In my last blog, I talked about the foods and beverages that could trigger migraines. Today, I cover the other most common triggers of migraines as well as some natural non-medicated solutions that have been proven to work for many migraineurs.
This article is for educational purposes only. It is not a substitute for professional medical advice and is not intended to diagnose, treat, cure, heal or prevent any disease or medical condition. See full Disclaimer here. I encourage you to do your own research and to discuss with a qualified healthcare practitioner before taking any supplement, to identify the best (and safe) option for your specific circumstances.
1- The most common triggers of migraines
Apart from certain foods and beverages, the most common triggers cited by migraineurs are:
stress, for 62% to 80% of migraineurs depending on the study
sleep issues, for 50% to 81%
loud noises, for 69% to 78%
hormone fluctuations, for 53% to 65%, especially for women during the pre-menstrual period but also during pregnancy, menopause or due to HRT (hormone replacement therapy) or oral contraceptives
changes in humidity, pressure or temperature, for 43% to 53%
strong smells, smoke/pollution or bright lights, each for 36% to 44% of migraineurs.
Researchers have also identified other triggers that most migraineurs might not be aware of:
medication overuse
genetic predisposition
mitochondrial or energy metabolism dysfunction
vitamin and mineral deficiencies, neurotransmitter imbalance, inflammation...
Stress is the trigger that is the most often cited by migraineurs. As both the migraines themselves and the fear of having migraines are stressful, it creates a vicious circle that can increase migraine frequency. Stress can also produce muscle tension in the neck, leading to tension-type headaches.
The daily stressors of our busy lives are difficult to avoid and managing our stress response is paramount to reduce the severity and frequency of migraine attacks. See my blog series on stress: How full is your stress bucket?, Time to relax! and Mastermind your stress - The power of the thoughts.
Sleep issues are also very often cited as a trigger of migraine attacks. If this is your case, you need to get sufficient quality sleep that allows you to wake up feeling refreshed in the morning. That usually means 7 to 9 hours of uninterrupted sleep.
Both too little and too much sleep (including daytime napping) can be bad for migraines and you will have to find the amount that works the best for you. See my 10 tips to improve your sleep.
Hormone fluctuations. 60 to 70% of women suffering from migraines report that they are hormone-related. Their attacks typically occur around menstruation but also during puberty, pregnancy or menopause, generally due to a drop in estrogen. Men can also suffer from hormone-related migraines, during puberty or when their testosterone levels drop.
If you think you might suffer from this type of migraine, talk to your medical practitioner: simple blood, saliva or urine tests are available to check your sex hormone levels. If they are too low, there are a number of ways to support them naturally, including by having a healthy nutrient-dense diet (swapping processed foods, carbs and sugar for fresh wholesome foods and healthy fats, supplementing vitamin and mineral deficiencies...), exercising regularly (but not over-training), getting enough quality sleep and avoiding toxins. Adaptogen herbs (such as ashwagandha, astragalus, licorice and rhodiola rosea) have also been shown to help balancing hormones.
I will cover this subject in a future blog. In the meantime, you can read my blogs on nutrition (#8 and #14) , toxins (#9) and exercise (#15).
Migraine medication overuse. I have mentioned in my previous blog that half of the migraineurs don't get enough relief from their medication. This can lead to medication overuse, which unfortunately usually results in more migraines. Researchers believe that medication overuse is one of the most frequent triggers of migraines. Also, when a migraineur stops taking his/her regular medication or when the medication wears off (typically in the morning), migraines tend to reappear.
So, check with your healthcare provider that you are not overdosing your medication. If you are, discuss with him/her the best way to wean off excess medication. Studies have shown that more is not better!
Family history and genetic susceptibility. Researchers have identified specific genes that might impact the development of migraines and studies have found that immediate family members of migraineurs have a much higher risk of suffering from migraines.
However, even if migraines run in your family, all is not lost! You can have a significant impact on how your genes are expressed. That means you can contribute to "turn off bad genes" with healthy lifestyle practices and, in the case of migraines, by avoiding or minimising the triggers.
Mitochondrial or energy metabolism dysfunction, vitamin and mineral deficiencies, high levels of inflammation that affect nerves in the brain and blood vessels, neurotransmitter imbalances (including low serotonin or GABA, or high glutamate), heavy metal toxicity (in arsenic, copper, lead, mercury and many others) can also be involved in the pathophysiology of migraines.
The best way to know whether these factors may apply to you is to test: blood tests for vitamins, minerals and inflammation markers; organic acid (urine) test for mitochondrial dysfunction or neurotransmitters levels ; hair mineral analysis to help identify heavy metal toxicity. Again, discuss your options with your qualified healthcare provider.
2- The best supplementation for migraineurs
A lot of research has proven the efficacy of natural remedies to reduce the frequency, duration and severity of migraines, with vitamins, minerals, herbs or other natural supplementation. Some of these remedies could be as efficient as migraine medication, usually with less side effects. Others can be a good addition to the migraineur "tool box", as different supplements can have different modes of action with additive effects. In the 2018 Migraine In America survey, 8 out of 10 respondents reported using alternative therapies, including taking vitamins and supplements.
In any case, the recommended plan of action is once again to do your own research, discuss with a qualified health provider and test (your blood or urine) rather than guess. Once you have identified a supplement that could be beneficial and safe for you, try it and see whether it works. Try one supplement at a time, to identify whether it provides any relief or not. Also, certain studies indicate that the best results are obtained after a few weeks or a few months of supplementation. So be persistent if it doesn't work right away.
Magnesium is one of the most successful natural headache remedies. Several studies have shown that most migraineurs and especially women suffering from menstrual attacks have low levels of magnesium and that magnesium is effective to significantly reduce migraine frequency, duration and intensity.
This mineral is needed for more than 300 biochemical reactions in our body, including many that are involved in the pathophysiology of migraines, such as neurotransmitter release, nitric oxide synthesis, inflammatory mediators, platelet aggregation, vasoconstriction and reactivity to hormones and neurotransmitters. It may also prevent the signalling involved in migraines and block the pain-transmitting chemicals.
To test your magnesium levels, a red blood cell test, whilst not perfect, is considered more accurate than a standard serum test. Magnesium is stored in the cells (bones and soft tissues) and only about 1% can be found the serum and red blood cells. About 50 to 75% of the population in developed countries do not get enough magnesium in their diet. So even non-migraineurs could benefit from supplementation.
If you have a magnesium deficiency, you can take supplements and/or eat plenty of magnesium-rich foods, such as nuts (almonds, Brazil nuts, cashews, pine nuts and pecans), seeds (pumpkin, sunflower and flaxseed), broccolis, squashes, spinach, leafy greens, yogurt, black beans, avocado, sweet potatoes, quinoa, meat, dark chocolate and coffee. Note that magnesium supplements come in different forms, with various degrees of efficacy and absorbability.
B Vitamins help our body produce energy and are important for the formation of neurotransmitters, as well as for brain cells, blood flow, the immune function and cardiovascular health. They help address the mitochondrial dysfunction mentioned earlier and impaired oxygen metabolism that could influence neuronal information processing involved in migraines. Many of us have deficiencies in one or more of these vitamins, which can cause headaches.
Several studies have shown the benefits of certain B vitamins to reduce the frequency and duration of migraines: B2 (riboflavin), B3 (niacin), B9 (folate) and B12 (cobalamin). B2 is the most researched and several studies have found that migraines where reduced by half for 59 to 77% of participants taking supplementation.
B vitamin supplements can be found either as stand-alone vitamins or as a full B-complex. Certain foods are also rich in these vitamins, such as salmon and trout, leafy greens, liver and organ meats, eggs, milk and yogurt, beef, poultry, pork, legumes, oysters, clams and mussels, and nutritional yeast.
Butterbur is a root extract used for many centuries as a remedy for pain, fever, spasms and wound healing. It contains compounds that reduce the inflammatory effect of chemicals that trigger migraines. It also acts as a beta blocker to normalise blood flow to the brain. In its natural form, butterbur contains a toxic substance that is then removed from commercial supplements. So, make sure to buy only butterbur products that are certified and labelled “PA‐free”. Also, people allergic to ragweed and certain flowers could develop an allergic reaction to this root.
Several studies have shown the efficacy of butterbur to significantly reduce the frequency (by 47 to 63%) and severity of migraines for most patients. 9 out of 10 patients felt at least some improvement. The American Academy of Neurology and the American Headache Society classified butterbur as level A (the most efficient) for migraine prevention and concluded that it should be offered to migraineurs to reduce the frequency and severity of their attacks.
Feverfew is a plant of the daisy family that has also been used for centuries in the treatment of fevers, headaches, infertility, toothaches, inflammation and arthritis. It may act by inhibiting platelet aggregation and the release of serotonin from platelets and white blood cells as well as by reducing inflammation. Feverfew has a few contraindications (pregnancy, allergic reactions), which highlights once again the importance of consulting a qualified healthcare provider before taking any herb or supplement.
Research has shown that feverfew can reduce the frequency and symptoms of migraines, including pain, nausea, vomiting and sensitivity to light and noise. The earliest studies yielded mixed results, probably due to the poor quality of the feverfew preparations. Since then, better feverfew extracts have been developed and the most recent studies show a significant reduction in migraine frequency and severity. The American Academy of Neurology and the American Headache Society classified feverfew as level B (i.e. probably effective) for migraine prevention.
Kudzu is a root native to Japan that contains over 70 phytochemicals or phytonutrients. It has been used in Chinese medicine for centuries for its anti-inflammatory and antioxidant properties. The extract comes in a dry form that can be used to make thick and creamy smoothies or desserts.
A few studies have concluded that kudzu can be useful for migraines and cluster headaches, to reduce their intensity (for 69% of patients in one study), frequency (for 56% of patients) and duration (for 31%).
Cannabidiol or "CBD" oil seems to be the miracle remedy for all sorts of conditions that involve pain and inflammation. CBD is one of the many active compounds found in cannabis but without psychoactive effects coming from the THC compounds.
Many studies have confirmed the efficacy of the oil as a pain reliever. Fewer studies have looked specifically at its efficacy for migraines, but they have found good results as well. The oil is believed to work by reducing inflammation, inhibiting serotonin type 3 receptors and blocking pain signalling in the brain. One Study has even concluded that cannabinoids are as suitable for migraines as other pharmaceutical treatments, with a pain reduction of 55%.
The legal status of cannabis, marijuana and their derivatives (CBD and THC) varies from country to country and is rapidly changing, as more research becomes available to show their efficacy and safety. CBD is currently legal in the US, in the EU and in Australia if it contains less than 0.3%, 0.2% and 0.005% of THC, respectively. But there are still a few exceptions or grey areas.
Ginger is another root that has been used for thousands of years for the treatment of many ailments, such as colds, nausea, arthritis, migraines and hypertension.
2 studies have shown that ginger was as effective as the gold standard migraine prescription drug, achieving 90% relief within 2 hours and with less side effects than the drug. A 3rd study has found that the addition of ginger to non-steroidal anti-inflammatory drugs (such as ibuprofen and aspirin) further reduced the pain and symptoms of migraines. And a 4th study reported that 32% of patients were pain-free after 2 hours, whilst 63% found pain relief, with a treatment combining ginger and feverfew.
Ginger is easy to add to sweet or savoury dishes, smoothies or beverages, it tastes great and has many other health benefits (anti-inflammatory, anti-oxidant, anti-bacterial, blood sugar regulation...). So spice up your meals!
3- Other natural remedies
Peppermint and Lavender Essential Oils. Several studies have reported that peppermint oil considerably reduced migraine frequency and intensity (for 41% of patients in one study), achieving results similar to those of lidocaine, aspirin or paracetamol. The relief seems to come from increased blood flow to the forehead and reduced muscle contractions.
Another study has shown that the use of lavender oil is an effective treatment for 71% of migraineurs. Lavender can also improve sleep quality, decrease muscular tension and act as a natural antidepressant, which could all help migraineurs.
The oils can either be used topically or in diffusion. For a topical application, add 3 drops of peppermint or lavender oil in 1 teaspoon of carrier oil (such as almond, coconut or olive oil) and rub the blend on your forehead, temples and back of your neck. Alternatively, apply a few drops of either peppermint or lavender oil on a heated towel and use it as a compress. The third option is to use the blend in a diffuser for up to 30 minutes, several times a day.
These are only 2 examples of oils that can provide some relief to migraineurs. There are many other oils that have been proven to increase blood flow and reduce pain, inflammation and stress, such as eucalyptus, frankincense, rosemary and chamomile. You can combine several oils in one blend, for a synergistic effect, as long as you keep a dilution ratio of 2 to 3%.
Coenzyme Q10 or "CoQ10" is an anti-oxidant and an enzyme co-factor involved in the mitochondrial energy generation and aerobic cellular respiration, both useful in migraine prevention. It can be found in meat, fish, liver, broccoli and parsley, and is also sold as a supplement.
Several studies have found that CoQ10 supplements significantly reduced migraine frequency (-35 to -60%) and migraine symptoms (-52%). As for feverfew, it has been classified as "probably effective" for migraine prevention by the American Academy of Neurology and the American Headache Society.
Alpha Lipoic Acid is a fatty acid found in foods such as liver and organ meat, spinach, broccoli, potatoes and Brussel sprouts. Like riboflavin (vitamin B2) and CoQ10, it augments mitochondrial oxygen metabolism and ATP (i.e. energy) production. One study has observed a significant reduction in migraine attack frequency, duration and severity after supplementation.
These are just some of the most researched natural remedies to help migraineurs. As different solutions have different mechanisms of action, experts recommend multidisciplinary treatments as the most efficient way to treat migraines.
In my next blog, I will talk about other well-researched non-medicated treatments including behavioural and physical therapies, to maximise your chance of controlling your migraines. In the meantime, maintain a healthy lifestyle, avoid stress, get good sleep and eat a balanced nutritious diet!
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