A throbbing, recurring headache, typically affecting only one side of the
head. Onset is sudden, and pain is usually severe. Visual, auditory,
neurological, or gastrointestinal symptoms may appear 10 to 30 minutes before
head pain or may accompany the headache. Duration may be from a few hours to
several days. True migraine headaches affect approximately 11% of the population
and are more common in females than males. True migraine is consistently present
with aura, which provides warning of the upcoming attack. Migraines may begin at
any age; they are most common between age 10 and 30 and may vanish after age 50
or, in women, after menopause.
Blood vessels to the brain and scalp constrict and then dilate, irritating
surrounding nerves and resulting in pulsating or pounding pain with blood flow.
The underlying etiology is not known. Possible causes include the
- Abnormal blood levels of serotonin, a neurotransmitter that may
- Vasoactive medications such as drugs to treat hypertension, angina,
- Hypersensitivity to certain foods or odors, missed meals, excessive
sun exposure, altered sleep patterns, alcohol consumption
- Menstruation, hormonal changes
- Malformed cranial blood vessel
- Female gender
- Family history of migraine
- History of motion sickness, recurrent vomiting spells
- Patients who chronically suffer from migraine headaches have levels
of blood magnesium well below normal levels
|Signs and Symptoms|
The following symptoms may vary between patients but usually remain
consistent in individuals.
- Aura preceding headache, irritability, restlessness, hearing or
vision disturbances, numbness, weakness, or tingling sensations may precede head
pain by 10 to 30 minutes or may be present with headache
- Severe, throbbing, usually unilateral headache
- Headache accompanied by increased sensitivity to light and
- Headache persists for hours and if untreated may last days
- Pounding pain worsens with movement or bending
- Nausea, vomiting
- Near-syncope, vertigo
- Feet and hands may be cold and cyanosed
- Scalp arteries may be
- Brain tumor or brain abscess
- Systemic disease
- Meningitis or meningeal irritation
- Seizure disorder
- Subarachnoid hemorrhage
- Subdural hematoma
Patient describes migraine symptoms, without intracranial pathologic
No laboratory tests are available to diagnose migraine. Lumbar puncture to
rule out meningitis/encephalitis. Assessment of thyroid function is essential.
Headaches, menstrual cramps, constipation, and depression are some of the hidden
symptoms of functional hypothyroid, even in the presence of normal thyroid
Intracranial blood flow changes.
Usually not appropriate. Some migraines can mimic strokes, and cause
one-sided numbness or paralysis. The first episode of these types of migraines
should be evaluated with an MRI.
- Careful patient history should note characteristics of headache,
timing, frequency, duration, and possible triggers.
- Positive response to a migraine drug will confirm diagnosis of
Treatment varies according to the severity of the migraine attack. Proper use
of analgesics should be explained to patients to help prevent rebound headaches
from overuse. Cold compresses to forehead and eyes, complete immobility, and
minimalization of light, noise, and odor are management
There is no simple drug of choice.
For mild migraines: Aspirin (600 to 1,000 mg every four hours), ibuprofen
(800 mg followed by 400 mg every 4 hours), naproxen (500 mg), and codeine may be
sufficient if taken early in attack.
For moderate migraines: NSAIDS, ergotamines
(dihydroergotamine—DHE, particularly ergotamine
combined with anti-emetic), ergotamine suppositories (1/2 up to 2 suppositories
For severe migraines:
- First treatment: DHE by subcutaneous, intramuscular, or intravenous
injection, or sumatriptan (orally or subcutaneous injection); if an IV line is
used, 10 mg IV metoclopramide is recommended. If ineffective after 20 minutes,
0.5 to 1.0 mg of DHE may be added intravenously up to a maximum dose of 2 mg
over three hours.
- Other options include: chlorpromazine (0.1 mg/kg intravenously) may
be given over 20 minutes and may be repeated after 15 minutes, to a maximum dose
of 37.5 mg; saline (5 ml per kg of body weight or 50 mg intramuscularly) should
be given to prevent hypotension; prochlorperazine may be given rectally (25 mg),
intravenously, or intramuscularly (5 to 10 mg); ketorolac (39 to 60 mg
intramuscularly) or dexamethasone (12 to 20 mg intravenously) may be given in
Other treatment options include intranasal lidocaine.
|Complementary and Alternative
These therapies may be quite useful in decreasing the frequency of migraines.
Some homeopathics may be helpful in the acute stage, but most acute migraines
require greater pain relief than alternative therapies have to offer. It is
often helpful to differentiate migraines in treating them with complementary
therapies. Diet and allergy elimination have offered great relief to some.
Hormone balancing can be quite helpful for cyclic migraines. Just as the
specific symptoms of a migraine are often unique to the individual, the specific
treatments that are most effective may be a unique combination for each patient.
A combination approach of drugs for pain relief and complementary therapies to
reduce recurrence can offer effective management of migraines. Some patients
receive significant relief with chiropractic treatment.
Biofeedback: to control vascular contraction and dilation and improve stress
management; may influence both the frequency and the intensity of
- Allergy identification and elimination: Elimination/challenge diets
have been shown to effect a 30% to 93% decrease in migraines. Patient eliminates
suspected food allergens for two weeks and then reintroduces the foods and/or
additives, noting the response. Once the offending agents are identified, they
generally need to be eliminated for six months, and then they may be
reintroduced. While effective, elimination/challenge diets are more challenging
in hormonally influenced migraines. Some common allergens are alcohol
(especially red wine), cheese, chocolate, citrus, cow's milk, wheat, eggs,
coffee, tea, beef, pork, corn, tomato, rye, yeast, and shellfish. Food additives
(preservatives and coloring) and nitrates are also common irritants.
- Caffeine should be avoided due to its vasoactive effects.
- Essential fatty acids (1,500 and 3,000 mg/day) regulate platelet
aggregation and arachidonic acid metabolites, and may be very helpful for all
migraines. Dietary manipulation includes reducing animal fats and increasing
fish. Supplementing with fish or flaxseed oil (1 to 3 mg bid) may also be
- Magnesium (500 mg/day) minimizes nerve excitability and increases
muscle relaxation. Since magnesium-deficient people are more subject to vascular
headache, adequate intake from food or supplements is essential. Excess
magnesium may cause diarrhea in sensitive individuals. The diarrhea resolves
with cessation of magnesium. Patients with a heart block without a pacemaker
should refrain from high doses of magnesium.
- Intravenous injection of 1,000 mg of magnesium by a physician can
terminate an acute migraine headache within minutes (in up to nearly 100 percent
of subjects in some reviews).
- IV injection of folic acid (15 mg) in one study achieved total
subsidence of acute headache within one hour in 60 percent, with great
improvement in another 30 percent. These two agents are strikingly
- Omega-3 oils (EPA and DHA, average dose 14 g daily) greatly reduce
intensity and frequency of migraines.
- Vitamin B2 (riboflavin) (400 mg/day for three months) has been shown
to reduce migraine frequency by two-thirds.
- Vitamin C (2,000 mg/day), vitamin E (400 to 600 IU/day), vitamin B6
(100 mg/day), choline (100 to 300 mg/day), and mixed flavonoids (1,000 mg/day)
all inhibit the tendency to high platelet adhesion rates in migraine.
- 5-hydroxytryptophan (300 mg bid) works as well as methysergide for
prevention of migraine, enhanced by taking with 25 mg of vitamin
Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
- Feverfew (Tanacetum parthenium): Studies show that feverfew
cuts the frequency of migraines (25% to 70% in some studies); this may possibly
be by suppressing the release of inflammatory prostaglandins and histamines.
Feverfew also inhibits platelet aggregation. Feverfew helps with both frequency
and intensity of migraines. Dose is two fresh leaves daily, dried herb capsules
(250 to 300 mg bid), or 30 drops of tincture tid. It may take 2 months to show
an effect. Feverfew may be taken in larger quantities to help reduce pain during
- Jamaica dogwood (Piscidia piscipula): anodyne, antispasmodic,
anxiolytic, historic use is specifically for migraines
- Skullcap (Scutellaria lateriflora): sedative, antispasmodic,
bitter digestive aid
- Gingko (Gingko biloba): inhibits lipid peroxidation,
especially in the brain, prevents cerebral ischemia, stabilizes smooth muscle of
blood vessels, affects platelet activating factor (watch with
- Ginger (Zingiber officinale): anti-inflammatory, anti-emetic,
- Meadowsweet (Filipendula ulmaria): anti-inflammatory, contains
salicylic acid, anti-emetic, astringent
- Total herbal treatment could include feverfew by itself. In addition,
a combination of the above herbs may be useful. Dose is equal parts dried herb
as a tea—1 cup bid to qid, or a tincture of equal parts
60 drops bid to qid.
An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until symptoms resolve.
- Iris versicolor for periodic migraines that begin with blurred
vision, especially after eating sweets or after relaxing from a mental
- Lac defloratum for frontal migraine preceded by an aura of dim
vision, marked nausea, vomiting and chills, that may be brought on by
- Natrum muriaticum for migraines
"like hammers beating the head," that are much better lying down alone in the
quiet dark, especially if the migraines are associated with
- Sanguinaria for right sided migraines that begin in the neck
and move up, migraines with vomiting, especially if the vomiting provides some
Appropriate regular aerobic exercise—brisk walking,
gardening, low impact aerobics, and water aerobics—are
among the options that reduce the frequency and intensity of migraine episodes.
Chiropractic adjustments and/or craniosacral therapy may be
May be very helpful, especially in migraines that are hormonally influenced.
Acupuncture is one of the most effective treatments for
Stretching, yoga, massage and other stress management techniques can be quite
helpful. Massage may help release chronic neck and shoulder tension that may
Patient should seek medical assistance if headache begins after exercise,
straining, coughing, or sexual activity, or is accompanied by changes in mental
state or memory, confusion, or sleepiness. A sudden, severe headache may be
caused by brain hemorrhage, or if accompanied by stiff neck and fever,
meningitis or encephalitis.
- Patient should keep a headache diary to record migraine triggers.
Identified triggers should be avoided.
- Antihypertensive drugs including beta-blockers and calcium-channel
blockers help prevent attacks in some patients. Begin with low doses and
increase if needed: propranolol hydrochloride 40 to 80 mg bid, increasing to 320
mg/day, with a maximum of 640 mg/day; atenolol 50 to 100 mg/day; metroprolol
tartrate 100 mg/day, increasing to 400 mg/day; amitriptyline 75 mg/day,
increasing to 150 mg/day.)
- Prophylactic antihypertensives are contraindicated with certain
illnesses including asthma, chronic obstructive pulmonary disease,
insulin-dependent diabetes mellitus, peripheral vascular disease, heart block or
heart failure, hypotension, congestive heart failure, arrhythmias, and current
or previous depressive illness.
Severe migraine may be so incapacitating it requires emergency
Migraines start suddenly, sometimes waking patient from sleep, and then
usually last several hours but can persist for days. Headaches may occur
repeatedly over several weeks or months, then may disappear for weeks or months.
Frequency and severity may decrease with age.
Avoid prophylactic antihypertensive drugs and other medications or
alternative remedies that are contraindicated during
Berkow R. The Merck Manual. 15th ed. Rahway, NJ: Merck Sharp &
Dohme Research Laboratories; 1987.
De Weerdt CJ, Bootsma HPR, Hendricks H. Herbal medicines in migraine
prevention. Randomized double-blind placebo controlled crossover trial of a
feverfew preparation. Phytomedicine. 1996;3:225-230.
Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal
Medicines. Montvale, NJ: Medical Economics Co; 1998.
Minirth F. The Headache Book: Prevention and Treatment for All Types of
Headaches. Nashville, Tenn: Thomas Nelson; 1994.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms.
Albany, Calif: Hahnemann Clinic Publishing; 1993.
Murphy JJ, Heptinsall S, Mitchell JRA. Randomised double-blind
placebo-controlled trial of feverfew in migraine prevention. Lancet.
Murray MT. Encyclopedia of Nutritional Supplements. Rocklin, Calif:
Prima Publishing; 1996.
Palevitch D, Earon G, Carasso R. Feverfew (Tanacetum parthenium) as a
prophylactic treatment for migraine: a double-blind controlled study.
Phytotherapy Res. 1997;11:508-511.
Pryse-Phillips W. Guideline for the diagnosis and management of migraine in
clinical practice. Can Med Assoc J. 1997;156:1273-1287.
Walker L, Brown E. The Alternative Pharmacy: Break the Drug Cycle with
Safe Natural Treatment for 200 Everyday Ailments. Paramus, NJ: Prentice
Copyright © 2000 Integrative Medicine
CommunicationsThis publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein.