A migraine headache, often described as an intense throbbing or pulsing on one side of the head, is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound.
Migraine attacks can be especially debilitating and cause significant pain for hours to days. They can be so severe that they interfere with activities of daily living.
What are the signs/symptoms of a migraine?
Migraines may progress through four stages, consisting of prodrome, aura, attack and postdrome. However, you may not experience all four stages.
One or two days before a migraine, you may notice subtle changes which may indicate the onset of a migraine, including:
- Food cravings
- Sensitivity to smells or noise
- Neck stiffness
Most people experience migraine headaches without aura. Auras are usually visual but can also be sensory, motor or verbal disturbances. Each of these symptoms typically begins gradually over several minutes, then commonly lasts for 10 to 30 minutes. Examples of aura include:
- Visual phenomena, such as seeing various shapes, bright spots or flashes of light
- Vision loss
- Pins-and-needles sensations or numbness in arm or leg
- Speech or language disturbances
- Less commonly, an aura may be associated with aphasia or limb weakness (hemiplegic migraine)
When untreated, a migraine typically lasts from four to 72 hours, but the frequency with which headaches occur varies between individuals. You may have migraines several times a month or much less frequently. During a migraine, you may experience some of the following symptoms:
- Pain on one side of your head
- Pain that has a pulsating, throbbing quality
- Sensitivity to light, sound and sometimes smells
- Blurred vision
- Nausea and vomiting
- Diarrhea, lightheadedness, sometimes followed by fainting
The final phase, known as postdrome, occurs after a migraine attack, when you may feel weak and fatigued, though some people report feeling mildly euphoric.
What causes a migraine?
- Hormonal alteration (menstruation): Changes in estrogen can trigger headaches in many women. Women with a history of migraines often report headaches either immediately before or during their periods, when they experience a decline in estrogen. Others have a greater likelihood of developing migraines during pregnancy or menopause. Hormonal medications, such as oral contraceptives and hormone replacement therapy, can also worsen migraines.
- Stress/anxiety: Stress and/or anxiety atworkor home can cause migraines.
- Sleep disturbances: Changes in wake-sleep pattern, such as jet lag, is a main culprit. Getting too much or too little sleep can cause migraines.
- Certain drugs/foods: Common foods that cause migraines include alcohol, especially beer and red wine; aged cheeses; chocolate; aspartame; overuse of caffeine; monosodium glutamate; salty foods; and processed foods. Skipping meals or fasting also can trigger migraine attacks. Certain medications can aggravate migraines, especially oral contraceptives and vasodilators, such as nitroglycerin.
- Weather and/or environmental changes and factors: Changes inweatheror in atmospheric pressure can trigger a migraine.
What are conventional treatments for migraine?
If migraines are mild, analgesics such as NSAIDs or acetaminophen are often taken. If not, a dihydroergotamine (DHE)or a triptan may be prescribed by a physician.
- Dihydroergotamine is used for moderate to severe attacks whenvasculardiseaseand hypertension are absent. It should not be used during pregnancy or within 24 hours of triptans due torisk of heart attack.
- Triptans (sumatriptan, rizatriptan, almotriptan, zolmitriptan) are serotonin receptor agonists and are for moderate to severe migraine when vascular diseaseand uncontrolled hypertension are absent. Triptans inhibit vasoactive peptide release, cause vasoconstriction, and block pain pathways in the brainstem. They should be avoided in pregnancy and in hemiplegic or basilar migraine.
Nutritional approaches to migraine are often effective. They can be particularly useful for pregnant women.
- Elimination Diet: Avoid foods that are known to trigger migraine headaches and eliminate them from your diet. Foods commonly identified as migraine triggers include dairy products (eg, cheese), chocolate, eggs, citrus fruits, meat, wheat, nuts and peanuts. Tyramine- and phenylalanine-containing foods, such as aged cheese, beer, and red wine, are also migraine triggers. Eliminating food additives, including MSG (monosodium glutamate), aspartame, and sodium nitrate, is vital in reducing the intensity and frequency of migraine headaches. You need to read food labels and be aware of the ingredients of the food you are consuming.
Herbs are commonly used to provide relief from migraines. Feverfew and butterbur are remedies for a migraine in either preventing them or reducing their severity. Riboflavin also may prevent migraines. Seek the advice of a health professional to see if these treatments are right for you.
- Feverfew: an herb with anti-inflammatory properties. A study shows that feverfew extract of 6.25 mg three times a day decreased migraine attacks by nearly half.The primary active ingredient in feverfew can be found in some other plants such as artichoke, sunflower, lettuce, spinach, and ginkgo biloba.Feverfew action appears to affect a wide variety of physiologic pathways. Some of these mechanisms include inhibition of prostaglandin synthesis, decrease of vascular smooth muscle spasm, and blockage of platelet granule secretion.Feverfew supplements are available fresh, freeze-dried, or dried and can be purchased in capsule, tablet, or liquid extract forms. Feverfew supplements with clinical studies contain a standardized dose of parthenolide. Feverfew supplements should be standardized to contain at least 0.2% parthenolide. Parthenolide is central to the biological effects of feverfew.
- Butterbur (Petasites hybridus root): an ancient plant which has been used for medical and edible purposes. 50-75 mg twice a day have demonstratedsignificant reduction in migraine frequency.The mechanism by which butterbur may reduce migraine includes inhibiting the inflammatory effect of chemicals like leukotrienes and prostaglandin E2 in the pain pathway. Another mechanism of butterbur may be its ability to function as a natural beta blocker whose action results in the normal flow of blood to the brain. This helps control blood pressure and spasmodic capillary action, which can also contribute to the onset of migraine headaches.When purchasing butterbur products, be sure to choose a brand labeled PA-Free. This means the product was processed to remove potentially harmful, toxic chemicals found in the butterbur plant known as pyrrolizidine alkaloids (PA). The special butterbur extract is prepared by having all liver-toxic alkaloids removed.
- Riboflavin (Vitamin B2): a water-soluble vitamin, which means it is not stored in the body. Therefore, it needs to be replenished in the body every day. Riboflavin is important for body growth and red blood cell production. It is also required for energy metabolism, such as the metabolism of carbohydrates.
Studies show a deficit of mitochondrial energy metabolism may play a role in migraine pathogenesis. Therefore, riboflavin has been investigated as a treatment and/or prevention for migraine.
Studies have found significant reductions in headache frequency with daily pharmacologic doses (400 mg) of riboflavin. Furthermore, riboflavin was demonstrated to be a safe and well-tolerated alternative in migraine prevention and treatment. It even reduced the number of abortive anti-migraine tablets (ie. Ergotamines, triptans) used in migraine sufferers.
- Magnesium is another important mineral to add to your treatment plan. Magnesium deficiency is a major contributing factor to the development of migraine headaches and many of us are deficient in magnesium.The recommended amount of magnesium is 600-800 mg a day in in divided doses throughout the day. Taking it in this manner maximizes its absorption.While there are many different oral forms of Magnesium, one form that be extremely beneficial for migraine sufferers is Magnesium Threonate. This is because it is able to penetrate the brain unlike other forms of Magnesium.
- Ginkgolide B is an herbal extract derived from Ginkgo biloba. It is used not only for the acute attack of migraine headaches but is also extremely beneficial for the prevention of migraine headaches.In one study, patients with a history of migraine with auras when given the combination of Gingkolide B, Coenzyme Q 10 and Vitamin B2 (riboflavin) demonstrated not only a decrease in the frequency of migraines with aura but also their duration.
- Coenzyme Q10 (Ubiquinone): Supplementation with Coq10 has demonstrated to decrease the frequency of migraines headaches.Because ubiquinone can have a blood pressure-lowering effect, it is recommended to begin at low doses. Begin at 50 mg twice a day and increase slowly over the next few weeks.
- Omega 3 Fish Oil: Adding Omega 3 fish oil can help in the prevention of migraines, especially in adolescents and young adults. In one study, Omega 3 supplementation decreased the recurrence of migraines in adolescents.Begin at a dose of 1000-2000 mg a day. This can be slowly increased to 3-4 grams a day.As Omega 3 fish oil can thin the blood, talk with your healthcare practitioner if you are taking blood thinning medications such as Coumadin.
Acupuncture involves the insertion of fine needles through your skin at strategic points on your body followed by gentle manipulation of the needles. Clinical trials have found that acupuncture may be helpful for headache pain. Because the pain of a migraine may be associated with the dilation of blood vessels in the head, increasing circulation in this area can worsen symptoms. Thus, a unique approach to the treatment of migraine attacks is used. By avoiding points in the head, neck and upper body, and instead using points exclusively in the lower body, dilation of the blood vessels of the head is limited.
Biofeedback appears to be especially effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.
- Nutrition/Diet: refer to immediate above section
- Exercise: Regular aerobic exercise reduces tension and can help prevent migraines. Progressive muscle relaxation, meditationand yoga don’t require any equipment.
- Rest and relax: Spend at least a half-hour each day doing something you find relaxing — listening to music, gardening, taking a hot bath or reading. If possible, rest in a dark, quiet room when you feel the onset of a headache. Place an ice pack wrapped in a cloth on the back of your neck and apply gentle pressure to painful areas on your scalp.
Updated: August 2019
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