Migraine and Cluster Headaches

Paul Reller, L.Ac.

Migraine headaches in the United States population may be more common than asthma and diabetes combined, and affects women three times as much as men. The CDC (Centers for Disease Control and Prevention) states that the prevalence of chronic migraine headaches in the U.S. increased nearly 60 percent between 1980 and 1989, with an alarming upward trend since statistics were first gathered. In 2009, the CDC estimated that about 23 percent of adult women in the U.S. experienced migraines or severe headaches, and migraine studies show that perhaps more than 30 million people in the United States experience chronic migraine headaches, with about 75 percent of the female migraine sufferers experiencing at least one migraine per month. A variety of types of migraines and severe headaches are noted, and a variety of associated health problems as well. While migraines have been classified according to symptom presentation to date, more emphasis is now placed on a differentiation based on the underlying causes and associations with other health problems to improve treatment considerations, and progress from the one-size-fits-all approach in standard medicine, which has not yielded great results.

When the symptom of your health problem is debilitating, it is important to choose a plan of therapy that you are sure will work to decrease the frequency and intensity of the migraine or cluster headaches. Medical doctors in Europe are finding surprising success in incorporating acupuncture and herbal/nutrient medicine into their treatment protocol, and they have spent much time and money on scientific studies that prove that these treatments are effective, and that a holistic approach in treatment is necessary.

Modern medicine is finding that the mechanisms of migraine and cluster headaches are very complex and difficult to treat with pharmaceutical medication. For the patient, this is frustrating, and trying to find the right combination of treatment strategies to get your life back on track is a challenge. In the past, migraines were classified as a vascular headache that occurred because of an extreme reaction of vasodilation that suddenly increased pressure to parts of the brain and resulted in a long period of debilitating pain. Presently, we know that this was just part of the answer to the cascade of dysfunctions that result in the debilitating migraine neurovascular reflex. We now know that there are many forms of migraine and cluster vascular headache and that treatment strategies must target not only vasodilation, but the autonomic nervous system, protein metabolism, and balance of neurotransmitters both in the brain and brainstem, as well as the gut. Overall regulation of the autonomic nervous system and regaining of control may involve attention to the hormonal system, especially in menstrual migraines, and the immune responses associated with nitric oxide levels.

Treatment strategy must take into consideration both triggers of the migraine as well as correction of the neuroendocrine regulation. Restoration of healthy homeostatic maintenance of brain cells, immune responses, vascular maintenance, and nerve function must all be addressed for optimal success. This implies that an allopathic approach of blocking one specific physiological mechanism is not an optimal strategy for treatment of migraine and cluster headache. Treatment requires a more holistic approach to achieve success. For many patients, the treatment outcome must be to first reduce the frequency and intensity of the complex migraine neurovascular mechanism, and then work toward restoring healthy function and maintenance enough to eventually eliminate the problem. Migraines and cluster headaches cannot be looked at therapeutically like a typical headache, and the patient should not expect any pill to offer immediate relief like they get from aspirin in a tension headache. Treatment will only produce results with persistence and holistic correction of symbiotic mechanisms. Often, pharmaceutical approaches can be explored, and if they offer some relief, utilized temporarily in the overall treatment scheme, as the patient corrects the underlying array of homeostatic dysfunctions. Settling for minimal relief and giving up on the more complex course of holistic therapy is often chosen, but leaves the patient with a debilitating recurrent problem for life.

Patient choices in pharmacological medication involve a variety of medications that affect neurotransmitters and their receptors, some with alarming side effects and adverse long-term effects, and most with the potential of creating a medication overuse headache pattern. This type of headache, formerly called a rebound headache, involves temporary partial relief of the migraine, but a return of the original migraine intensity and symptoms when the drug is cleared in the brain. Many experts warn that this pattern often prompts increased use of the drug to try to relieve the headaches that are caused by the drug. A simple approach with pharmacological therapy is to first try an ergot, or dihydroergotamine nasal spray (e.g. Migranal), and perhaps a topical herbal cream or ointment, while exploring a more thorough and holistic approach with Complementary Medicine. Since the drug of choice, a triptan, or selective serotonin receptor agonist, is contraindicated with ergot medications, this is seldom suggested or prescribed. Given the history of limited succes with pharmacological treatment of migraine and cluster headaches, the intelligent patient will pursue a course of therapy and avoidance of triggers that results in fewer and milder headaches by correcting the underlying problems. Integrating a holistic approach into the treatment of migraine and cluster headaches is becoming more and more popular, and is often now suggested by migraine experts and treating physicians.

How common is a rebound headache syndrome from medication overuse? In 2011, Dr. Charles Argoff, Professor of Neurology at Albany Medical College and Director of the Comprehensive Pain Center at Albany Medical Center in Albany, New York, wrote and article for Medscape Neurology, where he stated, “it (rebound analgesic headache syndrome) is not as uncommon as you may think. Very often in the insidious, subtle, “Oh, its not going to happen to this patient” manner, many physicians think that because this is a generic medication, easy to prescribe, and because patients often respond to it (that it is a benign medication). But over time - over years - sometimes less - patient will become physically dependent on the butalbital/acetaminophen/caffeine preparation and have rebound headaches when they don’t take it.” The case used as an example involved a woman in her early-40s who had been prescribed topiramate and valproic acid with little success. The woman had been advised to first try an over-the-counter migraine medication, which she first used once or twice a month, but over a period of two years, had grown into a dependence on the drug and used it daily. A visit to the emergency room resulted in the prescription of the Floricet (butalbitol/acetaminophen/caffeine). The use of this prescription then increased from several times a month to several times a week. Finally, the patient was taking the medication daily, as the frequency of her migraines increased. Instead of addressing the underlying problems with the headache mechanism, her medical doctor prescribed additional medications. Finally, the intractable headaches were debilitating, and the patient turned to the pain center at Albany Medical Center. Here, Dr. Argoff reduced her medication slowly until the headaches occurred with a frequency of a few times per month. Dr. Argoff recommends acknowledging this scenario and utilizing tapering or detox regimens to help the patient deal successfully with this strategy of reducing medications to stop analgesic rebound headaches. Complementary Medicine plays a large role in this successful detox and tapering regimen, both utilizing herbal and nutrient medicines, and acupuncture, as well as a holistic protocol with diet and lifestyle to treat the headaches, the adverse effects of the medications, and reduce triggers. Added to this is the treatment of the underlying physiological problems that cause the headache syndrome. Complementary Medicine and TCM will provide a set of medical protocols outside of pharmacological means to insure success.

This means that the patient would have a better chance of overall success by incorporating a knowledgable Complementary Care physician into the treatment strategy. Such a physician could help with dietary and lifestyle advice to avoid triggers that are tailored to the individual, as well as supply evidence-based treatments to reduce the mechanisms of the headache episodes. In addition, the Complementary Care physician, such as the Licensed Acupuncturist and herbalist, would be able to help you improve overall health and solve the imbalances that led to your condition. In the last few years, scientific understanding of the complex migraine mechanisms has blossomed, and even standard medicine has reluctantly incorporated herbs and nutrient medicine into the protocol. A Licensed Acupuncturist with the right treatment specialties is able to bring more knowledge of herbal and nutrient medicine to the table than an M.D., and provide proven effective acupuncture and soft tissue mobilization to the overall treatment plan within the same office visit. Mechanical stresses related to myofascial pain syndromes and impingement on the nerve and blood circulation may be a significant contributor to the migraine and cluster pathology. Chronic myofascial syndromes may induce autonomic nervous system imbalances that are a signifcant contibutor to the underlying causes of the neurovascular responses creating migraine and cluster headache patterns. Most scientific studies reveal that immediate relief from a thorough and holistic treatment protocol is not expected, but that effective treatment will produce results after 2-3 months. In clinical practice, many types of migraine and cluster patterns do respond fairly quickly to a treatment combining herbal and nutrient medicine with acupuncture stimulation and myofascial release, though. Scientific studies, by nature, do not study such a comprehensive approach, but instead study one specific type of therapy at a time. These studies do not reveal the effectiveness of a thorough and comprehensive treatment strategy.

For the patient, this commitment to prolonged therapy often involves a challenge to understand how Complementary Medicine actually works, and whether it is a proven scientific treatment that offers some guarantee of success. In many difficult medical problems, the patient must often stick with the treatment protocol for some time to achieve success. One or two acupuncture visits is not going to make this problem go away. This article is intended to help the patient, and other physicians, to understand the recent positive research on acupuncture and migraine headache therapy, and to understand the approaches now taken with herbal and nutrient chemicals.

Understanding the evidence for acupuncture and herbal nutrient medicine in the control and cure of migraine and cluster headaches

One question that keeps most patients from actually benefiting from the treatments in Complementary and Integrative Medicine in the alleviation of migraine and cluster headaches is the question of proof of effectiveness. Since these health problems are difficult to treat, often eluding significant benefit from standard pharmaceutical protocol, and usually require a persistent course of therapy with acupuncture, herbs and nutrient medicine, which is poorly covered by standard insurance plans until voters demand that Complementary Medicine coverage is mandated, as it is in Europe, the treatment course requires some commitment on the part of the patient.

In the last few years scientific study of acupuncture, herbs and nutrient medicine has blossomed, and scientific understanding of the complex mechanisms of migraine and cluster headache have also born fruit. The German 3 year human trial at Essen University proved that a simple uniform acupuncture treatment reduced frequency and intensity of migraine episodes as well as an intensive course of pharmaceuticals. Research has revealed that for many patients, a genetic propensity for nerve cell dysfunction in the regulatory brain stem, involving deficient function of cellular mitochondria, lies at the heart of the sequence of dysfunction allowing the migraine episode, which involves a neuroreflex of excess vasodilation. A number of factors must be evident in most patients for the episodes to trigger, including chronic problems handling oxidative stress, chronic arterial inflammation that is poorly modulated, problems with regulation of excess histamine production, and nutritional deficiencies that keep the body from being able to produce enough niacin in the brain cells. A variety of contributing health problems may also be involved, depending on the individual case. This research has pointed to a more holistic approach in treatment, with restoration of normal homeostatic mechanisms needed to correct the problem. Utilizing this scientific understanding, human clinical trials with combinations of herbs and nutrients has produced very successful clinical trial results.

Designing clinical study trials for manual therapies along the requirements of studies meant for pharmaceutical pills has long presented overwhelming challenges. A double blinded placebo study means that both the patient and the phsician administering treatment is unaware of whether placebo or actual treatment is being performed, and that a believable placebo treatment is being used. Of course, anyone can see that this works well with pills, but how do you devise a believable blinded placebo for needle stimulation or any other manual therapy? The National Institute of Health has a governmental organization devoted to health research quality assessment (AHRQ) that has determined that less than 19% of manual therapies meet these requirements in proving that they work. Of course, no surgeries meet this criteria. But acupuncture has had to meet this criteria in the West because of such amazing amounts of lobbying against the practice by big pharmaceuticals, the insurance industry and the AMA. Despite this, acupuncture has met these criteria and is adopted by the WHO and NIH as scientifically proven. In Germany, large trials in 2006 proved that acupuncture was a viable, and in fact superior, treatment for the migraine headache.

When designing these placebo studies, the industry may choose placebo acupuncture that is actually real acupuncture at different points than what are being studied. This so-called sham acupuncture is often found almost as effective as the points used in the so-called real acupuncture. The real acupuncture is often inhibited in its design effectiveness by not allowing manipulation of the needles, by not allowing individualized treatments, and by not allowing acupuncturists that have developed the necessary treatment repoire with the patients. Clearly, this is a lot to overcome to make the study treatment effective, and the treatment design can be utilized to obscure the results. Since acupuncture and herbal medicine present a low-cost alternative to expensive and lucrative pharmaceutical approaches, the monetary incentive for such poor study design is evident.

Despite these problems, the German study on effectiveness of acupuncture for migraine patients showed that acupuncture was just as effective as standard treatment with the latest migraine medications. Of course, the so-called sham acupuncture in the study also worked quite well. This type of finding is typical of randomized trials of acupuncture, and today, government panels are created in Europe to address this problem of manipulated study design with acupuncture. Acupuncture almost always has very positive results in these clinical trials, but ultimate outcome is measured by the degree of success greater than the so-called sham acupuncture, which is actually real acupuncture with needle locations other than the ones chosen for the so-called real treatment. Study design frequently omits comparison study with standard treatment, and shows that the so-callled sham acupuncture also has very good treatment results compared to the chosen needle points. The study summary omits these details, and often states that the real acupuncture did not perform significantly better than the so-called sham acupuncture. The public has to make the decision on what information to believe when the headlines in medical journals that oppose the acupuncture industry cite the failure of these studies. Numerous studies that meet the requirements of this nearly impossible study method are, miraculously enough, showing very positive outcomes, but the funding is not great enough to allow a large patient participation, and so these study findings are usually not allowed in the journals' overall assessments.

The bottom line is that, even with this almost insurmountable problem of evidence-based study design, Europe is finding that acupuncture and Complementary Medicine is proven effective, and the European Union has mandated coverage for these therapies. The patient population continues to increase its belief in and use of Complementary Medicine, in Europe and in the U.S., with over 80% of the population now utilizing some form of Complementary Medicine.

The German Study: Diner, Kronfeld et al, Dept of Neurology, University Essen, Essen Germany; Lancet Neurol. 2008 Jun 7(6);475: a prospective, randomized, double-blind, parallel-group, controlled, clinical trial, undertaken between April 2002 and July 2005 with 1295 migraine patients who had 2 to 6 migraines per month showed that acupuncture treatment outcomes for migraine did not differ from standard therapy using calcium channel blockers, antiseizure drugs and beta blockers, with 47% of the acupuncture patients showing a reduction of migraine days by at least 50% after 26 weeks following a course of 10 treatments in 6 weeks versus continuous prophylaxis with drugs. I repeat, 10 treatments in 6 weeks versus continuous use of 3 common expensive medications. Unlike these medications, acupuncture therapy has no risk and side effects. Acupuncture can also be combined with herbal and nutrient therapy, as well as soft tissue mobilization and myofascial release, offering the patient a number of treatment options proven effective for subsets of migraine patients.

Migraine Headaches and the Importance of Knowing Which Type you have and Treating the Causes:

Standardized treatment does not make sense for migraine headaches. Different patients have different factors triggering the migraines and these need to be addressed in the treatment protocol. As study of migraine mechanisms evolves, we learn that there are a number of important mechanisms in this type of headache, and hence, a pill that allopathically targets a single chemical reaction has not worked well for every patient. This is why Complementary care is very important to success. No matter whether you utilize a pharmaceutical medication or not, acupuncture, herbal medicine and dietary changes may greatly improve the outcome. The first step is to understand and assess what type of migraine you have by noting with a diary when they occur and how this corresponds to triggers, whether these are related to the hormonal changes of the menstrual cycle, what you eat, weather changes and the environmental triggers, etc.

Headaches often involve a number of types of headache causes combined into a more complex syndrome. Headaches can be distinguished by classification of cause as vascular, inflammatory, lesion generated, degenerative, traumatic, endocrine, and autoimmune. This is why the migraine and cluster headache syndromes are so difficult to cure. Both extracranial and intracranial tissues may be involved, as is evident from the success with a small percentage of patients who receive Botox injections extracranially and experience symptom relief, as well as patients who obtain much relief from soft tissue therapies and myofascial release. Muscle tension, or traction, headaches can be a migraine trigger, or secondary to migraines. Common inflammatory headaches include sinus allergy headaches, as well as fibromyositis, a chronic inflammatory condition of the muscle and connective tissues. Lesions in temporomandibular joint syndrome (TMJ) or tumor growths, may produce pressure and irritation on facial nerves, increasing the potential of a migraine trigger or episode.

A number of studies have identified a brainstem cellular dysfunction associated with migraines. Key regulatory centers in the brain experience dysfunction associated with increased oxidative stress and poor mitochondrial function. The mitochondria are parts of our cells that turn oxygen into energy, and many neurological dysfunctions are associated with poor mitochondrial function and oxidative stress. When these brainstem regulatory centers overreact to a normally inocuous stimuli, a signal is sent that results in rapid vasodilation, especially of the temporal arteries which lie alongside the optic portion of the trigeminal nerve. A number of factors will increase the severity of this neurovascular reaction. The holisitic approach in Complementary Medicine tries to correct various factors that contribute, improving mitochondrial health, decreasing oxidative stress, helping to improve inflammatory regulation, aiding neurological health, and helping the body to decrease excess histamine response. Many receptors in the brain respond to both hormones and neurotransmitters, and if there is a hormonal imbalance, this too can be addressed with Complementary Medicine.

Research has revealed that the most common direct cause of migraine headache is temporal arteritis, which is inflammation of the small cerebral extracranial arteries under the temple, although the extent of this condition is usually mild and episodic, and a host of other contributing causes may participate. These inflamed arteries are often running with superficial nerves, which are irritated, leading to the migraine episodes. The occipital nerve is another focus of research, and may be inflamed or compressed, often with myofascial contracture and syndrome underlying, triggering the blood vessel spasm. The prodrome, or aura, that precedes a classic migraine results from cranial vasoconstriction, and both temporal arteritis and occipital vasoconstriction, as well as myofascial contracture at the neck, base of the skull, and scalp, may contribute. This aura typically develops over 10-30 minutes and varies in intensity and manifestation, with the patient potentially experiencing light flashes, anxiety, numbness and tingling, dizziness, slight confusion, sensitivity to light and sound, nausea, and a throbbing headache. Each patient must be assessed to determine the underlying causes, and a treatment protocol must address a number of these factors.

Classification of migraine in standard medicine includes the classic migraine with aura, the common migraine without an aura, menstrual migraines, hemiplegic migraines (one-sided temporal headaches, sometimes with balance problems, dizziness and vertigo), opthalmoplegic migraines (pain in the eye orbit, sometimes with double vision, droopy eyelid, or other visual disturbance), basilar artery migraine (intracranial and involving the main brain artery), benign exertional migraine, and status migrainous (severe prolonged migraines requiring hospitalization, and often preceded by anxiety and depression). Each type of migraine will require differences in the treatment protocol. The complexity of this differential assessment shows the patient that they must allow the Complementary Care physician some time to properly assess and determine the individualized course of therapy. There is no magic acupuncture point and magic herb with a one-size-fits-all effect.

What are the types of pharmaceutical approaches to migraine and how can Complementary Medicine have success with these same approaches?

In the recent past, almost all migraine patients were given a drug that selectively inhibited serotonin to stop the hyperreaction of vasodilation in the brain with migraine episodes. This treatment failed for most patients, just like the prior treatments with various pain relievers. Medical doctors started to use medications that were meant for other pathologies when patients reported decreases in migraine frequency with the use of the drugs. Today, a variety of drugs are tried, Beta blocking hypertension medications, synthetic estrogens, anti-seizure drugs, drugs for depression, anticholinergic drugs, etc. Patients today are starting to look at the side effects and risks of these medications a little more closely and looking either for alternatives, ways to decrease frequency of use of drugs, or ways to decrease side effects and risks with Complementary Medicine. The failure of pharmacological treatment for a great percentage of patients is well known.

Some of these medications used for migraine therapy were not created to treat migraine, and present considerable risk and side effect problems. Topomax, or topiromate, is a widely prescribed migraine medication today. It is an antiseizure medication, and the exact mechanism of action is still unclear. In February of 2008, the FDA issued warnings that clinical studies showed an alarming association with mental changes with chronic use that included inexplicable ideas of suicide and suicidal attempts. Warnings of cognitive dysfunction, mood disorder, somnolence, fatique, neuropathy, dizziness, onset of glaucoma, metabolic acidosis and kidney stones had already been of concern, as well as adverse effects on liver function. Clinical incidence of these nervous system problems occured in up to 30% of study participants. It is surmised that this drug may act on a variety of systems, antagonizing glutamate receptors, enhancing GABA activity, and blocking sodium channels in neural cells, much like the benzodiazapine anti-depressants.

In recent years, many M.D.s are resorting to botox treatment for migraines, especially serious migraines not helped by pharmaceutical therapy, but controversy has again risen with this therapy in 2010. The New York Times reported that the company that makes botox, Allergen, agreed to settle an FDA suit for improper kickbacks to prescribers and improper marketing techniques for $600 million, rather than face the publicity of a trial for these criminal allegations (NY Times Sept. 9, 2010, Business). The Times reports that many neurologists stated that standard pharmaceutical treatment for severe migraine does not improve very many patients' overall condition, and botox seems to have a significant effect. In some studies, though, botox did not perform significantly better than placebo injections, and in a second Allergan study to support migraine botox therapy, patients with at least 15 days of migraine headaches per month were helped by reducing these headaches by 2.3 fewer days of suffering per month over placebo injections. Dr. David M. Simpson, a professor of neurology at Mt. Sinai School of Medicine questions whether the botox injections helped only with a placebo effect, and Dr. Sidney M. Wolfe, the director of public health research at the group Public Citizen, stated that a small benefit that might be due to placebo effect may not be worth the risk and expense. The cost of these treatments was $4000 to $8000 per year, and Dr. Wolfe stated that perhaps acupuncture needling could be a much less expensive alternative. In any case, integrating acupuncture and herbal/nutrient medicine into the botox protocol would seen a smart move.

Many patients wonder what botox really is. Botulinum toxin is a protein neurotoxin produce by the bacteria Clostridium botulinum. Botulinum toxin is highly toxic systemically, but targeted injection into muscles has been shown to be safe, as long as the toxin is broken down locally. Unfortunately, a number of cases of the botox migrating through the body and causing respiratory failure and death following treatment have occurred. Canadian authorities have also issued a warning that botox may spread to other parts of the body and cause muscle weakness, difficulty swallowing, pneumonia, breathing problems and speech disorders. Nevertheless, the use of botox in cosmetic treatment to smooth skin, and now to treat migraines is very common now. Studies in 2010 have also found that emotional expression and cognition may also be affected by botox injections (Havas et al), and concerns of more widespread use, especially by unqualified practitioners, has been voiced. Patients looking for a more conservative approach are trying Complementary Medicine first.

Migraine therapies in Complementary and Integrative Medicine

Research into the effects of herbal medicines and nutraceuticals has exploded in the last decade worldwide. PubMed, an official U.S. NIH database of published studies, is easily accessible, and while this database only includes about 20% of all published studies, an increasing number of these rigorous medical clinical and laboratory reviews concern herbal study. A single medicinal herb may have 100 studied chemicals of medicinal value in it, and each of these chemicals may have 50 known useful biochemical actions. Databases outlining this elaborate information are now available online, sponsored by the government, and information is as easy to obtain as googling phytochemical database.

A number of herbs have the same mechanisms of action as we believe are important with Topomax. Simple and safe herbs like California poppy flowers and magnolia stems have significant benzodiazapine-like effects, without side effects. Various nutraceutical approaches may provide your body with bioavailability of nutrient chemicals that enhance GABA activity and improve the glutamate metabolism in the brain. Kava kava has been shown to be an effective sodium channel blocker. More and more practitioners of Traditional Chinese Medicine are becoming acquainted with these specific uses of herbal chemicals and nutrient supplements to add to the already extensive knowledge and researched use of modified traditional herbal formulas.

Some specific herbs have been widely studied. Feverfew is now widely studied and utilized in herbal formulas. Research has tried to discover which of the 50 or so known medicinal chemicals in the extract results in Feverfew's effectiveness. This research has identified that Feverfew chemicals exert positive effects on genetic stimulation of production of key inflammatory modulators. This research is avalable by clicking below on the link. Feverfew exerts proven genetic stimulation of monocyte chemoattractant protein 1 (MCP-1), as well as tumor necrosis factor alpha (TNFalpha), and these may explain it's effectiveness. What we learn from such research is that by persisting with therapy that includes the herb feverfew, our bodies genetic responses may be stimulated to react to the migraine triggers properly. Homeostasis may be restored to some extent with this therapy. By combining feverfew with other studied herbs and acupuncture, the chances of a successful outcome are great. By taking such herbs for only short periods and jumping from one therapeutic agent to another, you might not achieve this success in therapy. Butterbur is another native American herb that has shown success in clinical trials, and this and other herbs shown effective in scientific study may be combined in formula, or incorporated into the treatment strategy to insure greater chance of success. Not all treatments are effective on their own for all patients. Herbal treatment protocol needs to be individually prescribed and often the herbal formulas need to be adjusted as therapy proceeds. A professional herbalist will be able to follow through on this more complicated herbal approach.

Nutritional supplements have also been the subject of much research in the treatment of migraine, and are being integrated into the protocol of many M.D.s. In Europe, a combination of Coenzyme Q10, Vitamin B6 (pyroxidine), riboflavin (B2), and magnesium, have been studied in human clinical trials and shown promise with use over a period of 3-4 months. Coenzyme Q10 works by increasing efficiency of various cellular mechanisms, especially the electron transport chain in mitochondria in the brain. It is also a potent cellular antioxidant, and helps regulate excess inflammatory responses. It is a molecule that is called ubiquitone because it is found in almost every cell of the body. Many patients studied in recent years had a relative deficiency of CoQ10, which could result from poor diet as well as a side effect of common medications, such as cholesterol lowering statins and hypertension medications such as beta-blockers. CoQ10 deficiency is implicated in both cardiovascular and neurological pathologies as a primary cause in some diseases. Vitamin B6 pyroxidine is useful in the treatment of migraine because it is a coenzyme for diamine oxidase, which aids in breaking down histamine. Excess histamine causes the blood vessels to dilate rapidly. Vitamin B2 riboflavin is a coenzyme that is needed for the metabolism of the amino acid tryptophan, which is converted to niacin in the body. Niacin (B3) is needed for proper circulation, and is involved in the synthesis of sexual hormones. Riboflavin deficiency is associated with slow neurological responses, sensitivity to bright light, dizziness, and inflammation. While this combination of nutrient medicines is a little expensive, it would not need to be used continuously for a prolonged period, only until the underlying pathology is resolved. The efficacy in small trials with CoQ10 was demonstrated, as CoQ10 produced a greater than 50% decrease in number of days with migraine for 60% of patients.

Other nutrients that have been explored and found useful in the treatment of migraines includes Vitamin B3 niacin (which does produce a temporary flush after taking for the first few weeks in most patients), lecithin, and Omega-3 fatty acids.

The most promising studies of migraine treatment combine key herbs and nutritional supplements. A 2009 study at the Headache and Cerebrovascular Center in Vicenza, Italy, showed that a combination of Gingko biloba extract with CoQ10 and Vitamin B2 significantly reduced incidence of migraine, from an average of 3.7 per week to 1.2 after 4 months. Total disappearance in migraine attacks occurred in 11% of patients in the first 2 months, and 42% in the 4 month period (PMID: 19415441). The problem with human studies is that the number of herbs and supplements given must be kept to a minimum to better judge results. Funding is also a problem, and most of the funding goes to the most well known or publicized herbs and supplements. The actual clinical course expected is a combination of more herbs and supplements than seen in these studies, because this would increase the success rate. Once again, if the patient, for some reason, is not responsive to a particular combination of herbs and supplements with scientific validity, then the professional herbalist will change the treatment protocol to achieve successful results. The patient just needs to persist with treatment and trust in the eventual outcome. Lack of persistence and trust is perhaps the greatest inhibitor of success in migraine therapy utilizing Complementary and Integrative Medicine.

Hormonal migraines, usually triggered during the premenstrual period, have also been the subject of much research in recent years. During this phase of the menstrual cycle, relative deficiency of progesterone accounts for most symptoms. This creates a cascade of neurohormonal events, such as a serotonin deficiency, nitric oxide deficiency, and increased stress on the immune system. Often, a combination of acupuncture, progesterone stimulating cream, 5HTP, L-arginine, B6, and herbal formula directed at various symptoms, will normalize the neurohormonal effects and significantly reduce the occurrence and intensity of migraine headache. Standard medicine has issued warnings concerning oral contraceptive use for migraine sufferers, especially during perimenopause. Oral contraceptives decrease natural hormonal production, and are associated with increased need for riboflavin. Riboflavin deficiency is associated with increased migraine potential, reducing the ability of the body to produce sufficient niacin to maintain vascular health and regulation of vasodilation.

While the complete treatment protocol for difficult diseases such as migraine headache may be more complicated than the patient desires, adhering to a thorough treatment protocol which is individualized for the the patient will produce the best chance of success. Modern medicine is still stymied when faced with effective pharmaceuticals for migraine patients. A wide variety of pharmaceutical approaches is now tried. What works for one patient does not work for another. This illustrates the degree of difficulty in treating this disorder. Following through with a course of acupuncture, and being consitent with herbal formulas and nutrient prescriptions that are tailore to the individual offers the patient the best chance of outcome over a few months. If therapy is now working after a month, the physician will alter the treatment to insure greater success. Persistence is the key.

What you can do at home to decrease migraine and cluster headache frequency and severity: an important part of overall protocol

Besides seeking out a knowledgable Complementary Med physician, such as a Licensed Acupuncturist with good knowledge of herbs and nutrient medicine, there are a number of things the migraine and cluster headache patient may do work toward significant decrease of elimination of these headache episodes.

Keep a migraine or cluster headache diary, noting times of onset, symptom descriptions, what you had been eating or doing beforehand, what the weather pattern was or whether you had been exposed to environmental chemicals, even household cleaners and scents. Evaluate this information to see if you are overlooking some important triggers.

Some activities work when you feel the headache coming, or feel the prodrome headache of symptoms that precede the full vascular migraine or cluster episode. A percentage of patients will find immediate relief in stopping this extreme vascular reaction by taking some excedrin and strong caffeine (although caffeine in daily use should be curbed or eliminated). Others will find that the excedrin and caffeine has no effect. One needs to find the right environment to stop the vascular hyperreaction, going to a quiet and dark room is possible, or outside to a shady quiet location, lying down or getting into a comfortable resting position for about 10 minutes, and finding a focused routine that works for you. Earplugs and eye coverings may be helpful, or an iPod with soothing quiet music. Breath slow and deep, from the belly to the upper lungs, and sigh when letting the breath out. Don't push the exhalation. Try to imagine warmth in the palms of your hands, perhaps rubbing them together briefly first to mentally find this sensation. When you get good at this technique, it may work very well to stop the onset of the severe headache and allow you to continue your day at peace.

The main dietary approaches in reducing migraine occurence are to reduce simple sugars and carbohydrates, refined foods, preservatives and aged foods, chocolates, avocadoes, lunchmeats, hot dogs, spicy foods, MSG, beer, yeast, alcohol, greasy foods and acid forming foods such as breakfast cereals, granola and heavy meats. Eating less red meat and fatty meats, especially grilled or fried, and eating more fresh green vegetables, whole grains and lean meats that are fresh and organically produced without preservatives and chemical additives, will help the migraine sufferer achieve their goals of reduction of triggers and improvement in related health systems in the body. Over time, I have witnessed many patients achieve much improvement with such dietary changes. Many of the common triggers to migraine contain histamines, such as beer, cheese, wine, chocolate, and it is surmised that this is the reason that Vitamin B6 is often effective in preventing migraines, with its promotion of enzymatic breakdown of histamine. These foods also contain nitrite preservatives.

Since migraines and cluster headaches are vascular headaches, dietary protocol to improve vascular health has long been recommended. Fatty acid balance and Omega-3 fatty acids is explained thoroughly on another article on this website, and has long been recommended as part of the protocol for migraine sufferers. Without a fatty acid balance a patient may develop inflammatory dysfunction that leads to various cardiovascualar problems, and may increase the chance that your system will react with a hypersensitive vascular reaction, or migraine.

Studies have shown that a small percentage of migraine sufferers also had celiac disease, an allergic hypersensitivity to gluten and gliadin, that was linked to the migraine mechanism. If this is suspected, elimination of gluten from the diet as much as possible for a few months, along with therapy to improve the intestinal mucosa and immune health may produce dramatic results.

A combination of reduction of trigger stimulation with a holistic protocol to resolve the underlying disease mechanisms is very important. Decreasing triggers and improving overall health allows the treatment to work. If you continue to trigger migraines with unhealthy diet and lifestyle, reducing the disease mechanisms is much more difficult. Adopting a thorough holistic approach may eliminate this problem completely in the long run, and this would be worth the extra effort of a thorough holistic approach.

Information Resources

1. A 2008 article from a migraine specialist published in Nature, Nature Reviews Neurology, confirms that standard medical protocol for migraine treatment includes Complementary medicine and nonpharmacological treatments (meaning herbs and nutrient supplements): http://www.nature.com/nrneurol/journal/v4/n9/full/ncpneuro0861.html
2. A 2005 article published in Australian Family Physician reveals that current migraine protocol includes evidence-based acupuncture and nutritional supplements, instruction in dietary and environmental factors, and a mind-body approach, pioneered by Traditional Chinese Medicine in the standard treatment approach: http://www.ncbi.nlm.nih.gov/pubmed/16113701
3. A research abstract that demonstrates the complexity and holistic nature of the migraine and cluster headache mechanisms in pathophysiology published in Pharmacology and Toxicology Journal in 2001http://www.ncbi.nlm.nih.gov/pubmed/11555322 If you have trouble accessing this database by clicking on this address, Google PubMed or NCBI.
4. Another research abstract that demonstrates the complexity and holistic nature of the migraine and cluster headache mechanisms in pathophysiology published in the journal Cephalalgia in 2001http://www.ncbi.nlm.nih.gov/pubmed/11595008 If you have trouble accessing this database by clicking on this address, Google PubMed or NCBI, and search for 11595008.
5. The U.S. government maintains a research database website for the public that can be quickly found at http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed&itool=toolbar If you have trouble accessing this database by clicking on this address, Google PubMed or NCBI.
6. A 2005 randomized controlled human trial of Coenzyme Q10 and Vitamin B2 riboflavin at the Headache and Pain Unit of Unversity Hospital Zurich, Switzerland, found that this protocol produced a dramatic success rate over placebo over a 3 month period: http://www.ncbi.nlm.nih.gov/pubmed/15728298
7. A 2009 assessment of standard therapy for migraines, published in the Journal of Headache Pain, summarizes that almost no pharmaceutical medicines have been developed for migraine therapy, but various pharmaceuticals intended to treat other disorders have been used in the past. Recently, specific therapies have been found, one revisiting the delivery of the old ergot chemicals derived from herbal medicine, but these are as yet unproven. Some proof of efficacy has been found for herbal medicine, though, as well as standard pain killers. http://www.ncbi.nlm.nih.gov/pubmed/19795182 If you have trouble accessing this database by clicking on this address, Google PubMed or NCBI.
8. Research in 2009 demonstrates with sound clinical study that over 40% of patients with classic migraine with aura (prodrome) found significant benefit from gingko biloba extract if they persisted with therapy for 2 months. Of course, quality professional extract from a professional concerned with quality is important with almost no regulation of the herbal industryhttp://www.ncbi.nlm.nih.gov/pubmed/19415441 If you have trouble accessing this database by clicking on this address, Google PubMed or NCBI.
9. Research in 2008 reveals how herbs like feverfew are proven to exert effects of genetic stimulation of key inflammatory mediators, and that this may reveal the physiological mechanisms which account for its success in migraine therapyhttp://www.ncbi.nlm.nih.gov/pubmed/18066113 If you have trouble accessing this database by clicking on this address, Google PubMed or NCBI.
10. Research in 2006 in China shows the extent of new herbal products proven to effect migraines: a novel approach is to use a small dose of herbs as a nose drop to stop the vasoreactivity in migraines: http://www.ncbi.nlm.nih.gov/pubmed/16800989 If you have trouble accessing this database by clicking on this address, Google PubMed or NCBI.
11. Research in 2002 at the Jefferson Headache Center at Thomas Jefferson University in Philadelphia produced the first human trial results confirming the efficacy of Coenzyme Q10 for migraine treatment: http://www.ncbi.nlm.nih.gov/pubmed/11972582.
12. Continuing research of CoQ10 at the Institute of Biochemistry at Polytechnic University of Marche, in Ancona, Italy, confirmed the beneficial effects of CoQ10 for many disorders, including neurological and vascular: http://www.ncbi.nlm.nih.gov/pubmed/16205466.
13. By 2004, a review of various human clinical trials revealed the potential for a combination of CoQ10, B12, B2 and magnesium in the overall integrative protocol to treat migraine: http://www.ncbi.nlm.nih.gov/pubmed/15196887.
14. A 2009 review of oral contraception use for migraine sufferers finds that the use of combined oral contraceptives is always contraindicated for patients suffering migraine with aura. Hormone-induced headache and estrogen withdrawal headache are also accepted as definitive diagnoses by the International Classification of Headache Disorders: http://wwww.ingentaconnect.com/content/ftd/ern/2009/00000009/00000003/art00012.

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.