Categories: Diseases & Treatment Plans

Migraine/Headaches

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.
Bone, K. (2007). The Ultimate Herbal Compendium. Phytotherapy Press
Braun, L., & Cohen, M. (2015). Herbs and Natural Supplements, Volume 2. Elsevier Health Sciences.
Hechtman, L. (2018). Clinical Naturopathic Medicine. Elsevier Health Sciences.
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
Özön, A. Ö., Karadaş, Ö., & Özge, A. (2016). Efficacy of Diet Restriction on Migraines. Noro psikiyatri arsivi, 55(3), 233–237. https://doi.org/10.5152/npa.2016.15961
Weatherall M. W. (2015). The diagnosis and treatment of chronic migraine. Therapeutic advances in chronic disease, 6(3), 115–123. https://doi.org/10.1177/2040622315579627
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4 years ago

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