A migraine is a severe, throbbing, recurring headache, typically only affecting one side of the head and lasting 2 to 72 hours. The pain is commonly centred at the temple, over one eye or behind one ear. It commonly occurs with nausea, vomiting and sensitivity to light.
Some migraine sufferers also experience an “aura”, prior to the onset of the headache, which usually manifests as visual disturbances or disruption of smell.
The pathophysiology of a migraine involves the constriction of blood vessels to the brain followed by a rebound dilation, irritating surrounding nerves and resulting in a pulsating or pounding pain.
Migraines tend to first appear between the ages of 10 and 45 and occur more commonly in women than men. In children, symptoms may be experienced as colic, abdominal pain and vomiting.
Causes of Migraines
Caused by abnormal brain activity although the underlying aetiology is unclear.
It is believed it involves nerve pathways and neurotransmitters which affect the blood flow in the brain (neurovascular theory). Migraines can run in families.
There are often histamine, glutamate and other excitotoxins that can be the trigger for many patients migraines.
Poor methylation can be a chief underlying problem in migraines. Those with the MTHFR gene variation are at higher risk of headaches and migraines.
Migraines may be triggered by a number of factors including:
- Poor methylation
- Stress and anxiety
- Lack of sleep
- Caffeine withdrawal
- Missed meals of meals high in histamine or glutamate
- Certain odours or perfumes
- Loud noises or bright lights
- Changes in hormone levels during menstrual cycle or with OCP use
- Vasoactive dietary amines: red wine, chocolate, cheese, smoked fish and other histamine containing foods
- Food additives: MSG, nitrates, tartrazine, citric acid
- Food intolerance: fermented and pickled foods, dairy, wheat, citrus fruits, onions, gluten
- Exercise or physical stress
- Brain tumour or abscess
- Seizure disorder
- Subdural haematoma
TREATMENT STRATEGY FOR MIGRAINES
- Identify / manage triggering factors (e.g. stress, lack of sleep, hormonal changes, food allergies, hypoglycaemia etc)
- Assess for food sensitivities
- Assess methylation
- Reduce inflammatory response
- Regulate vasoactivity
- Reduce platelet aggregation
- Support nervous system
- Support liver function
- Balance blood sugars
- Manage stress
Diet plan guidelines for Migraines
- Identify / remove allergenic foods: may need elimination diet. 90% of migraine sufferers get relief when put on a low allergenic diet (gluten in particular is implicated)
- Avoid amine-rich foods: aged meats, red wine, chocolate, aged cheeses, smoked fish, shellfish and other high histamine foods
- Avoid food additives: especially MSG, nitrates, tartrazine, citric acid
- Avoid excessive alcohol
- Anti-inflammatory diet: high in oily fish, linseeds, nuts and seeds; low in animal products, sugar, refined carbohydrates
- Low glycaemic load diet: regular meals low in sugars and refined carbohydrates, high in complex carbohydrates, adequate protein
- Magnesium-rich foods: helps to relax spasms in the blood vessels of the head and neck
- Cayenne pepper: a small amount mixed with honey and warm water may help reduce inflammation
- Ginger: ginger tea may help relieve the nausea and inflammation associated with migraine
- Feverfew: 1-4 leaves consumed daily may be effective as a migraine prophylactic
Supplements that support Migraines
- Magnesium – intracellular magnesium is often lower in people with migraines. Magnesium may lower neuroexcitability and vasoactivity; also reduces stress response and muscle tension which may be associated with migraine
- Riboflavin – high doses for three months: shown to reduce migraine frequency. High doses should be taken with food.
- SAMe – preliminary studies show a reduced frequency, intensity and duration of migraine, this supplement should heavily influences methylation and should be prescribed by a practitioner, often there are other underlying methylation issues that need addressing to treat the underlying block in the methylation pathway.
- Niacin – regulates blood flow, also uses up methyl groups in the body, contraindicated in some individuals
- Vitamin B6 – reduces platelet aggregation; particularly useful in hormonal migraines, assists with the processing of histamine
- Quercetin – anti-inflammatory and anti-histamine
- Evening Primrose Oil – specially in hormonal migraines
- Reduce inflammatory response – feverfew, ginger, turmeric, butterbur (used in Germany for migraines for more than 30 years and supported by large studies)
- Regulate vasoactivity – chamomile, passionflower, valerian, scullcap, black cohosh, goldenseal (blocks conversion of tyrosine to tyramine)
- Reduce platelet aggregation – ginkgo, hawthorn
- Support liver function – St Mary‘s thistle, bupleurum, schisandra, dandelion, greater celandine
- Adaptogens – withania, ginseng, rehmannia, codonopsis
- Balance hormones: chaste tree if indicated
- Balance blood sugars: fringe tree, gymnema, cinnamon
- Symptomatic treatment – Jamaica dogwood, willow bark, corydalis
Lifestyle / Physical measures
- Regular aerobic exercise and yoga linked to decrease in frequency of attacks
- Stress reduction techniques e.g. massage, meditation, yoga, deep breathing
- During migraine: cold compresses to forehead and eyes, complete immobility and minimisation of light, noise and odour; topical applications of essential oils.
FUNCTIONAL MEDICINE TREATMENT OF MIGRAINES
Recurrent migraines have an underlying dysfunction that is driving the condition. Identifying the underlying cause for the individual patient is the key in resolving the condition. Often there are problems with the processing of histamine and other amines, this can be due a deficiency of the DAO enzyme or related to sub optimal methylation and other genetic variations with multiple genes including the MTHFR gene.
Addressing gut function, SIBO and other bacterial overgrowths is also highly indicated as many of these bacteria produce substances that contribute to the amine load that is triggering the migraine attacks.
At our Perth clinic of Advanced Functional Medicine we treat patients both in person and Australia wide via video link. If you or a family member are suffering from migraines we would love to hear from you. What changes have most improved your migraines? Have you addressed histamines and methylation and resolved your migraines for good? Please leave a comment below