I had the opportunity to host another pharmacist, Christine Lewis, over the last few weeks at my practice site. Dr. Lewis is actually doing a residency in Arizona but has a huge passion for functional medicine and heard me speak at the ASHP Midyear Clinical Meeting last December and called me up and asked if she could do a rotation at my site. She is also working on an elective in functional medicine for the pharmacy school there. It’s exciting to see more and more pharmacists engage with this type of practice. I was flattered that she wanted to come out to my small practice in Ohio (she didn’t know it was going to snow in April before she signed up!). This month as part of her projects, she put together a two part series for you on migraines. Enjoy and stay tuned for part 2!
Migraine headaches are a debilitating condition that affects as many as 12% of the US population (1). Migraines are more common among women than men and occur more frequently between the ages of 18-44 (2). Migraine headaches typically are one-sided, pulsating, aggravated by daily routine activity, and can vary in duration from 2-3 hours to days (3f).
The Headache Society guidelines, which are what many providers refer to when treating patients, recommend anti-seizure medications and beta-blockers (blood pressure/heart medication) for migraine prevention and a class of medications called triptans and non-steroidal anti-inflammatory medications (like ibuprofen) for acute symptoms (4). While these agents have been shown to be effective, these agents come with side effects including mood changes, nausea, dizziness, and fatigue (5). Not to mention there are many drug-drug interactions with anti-seizure medications.
Fortunately, a 2012 update to the guidelines include evidence supporting alternative therapies (such as supplements) that are effective at prevention of migraines (6). In my experience many providers are not aware of this update and routinely still only recommend pharmacologic methods for migraine prevention. Some providers may recommend their patients to keep a migraine diary so that potential triggers can be identified. While the migraine diary is good advice, the guidelines treat all patients suffering from migraines similarly. Biologically we are all unique with differences in genetics, environments, exposures, diet, lifestyle, etc. thus having different factors affecting the etiology of migraines.
Functional and natural approaches to migraine headaches include to identify the root cause. Three people may have migraines, but they could have different underlying root causes. One person could have a food sensitivity or allergy, one could have a magnesium deficiency, and one may have hormone imbalances. For providers it’s important to gather a patient’s history that includes environment, toxin exposure, diet, stress management, and lifestyle as well as requesting appropriate laboratory assessments to determine each patient’s underlying cause of migraine headaches.
Common causes of migraine headaches
Food sensitivities/ intolerances/ or allergies:
Food sensitivities intolerances, and allergies are common and can contribute to disease by causing chronic inflammation. Common food culprits include gluten, eggs, soy, dairy, or peanuts (7). Many patients may not realize that they have a sensitivity to a food group until that group is eliminated and later reintroduced. If you are a follower of this blog, you have read about leaky gut and why the number of people with food sensitivities is increasing.
Nutrient deficiency is thought to cause migraines in some patients such as magnesium deficiency or some b-vitamin deficiencies. Magnesium deficiency is prominent. In 2005 over 48% of the population did not consume enough magnesium in their diet (9). Even if you do eat healthy and have lots of fruits and vegetables in your diet you still may be deficient in certain vitamins, minerals, and phytonutrients. This is due to nutrient depleted soil, because decreased crop rotation, the use of pesticides, GMO’s, and the lack of animals fertilizing the soil. Vegetarians and vegans may be more susceptible to nutrient deficiencies for multiple reasons but should be cautious of B-vitamins, magnesium, calcium, and iron.
As we get busier and busier in our day to day our bodies are vulnerable to becoming chronically stressed. Those of us that have recently lost a loved one, moved, changed jobs, have other health conditions are more susceptible to adrenal fatigue or dysregulation of the stress response in our system. During the stress response the body produces more cortisol. While we need cortisol to handle stress and engage the fight or flight response, chronically elevated levels of cortisol can cause headaches and have other adverse effects on our health as well (10).
Stress, sedentary lifestyle, high sugar intake can all affect hormone balance negatively. When hormones become unbalanced it can trigger migraine headaches. Some women only experience headaches in premenstrual times demonstrating that for some, migraines are caused by hormone imbalances. Some studies have found that estrogen is possibly effective at the prevention of migraines (6). Evidence to support only using estrogen therapy alone is not strong and may not be appropriate for everyone. Hormone replacement therapy should be personalized and should be balanced for optimal outcomes. Other women may be deficient in other hormones other than estrogen such as progesterone or testosterone which can also contribute to headaches (11).
Other causes of migraine headaches for some may be blood glucose dysregulation, electrolyte imbalances, inadequate sleep, infections, high sodium intake, decreased hydration, and vasoactive foods such as chocolate, cheese, citrus, and alcohol (7).
Stay tuned later this week for Part 2 which includes natural treatment approaches and supplements.
- About migraine. Migraine Research Foundation.http://migraineresearchfoundation.org/about-migraine/migraine-facts/. Accessed April 5, 2018.
- QuickStats:Percentage of Adults Aged ≥18 Years Who Reported Having a Severe Headache or Migraine in the Past 3 Months, by Sex and Age Group — National Health Interview Survey, United States, 2015. MMWR Morb Mortal Wkly Rep 2017; 66:654. DOI: http://dx.doi.org/10.15585/mmwr.mm6624a8
- Headache disorders. World Health Organization. http://www.who.int/mediacentre/factsheets/fs277/en/ Updated: April 2016. Accessed April 5, 2018.
- Loder E, Burch R, Rizzoli P. The 2012 AHS/AAN guidelines for prevention ofepisodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache. 2012 Jun;52(6):930-45.
- He A, Song D, Zhang L, Li C. Unveiling the relative efficacy, safety and tolerability of prophylactic medications for migraine: pairwise and network-meta analysis. The Journal of Headache and Pain. 2017;18(1):26. doi:10.1186/s10194-017-0720-7.
- Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346-1353. doi:10.1212/WNL.0b013e3182535d0c.
- Gaby, AR. Migraine. Nutritional Medicine, 2ndEdition. Concord, NH: Fritz Perlberg Publishing; April 2017.
- Żukiewicz-Sobczak WA, Wróblewska P, Adamczuk P, Kopczyński P. Causes, symptoms and prevention of food allergy. Advances in Dermatology and Allergology/Postȩpy Dermatologii I Alergologii. 2013;30(2):113-116. doi:10.5114/pdia.2013.34162.
- Andrea Rosanoff, Connie M Weaver, Robert K Rude; Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutrition Reviews, Volume 70, Issue 3, 1 March 2012, Pages 153–164, https://doi.org/10.1111/j.1753-4887.2011.00465.x.
- Ramachandran R. Neurogenic inflammation and its role in migraine. Semin Immunopathol. 2018 Mar 22.
- Li W, Diao X, Chen C, Li C, Zhang Y, Li Y. Changes in hormones of the hypothalamic-pituitary-gonadal axis in migraine patients. J Clin Neurosci. 2018 Apr; 50:165-171.