“Migraine” is a complex, chronic neurologic disorder characterized by recurrent debilitating headaches. Over 30 million Americans suffer at least one migraine headache each year. (1) The condition affects 18% of females and 6% of males and is the leading cause of “severe” headaches. (1) Over 80% of migraineurs miss work as a result of their headaches, with an average of 4-6 absences per year. (2)
Early explanations for the genesis of migraine focused on cerebrovascular vasoconstriction with subsequent vasodilation. (3) Migraine is now recognized as a more complex series of neurologic and vascular events wherein vasodilation may or may not be present. (4-8) Evidence suggests that a migraineur’s brain is hyperexcitable and uniquely predisposed migraine headaches in much the same way that an epileptic is susceptible to seizures. (8,9) The hyperexcitable migraineur brain is susceptible to various “triggers”. Migraines develop when the number of triggers exceeds a critical threshold for a given patient.
Migraine treatment is subdivided into “abortive” therapies that seek to stop or reverse the progression of an existing headache and “prophylactic” treatments, which seek to prevent or reduce the frequency of future attacks. Abortive treatments are most effective when given within the first minutes of an attack. (10) Unfortunately, once the migraine brain has been “triggered”, conservative therapy may not always abort that particular episode. However, prophylactic management directed at controlling migraine triggers is often helpful.
Spinal manipulation is a useful tool in migraine prophylaxis. One study demonstrated a “significant reduction” of migraine intensity in almost half of those patients receiving spinal manipulation. Nearly ¼ of migraine patients reported greater than 90% fewer attacks. (11) Spinal manipulation has demonstrated similar effectiveness but longer lasting benefit with fewer side effects when compared to a well-known and efficacious medical treatment (amitriptyline). (11,12,13,14)
Conservative care should also include evidence-based dietary and nutraceutical recommendations. An excellent literature review by Orr, provides the following recommendations for migraine prophylaxis (15):
1. Lose Weight
Weight loss may decrease the frequency of migraine and other primary headaches (tension, cluster). (16-18) “Migraine has a specific association with obesity. Furthermore, obese individuals appear to be more likely to suffer from chronic migraine as compared to their peers. There is increasing evidence to suggest that migraine and obesity may be linked through inflammatory mediators released by adipose tissue.” (15)
2. Limit Fats
Dietary fats trigger synthesis of prostoglandins which are known migraine triggers (19). Low fat diets have been shown to play a role in migraine prophylaxix. (20,21)
3. Drink Water
Increased hydration may produce subjective improvement in headache disability and intensity, however no difference in frequency. (22)
4. Decrease Sodium
Patients on a low sodium (DASH) diet report a decrease in headache frequency vs those on a high sodium diet. (23)
5. Feverfew (125mg)
Feverfew may be a useful tool for preventing migraines. (24,25,26) Dosage recommendations vary, however the average dose used in the studies was 125mg/day.
6. Ginger
Adding ginger to feverfew may provide relief for acute migraine. (27,28) The proprietary ginger preparation used was (LipiGesic™ M)
7. Riboflavin (400mg)
Riboflavin (Vit B2) may help prevent migraines. (26, 29-38) Dosage recommendations vary, however the average dose used in the studies was 400mg/day.
8. Magnesium (400-600mg)
Magnesium may provide migraine prophylaxis. (26, 39-42) Dosage recommendations vary, however the average dose used in the studies is
400-600mg/ day for the prevention of migraine in non-pregnant patients.
9. CoEnzyme Q10 (100mg TID)
CoEnzyme Q10 may be effective in migraine prophylaxis. (26, 43-46) Dosage recommendations vary, however the average dose used in the studies was 100mg TID.
Please review the ChiroUp migraine headache condition reference for more information about the current chiropractic standard of care for managing this debilitating problem. By applying current scientific knowledge to clinical practice, we will certainly improve patient outcomes. ChiroUp is a tool that allows you to instantly provide your patients with the best recommendations- making you the “expert” at managing their musculoskeletal needs. We are proud to be your partner in delivering clinical excellence.
