Migraine Headaches

The term migraine refers to a class of headaches sharing certain characteristic symptoms. The two main subcategories of migraine are the common and the classic migraine.

In common migraines, headache pain usually occurs in the forehead or temples, often on one side only and typically accompanied by nausea and a preference for a darkened room. Headache attacks last from several hours up to a day or more. They are usually separated by completely pain-free intervals.

In the rarer form of migraine, called classic migraine, headache pain is accompanied by a visual disturbance known as an aura. Otherwise, symptoms are similar to those of the common migraine.

Migraines can be triggered by a variety of causes, including fatigue, stress, hormonal changes, and foods such as alcohol, chocolate, peanuts, and avocados. However, in many people, migraines occur with no obvious triggering factor.

The cause of migraine headaches has been a subject of continuing controversy for over a century. Opinion has swung back and forth between two primary beliefs: that migraines are related to epileptic seizures and originate in the nervous tissue of the brain; or that blood vessels in the skull cause headache pain when they dilate or contract (so-called vascular headaches). Most likely, several factors are involved, and more than one stimulus can light the fuse that leads to a full-blown migraine attack.

Conventional treatment of acute migraines has lately been revolutionized by the drug sumatriptan (Imitrex). This drug can completely abort a migraine headache in many individuals. It works by imitating the action of serotonin on blood vessels, causing them to contract. Drugs made from ergot mold are also effective.

People interested in prevention can choose from a bewildering variety of drugs, including ergot drugs, antidepressants, beta-blockers, calcium channel–blockers, and antiseizure medication. Picking the right one is mostly a matter of trial and error.

Principal Proposed Treatments for Migraine Headaches:

Scientific evidence suggests that the herb feverfew and the mineral magnesium can help prevent migraine headaches.

Keep in mind that serious diseases may occasionally first present themselves as migraine-type headaches. If you suddenly start having migraines without a previous history, or if the pattern of your migraines changes significantly, it is essential to seek medical evaluation.

Feverfew: Dried Leaf May Reduce Frequency and Severity of Headaches

Feverfew was widely used in ancient times as a treatment for headaches and other conditions. However, it fell out of favor for several centuries until an unexpected but fortunate event occurred in the late 1970s. At that time, the wife of the chief medical officer of the National Coal Board in England suffered from serious migraine headaches. When this fact became known to workers in the industry, a sympathetic miner suggested that she try a folk treatment he knew about. She followed his advice and chewed feverfew leaves. The results were dramatic: Her migraines almost completely disappeared.

Her husband was impressed, too, and used his high office to gain the ear of a physician who specialized in migraine headaches, Dr. E. Stewart Johnson of the London Migraine Clinic. Johnson subsequently tried feverfew on 10 of his patients. The results were so good that he subsequently gave the herb to 270 of his patients. A whopping 70% reported considerable relief.

Thoroughly excited now, Dr. Johnson enrolled 17 feverfew-using patients in an interesting type of double-blind study. Half were continued on feverfew, and the other half transferred without their knowledge to placebo. Over a period of 6 months, the participants withdrawn from feverfew demonstrated a dramatic increase in headaches, nausea, and vomiting.

Unfortunately, this study had some serious flaws. It was too small, and because the participants were already feverfew users who felt it worked for them, it didnt say anything about the effectiveness of feverfew in the population at large. This type of error in a study is called self-selection. Nonetheless, the study brought a flood of response from the public and ultimately led to three preliminary but properly performed double-blind experiments.

Today, feverfew is used mainly for the prevention of chronic, recurrent migraine headaches, especially in the United Kingdom. Those who use it say that their headaches become less frequent and less severe, and may even stop altogether. However, feverfew must be taken religiously every day for best results.

What Is the Scientific Evidence for Feverfew?

Two published double-blind studies suggest that regular use of feverfew leaf can help prevent migraine headaches and reduce their severity when they do come.

The so-called Nottingham trial followed 59 individuals for 8 months. For 4 months, half received a daily capsule of feverfew leaf, and the other half received placebo. The groups were then switched and followed for an additional 4 months. Treatment with feverfew produced a 24% reduction in the number of migraines and a significant decrease in nausea and vomiting during the headaches.

A recent double-blind study of 57 people with migraines, who were given feverfew leaf daily, also showed distinct reductions in headache severity.3 Unfortunately, the authors did not report whether the frequency of headaches improved.

However, the herb world was surprised when a Dutch study of 50 people showed no difference whatsoever between placebo and a special feverfew extract standardized to its parthenolide content. This unexpected result reversed a widely held view about how feverfew works.

For many years it was assumed that the active ingredient in feverfew was a substance named parthenolide. Many articles were published explaining exactly how parthenolide prevented migraines. On the basis of this premature explanation, indignant authors complained that samples of feverfew on the market vary as much as 10 to 1 in their parthenolide content. No less an authority than the herbal expert Varro Tyler said that "standardization of the herbal material on the basis of its parthenolide content is urgently required if this potentially valuable herb is to be used effectively."

However, everyone was jumping the gun. The special feverfew extract used in the negative Dutch study was standardized to a high parthenolide content. Apparently, this extract lacked some essential substance or group of substances that is present in the whole leaf, which was used in the positive studies. Without these unknown constituents, it seems that feverfew does not work. What those substances may have been remains mysterious.

An unpublished double-blind placebo-controlled study of 147 individuals found equivocal evidence for feverfew. Researchers first measured the number of migraine headaches that participants experienced during a 4-week period of no treatment. Then, for a subsequent 12 weeks, participants received either placebo or one of three doses of a proprietary feverfew extract. Researchers compared the number of migraine attacks during the final 4 weeks of treatment against the number of migraines during the initial 4-week monitoring period.

The results showed no statistically significant benefit overall. However, in a subgroup of individuals with the most frequent migraines, the two higher doses of feverfew extract significantly reduced migraine attacks.

For more information, including dosage and safety issues, see the full feverfew article.

Magnesium: May Help Prevent Migraines

Magnesium is another natural treatment that appears to be effective for the prevention of migraine headaches. A recent 12-week double-blind study followed 81 people with recurrent migraines. Half received 600 mg of magnesium daily (in the rather unusual form of trimagnesium dicitrate), and the other half received placebo.

By the last 3 weeks of the study, the frequency of migraine attacks was reduced by 41.6% in the treated group, compared to 15.8% in the placebo group. The only side effects observed were diarrhea (18.6%) and digestive irritation (4.7%).

Similar results have been seen in other double-blind studies. There was one study that did not find a benefit, but there were many problems with its design.

Preliminary studies suggest that magnesium may also be helpful for menstrual migraines.

For more information, including dosage and safety issues, see the full magnesium article.

Other Proposed Treatments for Migraine Headaches:

Several other herbs and supplements are widely recommended for migraine headaches, but as yet there is little scientific proof that they are effective.

5-HTP

A number of drugs are used to prevent migraine headaches, including antidepressants in the Prozac family. Although we dont know for sure, many of them appear to work by either changing serotonin levels or producing serotonin-like effects in the body. Since the body uses 5-HTP to make serotonin, supplemental 5-HTP might also affect serotonin levels. There is some evidence that 5-HTP may help prevent migraines too, when taken at a dosage of 400 to 600 mg daily. Lower doses may not be effective.

In a 6-month trial of 124 people, 5-HTP (600 mg daily) proved equally effective as the standard drug methysergide. The most dramatic benefits seen were a reduction in the intensity and duration of migraines. Since methysergide has been proven better than placebo for migraine headaches in earlier studies, the study results provide meaningful, although not airtight, evidence that 5-HTP is also effective.

Similarly good results were seen in another comparative study, using a different medication and 5-HTP (at a dose of 400 mg daily).

However, in one study, 5-HTP (up to 300 mg daily) was less effective than the drug propranolol. Also, in a study involving children, 5-HTP failed to demonstrate benefit. Other studies that are sometimes quoted as evidence that 5-HTP is effective for migraines actually enrolled adults or children with many different types of headaches (including migraines).

Putting all this evidence together, it appears likely that 5-HTP can help people with frequent migraine headaches if taken in sufficient doses, but further research needs to be done. In particular, we need a large double-blind study that compares 5-HTP against placebo over a period of several months.

For more information, including dosage and safety issues, see the full 5-HTP article.

Vitamin B2 (Riboflavin)

According to a 3-month double-blind placebo-controlled study of 55 people with migraines, vitamin B2 can significantly reduce the frequency and duration of migraine attacks.

This study found that, when given at least 2 months to work, vitamin B2, at a daily dose of 400 mg, can produce dramatic migraine relief. The majority of the participants experienced a greater than 50% decrease in the number of migraine attacks as well as the total days with headache pain. A larger and longer study is needed to follow up on these results.

For more information, including dosage and safety issues, see the full vitamin B2 article.

Butterbur

The herb butterbur was tested as a migraine preventive in a double-blind placebo-controlled study involving 60 men and women who experienced at least 3 migraines per month. After 4 weeks without any conventional medications, participants were randomly assigned to take either 50 mg of butterbur extract or placebo twice daily for 3 months.

The results were positive: both the number of migraine attacks and the total number of days of migraine pain were significantly reduced in the treatment group as compared to the placebo group. Three out of four individuals taking butterbur reported improvement, as compared to only one out of four in the placebo group. No significant side effects were noted.

For more information, including dosage and safety issues, see the full butterbur article.

Fish Oil

The results of a small, preliminary, double-blind study suggest that high doses of fish oil may be helpful for migraine headaches. However, a 16-week double-blind, placebo-controlled study of 167 individuals with recurrent migraines found that fish oil did not significantly reduce headache frequency or severity.

Other Supplements

Calcium, chromium, folate, ginger, and vitamin C have also been reported to be helpful for migraines, but there is as yet not much scientific evidence for any of these treatments.

Other Treatments

Identifying and eliminating allergenic foods from your diet appears to be helpful in reducing the frequency of migraine attacks.

At least one small double-blind study using real and "sham" treatments suggests that acupuncture can reduce the intensity and number of migraine attacks. Furthermore, the improvements were found to continue for at least a year after the cessation of acupuncture treatment.