Migraine causes & treatments

If you’ve ever suffered with a migraine headache, you’ll know just how unpleasant they can be. They are thought to effect up to 2.2% [1] of the population and have a huge impact of well-being and quality of life. It's no wonder historically people resorted to measures as drastic as trepanning (cutting holes in the skull) and using live electric fish from the Nile [2] to try and cure them!

Migraines are often defined as “a disabling primary headache characterized by unilateral (one sided) pulsating pain”[3].  This can be contrasted to more common headaches, such as tension headaches, where pain tends to be constant, spread across the head and less severe.

What types of migraines are there?

The two major sub-types of migraines are common:

1. Migraine (without aura).
2. Classic migraine (with aura or neurological symptoms).

It’s common to also experience nausea, vomiting sensitivity to light, noise, movement and smell [4] when suffering an attack. As brain tissue itself has no sensory nerve endings, headache pain actually arises from the meninges (the lining of the brain), blood vessels and muscles when they are stretched or tense.

What causes migraines?

The mechanisms underlying pain in migraines are not completely understood but there are a number of theories, ranging from vascular constriction and dilation, platelet aggregation, excessive serotonin release or breakdown and neurogenic factors. It’s likely that a number of these mechanisms (if not all) are at play in the patho-physiological process of migraines, which is why they can be so difficult to treat.

How to treat a migraine

Pharmaceuticals (prescription and over the counter) for acute relief are the most common intervention. However, their effectiveness is often poor and there are concerns about side effects, with some evidence to suggest that regular use can actually increase headache frequency [5]. With this in mind, many people are now looking for a more natural solution and there is increasing evidence that diet and lifestyle changes can have beneficial effects.

Low magnesium

It's thought that magnesium deficiency may be present in up to half of all migraine sufferers [15]. Magnesium plays a central role in maintaining vascular tome and preventing neuronal hyper-excitation. It can become depleted by intense exercise, stress, alcohol, hormonal imbalances and other factors.

Hidden food allergies & intolerances

A variety of foods and food ingredients may trigger migraine attacks. This can occur within a few hours or more long-term with reactions occurring days after eating them.  This can make the identification of trigger foods difficult.

However, several common culprits have been identified

1. Alcohol - especially wine and beer.
2. Catecholamine inducing foods  - chocolate, cheese, caffeine, and citrus.
3. Tyramine containing foods - fermented, cured, aged or spoiled foods (eg. strong/aged cheeses, cured meats and fish, overripe fruit, fermented soy products such as soy sauce, tofu and miso, saurkraut and other pickled products, fava and broad beans [6]).
4. Food additives such as nitrates and MSG - in processed meats and other processed foods.
5. Onions
6. Tomatoes
7. Artificial sweeteners such as sucralose and aspartame
8. Gluten - gluten sensitivity can often present itself in symptoms outside of the gastrointestinal tract and has been associated with neurological disorders, including migraines [7]. A gluten-free diet has been shown to be beneficial for some migraine sufferers [8].
9. Histamine-rich food - histamine intolerance (where the body isn’t able to adequately breakdown and detoxify histamines) has also been identified as potentially contributing to migraines [9] and can lead to other allergy type symptoms such as hives, asthma and rhinitis. Histamine tends to be present in high amounts in similar foods to tyramine.

If it’s obvious which foods trigger your symptoms, it’s best to avoid these as much as possible. If it’s less clear whether food is playing a part your could consider:

1. Keeping a food diary of what you eat and drink and recording any corresponding symptoms;
2. Carrying out an elimination diet where commonly allergenic/intolerable foods are removed for a period of time and reintroduced in a systematic way. As elimination diets can be restrictive, I would recommend seeking the advice of a nutrition professional before embarking on one to ensure you are still getting all the nutrients you need;
3. Carrying out antibody based food allergy/intolerance testing and following an elimination diet based on the results. This has been shown to have positive results in a number of clinical studies [10].

Inflammation

Neurogenic inflammation plays a key role in the development of migraines, with low-grade systemic inflammation thought to contribute to localized inflammation in the brain. Clinical studies have shown that a combination of increasing dietary omega 3, and reducing omega 6 intake, can help reduce both duration and frequency of migraines, and the need for medication [11].

To help reduce inflammation

1. Increase dietary omega 3 - oily fish such as salmon, mackerel, anchovies, sardines, herring (aim for 2-3 portions a week), flaxseeds, chia seeds and walnuts.
2. Reduce omega 6 fatty acids - vegetable oils, processed foods, excessive meat and cereals.

If for whatever reason you can't increase your fish intake, consider a fish oil supplement like Wiley's Peak EPA Fish Oil.

Poor blood glucose regulation

Poor blood glucose regulation has been associated with migraines and hypoglycemia (low blood sugar) and can be a trigger for attacks. Blood glucose volatility is most often due to a diet of high-glycemic-index carbohydrates (eg. sugar and refined carbs).

Ways to help regulate your blood glucose

1. Avoiding sugary processed foods and refined carbohydrates such as chocolate, sweets, fizzy drinks, cakes, cookies, white bread and pasta.
2. Eating smaller meals more often throughout the day. Instead of eating 3 big meals a day, consider having 3 smaller meals and a mid-morning and mid-afternoon snack.
3. Ensure good quality protein each time you eat (eg. organic meat, fish, tofu, eggs, pulses, beans, peas, nuts and seeds. Hummus and veg sticks, chia puddings, boiled eggs, nut butter spread on fruit or oatcakes and edamame beans are great protein-rich snacks.
4. Switch to more complex carbohydrates such as oats, lentils, quinoa, and wholegrain varieties of rice, pasta and bread and keep portions of carbohydrates to about the size of your fist.
5. Exercise! Physical activity stimulates receptors on our cells making them more sensitive to insulin and better able to uptake glucose from the blood. Shorter bursts of intensive exercise have been shown to be particularly effective [12].

Being overweight

Obesity can increase the risk of migraines as well as exacerbate frequency and severity (potentially due to the associated increased inflammation).

Studies have shown that weight loss intervention can significantly reduce migraine frequency and intensity [13].  An integrative approach to weight loss including nutrition, physical activity and cognitive behavioral therapy has been shown to be particularly effective [14].

How your health affects migraines

It’s clear that there is no one clear cause or solution to migraines. Tackling them may require investigation into a number of different aspects of your health.

However, by approaching them through changes to diet and lifestyle and with appropriate supplementation, it’s been shown that significant reductions in attacks and improvements in quality of life can be achieved.

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By Hannah Braye, Nutritional Therapist (DipCNM, mBANT, CNHCreg)

References

[1] Natoli JL, Manack A, Dean B, Butler Q, Turket CC, Stovner L, et al. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2010;30:599–609.

[2] Stabatowski, R., et al. (2004) Pain Treatment: A Historical Overview. Current Pharmaceutical Design; 10(7):701-16.

[3]https://www.ncbi.nlm.nih.gov/mesh?Db=mesh&Cmd=DetailsSearch&Term=%22Migraine+Disorders%22%5BMeSH+Terms%5D

[4] http://www.nationalmigrainecentre.org.uk/migraine-and-headaches/

[5] Isler H. (1982) ‘Migraine treatment as a cause of chronic migraine’. Advances n migraine research therapy, ed. Rose FC. New York: Raven Press, 159-164.

[6] http://www.healthline.com/health/tyramine-free-diets#foods4

[7] Hadjivassiliou M, et al. (2002) ‘Gluten sensitivity as a neurological illness’. J Neurol Neurosurg Psychiatry; 72(5) pp. 560-3.

[8] Hadjivassiliou M, et al. (2002) ‘Headache and CNS white matter abnormalities associated with gluten sensitivity’. Neurology; 56, pp. 385-388.

[9] https://www.ncbi.nlm.nih.gov/pubmed/24433203

[10] Alpay K,  et al. (2010) ‘Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial’. Cephalalgia;30(7) pp. 829-37

[11] Ramsden CE, et al. (2013) ‘Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial. Pain’;154(11) pp. 2441-51.

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587394/

[13] Cervoni C, Bond DS, Seng EK. Behavioral Weight Loss Treatments for Individuals with Migraine and Obesity (2016). Curr Pain Headache Rep; 20(2), pp.13.

[14] Verrotti A, Agostinelli S, D’Egidio C, et al. Impact of a weight loss program on migraine in obese adolescents. Eur J Neurol. 2013 Feb;20(2):394-7.

[15] https://www.ncbi.nlm.nih.gov/pubmed/22426836

[16] https://www.ncbi.nlm.nih.gov/pubmed/8792038

Hannah is a registered nutritional therapist providing evidence-based nutrition advice from a naturopathic, person-centred approach. She offers 1-1 consultations in central Bristol and by Skype.

Hannah is also: a member of the World Health Heroes, a network of health and well-being practitioners, promoting affordable health and well-being across local communities; an Assistant Clinical Supervisor at the College of Naturopathic Medicine; and she works part-time for the Soil Association where she helps caterers improve the quality and sustainability of their food.

W. www.finefeathernutrition.com

E. hannah@finefeathernutrition.com

T. 07572 094 019