6 Ways to Manage Migraines

I'm one of nearly 30 million Americans who suffer from the painful, disorienting, and life-disrupting headaches known as migraines. No matter what else is going on in my day, I’m subject to being hijacked at any moment by one of these blinding, full-body attacks. A storm moves in? So does a migraine. Music too loud? Throbbing agony. A glass of red wine? A whiff of cologne? A stressful week? You guessed it: headache, headache, headache.

MIGRAINE PAIN. “Think of your migraine as a wave,” says Carolyn Bernstein, M.D., assistant professor of neurology at Harvard Medical School and author of The Migraine Brain (Free Press, 2008). “When one hits, it sets off a cascade of cellular events throughout the brain, triggering responses that may differ from a regular headache. For some people, it’s nausea; for others, it’s pain in the face and jaw.”

MIGRAINE TRAITS. No two migraines are alike: You may experience auras, or vomiting, or widespread muscle pain, or dizziness, or sinus pressure, or ringing in the ears, or even partial paralysis. Or not. But there is one underlying constant: hyper-excitability. “In the brain of a migraine sufferer, the neurons are unstable and more susceptible to being triggered,” explains Bernstein.

MIGRAINE CAUSES. The list of migraine triggers includes—but is not limited to—barometric pressure changes, too much or too little sleep, stress, bright sunlight, intense heat or cold, muscular tension, hormonal shifts, loud noises, chemical odors or perfumes, overexertion, and a broad range of foods that includes aged cheese, chocolate, caffeine, canned foods, artificial sweeteners, MSG, red wine, beer, and processed foods of all sorts.

MIGRAINE MANAGEMENT. A lucky few will be able to identify one or two triggers. For most of us, it’s not so clear. “It could be a bit of misalignment, a bit of toxicity, or a little digestive problem,” says James Sensenig, N.D., founding president of the American Association of Naturopathic Physicians. Because of their variability, migraines are best treated from several angles including body alignment, diet, and emotions. Here are six of the best strategies:

1. Track triggers “People often don’t realize how many headaches they’re having,” says Audrey Halpern, M.D., holistic neurologist and founder of Manhattan Headache and Neurology. “It’s only when you understand how often you get them and what might be causing them that you can start to work toward natural balance.” And keeping a diary or journal is a great way to understand your particular triggers and headache patterns, says Halpern.
CHART EVERYTHING. Note all the conditions leading up to the headache—including weather patterns, menstrual cycle, and stress load—and see what patterns emerge. You can download a migraine diary form at Halpern’s website, audreyhalpern.com.

2. Detox your digestive system Ayurveda, India’s traditional system of medicine, believes digestion is a key factor in chronic headaches, so practitioners emphasize detoxification. “A migraine is a sign that the digestive system isn’t removing waste effectively,” says John Douillard, D.C., Ph.D., director of the LifeSpa Ayurveda center in Boulder, Colo. He likens the problem to a clogged drain. “If you have too much mucus in your intestinal tract, the drains can get clogged, which creates toxicity in the lymph, resulting in dilated blood vessels— or headache.”
SIP A TEA TONIC. To lubricate the intestinal lining, drink tea with demulcent herbs—like slippery elm, marshmallow, or licorice—every day, says Douillard. See Traditional Medicinals Throat Coat (traditional medicinals.com). To clean your lymphatic system, take sips of hot water every 15 minutes for two weeks.

3. Use acupuncture Acupuncture—using needles to stimulate certain energy points on the body—can have the same effect as Imitrex and other triptan anti-migraine drugs (See “Migraine Meds,” opposite.): Both release chemicals that cause blood vessels to constrict, says William Reddy, L.Ac., Dipl.Ac., spokesperson for the American Association of Acupuncture and Oriental Medicine.
NEEDLES LAST LONGER. Unlike medications, which wear off, “acupuncture teaches the blood vessels to stay toned so that over time you don’t have migraines anymore,” Reddy adds. Most people find relief in four to eight sessions, he says, noting that acupuncture has been effective for 85 to 90 percent of his patients. A meta-analysis published in the journal Anesthesia and Analgesia found that acupuncture worked to relieve migraines more often than not.

4. Get realigned “Migraines are often caused by structural issues in the soft tissues surrounding the dural tube, which houses the fluid that nourishes the brain and spinal cord,” says Sheryl McGavin, of the Upledger Institute in Florida. “With craniosacral therapy, you can remove restrictions so the system flows freely.” During a session, a practitioner uses a light touch to make adjustments on the head, neck, and upper thorax. Find a certified therapist near you through Upledger’s International Association of Healthcare Practitioners (iahp.com).
OTHER OPTIONS. Bodywork and massage also help you relax, improve blood flow, and correct misalignments that contribute to headaches.

5. Try biofeedback therapy No matter what triggers your migraines, or how they manifest, stress makes everything worse, says James Gordon, M.D., founder of the Center for Mind-Body Medicine in Washington, D.C. He suggests a type of biofeedback therapy that measures body temperature: When you’re stressed and more likely to have migraines your hands grow cold. With these biofeedback devices, you can learn to warm your hands and raise your body temperature, which reduces stress.
GO WITH A PRO. To find a certified biofeedback practitioner, go to healthfinder.gov.

MIGRAINE MEDS If natural solutions aren’t working, consider one of these prescribed medications.

PREVENTIVES. Anti-seizure drugs like Topamax or Depakote, low-dose antidepressants, anti-nausea drugs, anti-inflammatories, or heart medications can keep migraines at bay, but finding the right drug is hit-or-miss and side effects can include weight gain, foggy brain, and hair loss.

ABORTIVES. A class of drugs called triptans (such as Imitrex or Zomig) can halt a migraine in its tracks, but can cost $25 or more per dose.

RESCUERS. Opiates (such as Percocet or Vicodin) or shortacting barbiturates (such as Fioricet) can bring short-term relief by masking pain but may be habit-forming and can cause lightheadedness and other side effects.

6. Take supplements One of the best long-term prevention strategies is to take natural supplements. Try these one at a time for at least three months to determine whether they’re working for you:

GUT BRAIN THERAPY: You can trigger-proof your digestive tract with Gut Brain Therapy’s two-part protocol, which works to strengthen the enteric nervous system housed in your gut. The Foundation Formula “feeds” the gut with easily digestible proteins derived from fish, and the Renew Formula stimulates liver and kidney function with an herbal blend that includes milk thistle, dandelion, beet root, and artichoke. (See foreverwell.com.)
Research: A small study published in Alternative Medicine Review found that 80 percent of the participants who took Gut Brain supplements for three months reported improvements in migraine frequency and severity.
Dosage: Follow label guidelines

COENZYME Q10: It’s not clear exactly how the vitamin- like substance known as CoQ10 works—it might improve the brain’s ability to metabolize glucose, Halpern hypothesizes.
Research: A study published in the journal Neurology found that CoQ10 could reduce migraine frequency by up to 50 percent.
Dosage: 100 mg, three times a day

MAGNESIUM: This simple mineral has musclerelaxing properties and may stave off a migraine by preventing blood vessel spasms, notes Maureen Williams, N.D., a naturopath in private practice on Cortes Island, British Columbia.
Research: In a study published in the journal Cephalalgia, patients who took magnesium every day for 12 weeks reported significantly fewer migraine attacks (versus those taking a placebo) after only nine weeks.
Dosage: 600 mg a day, says the Cephalalgia study

BUTTERBUR: The herb butterbur stabilizes the cells that produce histamine, so it’s a good choice for those who also suffer from allergies, says Debra Brammer, N.D., clinical dean of naturopathic medicine at Bastyr University. Look for products such as Petadolex (migraineaid.com) that are free of pyrrolizidine alkaloids (potentially toxic compounds).
Research: The herb was shown to significantly reduce migraine frequency in some people, according to a study in the journal Neurology.
Dosage: 100 mg, three to four times a day

FEVERFEW: “This herb may work by inhibiting the inflammation cascade and stabilizing substance P, the neurotransmitter responsible for the pain response,” Brammer says.
Research: Clinical studies are mixed but feverfew has been used as a migraine treatment in folk medicine.
Dosage: 100 mg, three times a day

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