Compassionate Acupuncture and Healing Arts

by Barbara Connor, M.Ac., L.Ac.

I thought I would write a little bit today about migraine headaches. I would like to share with you some of the studies I have found which show the effectiveness of acupuncture, herbs and nutrients in treating migraines as well as studies on the precipitating factors for migraine headaches. I hope you find this information helpful.

Therapies proven (to various degrees) to be effective for migraine include aerobic exercise; biofeedback; other forms of relaxation training; cognitive therapies; acupuncture; and supplementation with magnesium, CoQ10, riboflavin, butterbur, feverfew, and cyanocobalamin with folate and pyridoxine. (Mauskop 2012)

Acupuncture for Migraine Headaches

Acupuncture seems to be at least as effective as conventional drug preventative therapy for migraine and is safe, long-lasting, and cost-effective. It is a complex intervention that may prompt lifestyle changes that could be valuable in patients’ recovery. (Da Silva AN 2015)

In this study it was concluded that acupuncture is a better treatment option than conventional drug therapy in not only relieving the pain of migraine but in also improving the psychological profile in migraineurs. Hence its use should be encouraged as an alternative/adjunct treatment for migraine. (Vijayalakshmi et al 2014)

This study, which included 401 patients with chronic headache disorder, predominantly migraine, suggests that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. (Vickers et al 2004)

The following study showed an improvement of the quality of life and better analgesic effect of acupuncture combined with tanacetum parthenium (feverfew) treatment on migraine pain in women when compared with acupuncture or tanacetum parthenium alone. (Ferro et al 2012)

Acupuncture has been used to both prevent and treat diseases for over 3,000 years. Recently, a Cochrane review on its use in migraine concluded that acupuncture is effective and should be considered as a prophylactic measure for patients with frequent or insufficiently controlled migraine attacks. In contrast, there is no clear evidence to support or refute the use of homeopathy in the management of migraine. Among vitamins and other supplements, riboflavin and coenzyme Q10 significantly decreased the frequency of migraine attacks. Alpha lipoic acid also reduced migraine frequency, albeit not significantly as compared to placebo. The prophylactic efficacy of magnesium, particularly for children and menstrually related migraine, has recently been substantiated. Among the herbal remedies, butterbur (Petasites hybridus) significantly decreases attack frequency, whereas the efficacy of feverfew was not confirmed in a Cochrane review, probably because of the 400% variations in the dosage of its active principle. Finally, ginkgolide B has proved significantly effective in controlling migraine with aura and pediatric migraine in uncontrolled studies that need a confirmation. (Schiapparelli et al 2010)

Herbs and Nutrients for Migraine Headaches

CoQ10 – Evidence indicates that impaired energy metabolism may be present in brains of migraine sufferers. Rozen et al. [2002] supplemented migraine patients with 150 mg CoQ10 daily for 3 months and demonstrated a 50% reduction in the frequency of migraine headaches, regardless of whether patients experienced aura or not. Deficiency of CoQ10 may be common in pediatric and adolescent migraine. Determination of deficiency and consequent supplementation may result in clinical improvement [Hershey et al., 2007]. (Garrrido-Maraver et al 2014)

Cyanocobalamin, folate, and pyridoxine – Discovery of the high incidence of the C677T mutation of the methylenetetrahydrofolate reductase gene, MTHFR, and attendant elevation of homocysteine levels in patients with migraine with aura led to a trial of cyanocobalamin, folate, and pyridoxine in these patients. This trial showed that taking these three supplements resulted in a reduction of homocysteine levels and improvement of migraines. (Mauskop 2012)

Butterbur, riboflavin, coenzyme Q10, and magnesium citrate – Based on our review, 11 prophylactic drugs received a strong recommendation for use for migraine (topiramate, propranolol, nadolol, metoprolol, amitriptyline, gabapentin, candesartan, butterbur, riboflavin, coenzyme Q10, and magnesium citrate) and 6 received a weak recommendation (divalproex sodium, flunarizine, pizotifen, venlafaxine, verapamil, and lisinopril). (Pringsheim et al 2012)

Butterbur extract and vitamin B2 – Among “natural” treatments for headache, both butterbur extract and vitamin B2 have shown efficacy in more than one randomized trial and are thus potentially useful first-line preventive interventions. (Nicholson et al 2011)

Butterbur (Petasites hybridus) – significantly decreases attack frequency of migraines. (Schiapparelli et al 2010)

Feverfew (Tanacetum parthenium) –  The medicinal properties of feverfew have been recognized for centuries, and many people use it for prevention and/or relief of migraine as well as for anti-inflammatory effects in arthritis. Both in vitro and in vivo, these anti-inflammatory effects of parthenolide were associated with inhibition of IκBα depletion, which in turn resulted in inhibition of excessive activation of NF-κB. (Saadane et al 2007) 

Ginger – In this double-blinded randomized clinical trial, 100 patients who had acute migraine without aura were randomly allocated to receive either ginger powder or sumatriptan. Time of headache onset, its severity, time interval from headache beginning to taking drug and patient self-estimation about response for five subsequent migraine attacks were recorded by patients. Patients’ satisfaction from treatment efficacy and their willingness to continue it was also evaluated after 1 month following intervention. Two hours after using either drug, mean headaches severity decreased significantly. Efficacy of ginger powder and sumatriptan was similar. Clinical adverse effects of ginger powder were less than sumatriptan. Patients’ satisfaction and willingness to continue did not differ. The effectiveness of ginger powder in the treatment of common migraine attacks is statistically comparable to sumatriptan. (Maghbooli et al 2014)

Magnesium and L-Carnitine – Oral supplementation with magnesium oxide and L-carnitine and concurrent supplementation of Mg-L-carnitine besides routine treatments could be effective in migraine prophylaxis; however, larger trials are needed to confirm these preliminary findings. (Tarighat Esfanjani et al 2012)

Magnesium, Butterbur (Petasites hybridus), feverfew, coenzyme Q10, riboflavin, and alpha lipoic acid. The identification of food triggers, with the help of food diaries, is an inexpensive way to reduce migraine headaches. We also recommend the use of the following supplements in the preventative treatment of migraines, in decreasing order of preference: magnesium, Butterbur (Petasites hybridus), feverfew, coenzyme Q10, riboflavin, and alpha lipoic acid. (Sun Edelstein & Mauskop 2009)

Omega 3 Fatty Acids – There have been a number of clinical trials assessing the benefits of dietary supplementation with fish oils in several inflammatory and autoimmune diseases in humans, including rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, lupus erythematosus, multiple sclerosis and migraine headaches. Many of the placebo-controlled trials of fish oil in chronic inflammatory diseases reveal significant benefit, including decreased disease activity and a lowered use of anti-inflammatory drugs. (Simopoulos 2002)

Precipitating Factors for Migraine Headaches

Migraine pathophysiology – Scientific evidence supports the notion that migraine pathophysiology involves inherited alteration of brain excitability, intracranial arterial dilatation, recurrent activation, and sensitization of the trigeminovascular pathway, and consequential structural and functional changes in genetically susceptible individuals. (Noseda & Burstein 2013)

Inflammation has long been suggested to play a role in migraine. (Eising et al 2013)

Fasting, alcohol, chocolate and cheese – A relevant proportion of patients say that their migraine attacks may be precipitated by dietary items, the percentage of patients reporting foods as trigger ranging in different study from 12 to 60 %. Fasting, alcohol, chocolate and cheese are the dietary precipitating factors more frequently reported. The finding that diet-sensitive migraineurs are usually sensitive to several and different foods, lead to the hypothesis of antigenic similarities between these disparate foods or common chemical constituents, but a clear scientific explanation of the mechanisms implicated in the development of migraine attacks supposedly precipitated by food is still lacking. The possibility that the elimination diets based on the hypothesis of food hypersensivity IgE or IgG-mediated improve migraine has been explored in different studies but the results are inconclusive. Fasting as trigger for migraine is frequently reported. Some migraineurs show reactive hypoglycaemia due to diet-induced hyperinsulinism. In conclusion, identification of environmental factors (including dietary factors) that consistently trigger migraine in some subjects may be helpful to reduce attacks frequency. (Finocchi & Sivori 2012)

Estrogen’s effect on the brain – In nonpregnant women, the three major estrogens are estradiol (E2), estrone and estriol, with estradiol being the most potent form. Estrogen’s effect on the brain can occur via at least three distinct pathways: direct diffusion of peripheral estrogen into the CNS, conversion of testosterone and androstenedione in the brain by aromatases in the presynaptic terminals in the brain or de-novo synthesis of estrogen in the brain from cholesterol. In the brain, estrogen can exert its effect by binding to estrogen receptors, usually located in the nucleus or cytoplasm, with subsequent gene transcription and protein synthesis; or alternatively estrogen can act by nongenomic  mechanisms. Recent data suggest that the transcriptional activity of human brain estrogen receptors is cell-type specific. (Chai et al 2014) 

The primary trigger of menstrually-related migraine appears to be the withdrawal of estrogen rather than the maintenance of sustained high or low estrogen levels. However, changes in the sustained estrogen levels with pregnancy (increased) and menopause (decreased) appear to affect headaches. Headaches associated with oral contraceptive use or menopausal hormonal replacement therapy may be related, in part, to periodic discontinuation of oral sex hormone preparations. The treatment of migraine associated with changes in sex hormone levels is frequently difficult and the patients are often refractory to therapy. (Silberstein SD 2000)