Causes of migraines
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An Integrative Medicine approach to migraines, as to other
non-acute problems, involves a thorough look into all aspects
of a patient's condition. History includes other symptoms, diet, exercise and socio-emotional factors and triggers.
A physical examination includes a structural evaluation,
a look at energy balance, and an assessment of a patient's
psychological coping strategies.
- The first issue I explore with the patient who has migraines
is that of diet, and specifically, food sensitivities.
Estimates of food allergy and sensitivity as a trigger
for migraines have been as high as 70%1. Wheat and dairy
seem to be the most notable culprits, as they are in many other
food- related conditions, and withdrawing both at once seems
to be easier than doing one at a time, since many of our
common foods (bagel and cream cheese, cereal and milk, pizza,
pasta with cheese, etc.) I ask the patient to completely
withdraw wheat and dairy foods for a three week minimum,
and I provide dietary sheets with alternatives.
I then have the patient "challenge" with a wheat
or dairy meal, warning them that a migraine might be initiated.
I have also noticed that aspartame (NutrisweetT) and
various preservatives and additives can effect a migraine
history, and I ask the patient to withdraw those, and the
common migraine-associated foods (chocolate, red wine, etc.)
as well.
- The second piece to look for is a structural component.
The large majority of my patients with a diagnosis of migraine
have a superimposed musculoskeletal component which effects
the duration and intensity of the migraine.
I palpate along the occipital ridge, frequently finding tight
muscles and tender points. I then palpate down the
posterior strap muscles of the neck, the sternocleidomastoid
muscles, and the trapezius muscle. Trigger point maps,
developed by Dr. Janet Travell, show points in these muscles
which refer pain to the top of the head and to the temples.
I measure rotation and lateral bend of the neck to each
side. I also assess jaw motion. Although migraine
is thought to be a vascular phenomenon, it is surprising how
much the problem can be modified by good body work, chiropractic
and/or osteopathic adjustments.
- The next area I investigate is whether there is a hormonal
variation. Quite commonly, I have a female patient whose
migraines appear at ovulation and at the beginning of menses,
or premenstrually. This can be accompanied by other
symptoms suggesting a relative estrogen/progesterone imbalance.
Documenting this imbalance can be difficult since standard blood
tests give only a single snapshot of the hormones.
Recently, salivary assays have been developed to measure
estrogen and progesterone over the course of a monthly cycle.
In my experience, it is usually progesterone which is
relatively deficient. I sometimes treat this with
topical progesterone cream, but until there are more studies
of the absorption and release from adipose tissues of
progesterone delivered in this manner, I more commonly give
oral progesterone. For relative estrogen deficiency I
might use black cohosh extract, soy-based phytoestrogens,
or (if other symptoms co-exist) triple estrogen preparations
- Two herbs I have found to be effective are feverfew and ginger.
