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Dealing with Migraine: a Doctor’s Comprehensive Medicine Approach

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Dr. Teitelbaum is a leading fatigue and pain specialist who has researched ME/CFS & FM patients’ nutritional and therapeutic needs for more than 20 years. This article is reproduced with kind permission* from Dr. Teitelbaum’s educational web site at www.Vitality101.com, and is an excerpt from his book Pain Free 1-2-3. [If migraine isn’t your problem, see the attached sidebar discussing “Tension and Other Headaches.”]


Owing partly to migraine’s significant undertreatment, its cost to US employers in days lost averages out to $3,000 per year per employee.

A Comprehensive Medicine Approach to Migraines

Migraine headaches can be very severe and often leave people crippled for days. They may afflict as many as 28 million Americans. Migraines are often preceded by an “aura,” which may consist of visual disturbances such as flashing lights. The headaches are often associated with nausea, sweats, dizziness and slurred speech. Light and sound sensitivity can also be severe.

There is still marked debate over the cause of migraines.

For decades, researchers thought that these occurred because of excessive contraction and expansion of the blood vessels in the brain. Others thought that this blood vessel problem occurred because of inadequate serotonin, the neurotransmitter that controls sleep and mood, which also plays a role in how blood vessels expand. Low serotonin also amplifies pain by increasing the pain neurotransmitter called “substance P”. Muscle spasm and nutritional imbalances and deficiencies can also contribute to migraines, as can food sensitivities.

Most likely, it is a common endpoint for many different underlying problems.

Effective migraine treatment is important. Not only are migraines horribly painful for many people, but they are expensive as well. The average amount of work missed by those with migraines is 19.6 days a year, costing employers $3,000 per year per employee. It is also under-treated, with 31% of migraine patients never having sought treatment.

What Natural Remedies Can I Use to Knock Out an Acute Migraine?

Two natural treatments can knock out an acute migraine.

The first, which you can take at home on your own, is butterbur. This herb can both prevent and eliminate migraines. Take 50 mg 3 times a day for 1 month and then 50 mg twice a day to prevent migraines.

You can take 100 mg every 3 hours to eliminate an acute migraine. Use only high quality brands (e.g. Petadolex by Enzymatic Therapy). Many others that were tested had impurities and did not contain the amount of butterbur the label claimed (i.e., they don’t work).

In a hospital emergency room (if you get an open minded doctor – take this article with the research references below). They won’t know about magnesium for migraines because the magnesium costs 10 cents, so no one has told them about the research. Or go to a Holistic doctor’s office (see www.HolisticBoard.org to find one near you).

Intravenous magnesium can effectively eliminate an acute migraine. In one study of 30 patients with moderate or severe migraine attacks, half received 1 g of magnesium sulfate IV over 15 minutes and the other half placebo. (Those in the placebo group who were not better at a one-half-hour interval were then treated with the magnesium.)

Immediately after treatment, at 30 minutes, and at 2 hours, 86% in the magnesium group were pain-free, with the other 14% showing a reduction in pain. Associated symptoms such as nausea, light sensitivity, and irritability also resolved, and none of the patients in the magnesium group had a recurrence of pain within 24 hours.

In the placebo group, no patient became pain-free, and only one had a reduction in pain. When patients in the placebo group were later given the magnesium, responses were similar to those of subjects in the other, magnesium-treated group.

Mild side effects, which are a normal effect of magnesium working to open blood vessels (such as a burning sensation in the face and neck, flushing, and a drop in blood pressure of 5 to 10 mm systolic) occurred in 86% of the patients.

None of these side effects was serious, and no patient had to discontinue the treatment.(1) These results were similar to those in previous reports.(2-3)

I’m Happy I Can Eliminate an Acute Migraine Headache,
But How Can I Prevent Them?

Fortunately, natural remedies are even more effective in preventing migraines. They may take up to 3 months to start working, however, so the medications discussed below can be used while you’re waiting for the natural preventives to take effect.

Magnesium by Mouth
Oral magnesium has been found to be effective for migraine prevention and is as effective as the medication Elavil®.(4)

Magnesium serves in an enormous number of functions in the body, including the relaxation of muscles and arteries. Most Americans get nowhere near the optimum amount of magnesium in their diet, getting less than 250 mg a day as opposed to the 650 mg that the average Chinese diet supplies.

Blood testing to check magnesium levels is horribly unreliable and may not detect magnesium deficiency until it is severe.

A leading authority on natural prevention of migraine headaches is Dr. Alexander Mauskop, author of What Your Doctor May Not Tell You about Migraines. As discussed above, in 1995 Dr. Mauskop published a study showing that intravenous magnesium could abort a migraine headache.(5) He also found that intravenous magnesium could knock out other types of headaches as well.(6)

This powerful data spurred researchers to see whether magnesium could also prevent migraines. As noted above, the answer was yes. In one German placebo-controlled study, patients were given 600 mg of magnesium daily for 12 weeks or a placebo; there was a significant drop in migraine frequency in the magnesium group.(7)

Another study shows similar effects in women with menstrual migraine (see below).(8) It is a good idea for most migraine patients to take 150 to 200 mg of magnesium in the morning (present in the Energy Revitalization System vitamin powder) and again with dinner or at bedtime (less if diarrhea is a problem).

Riboflavin (Vitamin B-2)
Riboflavin assists in the production of energy. In one study, migraine patients were given riboflavin 400 mg with breakfast every day for at least 3 months. By the end of the study they had a 67% decrease in migraine attacks as well as a decrease in attack severity. This was later repeated in a placebo-controlled study.(9)

Note that it can take 3 months for the riboflavin to start working.

A recent study suggests that 100 mg a day may be enough to have the same effect, so the amount in the Energy Revitalization System is often adequate for maintenance after 3 to 4 months on the higher amount.

Vitamin B-12
Vitamin B-12 can also decrease migraine frequency. In one study in which patients received 1000 micrograms a day as a nasal spray, migraine frequencies decreased by an average of 43% after 3 months. (The B-complex in the Energy Revitalization System contains 500 micrograms a day).(10)

Feverfew is another helpful herb for migraine prevention.(11) Using Feverfew has resulted in a significant reduction in migraines in one-third of patients. It was also found to be very safe.(12)

However, other treatments are effective enough that I rarely use this anymore.

Butterbur (For Prevention, Too)
Butterbur is a shrub which grows in Europe, Asia, and Africa. The standardized Petadolex extract was used in two double-blind studies. By the third month, those receiving active treatment with 100 mg a day had 60% fewer migraine attacks than the control group.

Although 100 mg a day is effective, 75 mg twice a day with food may be the optimal dose for some.(13) I recommend 50 mg 3x a day of the Petadolex for 1 month, then 2x day.

Fish Oil
Fish oil has also been found to decrease the frequency of migraines. In two placebo-controlled studies of patients with frequent severe migraines that did not respond to medication, fish oil was found to be effective.

Use 1 to 2 tbs a day and give the treatment 6 weeks to see the effect. Then you can decrease it to the lowest dose that maintains benefit.(14,15)

Other Natural Compounds
Other natural compounds that may be helpful include: Glucosamine, 1500 to 2000 mg a day (this compound was found to be helpful in a small study of 10 patients over 4 to 6 weeks); and
Coenzyme Q10. Co Q10, 150-200 mg daily, decreased the average number of migraine attacks per month from 4.8 to 2.8 in an open study.(16)

All this Suggests That Many, If Not Most, Migraines Can Be Prevented Naturally.

I would begin by taking the Energy Revitalization System vitamin powder, plus 300 mg of Vitamin B-2 in the morning, plus 200 mg of magnesium at night.

If the cost is not prohibitive, I would add butterbur (Petadolex) as well.

Also check for food allergies, as noted below, and follow the advice for hormones if the migraines are predominately around your periods or associated with taking estrogen.

I have seen this approach commonly eliminate frequent and horribly severe migraine problems – but remember that it may take 3 months to see the effect.

What Else Can I Do to Eliminate the Underlying Cause of the Migraines?

Acupuncture is another option to consider for chronic migraine and tension headaches. It results in reduced pain, reduced frequency of headaches, and improved function, energy and health.

In two studies conducted in New York City and London, acupuncture was found to be cost-effective. In a randomized controlled study of 401 patients with chronic headaches (the majority having migraines), patients received up to 12 acupuncture treatments over a 3-month period vs. a control group that received standard care. The acupuncture patients had 22 fewer headache days per year, 15% fewer sick days, and 25% fewer visits to the doctor.(17)

Food Sensitivity/Allergy Investigation
Food allergies are also very important to consider. Approximately 30% to 50% of migraine patients get marked improvement by avoiding certain foods – and most people with migraines are not aware of what foods are triggering their headaches.

This has now been demonstrated in at least four placebo-controlled studies.

Food sensitivities are an even bigger problem in children with migraines.(18-21)

To determine if foods are playing a role in causing your headache, it is helpful to do an elimination diet. This requires eating a limited diet for five days. The link will give you instructions for a gentler and easier elimination diet.

Or you can do a very strict one if you prefer, eating only pears and lamb, and drink only bottled spring or distilled water. This kind of strict elimination diet will make it easier to tell if food allergies/sensitivities are present and triggering your migraines when you reintroduce foods into your diet.

In one study, by avoiding the 10 most common food triggers, subjects exhibited a dramatic reduction in the number of headaches per month, with 85% becoming headache-free. Additionally, 25% of the patients with high blood pressure also had their blood pressure reduce to normal.

The most common reactive foods were wheat in 78% of patients; oranges in 65%; eggs in 45%; tea and coffee in 40% each; chocolate and milk in 37% each; beef in 35%; and corn, cane sugar, and yeast in 33% each.

Some studies also suggest that the artificial sweetener aspartame (NutraSweet®) can trigger migraines and other headaches, although this is controversial.(22-23)

If you have severe and frequent migraines, it is definitely worth exploring food sensitivities.(24) But you may find that instead of avoiding foods that trigger your migraines for the rest of your life, you can eliminate the sensitivities/allergies using a powerfully effective acupressure technique called NAET (see www.naet.com).

What Medications Can I Take to Get Rid of an Acute Migraine Headache?

Imitrex® Family
In the U.S., medications in the Imitrex family still remain the first choice that physicians use for the treatment of acute migraines.

Aspirin/Tylenol/Caffeine Combo
No one is paying to give them the research showing that the old combo of aspirin, Tylenol and caffeine (cost, about 20 cents vs. $10 to $25 per dose) is equally effective, so don’t forget that you can use these if needed (e.g., 1-3 Excedrin Migraine or Excedrin Extra strength). Can take up to 8 spread through the day if the caffeine doesn’t make you hyper; the dose recommendations on the bottle are fairly low.

Midrin, which is  a prescription mix of three medications, can be effective. Two capsules are taken immediately, followed by 1 capsule every hour until the headache is relieved (to a maximum of 5 capsules within a 12-hour period).

A fascinating study can guide you on when to use Imitrex family medications vs. when to go with other therapies. About 75% of migraine patients get painful sensitivity to normal touch around their eyes (e.g., to wearing eyeglasses).

• If you use Imitrex before you get the tenderness/pain around the eyes, it will knock out the migraine 93% of the time.

• If the pain/tenderness around the eyes had already set in, Imitrex only eliminated the migraine 13% of the time (although it still helped the throbbing).(25)

In other words, if you are one of the lucky ones who does not get pain around the eyes, the Imitrex can knock out your migraine at any time. If you are one of those who do get pain/tenderness around the eyes, it is a race against the clock to take the Imitrex before that pain starts.

This means that you should take the Imitrex early in the attack (the first 5 to 20 minutes), before the skin hypersensitivity gets established.

When All Else Fails
For the few of you where all else fails, the following prescription medications can reduce the number of headache days per month by an average of 50%.(24) These include Neurontin®, beta-blockers (Inderal® – avoid this if you have asthma or fatigue), calcium channel blockers, Depakote®, Topamax®, Elavil® and Doxepin®.

The good news, though, is that migraines can be prevented naturally in most cases.

* * * *


Tension Headaches
Tension Headaches cause moderate pain on both sides of and across the forehead, tend to both start and fade away gradually, and are the result of muscle tightness in the sterno-cleidomastoid muscles of the neck. If the pain is coming from the suboccipital muscles at the base of the skull, the pain is often behind the eyes and/or on top of the head.

Because tension headaches are muscular,… treatments … that cause your muscles to relax will often eliminate the recurrence of these headaches. Paying attention to structural factors can also help.

Many medications can be used to prevent chronic tension headaches. These include anti-depressants such as Remeron®, 15 to 30 mg, or Elavil®, 10 to 50 mg at bedtime.

To treat the acute pain of headaches, begin with herbal remedies such as the End Pain formula, which contains willow bark, boswellia, and cherry. This can be helpful for acute attacks, but it takes 2 to 6 weeks to fully kick in.

A physical therapy technique called Spray and Stretch, which approximately 10% of physical therapists are familiar with, is also an excellent and pain-free way to release your muscles and eliminate a tension headache. [Dubbed “the workhorse of myofascial therapy,” this involves manual stretching of taut muscle bands that have been cooled/relaxed by an evaporating spray.]

In addition, there are the old standbys of Tylenol® and Motrin®/Advil®. Other medications that can be quite helpful include Midrin® and Ultram®. I would begin with the natural therapies first, however, as I think these are both more effective and safer.

Sinus Headaches
Sinusitis is another common cause of headaches. It is usually associated with pain and tenderness over the sinuses, by the cheeks, or above the eyes. Nasal congestion, often with yellow/green nasal mucus, is also common.

Interestingly, we have found that most cases of chronic sinusitis are caused by fungal (yeast) overgrowth in your body, especially your bowels, which can then cause gas, bloating, diarrhea, or constipation.

Chronic sinusitis routinely resolves when we treat it with Diflucan® and the other yeast/anti-fungal therapies.

It is also helpful to use a special prescription nose spray that contains anti-bacterials and anti-fungals. Your doctor can order it by calling Cape Apothecary at 410-757-3522. Use 1 to 2 sprays in each nostril twice a day. Silver spray taken with it can also be effective.

Caffeine Withdrawal Headaches
Caffeine withdrawal headaches are common in people who drink a lot of coffee. It is especially common in the morning before people get their coffee “fix” and often occurs approximately 18 hours after the last cup of coffee. Weaning off excess caffeine is the solution.

Cluster Headaches
Cluster headaches occur as a repeating series of headaches that can each last 30 to 90 minutes and are very severe. They cause excruciating, piercing pain on one side of the head (often centered around one eye) and are much more common in men.

Many medications can help. These include anti-seizure medications like Valproic Acid, 500 to 1000 mg a day, or Topamax®, 50 to 100 mg a day. These often start to work in 1 to 2 weeks.

Trigeminal Neuralgia
Trigeminal Neuralgia is characterized by excruciating attacks of stabbing, shooting pain in the lips, gums, cheek, or chin that last for a few seconds to minutes. It occurs almost exclusively in the middle-aged and elderly. It often responds well to treatment with the medications Tegretol® and/or Neurontin®.

TMJ Dysfunction
Temporo Mandibular (Jaw) Joint Dysfunction (TMJ/TMD) is a common cause of facial pain and headaches. Although classically considered to come from the jaw joint (the area just in front of your ears), in many cases the pain is actually coming from tightness of the Masseter muscles [used for chewing]. Following the principles discussed above for myofascial / muscle pain… will often make this pain go away.

1. Clin Sci 1995;89:633-6

2. Dora B. Migraine Headache and Magnesium Sulfate. Clinical Pearls News, April 2002

3. Singer RS et al. Oral Transmucosal Fentanyl Citrate in the Outpatient Treatment of Severe Pain from Migraine Headache. The Pain Clinic. Jan/Feb 2004.P10-13.

4. Dora B. The Journal of Headache and Pain, 2000; 1:179-186

5. Clin Sci [Lond]1995 December; 89 (6): 633-6

6. Headache 1996 March; 36 (3): 154 -60

7. Peikert A,et al. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalgia 1996 June; 16 (4): 257-63

8. Facchinetti F, et al. magnesium prophylaxis of mention migraine: effects on intracellular magnesium. Headache 1991 May; 31 (5): 298- 301

9. Schoenen J,et al. High-dose riboflavin as a prophylactic treatment of migraine: results of an open pilot study. Cephalgia 1994 October; 14 (5): 328-9. & Schoenen J, et al. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology 1998 February; 50 (2): 466-70.

10. Van Der Kuy PHM,et al. Hydroxycobalamin, a nitric oxide scavenger, in the prophylaxis of migraine: an open, pilot study. Cephalgia 2002; 22:513-519

11. Murphy JJ, et al. Randomized double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet 1988 July 23; 2May (8604); 189-92

12. Prusinski A,et al. Feverfew as prophylactic treatment of migraine. Neurol Neurochir Pol 1999;33 supplement 5:89-95

13. Brown DJ. Standardized butterbur extract Petadolex – herbal approach to migraine prophylaxis. Townsend Letter for Doctors and Patients, October 2002

14. Glueck CJ et al. Amelioration of severe migraine with omega-3 fatty acids: a double-blind placebo-controlled clinical trial. Abstract. American Journal of Clinical Nutrition, 43:710, 1986

15. McCarren T. et al. Amelioration of severe migraine by fish oils. Abstract. American Journal of Clinical Nutrition 41:874 a, 1985.

16. Rozen TD, et al. Open label trial of coenzyme Q10 as a migraine preventive. Cephalgia 2002 March; 22 (2): 137 –41.

17. British Medical Journal Online 2004:10.1136/bmj.38029.421863.EB

18. Mansfield L. E., Food allergy and migraine. Postgraduate Medicine 83 (7): 46-55, 1988

19. Mansfield L. E. et al. Food allergy and adult migraine. Annals of Allergy 55:126, 1985

20. Monroe J. et al. Migraine is a food allergic disease. Lancet 2: 719 – 21, 1984

21. Egger J et al. Is migraine food allergy? Lancet 2: 865-9, 1983

22. Lipton R et al. Aspartame as a dietary trigger of headache. Headache 29:90-92, 1989.

23. Koehler SM, et al. The effect of aspartame on migraine headaches. Headache 28 (1): 10-14, 1988

24. Grant ECG . Food Allergies and Migraines, Lancet, May 5, 1979; 966-969

25. Wilner AN. Pain Medicine News. Vol 1 #4 p1&5, 2003


* Copyright © 2011 by The Annapolis Chronic Fatigue and Fibromyalgia Research Center for Effective CFS/FMS Therapies. All rights reserved.

Disclaimer: These statements have not been evaluated by the FDA. They are general information, based on the research and opinions of Dr. Teitelbaum unless otherwise noted, and are not intended to diagnose, prevent, treat or cure any illness, condition or disease. This material is not intended to replace a one-on-one relationship with a qualified healthcare professional and is not intended as medical advice. It is always very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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3 thoughts on “Dealing with Migraine: a Doctor’s Comprehensive Medicine Approach”

  1. nl2 says:

    I never, ever used to get migraines or really bad headaches until I developed “Fibromyalgia” which I was was getting about 3-5 times per week. So I started limiting my intake of certain items such as chocolate, wine, sugar, as they were triggers. But I still was getting migraines. Ahhhh they were terrible and hurt very badly. Someone suggested I eliminate “MILK” for 2 weeks and see how I feel. @ first, I was like ya right! Milk wouldn’t cause these horrible migraines! And how in the world was I going to do that since I absolutely love milk and drank about 1 gallon every week. I was desperate and dreaded the migraine attacks! So I gave it a try and did not drink any “MILK” for about 2 weeks. What do you know? My migraines disappeared almost totally!! I now get about 2 per month and feel so relieved. It took ALOT of effort, action, and lots of self-control and discipline. But it has all been worth it. Even though I don’t drink “Milk” I am trying different types of soy, almond, coconut, and rice milk. They totally don’t taste like the Milk I loved but I’m almost “Migraine-Free”.

  2. nl2 says:

    I never, ever used to get migraines or really bad headaches until I developed “Fibromyalgia” which I was was getting about 3-5 times per week. So I started limiting my intake of certain items such as chocolate, wine, sugar, as they were triggers. But I still was getting migraines. Ahhhh they were terrible and hurt very badly. Someone suggested I eliminate “MILK” for 2 weeks and see how I feel. @ first, I was like ya right! Milk wouldn’t cause these horrible migraines! And how in the world was I going to do that since I absolutely love milk and drank about 1 gallon every week. I was desperate and dreaded the migraine attacks! So I gave it a try and did not drink any “MILK” for about 2 weeks. What do you know? My migraines disappeared almost totally!! I now get about 2 per month and feel so relieved. It took ALOT of effort, action, and lots of self-control and discipline. But it has all been worth it. Even though I don’t drink “Milk” I am trying different types of soy, almond, coconut, and rice milk. They totally don’t taste like the Milk I loved but I’m almost “Migraine-Free”.

  3. Sandy10m says:

    For my every day regimen to avoid migraines, I take 2 fish oil capsules with every meal, for a total of 6 per day. This sounds like a lot, but I have no ill effects from this dose. I also take Magnesium Citrate (one of the best absorbed forms), 200 mg with each meal, for a total of 600 mg. That also works well for stool consistency. And maybe I’m alone in this one, but taking Vitamin D3 supplements CAUSES migraines for me. I am Vit D deficient (tested a few times now with blood tests), but yet I cannot take Vit D3 at all, at any dose. I even have a compounded Vit D3 that is 100 IU per drop, and that still causes migraines. And my skin reacts badly (such as a rash) when I go into the sun for any length of time. But I can go to the tanning salon every few weeks for 5 minutes, avoiding the sunburn and hopefully the damage, without migraines or rashes. I’d love for any doctor on this website to tell me why Vit D3 is such a problem.

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