Migraine - diagnosis and treatment
Migraine is the symptom which results from disordered blood flow to the brain. During the early part of an attack blood vessels constrict (get narrower) causing funny symptoms like flashing lights, loss of field of vision, seeing funny colours, distorted hearing or occasionally weakness down one side of the body (hemiplegic migraine). In the second part of the attack, the blood vessels dilate (get wider) and this causes the thumping headache, nausea, light sensitivity and need for sleep. Migraine headaches are usually felt either on one side of the head or the other or occasionally both.
Treating an acute attack
Migraine responds well to pain killers. The problem is getting the pain killers absorbed in time. During an attack the stomach stops working and pain killers are simply not absorbed. This means that they need to be given as early as possible during the first sign of symptom, or given with extra drugs to facilitate their absorption such as metoclopramide (a favourite is Paramax, a mixture of paracetamol and metoclopramide), or they need to be given injected, or per rectum. See Pain
Some people find that niacin 300-500mgs chewed and allowed to dissolve in the mouth will get rid of a migraine headache at the aura stage.
An alternative is to use drugs to treat the blood vessels such as the 5HT1 agonists (all the names end in triptan eg sumatriptan), which undoubtedly work well. These drugs have largely replaced other drugs which used to be used to target blood vessels such as ergotamine.
An extremely effective treatment for acute migraine is magnesium with the best results being achieved with intravenous magnesium. Unfortunately this is not freely available for obvious technical reasons, but some people find that inhaled magnesium, using injections subcutaneously, oral magnesium or even PR magnesium can be helpful - see Magnesium
Causes of migraine
Migraine again is a symptom which may have many causes and the more underlying causes one can identify the better one's chances of getting rid of migraine. In order of likelihood the causes are:
- Food allergies
- Foods with vasoactive amine - eg dark chocolate, red wine, cheese, some fish, food additives.
- Hormones (the Pill and HRT) - indeed hormones should never be given to women with migraine because this increases the risk of having a stroke.
- Chemical sensitivity - cigarette smoke, perfumes, travel sickness (car fumes) - see Multiple Chemical Sensitivity (MCS) - Principles of Treatment.
- Magnesium deficiency - see Magnesium - treating a deficiency.
- Low oxygen levels - my guess is that this is the mechanism which results in migraine with neurological symptoms such as hemiplegic migraine. One possible explanation would be a PFO - see Patent foramen ovale as a cause of fatigue. In this event sometimes oxygen can be a useful treatment.
Triggers are different from causes because once the cause is treated, the triggers often no longer apply. Migraine is the classical example of "the last straw which breaks the camel's back". There may be several causes of migraine and if they all come together an attack is triggered, but the last thing immediately prior is blamed. In the Egger study published in the Lancet 1983, before they dieted, children identified the following migraine triggers: exercise, trauma, emotional causes, travel, bright light, heat, noise and perfume or cigarette smoke. Once the food allergies had been found and avoided, the only triggers which remained was the perfume and cigarette smoke. This shows most triggers were just triggers. Interestingly chemicals were not triggers but causes.
In this same Egger study, all the children had migraine but some were also epileptic. These epileptic children stopped having fits once their food allergies were removed.
In the Grant study into migraine where she did elimination dieting and stopped hormones, the hypertensive patients had their blood pressure come back down to normal.
Prevention of migraine
This all depends on identifying the causes:
- The general approach to maintaining and restoring good health
- See Hypoglycaemia
- Food allergies need to be identified by elimination dieting - see Stone Age Diet and Food Allergy - which diet to do. More often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
- All hormones should be stopped
- If migraine is worse pre-menstrually (wobbly hormones), then tackle the PMT - see Pre-menstrual tension (PMT)
- All patients should take nutritional supplements - see Nutritional Supplements
- Magnesium deficiency is a risk factor for migraine - see Magnesium and Magnesium test - red cell
- If there were multiple food allergies then I would desensitise with enzyme potentiated desensitisation - see Enzyme Potentiated Desensitisation (EPD)
Additional useful nutritional interventions
There are a number of studies which have shown some nutritional supplements are a proven benefit in preventing migraine. In order of likelihood of effectiveness this is:
- Co enzyme Q 10 300mgs daily or more.
- Riboflavin (vitamin B2), 400mg daily with breakfast, for three months reduced migraine attacks by 67%
- Tryptophan 500mgs every 6 hours for three months is an effective treatment.
- Melatonin, up to 10mgs at night got rid of cluster headaches in 50% of patients.
- Feverfew 25-30mg daily often helpful.
- Finally I have a few patients who find that the package of treatment to support mitochondria has been helpful in relieving headaches - see CFS - The Central Cause: Mitochondrial Failure
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