As promised, I’m back with another post by Dr. Christine Lewis, PharmD. Last week we put up Part 1 which focused on the underlying cases of migraines, part 2 now focuses on the treatment to address those causes. The goal is to determine the root cause and address the root cause. The treatments mentioned below are non-pharmacological methods that migraine sufferers can try under the guidance of a healthcare professional to address the root cause (or eliminate a root cause) of their migraines. Just this week I had a patient with migraines daily that have significantly decreased by addressing yeast overgrowth. Sometimes it makes me jump up and down on the inside like a little kid when there are victories like that! Next step is looking at this particular patient’s nutritional deficiences. Hope you enjoy the rest of our discussion on migraines.
Is it stress? Is it diet? Is it lifestyle?
A good place to start is the elimination diet to discover if there are any food sensitivities, intolerances, or allergies. Complete the elimination diet (without cheat days) for 21-28 days and slowly re-introduce eliminated foods one at a time. A good elimination diet includes the Whole 30 Program or a diet that eliminates grains, refined sugar, dairy, soy, gluten, peanuts, processed meats, eggs, whey, butter, vegetable oil, caffeine, and alcohol. Both diets focus on whole foods with lots of vegetables, healthy sources of protein, and healthy fats. Neither diet is intended to help you lose weight but to identify and eliminate aggravating foods. Slowly reintroduce food groups one at a time and keep a food diary to track your symptoms. Remember that symptoms can present minutes to a couple of days later with food sensitivities. It is important to listen to your body and monitor for signs of intolerance such as bloating, gas, irregular bowels, allergies, headache, skin reactions, etc (1).
Other things to consider include supplementation with magnesium glycinate 200-300mg twice daily and/or vitamin b-complex (includes riboflavin, niacin, folate and vit B12). Other supplements that have been beneficial in clinical studies include CoQ10, alpha-lipoic acid, l-tryptophan, vitamin C, omega-3, vit D and calcium, feverfew, butterbur, and melatonin. Below is a chart with some common dosage forms and recommendations (2-7).
|Butterbur||50mg-75mg twice daily||Look for PA (pyrrolizidine alkaloids) free|
|Magnesium glycinate||100mg-300mg twice daily||May use magnesium oxide but may have GI side effects|
|Coenzyme Q10||60mg-300mg once daily|
|Riboflavin||15mg-400mg once daily|
|Folic Acid||5mg once daily||5-MTFH is the active form|
|Alpha-lipoic acid||100mg-600mg once daily|
|Feverfew||6.25mg three times daily||Not recommended in pregnancy|
|L-tryptophan||500mg two to four times daily||Should not take with anti-depressants, tramadol, triptans|
|Vitamin D3||5000 IU daily if deficient|
1000-2,000 IU daily to maintain
|Supplement dosage (not specific to migraine). Best to take with Vitamin K2!|
|Omega 3||1200mg-6000mg once daily||Can increase risk for bleeding when on blood thinners|
|Melatonin||3mg once daily||Take 1-3 hours before bedtime|
High quality supplements can be found at my FullScript Store. If you need help selecting a product that is right for you, don’t hesitate to reach out.
It is also important to restore hormone balance by exercising regularly, obtaining adequate sleep, and eliminating caffeine, alcohol, and sugar. Also, having adequate levels of b-vitamins is important for healthy metabolism of hormones. Talk to your provider about hormone level testing if lifestyle and diet modifications are not effective to see if there are underlying imbalances or deficiencies.
During an acute migraine, the use of essential oils has been shown to be effective. Lavender oil when inhaled can provide relief and relaxation after 15 minutes from migraines (8). Peppermint oil can also be of benefit for the treatment of migraine headaches. Peppermint oil can be applied to the forehead, temples, and back of the neck. It provides a cooling sensation, relaxes the muscles, and increases blood flow to the area (9,10). Both should be diluted appropriately. Check out my free e-book when you sign up for email updates for more about essential oils. You can find high quality essential oils here.
Other effective therapies that can address root causes of migraines and have been found to decrease frequency include acupuncture, chiropractic manipulation, mind-body techniques, yoga, and reflexology (11,12). It is suggested that these modalities can decrease stress, alter bio-feedback, block pain signaling, and other mechanisms that can be effective for the treatment of recurrent migraines.
If these treatments are not effective a thorough evaluation may be needed to find other underlying cause of migraine attacks. Hopefully this gives you a helpful starting point for various ways to attack your migraines!
- 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.
- Loder E, Burch R, Rizzoli P. The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache. 2012 Jun;52(6):930-45.
- 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.
- Sándor PS, Afra J. Nonpharmacologic treatment of migraine. Curr Pain Headache Rep. 2005 Jun;9(3):202-5. Review.
- National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/butterbur. Updated September 2017. Accessed April 9, 2018.
- National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/feverfew. Updated November 2016. Accessed April 9, 2018.
- Sasannejad P, Saeedi M, Shoeibi A, Gorji A, Abbasi M, Foroughipour M. Lavender essential oil in the treatment of migraine headache: a placebo-controlled clinical trial. Eur Neurol. 2012;67(5):288-91.
- Kligler B, Chaudhary S. Peppermint oil. Am Fam Physician. 2007 Apr 1;75(7):1027-30. Review.
- Göbel H, Schmidt G, Dworschak M, Stolze H, Heuss D. Essential plant oils and headache mechanisms. Phytomedicine. 1995 Oct;2(2):93-102.
- Chessman AW. Review: Acupuncture reduces migraine frequency more than usual care, sham acupuncture, or prophylactic drugs. Ann Intern Med. 2016 Oct 18;165(8): JC44.
- Millstine D, Chen CY, Bauer B. Complementary and integrative medicine in the management of headache. BMJ. 2017 May 16;357: j1805. doi: 10.1136/bmj.j1805.