Clinical Correlate: Migraine
Definition
Butterbur Petasites hybridus (L.) G. Gaertn. et al. has shown great promise as a migraine preventative.
Migraine is a chronic condition characterized by recurrent headaches of different severity. Migraine headaches often begin in childhood, adolescence, or early adulthood. They can be episodic or follow a well-established pattern.
Etiology¹
Migraine is usually the result of a blood vessel spasm followed by vasodilation (enlargement of the blood vessel), which causes an increased flow of blood to the brain. In addition, one or a combination of the following factors may cause migraine:
Congestion and thickening in the muscles at the base of the neck. These cause pressure on the arteries and nerves passing to and from the brain, resulting in headaches. Stress and strain (i.e., people who drive themselves relentlessly with little time for relaxation and sufficient sleep).Nutritional deficiencies, particularly B vitamins.Food allergies.If the pain is felt in the temporal area, then liver and gallbladder malfunction may be an associated factor.If the pain shoots over the top of the head, the kidneys and bladder may be involved.Many women have hormonal migraines. These tend to occur during ovulation or menstruation and may become worse during perimenopause but better after menopause.
Signs and Symptoms
Signs and symptoms of a migraine include severe throbbing headache often preceded by warning symptoms of flickering before the eyes, noises in the ears, and change in mood. During the attack, the sufferer cannot stand bright light. Nausea and vomiting may occur and vision can be affected. Often the migraine only affects one side and can last several hours.
Differential Analysis
Encephalitis
Encephalitis is inflammation of the brain that can cause flu-like symptoms, such as a fever or severe headaches. It can also result in confused thinking, seizures, or problems with senses or movement. The following symptoms are also characteristic for encephalitis: Personality change, lethargy, confusion, and irritability.
Meningitis
Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord. Meningitis may be caused by infection with viruses, bacteria, or other micro-organisms. Meningitis can lead to seizures, nerve damage, deafness, brain damage, paralysis, or even death if left unmanaged.
The following clues assist a medical professional to distinguish between migraine symptoms and meningitis:
Migraine headaches usually affect one side of the head only. With meningitis, head pain in not restricted to one side. While both meningitis and migraines may cause hypersensitivity to bright light, it does not affect the ability to tolerate loud noises, a mutual complaint among migraine sufferers. Migraines are often preceded by an aura, while there are no reports indicating visual distortions or blind spots occurring immediately before signs of meningitis.
Holistic Protocols
Exercise Program
It is recommended to develop and follow an exercise plan that incorporates moderate-level physical activities (e.g., aerobics, jogging, swimming, or yoga). For example, incorporation of moderate aerobic exercises (a twice-weekly, indoor exercise program including 45 minutes of gymnastics with music and 15 minutes of progressive muscle relaxation) was reported to result in a significant reduction of migraine pain intensity[2].
Yoga exercises were also reported to reduce the frequency of migraine headaches[3]. Studies suggest that this effect may be due to the increase in blood nitric oxide (NO) levels[4]. (Nitric oxide causes blood vessels to dilate, and blood vessel inflammation has long been associated with migraines.)
However, strenuous exercises should be avoided as they may trigger a migraine attack.
Holistic Nutrition
Diet should be rich with food products that have a blood-thinning activity (i.e., foods that inhibit platelet aggregation), such as vegetable oils, fish oils, garlic, and onion. Place an emphasis on raw alkaline foods, fruits and vegetables, and sprouted seeds. Make sure the client is not constipated and drinking plenty of water (six to eight glasses daily).
The diet should be low in chicken and other meat products that are rich with arachidonic acid, an omega-6 fatty acid. Avoid food products containing caffeine and aspartame (these may trigger migraine headaches), as well as cigarettes and alcohol. Reduce consumption of salt and processed foods.
The following food products have also been shown to contribute to allergy-induced migraines: Chocolate, cheese, eggs, cow's milk, tomatoes, oranges, strawberries, bananas, oats, oysters, and salmon.
While this method is not proven, you may choose to use the "pulse test" to identify "suspicious" food. The theory behind the "pulse test" is that foods that quicken the pulse immediately after being eaten may be causing an allergic reaction.
An elimination diet can also be used[4]. Start with a baseline diet including only those foods not implicated in migraine:
Brown rice.Cooked or dried fruits, other than citrus fruits (e.g., cherries, cranberries, pears, and prunes).Cooked green, yellow, and orange vegetables (e.g., artichokes, asparagus, broccoli, chard, collards, lettuce, spinach, string beans, squash, sweet potatoes, tapioca, and taro).Plain or carbonated water.Condiments (modest amounts of salt, maple syrup, and vanilla extract).
When migraines have stopped or diminished (usually within a week or so), keep a food diary and add in foods one at a time in generous amounts every other day to observe which causes migraine recurrence.
Supplements
Coenzyme Q10
Coenzyme Q10 is an important coenzyme that is a component of the electron-transport chain and, similarly to riboflavin, may facilitate mitochondrial energy production. A study in Neurology demonstrated that coenzyme Q10 supplementation (100 milligrams, three times per day) helps to significantly reduce the number of migraine headache attacks[5].
Magnesium
There is strong evidence that magnesium deficiency is much more widespread among people suffering from migraine headaches[6]. It is estimated that magnesium deficiency may be present in up to half of migraine patients. Magnesium citrate supplementation (600 milligrams per day) was reported to significantly reduce the frequency of migraine headaches[7]. Magnesium supplementation is highly recommended due to its low cost and high safety (diarrhea is the most common side effect)[8].
Niacin
Niacin is a water-soluble vitamin B3. Two case reports demonstrate that 500 milligrams of oral niacin can abort acute migraine headache[9]. Similarly to riboflavin and coenzyme Q10, niacin may induce mitochondrial energy production. However, additional research is required to evaluate the efficacy of supplementation[10].
Riboflavin (B2)
Riboflavin is a water-soluble vitamin B2 that is found in milk, meat, eggs, nuts, enriched flour, and green vegetables. Studies have demonstrated that taking high-dose riboflavin (400 milligrams per day) supplementation helps to significantly reduce the number of migraine headache attacks. As migraine headaches may be caused by mitochondrial dysfunction resulting in impaired oxygen metabolism, researchers speculate that riboflavin supplementation increases the mitochondrial energy efficiency and improves the way oxygen is metabolized in the brain[11].
Botanicals
Black cohosh Cimicifuga racemosa (L.) Nutt., feverfew Tanacetum parthenium (L.), hops Humulus lupulus (L.), lady's slipper Cypripedium parviflorum (Salisb.), lobelia Lobelia inflata (L.), peppermint Mentha ×piperita (L.), rosemary Rosmarinus officinalis (L.), skullcap Scutellaria lateriflora (L.) (nervous headache), tilia Tilia ×europaea(L.) (lime flowers), and valerian Valeriana officinalis (L.)
For women with hormonal migraines, balancing the hormones can be helpful. Phytoestrogenic herbs, such as black cohosh C. racemosa, dong quai Angelica sinensis (Oliv.) Diels, vitex Vitex agnus-castus (L.), and wild yamDioscorea villosa (L.) can be helpful.
Since the liver metabolizes hormones, liver support herbs, such as burdock Arctium lappa (L.), dandelion Taraxacum officinale F.H. Wigg., fringe tree Chionanthus virginicus (L.), and milk thistle Silybum marianum (L.) Gaertn., may also be useful.
Butterbur
Butterbur Petasites hybridus (L.) G. Gaertn. et al. has shown great promise as a migraine preventative. A study showed that 75 milligrams of extract, twice a day, was significantly better than placebo in reducing the number of migraine attacks[12]. Another study included only children and adolescents between the ages of six and 17. Participants received between 50 and 150 milligrams of butterbur root extract depending on age for a period of four months. Approximately 77% of all participants reported a reduction in the frequency of migraine attacks by at least 50%, demonstrating the efficacy of the supplementation[13].
Feverfew
Feverfew T. parthenium is the most well-studied herb for migraine headache management. However, the results from these trials are mixed and do not convincingly establish that feverfew is more effective than placebo for preventing migraine. No major side effects were associated with feverfew in published studies[14].
Aromatherapy
Essential oils are often used to alleviate migraine headaches; chamomile Roman Chamaemelum nobile (L.) All., eucalyptus Eucalyptus globulus (Labill.), immortelle Helichrysum italicum (Roth) G. Don, lavender Lavandula angustifolia (Mill.), and peppermint M. ×piperita are the most popular. Essential oils can be applied topically onto the forehead when diluted in a base oil.
Topical application of a blend of sweet orange Citrus sinensis (L.) Osbeck, bergamot Citrus aurantium var. bergamia(Risso), patchouli Pogostemon cablin (Benth.), Sugandh kokila Cinnamomum glaucescens (Nees) Hand.-Mazz., peppermint M. ×piperita, and lavender L. angustifolia, and essential oils diluted in sesame or apricot oils, was reported to be effective for the migraine headaches management[15].
Homeopathy
Homeopathic remedies can give considerable relief to someone suffering from migraine headaches. Some commonly used remedies are Belladona, Cimicifuga, Cocculus indicus, Iris versicolor, and Lachesis.
A recent study demonstrated that homeopathic remedies are effective for the prevention and treatment of migraine in children; frequency, intensity, and duration of migraine attacks were significantly reduced with use.
The most common preventive remedies were Ignatia amara (25%; mainly 9C), Lycopodium clavatum (22%), Natrum muriaticum (21%), Gelsemium (20%), and Pulsatilla (12%; mainly 15C).
For migraine attacks, Belladonna (32%; mainly 9C), Ignatia amara (11%; mainly 15C), Iris versicolor (10%; mainly 9C), Kalium phosphoricum (10%; mainly 9C), and Gelsemium (9%; mainly 15C and 30C) were most often used[16].
The British Homeopathic Association recommends the following remedies for recurrent headaches caused by stress, anxiety, or tension: Aconite 30C, Arnica 30C, Apis 30C, Belladonna 30C, Bryonia 30C, Gelsemium 6C, Glonoinum 30C, Hypericum 30C, Ignatia 6C, Nux 6C, and Ruta 6C.
The following are recommended for use in emergencies: Iris 6C, Lycopodium 6C, Nat mur 6C, Pulsatilla 6C, Sanguinaria 6C, Silicea 6C, Spigelia 6C, and Thuja 6C[17].
Other Modalities
Acupuncture
Acupuncture is widely used to prevent migraine attacks and reduce their severity. Trials investigating the addition of acupuncture to basic care generally demonstrate that patients who receive acupuncture have fewer headaches[18].
Acute Migraine Management
For immediate symptomatic relief of a migraine attack:
Have your client put their feet in a bucket of hot water.While doing this, have your client sip on pure lemon juice or a cup of decaffeinated coffee.Following this, have your client lie down with a cold compress on the forehead and one at the back of the neck.
Behavioral Medicine
Behavioral medicine techniques, such as biofeedback and progressive muscle relaxation, were reported to decrease the frequency of migraine attacks and reduce their severity. Biofeedback was demonstrated to be more effective than propranolol (a beta-blocker often prescribed as a migraine-preventive medicine)[19] and was successfully used with kids[20]. Studies suggest that the effectiveness of biofeedback in limiting chronic migraine may be related to reduced anxiety and depression, muscular relaxation, and decreased oxidative stress[21].
Reflexology
As migraines have been linked to various problems (including spasms of the brain's blood vessels, stress and strain, and even food allergies), stimulation of different reflex points can help to resolve this problem. These are liver reflex points in the right hand and foot, cervical spine reflex points on the feet, and neck, brain, and spine reflex points on the hands.
References
[1] Etiology is the cause(s) for a disease or condition.
[2] Dittrich, S., Günther, V., Franz, G., Burtscher, M., Holzner, B., & Kopp, M. (2008). Aerobic Exercise with Relaxation: Influence on Pain and Psychological Well-being in Female Migraine Patients. Clinical Journal of Sport Medicine, 18(4):363-365.
[3] John, P., Sharma, N., Sharma, C., & Kankane, A. (2007). Effectiveness of Yoga Therapy in the Treatment of Migraine Without Aura: A Randomized Controlled Trial. Headache: The Journal of Head and Face Pain, 47(5):654-661.
[4] Osün Narin, S., Pinar, L., Erbas, D., Oztürk, V., & Idiman, F. (2003). The effects of exercise and exercise-related changes in blood nitric oxide level on migraine headache. Clin rehabil., 17(6):624-630.
[5] NutritionMD. (n.d.). Migraine: Nutritional Considerations. NutritionMD.org. [Online]. Retrieved from: http://www.nutritionmd.org/health_care_providers/neurology/migraine_nutrition.html
[6] Sandor, P., Di Clemente, L., Coppola, G., Saenger, U., Fumal, A., Magis, D., et al. (2005). Efficacy of coenzyme Q10 in migraine prophylaxis: A randomized controlled trial. Neurology, 64(4):713-715.
[7] Peikert, A., Wilimzig, C., & Kohne-Volland, R. (1996). Prophylaxis of Migraine with Oral Magnesium: Results from a Prospective, Multi-Center, Placebo-Controlled and Double-Blind Randomized Study. Cephalalgia, 16(4):257-263.
[8] Sun-Edelstein, C. & Mauskop, A. (2009). Role of magnesium in the pathogenesis and treatment of migraine.Expert Review of Neurotherapeutics, 9(3):369-379; Mauskop, A. & Varughese, J. (2012). Why all migraine patients should be treated with magnesium. Journal of Neural Transmission, 119(5):575-579.
[9] Prousky, J. & Sykes, E. (2003). Two Case Reports on the Treatment of Acute Migraine with Niacin: Its Hypothetical Mechanism of Action Upon Calcitonin-Gene Related Peptide and Platelets. Journal of Orthomolecular Medicine, 18:108-110.
[10] Prousky, J. & Seely, D. (2005). The treatment of migraines and tension-type headaches with intravenous and oral niacin (nicotinic acid): systematic review of the literature. Nutr J., 4(1):3.
[11] Schoenen, J., Lenaerts, M. and Bastings, E. (1994). High-dose riboflavin as a prophylactic treatment of migraine: results of an open pilot study. Cephalalgia, 14(5):328-329. Boehnke, C., Reuter, U., Flach, U., Schuh-Hofer, S., Einhaupl, K., & Arnold, G. (2004). High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. European Journal of Neurology, 11(7):475-477.
[12] Lipton, R.B., Göbel, H., Einhäupl, K.M., Wilks, K., & Mauskop, A. (2004). Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology, 63(12):2240-4.
[13] Pothmann, R. & Danesch, U. (2005). Migraine Prevention in Children and Adolescents: Results of an Open Study With a Special Butterbur Root Extract. Headache: The Journal of Head and Face Pain, 45(3):196-203.
[14] Pittler, M. & Ernst, E. (2004). Feverfew for preventing migraine. Cochrane Database of Systematic Reviews.
[15] Nautiyal, O.H. (2014). Arthritis and Migraine Aromatherapy Formulations with No Side Effects. EC Chemistry1.1:9-14.
[16] Danno, K., Colas, A., Masson, J. & Bordet, M. (2013). Homeopathic Treatment of Migraine in Children: Results of a Prospective, Multicenter, Observational Study. The Journal of Alternative and Complementary Medicine, 19(2):119-123.
[17] Lockie, A. (2013). The preventive role of homeopathy and the treatment of headaches and migraine - British Homeopathic Association. British Homeopathic Association. [Online]. Retrieved from: http://www.britishhomeopathic.org/bha-charity/how-we-can-help/conditions-a-z/the-preventive-role-of-homeopathy-and-the-treatment-of-headaches-and-migraine/
[18] Linde, K., Allais, G., Brinkhaus, B., Manheimer, E., Vickers, A., & White, A. (2009). Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews.
[19] Kaushik, R., Kaushik, R., Mahajan, S., & Rajesh, V. (2005). Biofeedback assisted diaphragmatic breathing and systematic relaxation versus propranolol in long term prophylaxis of migraine. Complementary Therapies in Medicine, 13(3):165-174.
[20] Scharff, L. (2002). A Controlled Study of Minimal-Contact Thermal Biofeedback Treatment in Children With Migraine. Journal of Pediatric Psychology, 27(2):109-119.
[21] Ciancarelli, I., Tozzi-Ciancarelli, M., Spacca, G., Di Massimo, C., & Carolei, A. (2007). Relationship between biofeedback and oxidative stress in patients with chronic migraine. Cephalalgia, 27(10):1136-1141; Vasudeva, S., Claggett, A., Tietjen, G., & McGrady, A. (2003). Biofeedback-Assisted Relaxation in Migraine Headache: Relationship to Cerebral Blood Flow Velocity in the Middle Cerebral Artery. Headache: The Journal of Head and Face Pain, 43(3):245-250.
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