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  • Writer's pictureKarine

References blogs 0014 to 0019

Updated: Jan 16, 2020

  • Complementary and Alternative Medicine Use among Adults with Migraines/Severe Headaches. 7 Jun 2017. Only 4.5% of adults with migraines/severe headaches use complementary and alternative medicine. Mind-body therapies (deep breathing exercises, meditation, herbal/other supplements) are used most frequently. Relaxation training (progressive muscle relaxation, autogenic training, meditation or passive relaxation), biofeedback combined with relaxation training have high quality (Grade A) evidence from well-performed research studies for the prevention of migraine.

  • Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments. 25 Feb 2011. Growing body of evidence supporting the efficacy of complementary and alternative medicine approaches in the management of headache disorders: Behavioral treatments (behavioral therapy, biofeedback, relaxation training). Physical treatments (acupuncture, oxygen therapy, chiropractic and ostheopathic manipulations, physical therapy, massage).

Behavioural treatments

  • Behavioral and Physical Treatments for Migraine Headache. 25 Aug 2010. Behavioral treatments have research indicating efficacy. Relaxation training, biofeedback, and cognitive-behavioral therapy are modestly effective in treating migraine. Acupuncture yielded mixed results.

  • Behavioral medicine for migraine. May 2009. Empirically supported and efficacious behavioral approaches to the treatment and management of migraine: cognitive behavioral therapy and biobehavioral training (biofeedback, relaxation training, and stress management).

  • Behavioral and pharmacologic treatment of transformed migraine with analgesic overuse: outcome at 3 years. Jun 2002. Combined treatment showed greater improvement for duration and consumption of medication. A combination of pharmacologic and behavioral treatment is more effective than drug therapy alone in long-term management of migraine after analgesic overuse.

  • Evidenced-Based Guidelines For Migraine Headache: Behavioral and Physical Treatments. 2000. Behavioral treatments for migraine used as independent therapies or combined with pharmacological therapy. Relaxation training, biofeedback therapy and cognitive-behavioral training. Physical treatments: Acupuncture, cervical manipulation, and mobilization therapy. Good options for people who do not respond well to or cannot take medication or are deficient in stress-coping skills. Relaxation training : 41% improvement. Biofeedback 37% to 40%. Biofeedback + relaxation training : improvement of 33%, better than propranolol plus analgesic. Even better results when combined with medication. Cognitive behavioural therapy: 49% improvement and 38% improvement combined with biofeedback. Acupuncture: 50 to 53% reduction frequency and as efficient as certain medication but not great quality research. Relaxation training, biofeedback + relaxation training, biofeedback and cognitive-behavioral therapy are Grade A for migraines. Behavioral therapy (relaxation, biofeedback) combined with preventive drug therapy to achieve additional clinical improvement for migraine relief (Grade B). Acupuncture: results are mixed (Grade C). Grade A - Multiple well-designed RCT yielded a consistent results. Grade B - Some evidence from RCT but not optimal. Grade C - absence of relevant RCT.

  • Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials. Apr 1997. Home-based treatments produce comparable or superior results to clinic-based treatments.

  • Long-term follow-up of migraine treatment: do the effects remain up to six years? 1990. 6 yr after biofeedback and relaxation training, headache reductions persisted and were enhanced during the follow-up period.

  • Long-term effects of behavioral treatment of chronic headache. Autumn 1987. Behavioral treatment : good maintenance of migraine reduction at 12 months.

Relaxation training

  • Relaxation training for tension headache: Comparative efficacy and cost-effectiveness of a minimal therapist contact versus a therapist-delivered procedure. Jan 1984. Relaxation treatment highly effective for reducing headache index, intensity, frequency, and medication consumption.

  • Home- versus clinic-based treatment of vascular headache. 1983. At least same efficacy of relaxation training and biofeedback at home and in clinic, for reduction of headache intensity and frequency and medication usage.


  • Biofeedback treatment for headache disorders: a comprehensive efficacy review. 26 Aug 2008. Biofeedback: migraine frequency showed the largest improvements. Also improvement of perceived self-efficacy, symptoms of anxiety and depression, and medication consumption. Reduced muscle tension in pain related areas. Levels of efficacy for migraine: efficacious, level 4 and tension-type headache: efficacious and specific, level 5.

  • Efficacy of biofeedback for migraine: a meta-analysis. 2 Nov 2006. BFB was effective. Frequency of migraine attacks and perceived self-efficacy demonstrated the strongest improvements. BFB with home training more effective than therapies without home training.

Cognitive behavioural therapy

  • Cognitive-behavioral therapy versus temporal pulse amplitude biofeedback training for recurrent headache. 27 Sep 2007. CBT was highly effective, with an average reduction in headaches of 68%, vs 56% for biofeedback. Headaches continued to decrease to 12 month follow-up for CBT. Improvement was associated with coping skills, social support, and physiological measures at rest and in response to stress.

  • Cognitive-behavioral therapy for migraine headaches: a minimal-therapist-contact approach versus a clinic-based approach. Jun 1989. Significant reduction in headache frequency, duration and peak intensity following CBT treatment, maintained at 6 months follow-up.

Physical treatments

  • Manual therapies for migraine: a systematic review. 5 Feb 2011. Massages, physiotherapy, relaxation and chiropractic spinal manipulations might be equally effective as propranolol and topiramate in the prophylactic management of migraine. But methodological shortcomings.

  • Physical treatments for headache: a structured review. Jun 2005. PT is most effective for migraine when combined with other treatments such as biofeedback, relaxation training, and exercise. Chiropractic manipulation: Evidence lacking regarding efficacy. Studies are of low quality.

  • Non-invasive physical treatments for chronic/recurrent headache. 2004. Spinal manipulation may be an effective treatment option with a short-term effect similar to that of a commonly used drug (amitriptyline).

  • Migraine and the neck. Feb 1994. 32/50 migraineurs reported neck pain or stiffness, 10 noted symptoms during premonitory phase, 30 during headache phase, and 10 postdromally. Extracerebral involvement of the migraine process.

  • A questionnaire survey of muscular symptoms in chronic headache. An age- and sex-controlled study. Jun 1991. Tightness and soreness of the neck, shoulder, and jaw muscles was reported significantly more frequently in the headache but only for the neck muscles (48.6%). When headache was present, neck muscle tightness increased to 68.8% and that of jaw muscles from 17.2 to 29.7%. Significant muscular symptoms in relation to headache.


  • Is acupuncture clinically viable for treating acute migraine? Sep 2009. Real acupuncture superior to sham acupuncture, but absolute pain relief was minimal.

  • Acupuncture for migraine prophylaxis. 2009. Consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. Acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. After 3 to 4 months of acupuncture, higher response rates and fewer headaches. Effects still there up to 9 months after cessation of treatment.

  • Acupuncture for the Treatment of Headaches: More Than Sticking Needles Into Humans? 1 Sep 2008. Efficacy of acupuncture vs standard migraine prophylaxis with β-blockers or drugs in the reduction of migraine days. Mean reduction of 2.3 days for acupuncture, 2.1 days for standard therapy. 47% responders for acupuncture vs 40% in standard group. Acupuncture is as effective as drug therapy.

  • Acupuncture in patients with headache. Sep 2008. At 3 months, headache days decreased from 8.4 to 4.7 with acupuncture, with also less intensity of pain and better quality of life. Treatment success was maintained through 6 months. Acupuncture plus routine care in patients with headache was associated with marked clinical improvements compared with routine care alone.

  • Cost-effectiveness of acupuncture treatment in patients with headache. Apr 2008. According to international cost-effectiveness threshold values, acupuncture is a cost-effective treatment in patients with primary headache.

  • Role of acupuncture in the treatment of migraine. Sep 2007. Since 2001, several large, randomized trials on the effectiveness of acupuncture as a treatment for headache have been published. Acupuncture not inferior to prophylactic drug treatment.

  • Acupuncture for treating acute attacks of migraine: a randomized controlled trial. 27 Apr 2007. Significant decreases in VAS scores observed after 4h for acupuncture (-1.0 cm). Most patients experienced complete pain relief (40.7%) and did not experience recurrence or intensification of pain (79.6%). Also effective in preventing migraine relapse or aggravation.

  • Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis. Nov 2004. Headache score at 12 months lower for acupuncture with 22 fewer days of headache per year, 15% less medication, 25% fewer visits to GPs and 15% fewer days off sick. Acupuncture leads to persisting, clinically relevant benefits for primary care of migraine.

  • Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. 15 Mar 2004. Acupuncture for chronic headache improves health related quality of life at a small additional cost. It is cost effective compared with other interventions.

  • Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks: a randomized controlled trial. Feb 2003. A full migraine attack was prevented in 35% of patients receiving acupuncture, 36% receiving sumatriptan. Response to 2nd attack was better with sumatriptan (17/31 vs 4/31). Side-effects for 14 for acupuncture, 23 with sumatriptan. Acupuncture and sumatriptan were effective in the treatment of migraine attack. When an attack could not be prevented, sumatriptan was more effective than acupuncture at relieving headache.

  • Acupuncture for idiopathic headache. 2001. Overall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing.

  • Analgesia inhibitory system involvement in nonacupuncture point-stimulation-produced analgesia. Mar 1992. Acupuncture produces analgesia.

  • Acupuncture reduces electrophysiological and behavioral responses to noxious stimuli: Pituitary is implicated. Jan 1977.

  • Acupuncture Reduces Electrophysiological and Behavioral Responses to Noxious Stimuli: Pituitary Is Implicated. 1 Jul 1976. Prolonged reduction of spinal cord nociceptive responses by acupuncture similar to clinical analgesia.

Chiropractic manipulations

  • Alleviation of chronic spine pain and headaches by reducing forward head posture and thoracic hyperkyphosis: a CBP® case report. 7 Aug 2018. Reduction of forward head posture and thoracic hyperkyphosis with cervical and thoracic exercises and manipulation resulted in dramatic improvement in symptoms. Poor postures should be corrected to avoid long-term consequences.

  • 10 researched benefits chiropractic adjustments. 6 Jul 2018. Chiropractic’s ability to help cure, prevent and ease the burden of headaches and migraines. One study found that 22% saw the number of attacks drop by 90% and 49% had a significant reduction in pain intensity.

  • Spinal manipulations for the treatment of migraine: a systematic review of randomized clinical trials. 21 Apr 2011. Significant improvements in migraine frequency, intensity, duration and disability associated with migraine.

  • Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. May 2003. Vertebral artery dissections associated with SMT within 30 days and pain before stroke/TIA. Patients undergoing SMT should be consented for risk of stroke or vascular injury from the procedure.

  • The effectiveness of chiropractic manipulation in the treatment of headache: an exploration in the literature. Nov-Dec 1995. Manipulation outcomes ranged from fair to excellent, equivalent to amitriptyline but with greater durability.

Oxygen therapy

  • High-flow oxygen therapy for treatment of acute migraine: A randomized crossover trial. 20 May 2016. Impaired oxygen utilization and cerebrovascular dysfunction are implicated in migraine. Oxygen at 10-15 l/min during migraine attacks decreased pain score after 30 minutes was 1.38. Relief of pain (24%), nausea (42%) and visual symptoms (36%) at 60 minutes. Pain relief was achieved by 46% of people. No significant adverse events. Safe strategy to treat acute migraine.

  • Oxygen treatment is effective in migraine with autonomic symptoms. 7 Nov 2012. A patient with migraine responded completely to inhalation of pure oxygen within 15 min but suffered from recurrence of attacks within 30 min after discontinuation.

  • Efficacy of high-flow oxygen therapy in all types of headache: a prospective, randomized, placebo-controlled trial. 3 May 2012. With oxygen therapy, significant improvement in VAS scores: 22 mm vs 11 mm at 15 minutes, 29 mm vs 13 mm at 30 minutes, and 55 mm vs 45 mm at 60 minutes. Reduction of medication requested by patients.

  • High-flow oxygen for treatment of cluster headache: a randomized trial. 9 Dec 2009. Cluster headache: oxygen worked for 78% and no important adverse events.

  • [Hyper- or normobaric oxygen therapy to treat migraine and cluster headache pain. Cochrane review]. Apr 2008. NBOT was effective in terminating acute cluster headache but not in comparison to sublingual ergotamine. No prophylactic effects. No serious adverse effects.

  • EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. Oct 2006. For the acute treatment of cluster headache attacks, oxygen (100%) at 7 l/min over 15 min and 6 mg subcutaneous sumatriptan are drugs of first choice.

  • Hyperbaric oxygen in the treatment of migraine with aura. Feb 1998. Increased levels of oxygen in the blood may work through vasoconstriction and local metabolic effects. Resolution of tenderness and edema following OT.

  • Hyperbaric oxygen in chronic cluster headaches: influence on serotonergic pathways. Jun 1997. Oxygen therapy could act through serotonergic pathways.

  • Effect of hyperbaric oxygen on the immunoreactivity to substance P in the nasal mucosa of cluster headache patients. Nociceptive neurons could be involved in the pathogenesis of headache. Decrease in the content of immunoreactivity for substance P found in patients exposed to hyperbaric oxygen. The content of neuropeptides could influence the mechanism of action of the beneficial effect of hyperbaric oxygen.

  • A preliminary report on hyperbaric oxygen in the relief of migraine headache. Apr 1995. The efficacy of raising blood oxygen levels in headache may be mediated by vasoconstriction and metabolic effects. 1/10 in the normobaric group achieved significant relief of headache symptoms, 9/10 in the hyperbaric group found relief. Hyperbaric (but not normobaric) oxygen may be useful in the abortive management of migraine headache. Possible increase in energy-producing and neurotransmitter-related metabolic reactions in the brain which require molecular oxygen.

  • Treatment of cluster headache. A double-blind comparison of oxygen v air inhalation. Apr 1985. Average relief score for oxygen was 1.93 out of 3 for cluster headache.

  • Extracranial Vascular Responses to Sublingual Nitroglycerin and Oxygen Inhalation in Cluster Headache Patients. Mar 1985. Inhalation of oxygen produced significantly greater reduction of symptoms than the drug. Significantly better results during cluster headache than between bouts.

  • Response of Cluster Headache Attacks to Oxygen Inhalation. Jan 1981. 75% of patients inhaling O2 obtained significant relief from cluster pain. Results were better (82%) than those of ergotamine users (70%), but not significantly. Rapidity of relief similar in both groups.


  • Effect of applying reflexology massage on nitroglycerin-induced migraine-type headache: A placebo-controlled clinical trial. Jul 2018. Reflexology massage two times for 20 min (at 3-h interval), in the upper part of both foot thumbs reduced the intensity of headache.

  • Effects of feet reflexology versus segmental massage in reducing pain and its intensity, frequency and duration of the attacks in females with migraine: a pilot study. Apr 2017. All variables (visual analogue scale, intensity, frequency and duration) decreased significantly 3 months after the treatment. Feet reflexology is a safe alternative to pharmacological treatment of migraine.

  • Revisiting reflexology: Concept, evidence, current practice, and practitioner training. Oct 2015. Systematic review failed to show concrete evidence for reflexology but anecdotal evidence show positive effects in a variety of health conditions.

  • Acupressure in the control of migraine-associated nausea. May 2012. Acupressure effective for nausea severity and offer a no-cost, convenient, self-administered intervention to reduce nausea. Nausea scores drop from 6.36 to 4.60 in T1, to 3.11 in T2, to 1.88 in T3 and to 0.92 in T4. High percentage of responders to the treatment: 46.8 % at 60 min; 71.8 % at 120 min; 84.3 % at 240 min. Results advocate the continuous application of PC6 acupressure in all migraine attacks with the accompanying symptom of nausea.

  • Effect of Acupressure and Trigger Points in Treating Headache: A Randomized Controlled Trial. 2010. Scores on the VAS significantly lower in the acupressure group (32.9) than in the muscle relaxant medication group (55.7). The superiority of acupressure remained at 6-month follow-up. 1 month of acupressure is more effective in reducing chronic headache than 1 month of muscle relaxant treatment, and the effect remains 6 months after treatment.

Physical therapy

  • Physical therapy and exercise in headache. Jul 2008. Conflicting results in previous studies might be due to the low number of clinical trials plus an indiscriminate application of different techniques.

  • Prevalence and Significance of Muscle Tenderness During Common Migraine Attacks. Mar 1981. All migraineurs had tenderness in the head, shoulders and neck and all but 2 had pain. Pericranial muscles and tendon insertions are important for common migraine pain.

Mild to moderate exercise

  • What to know about headaches after exercise. 4 Nov 2019. Exercise can trigger a migraine due to starting exercise too abruptly, low blood sugar, dehydration, lifestyle changes, such as diet.

  • The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis. 14 Feb 2019. Significant reductions in number of migraine days after aerobic exercise with reduction of 0.6 days/month. Small to moderate reductions in attack duration (20-27%) and pain intensity (20-54%) after aerobic exercise. No conclusion for pain intensity or duration of attacks due to a lack of uniformity.

  • Physical exercise and migraine: for or against? May 2018. Migraine can worsen during or after physical exercise. But studies consistently show an inverse association between physical exercise and migraine. Overall, reduction of frequency, severity and duration of migraine attacks observed after exercise interventions, and considerable improvement of the quality of life. Studies results: 1) 38% reported a risk of developing migraine attacks during exercise, mostly endurance (running). 2) Low physical exercise (<30 min per week) associated with 60% higher risk of developing migraine in women. 3) Risk of having a migraine 4.4-fold higher with low level of physical exercise (<30 min on most days). 4) Physical activity led to pain worsening during attacks in only 10% of participants. 5) 1 to 3 hours of low-intensity physical exercise per week and 1 to 2 hours of hard physical exercise per week were respectively associated with a 22% lower risk of developing migraine compared to inactivity. 6) 1-hour aerobic exercise 3 times weekly had a substantial improvement of all migraine features with reduction of pain intensity (−55%), pain duration (−67%), pain frequency (−51%) and pain disability index (−56%). 7) 1-hour of twice-weekly indoor aerobic exercise program for 6 weeks led substantial reduction of migraine pain (−80%) and frequency (≥1 per week; −50%). 8) 40 min indoor cycling 3 times weekly for 12 weeks led substantial improvement with reduction of pain intensity (−18%), migraine attacks per month (−23%), days with migraine (−28%) and use of anti-migraine drugs (−24%), improved quality of life (+12%). Also on Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls. Oct 2011. 9) 40 min of moderate intensity aerobic exercise 3 times weekly: frequency, intensity and duration of migraine attacks were found to be substantially reduced. 10) Exhaustion tests in people who say exercice trigger migraines: attack developed in 36%, whilst 43% did not develop an attack. Modest association between test-provoked migraine and baseline frequency of migraine attacks. 11) Both high and moderate intensity exercises were associated with a reduced frequency of migraine attacks, although HIT seemed globally more efficient (−63%) than MCT (−26%). 12) 45 min of aerobic exercise 3 times weekly led substantial improvement of all the main migraine features: reduction of days (−23%), pain intensity (−16%) and duration (−28%). The quality of life substantially improved. Conclusion: regular moderate-intensity aerobic exercise (i.e., ≥40 min, 3 times per week) is a reasonable preventive measure. Adaptation towards enhanced pain threshold and lower stress commonly induced by regular physical exercise. But not for patients with exercise-provoked migraine, probably due to acute increase of the powerful vasodilation compound nitric oxide.

  • The association between migraine and physical exercise. 10 Sep 2018. Exercise may trigger migraine attacks by release of neuropeptides or lactate metabolism. Exercise may prevent migraines by increased beta-endorphin due to an altered migraine triggering threshold. However, the frequency and intensity of exercise is still an open question.

  • Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes. Feb 2016. Weak understanding of the optimal parameters of exercise regimens for migraine (when, who, optimal types and doses/intensities of exercise). Regular aerobic exercise changes cardiopulmonary, inflammatory, and neurovascular processes that impact migraine pathways. Improvements in aerobic fitness and migraine likely mediated by changes in psychological, behavioral, and sociocognitive factors (eg, self-efficacy beliefs, outcome expectancies) for both exercise participation and migraine self-management.

  • Why does increased exercise decrease migraine? Dec 2013. Consistent evidence that cardiovascular exercise can activate multiple pain modulatory mechanisms, if not the underlying mechanisms that initiate the attack. Exercise activates neurotransmitter signals that could reduce the intensity of migraine pain. Evidence supporting the role of exercise in migraine management. Also interesting indicator of patient self-efficacy when patients engaged in their own treatment and motivated to take control of their own health.

  • Migraineurs with exercise-triggered attacks have a distinct migraine. Dec 2013. 38% of migraineurs have exercise-triggered migraine. Neck pain as the initial migraine symptom was more frequent.

  • The effects of aerobic exercise on migraine. Jan 1992. Aerobic classes effective in significantly improving cardiovascular fitness & decreased Pain Severity significantly.

Stretch and move

  • Effect of neck exercises on cervicogenic headache: a randomized controlled trial. Apr 2010. Headache decreased by 69% with strength exercise, 58% with endurance and 37% with stretching.

Heat or cold

  • Randomized Controlled Trial: Targeted Neck Cooling in the Treatment of the Migraine Patient. Jul 2013. Max pain reduction after 30 minutes with a 31.8% decrease in pain vs a 31.5% increase in pain in the control group. The application of a frozen neck wrap at onset of migraine headache significantly reduced pain in participants with migraines.

  • Why do ice packs feel good when you have a migraine? The National Headache Foundation and the Mayo Clinic include cold compresses and ice packs among their recommendations to ease migraine symptoms. Cold therapy is the most common self-administered pain-relief measure used by migraineurs. 75% found that cold therapy provided them with at least some relief. Cold constricts the blood vessels, possibly creating decreased downstream blood flow and lessening the pain. It may also reduce swelling. The cold inhibits the ability to feel the pain by slowing nerve conduction. Cold may decrease metabolic and enzymatic activity, which reduces local tissue demand for oxygen.

  • Cold Therapy in Migraine Patients: Open-label, Non-controlled, Pilot Study. Dec 2006. 25 min after treatment, VAS score decreased from 7.89 to 5.54. 25 min after treatment of the 2nd attack, VAS score decreased from 7.7 to 5.4. Cold application may be effective for migraine attacks.

  • Self-Administered Pain-Relieving Manoeuvres in Primary Headaches. 1 Sep 2001. Application of cold and compression on forehead and temples had a sensitivity of 33% and a specificity of 86%; for cold only 36% and 84%. But the efficacy in reducing pain was scarce. Only 8% resulted in a good or excellent pain control, wearing off when the manoeuvre stopped.

  • Pressure, Heat, and Cold Help Relieve Headache Pain. 9 Sep 2000. The effectiveness of extracranial pressure coupled with heat or cold to treat headaches is supported by anecdotal and scientific evidence. 87% rated effectiveness as "optimally effective," and 13% as "moderately effective." All patients preferred pressure. Those with migraines found heat and cold equally effective. The duration of headaches while using the headband ranged from 0.67 to 2.83 hours, and the duration of headaches without the headband but with medication ranged from 2 to 8 hours. Simultaneous pressure, heat, and cold help relieve headache and reduce headache duration.

  • Cryotherapy for headache. Oct 1989. Effectiveness of a coldwrap for headache relief : 35.5% not effective, 29% mildly effective, 26.5% moderately effective, and 9% completely effective.

  • Cold as an adjunctive therapy for headache. Jan 1986. Standard headache medication vs standard medication plus application of frozen gel pack. 71% considered the pack effective; 52% reported immediate decrease in pain, and 63% reported an overall decrease in pain. 71% of patients intended to use the gel pack in the future.

Nocebo and limiting beliefs, versus self-efficacy and empowerment

  • Locus of control moderates the relationship between headache pain and depression. 5 Aug 2008. Greater self-reported headache pain severity associated with higher levels of depression. High internal locus of control weakened the relationship between the headache severity and depression. Relationship between pain severity and internal locus of control and perceived efficacy of pharmacologic intervention. Stronger coping skills might reduce depression among headache sufferers.

  • Impaired functioning and quality of life in severe migraine: the role of catastrophizing and associated symptoms. 4 Sep 2007. A psychological response to migraines (catastrophizing) is associated with impaired Fn/QoL independent of migraine characteristics.

  • Using the self-regulatory model to cluster chronic pain patients: the first step towards identifying relevant treatments? Apr 2004. Utility of a model of illness representations to identify pain groups, with different measures of pain, mood, and functioning.

  • Perceived self-efficacy and headache-related disability. Sep 2000. Patients confident they could prevent and manage their headaches also believed that factors influencing their headaches were within their control. Self-efficacy positively associated with the use of positive psychological coping strategies to prevent and manage headaches and negatively associated with anxiety. Headache severity, locus-of-control beliefs, and self-efficacy beliefs each explained independent variance in headache-related disability.

  • The Headache Self‐Efficacy Scale: Adaptation to Recurrent Headaches. May 1993. The Headache Self‐Efficacy Scale assesses individuals' belief that they are able to prevent headaches when confronted with personal precipitants. High self‐efficacy associated with less depression, anxiety, and physical symptoms, and less use of passive coping strategies. Self‐efficacy explained variance in psychological and somatic symptoms beyond that explained by locus of control and general self‐efficacy. Adaptation to headaches is influenced by self‐efficacy beliefs.

  • The Headache‐Specific Locus of Control Scale: Adaptation to Recurrent Headaches. Nov 1990. The belief that headache problems and relief are determined by chance factors associated with higher levels of depression, physical complaints, reliance on maladaptive pain coping strategies, and greater headache‐related disability; (2) the belief that headache problems and relief are influenced by health care professionals was associated with higher levels of medication use and preference for medical treatment ; and (3) the belief that headache problems are determined by the individual's behaviors was associated with a preference for self‐regulation treatment. Adaptation to headache problems is influenced not only by the frequency and severity of the headache episodes, but by locus of control beliefs.

  • A migraine trigger is anything that brings on a migraine attack. Accessed on 2 Jan 2020. Most common triggers: sleep issues, strong smells, bright lights, smoke/pollution, air pressure, humidity, temperature, changes in hormone levels, hormone replacement therapy, oral contraceptives, medication overuse...

  • The diagnosis and treatment of chronic migraine. May 2015. 3 approaches for migraines: lifestyle and trigger management, acute treatments and prevention. Regularity of sleep and stress are helpful in reducing migraines.

  • Use of complementary and alternative medicine in patients suffering from primary headache disorders. 7 Sep 2009. Complementary and alternative medicine is used by 81.7% of patients mostly in combination with standard care.

  • Trigger factors in childhood migraine: a clinic-based study from eastern India. 25 Aug 2009. Triggers mostly environmental (sun exposure 84%-94%, hot humid weather 85%-94%, smoke and noise 37%-41% and 69%-78%) and stress related (89%-79%).

  • Trigger factors in migraine patients. Sep 2008. Hormonal factors in 53%, mostly pre-menstrual period. 64% emotional stress. 81% sleep problem. Smells 36.5%.

  • The triggers or precipitants of the acute migraine attack. 30 Mar 2007. 76% reported triggers: stress (79.7%), hormones in women (65.1%), weather (53.2%), sleep disturbance (49.8%), odours (43.7%), light (38.1%), smoke (35.7%), heat (30.3%).

  • Modifiable risk factors for migraine progression (or for chronic daily headaches)--clinical lessons. Oct 2006. 6 key interventions including avoiding medication overuse and treating sleep problems.

  • Triggers of headache episodes and coping responses of headache diagnostic groups. Jul-Aug 1995. Migraine patients triggers: noise, light and physical activity.

  • Precipitating factors in migraine: a retrospective review of 494 patients. Apr 1994. The most frequent triggers: Stress (62%), weather (43%), bright sunlight (38%), perfumes, cigarette smoke.


  • This App May Help Reduce Migraine Attacks by Nearly 30%. 4 Jun 2019. Relaxation techniques can help cut migraine attacks.

  • The stress and migraine interaction. 8 Jul 2009. Stress is the most frequent trigger. Migraine can act as a stressor, leading to a vicious circle of increasing migraine frequency. Individual's responses to stressors and stress management skills can reduce the impact on migraine.

  • Anxiety, stress and coping behaviours in primary care migraine patients: results of the SMILE study. 15 Jul 2008. 67% found anxious, due to stress and maladaptive coping strategies. Anxiety associated with elevated consumption of migraine medicine and low effectiveness. Stress and anxiety should be looked for carefully in migraineurs.


  • Sleep deprivation headache. Aug 1990. Headaches due to insufficient or interrupted sleep are generally labelled "tension headaches". Sleep loss caused headaches lasting from 1 h to all day. Sleep has a restorative function in the brain.

  • A case-control study on excessive daytime sleepiness in episodic migraine. 24 Aug 2004. EDS correlated with migraine, sleep problems and anxiety.


  • Testosterone levels in men with chronic migraine. 18 Jun 2019. Men with migraine had lower total testosterone levels.

  • Headaches and hormones: What's the connection? 10 May 2019. Steady estrogen levels may improve headaches, low estrogen levels can make headaches worse.

  • 7 Ways to Balance Hormones Naturally. 23 May 2018. 1: Swap Carbs for Healthy Fats. 2: Use Adaptogens 3: Address Emotional Imbalance 4: Use Essential Oils 5: Supplement deficiencies (vitamin D, probiotics, bone broth...) 6: Beware of Medications and Birth Control 7: Get More Sleep

  • Menstrual migraine: an updated review on hormonal causes, prophylaxis and treatment. 6 Aug 2014

  • The impact of migraine on the health and well-being of women. Nov 2007. Potential association between migraine and hormonal changes during menarche, pregnancy or perimenopause.

  • Hormones and Migraine. 2007. 60% of women sufferers related attacks to their menstrual cycle. Also mid-cycle or at the time of ovulation. In association with drops in estrogen levels. Hormones are just one of many triggers.


  • A migraine trigger is anything that brings on a migraine attack. Accessed on 2 Jan 2020. Medication overuse is one of the most frequent trigger.

  • Migraine Progression: A Systematic Review. 27 Dec 2018 The main risk factors are acute medication overuse/high-frequency use and depression.

  • Diagnosis and treatment for chronic migraine. 22 May 2016.

  • Ineffective acute treatment of episodic migraine is associated with new-onset chronic migraine. 17 Feb 2015. Inadequate treatment efficacy was associated with an increased risk of CM.

  • Impact of NSAID and Triptan use on developing chronic migraine: results from the American Migraine Prevalence and Prevention (AMPP) study. 28 Aug 2013. Triptan is associated with an increased risk of CM that increases with days of medication use. NSAIDs associated with increased risk with >=10 headache days per month.

  • Modifiable risk factors for migraine progression (or for chronic daily headaches)--clinical lessons. Oct 2006. Amongst the Key interventions: avoid medication overuse.

  • Transformed migraine and medication overuse in a tertiary headache centre--clinical characteristics and treatment outcomes. Jun 2004. Many migraineurs may overuse medications. Overuse may be responsible for development of daily headaches. Detoxification is necessary to improve.

Family history and genetic susceptibility

  • Is the genetic liability in multifactorial disorders higher in concordant than discordant monozygotic twin pairs? A population-based family twin study of migraine without aura. May 2001. No significant difference in genetic liability to MO among twin pairs.

  • Migraine without aura: a population-based twin study. Oct 1999. Significant genetic factor in migraine.

  • The relative role of genetic and environmental factors in migraine without aura. 22 Sep 1999. Genetic factors play a role in migraine. Environmental factors are equally important and are individual to the migraineurs.

  • The inheritance of migraine with aura estimated by means of structural equation modelling. Mar 1999. High degree of genetic. Additive genetic effects and environmental effects.

  • Evidence of a genetic factor in migraine with aura: a population-based Danish twin study. Feb 1999. Importance of genetic factors in MA. Environmental factors are also important.

  • Familial risk of migraine: a population-based study. Feb 1997. Familial factors (environmental or genetic) account for less than half of migraines. Migraine determined by complex genetic as well as environmental factors.

  • Inheritance of migraine investigated by complex segregation analysis. Dec 1995

Other factors

  • 31P-MRS demonstrates a reduction in high-energy phosphates in the occipital lobe of migraine without aura patients. 2 Feb 2011. Energy metabolism impaired. Decrease in ATP. Mitochondrial component in the pathophysiology of migraine.

  • Mitochondrial dysfunction and migraine: evidence and hypotheses. Apr 2006. Impairment of mitochondrial oxidative metabolism might play a role in migraine, by influencing neuronal information processing. Decreased activity of the respiratory chain enzymes. Impairment of brain oxidative energy metabolism.

  • Deficit of brain and skeletal muscle bioenergetics and low brain magnesium in juvenile migraine: an in vivo 31P magnetic resonance spectroscopy interictal study. Dec 1997. Bioenergetic failure.

  • [Migraine and mitochondrial dysfunction]. Apr 1996. Mitochondrial involvement, abnormalities in cerebral oxidative metabolism, may play a role in migraine.

  • 31P-magnetic resonance spectroscopy in migraine without aura. Apr 1994. Energy metabolism is abnormal in migraine.

  • Muscle mitochondrial DNA deletion and 31P-NMR spectroscopy alterations in a migraine patient. Aug 1991. Defective energy metabolism.

Best supplementation for migraineurs

  • Canadian Headache Society guideline for migraine prophylaxis. Mar 2012. 11 strong recommendation including butterbur, riboflavin, coenzyme Q10, and magnesium citrate.

  • Nonmedication, alternative, and complementary treatments for migraine. Aug 2012. Therapies effective for migraine include supplementation with magnesium, CoQ10, riboflavin, butterbur, feverfew, and cyanocobalamin with folate and pyridoxine.

  • Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments. 25 Feb 2011. Efficacy of alternative approaches, including vitamins and supplements (magnesium, riboflavin, coenzyme Q10, and alpha lipoic acid) and herbs (feverfew, and butterbur).


  • Magnesium Fact Sheet for Health Professionals. 11 Oct 2019. A majority of Americans ingest less magnesium than EARs. Magnesium deficiency can promote headaches, due to neurotransmitter release and vasoconstriction. Migraineurs have lower levels of magnesium.

  • Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. 13 Jan 2018. Serum magnesium does not reflect intracellular magnesium (99% of total body magnesium). The vast majority of people in modern societies are at risk for magnesium deficiency.

  • The effects of magnesium prophylaxis in migraine without aura. Jun 2008. Migraine attack frequency, severity and P1 amplitude decreased after magnesium treatment. Might work with both vascular and neurogenic mechanisms.

  • Serum ionized magnesium levels and serum ionized calcium/ionized magnesium ratios in women with menstrual migraine. Apr 2002. Mg deficiency of 45% during menstrual attacks. Possible role for magnesium deficiency in the development of menstrual migraine.

  • Free and total magnesium in lymphocytes of migraine patients — effect of magnesium-rich mineral water intake. May 2000. Magnesium is an intracellular cation. Total or ionized magnesium of blood cells as the most adequate tests. Magnesium levels significantly lower in migraine patients.

  • Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Jun 1996. Attack frequency reduced by 41.6%. Duration and the drug consumption also decreased significantly. Some diarrhea (18.6%). Magnesium appears effective for migraine.

  • Serum and red blood cell magnesium levels in juvenile migraine patients. Jan 1995. Migraineurs had significantly lower magnesium levels.

  • Red blood cell magnesium levels in migraine patients. Apr 1993. Migraineurs had significantly lower magnesium levels.

  • Serum and salivary magnesium levels in migraine. Results in a group of juvenile patients. Mar 1992. Migraineurs had lower levels of magnesium. Levels further reduced during attacks. Mg levels could contribute to defining the threshold for migraine attacks.

  • Serum and salivary magnesium levels in migraine and tension-type headache. Results in a group of adult patients. Feb 1992. Migraineurs had significantly lower levels of magnesium. Levels further reduced during attacks.

  • Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. May 1991. Pain decreased by Mg as well as duration. Supplementation can help for menstrual migraine. A lower migraine threshold could be related to magnesium deficiency.

  • Low brain magnesium in migraine. Oct 1989. Magnesium levels low during migraine attack. Low brain magnesium is an important factor in migraine attack.

B-Complex Vitamins

  • Riboflavin. Aug 2019. Riboflavin supplementation can reduce migraine attacks and symptoms by helping the functioning of the mitochondria. 8/10 migraineurs use alternative therapies, including vitamins and supplements.

  • Assessment of pyridoxine and folate intake in migraine patients. 16 Mar 2016. Migraineurs had lower intake of dietary folate. No significant association between intake of folate with the frequency of migraines.

  • Effects of dietary folate intake on migraine disability and frequency. 19 Jan 2015. Significant inverse relation between dietary folate (B9) and migraine frequency. Especially for individuals with CC MTHFR C677T variant. Folate intake may influence migraine frequency.

  • Mitochondrial dysfunction in migraine. Sep 2013. Some migraines may be related to a mitochondria (mt) defect. Agents that have a positive effect on mt metabolism are effective in the treatment of migraines: riboflavin (B2), co-Q10, magnesium, niacin (B3), lipoic acid...

  • Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. 24 Apr 2012. feverfew, magnesium, riboflavin (B2) are probably effective for migraine prevention (Level B).

  • The effect of 90 day administration of a high dose vitamin B-complex on work stress. 8 Sep 2011. The vitamin B complex treatment resulted in significantly lower strain, stress and depressed mood.

  • Riboflavin prophylaxis in pediatric and adolescent migraine. Oct 2009. Attack frequency and intensity decreased during treatment for 77.1%. 68.4% of cases had a 50% or greater reduction in frequency and 21.0% in intensity. Riboflavin seems to be a well-tolerated and effective.

  • Mitochondrial DNA haplogroups influence the therapeutic response to riboflavin in migraineurs. May 2009. 63% patients responded to riboflavin.

  • Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Feb 1998. A deficit of mitochondrial energy metabolism may play a role in migraine. High-dose riboflavin was effective in reducing attack frequency and duration. 59% responders with at least 50% improvement in duration.


  • Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. 24 Apr 2012. Petasites (butterbur) is effective for migraine prevention and should be offered to patients to reduce the frequency and severity of attacks (Level A).

  • Butterbur root extract and music therapy in the prevention of childhood migraine: an explorative study. 30 Jul 2007. Music therapy and butterbur root extract showed a substantial reduction of attack frequency.

  • Migraine prevention in children and adolescents: results of an open study with a special butterbur root extract. Mar 2005. 77% reported a reduction in the frequency of migraine attacks of at least 50%. Attack frequency reduced by 63%. 91% felt improvement.

  • Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Dec 2004. Migraine attack frequency reduced by 48% and >50% reduction in attack frequency after 4 months for 68%.

  • The first placebo-controlled trial of a special butterbur root extract for the prevention of migraine: reanalysis of efficacy criteria. 28 Jan 2004. Attack frequency decreased by 47% after 3 months. 45% responders (improvement >=50%).

  • An extract of Petasites hybridus is effective in the prophylaxis of migraine. Jun 2001. The frequency of attacks decreased by up to 60% with butterbur.


  • Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. 24 Apr 2012. Feverfew, magnesium, riboflavin are probably effective for migraine prevention (Level B).

  • Efficacy and safety of 6.25 mg t.i.d. feverfew CO2-extract (MIG-99) in migraine prevention--a randomized, double-blind, multicentre, placebo-controlled study. Nov 2005. Migraine frequency decreased by 61% with MIG-99.

  • The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review. Dec 2000. Feverfew likely to be effective in the prevention of migraine.

  • Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: a double‐blind placebo‐controlled study. 4 Dec 1998. Feverfew caused a significant reduction in pain intensity, and profound reduction of symptoms such as vomiting, nausea, sensitivity to noise and sensitivity to light.


  • Response of migraine without aura to kudzu. May 2019. Preventive treatment for migraine helps to reduce disability by decreasing the frequency, severity, and duration of migraine attacks.

  • Response of cluster headache to kudzu. Jan 2009. 69% experienced decreased intensity of attacks, 56% decreased frequency, and 31% decreased duration.

  • An Evidence-Based Systematic Review of Kudzu (Pueraria lobata) by the Natural Standard Research Collaboration. 11 Mar 2014. Safety and efficacy data about Kudzu available in the scientific literature.

CBD oil

  • Emerging Role of (Endo)Cannabinoids in Migraine 24 Apr 2018. Cannabinoids – due to their anticonvulsive, analgesic, antiemetic, and anti-inflammatory effects – can help relieve migraine pain. CB1 receptors in the brain. Block nociceptive traffic and reduce cortical excitability predisposing to CSD. CB2 receptors in immune cells targeted to reduce inflammatory component associated with migraines.

  • The Use of Cannabis for Headache Disorders. 1 Apr 2017. Anecdotal and preliminary results, and plausible neurobiological mechanisms for headaches.

  • Cannabinoids suitable for migraine prevention. 24 Jun 2017. Cannabinoids are as suitable as for migraine attacks as other pharmaceutical treatments. Acute pain dropped by 55% (dose dependent).


  • Double-blind placebo-controlled randomized clinical trial of ginger ( Zingiber officinale Rosc.) addition in migraine acute treatment. Jan 2019. Ginger treatment promoted reduction in pain and improvement on functional status. The addition of ginger to NSAIDs can help for migraines.

  • Ginger as effective as synthetic drug in migraine, but without the side effects. 22 Aug 2017. Ginger equally as effective as sumatriptan achieving 90% relief within 2 hours, without the side effects of the drug (dizziness, drowsiness, or heartburn). Sumatriptan is the gold standard: it brings immediate relief for many patients, but headache recurs in 40% of patients within 24 hours and can also cause serious side effects (coronary artery spasms, heart attacks, stroke, abnormal heart beats, and seizures).

  • Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine. 9 Mar 2013. 2h after using either drug, mean headaches severity decreased significantly. Efficacy of ginger and sumatriptan was similar. Clinical adverse effects of ginger powder were less than sumatriptan.

  • A double-blind placebo-controlled pilot study of sublingual feverfew and ginger (LipiGesic™ M) in the treatment of migraine. 1 Jun 2011. At 2 hours, 32% of subjects were pain-free, 63% found pain relief. Feverfew/ginger effective for migraineurs.

  • Chapter 7 The Amazing and Mighty Ginger. 2011. Ginger has been used for thousands of years for the treatment of numerous ailments, such as colds, nausea, arthritis, migraines, and hypertension.

Essential oils

  • Comparing the Effect of Intranasal Lidocaine 4% with Peppermint Essential Oil Drop 1.5% on Migraine Attacks: A Double-Blind Clinical Trial. 2019. Peppermint oil and lidocaine both considerably reduced intensity and frequency of headaches in 42% of patients.

  • Lavender essential oil in the treatment of migraine headache: a placebo-controlled clinical trial. 17 Apr 2017. 71% migraineurs had a relief with lavender. Inhalation of lavender essential oil may be an effective and safe treatment for acute migraines.

  • The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis/. 14 Dec 2016. Significant positive effect of aromatherapy in reducing pain. Aromatherapy is a safe addition to pain management procedures with no adverse effects.

  • Peppermint oil in the acute treatment of tension-type headache. Jun 2016. The topical treatment with peppermint oil is significantly effective, similar to acetylsalicylic acid or paracetamol.

  • HOW ESSENTIAL OILS CAN HELP WITH HEADACHES. Lavender, peppermint, rosemary, chamomille and eucalyptus can all be beneficial in the treatment of headaches, by relieving tensions and inflammation.

  • Lavender Essential Oil in the Treatment of Migraine Headache: A Placebo-Controlled Clinical Trial. May 2012. 71% migraineurs had a relief with lavender. Inhalation of lavender essential oil may be an effective and safe treatment for acute migraines.

  • Effectiveness of Oleum menthae piperitae and paracetamol in therapy of headache of the tension type. Aug 1996. Peppermint oil significantly reduced headache intensity after 15 minutes, similar to acetaminophen. The 2 treatments combined leads to an additive effect.

  • Essential plant oils and headache mechanisms. 1995. Significant analgesic effect with peppermint oil.

Coenzyme Q10

  • Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. 24 Apr 2012. Treatments possibly effective: Co-Q10.

  • Coenzyme Q10 deficiency and response to supplementation in pediatric and adolescent migraine. Jan 2007. Headache frequency reduced by 35% and disability by 52%, with coQ10. Deficiency of CoQ10 may be common in migraineurs.

  • Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. 22 Feb 2005. Riboflavin, which improves energy metabolism similarly to CoQ10, is effective in migraine prophylaxis. CoQ10 worked for attack-frequency (48% responders), headache and nausea days.

  • Open label trial of coenzyme Q10 as a migraine preventive. Mar 2002. 61.3% of patients had >50% reduction in number of days with migraine. Duration decreased by 60% after 3 months of CoQ10. Frequency reduced by 55% after 3 months.

Alpha Lipoic Acid (aka thiotic acid)

  • A randomized double-blind placebo-controlled trial of thioctic acid in migraine prophylaxis. Jan 2007. Significant reduction of attack frequency, headache days and headache severity in patients treated with thioctic acid for 3 months.

Multidisciplinary approaches

  • Predictors of outcome of the treatment programme in a multidisciplinary headache centre. 26 Mar 2010. A multidisciplinary approach in a tertiary headache centre for migraine. Absence from work reduced from 20 to 11 days for women and 5 to 2 days for men.

  • Efficacy of multidisciplinary treatment in a tertiary referral headache centre. Dec 2005. Efficacy of multidisciplinary treatment in a tertiary referral headache centre.

  • Effectiveness of an intensive multidisciplinary headache treatment program. Jul 2009. Multidisciplinary headache treatment highly effective for headaches. Higher reduction of migraine days and higher responder rates.

  • Pathophysiology of Migraine: A Disorder of Sensory Processing. 8 Feb 2017. With more than 1 billion patients having an attack in any year, migraine is the 6th most common cause of disability on the planet.

  • Migraine facts. Accessed on 23 Dec 2019.

  • Key facts and figures about migraine. The migraine trust. Accessed on 23 Dec 2019.

  • An update on migraine: current understanding and future directions. 20 Mar 2017. Migraine is a common brain disorder with high disability rates which involves a series of abnormal neuronal networks.

  • Diagnosis and treatment for chronic migraine. 22 May 2016. Migraine is a debilitating headache disorder that is underdiagnosed and undertreated worldwide, partially attributable to misdiagnosis and expectations of poor treatment outcomes.

  • Recurrence of primary headache disorders after emergency department discharge: frequency and predictors of poor pain and functional outcomes. 3 Apr 2008. Headache patients frequently experience pain and functional impairment during the hours and months after discharge (31% for migraine 24h after discharge and 37% in the 3 months after).

  • Transformed migraine and medication overuse in a tertiary headache centre--clinical characteristics and treatment outcomes. Jun 2004. A substantial proportion of headache sufferers may overuse acute medications, which may be responsible for the development or maintenance of a chronic daily headache. Detoxification is necessary to improve the headache status.

  • Triptans (serotonin, 5-HT1B/1D agonists) in migraine: detailed results and methods of a meta-analysis of 53 trials. Oct 2002.

  • Study Summary: Costs Associated With Migraine in the United States. 1 Jun 2018. The direct costs of migraine = medical costs. The indirect costs = lost productivity, absenteeism, short-term and long-term disability. In 2016, estimated total annual cost of $36 billion.

  • Indirect costs are a significant portion of the total economic burden of migraine. 10 Apr 2017. The “hidden” costs of migraine, ranging from job absenteeism to home modifications. Estimate of over 54 billion annually.

  • Global study by Novartis and European Migraine and Headache Alliance reveals 60% of employed people with severe migraine miss, on average, a week of work per month. 27 Jun 2018. Migraine overall costs estimated to range between €18-27 billion across Europe.

  • Migraine costs EU economy €95bn per year. Migraine costs Europe an estimated €95bn in lost productivity every year based on a report to EU Parliament dated 27 Feb 2019.

What causes migraines?

  • Everything You Need to Know About Headaches 2 Aug 2018.

  • A migraine trigger is anything that brings on a migraine attack. Most common triggers: changes in sleep patterns, fasting, skipping meals, dehydration, alcohol, over-exertion, exercise, stress. Strong smells, bright or flickering lights, smoke/pollution, altitude, air pressure, motion sickness. Humidity (high and low), changes in temperature or in barometric pressure, bright sunlight. Changes in hormone levels, pregnancy, menstruation, menopause, hormone replacement therapy, oral contraceptives. Medication: overuse, oral contraceptives, medication side-effects. Foods: artificial sweeteners, MSG, nitrates (cured meat) and tyramines (fermented foods, aged cheeses, yeast bread and cake), alcohol (especially red wine and beer), caffeine.

  • Migraine: Multiple Processes, Complex Pathophysiology. 29 Apr 2015.

  • Headache disorders: differentiating and managing the common subtypes. Aug 2012.

  • Migraine: Overview. 20 Jun 2012.

  • Trigger factors in migraine patients. Sep 2008. Most patients showed at least one dietary trigger, fasting the most frequent, followed by alcohol and chocolate. Hormonal factors in 53%, stress 64%, sleep problem 81%, smells 36.5%.

  • The triggers or precipitants of the acute migraine attack. 30 Mar 2007. 75.9% reported triggers: The trigger frequencies were stress (79.7%), hormones in women (65.1%), not eating (57.3%), weather (53.2%), sleep disturbance (49.8%), perfume or odour (43.7%), neck pain (38.4%), light (38.1%), alcohol (37.8%), smoke (35.7%), sleeping late (32.0%), heat (30.3%), food (26.9%), exercise (22.1%).

  • Modifiable risk factors for migraine progression (or for chronic daily headaches)--clinical lessons. Oct 2006. Key interventions include: (1) behavioral and pharmacologic interventions; (2) maintenance of normal weight; (3) Avoid medication overuse; (4) Avoid caffeine overuse; (5) treat sleep problems; (6) treat depression.

  • Triggers of headache episodes and coping responses of headache diagnostic groups. Jul-Aug 1995. Migraine patients triggers: noise, light and physical activity.

  • Precipitating factors in migraine: a retrospective review of 494 patients. Apr 1994. The most frequent triggers: Stress (62%). Weather changes (43%), missing a meal (40%), and bright sunlight (38%), perfumes, cigarette smoke.

Identify your personal triggers

  • Towards improved migraine management: Determining potential trigger factors in individual patients. 14 May 2016. 4 triggers on average and 85% of patients identified at least one association. Identification of individual factor-attack profiles is a prerequisite for development of trigger avoidance or desensitisation strategies.

  • Diet and Headache: Part 1. Oct 2016. Strong evidence for Caffeine withdrawal and MSG. Mixed evidence for Aspartame. Modest evidence for gluten, histamine and alcohol. 2/3 of elimination of IgG positive foods significantly decreased frequency of migraine. Certain foods, beverages, and ingredients may trigger migraine. Elimination diets can help prevent headaches.

  • Food as trigger and aggravating factor of migraine. May 2012. 12 to 60% of patients report foods as trigger. Fasting, alcohol, chocolate and cheese are the most frequent. Identification of triggers may be helpful to reduce attacks frequency.


  • Does gluten sensitivity cause migraine? The migraine trust. Accessed on 23 Dec 2019.

  • Headache in Patients with Celiac Disease and Its Response to the Gluten-Free Diet. 20 Mar 2019. A GFD led to a 48% improvement in headache frequency.

  • Headache Associated with Coeliac Disease: A Systematic Review and Meta-Analysis. 6 Oct 2018. GFD can be effective for patients with Celiac Disease, leading to total resolution in up to 75%.

  • Association between migraine and Celiac disease: results from a preliminary case-control and therapeutic study. Mar 2003. A significant proportion of patients with migraine may have CD and could improve with a gluten free diet. 4.4% of migraine patients had CD (vs 0.4% on average). 25% had no migraine attacks after going gluten free and 75% improvement in frequency, duration, and intensity of migraine.

  • In a 2002 migraine study published in Neurology by Prof Marios Hadjivassiliou, 7 of 10 patients with severe migraines got rid of their migraines by going gluten-free, 2 got partial relief and 1 refused to try. They were all sensitive to gluten.

  • Gluten In The Diet May Be The Cause Of Recurring Headaches. 4 Feb 2001. Removing gluten greatly reduced symptoms.

Caffeine withdrawal

  • Caffeine as a risk factor for chronic daily headache: a population-based study. Dec 2004. Caffeine consumption can trigger headaches.

  • A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Oct 2004. 50% of headache 12-24 h after abstinence, peak at 20-51 h, and duration of 2-9 days. Severity of symptoms increased with increases in daily dose. Abstinence from even 100 mg/day produced symptoms.

  • Caffeine-induced headache in children and adolescents. Jun 2003. Children with high daily consumption of cola drinks may suffer from caffeine-induced daily headache. Gradual withdrawal can be achieved without headache for complete disappearance of the headache.

  • Caffeine withdrawal: a parametric analysis of caffeine dosing conditions. Apr 1999. Caffeine withdrawal can occur with even the lowest dose (100 mg).

  • Is caffeine withdrawal the mechanism of postoperative headache? Apr 1991. Postoperative headache partly due to perioperative caffeine withdrawal.

  • Caffeine-Withdrawal Headache: A Clinical Profile. May 1980. Caffeine withdrawal is an important cause of headache.

Red wine and beer

  • Relationships between food, wine, and beer-precipitated migrainous headaches. Jun 1995. 16.5% migraines from cheese or chocolate. 11.8% red wine but not white wine; 28% beer.

  • The red wine provocation test: intolerance to histamine as a model for food intolerance. Jan-Feb 1994. Sneezing, flush, headache, diarrhea, skin itch, and shortness of breath in patients intolerant to red wine, due to diminished histamine degradation from deficiency of diamine oxidase.

  • Red wine as a cause of migraine. 12 Mar 1988. Red wine contains a migraine-provoking agent that is neither alcohol nor tyramine.


  • Diet and Headache: Part 1. Oct 2016. Gluten- and histamine-containing foods and alcohol may precipitate headaches. An elimination diet of IgG positive foods significantly decreased frequency of migraine.

  • Serum diamine oxidase activity in patients with histamine intolerance. Mar 2016. Testing serum diamine oxidase can help identify who can benefit from a histamine limitation diet or diamine oxidase supplementation.

  • The role of tyrosine metabolism in the pathogenesis of chronic migraine. Aug 2013. Altered tyrosine metabolism plays an important role in chronic migraines. Serum diamine oxidase activity as a diagnostic test for histamine intolerance. 12 Apr 2013. Determining DAO activity in serum is a useful tool in diagnosing HIT. A histamine-free diet can stop the majority of symptoms and DAO significantly increased.

  • Histamine and histamine intolerance. May 2007. The ingestion of histamine-rich food, alcohol or drugs may provoke diarrhea, headache, rhinoconjunctival symptoms, asthma, flushing... in patients with histamine intolerance. Symptoms can be reduced by a histamine-free diet or be eliminated by antihistamines.

  • Histamine induces migraine via the H1-receptor. Support for the NO hypothesis of migraine. 31 Jul 1995. A migraine attack can be caused by NO formation in the endothelium of cerebral arteries.

  • Histamine-free diet: treatment of choice for histamine-induced food intolerance and supporting treatment for chronic headaches. Dec 1993. Food rich in histamine or red wine may cause allergy-like symptoms such as sneezing, flush, skin itching, diarrhoea and headaches. Fish, cheese, hard cured sausages, pickled cabbage and alcoholic beverages had to be avoided. 73% improved considerably, including 18% with total remission. No change for 27% of patients. Symptoms could also be eliminated by anti-histamines. Histamine-rich food causes a worsening of symptoms.

  • The prevalence of diet-induced migraine. Sep 1984. Patients with migraine reported that headaches can be precipitated by chocolate (90%), by cheese (18%) and by citrus fruit (11%), alcohol (29%).

Processed Meat

  • Increased plasma nitrites in migraine and cluster headache patients in interictal period: basal hyperactivity of L-arginine-NO pathway? Feb 2002. Significantly higher nitrite concentrations in migraine patients. A dysfunction in the L-arginine-NO pathway may be involved.

  • "Hot-dog" headache: individual susceptibility to nitrite. 2 Dec 1972. A patient with headaches after eating frankfurters also got headaches after ingestion of sodium nitrite or tyramine.


  • Does monosodium glutamate really cause headache? : a systematic review of human studies. 17 May 2016. MSG is a cause of headache in the ICHD-III beta. 5 of 13 studies showed a significant impact of MSG.

  • Effect of systemic monosodium glutamate (MSG) on headache and pericranial muscle sensitivity. Jan 2010. Significant increase in reports of headache after MSG.

  • MSG and hydrolyzed vegetable protein induced headache: review and case studies. Feb 1991. MSG may hide under "natural flavor," "flavoring," or "hydrolyzed vegetable protein (HVP)," on food labels. Elimination of MSG resulted in decreased headache frequency.

Other potential triggers

  • Diet and Headache – Foods. Accessed on 26 Dec 2019. Avoid Ripened cheeses. Herring. Chocolate. Anything fermented, pickled or marinated. Nuts. Peanut butter. Sourdough bread. Broad beans, lima beans, fava beans and snow peas. Foods containing MSG. Pizza. Excessive amounts of tea, coffee or cola beverages. Sausage, bologna, pepperoni, salami, summer sausage and hot dogs. Chicken livers and pâté. Alcoholic beverages. Limit caffeinated beverages, including soft drinks to max 200 mg per day.

  • Popular Sweetner Sucralose as a Migraine Trigger. 22 Aug 2006. Sucralose (Splenda) could cause migraines.

  • Migraine triggered by sucralose--a case report. Mar 2006. Migraines triggered by sucralose. Withdrawal of sucralose led to complete resolution.

  • Aspartame ingestion and headaches: a randomized crossover trial. Oct 1994. Some people are susceptible to headaches caused by aspartame.

  • Aspartame as a dietary trigger of headache. Feb 1989. Aspartame may be an important dietary trigger of headache in some people.

  • The Effect of Aspartame on Migraine Headache. Feb 1988. Aspartame could cause a significant increase in migraines.

  • Aspartame and susceptibility to headache. Nov 1987. Aspartame is no more likely to produce headache than placebo.

A ketogenic nutrition could help

  • Ketones and Migraines. 20 May 2019. In one study, the ketogenic diet resulted in up to an 80% reduction in migraine frequency, severity and use of medication. In another study, the ketogenic diet reduced migraine days by 62.5%. Ketones may target all features of migraine: inadequate brain glucose availability/metabolism, mitochondrial dysfunction, oxidative stress, excitability of the brain (excess of glutamate vs GABA), inflammation, GI issues.

  • Cortical functional correlates of responsiveness to short-lasting preventive intervention with ketogenic diet in migraine: a multimodal evoked potentials study. 31 May 2016. After KD, significant reduction in attack frequency and duration. KD may balance excitation and inhibition at the cortical level.

  • Migraine improvement during short lasting ketogenesis: a proof-of-concept study. 25 Aug 2014. In the KD group, attack frequency, duration and tablet intake were significantly reduced after the first month of diet and after 6 months. KD efficacy could be related to its ability to enhance mitochondrial energy metabolism and counteract neural inflammation.

Don't skip meals and stay hydrated

  • Trigger factors in childhood migraine: a clinic-based study from eastern India. 25 Aug 2009. Triggers in 94% of subjects: sun exposure 84%-94%, hot humid weather 85%-94%, smoke 37%-41% and noise 69%-78%, crowded places 54%-78% and stress 89%-79%. Missing meals 13%-32%.

  • Effects of food deprivation and a stressor on head pain. Jul 1997. Hunger, anxiety, depression and anger can precipitate migraine and tension-type headaches.

  • Water-deprivation headache: a new headache with two variants. Jan 2004. 10% experienced water-deprivation headache. 22/34 got relief within 30' by drinking 0.5L, 11/34 within 1 to 3h with 0.75L and 1 required sleep in addition to fluid intake. Water deprivation may play a role in migraine, particularly in prolonging attacks.

1- Strength training

  • Complexity: A Novel Load Progression Strategy in Strength Training. 3 Jul 2019. Increasing the technical difficulty of the strength exercise enhances muscle strength synergistically with other physical fitness components.

  • Resistance training for health and performance. Jun 2002. Increases in muscle strength and hypertrophy are observed during resistance training. A program that uses progressive overload, variation, and specificity, is essential to maximize the benefits.

2- Proteins

  • Dietary Protein Quantity, Quality, and Exercise Are Key to Healthy Living: A Muscle-Centric Perspective Across the Lifespan. 6 Jun 2019. Physical activity and protein are required to build muscle mass. A higher protein intake than the current RDA or EU recommendations might be necessary for optimizing muscle mass.

  • Recent Perspectives Regarding the Role of Dietary Protein for the Promotion of Muscle Hypertrophy with Resistance Exercise Training. 7 Feb 2018. Total daily protein intake is the most important for muscle gains. Between 1.6 to 2.2g/kg body mass per day is optimum. Energy restriction result in significant reductions of lean body mass.

  • The Effects of Overfeeding on Body Composition: The Role of Macronutrient Composition – A Narrative Review . 1 Dec 2017. Consume between 2.2 g/k/d and 3.4 g/kg/d of protein to gain muscle mass.

  • A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis (MPS) in young and elderly subjects. Sep 2009. 30g of protein in a single meal increased muscle protein synthesis by 50%. No further increase beyond 30 g of protein.

  • Ingested protein dose response of muscle and albumin protein synthesis after resistance exercise in young men. Jan 2009. Ingestion of 20g of protein maximally stimulate MPS after resistance exercise.

  • Targeted Leucine Supplementation and Dietary Protein Distribution Strategies: Applications for Recovery from Exercise in Trained Men, and Supporting Adaptations to Exercise Training in Older Adults. 2018

  • The Ultimate Guide to Muscle Protein Synthesis. 17 Aug 2016.

  • Nutrient Administration and Resistance Training. 11 Jun 2005. Amino acids prior to and after exercise causes a rapid pronounced increase in protein synthesis.

  • Plant Gains? Advice to the Vegetarian and Vegan Athlete. 4 Jun 2018. Plant-based protein needs to be eaten in larger amounts to gain muscles. They are absorbed less readily and miss many essential amino acids.

  • Protein timing and its effects on muscular hypertrophy and strength in individuals engaged in weight-training. 14 Dec 2012. To maximize muscle hypertrophy: 1.2-2.0 g protein/kg and ≥44-50 kcal/kg of body weight. Including 3–4 g of leucine. Combined with a resistance training of >10–12 weeks with compound movements.

3- Hormones

  • Sleep and Human Growth Hormone. 5 Aug 2019. 75% of human growth hormone is released during deep sleep, ~1h after the onset of sleep. It declines with age. Exercise promotes GH secretion whereas high carbs diets inhibits it.

  • Will the real fitness hormone please stand up. High intensity sprint increased HGH by 530% and low intensity sprint by 450%.

  • The role of hormones in muscle hypertrophy. Feb 2018. Supplementation with hormones might lead to muscle hypertrophy.

  • Exercise and fasting activate growth hormone-dependent myocellular signal transducer and activator of transcription-5b phosphorylation and insulin-like growth factor-I messenger ribonucleic acid expression in humans. Sep 2010. During exercise, GH concentrations rapidly increased.

  • The exercise-induced growth hormone response in athletes. 2003. Sleep initiates HGH secretion, needed to grow muscle. Resistance training significantly increases HGH. Higher intensity above lactate threshold for >10 minutes results in the greatest secretion. Endurance training decreases HGH.

  • Growth hormone release during acute and chronic aerobic and resistance exercise: recent findings. 2002. Aerobic and resistance exercise result in significant increases in HGH. The higher the intensity, the higher the increase: aerobic training above the lactate threshold resulted in a 2-fold increase in 24-hour HGH.

  • The time course of the human growth hormone response to a 6 s and a 30 s cycle ergometer sprint. Jun 2002. HGH after 30s sprint 450% greater than after the 6s sprint.

  • Age-Related Changes in Slow Wave Sleep and REM Sleep and Relationship With Growth Hormone and Cortisol Levels in Healthy Men. 16 Aug 2000. 60% to 70% of daily GH secretion occurs during early (deep) sleep.

  • Impact of acute exercise intensity on pulsatile growth hormone release in men. Aug 1999. HGH response to exercise correlates with exercise intensity.

  • Human growth hormone response to repeated bouts of aerobic exercise. Nov 1997. HGH response is augmented with repeated bouts of acute exercise.

  • Physiology of growth hormone secretion during sleep. 1996

  • Growth hormone secretion during sleep. Sep 1968. HGH peak lasting 1.5-3.5 hr appeared with the onset of deep sleep.

4- Calorie surplus

  • Is an Energy Surplus Required to Maximize Skeletal Muscle Hypertrophy Associated With Resistance Training. 20 Aug 2019. Start with an energy surplus of ~1,500–2,000 kJ/day and monitor response.

  • Nutrition Recommendations for Bodybuilders in the Off-Season: A Narrative Review. 20 May 2019. A calorie surplus (+10–20%) is needed to gain 0.25–0.5% of bodyweight/week for novice/intermediate bodybuilders. Less for advanced bodybuilders. Including 1.6–2.2 g/kg/day of protein and 0.40–0.55 g/kg per meal.

What are the best muscle building exercises?

  • The mechanisms of muscle hypertrophy and their application to resistance training. Oct 2010. Tension and muscle damage play a role in muscle growth. 6-12 reps per set with rest intervals of 60-90 seconds. Multiplanar, multiangled. Multiple sets and some to muscular failure. Periodize training with period of higher-volume followed by a taper.

  • The time course for elevated muscle protein synthesis following heavy resistance exercise. Dec 1995. Muscle protein synthesis increases by 50% 4 hours after a heavy training, by > 100% 24 hours after and returns to baseline after 36 hours.

  • The effectiveness of 0.5-lb increments in progressive resistance exercise. Feb 2001. Both traditional progressive and small increment resistance exercises proved effective for increasing strength.

  • Mind-muscle connection: effects of verbal instructions on muscle activity during bench press exercise. 7 May 2019. Verbal instructions can increase activity of the triceps but not the pectoralis.

  • Differential effects of attentional focus strategies during long-term resistance training. Jun 2018. The mind-muscle connection can enhance muscle hypertrophy (+12% for elbow flexor and quadriceps).

  • Mind-muscle connection training principle: influence of muscle strength and training experience during a pushing movement. Jul 2017. Pectoralis activity can be increased by 9% when focusing on using this muscle.

  • Importance of mind-muscle connection during progressive resistance training. Mar 2016. Triceps or pectoralis activity can increase when focusing on using the muscle.

  • Mind-Muscle Connection: Fact or BS? 2/11/14. The mind-muscle connection influences neuromuscular dynamics. Glutes up to +32%. Pecs up to +23%. Triceps up to +32%. Biceps up to 40%. Lats up to +15%...

What about warm-ups, stretches and muscle soreness?

  • Warm-up reduces delayed onset muscle soreness but cool-down does not: a randomised controlled trial. 2007. Warm-up prior to unaccustomed exercise reduces DOMS but cool-down performed after exercise does not.

  • Effect of caffeine on perceived soreness and functionality following an endurance cycling event. Mar 2017. Caffeine can reduce pain and improve functionality following muscle-damaging exercise.

  • The effect of caffeine ingestion on delayed onset muscle soreness. Nov 2013. Caffeine before resistance training enhances performance and attenuates the perception of DOMS.

  • A comparison of topical menthol to ice on pain, evoked tetanic and voluntary force during delayed onset muscle soreness. Jun 2012. Topical menthol-based analgesic decreased DOMS more than ice.

  • Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Dec 1984

  • The Use of Nonsteroidal Anti-Inflammatory Drugs for Exercise-Induced Muscle Damage. 23 Dec 2012. NSAID use may be detrimental to muscle gain.

  • Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Mar 2002. Analgesic and anti-inflammatory drugs suppress the protein synthesis response in muscle after resistance exercise.

  • the effects of self‐myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: a systematic review. Nov 2015. Foam rolling and roller massage may be effective for pre and post exercise muscle performance.

  • Muscle Soreness and Damage and the Repeated-Bout Effect. 2008

  • Global Strategy on Diet, Physical Activity and Health. Physical inactivity is the 4th leading cause of mortality.

  • Lack of exercise is a major cause of chronic diseases and is sufficient to increase death.

  • Prevention of Chronic Disease by Means of Diet and Lifestyle Changes.

  • Up to Half of U.S. Premature Deaths Are Preventable; Behavioral Factors Key. Up to 1/2 of premature deaths in the US are due to factors including tobacco use, poor diet and lack of exercise.

  • Physical activity in older age: perspectives for healthy ageing and frailty. 2 Mar 2016. The risks of developing major diseases, obesity, falls, cognitive impairments, osteoporosis... are decreased by regular physical activity.

  • Physical activity is medicine for older adults. 19 Nov 2013. Worldwide, 3.2 million deaths per year are attributed to inactivity. Exercising for at least 5 days per week improves health.

Exercise slows down aging

  • Fitness Equals Longer Life Expectancy Regardless of Adiposity Levels. June 2019

  • Exercise Attenuates the Major Hallmarks of Aging. 1 Feb 2015. Higher levels of moderate-to-vigorous exercise (≥450 min/week) are associated with longer life expectancy. Exercise attenuates many of aging deleterious effects and chronic conditions.

  • Skeletal muscle mass as a mortality predictor among nonagenarians and centenarians: a prospective cohort study. 2019

  • Muscle mass index as a predictor of longevity in older adults. 2014

  • Functional Capacity and Levels of Physical Activity in Aging: A 3-Year Follow-up. 9 Jan 2018. The 6-min walk test and handgrip strength explain variables of aging. Active participants showed less decrements with aging.

  • Organ reserve, excess metabolic capacity, and aging. Jan 2018. Organ reserve correlates with the ability of older adults to cope with stress, suggesting a role in the process of aging.

  • Aging Hallmarks: The Benefits of Physical Exercise. 25 May 2018. Exercise improves the health and functional capabilities while mitigating physiological changes and comorbidities associated with aging.

  • Exercise, cognitive function, and aging. 1 Jun 2015. Aging is associated with cardiovascular diseases, reduced cognitive function, neurodegeneration and the onset of dementia. Regular exercise improves cognitive function.

  • Effects of Aging and Lifelong Aerobic Exercise on Basal and Exercise-Induced Inflammation. 21 Nov 2019. Exercise reduces inflammation.

  • Lifelong aerobic exercise protects against inflammaging and cancer. 25 Jan 2019. Biological aging is associated with loss of organ reserves and systemic inflammation, which predispose for chronic diseases, including cancers. Aerobic exercise reduces inflammation, lowers all-cause mortality, and enhances health and lifespan.

  • Advanced glycation end products can be a factor in aging and in the development of many diseases, such as diabetes, atherosclerosis, chronic kidney disease, and Alzheimer's.

  • The role of glycation in the pathogenesis of aging and its prevention through herbal products and physical exercise. 30 Sep 2017. AGEs is a natural process of aging. Regular physical exercise can reduce AGE, which can lead to an increase in lifespan.

  • Advanced Glycation End Products Are Associated With Physical Activity and Physical Functioning in the Older Population. 28 Apr 2018. AGEs contribute to age-related decline in cells and tissues.

  • Regular moderate exercise reduces advanced glycation and ameliorates early diabetic nephropathy in obese Zucker rats. Aug 2009. AGEs play a key role in the pathogenesis of diabetes. Regular exercise can reduce AGE.

  • A lifetime of regular exercise slows down aging, study finds. 8 Mar 2018. Those who have exercised regularly have defied the aging process, having the immunity, muscle mass, testosterone levels, body fat and cholesterol levels of a young person.

Exercise makes us smarter

  • - the exercise and the brain

  • Aerobic Exercise Training Increases Brain Volume in Aging Humans. 1 Nov 2006. Significant increases in brain volume found as a function of fitness training. Aerobic fitness enhances cognitive functioning.

  • The Influence of Exercise on Cognitive Abilities. Jan 2013. Physical activity improves cognitive health and spares age-related loss of brain tissue. Fitter individuals have better focus and process information more quickly.

  • Carbohydrate-restricted Diet and Exercise Increase Brain-derived Neurotrophic Factor and Cognitive Function: A Randomized Crossover Trial. 9 Sep 2019. Exercise can improve serum BDNF, neuroprotection and cognitive.

  • Effects of Physical Exercise on Cognitive Functioning and Wellbeing: Biological and Psychological Benefits. 27 Apr 2018. Physical exercise improves cognitive functioning and protects against neurodegeneration.

  • Adaptive responses of neuronal mitochondria to bioenergetic challenges: Roles in neuroplasticity and disease resistance. Jan 2017. Exercise and an intellectually challenging lifestyle can protect neurons against the degeneration in acute brain injuries and neurodegenerative disorders.

  • Impact of physical exercise on memory and reduction of risk of dementia.

  • Leg exercise is critical to brain and nervous system health. 23 May 2018. Legs exercise sends signals to the brain and is good for healthy neural cells.

  • Young adults who exercise get higher IQ. 1 Dec 2009. Young adults who are fit have a higher IQ and are more likely to go on to university.

Exercise boosts our energy

  • How exercise -- interval training in particular -- helps your mitochondria stave off old age. 7 Mar 2017. Interval training resulted in a 49% increase in mitochondrial capacity in younger volunteers and a 69% in older ones.

  • The Mitochondrial Basis of Aging. 3 Mar 2017. Regular physical activity benefits a range of human age-related pathologies and stimulates mitochondrial biogenesis.

Exercise makes us feel good

  • Harvard Medical School notes that exercise is "about as effective as antidepressant medications or cognitive behavioral therapy". Also on

  • Physical Exercise in Major Depression: Reducing the Mortality Gap While Improving Clinical Outcomes. 10 Jan 2019.

  • Physical exercise and psychological well being: a critical review. 1998. Physical exercise helps with depression, anxiety, stress, mood, self esteem, premenstrual syndrome, and body image.

  • “If you are in a bad mood go for a walk. If you are still in a bad mood go for another walk.”

  • Mental health. April 2018. The Global Burden of Disease study 2017.

  • Depression. 4 Dec 2019. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators.

  • Effects of Exercise on Cognitive Performance in Children and Adolescents with ADHD: Potential Mechanisms and Evidence-based Recommendations. 12 Jun 2019. Exercise can improve cognitive performance linked to ADHD in children.

  • Attention Improves During Physical Exercise in Individuals With ADHD. 9 Jan 2019.

  • Acute Physical Activity Enhances Executive Functions in Children with ADHD. 17 Aug 2018. Physical activity can improve executive functions in children with ADHD.

  • Aerobic Exercise and Attention Deficit Hyperactivity Disorder: Brain Research. 11 Jul 2017. Aerobic exercise increased brain activity.

  • Effects of an 8-week yoga program on sustained attention and discrimination function in children with attention deficit hyperactivity disorder. 12 Jan 2017. Yoga can help children with attention and inhibition problems.

  • Acute Exercise Improves Mood and Motivation in Young Men with ADHD Symptoms. Jun 2016. Exercise helps men with ADHD by improving motivation and energy, and reducing confusion, fatigue, and depression.

  • Exercise Improves Behavioral, Neurocognitive, and Scholastic Performance in Children with ADHD. 1 Mar 2014. Exercise benefits children with ADHD.

  • Emerging Support for a Role of Exercise in Attention-Deficit/Hyperactivity Disorder Intervention Planning. 1 Oct 2013. Exercise can enhance neural growth and improve cognitive and behavioral functioning, which can help children with ADHD.

  • The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance. Jul 2010. Exercise helps children and adolescents improve cognitive skills, behaviors, and academic achievement.

Exercise for weight loss?

  • exercising fasted first thing in the morning can be a good strategy to burn more fat

Other health benefits

  • bidirectional relationship between exercise and sleep: implications for exercise adherence and sleep improvement. Nov-Dec 2014.

How much exercise should you do?

  • Exercise Attenuates the Major Hallmarks of Aging. 1 Feb 2015. Exercise (≥450 min/week) is associated with longer life expectancy and can attenuates many of aging deleterious effects and chronic conditions.

Vegetable oils are heavily processed

  • The Great Con-ola. 28 Jul 2002. Oil processing includes degumming, caustic refining, bleaching, hydrogenation, deodorization, plasticization...

  • Hexane. Jan 2000. Hexane is used to extract oils from seeds. Exposure to hexane can cause nausea, headache, polyneuropathy, muscular weakness, blurred vision and fatigue.

Vegetable oils are easily oxidised

  • Effects of Cyclic Fatty Acid Monomers from Heated Vegetable Oil on Markers of Inflammation and Oxidative Stress in Male Wistar Rats. 11 Jul 2018. Heated vegetable oils increase oxidative stress.

  • Evaluation of the deleterious health effects of consumption of repeatedly heated vegetable oil. 16 Aug 2016. The oxidation of vegetable oil generates free radicals and have detrimental health effects.

  • Vegetable oil – The silent killer w/ Dr. Cate Shanahan. 2016. French fries age gives you the arteries of an unhealthy 80-year-old for 24h and impacts cognitive function.

  • Reprint of "heated vegetable oils and CVD risk factors". 16 May 2014. Consumption of repeatedly heated oil increases blood pressure and cause inflammation that predisposes to atherosclerosis, due to oxidation.

  • Oxidative stress, polyunsaturated fatty acids-derived oxidation products and bisretinoids as potential inducers of CNS diseases: focus on age-related macular degeneration. 2013. Vision-threatening disease as a CNS disorder from lipid oxidation.

  • The effects of heated vegetable oils on blood pressure in rats. 2011. The oxidation of the cooking oils generates free radicals and may result in hypertension.

  • Association of elevated blood pressure and impaired vasorelaxation in experimental Sprague-Dawley rats fed with heated vegetable oil. 23 Jun 2010. Elevation in blood pressure after consumption of repeatedly heated soy oil.

  • Lipid peroxidation in culinary oils subjected to thermal stress. Aug 2000. PUFA rich oils more harmful than SFA and MUFA rich oils.

  • Blood coagulation and osmolar tolerance of erythrocytes in stroke-prone spontaneously hypertensive rats given rapeseed oil or soybean oil as the only dietary fat. 16 Aug 2000. Canola oil may promote strokes in hypertensive rats.

  • Low Selenium State and Increased Erucic Acid in Children from Keshan Endemic Areas — A Pilot Study. 1989. Rape seed oil causes cardiac lipodosis, focal necrosis and fibrosis in the heart.

  • A Controlled Trial of the Effect of Linolenic Acid on Incidence of Coronary Heart Disease. The Norwegian Vegetable Oil Experiment of 1965–66. 1968. Linseed and sunflower seed oil.

Vegetable oils can be hydrogenated

  • Limiting trans Fats in Foods: Use of Partially Hydrogenated Vegetable Oils in Prepacked Foods in Slovenia. Mar 2018. PHVO in cakes, muffins, pastries and biscuits.

  • Medicines and Vegetable Oils as Hidden Causes of Cardiovascular Disease and Diabetes. 2 Jun 2016. Certain vegetable and hydrogenated oils increase the onset of CVD, DM, chronic kidney disease, bone fracture and mental disorder. High O6/O3 ratio is a risk factor for many diseases. Increased intake of vegetable oils and reduced intake of animal fats resulted in increased CVD and all-cause mortality.

  • The relation between dietary intake of vegetable oils and serum lipids and apolipoprotein levels in central Iran. Winter 2012.

  • Effect of hydrogenated and saturated, relative to polyunsaturated, fat on immune and inflammatory responses of adults with moderate hypercholesterolemia. Mar 2002. Hydrogenated fat increase inflammation, associated with atherosclerosis.

Vegetable oils can contain trans fats

  • Trans fat in food. The EU Commission restricted man-made trans fat to 2% of total fats, effective from 1 April 2021.

  • Final Determination Regarding Partially Hydrogenated Oils (Removing Trans Fat). 18 May 2018. 2015: PHO no longer recognized as safe by the FDA. PHO cannot be added to foods from Jan 2020 (Jan 2021 for certain products).

  • Trans Fat. 18 May 2018. Trans fat raises bad cholesterol, which increases the risk of heart disease. Removing PHO from foods could prevent thousands of heart attacks and deaths each year.

  • Trans fat is double trouble for your heart health. 1 Mar 2017. Trans fat raises bad and lowers good cholesterol.

  • Analysis of Trans Fat in Edible Oils with Cooking Process. Sep 2015. Corn oil has 0.25% of trans fat and can be declared as ‘0’ based on regulations.

  • Intake of trans fat and incidence of stroke in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. May 2014. For every 2g/d increase in TFA intake, 14% increase in the risk of stroke in men.

  • Trends in trans fatty acids reformulations of US supermarket and brand-name foods from 2007 through 2011. 23 May 2013. TFA consumption is harmful at low levels. Need to eliminate PHVO.

  • Rapid FT‐NIR Analysis of Edible Oils for Total SFA, MUFA, PUFA, and Trans FA with Comparison to GC. 12 Apr 2013. SFA, MUFA, and PUFA contents for many vegetable oils differ from the values on the labels.

  • Trans fatty acid intake is associated with insulin sensitivity but independently of inflammation. Jul 2012. Trans fat intake impairs insulin sensitivity.

  • Trans fats—sources, health risks and alternative approach - A review. Oct 2011. Direct connection of trans fats with CVD, breast cancer, risks of preeclampsia, disorders of nervous system and vision, colon cancer, diabetes, obesity and allergy. Trans fat intake should be zero.

  • Dietary fat intake and the risk of depression: the SUN Project. 26 Jan 2011. Association between trans fats and depression risk and CVD, versus inverse association for MUFA, PUFA and olive oil.

  • The negative effects of hydrogenated trans fats and what to do about them. Aug 2009. When trans goes down, death rates go down. Trans fat should be banned.

  • A prospective study of trans fatty acids in erythrocytes and risk of coronary heart disease. 10 Apr 2007. High trans fat consumption is a significant risk factor for CHD.

  • Trans Fat Leads To Weight Gain Even On Same Total Calories, Animal Study Shows. 19 Jun 2006. The increases of diabetes and heart disease risk for apple body shapes may be accelerated by trans fat such as PHVO.

  • Trans fatty acids and cardiovascular disease. 13 Apr 2006. Trans fat associated with CHD, sudden death from cardiac causes and diabetes.

  • Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction. Mar 2005. Higher intake of trans fats could affect the endothelial function and might increase risk of CVD.

  • Small Entity Compliance Guide: Trans Fatty Acids in Nutrition Labeling, Nutrient Content Claims, and Health Claims. Aug 2003. A serving <0.5g of trans fat can be expressed as 0g. No declaration required if no info on fat or cholesterol content.

  • Trans Fatty Acids: Properties, Benefits and Risks. 2002. Trans fat acids may lead to CHD, infant neurodevelopment, growth and allergies.

  • Replacement of dietary saturated fatty acids by trans fatty acids lowers serum HDL cholesterol and impairs endothelial function in healthy men and women. Jul 2001. Trans fats impaired vasodilation of the brachial artery, which may increase the risk of CHD.

  • Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population-based study. 10 Mar 2001. Trans fat intake positively associated with the risk of CHD.

  • Health effects of trans fatty acids. Oct 1997. Trans fats increase LDL and reduce HDL, which is associated to higher risk of CAD. More than 30,000 premature deaths / year in the US are attributable to consumption of trans fats.

  • Levels of trans geometrical isomers of essential fatty acids in some unhydrogenated US vegetable oils. Sept 1994. The trans contents in soybean and canola oils in the US were between 0.56% and 4.2% of the total fats.

Vegetable oils are high in inflammatory omega-6

  • Omega-6 vegetable oils as a driver of coronary heart disease: the oxidized linoleic acid hypothesis. 26 Sep 2018. O6 consumption dramatically increased due to vegetable oils and promotes oxidative stress, oxidised LDL, chronic inflammation and atherosclerosis and is likely a major culprit for CHD.

  • An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity. 2 Mar 2016. Increase in O6/O3 ratio from 1:1 during evolution to 20:1 today, which increases risk of obesity, whereas high O3 decrease the risk.

  • Dietary fats and health: dietary recommendations in the context of scientific evidence. 1 May 2013. O6 promote inflammation and many diseases. O3 counter these effects.

  • The inflammation theory of disease. The growing realization that chronic inflammation is crucial in many diseases opens new avenues for treatment. Nov 2012.

  • Health implications of high dietary omega-6 polyunsaturated Fatty acids. 5 Apr 2012. O6 are pro-inflammatory. O3 are anti-inflammatory. Over past decades, increase in the O6/O3 ratio (15 : 1), coinciding with increases in chronic inflammatory diseases such as NAFL, CVD, obesity, IBD, RA and Alzheimer's disease. Increasing O3 can reduce these diseases.

  • Dietary intake of fatty acids and serum C-reactive protein in Japanese. May 2007. Intakes of oleic acid, linoleic acid, and ALA would reduce serum CRP.

  • Dietary factors that promote or retard inflammation. May 2006. Inflammation plays a major role in atherosclerosis, the risk of CVD and metabolic syndrome. Oleic acid, ALA and antioxidants can reduce inflammation.

  • The importance of the ratio of omega-6/omega-3 essential fatty acids. Oct 2002. Humans evolved on a diet with an O6 to O3 ratio of 1:1. In Western diets the ratio is 15/1-16.7/1. Excessive O6 and high O6/O3 ratio increase the risk CVD, cancer, asthma, and inflammatory and autoimmune diseases, whereas increased levels of O3 (low O6/O3 ratio) reduce the risk. A ratio of 4/1 is associated with a 70% decrease in total mortality.

  • Nutrition facts - Oil, sesame, salad or cooking


Vegetable oils can contain GMO

  • GE food & your health. The US FDA does not require labeling or safety testing of genetically engineered products. Health risks posed by GMO include Toxicity, Allergic Reactions, Antibiotic Resistance, Immuno-suppression, Cancer and Loss of Nutrition.

  • Top 7 Genetically Modified Crops. 30 Dec 2012. 88% Corn is GM in the US. 93% of Soy. 94% of Cottonseed. 90% of Canola.

  • Genetically modified crops safety assessments: present limits and possible improvements. Dec 2011. Possible onset of chronic diseases. No minimal length for GMO testing. Studies should be compulsory.

Foods containing vegetable oils

  • The Scandal of Infant Formula. 9 Dec 2015. Infant formula contain refined vegetable oil that can contain GMO.

  • Canola Oil Deemed GRAS for Infant Formula. 14 Jan 2013. US manufacturers can use canola oil in infant formula up to 31% of total fat, says FDA.

  • Effects on Edibility of Reused Frying Oils in the Catering Industry. 24 Jun 2011. More than half of the companies use frying oils more than 3 times.

Healthy substitutes to vegetable oils

  • Template:Smoke point of cooking oils. Last updated 9 Sep 2019

  • Dietary fat intake and endometrial cancer risk: A dose response meta-analysis. Jul 2016. Higher MUFA intake associated with lower endometrial cancer risk.

  • Dietary monounsaturated fatty acids are protective against metabolic syndrome and cardiovascular disease risk factors. Mar 2011. Consumption of MUFA promotes healthy blood lipid profiles, blood pressure, insulin sensitivity and glucose levels. Can ameliorate body composition, decrease the risk of obesity and have a cardioprotective activity.

  • What Is the Healthiest Cooking Oils by Smoke Point and Omega 3 to 6 Fatty Acid Ratios?

  • Oils Chart. Smoke Temperature, Composition & Stability.

  • Cooking with Fats, Oils, and Their Smoking Points.

  • Smoke Point of Oils.

Coconut oil

  • Effects of beta-hydroxybutyrate on cognition in memory-impaired adults. Mar 2004. MCT facilitates performance for Alzheimer's cognitive and memory assessments.

  • Twenty-four-hour energy expenditure and urinary catecholamines of humans consuming low-to-moderate amounts of medium-chain triglycerides: a dose-response study in a human respiratory chamber. Mar 1996. MCT may enhance daily energy expenditure.

Olive oil

  • Effect of the replacement of dietary vegetable oils with a low dose of extravirgin olive oil in the Mediterranean Diet on cognitive functions in the elderly. 19 Jan 2018. Improvement of cognitive functions with extra-virgin olive oil, which may have a neuroprotective effect.

  • Does cooking with vegetable oils increase the risk of chronic diseases?: a systematic review. Apr 2015. Virgin olive oil significantly reduces the risk of CVD.

Avocado oil

  • Lutein and zeaxanthin and the risk of cataract: the Melbourne visual impairment project. Sep 2006. Inverse association between high dietary LZ intake and prevalence of nuclear cataract.

Red palm oil

  • Health Effects of Palm Oil. 24 Oct 2017. The consumption of palm oil does not pose risk for CAD as part of a healthy diet.

  • A Guide to Red Palm Oil: Health, Nutrition, Sustainability & Brands. 1 Oct 2016

Animal fats

  • A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef. 10 Mar 2010. Grass-fed beef ahs better fatty acid composition and antioxidant content, more CLA, O3 and precursors for Vitamin A and E, cancer fighting antioxidants (glutathione) and superoxide dismutase activity as compared to grain-fed beef.

  • Effects of conventional and grass-feeding systems on the nutrient composition of beef. Dec 2008. Grass-fed beef had significantly less MUFA and more SFA, O3, CLA, and trans-vaccenic acid.

  • Effect of feeding systems on omega-3 fatty acids, conjugated linoleic acid and trans fatty acids in Australian beef cuts: potential impact on human health. 2006. Only grass-fed beef can be considered as a source of O3 according to Australian and NZ standards. Trans fats and O6 are higher in grain-fed beef. Grain feeding decreases O3 and CLA and increases trans and saturated fats.

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