By Dr. Mercola
Migraines affect an estimated 38 million Americans.1 They can strike both young and old, but a majority of sufferers are women, and/or between the ages of 35 and 55.2
Worldwide, as many as 1 billion people are affected,3 making migraine the third most prevalent illness in the world. Yet, despite its prevalence, researchers still struggle to understand exactly how and why migraines occur. Adding to the complexity, there are several different types of migraines, including:4,5
✓ With aura
✓ Without aura
✓ Status migrainous
What Sets Migraine Apart From Other Headaches?
Migraine attacks are typically recurring, of moderate to severe intensity, many times occurring only on one side of your head.
Along with throbbing, piercing or "burning" pain, other common symptoms include nausea, visual disturbances, dizziness, numbness in your extremities or face, and extreme sensitivity to light, sound, smell and touch.6
An attack may last from a couple of hours to as long as three days, often requiring bed rest in complete darkness and silence.
Generally speaking, migraine is thought to be a disorder of your central nervous system, most likely originating in your brain stem.7 While most brain regions do not register or transmit pain signals, the trigeminal nerve network does.
Pain is relayed through the trigeminal network to an area in your brain stem called the trigeminal nucleus. From there, it is conveyed to the sensory cortex in your brain that is involved in awareness of pain and other senses. However, what initially activates your trigeminal nerve to set off your migraine is still under debate.
One hypothesis is that a wave of neurotransmitters racing across your cortex can directly stimulate your trigeminal nerve, setting off a chain reaction that ends in the transmitting of pain signals.
In all likelihood, there are several mechanisms at play. We know, for example, that migraine is more common in women than men, and this has been linked to hormonal influences.
What Does a Migraine Feel Like?
A migraine is more than just a bad headache.8 In a recent Greatist article, migraine sufferers were asked to describe their pain. Here are some of their answers:9
• "My head feels like it's in a vise." Triggers often include stress,10 weather changes, physical exertion, lack of sleep and/or eating the wrong foods. Artificial sweeteners11 such as aspartame are also known to commonly trigger migraine.
Doctors suggest keeping a food diary to track the emergence of symptoms to pin down certain food triggers. You could do the same for weather and stress if you believe such factors may play a role.
• It's "like when a light fixture starts to go out." This patient is describing the effects of ocular migraine, the onset of which often starts with flickering or flashing light phenomena, or zigzagging lines in the peripheral vision, which can eventually take over the entire field of vision.
These visual disturbances are referred to as an "aura." Other common auras include blind spots, blurry, wavy or kaleidoscope vision. Auras can also involve other senses.
For example, you may experience paresthesia (tingling or numbness), aphasia (trouble speaking), auditory hallucinations or smelling something that isn't there.
Approximately one-quarter of all migraines are accompanied by aura, which is thought to be caused by a chemical or electrical wave in the brain region that processes sensory signals.12
• "It's like I've been staring at the sun." Oftentimes, the entire head, from the neck up, can feel overworked, "battered and bruised," or like your brain has been pounded with a hammer. Post-symptoms can also include a stiff neck for up to a day after the headache ends.
• "Like I'm on a ship during a storm." Nausea and a feeling of being in motion is also common.
Some Migraines May Indicate a More Serious Blood Vessel Problem
One long-held theory was that a migraine is caused by vascular changes in your brain, from initial blood vessel constriction and a drop in blood flow, followed by dilation and stretching of blood vessels, which activates pain-signaling neurons.
Newer studies have negated this theory, however, as researchers determined migraines are not actually preceded by constriction and decrease in blood flow, but rather by a blood flow increase of nearly 300 percent.
Despite that, circulation appears normal, or even slightly reduced, once the attack is in full swing. The question remains: Why? One small observational study13 found that migraineurs tend to have a different blood vessel structure in their brains compared to those who do not get migraines.
Using magnetic resonance angiography, the researchers examined the structure of blood vessels and the changes in cerebral blood flow, focusing on a system of arteries that deliver blood to the brain called "circle of Willis."
They found that an incomplete circle of Willis was significantly more common in those who get migraines, with or without aura, compared to the control group (73 percent and 67 percent versus 51 percent, respectively).
As a result, compared to those with a complete circle of Willis, those with an incomplete circle had greater asymmetry in hemispheric cerebral blood flow. According to one of the authors of the study, Dr. John Detre, a professor of neurology and radiology:14
"Abnormalities in both the circle of Willis and blood flow were most prominent in the back of the brain, where the visual cortex is located. This may help explain why the most common migraine auras consist of visual symptoms such as seeing distortions, spots or wavy lines."
Interestingly, recent research15 suggests some migraines — primarily migraines without aura — may even be caused by a tear in your neck artery (arterial dissection), which raises your risk of stroke.
Compared to people who had migraine with aura, those without aura were 1.7 times more likely to have an arterial tear. Arterial dissection and stroke was also more likely in men and those under the age of 39. Overall, your probability of having this problem is very low, but it may be worth getting it checked out if you fall into a high-risk category.
Nutrient Deficiencies Linked to Migraine
Nutritional deficiencies can contribute to or cause a number of different health problems, including migraines. In the video above, "America's pharmacist" Suzy Cohen discusses drug-free solutions for migraine and headache relief, including nutritional supplements. Nutrients of particular importance here are vitamin D,16 magnesium, Coenzyme Q10 (CoQ10) and riboflavin (vitamin B2), and deficiencies in one or more of these is quite common.
In a migraine study17 involving more than 7,400 children, teens and young adults, 16 to 51 percent of participants had below average levels of vitamins depending on the vitamin tested.18 Those suffering from chronic migraines were overall more likely to have CoQ10 and riboflavin deficiency compared to those with episodic migraines.
Unfortunately, many of the patients in this study were prescribed preventive therapy and too few were given supplements alone for the researchers to determine if supplementation was enough to actually prevent migraines.19 However, other research suggests they can.
For example, research using vitamin D supplementation demonstrated a reduction in C-reactive protein (CRP) and a statistically significant reduction in headache frequency.20 Another more recent study by Finnish researchers found that men with the lowest vitamin D levels were twice more likely to suffer frequent headaches than those with the highest levels.
Overall, the lower the men's blood level of vitamin D, the more frequent their headaches. Those with a vitamin D blood level of 15.3 nanograms per milliliter (ng/mL) or lower typically had one or more headaches per week, while those with a level of 11.6 ng/mL or lower reported up to seven headaches per week. Ideally, your vitamin D level should be in the 40 to 60 ng/mL range, so both of these groups were severely deficient. As reported by Deming Headlight:21
"The researchers theorized that vitamin D has anti-inflammatory properties that prevent swelling in the sensory neurons and the microglial cells in the brain and is essential for proper brain function. In the study information, they also note that previous studies show vitamin D prevents musculoskeletal pain, a major cause of tension headaches."
According to research presented at the 50th Annual Meeting of the American Headache Society22 in 2010, nearly 42 percent of patients with chronic migraine were deficient in vitamin D. The study also showed that the longer you suffered from chronic migraines, the more likely you are to be vitamin D deficient.
Magnesium Is Empirically Recommended for All Migraine Sufferers
Magnesium — which can affect both serotonin receptor function and the production and use of neurotransmitters — has also been shown to play an important role in the prevention and treatment of migraines, and migraine sufferers are more likely to suffer from magnesium deficiency than non-migraineurs.23
Researchers theorize that migraine sufferers may develop magnesium deficiency from a variety of reasons, including poor absorption, renal wasting, increased excretion due to stress or low nutritional intake. Since magnesium administration is both easy and safe, researchers have noted that empiric treatment with a magnesium supplement is justified for all migraine sufferers.24
As a prophylactic, be prepared to boost your magnesium intake for at least three months to experience results, ideally in combination with CoQ10.
In many cases, receiving a high dose of magnesium can also abort an attack in progress. The most effective way to administer magnesium for migraine would be to get an intravenous (IV) infusion. I used to regularly administer magnesium IVs for those with acute migraines and it seemed to work for most patients to abort the headache.
Barring that option, magnesium threonate may be your best option for an oral supplement. It has superior absorbability compared to other forms of magnesium, and since its ability to cross the blood-brain barrier makes it more likely to have a beneficial effect on your brain.
B Vitamins Are Also Important
Besides CoQ10, magnesium and vitamin D, other vitamin deficiencies linked to migraines include riboflavin (B2), B6, B12 and folic acid. One 2009 study25 evaluated the effect of 2 mg of folic acid, 25 mg vitamin B6 and 400 micrograms (mcg) of vitamin B12 in 52 patients diagnosed with migraine with aura.
Compared to the placebo group, those receiving these supplements experienced a 50 percent reduction in migraine disability over a six-month period. Previous studies26 have also reported that high doses of riboflavin can help prevent migraine attacks. For example, in one study patients who received 400 mg of riboflavin per day experienced a 50 percent reduction in migraine frequency after three months.
Are You Eating Plenty of These Foods?
Although supplements are convenient, it's important you get as many nutrients from your diet as possible, as your body can metabolize and absorb vitamins and minerals from your diet more effectively and efficiently than from most supplements.
In addition to adding foods rich in magnesium, riboflavin and CoQ10 to your daily diet, look for organic, grass fed products to reduce your exposure to toxins and additional stressors. As for vitamin D, sensible sun exposure is your best bet. If you opt for a vitamin D3 supplement, be sure to increase your vitamin K2 and magnesium as well.
Are Migraines a Mitochondrial Problem?
The fact that nutritional deficiencies worsen migraine and supplementation can ease it lends support to the theory that migraines are a mitochondrial disorder.30 Ubiquinol — the reduced form of CoQ10 — plays a vital role in ATP production, which is the basic fuel for your mitochondria.
Your body does produce ubiquinol naturally; in fact it is the predominant form in most healthy cells, tissues and organs. However, with rampant pollution and poor diet, mitochondrial dysfunction has become increasingly common, warranting supplementation with either ubiquinol or CoQ10.
One study published in the journal Neurology31 found that CoQ10 was superior to a placebo in preventing migraines and reducing severity. Of the patients who received 100 milligrams (mg) of CoQ10 three times a day, 50 percent reported significantly reduced frequency of headaches compared to only 14 percent of those who took the placebo. Other research has shown that ubiquinol is far more effective than CoQ10 due to its superior bioavailability, so while it costs more, it may provide you with better results.
That said, while ubiquinol may be beneficial, for long-term migraine relief you really need to address your diet in a more comprehensive manner. One of the most effective strategies to optimize your mitochondrial function is nutritional ketosis and, indeed, a ketogenic diet may be quite beneficial if you struggle with migraines. As explained by the Migraine Relief Center:32
"The links between diet and migraine are well established. Most migraineurs recognize certain foods that either trigger an attack or make an episode worse … The ketogenic diet, while not new, has been found to have a beneficial effect for some migraine patients, and research into how this diet works provides interesting links to migraine causes that may encourage sufferers to experiment …
Ketones are produced when the body burns fat for energy instead of carbohydrates (glucose). A ketogenic diet is very low in carbohydrates … Anti-seizure medications originally intended for those with epilepsy are often prescribed to migraine sufferers.
These medications typically block glutamate (a neurotransmitter), high concentrations of which are often found in both migraine and epilepsy patients. As ketones block high concentrations of glutamate, a ketogenic diet can have a beneficial effect for migraine sufferers."
This is another reason to consider picking up a copy of "Fat for Fuel" that teaches you in great detail how to shift your body to burn fat as your primary fuel and generate ketones, which improve mitochondrial function just like CoQ10.
But there are many other biohacks to improve this as well, including exercise, cold thermogenesis, infrared light and optimally cycling your eating between feast and fasting modes. Keeping your mitochondria functioning at their highest level will not only prevent migraines but also cancer, heart disease and neurodegenerative diseases like Alzheimer's, ALS and Parkinson's.
Migraine Prevention 101: Avoid Triggers
Migraine medications only work about half of the time in 50 percent of those taking them. They can also cause severe side effects, including medication overuse headache, which often occurs when you take too much or use it too frequently.
Worse yet, if you take tryptamine-based drugs (which bind to serotonin receptors to constrict your cranial blood vessels) but your pain is not due to engorged blood vessels, then constricting them can potentially do harm. Serious cardiovascular events, including heart attack and stroke, are in fact side effects of these types of drugs.
Your best bet, really, is to try to pin down the root causes of your migraine rather than rely on medication each time one strikes. Your first step would be to avoid any potential triggers. While there are many (and what triggers a migraine for one might not trigger it in another), the following are some of the most common. Keeping a journal where you record and track suspected triggers can help you determine any correlations:
✓ Food and drink, especially wheat and gluten, dairy, cane sugar, yeast, corn, citrus, eggs, artificial preservatives or chemical additives, cured or processed meats, alcohol (especially red wine and beer), aspartame, caffeine and MSG.33,34
✓ Allergies, including food allergies35 and food sensitivities and chemical sensitivities. Research published in the journal Lancet back in 197936 showed migraineurs with food antigen immunoreactivity experienced profound relief when put on an elimination diet.
Another randomized, double-blind, cross-over study published in 201037 found that a six-week-long diet restriction produced a statistically significant reduction in migraines in those diagnosed with migraine without aura.
If you suspect you might have a food allergy, I suggest doing a diet elimination challenge to see if your symptoms improve. Keep in mind that depending on your typical migraine frequency, you may need to avoid the suspected food for a few weeks in order to evaluate whether it had an effect or not.
To confirm the results, reintroduce the food or drink on an empty stomach. If the suspected food is the culprit, you will generally be able to feel the symptoms return within an hour, although migraines can sometimes have a longer lag time than, say, bloating or drowsiness.
✓ Hormones: Some women experience migraines before or during their periods, during pregnancy or during menopause. Others may get migraines from hormonal medications like birth control pills or hormone replacement therapy.
✓ External stimuli: Bright lights, fluorescent lights, loud noises and strong smells (even pleasant ones) can trigger and/or exacerbate a migraine. Blue light in particular can be problematic. Many digital devices and LED light sources emit mostly blue light.
Research has found that this light increases your migraine pain and activates your trigeminal nerve, associated with the pain of migraines.38 Meanwhile, green light may help ease migraine pain and photosensitivity.39
✓ Changes in sleeping cycle, either missing sleep and oversleeping.
✓ Stress/Post-stress. Any kind of emotional trauma can trigger a migraine, even after the stress has passed.
✓ Dehydration and/or hunger. Skipping meals or fasting are also common triggers.
✓ Physical exertion: Extremely intense exercise, or even sex, has been known to bring on migraines.
✓ Weather changes, and/or changes in altitude.
Acupuncture and Chiropractic May Be Helpful Adjuncts to Migraine Treatment
While I believe cleaning up your diet (avoiding food triggers and allergic ingredients, and going ketogenic, which I explain in great detail in my new book, "Fat for Fuel") and avoiding other triggers listed above, acupuncture may be a helpful adjunct therapy. Recent research found getting regular acupuncture treatments helped reduce the frequency and severity of migraine attacks in those suffering from migraine without aura.40,41,42
In all, 249 adult migraineurs who reported two to eight migraine attacks per month were included in the study. They were randomly assigned to receive either 20 real acupuncture treatments or 20 sham treatments over four months.
Among those receiving the real treatment, migraine frequency declined by about three episodes per month, while the sham group had two attacks less per month. According to the authors, "Acupuncture should be considered as one option for migraine prophylaxis in light of our findings."
It's interesting to note that even sham treatment had a significant response. Indeed, previous research has shown the placebo effect can be a potent tool in the prevention and treatment of migraines and other types of pain. As noted by neurologist Dr. Amy Gelfand, while the placebo response is troublesome for researchers, it can be a very beneficial effect for patients, especially when the treatment is otherwise safe, be it acupuncture or sugar pills.43
Chiropractic adjustments have also helped many patients, but not all chiropractors are skilled with the techniques to address migraine, so before you schedule an appointment it is important to confirm that your chiropractor has significant experience in helping people treat their migraines.