Migraine Headaches

Q: My neurologist wants to put me on calcium channel blockers for my migraines, which I get several times a month. I don't want that, but I wonder what else to do. Imitrex etc. did not work too well either, and I have tried feverfew, magnesium, and B-2 without success.

A: Migraine headaches are a complex problem. They are probably caused by a combination of factors including some sort of blood vessel constriction and dilation, excess release of serotonin by platelets in the blood (causing blood vessel constriction and relaxation), excess release of substance P (which causes pain) and histamine, and low brain serotonin levels (which decreases pain tolerance). Many factors can trigger a migraine including low serotonin levels, food allergies, histamine containing foods, alcohol, food preservatives like nitrates, MSG, caffeine withdrawal, stress, intense emotions, hormonal changes, sleep excess or deficiency, muscle tension, eye strain and weather changes.

The most common food allergens in migraine sufferers are cow's milk, wheat, chocolate, eggs, citrus fruit and tomatoes. Allergies to benzoic acid (a preservative) and tartrazine (a food dye) are also common. Foods that contain histamine or cause the body to release histamine include chocolate, cheese, beer and wine. Elimination of food allergies and histamine increasing foods should be helpful for most migraine sufferers.

Magnesium is probably only helpful for patients with low tissue magnesium levels. Oral supplementation will help these patients by decreasing the frequency of headaches, while IV magnesium will relieve acute headache in 90%.

Stress management with biofeedback and relaxation training has been shown in many studies to reduce both frequency and severity of migraines. Manipulation, TENS and acupuncture have all been helpful in some patients.

Feverfew is useful as a preventative treatment, reducing frequency and severity of the headaches. It must be used on a daily basis over time to see results. Either freeze-dried herb or a standardized extract should be used. A well known headache specialist in Chicago uses feverfew along with caffeine to treat his patients. Ginger may be helpful for both prevention and treatment of acute headache.

There are many medications which are used to treat migraines. Imitrex is one which helps many people. It stops the acute pain and can be used as an injection, orally or as a nasal spray. A friend of mine with a long history of migraines is having good results with a combination of an antidepressant and a beta-blocker. He started this therapy when his use of Imitrex was up to several times a week and his doctor was concerned about his risk for heart problems. Some people have fairly good success with narcotic painkillers for relief of the acute headache, but too frequent use may result in dependence on them. I have not heard of using calcium channel blockers, but your neurologist probably has information that I don't.

Because migraine headaches, especially if they are frequent can be quite debilitating, I would suggest a comprehensive approach, utilizing dietary restrictions, supplements, stress management, manipulation, massage or TENS to relieve muscle tension along with medication. Work with your neurologist to find what medication or combination of medications works best for you.

* The information presented in this web site is intended to inform and educate. It is not intended replace a qualified medical practitioner to diagnose or treat medical conditions.