Migraines are a leading cause of disability worldwide [1], and those who suffer with migraine headaches understand how disabling they can be. Although there are other categories of headaches (see below chart), the hallmark of a migraine is a disabling headache that is often associated with nausea, sound, or light sensitivity.
The International Classification of Headache Disorders (ICHD) is an important resource for the diagnosis of migraine, but the heterogeneity of migraines can make them difficult entity to diagnose. Attack symptoms and severity can vary from person to person, and also from attack to attack in the same person.
For those who suffer from headaches, any change in the pattern of headache (such as an increase in attack frequency or severity) can indicate a more serious condition. Please see your primary healthcare practitioner for evaluation.
Common Migraine Triggers:
Typically triggers can be placed within 6 main categories:
- Emotional Stress
- Anxiety, depression
- Reduced serotonin levels
- Menstrual-induced
- Fluctuating estrogen levels
- Sleep disturbance
- Sleep apnea
- Stress or anxiety induced insomnia
- Food and Alcohol
- Histamine Intolerance
- Food sensitivities
- Reactive hypoglycemia
- Caffeine
- Aspartame
- Medications
Common options for prevention:
This is not an exhaustive list, but it is a snapshot of what therapies may be employed. Treatment is always be a discussion between you and your healthcare provider. It should be catered to your lifestyle, individual risk factors, and bandwidth for change.
Occipital Nerve Blocks [1]
A local anaesthetic is injected (with or without steroids) on the back of your skull, assisting in calming nerves that may be contributing to your migraines. Occipital nerve blocks are routinely done as preventative therapy and may be most beneficial for those who experience very frequent migraines. You may be a good candidate for these if your pain radiates from the back of the head to the top, in a “C” shape.
Pharmaceutical Preventative Medications: [1,2]
Medications for preventative therapy of migraines has had little change since 2012 [1]. Beta blockers, tricyclic antidepressants, anticonvulsants, and botox injections are the common standard of care for migraine prophylaxis. Pharmaceutical prevention choices are chosen based on an individual basis, comorbid conditions, and tolerability.
Botanicals: Petasites & Tanacetum [2,3, 4]
Both of these are herbal extracts that may be effective in reducing migraine attack frequency. Petasites is a purified extract of the butterbur plant and is generally well tolerated when used for prophylaxis. Keep in mind that herbal supplements are not regulated, and thus it is difficult to gain an accurate estimation of how much therapeutic extract/herb is in the product.
Studies on Tanacetum parthenthium have mixed results but a systematic review of six trials showed a reduced headache frequency with stable Tanacetum extract compared with baseline.
Oral Nutraceuticals: Coq10, Omega-3 FA, Magnesium, Melatonin [2, 4]
Nutraceutical prophylaxis research is limited, and it is difficult to study due to the lack of regulation around natural health products. That said, some products show promise in supporting migraine prophylaxis without the use of pharmaceutical intervention. Supplementation with Coq10 may have utility in reducing attack frequency from baseline (but not severity of duration). Omega-3 fatty acid supplementation showed a very strong placebo effect in reducing migraine attacks, and actual efficacy cannot be discerned. Oral magnesium showed a reduction in the number of migraine attacks by 22-43%. A study of melatonin use in 32 patients with migraine showed a 78% responder rate with reduction in frequency, intensity and duration of headaches at both 1 and 3 months compared to baseline. [5]
Hormone Replacement Therapy [2]
HRT for migraines is limited to premenopausal women, as the data on postmenopausal women generally suggests that HRT may worsen migraines in this population. HRT can be in the form of birth control or an estrogen patch, and it is reserved for those who experience menstrual related migraines.
Acupuncture [6]
Acupuncture is a component of Traditional Chinese Medicine (TCM) and involves the insertion of thin needles into specific points along energy meridians. Insertion of needles has been evidenced to increase the activity of the opioidergic system, which may be effective for the relief of pain. Research suggests that acupuncture may be able to reduce the frequency of acute migraine attacks, but the results likely will depend heavily on the expertise of the practitioner, as well as the chronicity of migraine.
Approach to Prevention of Migraines:
Effective treatment and prevention of migraines requires an diagnosis of why your migraines are occurring. Once lifestyle and general health have been examined and assessed, treatment options available can be discussed and a treatment strategy is formulated.
Identifying triggers, employing stress management techniques, and changing lifestyle & diet alone can make a large difference in your quality of life with migraines.
- Charles, A. (2018). The pathophysiology of migraine: Implications for clinical management. The Lancet Neurology, 17(2), 174–182. https://doi.org/10.1016/s1474-4422(17)30435-0
- Holland, S., Silberstein, S. D., Freitag, F., Dodick, D. W., Argoff, C., & Ashman, E. (2012). Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults. Neurology, 78(17), 1346–1353. https://doi.org/10.1212/wnl.0b013e3182535d0c
- Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology. 2004 Dec 28;63(12):2240-4. doi: 10.1212/01.wnl.0000147290.68260.11. PMID: 15623680.
- Patel, P. S., & Minen, M. T. (2019). Complementary and Integrative Health Treatments for Migraine. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society, 39(3), 360–369. https://doi.org/10.1097/WNO.0000000000000841
- Peres MF, Zukerman E, da Cunha Tanuri F, Moreira FR, Cipolla-Neto J. Melatonin, 3 mg, is effective for migraine prevention. Neurology. 2004 Aug 24;63(4):757. doi: 10.1212/01.wnl.0000134653.35587.24. PMID: 15326268.
- Millstine, D., Chen, C. Y., & Bauer, B. (2017). Complementary and integrative medicine in the management of Headache. BMJ. https://doi.org/10.1136/bmj.j1805
