Migraine Headache

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Imagine a feeling of dread coming over you as the familiar flashing lights and hallucinations creep into your consciousness. It’s happening again!  Is this a bad script from a horror movie or a sign that you need to take some time off? Well, it could be, but for many folks it is no laughing matter. Apparitions such as these may indicate the imminent arrival of a severe and painful headache known as a migraine. Many folks suffer from these on a regular basis. Let’s try to find out what causes these terrible headaches, and if anything can be done to prevent them.

What is a Migraine Headache?

A migraine headache is a chronic vascular headache that produces intense pain that is often debilitating, and may last for several hours or longer. Some migraine sufferers experience sensory warning signs that predict a pending attack, while most do not. Other symptoms may accompany the headache, including nausea, vomiting, and oversensitivity to light and sound. Most migraine headaches mainly attack only one side of the head.

It is thought that over 28 million Americans experience migraine headaches, with women being affected approximately three times as often as men. About 18% of women and 6% of men experience one or two attacks per year, while about three million women and one million men suffer from one or more monthly migraines. Children may be afflicted, but most patients have their first headache as a teenager, and migraines are rarely found in folks over the age of sixty. Estimates place the cost of missed work, poor performance on the job, and direct medical expenses due to migraines at billions of dollars annually.

80% of migraines are not accompanied by sensory warning signs, or “aura,” as it is called. This type of migraine is known as “migraine without aura,” and was formerly called “common migraine.”  “Migraine with aura” used to be called “classic migraine,” and is found in only 20% of cases. The aura may include visual disturbances, hallucinations, and numbness in the extremities, and can appear as early as 72 hours before the actual headache is manifested.

What Are the Signs and Symptoms of a Migraine Headache?

Signs of a migraine will vary from person to person, and are somewhat different for children and adults. General symptoms include:

  • Moderate to severe head pain, often on only one side of the head
  • Pain characterized by sharp pounding or throbbing
  • Over sensitivity to light and sound
  • Nausea, sometimes accompanied by vomiting
  • Pain that increases with physical activity
  • Pain that interferes with daily activities

These chronic headaches vary in frequency and intensity, and the symptoms can last anywhere from 4 to 72 hours. Even for the majority of patients who do not have an aura, many will experience “premonitions” that can predict an oncoming migraine. While not as distinct as an aura, these sensations typically include:

  • Elevated mood and/or energy level
  • Drowsiness or excessive yawning
  • Craving for sweets
  • Excessive thirst
  • Depression or irritability

The minority of cases, who have migraine with aura, usually experience some of the following signs 15-30 minutes before the headache, although some people see these patterns appear after the headache begins:

  • Blurry or bright spots in the vision
  • Dazzling flashes of light, often described as “jagged” or “zig-zagged”
  • Slowly spreading blind spots in the field of vision
  • Hallucinations
  • Pins-and-needles or numbness, usually in one arm or leg
  • Weakness or fatigue
  • Language and speech problems
  • Disturbed thinking
  • Anxiety

While migraines are rare in children, they occasionally affect infants as young as one year of age. Migraines usually become less intense and occur less often as the child gets older. Kids typically experience migraine headaches that last for a shorter time than they do for adults, and migraines in children more commonly affect both sides of the head. Only rarely will they have the visual auras associated with some migraines.  In addition to nausea, vomiting, and light/sound sensitivity, look for:

  • Excessive yawning
  • Fatigue or listlessness
  • Excessive sleepiness
  • Craving for certain foods, such as sugary snacks, chocolate, bananas, and yogurt
  • Some children may experience a phenomenon known as “abdominal migraines.”  When this occurs, they may have all the symptoms except the head pain. It can be hard to identify these as migraine symptoms, and therefore many diagnoses are missed due to symptoms that mimic other conditions.

What Causes Migraine Headaches?

Much research has been done on migraine headaches, and some of the pieces of the puzzle are starting to come together. Evidence indicates that migraines may be related to functional changes in a major structure of the central nervous system called the trigeminal nerve system. Levels of certain chemicals in the brain, such as serotonin, are also likely factors.

The mechanism whereby migraines occur is rather complex, and can be summarized as a three-phase process:

  • Initiation:  This initial stage is thought to be caused by a number of possible “triggers” or “stressors” that can affect individuals who are prone to get migraines. (More on that in a moment). These triggers seem to have a cumulative effect, and eventually lead to abnormal serotonin absorption.
  • Prodrome: The prodrome is the period of time between the initiation and the appearance of the actual symptoms. This is when patients experience premonitions or auras indicating a migraine is on the way.
  • Headache:   Once the “threshold” has been reached, symptoms begin to kick in, and a migraine headache results.

Pain sensing neurons in the brain called nociceptors release chemicals (neurotransmitters) known as neuropeptides. One of these neurotransmitters is known as substance P, and it causes increased pain sensitivity in adjacent nociceptors, resulting in a progressive increase in the pain.

Migraines are vascular headaches that are the result of unstable blood vessels. Other neuropeptides act on the smooth muscles of the blood vessels surrounding the cranium. During the headache phase, the muscles are relaxed, causing dilation of the cranial blood vessels, and increased blood flow to the area. Another factor in the pain is the result of other neuropeptides that enable the blood vessels to “leak,” causing tissue swelling and inflammation. The aura that some folks experience is thought to be the result of contracted cranial blood vessels, the same ones that dilate during a headache.

Researchers have also discovered a drop in serotonin levels during a migraine headache, and believe this may be what stimulates the trigeminal nerve to release neuropeptides. It has also been discovered that magnesium levels decrease in migraine patients just before or during a headache. Insufficient magnesium has been linked to nerve cell dysfunction in the brain, and may help to explain the physiology behind the instability of the blood vessels.

What Are the Possible Triggers of a Migraine Headache?

Certain foods, environmental factors, medications, and other triggers are the prime stressors that set the migraine process in motion for most people:

  • Food allergies and sensitivities are thought to be responsible for many migraine headaches. There is solid research that has shown that many patients may significantly reduce their symptoms or even completely eliminate them by avoiding problem foods. Scientists think the allergic/intolerance reactions are related to both serotonin levels in the body, and histamines, tyramines, phenols, and other substances in certain foods that cause blood vessels to dilate. Typical foods that may act as triggers include:
    • Wine–especially red wine, which contains more phenols and 20-200 times as much histamine as does white wine.
    • Processed foods, which often contain many preservatives such as nitrites, sulfites, and monosodium glutamate (MSG).
    • Beer
    • Aged cheeses
    • Chocolate
    • Caffeine (and caffeine withdrawal)
    • Pickled, fermented, or marinated foods
    • Aspartame
    • Overly sweet foods
    • Dairy products
    • Citrus fruits
    • Certain nuts
    • Canned figs
    • Chicken liver
    • Brewer’s yeast
    • Certain beans.
    • Fasting or missing meals.
  • Environmental and incidental factors that are triggers for many folks include:
  • Stress:  Emotional stress can set off migraines, or a period of relaxation following hard physical or mental work. This is sometimes referred to as a “weekend migraine.”
  • Sleep patterns:  Any changes in your normal sleep patterns can cause migraines. This includes insomnia, too little, or too much sleep.
  • Physical exertion beyond what you are typically used to can lead to problems, such as moving, household projects, or playing high-energy sports that you are not accustomed to. Try to avoid getting burned out physically and emotionally.
  • Prolonged periods of poor posture
  • Sensory stimulus:  Bright lights, excessive exposure to sunlight, and unusually strong odors can set of migraines in some folks. Odors can be pleasant (perfume, flowers) or unpleasant (gasoline, paint thinner, etc.). Secondhand smoke is also a common trigger.
  • Weather:  Changes in barometric pressure are especially troublesome for many migraine patients. Other factors may include changes in season, altitude, or even time zones. Jet lag is a trigger for some folks.
  • Hormonal changes are a possible stressor as well. Many women find their migraines get worse just before or during their period, during pregnancy, and during menopause.
  • Certain medications or medical treatments are problematic for many folks with a history of migraines:
    • Oral contraceptives
    • Estrogen Replacement Therapy
    • Theophylline (for respiratory conditions)
    • Indomethicin (for gout and arthritis)
    • Climetidine (as an antacid or for ulcers)
    • Pain medications such as non-steroidal inflammatory drugs (NSAIDS) should not be over used. Their effectiveness will decrease, and they can even begin to actually cause headaches due to a phenomenon called “rebound headaches.”
    • Decongestants, especially if over used.

What Treatments Are Available for Migraine Headaches?

The best and most effective treatment and prevention for migraines is to identify any triggers that may set your symptoms off, and eliminate them. These often take the form of foods, so changing your diet can be very effective.

Mainstream medical has drugs that are often prescribed, but there are more natural options that are just as effective and much safer. Some remedies that many have found helpful are:

  • 5-Hydroxytryptophan (5-HTP):  Supplementation with this serotonin booster has been clinically proven to be effective and safe for treating migraines. The effects of 5-HTP have been studied for over thirty-five years.
  • Riboflavin:  Vitamin B2, or vitamin G as it is sometimes called, has shown a lot of promise in helping to prevent migraines. Its affects on the cranial blood vessels are very positive, and there are no known side effects.
  • Magnesium:  Studies have shown that migraine patients who boost their magnesium levels have less frequent and less intense symptoms. Magnesium is thought to have a calming affect on the nervous system and to help keep the blood vessels toned and healthy. Use a supplement that is bound to citrate, aspartate, or malate as these are more easily absorbed by the body.

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