Headache

15 January 2007

Make it go away…

By disarming your triggers the natural way, you can alleviate — or even eliminate — devastating migraine attacks.

By disarming your triggers the natural way, you can alleviate — or even eliminate — devastating migraine attacks.

There is no mistaking a migraine; that is, unless you’ve come up with another explanation for the throbbing headache, intense nausea and sensory sensitivity that can last for days.

“About six million South Africans suffer from migraines every year,” says Dr Elliot Shevel, medical director of The Headache Clinic in Johannesburg.

Migraine is actually a condition that has many symptoms, with severe headaches being the most familiar. While migraine tends to run in families, the exact cause is unknown.

A migraine may occur when overactive nerve cells in the brain overstimulate blood vessels, leading to inflammation. Another theory is that migraines are jump-started by low levels of serotonin, a neurotransmitter that regulates pain perception (and is also well-known for influencing depression levels). Also, fluctuations in oestrogen and progesterone levels seem to prompt migraines and women often report attacks just before or during menstruation, while pregnant, or once they enter menopause.

Hormones and heredity aside, migraine triggers include stress, smoking, skipping meals, sleep disruption, weather changes, intense odours or lights and certain food ingredients. With all these variables at play, it can take time to figure out which combination of therapies will work best for you.

Classic or common
There are two types of migraine: classic and common. The classic variety is accompanied by a neurological disturbance — an “aura” — that might consist of a quick flash of light, wavy lines, a blind spot, tunnel vision, and/or numbness or tingling in your extremities about 15 to 30 minutes before the headache hits. Sometimes there is warning of an attack several hours or days before: thirst, drowsiness, irritability or a craving for sweets.

“Only 15—20% of migraine sufferers get auras,” adds Dr Shevel. Most sufferers experience common migraines without the aura.

But any migraine can be excruciating. The afflicted usually feel pulsating pain on one side of the head (though two-sided or shifting pain is possible), which may be accompanied by nausea, vomiting and sensitivity to light, sound and smell.

Left untreated, a migraine typically lasts from four to 72 hours, followed by exhaustion and neck pain.

Episodes can strike two to eight or more times a month, or inconsistently through the year.

Integrated medicine practitioner and Shape advisory board member, Dr Geraldine Mitton, says that over-the-counter pain relievers can help control mild migraines by inhibiting inflammation. “These include aspirin and other non- steroidal anti-inflammatory drugs like ibuprofen (Advil, Brufen, Inza, Neurofen) and naproxen (Naprosyn).”

To prevent the recurrence of migraines, some patients are given beta-blockers like Propranolol, which helps control blood pressure; other migraine sufferers take calcium channel blockers, antidepressants or anticonvulsants to lessen the frequency of occurrence.

Going natural
Even if medication works to ease migraines, it doesn’t address the problems that may be behind the attacks, such as physical and emotional strain, physiological imbalances, food sensitivities and nutritional deficiencies. This is where natural remedies can help.

“Migraines often have underlying causes, and the only way to treat them is to identify the causes and treat them specifically,” advises Dr Shevel.

But patients often don’t value the role of complementary techniques because they’re not quick-fix solutions —it can take several weeks or months to show results. A number of natural responses help prevent migraines or lessen their frequency and severity. Here’s a roundup of those with the best track records and how — after you consult your doctor — they may benefit you.

1. Massage
A migraine is sometimes ignited by muscular stress, which can be relieved by massage therapy.

“Tension in the neck is helped by manual massage. Whole body massage is relaxing and I would recommend that a migraine sufferer has regular massages as part of the whole approach to preventing migraines,” says Dr Mitton.

A study in the International Journal of Neuroscience also found that regular massage greatly reduced the number and duration of migraines.

At home, you can combine self-massage with aromatherapy. Massage the temples with a few drops of lavender or rosemary essential oil. Apply with your index fingers in circular motions starting at the centre of your forehead at the hairline and proceed to the temples, then continue to the area behind the ears and finally to the back of the neck. Repeat for a total of 10 minutes.

2. Biofeedback
Biofeedback is essentially a technique that uses sensors and imagery to measure your reactions to different stressors. Often this is done with the help of an electronic device, which is hooked up to your skin to measure changes in your pulse and other patterns. With the help of your biofeedback therapist and these measurements, you can learn how to control your responses, and to some extent those functions of the body that normally happen automatically.

“Biofeedback is helpful, but should be combined with other methods such as progressive relaxation, and meditation,” says Dr Mitton.

3. Herbs
Butterbur and feverfew might sound like they belong in a witch’s cauldron, but are in fact the two herbs most often used to control and prevent migraines. Both have anti-inflammatory compounds.

Of the two, butterbur (Petasites hybridus) has received the most scientific support. A 2004 report in the journal Neurology observed that patients who suffered from two to six migraines monthly cut their attacks down by 48 percent after taking 75mg of butterbur extract twice daily for four months. (The only notable side-effect was burping.)

As for feverfew (Tanacetum parthenium), anecdotal success is widely reported, and the herb has no major side-effects, which makes it a popular migraine fighter.

Both herbs are available at selected natural health stores, but check dosages with your alternative health practitioner.

4. Diet
Some people can eliminate migraines by avoiding specific food chemicals, such as caffeine, monosodium glutamate (MSG) and the sugar substitute aspartame. Other possible triggers are tannins (which can be found in apple juice, beer, red wine, chocolate, bananas and most herbs), which affect serotonin levels; and tyramines (in yoghurt, sour cream, chicken livers, sausages, avocados, raisins, peanuts, soya sauce, freshly baked breads and pork).

Avoid these potential troublemakers for at least six weeks to pinpoint which foods could be related to your attacks; you can then cross them off your shopping list, or at least keep your intake to a minimum.

Dr Mitton agrees: “Certain foods can trigger a migraine attack. Usually coffee or chocolate are the culprits, and people who drink a lot of coffee during the week, can experience a ‘weekend migraine’ due to caffeine withdrawal.”

5. Acupuncture
A 2004 study reported on the British Medical Journal’s website found that acupuncture coupled with medication significantly lessened the occurrence of migraine attacks.

Acupuncture locates imbalances in sufferers, often related to the liver or gallbladder meridians, or energy pathways. Points along those meridians are then manipulated to rebalance the body.

“The acupressure point is the area just below base of skull on either side of the midline of the neck (GB 20). There is another point which is in the hollow between thumb and forefinger (LI 4). Press hard for three minutes, release and repeat,” advises Dr Mitton.

6. Supplements
Studies have found that a drop in magnesium levels is common before or during migraine attacks. This essential mineral plays a role in nerve cell function and may alter serotonin levels, which could explain its effectiveness.

Riboflavin (B2) and vitamin B12 may also ward off attacks. These vitamins boost energy, and their efficacy might be tied to the low mitochondrial energy metabolism seen in the brains of migraine sufferers. Although previous research found that 400mg daily of riboflavin (more than 300 times the amount recommended for a healthy diet) can significantly reduce migraine frequency, a 2004 study in the journal Headache determined that 25mg per day might also do the trick.

7. Yoga
If you suffer from migraines, the stress-reducing effects of a yoga workout could prove advantageous.

Since stress is such a major contributor to migraines, anything that promotes relaxation can be beneficial.

Start with a sequence that begins and ends quietly, with a gradual build-up to more challenging poses in the middle.

If you feel a migraine coming on, or are recovering from an episode, try restorative poses to quiet the nervous system. Particularly useful are asanas where the head stays above the heart for 10 to 20 minutes. Other good relaxors include Tai Chi, Qi Gong, progressive relaxation and meditation and labyrinth walking.

- Matthew Solan and Ursula Beatty, Shape magazine, January 2007

 

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Headache expert

Dr Elliot Shevel - Founder and Medical Director - The Headache Clinic, (Johannesburg, Durban, Cape Town) South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon.

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