A migraine is a moderate to severe, recurring headache that usually affects one half of the head, is pulsing, and lasts 2 to 72 hours. It may be associated with nausea, vomiting and light, sound or smell sensitivity. Physical activity often worsens the pain. About 1/3 of sufferers also experience an aura – a short period of visual disturbance before the headache commences. Occasionally auras occur with little or no headache.
There are many possible environmental triggers, plus a genetic/inherited predisposition.
Migraines are not associated with increased risk of death, but can cause periods of lost productivity.
Major depression, anxiety disorders, bipolar disorder and obsessive compulsive disorder are 2-10 times more common in migraine sufferers.
Migraine triggers include:
food ie tyramine (in chocolate, alcoholic beverages, cheese, processed meats), monosodium glutamate (MSG).
A headache diary recording diet, lifestyle, triggers, headache intensity and frequency can assist to identify triggers.
The mechanism of migraine is believed to start in the brain and spread to the blood vessels within and around the brain (nerve excitation followed by suppression, causing the initial aura) and of the head and neck (dilation of extracranial arteries triggers sensory nerves leading to pain). Low levels of the neurotransmitter serotonin are believed to be involved in the vessel dilation.
Conventional care to control the symptoms of a migraine attack is to start with simple pain medication (ie paracetamol, aspirin or ibuprofen), anti-nausea medication (ie Stemetil or Maxalon) and avoiding known triggers.
If these are not effective, specific medications can be used ie
triptans to mimic the effect of serotonin on nerves and blood vessels in the brain leading to constriction of the dilated blood vessels (ie sumatriptan (Imigran), zolmitriptan (Zomig), naratriptan (Naramig), rizatriptan (Maxalt), eletriptan (Relpax)). Other effects of triptans include dizziness, fatigue, skin tingling, dry mouth, flushing and chest pain.
ergotamine also mimics the effect of serotonin on nerves and blood vessels in the brain leading to constriction of the blood vessels. Other effects include nausea, vomiting, increased blood pressure, muscle pain, leg weakness via its binding to dopamine and adrenaline receptors.
Caffeine blocks adenosine receptors to cause vasoconstriction, but also stimulates nitric oxide production leading to vasoconstriction.
Ergotamine and caffeine were available for many years for migraine treatment as Cafergot, but this is not now available in Australia.
Botox (toxin from clostridium botulinum bacteria) may help with recurring migraines.
Medications to prevent regular attacks include beta blockers that inhibit arterial constriction (metoprolol, propranolol and timolol), valproate that increases brain GABA and has multiple effects (Valpro, Epilim) and topiramate that blocks voltage-dependent sodium and calcium channels and has multiple effects (Topamax ).
Common side effects include:
Beta-blockers – dizziness, weakness, fatigue, drowsiness, dry mouth, headache, diarrhoea or constipation
Valproate – abdominal pain, fatigue, drowsiness, nausea, tremor, vomiting, diarrhoea, dizziness and appetite loss
Topiramate - weight loss, numbness, tingling, flushing, headache, drowsiness, nausea, diarrhoea, stomach pain.
Medication overuse can lead to chronic daily headaches.
Alternative management options include magnesium, a ketogenic diet, butterbur, feverfew, vitamin B2 and melatonin.
The worldwide use of triptans (serotonin mimics) to manage a migraine attack suggests that low serotonin level may be a causative mechanism. The increased occurrence with migraines of major depression, anxiety disorders, bipolar disorder and obsessive compulsive disorder, which are also treated with serotonin increasing drugs (selective serotonin re-uptake inhibitors) supports this theory.
A more natural way to increase serotonin levels in the brain is to increase the intake of the amino acid that is used to make serotonin (5-HTP, 5-hydroxy-tryptophan) to levels above that obtained from an optimal diet. Because of the interaction of serotonin production, transport and metabolism with catecholamine (dopamine, nor-adrenaline, adrenaline) production, transport and metabolism, and with thiols (sulphur containing amino acids) and the vitamin and mineral co-factors consumed, these amino acids need to be balanced with the 5-HTP consumed to avoid causing new symptoms
By taking the supplements regularly, it may be possible to significantly reduce the frequency or cease the occurrence of the migraines. Of cause this approach, as with using drugs, is not addressing the underlying cause/s of the migraine, but it can safely and naturally manage the symptoms. There are costs to the supplements, that vary depending upon the amount needed by the individual, and the effect is only maintained as long as the supplements are taken.
Dr Marti Hinz, a medical doctor and organic chemist has developed the NeuroResearch protocol of using specific nutritional support (amino acids, vitamins, minerals) to assist in situations where neurotransmitter (serotonin, dopamine, nor-adrenaline, adrenaline) balance is impaired.
Dr Hart was one of the first doctors in Australia to train with Dr Hinz in this protocol.