Migraine Headaches

Description

Lifestyle Changes

Avoiding Food Triggers. Avoiding foods that trigger migraine is important in people who are susceptible to these triggers. Keeping a headache diary that includes tracking diet and headache onset can help identify them.

Healthy Diet. One study indicates that a diet low in fat and high in complex carbohydrates may significantly reduce the frequency, severity, and duration of migraine headaches. Such a diet is healthy in general in any case.

Eating Regularly. Eating regularly is important to prevent low blood sugar. People with migraines who fast periodically for religious reasons might consider taking preventive medications.

Fish Oil. Some studies suggest that omega-3 fatty acids, which are found in fish oil, have anti-inflammatory and nerve protecting actions. These fatty acids can be found in oil fish, such as salmon, mackerel, or sardine. They can also be obtained in supplements of specific omega-3 compounds (DHA-EPA).

Smelling Pleasurable Foods. One interesting study suggested that smelling certain pleasurable foods may reduce migraine pain. (The study used green apples as part of the experiment; patients with headaches who liked the smell of green apples had less pain. The scent had no effect on those who didn't like the fruit.)

Sleep Hygiene

Improving sleep habits is important for everyone, and especially those with headaches.

Aerobic Exercise

Exercise is certainly helpful for relieving stress and an analysis of several studies reported that aerobic exercise might help prevent migraines. It is important, however, to warm up gradually before beginning a session, since sudden, vigorous exercise might actually precipitate or aggravate a migraine attack.

Avoiding Oral Contraceptives

Hormonal agents, such as oral contraceptives (OCs) or hormone replacement therapy, have a mixed effect on women with migraines. Oral contraceptives (OCs) have been associated with worse headaches in 18% to 50% of women and have also been linked to a higher risk for stroke in women with classic migraines (with auras). Young women should avoid or stop oral contraception if they have classic migraines, migraines that worsen or change character after OCs, if they have close relatives with stroke or heart disease, or if they smoke.

Some evidence suggests, however, that OCs may help prevent true menstrual migraines (which do not have auras). In such cases, their benefits may outweigh the low risk of a serious adverse event. Keeping a migraine record for at least three menstrual cycles can help to confirm whether a woman actually has a true menstrual migraine.

Behavioral Treatments

Behavioral techniques that reduce stress and empower the patient may help some people with migraines. Studies report between 35% and 50% reduction in migraine and tension-type headaches with these approaches. They generally include the following:

• Biofeedback therapy.
• Cognitive-behavioral therapy.
• Relaxation techniques.

Behavioral methods may help counteract the tendency for muscle contraction and uneven blood flow associated with some headaches. They may be particularly beneficial for children, adolescents, and pregnant and nursing women, and anyone who cannot take most migraine medications.

Biofeedback. Studies have demonstrated some effectiveness from biofeedback for migraine headaches. Biofeedback training teaches the patient to monitor and modify physical responses, such as muscle tension, using special instruments for feedback.

Cognitive Behavioral Therapy. Behavioral therapy may be useful alone but is particularly beneficial for patients who are on preventive drug treatments. It typically employs the headache diary to track activities and headaches. The patient then works with the therapist to change or add behaviors or medications that will reduce the frequency and severity of attacks.

Alternative Treatments

People increasingly use alternative remedies for chronic problems. It should be strongly noted that alternative or natural remedies are not regulated and their quality is not publicly controlled.

Non-Drug Therapies. Alternative non-drug therapies used for headache management include hypnosis, meditation, visualization and guided imagery, acupuncture, acupressure, yoga, and other relaxation exercises. There is no clear evidence that any of these techniques have specific value for migraines.

Some studies report the following:

• Acupuncture. A number of individuals have tried acupuncture with varying response. In one 2003 study, it had some benefits in the early treatment of a migraine attack, but a triptan was more effective at relieving the headache.
• Relaxation Techniques. Muscle relaxation techniques may be helpful. One interesting 2001 study reported that relaxation treatments appeared to help adolescents with migraine but not tension headaches.
• Electrical Stimulation. Small studies have found that therapy with transcutaneous electrical stimulation (TENS) may reduce migraine headache episodes. The procedure involves a very mild electrical sensation across the skin. One course of TENS takes about a half hour. One report suggests that using TENS with acupuncture points, along with self-hypnosis and relaxation techniques, may be an effective management option among patients with migraine headaches, but long-term and well-conducted studies are needed to confirm this.

Riboflavin (Vitamin B2). There is reasonable evidence on the benefits of vitamin B2 for migraine sufferers. In one study, patients who took 400 mg of vitamin B2 (riboflavin) reduced their migraine attacks by half, although the vitamin had no effect on the severity or duration of migraines that did occur. In another study, it helped increase the effectiveness of beta-blockers, drugs used to prevent migraines in some people. Vitamin B2 is generally safe, although some people taking high doses develop diarrhea.

Feverfew. Feverfew is the most studied herbal remedy for headaches and is effective in some cases. It should be noted, however, that, like all effective headache remedies over use can cause a rebound effect. Some experts recommend purchasing feverfew in dried leaf form. It appears to be safe, but side effects can be distressing.

Phytoestrogens. Phytoestrogens are plant products that have estrogen-like properties. They include soy and black cohosh. In one study, a combination of soy compounds, dong quai, and black cohosh was associated with a lower risk for menstrual migraines. Because of the association between oral contraceptives, which contain estrogen, and a higher risk for stroke in people with migraines, no one should take such remedies without consulting a physician.

Glucosamine. Glucosamine is a natural substance being used with some success for patients with osteoarthritis. Anecdotal reports are suggesting that the use of this agent may prevent migraines. As with other natural remedies, products are not regulated by the FDA. It is being well studied for arthritis, however, and to date has few side effects. Many available brands (e.g., CVS, Walgreens, Wal-Mart) are manufactured with appropriate ingredients.

Coenzyme Q10. Coenzyme Q10 is a natural substance that is important for the transport of electrons. One study reported that patients who took it experienced a significant reduction in migraine headaches after three months.

Magnesium Supplements. Some studies have reported a higher rate of magnesium deficiencies in some migraine patients, such as those with menstrual migraines. Whether supplements are helpful, however, is unproven.