Migraine Flashcards
Migraine
Migraine = recurrent neurological headache involving multiple networks and regions in the head
Signs and symptoms
- Moderate to severe headache (pulsating or
throbbing; often unilateral; lasting < 72 hours) ― often preceded by tiredness, increased food cravings or bowel changes. - Nausea and / or vomiting, photophobia and phonophobia.
- ⅓ of individuals also suffer from an aura. This presents as transient neurological symptoms e.g., visual zig-zag lines, pins and needles.
It can precede or accompany the headache.
Causes and risk factors
- Diet — Food allergy / intolerance, histamine /
tyramine foods (chocolate, wine, cheese), caffeine, aspartame, MSG, nitrites, citrus fruits. - Inflammation — migraines linked to ↑ cytokines such as IL-6, IL-8 and TNF-α. Consider causes such as poor sleep, obesity, metabolic endotoxemia etc.
- Stress — contributor to chronic inflammation and a known trigger.
- Toxic overload / poor detoxification processes (smoking a trigger).
- Oestrogen imbalance — oestrogen influences cellular excitability, serotonin cerebral vasculature. The OCP is known to ↑ migraines.
- Excess histamine (inflammation or diet) — plays a role in migraine pathogenesis. The interaction between mast cells and calcitonin-gene related protein (CGRP) results in sensitisation of the trigeminal nerve and ‘neurogenic inflammation’. It can be associated with:
‒ Low DAO levels — e.g., due to a DAO SNP; insufficient DAO co-factors (Cu, B2, B6, Vit C); alcohol and caffeine (inhibit DAO); NSAID use;
DAO = diamine oxidase (the enzyme that degrades histamine)
- Gut-brain axis — dysbiosis / permeability via metabolic endotoxemia. H. pylori associated with ↑ inflammatory mediators and vasoactive compounds. Raised CGRP is linked to H. pylori infection. Bifidobacterium and Lactobacilli lower histamine.
- Nutrient deficiencies — nutrients that support mitochondria (e.g., vitamins B2, B3, B12, D, carnitine and alpha-lipoic acid).
- Low magnesium — magnesium affects serotonin synthesis and receptors, nitric oxide synthesis and other migraine-related receptors and NTs.
- Low serotonin — dysfunctional sleep is common (↓ serotonin-melatonin conversion).
Natural approach
- CNM Naturopathic Diet (avoid alcohol / caffeine) — focus on blood sugar balancing (hypoglycaemia is a common migraine trigger).
- Identify and remove trigger foods (gluten, dairy, peanuts).
- Avoid / reduce tyramine / histamine, e.g., fermented foods / drinks such as dairy (esp. cheese), alcohol, dried fruits, etc. Also:
‒ Increase status of DAO co-factors (Cu, B2, B6, Vit C).
‒ Probiotics (those shown to downregulate histamine) e.g., L. rhamnosus, B. infantis, B. bifidum B. longum, L. plantarum. ‒ Quercetin (500‒3000 mg / day) — inhibits histamine release; ↓ oxidative stress and influences glutamatergic transmission
- Support serotonin status (see earlier), e.g., tryptophan-rich foods.
- Support the GBA — e.g., digestive support (i.e., bitters), Vagus stimulation, probiotics (see earlier), supporting the intestinal barrier (see GI health).
- Increase omega-3 sources — ↓ migraine frequency.
Higher omega-3 FAs ↑ serum 17-hydroxydocosahexaenoic acid (17-HDHA) — an antinociceptive derivative.
- High-quality multivitamin + mineral supplement with CoQ10 to cover nutrient deficiencies associated with mitochondrial dysfunction.
- Support detoxification pathways
Magnesium
200–400 mg / day Mag. citrate
- Plays a key role in migraines headaches by altering neurotransmitter secretion, synaptic transmission by cortical spreading depression, and platelet aggregation.
Vitamin B6 (pyridoxine) 50–100 mg / day.
- Exerts modulatory effects on GABA and serotonin.
- It is also a DAO co-factor (lowering histamine).
- Studies have also shown that raised homocysteine is linked to migraines. B6 reduces homocysteine
5-HTP 100–200 mg twice daily
- Supports serotonin levels, and has been shown to reduce migraine frequency. Check for interactions!
Ginger (Zingiber officinale)
400 mg x 3 per day or 1-inch fresh ginger infusion
Has been shown to reduce migraines: it is anti-inflammatory (COX-2 inhibiting), analgesic and anti-oxidant. It is also thought to increase serotonin levels.
Feverfew (Tanacetum parthenium)
300 mg daily
- Has been shown to reduce migraine headache frequency, pain, nausea / vomiting, and light sensitivity.
- Inhibits both histamine release and prostaglandin synthesis; reduces vascular smooth muscle spasm.
- Or feverfew tincture 2‒3 ml two to three times a day.
Avoid in pregnancy and anticoagulant use
Ginkgo biloba (100‒240 mg / day
in divided doses)
modulates brain glutamatergic transmission and inhibits platelet-activating factor.
Also GABA-enhancing nervines such as chamomile and valerian
Ginkgo is not to given with anti-coagulant medications
