Review of Migraines

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HeadacheAntony Haynes BA, RNT explores the nutritional links with Migraines. The recent heat wave in England in July 2016 with blue, cloudless skies & over 30 degree temperatures has been welcomed by most. However, some people suffer migraines in the bright sunshine, and this is what prompted me to focus on this subject matter, because I used to suffer from completely debilitating migraines myself after playing tennis in the bright sunshine. You may listen to the podcast of this piece here.

This is a review of the subject of migraines and of research into the possible role of key nutrients in the resolution of this disabling condition. You can read this document on the screen, and that gives you the opportunity of viewing the many references provided at the end. The review will take a brief look at the definition and description of migraine, then the incidence of it throughout the world, and then and of most interest, at the possible nutritional interventions that may bring some relief to sufferers.

Incidence

Worldwide, migraines affect nearly 15% or approximately one billion people. It is more common in women at 19% than men at 11%[i].

Migraine is a common disorder that affects up to 12 percent of the general population.  It is more frequent in women than in men, with attacks occurring in up to 17 percent of women and 6 percent of men each year. Migraine is most common in those aged 30 to 39, an age span in which prevalence in men and women reaches 7 and 24 percent, respectively.  Migraine also tends to run in families[ii],[iii].

The medications which contain triptans are considered the “gold standard” of migraine therapy, but they do have limitations and many patients are seeking other therapeutic alternatives. Any drug most certainly does NOT address the underlying reasons why they occur.

Types of Migraine

The International Headache Society (IHS) has classified migraine into migraine with aura (MA) and migraine without aura (MO). Migraine without aura (MO) is the most common type, accounting for approximately 75 percent of cases.

The incidence of migraine is much higher in females (70 %) than in males (30 %) and is at its highest during the peak reproductive years (between the ages of 25 and 55 years)[iv].

Migraine is a disorder of recurrent attacks.  The attacks unfold through a cascade of events that occur over the course of several hours to days.  A typical migraine attack progresses through four phases: the prodrome, the aura, the headache, and the postdrome[v].

Possible Causes

Studies have identified neurological, vascular and hormonal pathways to be involved in migraine susceptibility and pathophysiology[vi],[vii].

The exact causes for any individual may be unknown but there are certainly some well-known triggers: fatigue & blood glucose imbalances, stress, charged emotional states, physical tension, bright lights, flickering screens, food intolerances (cheese, citrus fruits, chocolate, wine), caffeine, hormonal imbalances, dehydration, jet lag, strong smells, changes in climate & humidity, & medications.

In my experience, the first matter is to help identify any triggers and then avoid them, and the best way to gather this information is via a journal, and it is helpful to be familiar with the list of common triggers at the same time.

Dietary wise, there may be great benefit in the allergy elimination diet, but this can be problematic for practical reasons. Typical culprits include cheese, chocolate and wine and this may be due to the high level of amines they contain. For example,

  • tyramine is in cheese
  • phenylethylamine is in chocolate
  • histamine is in wine

Amines are formed by the breakdown of proteins in foods. They are normally quickly broken down in the body with the help of enzymes such as MAO (monoamine oxidase-A) which render them harmless.  Missing, deficient or blocked enzymes can lead to a buildup of amines in the body[viii].

To simplify matters for patients, it may be best to avoid monosodium glutamate (MSG), artificial colours, sweeteners and preservatives, along with avoiding foods that are moderate to very high in amines. A blood sugar stabilising diet is certainly to be recommended[ix],[x],[xi].

Prevention, relief, resolution

Therapies proven, to various degrees, to be effective for migraine include aerobic exercise; biofeedback; other forms of relaxation training; cognitive therapies; acupuncture; and supplementation with magnesium, CoQ10, riboflavin, butterbur, feverfew, & vitamin B12 with folate and pyridoxine[xii].

Magnesium

Magnesium supplementation has been found to help reduce tension headaches and migraines[xiii]. Low serum levels are an independent risk factor in migraine attacks[xiv]. Even though serum levels may not be the most accurate marker for this mineral, since RBC levels may be a better marker, in this study the serum levels were very relevant. The odds of acute migraine headaches increased 35 times when serum levels of magnesium reached below the normal level.

In other studies, oral magnesium alleviates the frequency and intensity of migraine, and should be adapted as parts of multimodal approach to reduce migraine[xv].

Given that low levels of magnesium have been associated with a number of chronic diseases, such as Alzheimer’s disease, insulin resistance and type-2 diabetes mellitus, hypertension, cardiovascular disease (e.g., stroke), and attention deficit hyperactivity disorder (ADHD) as well as migraine headaches[xvi], ensuring sufficient magnesium in the population at large seems a sensible target, but especially in those who suffer from migraines.

Butterbur (Petasites hybridus)

Butterbur root extract (standardised to 15% petasins) has been shown to be both safe and effective for the prevention of migraines[xvii].

Feverfew (Tanacetum Parthenium)

Feverfew has a long traditional use for headaches & migraines dating back in folklore. Although not all studies have confirmed the anti-migraine effects of feverfew, some have shown the molecular mechanisms as to how it works. This study is one of a number that found benefit in the prevention of migraines[xviii], as did this review by D’Andrea et al[xix], although it was acknowledged that the quality of the trials is low.

CoQ10

CoQ10, at doses of 100-300 mg daily, has been shown to be beneficial for preventing and reducing the frequency of migraine attacks among adults[xx],[xxi],[xxii].

Riboflavin

Riboflavin (vitamin B2) has been shown to be effective for the prevention of migraine among both children and adults[xxiii]. I believe that it is worth reporting on the specifics of the Condo et al study. This retrospective study used riboflavin for migraine prophylaxis in 41 paediatric and adolescent patients, who received 200 or 400 mg/day single oral dose of riboflavin for 3, 4 or 6 months. Attack frequency and intensity decreased during treatment, and these results were confirmed during the follow-up. During the follow-up, 68% of cases had a 50% or greater reduction in frequency of attacks and 21% in intensity.

In conclusion, riboflavin seems to be a well-tolerated, effective, and low-cost prophylactic treatment in children and adolescents suffering from migraine.

It is believed that riboflavin’s beneficial effects are due to its ability to enhance mitochondrial energy production this is based on data indicating that riboflavin is especially effective among migraine patients with mitochondrial genetic abnormalities[xxiv].

B12 & Folate & B6

These 3 B vitamins have been studied for their ability to reduce migraines. One 2009 study caught my eye, in particular. It examined the homocysteine-lowering effects of vitamin supplementation on migraine disability, frequency and severity and whether MTHFR C677T genotype influenced treatment response.

This was a randomized, double-blind placebo, controlled trial of 6 months of daily vitamin supplementation using 2 mg of folic acid, 25 mg vitamin B6, and 400 mcg of vitamin B12 in 52 patients diagnosed with migraine with aura.

The vitamin supplementation reduced homocysteine by 39% (about 4 points or 4 mumol/l) and importantly also reduced the prevalence of migraine disability from 60% at baseline to 30% after 6 months. Headache frequency and pain severity were also reduced. The placebo group experienced no changes.

In this patient group the treatment effect on both homocysteine levels and migraine disability was associated with MTHFR C677T genotype[xxv].

With regard to my own migraines this is of interest. I have had certain gene test conducted and I do have the MTHFR C677T genotype. My mother used to have migraines so this helps to confirm a genetic link with migraines, in principle.

Previously, I had taken magnesium and CoQ10 and they had no effect on my migraines. It was only on taking the B12 Folate Plus that they were prevented 100%. This highlights the need to consider all of the nutrients we are discussing today when attempting to reduce or resolve migraines.

The specific product I took to effectively completely prevent the migraines was the B12 Folate Plus with Tillandsia extract by Biotics Research. It resolved my migraines on the first day of taking them and they have worked for over 9 years – I have taken them daily for 9 years. Yet the dosing of this product is low with just 4 mcg of B12, 200 mcg of folic acid, with 30 mg of vit C and 250 mg of Spanish Moss extract (Tillandsia usneoides). Even taking 6 a day of these provided me with 24 mcg of B12, 1,200 mcg of folic acid and no additional B6. Yet, it still worked for me, as it has with other migraine sufferers to whom I have recommended it.

MTHFR C677T study (2009) B12 Folate Plus (Biotics Research) @ 6 p.d.
2,000 mcg folic acid 1,200 mcg folic acid
25 mg vitamin B6 0 mg vitamin B6
400 mcg vitamin B12 24 mcg of vitamin B12
  250 mg of Spanish Moss (Tillandsia extract)

 

Although I have researched Tillandsia, I have not found any meaningful research on it but it would appear that it supports the efficacy of B12 & folic acid, at least in their role in resolving migraines in a sub-group of migraine sufferers.

I had previously taken multi nutrient formula with significantly more B12 & folic acid than contained in the B12 Folate Plus (BRC) but they had not had any effect on my migraines.

In summary

Migraines are debilitating and completely change an individual’s life for their duration. If there was a means by which to reduce or resolve them in a natural biochemical / biological way without the need to take powerful medications, then that would be life-changing.

Whilst there is no guarantee and we are all different, there are a handful of nutrients which have been shown to do just this, which I have discussed here: vitamin B12, folic acid, vitamin B6, CoQ10, magnesium, riboflavin and the plant extracts of Butterbur and Feverfew.

Of course, avoid the triggers where possible too.

I have provided here a suggested list of supplements that contain these nutrients for you to consider for yourself, if you get migraines, or for those you know who do.

MygranX™ (BRC) – 2 capsules provides 400 mg of riboflavin, 50 mg of fully emulsified CoQ10, and 177 mg blend of feverfew & butterbur extract.

1-2 caps one to three times a day – http://tinyurl.com/p4ayb3j

Magnesium Malate Forte (ARG) – 2 tablets provide 124 mg of magnesium, with 10 mg of riboflavin and 500 mg of malic acid.

2 tabs with each meal – http://tinyurl.com/bnnx25g

B12 Folate Plus (BRC) – 1 caps provides 4 mcg of B12, 200 mcg of folic acid, with 30 mg of vit C and 250 mg of Spanish Moss extract (Tillandsia usneoides).

2-3 caps with each meal

I certainly hope this information helps you or someone you know with migraines.

Thanks for listening. Til the next podcast.

References

[i] Vos, T; Flaxman, AD; Naghavi, M; Lozano, R; Michaud, C; Ezzati, M; Shibuya, K; Salomon, JA et al. (Dec 15, 2012). “Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010”. Lancet 380 (9859): 2163–96. View Abstract

[ii] Lipton RB, et al.  Prevalence and burden of migraine in the United States: data from the American Migraine Study II.  Headache. 2001;41(7):646. View Abstract

[iii] Lipton RB, et al.  Migraine prevalence, disease burden, and the need for preventive therapy.  Neurology. 2007;68(5):343. View Abstract

[iv] Stovner Lj, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, Steiner T, Zwart JA. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007 Mar; 27(3):193-210. View Abstract

[v] Charles A.  The evolution of a migraine attack – a review of recent evidence. Headache. 2013;53(2):413. View Abstract

[vi] Cutrer FM. Pathophysiology of migraine. Semin Neurol. 2010 Apr;30(2):120-30. doi: 10.1055/s-0030-1249222. Epub 2010 Mar 29. View Abstract

[vii] Pietrobon D, Moskowitz MA. Pathophysiology of migraine. Annu Rev Physiol. 2013;75:365-91. doi: 10.1146/annurev-physiol-030212-183717. Epub 2012 Nov 26. View Abstract

[viii] Dengate S. Food Intolerance Network Factsheet. Amines. 2006. View Information

[ix] Van den Eeden SK, et al.  Aspartame ingestion and headaches: a randomized crossover trial.  Neurology. 1994 Oct;44(10):1787-93. View Abstract

[x] Wilkinson CF Jr.  Recurrent migrainoid headaches associated with spontaneous hypoglycemia.  Am J Med Sci. 1949 Aug;218(2):209-12. View Abstract

[xi] Rockett FC et al. Dietary aspects of migraine trigger factors. Nutr Rev. 2012 Jun;70(6):337-56. doi: 10.1111/j.1753-4887.2012.00468.x. View Abstract

[xii] Mauskop A. Nonmedication, alternative, and complementary treatments for migraine. Continuum (Minneap Minn). 2012 Aug;18(4):796-806. doi: 10.1212/01.CON.0000418643.24408.40. View Abstract

[xiii] Woolhouse M. Migraine and tension headache–a complementary and alternative medicine approach. Aust Fam Physician. 2005 Aug;34(8):647-51. View Abstract

[xiv] Assarzadegan F, Asgarzadeh S, Hatamabadi HR, Shahrami A, Tabatabaey A, Asgarzadeh M. Serum concentration of magnesium as an independent risk factor in migraine attacks: a matched case-control study and review of the literature. Int Clin Psychopharmacol. 2016 May 2. [Epub ahead of print]. View Abstract

[xv] Chiu HY, Yeh TH, Huang YC, Chen PY. Effects of Intravenous and Oral Magnesium on Reducing Migraine: A Meta-analysis of Randomized Controlled Trials. Pain Physician. 2016 Jan;19(1):E97-112. View Abstract

[xvi] Gröber U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. Nutrients. 2015 Sep 23;7(9):8199-226. doi: 10.3390/nu7095388. View Abstract

[xvii] Diener HC et al. The First Placebo-Controlled Trial of a Special Butterbur Root Extract for the Prevention of Migraine: Reanalysis of Efficacy Criteria. European Neurology. 2004;51(2):89-97. View Abstract

[xviii] Studzińska-Sroka E, Znajdek-Awizeń P, Gawron-Gzella A. [Studies on the antimigraine action of Feverfew (Tanacetum parthenium (L.) Sch. Bip.)]. [Article in Polish]. Wiad Lek. 2013;66(2 Pt 2):195-9. View Abstract

[xix] D’Andrea G, Cevoli S, Cologno D. Herbal therapy in migraine. Neurol Sci. 2014 May;35 Suppl 1:135-40. doi: 10.1007/s10072-014-1757-x. View Abstract

[xx] Silberstein SD. Preventive Migraine Treatment. Continuum (Minneap Minn). 2015 Aug;21(4 Headache):973-89. View Abstract

[xxi] Markley HG. CoEnzyme Q10 and riboflavin: the mitochondrial connection. Headache. 2012 Oct;52 Suppl 2:81-7. View Abstract

[xxii] Pringsheim T et al. Canadian Headache Society guideline for migraine prophylaxis. Canadian Headache Society Prophylactic Guidelines Development Group. Can J Neurol Sci. 2012 Mar;39(2 Suppl 2):S1-59. View Abstract

[xxiii] Condò M, Posar A, Arbizzani A, Parmeggiani A. Riboflavin prophylaxis in pediatric and adolescent migraine. J Headache Pain. 2009 Oct;10(5):361-5. doi: 10.1007/s10194-009-0142-2. Epub 2009 Aug 1. View Abstract

[xxiv] DiLorenzo C et al. Mitochondrial DNA haplogroups influence the therapeutic response to riboflavin in migraineurs. Neurology 2009;72:1588–1594. View Abstract

[xxv] Lea R, Colson N, Quinlan S, Macmillan J, Griffiths L. The effects of vitamin supplementation and MTHFR (C677T) genotype on homocysteine-lowering and migraine disability. Pharmacogenet Genomics. 2009 Jun;19(6):422-8. doi: 10.1097/FPC.0b013e32832af5a3. View Abstract

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