Migraine Headaches Part 2

The end of the last post stated that patients who took Butterbur extract prophylactically for migraine, reduced the incidence of migraine attacks by 50%. Other allergy based interventions include an elimination diet, reduced fat intake and lowering of inflammation. These have been used with great clinical success for migraine prophylaxis.

Mitochondria, the energy packets of our cells, seem to function abnormally in migraineurs to a great extent. Studies have shown that mitochondrial dysfunction leads to an unstable metabolic state of the brain and a decreased ability to cope with further energy demand. The involvement of mitochondrial dysfunction is also supported by the clinical benefit of nutrients that enhance energy production, namely riboflavin and Coenzyme Q 10. Both nutrients given together or separately to migraine patients do reduce the frequency of attacks as reported in several studies. Our metabolic protein shake here at the clinic (ENDURE) is rich in these and other energy producing nutrients and may help. Alpha lipoid acid at 600mg daily was shown to reduce headache frequency, number of headache days and severity when compared to a placebo. This potent antioxidant is vital to energy production in the mitochondria.

Although the neuronal theory of migraine is widely accepted, it still does not explain all of the features of migraine and there is still considerable evidence for a secondary vascular component. One aspect is an abnormality in homocysteine metabolism. Homocysteine is an intermediary in the metabolism of the amino acid cysteine to methionine. If it accumulates it causes vascular damage and is a serious risk for heart disease. Abnormalities in the MTHFR gene (MTHFR or methyltetrahydrofolate reductase is an enzyme required to transform homocysteine ultimately into methionine) can cause high levels of homocysteine and together cause a definite predisposition to migraine. B vitamins, especially B6, B12 and Folic Acid are required cofactors for this enzymatic conversion. When given to patients with high homocysteine levels, these vitamins lower the concentration of homocysteine in the blood and can actually reduce the frequency and duration of migraines!

An increase in brain excitability seems to be a feature of migraine but the mechanism is not well established. Glutamate, the primary excitatory neurotransmitter in the brain has been implicated in this phenomenon. There seems to be an imbalance between glutamate and GABA, the major inhibitory neurotransmitter. Drug development is now underway to create glutamate antagonists.

The hormone melatonin has found to be low in migaineurs compared to controls, suggesting that it may have a beneficial role. Magnesium has been examined in a number of clinical trials for migraine. Levels have been shown to be reduced in the brains of migraineurs, especially during an attack. In a recent study, 600mg daily of magnesium citrate was given to migraine sufferers for three months. This produced reductions in both attack frequency and severity compared to placebo.

Caffeine is a vasopressor (constricts blood vessels) and stimulant found in coffee, tea, cocoa, mate and guarana and is the most widely used psychoactive agent worldwide. The caffeine withdrawal syndrome is well documented and described involving headache, fatigue, drowsiness, loss of concentration, irritability, anxiety, depression, nausea, vomiting and motor performance impairment. Many migraineurs report that both caffeine consumption and caffeine avoidance/cessation as a risk factor.

Next time we will conclude our discussion of Migraines with natural treatment options for prophylaxis and prevention. Thanks again for reading…

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