Migraines can be debilitating and most migraine sufferers never get effective medical treatment. The World Health Organization lists migraines as being in the top 20 causes for years lived with disability (YLDs). A migraine is characterized by an intense throbbing, on one or both sides of the head, that may be behind the eyes, ears, or in the temples. Migraines more often afflict females, occur monthly, and are caused by stretching of blood vessels around the brain. The pounding sensation is often aggravated by light and sound with possible nausea and vomiting. Long after being afflicted with migraines ourselves, after several visits to neurologists, endocrinologists, and Ear / Nose / Throat specialists, we finally stumbled across some answers to our most painful ailment in a book by endocrinologist and hormone superhero Dr. Geoffrey Redmond, M.D..
The World Health Organization confirms that the higher rates of attack in women are hormonally driven, and that most migraines occur monthly lasting for a few days. The answer for most of these women lies in estrogen, which functions to keep blood vessels open. Estrogen levels drop sharply before menstruation and can fluctuate throughout a woman’s cycle. Estrogen receptors in the blood vessels detect when this hormone drops, leading to narrowing of the arteries. This “contraction” phase may cause what is known as an “aura” as less blood flows to the brain. An aura can be described as a period of visual changes, blindness or temporary paralysis and is a sign that the headache is about to come on.
Pain is felt in the second phase when the blood vessels relax and open up; the pounding begins as the heartbeat sends blood into the blood vessels. Pain is caused not only by the stretching of delicate blood vessels but there is also “pain producing inflammatory hormones” that seep into surrounding tissues, according to Redmond. Sometimes this change in blood pressure can be triggered by alcohol; particularly red wine due to an ingredient called Tyramine which is also found in aged cheeses.
For the aforementioned migraines, the key to prevention is to even out estrogen levels in the body and try to prevent sharp drops. In his books, Dr. Redmond recommends the following strategies:
1. Take Mircette, an oral contraceptive with active estrogen for 26 days (instead of 21).
2. Take a standard oral contraceptive continuously without stopping for the 7 day menstrual period. Some women choose to take a 7-day break after several consecutive weeks.
3. Take a standard oral contraceptive and during the 7 day menstrual period use an estrogen patch such as Climara (each patch lasts one week).
4. Use an estrogen patch during your 7 day menstrual period. This may be difficult to time, particularly for women who do not take the pill.
5. Hormone Replacement Therapy (HRT) may be useful in preventing estrogen-related migraines in menopausal women.
Men or people with frequent attacks may be able to prevent their migraines using these methods:
- Coffee may help improve blood circulation during the arterial narrowing phase which can delay or stop attacks. We recommend this only during the onset of an attack and caution against heavy coffee consumption since caffeine withdrawl can actually induce a migraine.
- The herb Feverfew can help prevent migraines by inhibiting the release of seratonin from blood vessels (whichreduces fluctuations in blood vessel tone). We have found it to be effective and recommend a formula with magnesium and riboflavin such as Migrelief by Quantum Health. Look for a formula high in parthenolides, the active ingredient in feverfew, atleast 0.2%.
- Adequate sleep and relaxation (ie. massage, meditation, accupuncture) may be able to induce a steady state of calm and prevent a stress-triggered migraine.
- Drugs such as beta blockers, channel blockers, and anticonvulsants (last resort, consult your doctor).
Pain Relief During an Attack
The blood is flowing, throbbing through your veins. Sleep may help to calm blood flow and you may find the headache gone when you awake. Light has been known to aggravate migraines, and we have found that sitting at a computer screen has sometimes been a trigger. Avoid computers, television, or anything that could put strain on your eyes. Research has found light to trigger pain neurons that are active during migraine attacks, causing headaches to intensify and then improve after 20-30 minutes in the dark. If darkness does not improve your conditions or if you are in a situation which doesn’t allow for escape to a dark room, the most effective and least harmful pain relief will be from NSAIDs, such as ibuprofen, Advil, Aspirin or Aleve. Always take these medications with food and plenty of water to prevent damage to stomach lining. We find the most effective pain relief from a combination of ibuprofen and aspirin. Triptans are a class of prescription medication that reverse the blood vessel stretching that causes pain. The most common is Imitrex, which comes in oral and nasal spray forms and lasts 3-4 hours. Amerge provides longer lasting relief, for up to 12 hours. Triptans have side effects due to the blood vessel constriction. Try to stick with the following line of defense for pain relief.
- No light – no TV or computer!
- Triptans (last resort, consult your doctor)
A Note from U R B A N C L I N I C
We have seen first-hand how neurologists, ENTs and even migraine specialists operate. First they rule out serious conditions (which is important), they may misdiagnose your symptoms to be sinus-related or even thyroid eye disease (for which there is no cure), and if they do chalk your symptoms up to being a migraine they will hand you a prescription for triptans to treat attacks or anticonvulsants to prevent them. Few doctors are willing to search for the underlying cause because they either aren’t comfortable with addressing hormones or they don’t have the patience required for non-conventional treatments such as herbs, coffee and oral contraceptives. Perhaps they aren’t even aware of these methods to prevent and treat migraines or perhaps they just don’t have the time. Whatever the case, we would rather address the cause rather than put a bandaid on the symptoms, in hopes that the underlying cause can be corrected and possibly lead to permanent relief. Although we recommend treatments that address hormonal problems please be aware that medications such as oral contraceptives and HRT still carry risks and possible side effects. Please make sure you understand all risks and possible side effects before taking any medication and always consult your doctor.