Migraine Headache

Migraine headaches are recurrent, painful headaches often accompanied by nausea, photophobia and/or phonophobia. Migraine headache is often described as intense throbbing or pulsating head pain that interferes with a person's ability to go about normal daily functioning. Migraine headache pain is often made worse by physical activity.

Frequently Asked Questions

  • 1What is migraine?
  • 2What are the symptoms of migraine?
  • 3What are the causes of migraine?
  • 4What is the role of Serotonin in migraine?
  • 5What is the role of hormones in migraine?
  • 6How do steroid hormones influence calcium and magnesium?
  • 7What is the neuro hormonal and metabolic days balance hypothesis of migraine?
  • 8What are the risk factors for migraine?
  • 9What other factors influence migraine?
  • 10Why does conventional medicine sometimes fail in efforts to prevent migraine?
  • 11How is migraine managed at Health Renewal?
  • 12What are the risks and complications of this condition and it’s management?
  • 13What nutraceuticals may be recommended to improve migraine?
  • 14Why should one not self-medicate?
  • 15How do I get started?
  • 16How do we treat this at Health Renewal?
  • 17What should you bring along to your appointment with your Health Renewal doctor?
  • 18What is the cost of the extended consultation with the Health Renewal doctor?
  • 19How often should I see the integrative Doctor?
  • 20Health Renewal Tip: How does one prevent migraine?
  • 21What foods must one avoid?
  • 22Health Renewal's 10 Inspiring Quotes For Healthy Living:
  • Migraine headaches are recurrent, painful headaches often accompanied by nausea, photophobia (i.e., light sensitivity) and/or phonophobia (i.e., sound sensitivity). A migraine is often unilateral and pulsating, and may occur with or without an aura.
  • Migraine headache is often described as intense throbbing or pulsating head pain that interferes with a person's ability to go about normal daily functioning. Migraine headache pain is often made worse by physical activity.
  • Migraine sufferers frequently describe the pain as being limited to one side of the head. However, some people do experience migraines on both sides of the head
  • Migraine is commonly associated with nausea, as well as light and/or sound sensitivity. Although migraine duration varies from patient to patient, a typical attack lasts for several hours, and sometimes persists for up to several (e.g. 2-3) days.
  • Various physical and/or psychological changes sometimes precede the onset of a migraine headache by a few hours to a few days. This phase of a migraine is called prodrome. The experience of prodrome varies from person to person but can include such things as appetite changes, loss of balance, mood changes, tiredness, neck stiffness, and changes in alertness. The prevalence of a distinct prodrome phase is not entirely clear because studies have reported differing rates, but a significant portion of migraineurs indicate that they experience symptoms that predict the onset of migraine. Individuals who have experienced migraine preceded by prodrome in the past may be able to recognize an impending headache based upon their prodrome symptoms and plan accordingly for the next hours or few days by taking steps such as avoiding rigorous or stressful activity and ensuring that they have adequate stock of migraine relief medication.
  • Approximately 25% of migraineurs will experience a pre-migraine phenomena called aura, which is a neurologic abnormality causing mostly visual, but also other sensory and/or movement disturbances that manifests within a few hours of a migraine headache. Most experts believe that migraine aura is caused by a phenomena in the brain called cortical spreading depression (CSD), a slowly progressing wave of excitability followed by long-lasting neuronal inhibition

In the early years of migraine research, scientists believed that the headache portion of a migraine resulted from the dilation of blood vessels, while the aura portion of migraine was caused by vasoconstriction . However, more recent evidence suggests that these vascular changes are not the cause of migraine, but rather an epiphenomenon that accompanies the pain Today, migraine is viewed as a result of complex dysfunction within the central nervous system. Various factors that contribute to this dysfunction are reviewed below.

The neurotransmitter serotonin (5-hydroxytryptamine [5-HT]) plays a role in the development of migraine attacks. This conclusion is supported by evidence indicating that migraine patients tend to have low levels of serotonin in their brains Additional support for this theory is found in data indicating that tricyclic antidepressants, which increase serotonin signaling, reduce the frequency of migraine attacks. Furthermore it was found that, melatonin, an active metabolite of serotonin, can be deficient among migraine patients, and melatonin supplementation has resulted in symptom improvement among some migraine patients.

Although the exact mechanism linking low serotonin levels to migraine pathology has not yet been fully described, researchers have hypothesized that serotonin may interfere with pain processing in the brain. Serotonin also affects on the dilation and contraction of blood vessels in the brain Though low serotonin levels may give rise to an attack, some evidence suggests that elevated serotonin levels may contribute to migraine pathology during an attack. Due to the complexity of serotonin's role in migraine, further study is needed to fully characterize the effects of modulating serotonin levels and/or signaling in migraine patients.

Migraine disproportionately affects women – females make up about 70% of all migraine patients – suggesting a potential hormonal link.

  • Although many hormonal events in a female's life may influence the occurrence of migraine (e.g., menarche, menstruation, pregnancy, and menopause), menstruation appears to be the most important. For example, 70% of female patients who experience migraine report some type of menstrual link. This is a phenomenon called "estrogen withdrawal," which occurs in the late luteal phase of the menstrual cycle and is characterized by an abrupt decline in estrogen levels, is likely an important migraine trigger in some women.
  • Imbalances between estrogen and progesterone, if restored , can improve migraines.
  • Fluctuations in estrogens levels associated with migraine produce biochemical changes in prostaglandin production, prolactin release, and endogenous opioid regulation.
  • Prostaglandin E2 (PGE-2) is a well-defined mediator of fever and inflammation. PGE-2 increases vasodilatation and thereby induces pain. Estrogens increase the production of PGE-2. An excess of estrogens, deficit of progesterone, or dominance of estrogens can cause increased production of PGE-2, resulting in migraine.
  • Elevation of the prolactin level or increased sensitivity to prolactin leads to a decreased level of prostaglandin E1 (PGE-1).
  • If a patient has a dominance of PGE-2, vasodilatation of major arteries with spasm of collateral circuits would be expected, which in turn can cause pain. Restoration of hormonal levels and balance between them can stabilize levels of prostaglandins.
  • Steroid hormones also influence the metabolism of calcium and magnesium. Estrogens regulate calcium metabolism, intestinal calcium absorption, and parathyroid gene expression and secretion, triggering fluctuations across the menstrual cycle. Alterations in calcium homeostasis have long been associated with many affective disturbances.
  • Clinical trials in women with premenstrual syndrome have found that calcium supplementation may help alleviate most mood and somatic symptoms. Evidence to date indicates that women with symptoms of premenstrual syndrome have an underlying calcium abnormality.
  • A low brain magnesium level can be an expression of neuronal hyperexcitability of the visual pathways and be associated with a lowered threshold for migraine attacks. Clinically, it is known that magnesium supplementation relieves premenstrual problems (for example, migraine, bloating, and edema) that occur late in the menstrual cycle, and that migraine, particularly in women, is associated with deficiencies in brain and serum magnesium levels. Testosterone was not shown to produce any significant alteration in magnesium levels.
  • Among women with menstrual-related migraines, using hormone therapy to minimize monthly declines in estrogen concentration may be effective in preventing migraine attacks.
  • Studies suggest that non-oral routes of estrogen therapy, such as a topical cream to be applied to the skin, are more likely to improve migraine than oral estrogens.
  • Clinical experience strongly supports the notion that migraine can be managed ONLY when levels of all the basic hormones (including: pregnenolone, DHEA, testosterone, oestrogen, and progesterone) are optimal throughout the physiological cycle. Women who struggle with underling migraines, without relief, should consider comprehensive or one teasing and restoration of hormonal balance using Bio-Identical Hormone Replacement Therapy (BIHRT).

Migraine triggers are for instance intense emotional stress, poor sleep habits, and unbalanced hormone levels.

The following lifestyle interventions may prevent migraines

  • Avoidance of caffeine, nicotine, red wine, and other migraine triggers
  • stress reduction (see the Stress Management protocol)
  • improving sleep hygiene (see the Insomnia protocol)
  • massage therapy
  • chiropractic manipulation
  • acupuncture / Biopuncture
  • getting sufficient exercise
  • and frequent stretching
  • Sleep read more on Sleep Renewal about Headaches

Most migraine treatment plans involve both acute and preventive strategies. Conventional pharmacologic migraine treatments often meet with limited success and may have intolerable side effects or be contraindicated with other common co-existing conditions.

Your Doctor at Health Renewal will manage this through a consultation and examination. You may be requested to undergo some blood tests.

The initial medical consultation at Health Renewal will be approximately 45 minutes. You will have to complete an in depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation your Health Renewal doctor will obtain a full medical history from you to determine your personal risk . A physical examination will be done after which he will decide which blood tests need to be requested from your local pathology laboratory . These results will then be analyzed by your Doctor and this will be discussed with you at your follow up appointment. This will determine whether a definite deficiency exists and you will be advised on your treatment options. These options may range from prescription medications, nutraceuticals, bio-identical hormonal creams / tablets or alternatively to having bio-identical implants / pellets inserted.

Exclude other serious conditions:

It is important that your doctor rule out other possible causes of headache, especially in the absence of history of migraine Such as less common but potentially more serious disorders including subarachnoid hemorrhage, intracranial mass lesions, cerebral vasculitis a amongst others. These conditions also can cause migraine-like symptoms and must be excluded. When doctors are not sure that migraine is the proper diagnosis, tests such as computerized tomography (CT), magnetic resonance imaging (MRI), and a spinal tap (lumbar puncture) may be used to help rule out other possible conditions.

Medications:

Although the triptans are arguably the most effective treatment for acute relief of a migraine headache (i.e., the "gold standard"), they have a number of side effects For example, triptans should be avoided (when possible) in patients who are at risk for cardiovascular events and stroke (i.e., patients with heart disease). Furthermore, triptans require careful monitoring because they are known to interact with a large number of other commonly used medications medication overuse headache Ironically, taking too much migraine prevention medication for too long can lead to "medication overuse headache". Medication overuse headache can become a chronic, self-perpetuating condition called "chronic daily headache", in which patients experience daily headaches caused by medication overuse, but continue to use medication to relieve the headaches.

Butterbur is a plant that flourishes in moist conditions, and has been used for a wide range of medicinal purposes in Europe since ancient times Butterbur extracts possess analgesic, anti-inflammatory, anti-spasmodic, and vasodilatatory properties, which may explain their efficacy for migraine prevention.

Coenzyme Q10 – is a potent antioxidant and an important component of cellular energy production. Researchers have found that organs with high metabolic rate, such as the brain, appear to quickly deplete CoQ10 stores, potentially leading to a deficiency. CoQ10 (at doses of 100-300 mg daily) has been shown to be beneficial for preventing and reducing the frequency of migraine attacks among adults . These actions are attributed to CoQ10's potential to interfere with inflammatory mechanisms and mitochondrial dysfunction, both of which have been implicated in the migraine process.

Riboflavin (i.e., Vitamin B2) contributes to cell growth, enzyme function, and energy production (AMR 2008). High quality data indicate that riboflavin is effective for the prevention of migraine among both children and adults and may decrease the need for traditional rescue medications One study involving 23 participants showed that supplementation with 400 mg riboflavin daily reduced headache frequency by an impressive 50% at three months, with improvement persisting through six months.

Feverfew (Tanacetum parthenium) is a small, daisy-like flower with a distinctively strong, bitter odor. Recent evidence has revealed that feverfew inhibits the production of several inflammatory mediators that may be involved in migraine including arachidonic acid, cyclooxygenase-2, TNF-α, IL-1, MCP-1. Due to these anti-inflammatory properties, feverfew's use in the management of migraine attacks is promising . A combination of ginger and feverfew has also been shown to be effective for migraine prevention with minimal side effects . A dosage of 100-300 mg up to 4 times daily is recommended.

Magnesium modulates many important neural and vascular processes involved in the development of a typical migraine attack. Migraine patients commonly exhibit low magnesium levels (in the serum, tissue, and lymphocytes), especially during an attack (A dosage of 600 mg of magnesium daily has been shown to be effective for the prevention of migraine attacks , and is inexpensive and well-tolerated In combination with CoQ10, vitamin B2, and ginkgo, magnesium has been shown to significantly decrease the amount of migraine headaches. Although not yet proven in clinical trials, a form of magnesium called magnesium-L-threonate may be ideal for people with migraine because experimental data indicate that it enters the central nervous system more efficiently than other forms of magnesium.

Melatonin is a natural compound produced by the pineal gland that helps regulate the sleep-wake cycle (i.e., circadian rhythms), and has been clinically shown to possess potent antioxidant and analgesic properties. Since melatonin is often found in lower-than-normal levels among migraine patients (especially during an attack), it is thought that it may play an important role in migraine pathology (Some researchers hypothesize that migraines are triggered by an irregularity in pineal gland function. This imbalance can be corrected through melatonin. This response rate may have been more statistically significant if the researchers used a larger dose of melatonin (3 mg instead of 2 mg), and if treatment was extended for a longer period of time (12-16 weeks, instead of 8 weeks.

S-adenosylmethionine (SAMe) is a nutritional supplement derived from the amino acid methionine and adenosine triphosphate, a nucleic acid. It is a naturally occurring substance produced by the body to perform a variety of important biochemical processes, especially involving the central nervous system (CNS). Some data suggest that long-term supplementation with SAMe may relieve pain among migraine sufferers, possibly due to its ability to increase serotonin.

L-tryptophan: This amino acid is a precursor to serotonin. Several lines of evidence indicate that low serotonergic signaling within the brain may precipitate migraine Therefore, supporting serotonin synthesis by providing precursors like L-tryptophan may help avoid physiological conditions that promote migraine headache. Indeed, in an older clinical trial, supplementation with 2 - 4 grams of L-tryptophan daily was as effective at preventing migraine attacks as the medication methysergide . Also, a more recent trial found that dietary tryptophan depletion caused exacerbation of migraine symptoms.

Miscellaneous Beneficial Ingredients: The following list of natural ingredients may also be useful for managing migraine symptoms, though definitive clinical data is lacking:

  • Lipoic Acid
  • Ginkgo Biloba
  • Vitamin B6
  • Ginger

For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. It cannot be overemphasized that one must not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified and practising integrative medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure, high sugar level, high stress levels (that can lead to adrenal burnout ) and high blood clotting factors that could lead to heart attacks and stroke. In addition, aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. There is no single supplement prescribed to clients as there is no magic bullet that can support all the essential nutrients that one's body needs. Today's food is not functional and we need to supplement in order to maintain optimal bodily functions and nutrition.

Make an appointment to consult with your Health Renewal Doctor who is an integrative doctor and he / she will assist you in determining your risk factors and how best to prevent any problems or conditions that you may be susceptible to. The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments , nutritional supplements and a healthy diet and lifestyle.

The initial medical consultation at Health Renewal will be approximately 45 minutes. As this is a prolonged medical consultation, the initial consultation fee will be R 975 on arrival (for non loyalty programme members) you will have to complete an in depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation your Health Renewal doctor will obtain a FULL medical history from you to determine your personal risk. A physical examination will be done after which the Doctor will decide which blood tests need to be requested from your local pathology laboratory. If you have a medical aid, these should be able to be claimed as well.

Once your blood results are received, they will then be analyzed by your Health Renewal doctor who will begin working on a unique prescription plan for you with the compounding pharmacy. At your pre-scheduled second appointment 2 weeks later, the results and examination findings will be discussed with you. This will determine what abnormalities or deficiencies exist and you will be advised on your treatment options. These options may range from prescription medications, nutraceuticals, bio-identical hormonal creams / tablets or alternatively to having bio-identical implants / pellets inserted.

In office treatments such as carboxytherapy may also be recommended for certain conditions such as hair loss, erectile dysfunction ED, menopause or PMS. If you need to lose weight our Body Renewal Medical Weight loss program may be recommended. All these recommendations will be summarized on a sheet / print out which you can take home with you. The nutraceuticals offered at Health Renewal are of superior quality (Solgar) and are not rancid nor contain Hg (mercury ) or PCB'S (which is very important for Omega 3 Essential fatty acids EFA's). They are also free of gluten, preservatives, wheat, dairy, soy, yeast, sugar, artificial flavor, sweetener and colour. We have a great professional team made up of doctors, trained and registered nurses and therapists to support you at any time.

1. You are kindly requested to bring any supplements that you are currently taking, along to your consultation. The doctor can check the ingredients in take this into account when prescribing a treatment plan for you.

2. Also, if you have had any blood work done in the past 6 months, please bring the results along to the consultation. Should you not be in possession of the hard copies, please request these results from the lab you visited. Usually your ID number is sufficient.

Depending on the exact prescription given, you may be required to return to the doctor within 1-4 months’ time, in order to ensure optimum hormone levels are achieved. This will be determined by a repeat blood test and may be requested by your Health Renewal doctor.

You should ensure that you are current with your gynaecological visits/breast exams/mammograms (for female patients) and prostate exams (for male patients) as recommended by your GP/gynaecologist.

Fees:

  • The fee for the initial consultation and evaluation of 45 minutes is R975. A deposit of R400 is required up front in order to secure your consultation with the doctor. This advance payment goes towards your consultation fee. Proof of payment needs to be received one week in advance of appointment email. Please see banking and contact details below. This consultation fee may be claimed back from your medical aid depending on which kind of medical over you have.
  • A second follow up consultation is essential in order for the doctor to assess your blood work and prescribe a personalised treatment plan for you. Another deposit of R400 will be required to secure the second consultation.
  • All subsequent follow up consultations with the doctor will be charged at R650 for 30 minute consultations. This may be amended from time to time at the practice’s discretion.
  • You may pay for your consultation by cash, credit card or EFT.
  • BIHRT prescriptions must be paid for prior to ordering, as each patient’s prescription is unique to his/her own needs, and you will receive an invoice advising you of the cost.
  • The patient is responsible for paying all consultation and prescription fees to Skin, Body and Health Renewal – regrettably we do not accept medical aid.
  • An added bonus is that not only improving your health and well being , any nutraceuticals purchased will go towards loyalty points at any Skin, Body and Health Renewal branches

Depending on which form of supplementation you and your Health Renewal Doctor have decided on, one could expect to follow up with your physician from anything between every 3 months to once every 6 months.

The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments , nutritional supplements and a healthy diet and lifestyle.

Although there are a wide variety of acute and preventive drugs available for treating migraines, many patients will not experience significant symptom relief unless healthy lifestyle modifications are made. The following lifestyle interventions may prevent migraines:

  • avoidance of caffeine, nicotine, red wine, and other migraine triggers
  • stress reduction (see the Stress Management protocol)
  • improving sleep hygiene (see the Insomnia protocol)
  • massage therapy
  • chiropractic manipulation
  • Biopuncture/ acupuncture
  • getting sufficient exercise
  • and frequent stretching

A significant association between dietary intake and migraine incidence exists; one out of every four migraine patients report that certain foods can trigger an attack. Furthermore, the avoidance of food allergies and/ or sensitivities may reduce or eliminate migraine symptoms for some patients. Many of these nutritional migraine triggers have vasoactive properties (causes constriction or dilation of blood vessels), which is why they may contribute to migraine attacks. Other potential dietary triggers: include cow's milk, wheat, eggs, alcohol, artificial sweeteners, citrus fruits, pickled products, and vinegar . It is important to note that not all migraine patients are susceptible to the below mentioned nutritional triggers, thus the complete elimination of these items is not always necessary.

  • Nitrites are preservatives found in processed meats such as hot dogs.
  • Monosodium glutamate (MSG) is a commonly used flavor-enhancer found in some soups and Chinese food.
  • Tyramines are natural compounds found in wines and aged foods (e.g., cheeses).
  • Phenylethylamine is a stimulant compound found in chocolate, garlic, nuts, raw onions, and seeds.

Food diaries: In order to identify nutritional triggers, experts suggest the use of food diaries because they are simple, inexpensive, and removal of trigger foods is associated with a reduction in migraine headaches. Food allergy and sensitivity testing to measure immunologic reactivity to foods may allow for identification of potential migraine triggers Dietary fasting In addition to the above triggers, dietary fasting for longer than 4 hours should also be avoided (when possible) since it has been linked to an increased risk of migraine

Here are ten quotes from great thinkers to challenge, motivate and inspire us to exercise, eat right and live healthier lives: Health and intellect are the two blessings of life.

  • "Physical fitness is not only one of the most important keys to a healthy body, it is the basis of dynamic and creative intellectual activity." - John F. Kennedy
  • “If you don't take care of this the most magnificent machine that you will ever be given...where are you going to live?” ― Karyn Calabrese
  • "A healthy attitude is contagious but don't wait to catch it from others. Be a carrier." - Tom Stoppard
  • "Everybody needs beauty as well as bread, places to play in and pray in, where nature may heal and give strength to body and soul." - John Muir
  • A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses. - Hippocrates
  • "The way you think, the way you behave, the way you eat, can influence your life by 30 to 50 years." - Deepak Chopra
  • “Life is a tragedy of nutrition” ― Arnold Ehret, The Definite Cure of Chronic Constipation: Also: Overcoming
  • “Health is the greatest possession. Contentment is the greatest treasure. Confidence is the greatest friend.” ― Lao Tzu
  • “According to the surgeon general, obesity today is officially an epidemic; it is arguably the most pressing public health problem we face, costing the health care system an estimated $90 billion a year. Three of every five Americans are overweight; one of every five is obese. The disease formerly known as adult-onset diabetes has had to be renamed Type II diabetes since it now occurs so frequently in children. A recent study in the Journal of the American Medical Association predicts that a child born in 2000 has a one-in-three chance of developing diabetes. (An African American child's chances are two in five.) Because of diabetes and all the other health problems that accompany obesity, today's children may turn out to be the first generation of Americans whose life expectancy will actually be shorter than that of their parents. The problem is not limited to America: The United Nations reported that in 2000 the number of people suffering from overnutrition--a billion--had officially surpassed the number suffering from malnutrition--800 million.” ― Michael Pollan, The Omnivore's Dilemma: A Natural History of Four Meals
  • “The doctor of the future will be oneself.” ― Albert Schweitzer

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