Migraine/Headaches

Published by NHC on January 5, 2021January 5, 2021

Migraines/Headaches

Info
Description	Migraine: A recurrent throbbing headache that typically affects one side of the head and is often accompanied by nausea and disturbed vision.
Signs & Symptoms	Recurrent pain in head area Nausea Disturbed vision Often with aura Sensitivity to light and noise
Causes & Contributors	Food allergy/ Intolerances Hormonal influences Liver dysfunction Constipation Genetics Hormones As observed in headaches associated with menstruation Food allergies/intolerances More common in coeliacs Nitrites, amines, sulfites Histamines Reduced diamine oxidase activity, an enzyme needed for breakdown of histamine, leading to release of nitrate monoxide, causing headache. Most Common Foods associated with Migraine/Headaches Cows milk (57-67%) Wheat (43-57%) Chocolate (26-57%) Egg (22-60%) Orange (13-52%) Benzoic acid (35%) Cheese (32%) Tomato (14-32%) Tartrazine (30%) Rye (30%) Rice (30%) Seafood (17-29%) Grapes (12-33%) Onion (24%) Soy (17-24%) Pork (17-22%) Peanuts (12-29%) Alcohol (9-29%) MSG (19%) Walnuts (19%) Beef (14-20%) Tea (17%) Coffee (15-19%) Nuts (12-17%) Goats milk (14-15%) Corn (9-20%) Oats (15%) Cane sugar (7-19%) Yeast (12-14%) Apple (12%) Peach (12%) Potato (12%) Chicken (7-14%) Banana (7%) Strawberry (7%) Melon (7%) Carrots (7%) Medication attributed to headaches/Migraines Medications (that cause vasodilation) ACE inhibitors Calcium Channel blockers Medication Overuse Headache (MOH) Abuse of analgesics, triptans, and other acute headache medications. Migraine with Aura: Nitric oxide donors, Phospodiesterase inhibitors, tacrolimus, fluoxetine Migraine without Aura: Cyclosporin, dipyridamole, nitric oxide donors, phosphodiesterase inhibitors, Interferon-β, Ondansetron, Tacrolimus, Sertraline Cluster Headache: Nitric oxide donors, phosphodiesterase inhibitors Aura without Headache: Tadalafil
Pathophysiology/Aetiology	Platelet disorder Abnormalities in normal platelet function may be indicated in pathogenesis Not related to number or size of platelets, but rather the composition appears to be unique in migraine patients. Higher spontaneous platelet aggregation and adhesion observed in migraine patients Serotonin abnormalities
Complications	Increased risk of stroke and myocardial infarction in migraine sufferers
Treatment
Treatment of Specific Causes	Hangover headache Ensure adequate hydration, food intake before and after drinking Stop or lessen alcohol intake Ensure detoxification pathways are working properly Caffeine withdrawal headache Limit caffeine intake Ensure adequate hydration Ensure detoxification pathways are working properly Exertion headache Review of CVD function and possible serious conditions being cause Ensure adequate hydration and electrolyte intake/supplementation Hunger headaches Eat regular meals, stabilise blood sugar Gymnema TMJ headache Caused my malocclusion (poor bite), stress, jaw clenching Use muscle relaxants (e.g Mg) Fever headache Provide immune support Arthritis headache Herbal anti-inflammatories Eyestrain headache Refer for eye evaluation Muscle relaxants Tension headache Stress management Adaptogens Cluster headache Removal alcohol and cease smoking Herbal anti-inflammatories, hydration, detoxification pathway support Menstrual related headaches Correct hormonal imbalance Hypertension headache BP control Sinus headaches Address infection, anatomical deformities Allergy headache Reduce allergic response
Best Therapeutic Treatment	Complete Headache/Migraine Diary Consider the causative factor(s) Food reactivity, hormonal, caffeine withdrawal, dehydration, medication, hypoglycaemia, etc. Dietary Stabilise blood sugar by eating smaller more frequent meals Eat meals containing protein and fibre Consume These: Water Prevent dehydration Fibre Reduce hypoglycaemia Protein Reduce hypoglycaemia Flaxseed and Chia seeds Contains alpha lipoic acid Avoid These: Dairy Wheat Amines (tyramine and phenylethylamine) Cheese Chocolate Cured meats Smoked fish Beer Wine Citrus fruits Fermented foods Yeast extract Nitrites Cured meats Tinned meats Ham, salami, certain sausages, bacon, hot dogs Preservatives Aspartame (artificial sweeteners, diet soft drinks) Alcohol (especially red wine due to histamines) High Histamine Foods Consider removing if migraines persist after removal of amines, nitrites, preservatives, aspartame and alcohol. Nutritional Magnesium and B complex combination product Herbal Lavender essential oil Applied to temple or pillows Lifestyle Avoid environmental toxins Perfumes Paint, lacquer, plastic, glue These can trigger a migraine Ensure good posture when working and watching screens Get up, move around and stretch every 30 minutes
Herbal	Lavender essential oil Applied to temple or pillows Feverfew Dried or freeze dried preparations may be better than alcohol extracts Ginger Jamaican dogwood White willow
Nutritional	Magnesium Vasodilator, relaxant Vitamin B complex Studies on B2 and B3 show improvement in headache/migraine B6 for hormonal regulation and histamine breakdown CoQ10 Reduced number of and severity of migraines in studies 300mg/day Omega 3 Theoretical treatment option, although recent study showed no improvement compared to placebo
Dietary	Stabilise blood sugar by eating smaller more frequent meals Eat meals containing protein and fibre Consume These: Water Prevent dehydration Fibre Reduce hypoglycaemia Protein Reduce hypoglycaemia Flaxseed and Chia seeds Contains alpha lipoic acid Avoid These: Dairy Wheat Amines (tyramine and phenylethylamine) Cheese Chocolate Cured meats Smoked fish Beer Wine Citrus fruits Fermented foods Yeast extract Nitrites Cured meats Tinned meats Ham, salami, certain sausages, bacon, hot dogs Preservatives Aspartame (artificial sweeteners, diet soft drinks) Alcohol (especially red wine due to histamines) High Histamine Foods Consider removing if migraines persist after removal of amines, nitrites, preservatives, aspartame and alcohol. *Give food swap ideas if necessary
Lifestyle	Avoid environmental toxins Perfumes Paint, lacquer, plastic, glue These can trigger a migraine Ensure good posture when working and watching screens Get up, move around and stretch every 30 minutes
Pharmaceutical	Short duration attacks: Aspirin Diclofenac Ibuprofen Paracetamol Naproxen Long duration attacks: Amitryptaline Diazepam (sometimes beneficial) Anticonvulsants and botox for frequent tension headaches
Other	Caffeine Vasoconstricts blood vessels in the brain, reducing inflammation and pain Massage Chiropractic, Physiotherapy If structural, postural, muscular imbalance or tension is an issue
More
Differential Diagnosis/Red Flags	Headache Warning Signs Sudden onset, particularly with confusion, drowsiness, vomiting, or mild stroke-like symptoms or signs Subarachnoid or intracranial haemorrhage, carotid or vertebral artery dissection, cerebral venous thrombosis Recent onset, with confusion, drowsiness or fever Meningitis, encephalitis, intracranial abbess, severe hypertension (hypertensive encephalopathy) Recent onset, in young obese individual Idiopathic (benign) intracranial hypertension (papilloedema) Recent onset, in patient over age of 50 Brain tumour, giant cell arteritis, cervicogenic, medication overuse, subdural collection, herpes zoster, sinusitis Recent onset with cough, exertion or sexual activity Subarachnoid haemorrhage, brain tumour, Following head injury, particularly with loss of consciousness Intracranial haemorrhage
Testing/Examinations	CT or MRI if a more serious condition is suspected. Food allergy testing Functional Liver Detoxification Profile To assess toxin build-up. Especially in high chemical exposure patients Female hormone profile If worsened with menstrual cycle or menopause
Additional Notes	Before puberty is more common in males, after puberty is more common in females. This suggests a hormonal component.

References

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Braun, L., & Cohen, M. (2015). Herbs and Natural Supplements, Volume 2. Elsevier Health Sciences.
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Cavestro, C., Rosatello, A., Micca, G., Ravotto, M., Marino, M. P., Asteggiano, G., & Beghi, E. (2007). Insulin metabolism is altered in migraineurs: a new pathogenic mechanism for migraine?. Headache, 47(10), 1436–1442. https://doi.org/10.1111/j.1526-4610.2007.00719.x

Goadsby, P. J., Holland, P. R., Martins-Oliveira, M., Hoffmann, J., Schankin, C., & Akerman, S. (2017). Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiological reviews, 97(2), 553–622. https://doi.org/10.1152/physrev.00034.2015

Hindiyeh, N. A., Zhang, N., Farrar, M., Banerjee, P., Lombard, L., & Aurora, S. K. (2020). The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. Headache, 60(7), 1300–1316. https://doi.org/10.1111/head.13836

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