing a series of events that eventually lead to enlargement and inflammation of the blood vessels in the head, resulting in head pain.

 There are many known triggers for migraines.  Some of the most common include:

• Hormonal changes such as estrogen fluctuations that occur before or during periods, with pregnancy and menopause.
• Foods including alcohol (especially red wine), aged cheeses, chocolate, caffeine, fermented, pickled and marinated foods, soy, dairy, wheat, food additives, MSG and aspartame.
• Stress
• Sleep disorders
• Environmental changes such as with weather, seasons, altitude, barometric pressure and time zones.
• Sensory overload including loud noises, bright lights and strong smells

 An important part of prevention and treatment is to identify which trigger may be the underlying aggravator, and to remember that it is often more than one.  A common way to begin the investigation is to do a “Headache Diary”, in which one keeps note of when they get migraines, what foods have been eaten, stressful days or situations as well as menstrual symptoms like PMS or starting the period.  Jotting these down on a calendar can give insight in to patterns to the headaches.

 Food triggers are commonly identified through an elimination diet, in which the most common problematic foods are taken out of the diet for up to 3 weeks and then reintroduced one-by-one to see if the migraines come back.   Sometimes blood tests are used to identify potential problem foods which are eliminated in the same way. 

 In addition to diet, natural therapies are often effective in preventing migraine headaches.  Current research supports the use of riboflavin (vitamin B2), feverfew, butterbur, magnesium and CoQ10 in decreasing both the frequency and severity of migraine headaches in many patients.  A physical treatment called CranioSacral therapy can also be effective in prevention and treatment in that it can ease restrictions in the skull. 

 A sample treatment plan for migraine prevention may look like this:

• Headache diary x 4 weeks
• Identify and eliminate food triggers
• Hormone balance through use of specific vitamins, minerals, herbs and/or hormones
• Riboflavin—400mg daily
• Feverfew—100mg twice daily
• Butterbur—75mg twice daily
• Magnesium citrate—up to 600mg daily (less if it causes diarrhea)
• CoQ10—100mg three times daily

Some natural therapies should not be taken with certain medications, so it’s important to talk with your physician before beginning any herbal or nutritional treatment. 

 Finally, ensuring proper amounts of sleep and exercise, managing stress and eating regularly are important in preventing migraines.  Make an appointment with your naturopathic physician to discuss which of these options is appropriate for you.

 Melissa McCarty is a Naturopathic Physician practicing in Seattle, Washington.  She may be reached at her clinic Seattle Integrative Medicine, located at 5322 Roosevelt Way NESeattle, WA 98105.  Phone: (206) 525-8012