Migraines: Treating the Underlying Causes

Expert reference: Dr Charles Matthews: North Carolina Comprehensive Headache Clinic

Underlying Cause #1:

Mitochondrial (battery of the cell) dysfunction: Dr Mathews has found excessive lactic acid leaking from mitochondria in most of his headache cases, and he addresses his treatments to restoring mitochondria function. See “Anti-Aging: Stop Cell and Mitochondria Free Radical Damage”

With the energy loss in a small area of the brain, Calcitonin Gene-Related Peptide (CGRP) is produced and causes  abnormal brain electrical activity that spreads like a thunderstorm or a wave through the rest of the brain. Your preventative treatments need to include these abnormalities as you try to keep the brain cell mitochondria energized, and the surrounding brain areas “calm:”

A. Supplements to repair and restore your mitochondria: Acetyl-L-Carnitine, Alpha Lipoic Acid, Resveratrol & others listed under 

See “Anti-Aging: Stop Cell and Mitochondria Free Radical Damage”

B. Supplements that can increase your gene (Nrf2) production of powerful free radical defenses: Turmeric, Cruciferous Vegetables, Wasabe, Resveratrol, Protandim

C. Magnesium, Taurine and B2 (Riboflavin): Calm the cell as they block abnormal ion channel pathways and improve cell enzyme function

D. Avoid excitotoxins in food: Reduce glutamate/NMDA stimulation by avoiding MSG and any other substances that cause you to have “attention-deficits,” to be over-reactive or “hyper,” after you consume them.

E. The most effective drug is currently the “Tryptan” family that work on the Serotonin system in your brain.

F. Await the upcoming drug approval of a Calcitonin Gene-Related Peptide blocker-One of the first stages of headache initiation.

Underlying Cause #2:

Food and environmental and sensitivities, trigeminal nerve and brain artery inflammation 

A. Elimination diet, desensitizing environmental or food “triggers,” or allergens

B. Anti-Seizure nutrients and meds

C. Reduce CSD (See above picture)

D. Reduce Trigeminal Nerve hyperactivity

  1. Triptan medication;

  2. Triptan combined with NSAIA or ASA (studies in progress);

  3. Diagnose and treat chronic microbial trigeminal infection or other causes of irritation to this area.

More Advanced Overview:

1) Find a Diet that Works Best for You

A study showed that migraneurs were 10 times more likely than the general population to have celiac disease, and a gluten-free diet improved blood-flow to the brain and either eliminated migraines or reduced migraine frequency, duration, and intensity.

A study of 10 patients with a long history of chronic headaches that had recently worsened or were resistant to treatment found that all 10 patients were sensitive to gluten. MRI scans determined that each had inflammationin their central nervous systems caused by gluten-sensitivity. Seven out of nine of these patients that went on a gluten-free diet stopped having headaches completely (R).

As mentioned above, many have foods or environmental factors (changes in barometric pressure, pollens, dust mites, molds & mycotoxins that are ‘migraine triggers’ (bananas, chocolate, nitrates, aged cheeses, red wine and others)

The single most important thing you should do is implement an “Elimination Diet” to discover underlying food intolerances and practice avoidance from these foods and/or obtain “antigens” which allergists and environmental medicine specialists use to stop “triggers.”

2) Avoid Sugar, Especially Fructose

 

MAPK plays a significant role in the inflammatory process that releases CGRP, which is a significant cause of migraines (R).  MAPK is caused by AGEs, which is caused by sugar, especially fructose.

3) Use a Stimulant

Many studies have shown benefits with consuming caffeine (R).  The same mechanism should apply to other stimulants.

You can take the following:

4) Stop Stimulation of CGRP and TNF-Alpha

 

IL-1b increases COX-2, which causes  the trigeminal nerve, which mediates pain, to release CGRP (R). Reduce IL-1b

TNF, another cytokine, can also increase the expression of the CGRP gene (R). iNOS, which is induced by TNF and NF-kb ( a transcription factor), also increases the expression of the CGRP gene (R).

Further supporting the role of inflammation, studies have found people with migraines are more likely to have a variation of the gene that makes TNF-alpha.  These people have the “TNF-α -308G/A polymorphism”, which is associated with migraine risk (R).  This variation makes these people have a larger spike of TNF in response to an injury, infection or inflammatory agent (R).

Almost all of the things that increase or inhibit TNF will also affect IL-1b and NF-kB in a similar way. See “Change

ICES is a great way to inhibit inflammation locally.

5) Take a Cold Shower

 

Cold causes vasoconstriction, perhaps as a result of cortisol and epinephrine release.

Some people with a headache report that they have frequently used the application of cold to relieve their headache.

The first cold treatment was done for headache patients in 1849. James Arnott wrote a manuscript on cold therapy in which he used a mixture of saltand ice in patients to treat headache (R).

A study testing cold application found it to be effective in some patients suffering from migraine attacks (R).

6) Use An Oxygen Concentrator

Oxygen causes vasoconstriction and is used by people with cluster headaches

Two types of oxygen therapy could some help for adults who suffer from a disabling migraine and cluster headaches. Reviewers concluded that hyperbaric treatment might give some relief for migraine headache and that oxygen therapy at normal room pressure might provide similar relief for cluster headache. (R)

7) Magnesium

Magnesium deficiency is present in up to half of migraine patients (R).

A lack of magnesium may promote cortical spreading depression, hyper aggregation of platelets, affect serotonin receptor function, and influence synthesis and release of a variety of neurotransmitters. (R)

Migraine sufferers may develop magnesium deficiency due to a genetic inability to absorb magnesium, inherited renal magnesium wasting, excretion of excessive amounts of magnesium due to stress, low nutritional intake, and several other reasons. (R)

There is strong evidence that magnesium deficiency is much more prevalent in migraine sufferers than in healthy controls. (R)

Double-blind, placebo-controlled trials have produced mixed results, most likely because both magnesium deficient and non-deficient patients were included in these trials. (R)

Nitric Oxide is one of the main mechanisms for vasodilation. Magnesium is essential for the removal of trapped NO from within the cell, which does not occur under low magnesium levels.

In addition, magnesium is an NMDA antagonist, which can block glutamate‘s excitement.

8) Take B Vitamins: B6, B12, Folate

Migraines have been linked to B6 deficiency (R).

Vitamin B6, like magnesium, modulates Nitric Oxide in the cell, which is another mechanism by which deficiency causes vasodilation.

Deficiencies in vitamins B6, B12 and folate result in hypomethylation, which triggers migraine (R).

People with the MTHFRC677T genotype produce higher levels of homocysteine (R), and this is implicated in migraine susceptibility, particularly migraine with auras (R).  People with this mutation especially benefit by taking B vitamins (R).

I recommend Nutritional Yeast for b vitamins.

9) Butterbur

As far as herbs go, butterbur has the most evidence for its effectiveness for migraine prevention (R).

10) Feverfew and Willow Bark

Feverfew contains parthenolide, which potently inhibits NF-kB.  It has some evidence for preventing.

Willow bark contains a chemical similar to aspirin (salicin).

One study found attack frequency was reduced by 57.2% at 6 weeks and by 61.7% at 12 weeks in nine of ten patients (R).

11) CoQ10

Deficiency of CoQ10 may be common in pediatric and adolescent migraine. (R)

In a clinical trial, improvements were seen in weeks 1-4 and the study concludes that CoQ10 may lead to earlier improvement in headache severity.  However, at day 224 there was no difference. (R)

12) Cannabis

Cannabis was a standard treatment for migraines from 1874 to 1942 (R).

Cannabis is a known as a powerful pain reliever, for all kinds of pain.

It has been reported to help people through an attack by relieving nauseaand dulling the head pain, as well as possibly preventing the headache completely when used as soon as possible after the onset of pre-migraine symptoms, such as aura (R).

13) Cruciferous vegetables

Since migraines are much more common in women, likely because of hormones like estrogen, it may be wise reducing these levels by taking in lots of cruciferous vegetables, especially broccoli sprouts.  DIMI3C, and calcium-d-glucarate may also bring down estrogen levels.

14) 5-htp (serotonin precursor)

Serotonin is a vasoconstrictor.

One study found significant improvement was observed in 71% of the cases treated with 5-HTP. The most beneficial effect of 5-HTP appears to be felt with regard to the intensity and duration rather than the frequency of the attacks. (R)

15) Adrenal Glandular

The adrenal glands contain cortisol and norepinephrine.  Both of these are vasoconstrictors.

Cortisol also suppresses inflammation (TNF, IL-1b).

16) Aspirin

Aspirin inhibits COX-2, which is what releases CGRP.  Aspirin causes vasodilation, so it should be used more as a preventative.

Aspirin works better for vasoconstriction headaches.

17) TENS Device

TENS is the only device approved by the FDA for use.

The agency evaluated the safety and effectiveness of the device based on data from a clinical study conducted in Belgium involving 67 individuals who experienced more than two migraine headache attacks a month.

The 67-person study showed that those who used Cefaly experienced significantly fewer days with migraines per month and used less migraine attack medication than those who used a placebo device. The device did not completely prevent migraines and did not reduce the intensity of migraines that did occur. (R)

18) tDCS

Multiple studies show tDCS has beneficial effects for migraines (R).  This is something that migraine sufferers should try.

People with a chronic migraine have a positive, but delayed response to anodal tDCS of the primary motor cortex. (R)

One study concludes that clinical effectiveness of tDCS with 70-150 μA current for 30-45 min via 6.25 cm(2) stimulating electrodes is comparable to that of modern pharmacological drugs, with no negative side effects.  The obtained result was maintained on average from 5 to 9 months. (R)

I’ve zapped my brain with this probably a dozen times, though I don’t have a need for it currently.

19) Increase Your Natural Opioids

Our opioid system is the natural way our body reduces pain.  So I recommend reading my post on how to change/increase this system naturally.

20) “Shroom”

The active ingredient in magic mushrooms, psilocybin has some studies that show it’s effective for cluster headaches.  (R)

This is because it reduces blood flow to the areas where there’s too much vasodilation in people with cluster headaches.  This may not occur with other types of headaches.

Actually, it can increase some types of headaches by increasing nitric oxide. So this is to be used for cluster headaches only.

21) Potassium (will increase aldosterone)

Potassium increases aldosterone, which is a vasoconstrictor.

For potassium, you can eat potatoes, avocadoes, dates, bananas, tempeh and veggies.  This approach is theoretical and there’re no studies.

You can also take a Potassium supplement, but use care.

22) Licorice Root

I only recommend this for exercise headaches, which are often caused by low sodium.

My exercise headaches were caused by an aldosterone insufficiency (caused by too much ACE inhibition, low aldosterone, and other endocrine abnormalities), which excreted sodium from my body when I exercised and specifically when I sweated.

This loss of sodium put me in a quasi-hyponatremic state, which caused a vasodilatory headache.

Licorice root powder stops the breakdown of cortisol and aldosterone, causing increased vasoconstriction.

Since fixing my underlying issues, I don’t get exercise headaches, but until I did I only needed to take Licorice root powder and I was fine.

 

23) Hi-Maize Resistant Starch

Resistant starch is a fiber that digests in your large intestine to produce butyrate. One study found that resistant starch consistently produces more butyrate than other types of dietary fiber (R).

Butyrate increases mu-opioid receptors (R), which is useful for pain relief.

Butyrate is, more importantly, a powerful HDAC inhibitor, which acts via the same mechanism as valproic acid/depakote.  HDAC inhibitors uncoil histones and epigenetically express genes.

HDAC Inhibitors are mood stabilizers, anti-epileptic, anti-cancer and anti-inflammatory. (R)

Valproic acid is effective for migraine prevention (R) and it’s hypothesized that changing our expression of genes via HDAC inhibition (Epigenetics) accounts for this (R).

Butyrate increases the protein CREB, which increases expression of BDNF, a neurotrophic factor.  These mechanisms help in producing an anti-depressant effect.

Other significant effects for resistant starch include better gut health, decreased glycemic response, increased satiety, weight loss, increased insulin sensitivityincreased wakefulness and eye health (R).

 

For Vasoconstriction Headaches: Tension Headaches

A protocol for vasoconstriction headaches would require a vasodilator such as:

24) Destress

Stress increases cortisol and norepinephrine, which increases vasoconstriction

25) Exercise

Exercise is a potent vasodilator.  Exercise would probably help all types of headaches, but especially vasoconstrictive ones.

26) Heat (such as a hot shower or sauna)

Heat is a potent vasodilator.

27) Sex or Masturbation

Sex increases vasodilation.

28) Anti-inflammatories

The anti-inflammatory I prefer most is Longvida Curcumin.

29) Ginko and Vinpocetine

Ginkgo (preferable) and Vinpocetine increase brain blood flow and vasodilation.  They work.

30) Laser Therapy

LLLT increases nitric oxide and potently increases vasodilation, in addition to dampening inflammation.

31) Meditation

Stress is a well-known trigger for headaches and research supports the general benefits of mind/body interventions for migraines.

In a recent study, nineteen adults were randomly assigned to two groups with 10 receiving the Mindfulness-Based Stress Reduction (MBSR) intervention and nine receiving standard medical care. The participants attended eight weekly classes to learn MBSR techniques and were instructed to practice 45 minutes on their own at least five additional days per week.

The MBSR participants had 1.4 fewer migraines per month that were less severe, effects that did not reach statistical significance. The participants’ headaches were significantly shorter as compared to the control group. (R)

The following are based on MBSR: Jon Kabat Zinn – Where ever You Go, There You Are and Mindfulness for Beginners…

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