Getting ahead of migraine

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Publication Date: 
Mon, 2013-07-01

Exploring migraine experiences and approaches to treatment  

Writer Mary-Louise Leidl explores the topic of women and migraines, including migraine triggers, effects on health and the complementary medical treatments available. She interviews two women working at CWHN about their experiences and three healthcare practitioners about their approaches to managing migraines.

Jane Shulman, a Montreal-based journalist and webinar producer at CWHN, was only 11 years old when she experienced her first migraine: “It was terrifying. My mother and I ended up in the emergency room because we didn’t know what was wrong ... I was in so much pain all of a sudden and there was no reason for it.” Fortunately, the doctor on call was able to diagnose the sudden onset of symptoms as migraine, an affliction that plagues more than 2.7 million Canadians according to a Statistics Canada 2010/2011 Canadian Community Health Survey. The diagnosis, however, has not made it any easier for Shulman, and others like her, to manage this debilitating condition that is three times more common in women than in men.

More than a headache

A migraine is not a bad headache; it’s much worse. Migraine’s main symptoms, apart from the headache pain, include nausea, vomiting, as well as extreme sensitivity to light and/or noise, all of which are aggravated by physical activity. Throbbing pain is mostly confined to one side of the head, and can be severe enough to force a person to seek a dark quiet place to rest for as long as the migraine lasts, which can be anywhere from four hours to three days and more.

Migraine is classified into two main categories: migraine with aura and migraine without. Migraine with aura precedes the onset of the actual migraine, with temporary symptoms ranging from tingling or numbness in the face or hands to visual affects such as flashing or floating lights, jagged lines, blurred vision or peripheral blindness. Other short-term symptoms can include a distorted sense of taste, touch or smell. Migraine can even result in mental disorientation, affecting cognitive function and speech.

Getting to know the triggers

To those prone to allergic-type reactions, migraines are often triggered by specific substances found in food and drink. The main culprits are alcohol, especially red wine, caffeine, the tyramines found in various nuts, fermented foods and aged cheeses, phenyl ethylamine in cocoa, nitrites and nitrates in processed meats, monosodium glutamate (MSG), aspartame, and sulfites used in dried fruits, but there are many others.

Triggers are numerous and vary greatly from one individual to the next. Ellen Reynolds, editor of CWHN’s Network magazine, has experienced migraine, headache and visual disturbances since the age of about seven. She underwent various tests to ascertain the cause, but it was another three years before she understood, if not the cause, at least some of the triggers: “I first made the connection after eating a cake made from a mix that included artificial flavours and colouring. It was a particular lemon cake mix and I recognize the chemical smell to this day.” She felt a sudden flush of heat and experienced visual disturbances, migraine and vomiting. Over the years she has identified other triggers, including nitrites, MSG, perfume, dark chocolate and even the flavouring in dental fluoride preparations.

For Shulman, the main triggers are environmental, including fluorescent and halogen lighting, and the chemical smells emitted from cleaners and perfumes. In susceptible persons, certain sounds and even motion can set the stage for migraine. Too little sleep, passive smoking and sunlight can also be triggers. Heredity may play a part, but for women, perhaps the greatest underlying factors triggering migraine are fluctuating hormones associated with the menstrual cycle and acute periods of stress.

In 1998/99, Statistics Canada’s National Population Health Survey reported that 7.9 per cent of Canadians over the age of 12 had been diagnosed with migraine in that period: 11.7 per cent were female compared to 3.8 per cent male (up until the age girls begin their menses, migraine is slightly more common in boys). Migraine, however, was highest among those aged 25 to 39. In this age group almost 4 times as many women were diagnosed with migraine compared to men: 15.5 per cent and four per cent respectively.

More recent data from the Canadian Community Health Survey (CCHS) of 2010/11 reports that the percentage of Canadians diagnosed with migraines has remained the same (7.9 per cent); however, the more recent survey does not include gender-specific data.

The chemical connection

Most people turn to prescription and over-the-counter medication for help to alleviate migraine symptoms. While some will experience some relief, others will experience little or none. It is worth looking at the complementary approaches that are being used in conjunction with pharmaceutical intervention, as well as exploring the possible causes and preventative strategies currently available. Some of the treatments mentioned here, including naturopathic, chiropractic, acupuncture and massage therapy, are covered at least in part by some provincial medical insurance plans. They are worth looking into; however, unlike the long list of pharmaceutical drugs that are subsidized through our medical insurance plans, these complementary modalities can be prohibitively expensive, especially for women who may not have access to extended health insurance through employment.

John Molot, a Doctor of Environmental Medicine with practices in Ottawa and the Environmental Health Clinic, Women’s College Hospital, in Toronto, is about to publish his book 12,000 Canaries Can’t Be Wrong. Molot stresses that environmental influences, in particular chemical pollutants, contribute to chronic illness, and that how those influences affect an individual will depend on her physiological strengths and weaknesses and what she has been exposed to. Stress is a big factor and no two people will experience the same stressors the same way: “Some people will get a headache and some people will get gastrointestinal complaints, so it varies, but it also varies according to sex,” he says.

Every cell is a living organism and as such produces its own byproducts of metabolism. If the cell is not able to remove the toxic byproduct (oxidant), damage (oxidative stress) will occur within the cell itself, explains Molot. Antioxidants in the diet help maintain the detoxification system so that it can clear out these byproducts efficiently. Unfortunately, our systems are so burdened by the chemicals we ingest that, depending on exposure and our ability to detoxify, cellular damage could result: “We can start to measure changes in the way cells function so that one of the things we’re seeing as a result of oxidative stress is changes in neurons (brain cells), so we’re seeing a rise in chronic pain disorders.”

Women detoxify less well than men. Molot explains: “Men have better kidney function, which helps eliminate water-soluble toxins, and their detoxification systems in the liver work more efficiently. In the liver, there are two phases of detoxification: phase one prepares the toxins for phase two, which is to make the toxins water soluble, so the kidney can eliminate them. However, the new products from phase one are often more toxic. Unfortunately, women often have a faster phase one than phase two, so toxic by-products build up; sort of a log jam of toxins.” Toxins that cannot be easily eliminated get stored in fat, and as women generally have a higher percentage of body fat than men, they tend to store more toxins in their bodies. As well, women are exposed to more chemicals on a regular basis: in the home where they use cleaning and laundry products, as well as in the daily application of chemical-containing products on and therefore into their bodies. Consequently, women are more prone to chronic illness, including chronic pain disorders, such as chronic migraine.

Individuals who experience recurrent migraine have changes inside their cells as a result of oxidative stress, which in turn is due to the burden of chemical pollutants in the body. “Those people who have poor enzyme systems are more likely to suffer, some of that is genetic and some of that is by not taking in the required antioxidants because of poor diet,” says Molot. He also adds that the cell membrane is part of an intricate communication system and that each cell has receptors for specific messages: “This is like a key fitting into a lock, or the space station docking, it has to fit perfectly into the receptor and if it does, then the receptor gives the message to the cell.”

Receptors are sensitive to chemical pollutants. If neurons involved with the mechanism of pain become sensitized, a chronic pain disorder can develop. “So what gets turned on doesn’t necessarily get turned off by just trying to enhance the detoxification system, because it’s not about toxins being built up, it’s about the changes that occurred in the cells that may or may not be reversible—we don’t understand it that well,” says Molot.

Managing migraine: the importance of detoxification

Although there appears to be no known cure for migraine, there are ways to reduce its frequency, duration and to some degree its severity. Most patients learn to manage their condition over time. When treating patients, Patricia J. Wales, a Calgary-based Doctor of Naturopathic Medicine, looks at diet and the ability of the body to remove waste products, which can build up and become toxic to the body if not properly eliminated. Toxicity can be a factor in triggering migraine and other conditions. For this reason she stresses the importance of having regular bowel movements, at least once daily.

The liver also plays a vital role in cleaning the blood, processing wastes and excreting excess hormones. If the liver is not breaking down substances efficiently, Wales will direct treatment to that end. “Even a small decrease in liver function can cause symptoms,” she says. Improving the body’s detoxification processes is a key factor in enhancing basic overall health. “Hormones play a role but I don’t think they are the causative factor,” says Wales. Though there may be a hormonal imbalance, she looks at what is happening to a patient on a daily basis: “Because migraines seem to be a confluence of things coming together, the more factors involved the more likely there is to be a migraine.”

Wales stresses that the two things a patient can control are diet and how she responds to stress. Adequate sleep, exercise, and drinking water to keep tissues and blood vessels hydrated are basic but important steps in maintaining general good health overall. Most patients do an elimination diet to find out what foods trigger migraine, although it takes time and patience and involves some “detective work.”

Managing migraine: preventatives and pain relief

To alleviate pain, Wales may recommend magnesium, niacin (vitamin B3), quercetin (a bioflavonoid), fish oils, or evening primrose oil. She says that essential fatty acids keep blood vessels pliable and allow platelets to move through the blood vessels easily. She adds that botanical medicines such as feverfew and butterbur have been shown to “damp down the blood vessel response” so that a migraineur is not so sensitive. As for finding relief that works for individuals, that too takes a trial and error approach.

When Shulman was about 23 years old her migraines worsened. Her family doctor prescribed propranolol (a beta-blocker used to treat tremors, angina, hypertension and, at that time, migraine). It caused a serious drop in Shulman’s blood pressure leaving her feeling dizzy and tired. “I tried at least six or eight different medications and none of them worked,” she says. In an emergency, she tried Imitrex (also known as sumatryptan, a member of the tryptamine-based family of drugs used to stop the progression of migraines and cluster headaches), but found that in her case, like most of the medications she had already tried, it actually made the migraine worse.

Today Shulman takes vitamin B2 (riboflavin) twice daily to reduce the frequency and intensity of the migraines. She eats organically grown fruits and vegetables, avoiding chemicals and additives as much as possible. She invests in regular acupuncture treatments, although it can be “very expensive” she adds. She cut back on acupuncture treatments for a while but the migraines became so bad she felt she “could not afford to not do them.” For Shulman, meditation and visualization also helps, but “in terms of pharmaceuticals I haven’t had any success at all.” However, she opts for over the counter medication such as Motrin (ibuprofen, a non-steroidal anti-inflammatory) and Extra Strength Tylenol (acetaminophen, a pain reliever) with caffeine, when she feels a migraine coming on.

As a preventative and early treatment, especially for stress-related migraine, Reynolds practices meditation, yoga and massage. Although she was prescribed painkillers with codeine she found they only made her more nauseous and did not stop the pain, but if she can catch a migraine early enough she will take a couple of Extra Strength Tylenol to reduce its severity. Neck massage and the practice of Qi Gong meditation also help, but “if it’s a severe migraine, I can’t do much except lie down in a darkened room, cover my eyes and try to relax as much as possible.” 

Managing migraine: herbs may help

Vancouver Island-based medical herbalist Chanchal Cabrera suggests two strategies for treating migraine in women: a long-term treatment plan for balancing hormones, which can take anywhere from three to six months to be effective, and a quicker fix for pain management. She warns, however, that some of the herbal painkillers can make a person drowsy, which is fine if that person can lie down, but will defeat the purpose if the she has to be alert and functioning. Cabrera, herself an occasional migraineur, takes ibuprophen in those situations because “it knocks the edge off, it’s not enough, but it’s better than nothing and doesn’t make me drowsy.” 

Cabrera notes that there is a constitutional difference in people and will prescribe herbs accordingly. If a patient feels chilly and has a tight constrictive headache, she may suggest taking warming herbs that increase blood flow to the head, such as rosemary, ginger, cinnamon and cayenne; even a cup of strong chai tea with added black pepper can help. For a patient with a throbbing type headache, flushed face, and who may want a cold drink, she may prescribe the herb feverfew. However, feverfew is best used as a preventive and can take three to six months to come into effect. In the short term, Cabrera suggests taking the pain killing herbs that are not going to change the body temperature, such as willow that has pain killing affects similar to aspirin. 

But it is not all about taking herbs: “There are a lot of things that we look at doing. I definitely try to identify hormone connections, diet connections. I almost always send that person in for a good chiropractic assessment because quite often there is some kind of neuromuscular disturbance as well, and even if it doesn’t cause the migraine, it might be a trigger or aggravating factor.”

Ultimately, Cabrera practises what she calls collaborative integrated medicine: “It’s about being pragmatic and asking what’s going to work best for the individual. With migraines I am reasonably confident that we can make a noticeable difference…The people who have the most success are the people who have migraines for identifiable reasons; that is, menstrual or stress related or something we can actually change in their lives, and then of course the migraines change.”

A lifelong lifestyle practice

Obviously, the burden of living with migraine can be daunting. “The idea that it could happen any time, that it could interrupt anything, that I could be in the middle of something very important is a huge constant stress,” admits Shulman. “Migraines are not a joke, they’re a big deal, and I think we underestimate the impact they have on our lives.” This includes living with the stress of related health issues such as long-term depression and anxiety.

Although there are factors outside an individual’s immediate control, such as certain pollutants and other environmental influences, there are also actions a woman can take to decrease the frequency, duration and possibly the severity of migraine without relying on medications with their side effects. Detoxifying the body, getting regular exercise and promoting a healthy gut are important first steps. It is also necessary to know the triggers that set off migraine. Stress is a big issue and finding a way to mitigate its affects is vital, whether through meditation or enjoying a relaxing physical activity. For treating an episode of migraine women can find the approach that best works for them, and there are many that are complementary: medical herbalists, naturopaths and doctors working in the field of environmental medicine have the knowledge and means to help.

Adds Molot: “Chronic illness is clearly complex, so when we see chronic conditions such as chronic migraine the simplistic approach is usually symptom control. So with migraine there are anti-migraine medications, there are preventative medications, there are strong analgesics when the pain is there, and so on, but if you go after the mechanisms, there are no simple answers ... Women have to be able to commit to buying into lifestyle change, to do all the things that can influence migraine, on an organ level and a cellular level. The more they do the better chance they have to reduce the frequency and duration of migraine, and maybe the severity.”

Mary-Louise Leidl is a Vancouver Island-based freelance writer with interests that include health and the environment, food, travel and photography.