A naturopathic approach to resolving migraines and headaches

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By Carolina Brooks, BA, IFMCP

Over the last year, I’ve seen an increase in patients coming in with unbearable headaches and migraines. Many of the cases are multifactorial, but there is often a cervicogenic component, due to an inappropriate workstation set up at home. Some people are struggling with increased screen time, others sustain injuries while exercising from home, and, as people begin to spend time outdoors again, more are complaining of seasonal allergies. Along with these conditions come headaches and migraines.

I’ve encouraged all my patients who have worked from home for the last 18 months to speak to the occupational health departments at their workplace, and I refer to a physiotherapist to check for structural alignment issues. Biogenic amines such as histamine and tyramine can trigger headaches and migraines, so it’s often worth a trial removal of large quantities of common trigger foods, including smoked meats and fish, citrus fruits, spinach, tomato, fermented foods, dairy, soy sauce, and alcohol to monitor improvement.

It’s also wise to do a basic blood panel when checking for migraine and headache drivers.  Nutritional factors to consider when addressing headaches and migraines are iron, B vitamin status, magnesium intake, and omega-three (n-3) fatty acid status. Clinically, it’s also worth asking questions about energy and blood sugar regulation patterns, signs of histamine overload including anxiety, urticaria, or gastrointestinal upset, and in women, menstrual cycle patterns as hormone fluctuations are well known headache triggers.

A 2020 comprehensive review in The Journal of Headache and Pain also associated migraine with Helicobacter pylori infection, celiac disease, and irritable bowel syndrome and also shared findings that shifting diet to improve microbiome diversity, increasing fiber in the diet, and following low glycemic principles, clearing dysbiotic bacteria, following a gluten-free diet and supplementing with probiotics, vitamin D, and n-3 fatty acids were effective in reducing migraine frequency.

When vegetarians or vegans come in complaining of headaches, the primary drivers are often iron deficiency and a low n-3 intake or index, particularly as a 2002 clinical trial in The British Journal of Nutrition demonstrated that the conversion of alpha-linolenic acid (ALA) to docosapentaenoic acid (DPA) and eicosapentaenoic acid (EPA) in women of reproductive age is twenty one percent for EPA and nine percent for DHA.

In contrast, a further 2002 clinical trial also looked at the same conversion, and found that eight percent of ALA was converted to EPA, while between zero and four percent was converted to DHA. Omega three fatty acids modulate the inflammatory response and decrease platelet aggregation. I recommend two to three grams of combined DHA and EPA for migraine prophylaxis, and use high-dose DHA algal oil for plant-based patients. Clinically, I have seen fish oil is more effective, so I have a conversation with patients around if they are willing to take fish oil as a supplement. Many of them are open to it.

It’s also worth looking for signs of poor protein absorption. A 2008 article in The Journal of Headache and Pain discussed the implications of low tissular serotonin and an abnormal serotonin transmission on migraine pathophysiology. I have found some patients respond well to supplementation of amino acids.

A key herb for migraine treatment is Tanacetum parthenium (feverfew). Folkloric use advised eating 2 leaves between two slices of bread for migraine relief, but clinically, we would combine feverfew with other herbs such as Salix alba (white willow), Boswellia serrata (frankincense), Curcuma longa (turmeric), and Petasites hybridus (butterbur)  in tincture, powder, or capsule blends to reduce duration and frequency of migraines.

A 2011 review in Pharmacognosy Review discussed feverfew’s safety, analgesic, and anti-inflammatory properties.  Feverfew inhibits platelet aggregation, the secretion of histamine and serotonin, and its parthenolide compounds exert a tonic effect on vascular smooth muscle, which all support the plant’s anti-migraine effect. A 2004 clinical trial in Neurology evaluated the efficacy of a standardized extract of butterbur at a dose of 75 milligrams twice a day for the prevention of migraines and found it offered a significant reduction in migraine attack frequency of almost fifty percent.

Hormone-driven migraines are often triggered by fluctuating hormones and increasing histamine levels during the menstrual cycle. Key herbs which can help to alleviate this include Cimicifuga racemosa (black cohosh), Angelica sinensis (dong quai), and Paeonia lactiflora (peony).

Case Study

I recently saw a 38-year-old lady who had come to me with significant persistent bloating issues, severe constant migraines, daily brain fog, and worries that she was in the throes of early dementia. She had worked for a number of different government organizations in her career, and had experienced various toxic exposures, which is why I was keen to do some testing. I recommended that she do some bloodwork, a stool test, and organic acids testing. While we waited for her results, I put her on a low-histamine diet, supplements to support assimilation, magnesium, a high dose n-3 supplement, prebiotics, and diamine oxidase to support histamine breakdown.

We started regular bi-weekly combined hyperbaric oxygen therapy (HBOT) and frequency specific microcurrent (FSM) sessions, and I started her on an herbal tincture blend to support cognitive function and digestion, start to clear suspected bacterial and fungal overgrowth, reduce histamine and inflammation, and support detoxification pathways. Some of the herbs in her blend included Ginkgo biloba (ginkgo) and Ocimum sanctum (tulsi), for their adaptogenic properties, positive effects on brain function and inhibitory action on histamine release. I also included anti-inflammatory and key migraine, digestive, and antihistamine herbs such as feverfew, turmeric, Urtica dioica (nettle) Zingiber officinalis (ginger), and Foeniculum, vulgare (fennel).

Within a week of eliminating fermented foods, her bloating had disappeared. When we received her results back, we could clearly see she was suffering severe iron-deficiency anemia, she was not assimilating protein correctly, her serum magnesium  and folate levels were low, and her n-3 index was suboptimal. Her mucosal immune function was poor, and she was experiencing inflammation in the gut. I increased her digestive enzyme and betaine hydrochloride support with all meals, and brought in an iron supplement, probiotics and postbiotics . Within a month, her migraines had fully resolved. She continued with her weekly HBOT, and FSM sessions and we finally started to see her cognitive dysfunction issues start to improve as her iron levels and red blood cell function normalized.

References

Arzani, M., Jahromi, S.R., Ghorbani, Z., Vahabizad, F., Martelletti, P., Ghaemi, A., Sacco, S., & Togha, M. (2020) Gut-brain Axis and migraine headache: a comprehensive review. The Journal of Headache & Pain 21, 15. Retrieved from: https://doi.org/10.1186/s10194-020-1078-9

Burdge, G. C., Jones, A. E., & Wootton, S. A. (2002). Eicosapentaenoic and docosapentaenoic acids are the principal products of alpha-linolenic acid metabolism in young men. The British Journal of Nutrition, 88(4), 355–363. Retrieved from: https://doi.org/10.1079/BJN2002662

Burdge, G. C., & Wootton, S. A. (2002). Conversion of alpha-linolenic acid to eicosapentaenoic, docosapentaenoic and docosahexaenoic acids in young women. The British Journal of Nutrition, 88(4), 411–420. Retrieved from: https://doi.org/10.1079/BJN2002689

Lipton, R. B., Göbel, H., Einhäupl, K. M., Wilks, K., & Mauskop, A. (2004). Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology, 63(12), 2240–2244. Retrieved from:  https://doi.org/10.1212/01.wnl.0000147290.68260.11

Panconesi, A. (2008) Serotonin and migraine: A Reconsideration of the Central Theory. The Journal of Headache & Pain 9, 267–276. Retrieved from: https://doi.org/10.1007/s10194-008-0058-2

Pareek, A., Suthar, M., Rathore, G. S., & Bansal, V. (2011). Feverfew (Tanacetum parthenium L.): A systematic review. Pharmacognosy reviews, 5(9), 103–110. Retrieved from: https://doi.org/10.4103/0973-7847.79105