Migraines – Your Brain Being a Dick

So, full disclosure, even though I’ve always liked science, I really only got interested in it on a deeper level when I started getting migraines.

Looking back now, I’ve been getting them since I was probably eight or nine years old, but they were initially mild and infrequent. I assumed they were sinus headaches. When I was a sophomore in college, BAM – like a really shitty lightning bolt, I started getting them on what felt like a constant basis.

Nausea, diarrhea, light sensitivity, sound sensitivity, odor sensitivity, muscle cramps; you name it, I had it. My friends started forgetting what I looked like because I was spending so much time shut in my room with pillows jammed over my face. I went from adorably quirky (I think) to full-on mean and nasty. Everyone knew me as “the headache girl” (isn’t that everyone’s dream as a teenager?).

Not unreasonably, since I had turned into a miserable werewolf, well-meaning people started offering up all kinds of advice, some of it more fully-baked than others.

“Go see a doctor!”

“Go see a chiropractor!”

“Go see a snake shaman!”

“Stop eating gluten!”

“Try smoking weed! (cough) Here, you can have some of my joint.”

“I heard sex helps. You know, if you’re ever looking…”

By the time my problems came to a head, I was on both anti-seizure medicine and blood pressure medications, both serving as migraine preventives. I slept for 23 hours a day like a cat and still got 1-2 headaches a month. Anxious to try something, anything (except maybe the suspect propositions from my male colleagues), to give myself some semblance of a normal life, I decided to research alternative techniques myself. For those going through similar issues, here is what I came up with:

1. Gluten-free Diet.

Although modern science has put a man on the moon and grown an ear on a mouse’s back, the jury is still out on what, exactly, causes a migraine. According to the Mayo Clinic, the dominant theory is that migraines are caused by “changes in the brainstem and its interaction with the trigeminal nerve, a major pain pathway” (see source here). Imbalances in brain chemicals may also be involved; scientists believe that serotonin levels plummet during an episode, causing a release of neuropeptides to the meninges, the delicate covering surrounding the brain.

Perhaps this is where the dubious gluten connection comes into play; those continuing to claim gluten sensitivity (despite some rather compelling new research suggesting that it actually does not exist) feel that these wheat proteins cause inflammation and autoimmune distress. If inflamed meninges can cause migraines, could gluten not then be a trigger?

Well, maybe. A regular old Google search will turn up an abundance of articles claiming that there is a link between gluten and migraines. However, research supports this only in cases of migraineurs who go on to be diagnosed with celiac disease. A 2002 study by Gabrielli et al did find that a significant number of patients suffering from migraine also had celiac disease, and in those patients, a gluten-free diet was found to help their migraine symptoms.

For the average migraine sufferer, it may be worth your time to have celiac disease ruled out as a co-occurring condition – but, in the absence of that diagnosis, research doesn’t really support a gluten-free diet being a help to you.

However, if you are still convinced that something in a gluten-containing diet gives you headaches – by all means, cut it out for a few weeks and see if it helps. The placebo effect has long been documented to be real (cue eye rolling and screeching, but I’m not trying to be a dick). Basically, if you think your gluten-free, non-GMO, organic, everything-free whatever helps – just go with it. But if you’re not already on an altered diet and you’re looking for a sound cure method, I’d keep this one near the bottom of your list.

Grade: D+ 

2. Acupuncture

This is an area of alternative medicine that I find particularly interesting. I have never personally tried acupuncture, although I have had it recommended to me on multiple occasions. I also have several friends (some “earthier” than others, if you will) who swear that it cures everything from ear infections to unibrows. But I digress.

A 2008 study by Facco et al found that true acupuncture actually provided a statistically significant reduction in participants’ migraines, along with a subsequent reduction in the amount of Maxalt the patients were taking. A form of mock acupuncture provided a transient placebo effect, but over the study’s duration, only the actual acupuncture provided any benefit.

This study, also from 2008, also demonstrated some efficacy from true acupuncture treatments; however, after six months of treatment, participants receiving mock acupuncture were also showing improvement. This study, unlike the Facco study, was limited by a much smaller sample size, so any conclusions need to be taken with several grains of salt if you’re going to try to apply them to a larger group. Overall, it seems that both real and “sham” acupuncture helped improve migraines, demonstrating once again the power of the placebo effect.

As acupuncture becomes a more widely recognized treatment modality, it is becoming more affordable out-of-pocket. For someone with at least some discretionary income, or a larger healthcare budget, this might be something you want to try.

Grade: B+

3. Herbal remedies

Blahhh. I am always tempted to roll my eyes when someone suggests a new herbal remedy to me (“Oh my God, have you tried porcupine extract yet?”). For one thing, some of my social circle is actually into homeopathy, which is a whole different topic to go apeshit over, so I’ve been conditioned to just tune everything out while trying to keep my face from revealing how judgey I really am.

Furthermore, I’ll be honest – I kind of get scared. I worry, probably irrationally, that I’ll have some strange intolerance to whatever herb I’m ingesting, and I’ll end up dying in my sleep. “Well, at least she doesn’t have a headache anymore,” they can write on my tombstone.

However, there are a few herbs and supplements that actually might be somewhat legit, so if you aren’t a big baby like I am, you might want to consider them. This 2004 reanalysis of the data from a study in European Neurology shows that, in a small, placebo-controlled study, participants given butterbur extract demonstrated significant reductions in the frequency of their migraine attacks. Again, due to the small sample size, a lot more research is needed before any firm conclusions can be drawn – but it’s interesting nonetheless.

Speaking of more research, some good folks at the Canadian Medical Association Journal took it upon themselves to do some meta-analyses of existing research regarding migraine prophylactic medications, and herbal remedies were not left out. Their review found that, “based on two good-quality studies,” a 50mg twice-daily or 75mg twice-daily dosage of butterbur can actually help decrease migraines, with the only notable side effect being the Butterbur Burps.

In addition to information on butterbur, their review found one good-quality study demonstrating that riboflavin, at a dosage of 400mg per day, was significantly more effective than placebo. Another study found that magnesium citrate 600mg daily was significantly more effective than placebo. (Interestingly, magnesium is safe, although at a lower dose, for pregnant women or women trying to conceive – so this is an option for those having to get off of prescription meds because of babies.)

In terms of side effects – riboflavin had no more adverse effects than placebo, but those on magnesium did have “soft stools” or diarrhea (ew), two participants so badly that they discontinued the treatment.

So, overall – herbs and supplements may actually be a viable option for those suffering from migraines and looking for a more “natural” prophylaxis. The only limiting factor is small sample sizes – but, considering the lucrative possibilities of a successful migraine cure in the pharmacological world, I’m sure more research is  in the pipeline.

Grade: A- (but watch for side effects!)

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