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Nondrug Prevention and Treatment for Migraine Headaches

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Medications can help prevent and treat migraine, but fortunately there are many lifestyle and other treatment options that can help dramatically—without drugs.

The advice I give the migraineurs I treat…

KNOW YOUR TRIGGERS

Identifying your migraine triggers and avoiding them is key to preventing an attack. Triggers are highly individual, including particular smells, sounds, lighting, 3-D movies—even weather changes. Common food triggers include…

  • Alcohol—especially red wine, perhaps because of its high levels of histamine.
  • Nitrites. Found in hot dogs, bacon, sausage and processed meats.
  • Monosodium glutamate (MSG). A flavor enhancer that goes by many names, it is a powerful trigger for many people. (See below for more on MSG.)

WHEN TROUBLE STARTS

Taking the right steps at the first sign of a migraine coming on can lessen an attack—or avert it. These natural remedies can help…

  • Apply a cold pack to the site of the pain. Cold may reduce blood vessel inflammation. A bag of frozen peas makes a good cold compress. It conforms to the shape of your head, and you can refreeze the bag for reuse. (Note: Don’t eat thawed and refrozen peas—they can harbor unhealthy bacteria.)
  • Aromatherapy, a popular migraine treatment in Europe, is not backed by strong scientific evidence, but some patients find it helps them relax and eases their headache pain. Tiger Balm—a mixture of camphor, menthol, cajuput oil and other herbals—is particularly effective and is available in supermarkets and pharmacies. Rub a small amount into your temples at the first sign of migraine. Other essential oils to try: Eucalyptus, lavender and peppermint.
  • Drink a caffeinated beverage—but not more than 100 mg of caffeine (one cup of medium-roast coffee). Other options: Strong black tea (50 mg/cup)…green tea (25 mg/cup.) Warning: Caffeine triggers ­migraines for some people.

Regular tea and coffee drinkers: To avoid a caffeine-withdrawal headache—another migraine trigger—drink the caffeinated beverage at the same time each day.

VITAMINS AND HERBS THAT HELP

Certain supplements can reduce the frequency and/or intensity of migraines. Try these one at a time for two or three months…

  • Vitamin B-2 (riboflavin) may reduce migraine frequency. Try: 400 mg/day. Vitamin B-2 usually doesn’t have adverse side effects.
  • Magnesium gluconate and magnesium taurate may both prevent migraine. Try: 500 mg to 600 mg/day of either one. Lower the dose if you have loose stools. Option: 100 mg of either at the start of a migraine can reduce its intensity.
  • Feverfew has been used for centuries to prevent and relieve migraine. Studies show that it can reduce migraine frequency and severity. Try: A total of 50 mg to 125 mg/day (tablet or capsule) divided into three doses. Feverfew thins blood—don’t take it if you are on aspirin therapy or take a blood thinner such as warfarin (Coumadin). Also avoid it if you are allergic to ragweed. Other side effects include joint aches and gastrointestinal ­disturbances.

NERVE STIMULATION

The FDA recently approved Cefaly, a noninvasive nerve stimulator that looks like a headband and is worn across the forehead. It delivers tiny, painless electrical pulses to the upper branch of the trigeminal nerve—the nerve responsible for sensations­ in your face and head. When inflamed, the trigeminal nerve overresponds to stimuli, possibly causing migraine pain. Theory: Repeated pinging with electrical pulses might make the trigeminal nerve less sensitive to stimulation. In a recent Italian study, using Cefaly 20 minutes daily for four months reduced migraine frequency by more than 50%.

The device costs $349, plus $25 for three sets of electrodes (each set lasts about one month), and can be ordered online at Cefaly.us. It requires a prescription from your doctor and may not be covered by insurance. (Cefaly should not be used if you have a cardiac pacemaker, an implanted or wearable defibrillator, an implanted metallic or electronic device in your head or have pain of unknown origin.)

NEW HOPE FOR A CURE

New research shows that calcitonin gene-related peptide (CGRP), a strong vasodilator produced in neurons involved in the transmission of pain, could trigger and maintain migraines. During a migraine headache, CGRP binds to receptors in the trigeminal nerve. In recent clinical trials, an antibody treatment that blocks the activity of CGRP modestly reduced the number of days per month that patients were disabled by migraine and even eliminated migraines for up to 15% of patients. The treatment could become available as an injection later this year.

MSG ALIASES

As mentioned above. monosodium glutamate (MSG) is a common migraine trigger. Check the ingredient lists on food package labels for these other names for MSG…

  • Autolyzed, hydrolyzed or partially hydrolyzed additives such as…yeast…cornstarch…gelatin…milk protein…plant protein…protein…soy…wheat.
  • Plant protein extract.
  • Textured protein.
  • Yeast extract.

WHAT IS A MIGRAINE?

A migraine headache is a cascade of electrical, chemical and inflammation-related blood vessel changes that occur in the brain, typically in distinct stages, but they can overlap…

  • Prodrome. The warning stage. You may feel “off,” irritable or moody…have amplified senses, such as a heightened sense of smell…and crave certain foods, such as sweets.
  • Aura. Usually occurring five to 60 minutes before an attack, it involves visual disturbances such as flashing lights, zigzag lines or blind spots.
  • Headache. Pain, mild to severe, often described as intense pounding or pressure, usually on one side of the head.
  • Postdrome. The recovery period. You may feel fatigued over the next few hours or days.
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Source: Morris Levin, MD, chief of the Division of Headache Medicine and director of the Headache Center at UCSF Medical Center in San Francisco. He is coauthor of Understanding Your Migraines: A Guide for Patients and Families. Dr. Levin is board-certified in neurology, pain medicine and headache medicine. Date: May 1, 2018
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