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Townsend Letter for Doctors and Patients,
August-Sept, 2002 by Dr. Farhang Khosh,
Dr. Mehdi Khosh, Dr. Deena Beneda
28 million Americans suffer from migraine headaches.
Migraines account for an enormous loss of time from work, school and daily activities.
A significant majority of patients report severe disability due to migraine headaches. 80% of the patients rate the debilitating headaches as severe, 23% have sought emergency room treatment and 39% have pain so severe that they are bedridden for days. Since 1989 to the present the prevalence of migraines has been the same despite the advances in medical technology.
There are currently many approaches for treating migraine headaches that are not as effective as one would imagine.
The holistic approaches in treating migraine headaches must include lifestyle and psychosocial modifications, dietary changes, nutritional balances and proper therapeutic approaches.
This can be accomplished by avoiding migraine-triggers such as foods and certain food additives, taking herbs such as Tanacetum parthenium, Petasites hybridus and Zingiber officinalis, supplements such as 5-HTP, calc itonin, essential fatty acids, riboflavin and magnesium.
Migraine headaches affect nearly 28 million Americans, which means 1 out of every 4 households. Left untreated, migraines cause a significant reduction in the quality of life for the migraine sufferers. Migraines account for a remarkable loss of time from work, school and daily activities. 51% of migraine sufferers report a 50% or more reduction in work and/or school productivity; 66% report a 50% or more reduction in household work.
A significant majority of patients report severe disability and the need for bed rest due to an inability to control the pain and symptoms of the migraine headaches. The debilitating headaches are rated as severe in 80% of the patients, and 23% have had to seek the emergency room for treatment; 39% have pain so severe that they are bedridden for days. (1)
Total US prevalence of migraine headaches was virtually the same in 1999 as it was in 1989 (12.6% vs. 12.1%). Even though there has been significant advances in prescription medications for migraine treatment, 57% of patients still only use over-the-counter medications for treatment which is almost the same as 10 years ago when 59% of patients were using only OTC medications.
(2) Despite better understanding of migraine headaches and medications designed specifically for the treatment of migraines, many people continue to suffer from unnecessary pain and disability. Migraines may occur at any age, but are usually between the ages of 10 and 30 years old. Migraine headaches are more common in women than in men. (3)
Migraine headaches can be classified into three different types: the common, classical and complicated.
With the common migraine, the pain is frontal, unilateral or bilateral. It usually doesn't involve an aura and can last for one to three days. (4) The pain is usually unilateral in the classic migraine and can last anywhere from two to six hours. The pain and duration of the headache is unpredictable in a complicated migraine headache.
The classical and complicated migraine headache both have an aura. (5) The aura, which precedes the headache generally, includes scintillating scotomas, other visual field defects, paresthesias, restlessness, anxiety, anorexia, fatigue, irritability, or depression.
Within a few minutes, the headache begins, throbbing or pounding, very severe, accompanied by photophobia and nausea and/or vomiting.
The migraine headache occurrence is variable and it may strike every day or only once every several months. If left untreated the attacks can last from hours to days.
The exact cause of the migraine headache is unknown. However, there are many theories on the causes and many known triggers to the migraine attacks:
1) It may be due to regional alterations in cerebral blood flow. Studies measuring brain blood flow have shown a reduction of blood flow prior to a migraine attack. This is proceeded by an increase in blood flow that can persist for more than 48 hours. (6)
2) Studies have shown a difference between platelets of migraine suffers and those without migraines. These differences include structural composition, increase in platelet aggregation, and serotonin release. (7)
3) The nervous system may play a role in the development of migraine headaches. It has been found that nerve cells in blood vessels of the migraine patient release a compound called "substance P." Substance P triggers pain and its release into the arteries is associated with the dilation of blood vessels and the release of histamine and other allergic compounds.
(8) The prodromal symptoms that can be seen in a migraine may be due to the intracerebral vasoconstriction, and/or some suggest the head pain is due to substances released by the dilation of the scalp arteries.
4) Migraine headaches can be a result of serotonin deficiency. It was found that during migraine attack there is an increase in the serotonin breakdown product 5-hydroxyindoleacetic acid (5-HIAA) in the urine. (9, 10) The factor responsible for the increased serotonin breakdown is an increased activity of monoamine oxidase (MAO). (11-13)
The lower levels of serotonin leading to lower pain thresholds in patients suffering from chronic headaches, is supported by over 35 years of research with positive clinical results in double-blind studies with the serotonin precursor 5-hydroxytryptophan (5-HTP). (14)
5) Nutritional imbalance including nutritional deficiencies is an immense consideration in migraine headaches.
Also, a commonly known trigger of migraine headache is food and certain food ingredients. The following is a list of common triggers of migraines: (15, 16)
* Alcohol
* Tyramine: aged cheeses and fermented foods
* Aspartame (artificial sweetener)
* Caffeine
* Phenylethylamine (present in some OTC and chocolate)
* Foods prepared with monosodium glutamate (MSG) for example Chinese food, processed or frozen foods
* Nitrates (preservatives used in sausage, bacon, and lunch meats)
* Citrus foods and products
* Cow's milk
* Eggs
* Corn
* Soy
Other factors hypothesized to cause migraine headaches include 6) hormonal influences such as menstruation, ovulation or ovarian cyclic disorders. (17) 7) Drug-induced migraine headaches caused by the side effects from taking a drug for the headache or other medications. 8) Musculoskeletal problems including TMJ, poor posture or spinal misalignments. 9) Lifestyle factors such as stress, sleeping habits or missing a meal. And last of all, 10) Changes in the environment including exposure to chemicals such as household cleaning products, strong odors such as perfumes, overhead blinking lights, noise and changes in the weather. (18)
What are the treatments for migraine headaches?
Are there other alternatives for treatment of migraines besides drugs?
Pharmaceutical drugs for migraine headaches are numerous and so are the side effects. The drug treatment ranges from mild pain relievers such as ibuprofen (Advil, Nuprin), aspirin (Bayer, Ecotrin) or acetaminophen (Tylenol, Tempra), to stronger pain relievers such as codeine. If the headaches are not responding to ordinary painkillers other drugs including ergotamine preparation, (19) beta-blocker propranolol (Inderal), butorphanol (Stadol), calcium channel blockers or sumatriptan (Imitrex) may be prescribed.
Sumatriptan (Imitrex) is a serotonin agonist and works by increasing serotonin levels in the brain. Serotonin is involved in the constriction of blood vessels -- a component of migraine headaches is due to a disturbance in circulation to the brain, increasing serotonin levels can help to restore the balance in the tension of the blood vessels.
However, sumatriptan is expensive and can produce side effects such as increased heart rate, elevated blood pressure, and a feeling of tightness in the chest, jaw or neck. (20)
Herbal medicine has been used in treating ailments for centuries, so it is not surprising that treating migraine headaches with botanicals is not only effective but eliminates the side effects that pharmaceutical drugs have.
One of the most popular studied herbs for migraine headache is Tanacetum parthenium (Feverfew).
Feverfew has been used anciently for a wide variety of conditions which can be classified into three main groups, 1) treatment for fever, headache and migraine, 2) difficulties in labor, threatened miscarriage, and regulation of menstruation and 3) relief of stomachache, toothache and insect bites.
Current use of Feverfew is against headache, relief in arthritis and the treatment of psoriasis. (21)
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