Migraines – New Treatments, Old Disease
Migraines have been around for a long, LONG time. In the 2nd Century CE – Aretaseus of Cappadocia coined the term “heterocrania” describing it as “an illness by no means mild..” Those who suffer from migraines dont need Aretaseus to know just how debilitating and painful the attacks can get though, right?
The way migraines occur is rather complicated and every person can experience them differently. Generally speaking however, they are described as a unilateral headache with a throbbing quality. They tend to last from 4 to 72 hours, be classified as classic migraines (with aura) or common migraine (without aura) or with with a mild and transient sensory/visual symptoms that occur right before the pain comes on.
Studies have found that migraines with aura can result from – cortical spreading depression – a neuronal depolarization wave followed by inhibition of bioelectrical brain activity. A mouthful sentence, I know. But what this means is that migraines with aura are linked to changes in brain electrical signaling. This pattern, however, does not apply to migraines without aura and need to be approached differently. And one last layer, I promise – still other patients can experience some migraines with aura and some without and this can change throughout the individuals life.
A genetic component also exists for migraines with aura but not for migraines without aura. And some research is now finding links to methylenetetrahydrofolate reductase (MTHFR) mutations.
What about the vascular theory?
The vascular theory proposes that migraine pain is due to the vasodilation of intracranial blood vessels – this dilation then activates nociceptors (receptors for painful stimuli) causing the sensation of pain. This theory is substantianted by the fact that medications like triptans which cause vasoconstriction can be quite effective at dealing with migraine symptoms. However, new research is beggining to show that the vascular theory is only a piece of the puzzle and that there might be other secondary mechanisms at work. – That is a mechanism related to neuroinflammation. Some studies found no correlation between blood flow during migraines with aura – but instead found increased inflammatory markers present in the body.
Is that it?
Nope! More recently research is showing that calcitonin-related peptide (CGRP) – a potent vasodilator has been implicated in the role of migraine headaches. The studies showed that patients who suffered from migraines had elevated levels of CGRP and certain treatments that inhibit the release of CGRP reduced the symptoms as well.
Hormones may also play a role in cyclical headaches. The connection is believed to be related to the hormone estrogen. When estrogen levels drop – before menstruation, women have an increased likelihood to develop migraine headaches. The degree of fluctuation in the hormone, rather than the level itself, is thought to be the main instigator. Interestingly during pregnanacy – most women will stop experiencing migraines due to a stable rise in estrogen lebels. After pregnancy, however, the abrupt drop in estrogen levels may trigger headaches again. Since estrogen levels drop during perimenopause and menopause – migraines tend to occur more frequently due to the eneven rise/fall of hormones during this period.
The French (DIET) Connection –
Tyramine has long been linked with migraine symptom exacerbation – in individuals prone to migraines of course. This non-essential amino acid can be found in highest concentration in foods like ages cheeses, wine and cured meats. Tyramine foods can increase the sympathetic nervous system and this can lead to excessive cerebral dilation, thus triggering vasocongestion and migraine.
The Naturopathic Treatment:
From a naturopathic perspective – finding out the cause of the migraine is obviously key. From a digestive perspective specifically – going through a simple elimination diet, particularly – avoiding foods containing tyramine, nitrites, MSG, and aspartame can go a long way on its own. However this is often not enough especially since migraines may have multiple causes.
In order to tackle migraines that result from inflammtory states – certain “blood movers” can be prescribed. Some examples include Zingiber, Allium, Curcuma, and Cinnamomum as these may reduce platelet aggregation and activation.
Angelica Sp. – a herb often used in Chinese medicine has been found to reduce plasma calcitonin, nitric oxide and dopamine. Scutellaria baicalensis is often used in tandem with Angelica and both produce a synergistic antiinflammatory effect which can be effective at eliminating the some of the root causes of migraines.
Tanacetum parthenium is showing promise by inhibiting the release of seratonin – a neurotransmitter often elevated in individuals suffering from migraines, and reducing the symptoms of migraine. Tanacetum must be taken for several weeks of months on a daily basis before effects are noticable however and will not work if taken acutely to stave off current migraine attacks.
Several other botanicals can be prescribed, including topical treatments that are usually used in conjunction with more systemic therapies. Acupucture has also been well studied to help with migraine prophylaxis and probably deserves a whole article on its own. In sum, however, it’s important to know that there are effective treatments for migraines – once the pathophysiology is discovered is becomes that much easier to treat this prevalent condition.
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