Migraine and Cluster Headaches

Paul L. Reller L.Ac. / Last Updated: August 03, 2017


Migraine therapies in Complementary and Integrative Medicine (CIM)

Research into the effects of herbal medicines and nutraceuticals has exploded in the last decade worldwide. PubMed, an official U.S. NIH database of published studies, is easily accessible, and while this database only includes about 20% of all published studies, an increasing number of these rigorous medical clinical and laboratory reviews concern herbal study. A single medicinal herb may have 100 studied chemicals of medicinal value in it, and each of these chemicals may have 50 known useful biochemical actions. Databases outlining this elaborate information are now available online, sponsored by the government, and information is as easy to obtain as googling phytochemical database. Randomized controlled human clinical trials now prove with more sensible study design the efficacy of short courses of frequent acupuncture treatment, as well as more prolonged courses of nutrient formulas and herbal medicines. Presently, meta-review of these studies in China is being used to provide a more comparative guideline to improve care with integrative medicine.

A number of herbs have the same mechanisms of action as we believe are important with Topomax. Simple and safe herbs like California poppy flowers and magnolia stems have significant benzodiazapine-like effects, without side effects. Various nutraceutical approaches may provide your body with bioavailability of nutrient chemicals that enhance GABA activity and improve the glutamate metabolism in the brain. Kava kava has been shown to be an effective sodium channel blocker. More and more practitioners of Traditional Chinese Medicine are becoming acquainted with these specific uses of herbal chemicals and nutrient supplements to add to the already extensive knowledge and researched use of modified traditional herbal formulas. In China, extensive study and meta-review of recent randomized controlled human clinical trials with standard migraine herbal formulas have also provide evidence of efficacy and safety. The generic Tianshu Capsule has been studied and proven to be effective. This patent formula is a combination of the two most classic migraine formulas in TCM, Da Chuan Xiong Fang and Tianma Gouteng Yin. To facilitate such study, Chinese medical schools have had to individually study each herbal ingredient as well, in various extract forms, and even the individual chemical constituents. Of course, such extensive study has taken a long time to complete, but the results are proving that an array of benefits are obtained from even the small dosages of the key herbal chemicals.

Some specific herbs have been widely studied. Feverfew is now widely studied and utilized in herbal formulas. Research has tried to discover which of the 50 or so known medicinal chemicals in the extract results in Feverfew's effectiveness (Tanacetum parthenium). This research has identified that Feverfew chemicals exert positive effects on genetic stimulation of production of key inflammatory modulators. This research is avalable by clicking below on the link. Feverfew exerts proven genetic stimulation of monocyte chemoattractant protein 1 (MCP-1), as well as tumor necrosis factor alpha (TNFalpha), and these may explain it's effectiveness. What we learn from such research is that by persisting with therapy that includes the herb feverfew, our bodies genetic responses may be stimulated to react to the migraine triggers properly. Homeostasis may be restored to some extent with this therapy. By combining Feverfew with other studied herbs and acupuncture, the chances of a successful outcome are great. By taking such herbs for only short periods and jumping from one therapeutic agent to another, you might not achieve this success in therapy. Butterbur, or Petasites, is another native American herb that has shown success in clinical trials, and this and other herbs shown effective in scientific study may be combined in formula, or incorporated into the treatment strategy to insure greater chance of success. Not all treatments are effective on their own for all patients. Herbal treatment protocol needs to be individually prescribed and often the herbal formulas need to be adjusted as therapy proceeds. A professional herbalist will be able to follow through on this more complicated herbal approach.

Nutritional supplements have also been the subject of much research in the treatment of migraine, and are being integrated into the protocol of many M.D.s. In Europe, a combination of Coenzyme Q10, Vitamin B6 (pyroxidine, or P5P), riboflavin (B2), and magnesium, have been studied in human clinical trials and shown promise with use over a period of 3-4 months. Coenzyme Q10 works by increasing efficiency of various cellular mechanisms, especially the electron transport chain in mitochondria in the brain. It is also a potent cellular antioxidant, and helps regulate excess inflammatory responses. It is a molecule that is called ubiquitone because it is found in almost every cell of the body. Many patients studied in recent years had a relative deficiency of CoQ10, which could result from poor diet as well as a side effect of common medications, such as cholesterol lowering statins and hypertension medications such as beta-blockers, or increased demand for CoQ10. CoQ10 deficiency is implicated in both cardiovascular and neurological pathologies as a primary cause in some diseases. Vitamin B6 pyroxidine is useful in the treatment of migraine because it is a coenzyme for diamine oxidase, which aids in breaking down histamine. Excess histamine causes the blood vessels to dilate rapidly, and both histamine production and clearance are important. Vitamin B2 riboflavin is a coenzyme that is needed for the metabolism of the amino acid tryptophan, which is converted to niacin in the body. Niacin (B3, or inositol hexacotinate) is needed for proper circulation, and is involved in the synthesis of sexual hormones. Riboflavin deficiency is associated with slow neurological responses, sensitivity to bright light, dizziness, and inflammation. While this combination of nutrient medicines is a little expensive, it would not need to be used continuously for a prolonged period, only until the underlying pathology is resolved. The efficacy in small trials with CoQ10 was demonstrated, as CoQ10 produced a greater than 50% decrease in number of days with migraine for 60% of patients.

Other nutrients that have been explored and found useful in the treatment of migraines includes Vitamin B3 niacin (which does produce a temporary flush after taking for the first few weeks in most patients, and so the form inositol hexacotinate is used), lecithin (or the metabolite phosphatidylcholine), and Omega-3 fatty acids. Magnesium is now universally recognized as an effective nutritional medicine in the migraine protocol, but simple magnesium citrate supplement alone may not be enough to correct the depletion of magnesium that occurs in migraine attacks. In 1998, the New York Headache Center published research in the medical journal Clinical Neuroscience (1998;5(1):24-7) that showed that dysfunction of the magnesium metabolism in the brain was complex. Concentration of magnesium has an effect on serotonin receptors, nitric oxide synthesis and release, glutamate NMDA receptors, and a variety of other migraine related receptors and neurotransmitters. Some studies at that time showed that magnesium supplementation may also reduce the frequency of migraine headaches in a subset of patients with magnesium deficiency. By 2004, researchers at the University Pierre and Marie Curie in Paris found that this magnesium depletion was due to dysregulation of the magnesium metabolism, and magnesium supplementation alone was not enough to correct this important part of the migraine pathology. Dysfunction of the biological clock was found to play an important part of this dysregulation of the magnesium metabolism, either due to primary disorders of the suprachiasmatic nuclei and pineal gland, or secondary to nervous hyperexcitability and seasonal photoreactivity. This accounted for the many patients with worsened frequency of migraine attacks during the spring and summer. These researchers recommended the use of melatonin, L-Tryptophan (or 5HTP), taurine, and magnesium, as well as what they called "Darkness Therapy" to stimulate increased melatonin function. This is basically time spent in a completely dark room with eye covering.

Over time, the theory that magnesium played an integral role in migraine pathophysiology by affecting what was called spreading cortical depression, or episodes of generalized dysfunction of the membrane transport in the cortex of the brain, has become more prevalent. Experts at Harvard Medical School postulated that not only the magnesium ion, but the balance of mineral ions involved in cell membrane transport and gating, potassium, calcium and sodium, may be involved, affecting many neurotransmitter receptors, glutamate NMDA receptors, and the nitric oxide metabolism, leading to cortical spreading depression, trigeminal and peripheral nerve activation, and autonomic nervous system dysfunction. The question of how to reverse this cortical spreading depression effect and magnesium depression, or mineral ion imbalance, is most important if this is the case. Complementary Medicine offers the patient the best chance at restoration of homeostatic mechanisms, while allopathic medicine seeks to find the key chemical to block the process. Acupuncture, herbal and nutrient medicine thus may focus on gradual restoration of this homeostasis by electroacupuncture stimulation combined with an array of nutrient and herbal medicines. Simplistic use of nutritional supplements, such as is the case in standard medicine at this time, may not be enough to correct the complex array of homeostatic dysfunction. The quality and array of supplements and herbs may be all important, as well as an individualized step-by-step approach. As usual, in a complex pathology such as migraines, research has not made the treatment protocol simpler, but rather more complex, albeit more specific.

The most promising studies of migraine treatment combine key herbs and nutritional supplements. A 2009 study at the Headache and Cerebrovascular Center in Vicenza, Italy, showed that a combination of Gingko biloba extract with CoQ10 and Vitamin B2 riboflavin significantly reduced incidence of migraine, from an average of 3.7 per week to 1.2 after 4 months. Total disappearance in migraine attacks occurred in 11% of patients in the first 2 months, and 42% in the 4 month period (PMID: 19415441). Ginkgo biloba contains a number of chemicals that exert antihistamine, anti-inflammatory, hypotensive, and antioxidant effects, as well as being a vasodilator and inhibitor of inducible nitric oxide synthase, such as quercetin, apigenin, kaempferol and luteolin. The problem with human studies is that the number of herbs and supplements given must be kept to a minimum to better judge results, while a more comprehensive array of these medicinals may be needed. Funding is also a problem, and most of the funding goes to the most well known or publicized herbs and supplements. The actual clinical course expected to work is a combination of more herbs and supplements than seen in these studies, because this would increase the success rate. Once again, if the patient, for some reason, is not responsive to a particular combination of herbs and supplements with scientific validity, then the professional herbalist will change the treatment protocol to achieve successful results. The patient just needs to persist with treatment and trust in the eventual outcome. Lack of persistence and trust is perhaps the greatest inhibitor of success in migraine therapy utilizing Complementary and Integrative Medicine.

Hormonal migraines, usually triggered during the premenstrual period, have also been the subject of much research in recent years. During this phase of the menstrual cycle, relative deficiency of progesterone accounts for most symptoms. This creates a cascade of neurohormonal events, such as a serotonin deficiency, nitric oxide deficiency, and increased stress on the immune system. Often, a combination of acupuncture, progesterone stimulating cream, 5HTP, L-arginine, B6, and herbal formula directed at various symptoms, will normalize the neurohormonal effects and significantly reduce the occurrence and intensity of migraine headache. Standard medicine has issued warnings concerning oral contraceptive use for migraine sufferers, especially during perimenopause. Oral contraceptives decrease natural hormonal production, and are associated with increased need for riboflavin. Riboflavin deficiency is associated with increased migraine potential, reducing the ability of the body to produce sufficient niacin to maintain vascular health and regulation of vasodilation.

While the complete treatment protocol for difficult diseases such as migraine headache may be more complicated than the patient desires, adhering to a thorough treatment protocol which is individualized for the the patient will produce the best chance of success. Modern medicine is still stymied when faced with effective pharmaceuticals for migraine patients. A wide variety of pharmaceutical approaches is now tried. What works for one patient does not work for another. This illustrates the degree of difficulty in treating this disorder. Following through with a course of acupuncture, and being consitent with herbal formulas and nutrient prescriptions that are tailore to the individual offers the patient the best chance of outcome over a few months. If therapy is now working after a month, the physician will alter the treatment to insure greater success. Persistence is the key.

The potential role of detoxification and chelation in migraine therapy

It is well known that heavy metal toxicity is involved in many type of neurological disease and dysfunction. Accumulation of mineral ion molecules may affect the normal mineral ion homeostasis, as well as cause cell mutation and dysfunction. Oxidant stress is also highly implicated in many neurological diseases, with the body struggling to clear excess free radical oxidants, or reactive oxygen species (ROS). In addition, aldehyde toxicity is now a growing concern in neurological diseases, and since various aldehydes are known to trigger migraines in subsets of patients, this is becoming more of a concern. Aldehydes are byproducts that accumulate when drinking excess alcohol, and are responsible for many of the hangover symptoms, but in recent years aldehydes are also implicated in chronic fatigue syndromes, especially since parasitic systemic fungi may produce aldehydes in excess of the ability to clear them. Therapy for persistent migraines that are not responsive to other protocols may try various detoxification therapies to clear these problems.

Safe and effective mineral chelation therapy is now available, combining an array of chelators that are nontoxic (see the article entitled Lead, Mercury on this website). EDTA, DMSA, CoQ10, chlorella, N-acetyl cysteine, milk thistle, and activated charcoal, as well as coral calcium formulas are chelators gaining popularity. Many of the potent chelators are now combined in professional chelating formulas. Of course, an array of antioxidants are recommended, and should be used intelligently (see the article on this website entitled Antioxidants and Free Radicals). In addition, research has now led to effective formulas to clear excess aldehydes that are safe and nontoxic. Guidance by a professional, such as a knowledgeable Licensed Acupuncturist and herbalist, is important to insure safe and effective protocols.

What you can do at home to decrease migraine and cluster headache frequency and severity: an important part of overall protocol

Besides seeking out a knowledgeable Complementary and Integrative Med (CIM) physician, such as a Licensed Acupuncturist with good knowledge of herbs and nutrient medicine, there are a number of things the migraine and cluster headache patient may do work toward significant decrease of elimination of these headache episodes.

Keep a migraine or cluster headache diary, noting times of onset, symptom descriptions, what you had been eating or doing beforehand, what the weather pattern was or whether you had been exposed to environmental chemicals, even household cleaners and scents. Evaluate this information to see if you are overlooking some important triggers.

Some activities work when you feel the headache coming, or feel the prodrome headache of symptoms that precede the full vascular migraine or cluster episode. A percentage of patients will find immediate relief in stopping this extreme vascular reaction by taking some excedrin and strong caffeine (although caffeine in daily use should be curbed or eliminated). Others will find that the excedrin and caffeine has no effect. One needs to find the right environment to stop the vascular hyperreaction, going to a quiet and dark room is possible, or outside to a shady quiet location, lying down or getting into a comfortable resting position for about 10 minutes, and finding a focused routine that works for you. Earplugs and eye coverings may be helpful, or an iPod with soothing quiet music. Breath slow and deep, from the belly to the upper lungs, and sigh when letting the breath out. Don't push the exhalation. Try to imagine warmth in the palms of your hands, perhaps rubbing them together briefly first to mentally find this sensation. When you get good at this technique, it may work very well to stop the onset of the severe headache and allow you to continue your day at peace.

The main dietary approaches in reducing migraine occurrence are to reduce simple sugars and carbohydrates, refined foods, preservatives and aged foods, chocolates, avocados, lunchmeats, hot dogs, spicy foods, MSG, beer, yeast, alcohol, greasy foods and acid forming foods such as breakfast cereals, granola and heavy meats. Eating less red meat and fatty meats, especially grilled or fried, and eating more fresh green vegetables, whole grains and lean meats that are fresh and organically produced without preservatives and chemical additives, will help the migraine sufferer achieve their goals of reduction of triggers and improvement in related health systems in the body. Over time, I have witnessed many patients achieve much improvement with such dietary changes. Many of the common triggers to migraine contain histamines, such as beer, cheese, wine, chocolate, and it is surmised that this is the reason that Vitamin B6 is often effective in preventing migraines, with its promotion of enzymatic breakdown of histamine. These foods also contain nitrite preservatives.

Since migraines and cluster headaches are vascular headaches, dietary protocol to improve vascular health has long been recommended. Fatty acid balance and Omega-3 fatty acids is explained thoroughly on another article on this website, and has long been recommended as part of the protocol for migraine sufferers. Without a fatty acid balance a patient may develop inflammatory dysfunction that leads to various cardiovascualar problems, and may increase the chance that your system will react with a hypersensitive vascular reaction, or migraine.

Studies have shown that a small percentage of migraine sufferers also had celiac disease, an allergic hypersensitivity to gluten and gliadin, that was linked to the migraine mechanism. If this is suspected, elimination of gluten from the diet as much as possible for a few months, along with therapy to improve the intestinal mucosa and immune health may produce dramatic results.

A combination of reduction of trigger stimulation with a holistic protocol to resolve the underlying disease mechanisms is very important. Decreasing triggers and improving overall health allows the treatment to work. If you continue to trigger migraines with unhealthy diet and lifestyle, reducing the disease mechanisms is much more difficult. Adopting a thorough holistic approach may eliminate this problem completely in the long run, and this would be worth the extra effort of a thorough holistic approach.