the migraine solut

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the integrative approach to total well-being By disarming your triggers the natural way, you can alleviate — or even eliminate — these devastating attacks

tHERE'S NO MISTAKING A MIGRAINE, that is, unless you've come up with another explanation for the throbbing head pain, intense nausea, and sensory sensitivity that can last for days. Almost 30 million Americans — and three times more women than men — suffer from these debilitating attacks, reports the National Headache Foundation.

Migraine is actually a condition that has many symptoms, with severe headache as the most familiar. While it tends to run in families, the exact cause is unknown. A migraine may result when overactive nerve cells in the brain overstimulate blood vessels, leading to inflammation. Another theory is that migraines are jump-started by low levels of serotonin, a neurotransmitter that regulates pain perception. Also, fluctuations in estrogen and progesterone levels seem to prompt migraines, and women often report attacks just before or during menstruation, while pregnant, or once they enter menopause.

Hormones and heredity aside, migraine triggers include stress, smoking, skipping meals, sleep disruption, weather changes, intense odors or lights, and certain food ingredients (see page 56). With all these variables in play, it can take time to figure out which combination of therapies will work best for you.

classic or common
THERE ARE TWO types of migraine. The classic variety is accompanied by a neurological disturbance — an "aura" — that might consist of a quick flash of light, wavy lines, a blind spot, tunnel vision, and/or numbness or tingling in the extremities about 15 to 30 minutes before the headache hits. Sometimes the attack is signaled several hours or days prior by thirst, drowsiness, irritability, or a craving for sweets.

Most sufferers, about 80 percent, experience common migraines without the aura, says George Nissan, D.O., of the Diamond Headache Clinic in Chicago. But any migraine can be excruciating. The afflicted usually feel pulsating pain on one side of the head (though two-sided or shifting pain is possible), which may be accompanied by nausea, vomiting, and sensitivity to light, sound, and smell. Left untreated, a migraine typically lasts from four to 72 hours, followed by exhaustion and neck pain. Episodes can strike two to eight or more times per month or inconsistently through the year.

Over-the-counter pain relievers help control mild migraines by inhibiting inflammation. These include aspirin and other nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Nuprin, Motrin, Medipren) and naproxen (Aleve). Yet NSAIDs often cause gastrointestinal distress and rebound headaches, and should not be used more than two or three days a week, says Nissan.

To mitigate a migraine in progress, physicians frequently prescribe trip-tans like Imitrex, Amerge, and Axert. These selective serotonin receptor agonists are thought to work by reducing vessel dilation and inflammation and interrupting pain pathways. (Alternatives include Cafergot, an ergotomine derivative, and Midrin, which combines isometheptene and dichloralphenazone with acetaminophen.) To prevent the recurrence of migraines, some patients are given a beta-blocker like Inderal, which helps control blood pressure; others take calcium channel blockers, antidepressants, or anticonvulsants to lessen the frequency of occurrence.

going natural
EVEN IF MEDICATION works to ease migraines, it doesn't address the problems that may be behind the attacks, such as physical and emotional strain, physiological imbalances, food sensitivities, and nutrient deficiencies. This is where natural approaches can help most.

"Migraines inevitably have an underlying cause," says Zina Kroner, D.O., of the Huffman Center for Holistic Medicine in New York. "And complementary treatments work to identify the cause and address it."

Patients often confuse the role of complementary techniques because they're not quick-fix solutions — it can take several weeks or months to show results. "Natural treatments are sometimes abandoned prematurely," says Stuart Stark, M.D., director of the Neurology & Headache Treatment Center in Alexandria, Va. "But they can help people with minimal, if any, side effects."

A number of natural responses help prevent migraines or lessen their frequency and severity. Here's a roundup of those with the best track records and how — after you consult your physician — they may benefit you.

1 Massage
A migraine is sometimes ignited by muscular stress, which can be relieved by massage therapy, A study in the International Journal of Neuroscience found that regular massage greatly reduces the number and duration of migraines. Twice a week for about a month, subjects received a 30-minute massage focusing on muscles in the back of the neck, base of the skull, and head. Afterward, compared with a placebo group, the massage patients reduced their average number of monthly migraines from seven to two, with the typical duration cut in half from eight hours to about four.

At home, you can combine self-massage with aromatherapy. Massage the temples with a few drops of lavender or rosemary essential oil. Wholehealthmd.com suggests applying either oil (which you may want to blend with a carrier like sunflower oil) with your index fingers in circular motions. Start at the center of your forehead at the hairline and proceed to the temples, then continue to the area behind the ears and finally to the back of the neck. Repeat for a total of 10 minutes.

2 biofeedback
This behavior-modification technique employs sensors as well as imagery to measure your reactions to different Stressors; you then learn to alter and control your response to negative stress. Biofeedback has been used to treat about 150 ailments, and several studies have concluded that it can have a positive impact on migraine patients, especially when teamed with other relaxation treatments. Research on child patients published in Neurology found that thermal biofeedback — in which patients become aware of changes in skin temperature in response to stress — used in conjunction with a relaxation therapy like deep breathing resulted in the reduction of pain severity (from 5 to 4.5 on a 10-point scale), frequency (from 12.9 days per month to less than 10), and duration (from 6.9 hours to 5.2).

3 Herbs
Butterbur and feverfew are the two herbs most often used to control and prevent migraines; both have anti-inflammatory compounds. Of the two, butterbur (Petasites hybridus) has received the most scientific support. A 2004 report in Neurology observed that patients who suffered two to six migraines monthly cut their attacks by 48 percent after taking 75 milligrams of butterbur extract twice daily for four months; the only notable side effect was burping.

As for feverfew (Tanacetum parthenium), a recent German investigation found no significant preventive effects, yet earlier studies from the University of Nottingham in England and the London Migraine Clinic support its use to reduce migraine frequency and symptoms like vomiting. Anecdotal success is widely reported, and the herb has no major side effects (mild gastrointestinal distress is most often cited) — this makes it a popular migraine fighter, says herbalist Karta Purkh Singh Khalsa, co-author of Herbal Defense: Positioning Yourself to Triumph Over Illness and Aging. Typical doses range from 80 to 100 mg daily, yet Khalsa says a higher dosage — 500 to 1,000 mg — works better for some. (Check with your health practitioner.)

The herbal product MigraSpray (migraspray.com) combines feverfew with polyporus, goldenseal, and dandelion; in company-sponsored clinical trials it has shown efficacy rates of up to 90 percent in prevention and 88 percent in quick symptom relief. Goldenrod and dandelion are also in Migra-Zen Relief Plus (rznnutra.com), which adds in juniper, willow bark, and meadowsweet to decrease inflammation and relieve pain.

A popular migraine fighter in Traditional Chinese Medicine is the herb chuan xiong, says Yubin Lu, a doctor of TCM with the American Academy of Acupuncture and Oriental Medicine. In three published studies, Chinese researchers treated migraine patients with versions of the formula Chuan Xiong Cha Tiao San, which also contains angelica, licorice, and wild ginger. Response rates ranged from 88 percent to 94 percent.

4 diet
Some people can eliminate migraine by avoiding specific food chemicals, such as caffeine, the flavor enhancer monosodium glutamate (MSG), and the sugar substitute aspartame. Other possible triggers are tannins, which affect serotonin levels, and tyramines. The latter, along with related phenylethylamines and histamines, may trigger migraines by overexpanding small blood vessels, says Boston-based naturopath Cathy Wong, N.D., who suggests forgoing potential troublemakers (such as those listed below) for at least six weeks. This trial-and-error approach can pinpoint which foods could be related to your attacks; you can then cross them off your shopping list, or at least keep your intake to a minimum.

Tyramines: pickled and marinated foods, aged cheese, yogurt, beer, eggplant, citrus, bananas, avocado, chocolate, peanuts, beans (lima, navy, pinto, lentils).

Phenylethylamines: cheesecake, chocolate, red wine, canned berries.

Histamines: beef and pork, fish and shellfish, yeast, tomatoes (also sauces and paste), soy products (tempeh, tofu, miso).

Tannins: tea and coffee, red wine, black and red beans, pomegranates, bananas, eggplant, chocolate, nuts.

5 acupuncture
A 2004 study on the British Medical Journal Web site found that acupuncture coupled with medication significantly lessened the occurrence of migraine attacks. Subjects who received drugs plus 12 acupuncture sessions over three months had 34 percent fewer headaches, while the drug-only group reported a 16 percent reduction.

Acupuncture locates imbalances in migraine sufferers, often related to the liver or gallbladder meridians, or energy pathways, notes Marly Wexler, L.AC., a professor and clinical supervisor at the Pacific College of Oriental Medicine in San Diego. Points along those meridians are then manipulated to rebalance the body.

"A woman I treated used to go to the emergency room every month because of migraines," says Wexler. "After acupuncture treatments over a series of months, her migraine headaches stopped entirely."

Acupressure is potentially effective as well. To relieve distress, press the hollow between the front and back neck muscles (just behind the ear at the base of the skull) on the side where the pain is occurring. Press for three minutes, stop for two minutes, and repeat three to five times.

6 Supplements
Studies have found that drops in magnesium are common before or during migraine attacks. This essential mineral plays a role in nerve cell function and may alter serotonin levels, which could explain its impact. Supplementing with magnesium can provide relief. "It has an almost immediate effect in some patients," says Kroner. (The RDA is 320 mg for women, 420 mg for men.)

Riboflavin (B[sub2]) and vitamin B12 may also ward off attacks. These vitamins boost energy, and their effectiveness might be tied to the low mitochondrial energy metabolism seen in the brains of migraine sufferers, says Kroner. Although previous research found that 400 mg daily of riboflavin (more than 300 times the amount recommended for a healthy diet) can significantly reduce migraine frequency, a 2004 study in the journal Headache determined that 25 mg per day might also do the trick. The natural supplement MigreLief (migrelief.com) contains the larger dose of riboflavin, along with 300 mg of magnesium and 100 mg of feverfew.

Meanwhile, a study published in Cephalalgia found that 1 mg daily of vitamin B[sub12] cut migraines by more than half for 53 percent of those who had two to eight attacks per month.

7 yoga
If you suffer from migraines, the stress-reducing effects of a general yoga practice could prove advantageous. "Since stress is such a major contributor to migraines, anything that promotes relaxation can be beneficial," says Baxter Bell, M.D., a yoga teacher in Oakland, Calif. "But you want to ease into your practice and not jump right into poses that may cause strain and trigger an attack." He advocates a sequence that begins and ends quietly, with a gradual buildup to more challenging poses at its center. If you feel a migraine coming on, or are recovering from an episode, Bell suggests doing restorative poses to quiet the nervous system.

Particularly useful are asanas where the head stays above the heart, says Bell. "The point is to keep blood flowing away from the head to reduce pressure that may cause a migraine." He offers this variation of Supta Baddha Konasana (Reclining Bound Angle Pose), where the head is higher than the heart:

Fold a firm blanket into a 6-inch rectangle and place it lengthwise (in line with your spine), Have two pillows, blocks, or extra blankets handy.
Sit with your blanket behind you. Bring your legs into Cobbler's Pose, placing the bottoms of the feet together and dropping the knees out to the sides. Slip a pillow, block or extra blanket under each knee.
Lay back onto your blanket, turning the far end under to create a pillowlike lift for your head. Rest your arms out to the sides on the floor (at a comfortable angle, with your palms up), close your eyes, and enjoy for 10 to 20 minutes. There should be no pull on the inner thighs if you've set up correctly.
ayuRveda
While disorders in any of the three constitutions, or doshas, can cause migraines, they tend to be more common in people with a pitta predominance, says Mark Toomey, an ayurvedic consultant at The Raj Maharishi Ayur-Veda Health Center in Fairfield, Iowa. An ayurvedic practitioner can isolate which dosha is out of sorts and take steps to restore balance. For instance, since migraines are often associated with an imbalance in the fiery pitta dosha (associated with heat), you may need to "cool off" through diet (fewer warm, spicy foods) and lifestyle changes (less exertion and stress), and incorporate relaxation practices like pranayama (breath control) or pitta-soothing herbal formulas and ayurvedic treatments. Brahmi ghee (clarified butter cooked with Brahmi, a calming herb) is sometimes used to cool pitta; place five drops in each nostril and sniff.

9 tmj theRapy
Trouble with the temporomandibular joint, or TMJ, can lead to painful jaw clenching or teeth grinding; this aggravates the trigeminal nerve, disturbing blood vessels and setting off a migraine.

While stress reduction is useful, problem clenchers may benefit from the FDA-approved N.T.I, (Nociceptive Trigeminal Inhibition), a tiny plastic guard that stops teeth from clenching while you sleep. A 2001 trial led by Wesley Shankland, D.D.S., director of the TMJ & Facial Pain Center in Columbus, Ohio, found that 82 percent of N.T.I, users reported a 77 percent reduction in migraine symptoms after eight weeks. The device can be made in a dentist's office in about 20 minutes and costs from $600 to $800. For more information, visit headacheprevention.com.

PHOTO (COLOR): MAKE IT STOP! Combine herbs, vitamins, diet, yoga, TCM, and other options to get the most relief.

PHOTO (COLOR)

PHOTO (COLOR)

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By Matthew Solan

Illustrations by Hadley Hooper

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