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Migraines
What are the symptoms of migraine?
Migraines are commonly preceded by warning symptoms (prodrome), that may include depression, irritability, restlessness, loss of appetite, and a characteristic "aura" - usually a visual disturbance such as flashing lights or a localized area of blindness that follows the appearance of brilliantly colored shimmering lights. Migraines may also involve nausea, vomiting, and changes in vision.
Medical Treatments
Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin (Bayer®, Ecotrin®, Bufferin®), ibuprofen (Motrin®, Advil®), and naproxen (Aleve®), may help provide pain relief in mild cases.
Commonly used prescription drugs include, Fioricet (or it’s generic Butalbital), a pain reliever and sedative used to relieve moderate pain and tension headaches; Imitrex, used to treat migraine headache attacks once they occur, but not effective in preventing migraines; and Esgic Plus, a pain reliever and relaxant containing butalbital and acetaminophen.
Treatment might also include avoidance of certain triggers, such as alcohol and specific foods. Some individuals might benefit from the correction of vision, while others might benefit from biofeedback.
Dietary changes that may be helpful
Some migraine sufferers have an abnormality of blood-sugar regulation known as reactive hypoglycemia. In these people, improvement in the frequency and/or severity of migraines resulted from dietary changes designed to control the blood sugar.1 2 For the treatment of reactive hypoglycemia, many healthcare practitioners recommend strict avoidance of refined sugar, caffeine, and alcohol, and eating small, frequent meals (such as six times per day).
Migraines can be triggered by allergies and may be relieved by identifying and avoiding the problem foods.3 4 5 6 Uncovering these food allergies with the help of a doctor is often a useful way to prevent migraines. In children suffering migraines who also have epilepsy, there is evidence that eliminating offending foods will also reduce the frequency of seizures.7
Some people who suffer from migraines also react to salt, and reducing intake of salt is helpful for some of these people.8 Some people with migraines have been reported to improve after removing all cows’ milk protein from their diet. The presence of lactose intolerance was found to be a strong predictor of improvement in that study.9 In addition, some migraine sufferers have an impaired capacity to break down tyramine, a substance found in many foods10 that is known to trigger migraines in some people.11 People with this defect are presumably more sensitive than others to the effects of tyramine.12 Ingestion of the artificial sweetener, aspartame, has also been reported to trigger migraines in a small proportion of people.13 14
L-tryptophan, an amino acid found in protein-rich foods, is converted to serotonin, a substance that might worsen some migraines. For that reason, two studies have investigated the effect of a low-protein diet on migraines; in these studies some people experienced a reduction in migraine symptoms.15 16 However, in a small double-blind trial, four of eight people had marked improvement in their migraine symptoms while receiving L-tryptophan (500 mg every six hours).17 Moreover, some preliminary evidence discussed below suggests that 5-hydroxytryptophan, a supplement related to L-tryptophan, may reduce symptoms in some migraine sufferers. Therefore, the idea that a low-protein diet would help migraine patients due to its low L-tryptophan content appears doubtful.
Lifestyle changes that may be helpful
Some doctors have found that reactions to smoking and birth control pills can be additional contributing factors in migraines.
Infection with Helicobacter pylori (H. pylori, an organism that causes peptic ulcers) may predispose people to migraine headaches. In a preliminary trial, 40% of migraine sufferers were found to have H. pylori infection. Intensity, duration, and frequency of attacks of migraine were significantly reduced in all participants in whom the H. pylori was eradicated.18 Controlled clinical trials are needed to confirm these preliminary results.
Herbs that may be helpful
The most frequently used herb for the long-term prevention of migraines is feverfew.49 Three double-blind trials have reported that continuous use of feverfew leads to a reduction in the severity, duration, and frequency of migraine headaches,50 51 52 although one double-blind trial found feverfew to be ineffective.53
Studies suggest that taking standardized feverfew leaf extracts that supply a minimum of 250 mcg of parthenolide per day is most effective. Results may not be evident for at least four to six weeks. Although there has been recent debate about the relevance of parthenolide as an active constituent,54 it is best to use standardized extracts of feverfew until research proves otherwise.
Anecdotal evidence suggests ginger may be used for migraines and the accompanying nausea.55 Ginkgo biloba extract may also help because it inhibits the action of a substance known as platelet-activating factor,56 which may contribute to migraines. No clinical trials have examined its effectiveness in treating migraines, however.
A standardized extract of butterbur (Petasites hybridus) was shown in a double-blind trial to reduce the incidence of migraine attacks for three months.57 People in the study took 50 mg of the extract twice per day. It should be noted that butterbur contains pyrrolizidine alkaloids (PAs) - constituents that are potentially harmful to the liver. The extract used in this study lowered the amount of PAs to a level deemed safe by the German health authorities.
There is preliminary evidence that capsaicin, the active constituent of cayenne, can be applied inside the nose as a treatment for acute migraine.58 However, as intranasal application of capsaicin produces a burning sensation, it should be used only under the supervision of a doctor familiar with its use.
Holistic approaches that may be helpful
Many reports have shown acupuncture to be useful in the treatment of migraines. In a preliminary trial, 18 of 26 people suffering from migraine headaches demonstrated an improvement in symptoms following therapy with acupuncture; they also had a 50% reduction in the use of pain medication.59 Previous preliminary trials have demonstrated similar results,60 61 62 which have also been confirmed in placebo-controlled trials.63 64 Improvement has been maintained at one65 and three66 years of follow-up. In preliminary research, patients suffering from chronic headaches of various types (including migraine, cluster, or tension headaches) have also experienced an improvement in symptoms following acupuncture treatment.
Percutaneous Electrical Nerve Stimulation (PENS) is an electrical nerve stimulation technique that has become increasingly popular in the complementary and alternative management of pain syndromes. PENS involves insertion of needle probes, similar to acupuncture, at specific therapeutic points and then applying low levels of electrical current. In one study, PENS was significantly more effective than needles alone at relieving pain in migraine headaches (tension headaches and post-traumatic headaches were also improved).70
References
1. Wilkinson CF Jr. Recurrent migrainoid headaches associated with spontaneous hypoglycemia. Am J Med Sci 1949;218:209-12.
2. Dexter JD, Roberts J, Byer JA. The five hour glucose tolerance test and effect of low sucrose diet in migraine. Headache 1978;18:91-4.
3. Grant EC. Food allergies and migraine. Lancet 1979;i:966-9.
4. Monro J, Brostoff J, Carini C, Zilkha K. Food allergy in migraine. Lancet 1980;ii:1-4.
5. Egger J, Carter CM, Wilson J, et al. Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment. Lancet 1983;ii:865-9.
6. Hughs EC, Gott PS, Weinstein RC, Binggeli R. Migraine: a diagnostic test for etiology of food sensitivity by a nutritionally supported fast and confirmed by long-term report. Ann Allergy 1985;55:28-32.
7. Egger J, Carter CM, Soothill JF, Wilson J. Oligoantigenic diet treatment of children with epilepsy and migraine. J Pediatr 1989;114:51-8.
8. Brainard JB. Angiotensin and aldosterone elevation in salt-induced migraine. Headache 1981;21:222-6.
9. Ratner D, Shoshani E, Dubnov B. Milk protein-free diet for nonseasonal asthma and migraine in lactase-deficient patients. Isr J Med Sci 1983;19:806-9.
10. Hanington E. Preliminary report on tyramine headache. Br Med J 1967;2:550-1.
11. Smith I, Kellow AH, Hanington E. A clinical and biochemical correlation between tyramine and migraine headache. Headache 1970;10:43-51.
12. Perkine JE, Hartje J. Diet and migraine: a review of the literature. J Am Diet Assoc 1983;83:459-63.
13. Koehler SM, Glaros A. The effect of aspartame on migraine headache. Headache 1988;28:10-3.
14. Lipton RB, Newman LC, Solomon S. Aspartame and headache. N Engl J Med 1988;318:1200-1.
15. Hasselmark L, Malmgren R, Hannerz J. Effect of a carbohydrate-rich diet, low in protein-tryptophan, in classic and common migraine. Cephalalgia 1987;7:87-92.
16. Unge G, Malmgren R, Olsson P, et al. Effects of dietary protein-tryptophan restriction upon 5-HT uptake by platelets and clinical symptoms in migraine-like headache. Cephalalgia 1983;3:213-8.
17. Kangasniemi P, Falck B, Langvik V-A, Hyyppa MT. Levotryptophan treatment in migraine. Headache 1978;18:161-6.
46. Gatto G, Caleri D, Michelacci S, Sicuteri F. Analgesizing effect of a methyl donor (S-adenosylmethionine) in migraine: an open clinical trial. Int J Clin Pharmacol Res 1986;6:15-7.
47. Claustrat B, Brun J, Geoffriau M, et al. Nocturnal plasma melatonin profile and melatonin kinetics during infusion in status migrainosus. Cephalalgia 1997;17:511-7 (discussion 487).
48. Nagtegaal JE, Smits MG, Swart AC, et al. Melatonin-responsive headache in delayed sleep phase syndrome: preliminary observations. Headache 1998;38:303-7.
49. Volger BK, Pittler MH, Ernst E. Feverfew as a preventive treatment for migraine: a systematic review. Cephalagia 1998;18:704-8.
50. Murphy JJ, Hepinstall S, Mitchell JRA. Randomized double-blind placebo controlled trial of feverfew in migraine prevention. Lancet 1988;ii:189-92.
51. Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J 1985;291:569-73.
52. Palevitch D, Earon G, Carasso R. Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: A double-blind placebo-controlled study. Phytother Res 1997;11:508-11.
53. De Weerdt CJ, Bootsma HPR, Hendriks H. Herbal medicines in migraine prevention. Phytomed 1996;3:225-30.
54. Awang DVC. Parthenolide: The demise of a facile theory of feverfew activity. J Herbs Spices Medicinal Plants 1998;5:95-8.
55. Mustafa T, Srivastava KC. Ginger (Zingiber officinale) in migraine headache. J Ethnopharmacol 1990;29:267-73.
56. Chung KF, McCusker M, Page CP, et al. Effect of a ginkgolide mixture (BN 52063) in antagonising skin and platelet responses to platelet activating factor in man. Lancet 1987;i:248-51.
57. Grossman W. Migraine prophylaxis with a phytophramceutical remedy: The results of a randomized, placebo-controlled, double-blind clinical study with Petadolex". Der Freie Arzt 1996;May/June: 3.
58. Levy RL. Intranasal capsaicin for acute abortive treatment of migraine without aura. Headache 1995;35:277 [letter].
59. Baischer W. Acupuncture in migraine: long-term outcome and predicting factors. Headache 1995;35:472-4.
60. Boivie J, Brattberg G. Are there long lasting effects on migraine headache after one series of acupuncture treatments? Am J Chin Med 1987;15:69-75.
61. Loh L, Nathan PW, Schott GD, Zilkha KJ. Acupuncture versus medical treatment for migraine and muscle tension headaches. J Neurol Neurosurg Psychiatry 1984;47:333-7.
62. Spoerel WE, Varkey M, Leung CY. Acupuncture in chronic pain. Am J Chin Med 1976;4:267-79.
63. Vincent CA. A controlled trial of the treatment of migraine by acupuncture. Clin J Pain 1989;5:305-12.
64. Lenhard L, Waite PME. Acupuncture in the prophylactic treatment of migraine headaches: pilot study. NZ Med J 1983;96:663-6.
65. Vincent CA. A controlled trial of the treatment of migraine by acupuncture. Clin J Pain 1989;5:305-12.
70. Ahmed HE, White PF, Craig WF, et al. Use of percutaneous electrical nerve stimulation (PENS) in the short-term management of headache. Headache 2000;40:311-5.
* The information presented on www.webmedsnow.com is for informational purposes only. Consult with your doctor or pharmacist for further information regarding Tramadol.
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