There are many causes and triggers involved in the pathogenesis of migraine, and it is important to work with your functional medicine practitioner to identify the unique triggers. Here are some common ones:
Poor posture and/or spinal misalignment, which can cause nerve compression
Food sensitivities or intolerances
Tyramine-containing foods, such as cheese, cured meats, alcohol, and vinegar, are common triggers.
Tannins, such as in tea and wine.
Artificial sweeteners and additives such as MSG can trigger headaches in some.
Sulfites in wine and cheese are well-known triggers.
Histamine Overload
Histamine dilates blood vessels.
Women with migraines often have low DAO, the enzyme that breaks down histamine. Interestingly, DAO levels increase significantly during pregnancy, giving expectant mothers a nice break from migraines.
Serotonin causes vasoconstriction of the nerve endings in blood vessels, which affects pain sensitivity. Low serotonin levels dilate blood vessels, initiating migraines.
Certain heavy metals such as cadmium and lead
Hormonal changes can trigger menstrual migraines. If migraines occur consistently on certain days of the menstrual cycle (especially around ovulation or right before menstruation), they may be due to a drop in estrogen levels resulting in a surge in prostaglandins. Learn more about menstrual migraines here.
Caffeine has been linked to migraine for many years, but the effect seems to vary widely from person to person. Abrupt withdrawal can trigger a migraine in some, and in most people, caffeine is actually beneficial as rapid relief for a migraine attack.
Nutrient deficiencies are common in people with migraine. Studies show that high doses of magnesium, CoQ10, and certain B vitamins are effective for migraine.
Magnesium - Try 300-400mg twice daily with food. The glycinate and malate forms are easy to find, easily absorbed, and effective without overstimulating bowels.
CoQ10 is an absolutely critical enzyme for energy generation in our mitochondria (the little energy factories in every cell of our body, especially the heart and the brain). CoQ10 has been shown to be effective for migraine prophylaxis. I recommend 150mg twice daily with food. The ubiquinol form is preferred for better absorption, especially for those over 40 (some of us lose our ability to convert ubiquinone as we age).
Riboflavin - B2 is a key co-factor for multiple enzymes involved in cellular energy production. High-dose riboflavin treatment (400 mg) is effective in preventing migraine.
B6, B9 and B12 - Those with the T allele of the MTHFR C677T polymorphism often have elevated levels of homocysteine and increased incidence of migraine. Testing homocysteine levels may be useful in migraine patients. Preliminary studies support the use of folate, vitamin B6 and vitamin B12 for migraine prevention. These B vitamins are also needed for methylation, detoxification, and breaking down histamine. B6 is also critical for serotonin production, which plays a critical role in pain perception.
In addition to avoiding the triggers mentioned above and experimenting with the suggested supplements, there are several complementary therapies that have been shown to reduce the incidence of migraine.
Stress reduction strategies such as meditation have been found to be effective both in prevention as well as reducing pain of a migraine attack.
Chiropractic spinal manipulation has been shown to be helpful in the treatment of migraine.
Massage not only helps reduce stress but is also helpful for reducing migraines.
For pain management, there are natural alternatives without all the side effects of NSAIDs. In my practice, I frequently recommend curcumin (an excellent clinical overview here). An ancient spice, turmeric is the bright gold ingredient found in many
asian dishes, ubiquitous in curries. Excessive intake of whole herb turmeric might increase the risk of kidney stones due to its high content of oxalates. However, in pursuit of temporary pain relief, we can focus instead on curcumin, a polyphenol component of turmeric responsible for its rich color. There is a specific formulation of curcumin that is a phytosome has better absorption, bound to a lipid (fat) molecule. This allows it to be absorbed into our lymph system for greater distribution to our body-wide blood supply. This phytosome is called Meriva, and research shows that the bio-availability of Meriva is about 10 times that of plain curcumin. Thorne makes a great version of this without all the fillers. Start with a 500mg dose of Meriva twice a day for pain and inflammation
Working with a professional is crucial to identify the underlying cause of your migraines, this is not medical advise.
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