I have been a migraine sufferer almost all my life.  I can remember being a small kid and doing a trial avoiding potential trigger foods (chocolate and cheese) and walking through a department store at the holidays, seeing all the chocolate treats was torture! So I understand how intrusive they are. If they aren’t laying you out flat, it’s one of those heavy headaches that can make it really hard to get through the day.

Woman in white sweater leans on a sun dappled wall, holding her head in pain with her left hand. Photo by Carolina Heza on Unsplash

I’ve found that there are a lot of people that have normalized their headaches.  It’s just what we do – we have to get through the day, and if there are a few days that are miserable, it is what it is.  Many people don’t even really discuss it with their family doctors, managing with over the counter pain management. Checking in with a family doctor and possibly a referral to a neurologist is important, so that other underlying conditions can be ruled out. From there, one of the first treatment options is to try rescue medications called triptans.  Triptans, like Imitrex or Ralpax, can work well and be essential for day to day functioning.  Unfortunately, they are very expensive and won’t address the frequency of the migraines, and all these rescue options can and do cause rebounding.  Many people don’t realize that Tylenol with caffeine or Excedrin can commonly cause rebound headaches due to the caffeine.  The different triptans can do the same.  For me, while Ralpax worked well at first, over time I started to get a rotten rebound headache 48 hours after every dose.

With more frequent headaches and migraines, its often better to look at preventative medications and options.  And this is where Naturopathic Medicine fits into this picture.  A few years ago, I was referred to an amazing Neurologist.  She was understanding of Naturopathic medicine and said something that I found valuable.  She said something to the effect of “its your job as a Naturopathic Physician to help decrease the things that will push you into a migraine headache, the things that will tip you over your migraine threshold.  Its my job as your Neurologist to help you find the things that will make your migraine threshold more stable, so those triggers can’t push you over as easily”.

Some of the prescription medication options that are helpful for stabilizing that migraine threshold include: low dose amitriptyline, calcium channel blockers, beta blockers, and several seizure medications including topiramate and lamotrigine, and others[1].   Amitriptyline is an older generation antidepressant, which might seem odd but at low doses it can be very helpful for managing chronic pain conditions including migraine and fibromyalgia[2].  Side effects are varied, but with amitriptyline and beta – and calcium channel blockers, commonly include fatigue, dry mouth, constipation. Again, it seems odd that antiepileptic drugs are used for migraines, but again there is a good amount of research supporting their use[3].  In particular, topiramate has strong evidence behind it and can be titrated down after 6 months use with ongoing benefit.  Unfortunately, its side effects can be more profound  and can include cognitive side effects like fatigue, mood changes including suicidal ideation, dizziness, word-finding problems, slowed thinking/ mental processing, and concentration/attention and memory difficulty, as well as numbness or tingling in the hands or feet, and absolutely cannot be used in pregnancy.

So how do we use Naturopathic Medicine here as well.  There are lots of avenues to follow, as there can be many triggers for headaches, and its important to look at the individual’s full picture to decide on a therapeutic course. There is often a strong hormonal influence and so helping the body to support the estrogen/progesterone balance is a strong starting point[4].  I often use herbal medicine or bioidentical hormone replacement to support progesterone in the luteal phase (ovulation to period). 

There is also excellent research to support the use of specific herbs or supplements in headache prevention.  Melatonin has been examined in several ways, including head to head trials with amitriptyline and valproic acid.  It has consistently shown to be effective in reducing frequency, duration,  and the intensity of migraines[5].  I also use a blend of magnesium, Co Q10, butterbur, feverfew and B2 for migraine prevention, which is well tolerated and can be very effective[6][7][8].

The take home message here is that many people suffer from migraines and headaches and feel they have to power through and so don’t consider seeking treatment.  However, there are a host of therapeutic options both pharmaceutical and herbal or nutraceutical.  It’s also very important to check in with your Primary Care provider and/or a Neurologist to ensure there aren’t any underlying issues that need to be addressed immediately. From there, the best approach looks at the frequency, timing, known triggers and other symptoms such as menstrual or digestive complaints.  No one should have to push through without support.

[1] DW, R. (2019). Other Preventive Anti-Migraine Treatments: ACE Inhibitors, ARBs, Calcium Channel Blockers, Serotonin Antagonists, and NMDA Receptor Antagonists. – PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30880363 [Accessed 1 May 2019].

[2] Group, C. (2019). Amitriptyline in the prophylactic treatment of migraine and chronic daily headache. – PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21070231 [Accessed 1 May 2019].

[3] SD, P. (2019). Current Status of Antiepileptic Drugs as Preventive Migraine Therapy. – PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30880369 [Accessed 1 May 2019].

[4] Li W, e. (2019). Changes in hormones of the hypothalamic-pituitary-gonadal axis in migraine patients. – PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29366620 [Accessed 1 May 2019].

[5] Long R, et al (2019). Theraperutic role of melatonin in migraine prophylaxis: A systematic review. – PubMed – NCBI.[online] Ncbi.nlm.nih.gov. Available at https://ncbi.nlm.gov/pubmed/30653130 [Accessed 1 May 2019].

[6] Guilbot A, et al (2017). A combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study. PubMed – NCBI. Ncbi.nlm.nih.gov. Available at https://www.ncbi.nlm.nih.gov/pubed.28854909. [Accessed 1 May 2019].

[7] Rajapakse T, et al (2019).  Phytomedicines in the Treatment of Migraine. PubMed – NCBI. [online] Ncbi.nlm.nih.gov.  Available at  https://www.ncbi.nih.gov/pubmed/30627973. [Accessed 1 May 2019].

[8] Talebian A., et al (2018). Prophylactic effect of riboflavin on prediatric migraine: a randomized, double-blind, pacebo-controlled trial. -PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at https://ncbi.nlm.nih.gov/pmc/articles/PMC5878019/