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Dr. Tori Hudson, Portland, Oregon, Blog Healthline Blog

Women account for about three quarters of the 28 million Americans who experience migraine headaches. Migraines can begin at any age, and occur fairly equally in boys and girls until adolescence. The prevalence of migraines in women in their early forties, and then declines steadily with age.

How does a migraine occur?

MigraineThe process resulting in a migraine begins in the nervous system. Rather than a vascular or muscular disorder, as we thought in the past, migraines are a neurological condition. It begins when the sensitive nervous system of a migraine sufferer is faced with an environmental stressor that can reduce their migraine threshold. These risk and trigger factors include hormonal changes, alcohol consumption, skipping meals, sleep deprivation and medications. Under these circumstances, the neurochemical balance of the nervous system changes, and prodromal symptoms can occur. If this state progresses, the migraine threshold is crossed, and the “migraine generator” area of the brainstem is now activated. A wave like effect occurs across the surface of the brain; nerve cells, selected nerve branches and the vascular structures they supply are activated, releasing neuropeptides from the nerve. These then produce an inflammation of small arteries which stimulate blood platelet “stickiness” and serotonin release. Nerve impulses are transmitted back to the brainstem and as the process continues, brainstem reflexes are activated that produce the migraine related symptoms, ex/ nausea, vomiting and photophobia. Pain fiber activation can also result in nasal congestion and pain in the sinus cavities.

What can trigger a migraine?

For women, proper management of migraines would include the consideration of their hormonal situation. Migraines can be related in timing to the menstrual cycle, when there are fluctuations in our hormones, which affect the brain chemistry and vasculature. Migraines tend to reduce in frequency in postmenopausal women, when estrogen levels decrease significantly and stabilize (without monthly fluctuations.) The majority of women experience no change or even improvement in their headache pattern with oral contraceptives. Although many women experience relief from headaches during pregnancy, others find that migraine symptoms stay the same or worsen. As with menstrual migraines, migraines at perimenopause may require balancing or stabilizing the hormonal environment.

A holistic approach to improving migraines would include reducing or avoiding common triggers: dietary amines (chocolate, cheese, beer, wine). Reduce or avoid the most common foods that induce migraines (cow dairy, wheat, chocolate, eggs, fish, coffee, nuts), and known or suspected individual food allergens. Consider nutrient deficiencies, stress, skeletal misalignments and muscle tension. As always, eat a whole foods diet free of preservatives, white sugar, white flour and fried foods.

Herbs and supplements that can help

FeverfewButterbur, specifically the extract of the rhizome of the plant, when standardized to contain 15% petasins, reduces spontaneous activity and spasms in the smooth muscle of the vascular walls. It also reduces leukotrienes and thus provides an anti-inflammatory effect as well. Numerous research reports have demonstrated that butterbur reduces the frequency and intensity of migraine attacks.1 More recently, a randomized, double-blind, placebo-controlled clinical trial for migraine prevention was conducted on 229 migraine patients. Petasites extract was found to be safe and effective in reducing the frequency of migraine episodes, the number of days of migraine per month, and the intensity of the headache itself.2 Ginger is an excellant anti-inflammatory, and reduces blood platelet stickiness. Feverfew is rich in compounds known as sesquiterpene lactones, which inhibit platelet stickiness and histamine release, regulate serotonin release and is an anti-inflammatory. Of 270 migraine sufferers who had eaten feverfew daily, 70% had a decrease in the frequency and/or intensity of their attacks.3 Several clinical studies have shown an improvement in attacks and symptoms.4 Riboflavin has the potential of increasing energy efficiency within the cell, possibly stabilizing cerebral blood vessels. 49 migraine patients were treated with 400 mg per day of riboflavin for 3 months, showing a 68% reduction in the migraine severity score.5 Low magnesium levels have been detected in sufferers of both migraine and tension headaches.6,7,8,9 In one study, patients had a 41% reduction in frequency by week nine when taking magnesium daily.10 It may be that only those who have low magnesium levels in the tissue or blood may benefit from taking magnesium. 5-hydroxytryptophan (5-HTP) modulates serotonin levels and increases endorphin levels, making it especially helpful for sufferers of headaches accompanied by sleep disorders. In one of the largest clinical trials, 124 patients received either 5-HTP or methysergide for six months,11 with comparable results. Two other studies demonstrated that 5-HTP was superior to the pharmaceutical prescription.12,13

Note: If you are taking SSRI anti-depressants or have reduced kidney function, you should consult your physician before taking these herbs/supplements. These herbs/ supplements should be avoided if an individual is on anti-coagulant therapy, barbiturates, or blood sugar lowering medications and if pregnant, nursing or has liver disease.

  1. Gruia F. Biological treatment of pain. Results of a doctors’ practice study with a phytopharmaceutical. Erfarungsheilkunde 1986;35:396-401. (article in German)
  2. Lipton R, Gobel H, Wilks K, Mauskop A. Efficacy of Petasites ( an extract from Petasites rhizome) 50 and 75 mg for prophylaxis of migraine: results of a randomized, double-blind, placebo-controlled study. Neurology 2002;58:A472.
  3. Johnson E, et al. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J 1985;291:569-573.
  4. Schoenen J, Lenaerts M, Bastings E. High dose riboflavin as a prophylactic treatment of migraine: Results of an open pilot study. Cephalalgia 1994;14:328-329.
  5. Schoenen J, Lenaerts M, Bastings E. High dose riboflavin as a prophylactic treatment of migraine: Results of an open pilot study. Cephalalgia 1994;14:328-329.
  6. Mazzotta G, et al. Electromyographical ischemic test and intracellular and extracellular magnesium concentration in migraine and tension-type headache patients. Headache 1996:357-361.
  7. Swanson D. Migraine and magnesium: eleven neglected connections. Perspect Biol Med 1988;31:526-527.
  8. Ramadan N, et al. Low brain magnesium in migraine. Headache 1989;29:590-593.
  9. Gallai V, et al. Magnesium content of mononuclear blood cells in migraine patients. Headache 1994;34:160-165.
  10. Peikert A, et al. Prophylaxis of migraine with oral magnesium: Results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalagia 1996;16:257-263.
  11. Titus F, et al. 5-hydroxytryptophan versus methysergide in the prophylaxis of migraine: Randomized clinical trial. Eur Neurol 1986;25:327-329.
  12. Bono G, et al. Serotonin precursors in migraine prophylaxis. Adv Neurol 1982;33:357-363.
  13. Maissen C, Ludin H. Comparison of the effect of 5-hydroxytryptophan and propranolol in the interval treatment of migraine. Med Wochenschr 1991;121:1585-1590.

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