Managing Migraine

These complex neurovascular events are marked by a disturbance in sensory processing, which can present with myriad symptoms, including headache. There are diverse presentations of migraine, which include but aren’t limited to hemiplegic migraine, vestibular migraine, abdominal migraine, retinal migraine, and migraine with brainstem aura.

While aura is a common feature of migraine, it is not necessary for the diagnosis of migraine. An estimated one-third of migraineurs have aura.

Unlike episodic migraine, which might strike every once in a while, chronic migraine is diagnosed if you’re dealing with a migraine at least 15 days out of the month.

The phases of migraine

Regardless of the type of migraine, each episode typically lasts between four and 72 hours and consists of four main phases.

Prodrome

Nonpainful symptoms may occur days to hours before a migraine. These may include mood changes, neck stiffness, fatigue, and thirst.

Aura

This transient, focal neurological symptom can present as visual disturbances (blind spot, zigzag lines, sparkles), sensory disturbances (numbness and tingling), and speech or language difficulties (aphasia).

Headache

Activation of the trigeminal nerve sensory pathways (located on the sides of the face) triggers throbbing head pain, which typically interferes with one’s ability to carry on daily tasks. The pain is often accompanied by an aversion to light, touch, and sound, as well as by nausea and vomiting.

Postdrome

Often referred to by migraineurs as the “hangover,” this phase is marked by tiredness, difficulty concentrating, and sensitivity to noise. The intensity of the headache often dictates the intensity and duration of these symptoms.

Risk factors for migraine

Female sex

Women are the unlucky recipients of having a higher risk of migraine. This is suspected to be due to fluctuations in estrogen levels, as these fluctuations may contribute to a lower threshold for a migraine attack.

While migraines often begin in girls at puberty, women migraineurs can look forward to menopause for its stabilizing effect on migraines.

Genetics

Twin studies suggest that a single genetic polymorphism may be responsible for susceptibility to migraine. Familial hemiplegic migraines and migraines with aura are associated with genes that code for susceptibility to cortical spreading depression, a phenomenon that occurs in the brain during a migraine episode.

Migraineurs also tend to have genetic polymorphisms that impair the metabolism of glutamate (an excitatory neurotransmitter), histamine (an inflammatory chemical), and alcohol.

Musculoskeletal dysfunction

Migraineurs have significantly more musculoskeletal dysfunctions (such as trigger points and restrictions in joint range of motion) than non-migraineurs.

Anxiety

Anxiety is associated with increased risk of migraine.

Underlying causes of migraine

Migraine is multifactorial and associated with genetic, hormonal, environmental, and nutrient factors.

Looking under the surface, researchers have suggested dysfunction in the mitochondria (the energy-producers of the cells) and impaired antioxidant status may be implicated in migraine attacks.

Magnetic resonance spectroscopy studies also show different levels of the neurotransmitters GABA and glutamate in multiple brain regions among adults with migraine.

Researchers have also found that deficiency in magnesium; vitamins B2, B3, B12, and D; coenzyme Q10; carnitine; or alpha-lipoic acid may be associated with migraine.

The gastrointestinal microbiome has recently been implicated in the pathogenesis of migraine, highlighting the importance of the gut-brain axis and one’s diet.

Natural migraine management

The most common triggers of migraine attack are stress, skipping meals, atmospheric changes, sleep-related factors, and hormonal fluctuations in women. While we can’t control changes in the weather, we can take action to mitigate other factors through lifestyle changes.

Since migraine is multifactorial and each migraineur has unique contributing factors, treatment should reflect this. Dr. Shannon Ferguson, naturopathic doctor at Core Health Centre in Calgary, takes this approach in her practice, which is focused on complex conditions, including migraine.

“If the trigger is primarily hormonal in a woman, we need to look at estrogen metabolism and histamine pathways,” says Ferguson. Treatment may include supplements including resveratrol and quercetin.

Whereas if the trigger is primarily food, Ferguson says that “those patients tend to improve with addressing gut health (which usually means microbiome health).

“If the triggers are weather or stress, then looking at mitochondrial nutrients would be a first step,” says Ferguson.

Reach out to your natural health practitioner for individualized recommendations on migraine management.

Lifestyle can affect migraines

These are some evidence-based lifestyle practices for migraine prevention:

-          regular routines, including for sleep

-          good hydration

-          moderate exercise: 40 minutes, three times weekly

-          stress/anxiety management

-          regular meals

-          relaxation therapies, including yoga

-          moderate caffeine intake (under 200 mg daily)

-          identifying and avoiding food triggers

-          avoiding aspartame

-          avoiding strong odours (perfumes, fumes, smoke)

-          temporomandibular joint (TMJ) function assessment and use of dental splint, if indicated

-          proper head posture

-          physical therapy

Supplemental support for migraineurs