Migraine and its prevention

Migraine is a common disorder which causes headache attacks and is partially affected by genes. The physiological reason for migraine is a reactive disorder in the brain stem. Migraine is three times more common among women than men. In this article, we will cover migraine and its treatment from the perspective of western medicine as well as functional medicine.

What causes migraine?

The brain activities during a migraine attack are not completely known yet. However, an electrochemical change within the brain stem caused by a certain trigger is involved in every migraine attack.

According to an article by neurologist Sari Atula published in the medical journal Duodecim, certain external factors that vary by individual are often the reason for a migraine attack. These include for example stress or the ending of stress, alcohol usage, heat, changes in temperature, strong odours, certain foodstuff or taking too long breaks between meals. In addition, poor sight, unsuitable glasses or malocclusion can cause migraine attacks.

According to WHO (the World Health Organization), 6-8 % of men and 15-18 % of women in Europe and the United States are diagnosed with migraine per year. The fact that migraine is more common among women is due to the changes in the hormone cycle. Variation in the hormone levels is one of the most common factors that cause migraine. This is referred to as menstrual migraine.

According to Kathy Robinson, a physician assistant specialized in functional medicine, migraine can be caused by:

• Food allergies and sensitivities (e.g. peanut, gluten, dairy, egg)
• Celiac disease, gastroenteritis, unbalanced gut bacteria
• Hormonal imbalance (so called menstrual migraine or estrogen dominance when the level of progesterone is too low compared to estrogen)
• Vitamin B deficiency (especially the deficiency of riboflavin or vitamin B2)
• Lack of melatonin and irregular sleep pattern
• Magnesium deficiency
• Chemicals (e.g. aspartame, monosodium glutamate, nitrites, sulfites)
• Food coloring, artificial flavors
• Foods containing tyramine (e.g. chocolate and cheeses)
• Imbalance in mitochondria
• Fluctuation of blood sugar
• Emotional and physical stress

How does migraine attack begin?

The trigeminal nerve which innervates sensations in the head and facial area and monitors blood circulation plays an important role in the transmission of migraine. The trigeminal nerve which starts from the brain stem area triggers migraine by impacting the surface on the intimal medial thickness of meninges. The pain message is conveyed to the areas of brain which sense pain through the activated neural endings. The throbbing pain occurs when the sensitized nerve endings react to the pulse wave going through in the arteries.

For most people that suffer from migraine, a visual defect called aura appears as the first symptom of migraine. It occurs as the result of an electric wave which is sent by visual cortex located at the back of the head. This temporarily shuts down the activity of nerve cells and blood circulation. A typical visual defect is sawtooth which occurs when the electric wave passes the visual cortex. Correspondingly, the prickling and numbness related to the aura occurs when the electric wave passes the sensory cortex.

The treatment of migraine

Migraine is treated according to Current Care Guidelines in Finland. According to the guidelines, the right diagnose and a confidential doctor-patient relationship are the cornerstones of treatment. It is important that the doctor knows the patient’s lifestyle as well as life situation in order to give the best possible treatment for migraine.

According to Current Care Guidelines, treatment that doesn’t involve medicine are rest, sleep and a cold compress placed on the sore area. Avoiding stimulus and triggers such as bright light and the lack of sleep are recommended as ways to prevent migraine attacks. Eliminating stimulus from the surroundings is also recommended: cool, dark and quiet surrounding can often help during a migraine attack.

When the migraine attack is moderate or severe, the treatment often requires medicine or a combination of medicine. The Current Care Guidelines include directions for the use of painkillers and nausea medication. The guidelines recommend to take a big enough dose as soon as the first symptoms arrive. The medicine and their doses used in the treatment of migraine are presented in Table 3 ("Aikuisen migreenin lääkehoito", engl. The treatment of migraine with adults).

Patients who suffer from nausea can find nausea medication (metoclopramide) taken with or before painkillers helpful. All painkillers available have typically been used in the treatment of mild or moderate pain even though there is still very little scientific evidence on their effectiveness in the treatment of migraine. Triptans are used in the treatment of severe or disabling headache; triptans, ot serotonin receptor agonists, constrict blood vessels in the brain and the head which expand during a migraine attack. This mechanism prevents the inflammatory reaction and reduces pain. Triptans are effective in treating migraine but also cause undesired side effects such as fatigue, vertigo, numbing of limbs and a heavy or pressing feeling in the neck and the upper part of the chest.

Atula recommends that in addition to medical treatment, patients also focus on preventative lifestyle, such as a regular sleeping pattern and eliminating ongoing stress factors. According to Atula, regular exercise, stretching, massaging and physiotherapy can also help in the prevention and treatment of migraine. According to her, some of the patients also benefit from acupuncture and relaxation treatments.

From the perspective of functional medicine, the cornerstones in the treatment of migraine are avoiding certain foodstuff and using certain vitamins and magnesium in mitigating the migraine attack. Mark Hyman, a doctor focused on functional medicine, has compiled extensive guidelines in the prevention and treatment of migraine. According to him, it is more important to treat the reasons behind migraine rather than to focus on treating the symptoms.

The functional medicine guidelines for the treatment and prevention of migraine, suggested by Hyman:

• Elimination diet (more information below)
• 300–600 mg of magnesium (in glycinate or citrate form) twice per day
• 400 mg of riboflavin per day (note; the color of urine can turn into dark yellow)
• Balancing of hormones: avoiding coffee, sugar and alcohol and favoring a diverse vegetarian diet which includes for example broccoli, cabbage, linseed, tofu, other vegetables, berries and fruit
• 1-3 mg of melatonin per night
• 500 mg–2 g of fish oil (EPA/DHA) per day
• 100–150 mg of ubiquinone (coenzyme Q10) per day
• Regular sleep pattern and enough sleep (preferably eight hours per night)
• Keeping blood sugar levels stable (regular times between meals, no white sugar nor products containing white wheat flour, a light snack about an hour before going to bed)
• Minimizing stress (life choices that do not expose to stress and improving the stress tolerance for example through meditation and breathing exercises)
• Herb treatment according to professional guidance (e.g. butterbur, feverfew, ginkgo)
• Essential oils (e.g. peppermint, lavender, eucalyptus, rosemary) 
• Regular practice of yoga and/or tai chi
• Focusing on ergonomics (workplace ergonomics, ergonomics during training, sleep ergonomics)
• Physiotherapy and massage

The most common allergens and the foodstuff that cause oversensitivity are eliminated in an elimination diet.

These include for example:

• Peanuts
• Dairy
• Eggs
• Yeast
• Corn
• Sugar
• Citrust
• Black tea
• Coffee
• Milk chocolate and other chocolate that contains sugar
• Red meat
• Alcohol
• Soy
• Wheat
• Seafood

In addition to avoiding certain foodstuff, the elimination diet supports the important gut bacteria with quality probiotics or prebiotics. Every now and then digestive enzymes are used in balancing the gut bacteria.

Sources:

Atula, Sari. (2016) Migreeni. Medical journal Duodecim. http://www.terveyskirjasto.fi/terveyskirjasto/tk.koti?p_artikkeli=dlk00047. Reference July 9, 2018

Hyman, Mark. 5 Steps To Solve Your Migraines. http://drhyman.com/blog/2013/12/27/5-steps-solve-migraines/. Reference July 9, 2018.

Miles, Otesa & Downward, Emily. (2018) Coenzyme Q10 for migraine. https://migraine.com/migraine-treatment/natural-remedies/coenzyme-q10/. Reference July 9, 2018

Robinson, Kathy. A Functional Medicine Approach to Headaches. http://www.checksutterfirst.org/neuro/pdf/a-functional-medicine-approach-to-headaches-kathryn-robinson-pa-c.pdf. Reference July 9, 2018

Migraine. Current Care Guidelines. Working committee established by The Finnish Medical Society Duodecim and The Finnish Neurological Society. Helsinki: The Finnish Medical Society Duodecim, 2015 (Reference July 9, 2018). Available online: http://www.kaypahoito.fi/web/kh/suositukset/suositus?id=hoi36050

Migraine Association of Finland. https://migreeni.org/paansarkysairaudet/migreeni/. Reference July 9, 2018