Headaches and Migraines

by John G. Connor, M.Ac., L.Ac. edited by Barbara Connor, M.Ac., L.Ac.

An estimated 30 million Americans suffer from chronic headaches and an estimated 8 million Americans suffer from migraines. Acupuncture has been shown to be effective in preventing or lessening the severity of headaches in many people, and the treatment of migraines is one of the areas where craniosacral work really excels.  Craniosacral acupuncture works to improve the body’s assimilation and elimination mechanisms thereby diminishing and hopefully eliminating the cause of most migraines and headaches.  Barbara and I get excellent results combining acupuncture and craniosacral work in the treatment of both headaches and migraines.  When indicated we also use herbs, supplements and lifestyle recommendations.  We have written this article to give you a better understanding of how we treat these conditions.  We hope it proves helpful.

Tension headaches are due to an up-flushing of energy – usually from the Liver. This rebellious energy or Qi finds its way into the Tendino Muscular Meridians (TMMs) which are located in the musculature of the neck and head. This Qi congests causing muscular tightness and pain. Most often this tightness and pain follow the pathways and spill-over areas associated with the Gall Bladder TMM. In both the case of tension headaches and migraines it is Yang Qi flushing up which causes the pain.However in the case of migraines the Qi flushes up abruptly and more deeply and often spills over from the Gall Bladder channel into the various TMMs which encircle the head. This explains why the pain of a migraine often progresses to encompass the entire head.

Sometimes the excess Liver Qi or Yang vents itself upwards drafting with it Stomach Qi causing nausea and possibly vomiting.Postmenstrual migraines occur at or towards the end of a woman’s periods and are due more to Blood Deficiency.  Essentially there is not enough Blood in the upper body to maintain patency of flow in the head. Many women have a combination of both types of migraines, i.e., they have Excess Liver Qi and Heat type as well as Deficient Spleen and Blood type.

RESEARCH ON HOW ACUPUNCTURE BENEFITS CHRONIC HEADACHES AND MIGRAINES
A study done by Vickers et al entitled “Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial” published in the British Medical Journal 2004 Mar 27;328(7442):744 concluded that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. Expansion of NHS (National Health Service) acupuncture services should be considered.

The results of a study published in Neurol Sci 2003 May;24 Suppl 2:S138-42 by Allais et al entitled “Non-pharmacological approaches to chronic headaches: transcutaneous electrical nerve stimulation, lasertherapy and acupuncture in transformed migraine treatment” found that TENS, lasertherapy and acupuncture proved to be effective in reducing the frequency of headache attacks.  Acupuncture showed the best effectiveness over time.

The results of a study published in Scand J Dent Res 1979 Oct; 87(5):373-80 by Jensen et al entitled “Effect of acupuncture on headache measured by reduction in number of attacks and use of drugs” concluded that acupuncture is a relevant therapy for headache with a definite symptomatic effect.

The results of a study published in J Intern Med 1994 May;235(5):451-6 by Hesse et al entitled “Acupuncture versus metoprolol in migraine prophylaxis: a randomized trial of trigger point inactivation” concluded that trigger point inactivation by dry needling (acupuncture) is a valuable supplement to the list of migraine prophylactic tools, being equipotent to metoprolol in the influence on frequency and duration (but not severity) of attacks, and superior in terms of negative side-effects.

The results of a study published in Headache 2002 Oct;42(9):855-61 by Allais et al entitled “Acupuncture in the prophylactic treatment of migraine without aura: a comparison with flunarizine” concluded that acupuncture proved to be adequate for migraine prophylaxis.  Relative to flunarizine, acupuncture treatment exhibited greater effectiveness in the first months of therapy and superior tolerability.

The results of a controlled trial conducted on 20 patients suffering from chronic migraine published in Clin J Pain 1989 Dec;5(4):305-12 by Vincent CA entitled “A controlled trial of the treatment of migraine by acupuncture” concluded that true acupuncture was significantly more effective than the control procedure in reducing the pain of migraine headache.  Post treatment reductions in pain scores and medication of 43% and 38% respectively, were recorded in the true acupuncture group; and were maintained at 4-month and 1-year follow-up.

The pain behind migraines is thought to be due in part to arterial vasodilation, which is often preceded by vasoconstriction. Inflammation of arterial walls, with vasodilation and edema from vasoactive peptides and other pain-inducing substances, also contribute to the intensity of the pain.The trigeminal nerve carries pain messages from the inflamed arterial wall to the brainstem, triggering migraine pain. Headaches may be related to mechanical irritation of the sensitive nerve endings of the meninges.

About 50 percent of sufferers of migraines have a two to four hour premonitional period before the symptoms appear, during which time they experience vague effects, such as a mild increase in sensitivity to light, loss of appetite, a feeling of being ungrounded, or mild dyslexia. (Craniosacral work is most effective at this stage of the migraine.)

Twenty percent of sufferers see an aura or light display of some kind. The actual headache is accompanied by a throbbing pain, nausea, and light and noise intolerance. A migraine aura reflects some sort of cerebral dysfunction. It begins within 5 – 20 minutes of the migraine and fades away in less than an hour. There are various types of auras. Migraines without auras are preceded by a prodrome including such symptoms as fatigue, sleeplessness, slight behavioral problems and decreased appetite. The migraine appears quickly, and affects the suborbital, frontal and less often the occipital areas.  It is one-sided, pulsatile, and often causes photophobia, nausea, vomiting or a state of prostration. The migraine may last from a few hours to three days.

In a study done by Sensenig et al (2004) it was concluded that migraines may be, at least in part, caused by an underlying deterioration of normal body functioning.  They found that by improving assimilation and elimination mechanisms, the manifestation of migraine diminished or ceased for the majority of the participants.

Non-migraine headaches often begin with nuchal and occipital pain, which migrates slowly toward the anterior cerebral regions, unilaterally or bilaterally, and ends up in the sinuses, frontal, periorbital or more rarely zygomatic region.

Hypertension causes diffuse, predominantly occipital headaches in early evening or early morning.  Confusingly, hypotension can cause the same symptoms.The understanding of headaches has been deepened by the work of brain and orthopedic surgeons, who have documented the sensitivity of soft tissues in the spine, the dural membranes and the brain tissue itself.

Specific work with the sphenoid, maxillae, and mandible represents the most powerful way to both prevent and interrupt migraines. Maxillary position and motion, or its absence, seems to have a leading role in migraine causation, making craniosacral vault holds based on Dr. Sutherland’s work perhaps the best craniosacral treatments for migraine.

Emotions – such as frustration, irritability, anger and depression.

Missing meals – weakens the Spleen Qi and allows the Liver Qi to rise upwards.

Alcohol – is Hot and Damp. It enters the Liver making the Liver Hot and enters the Spleen making it Damp, i.e., weak. In addition, alcohol is outwardly and upwardly dispersing and can directly precipitate the venting of Liver Qi.

Chocolate- inflames the Ming Men Fire. Its oils and fats dampen the Spleen and cause Excessive Heat in the Stomach and Liver.

Cheese and milk products – tend to aggravate Dampness and weaken the Spleen at the same time plugging the Qi pathways with Phlegm. This plugging of the pathways increases internal pressure and any tendency to Liver Qi stagnation.

Coffee – disperses Stagnant Qi and wastes the Blood and Yin. So it should not be used by persons who are Stomach Yin Deficient, Blood Deficient or Heart and/or Kidney Yin Deficient. It liberates stored Jing or Essence in the Kidneys and therefore is deleterious to health over-all.  It should be used with care by women and the elderly.

Extreme exhaustion – can cause consumption of Blood or a relaxation of the holding Qi which allows pent up Qi to escape.

Smoking – Nicotine is also dispersing and discharging and can precipitate the venting of pent-up Liver Qi.  Nicotine constricts blood vessels while carbon monoxide tends to expand them.

Common causes of headaches are stress, tension, anxiety, allergies, constipation, coffee consumption, eyestrain, hunger, sinus pressure, muscle tension, hormonal imbalances, TMJ syndrome, trauma to the head, nutritional deficiencies, the use of alcohol, drugs or tobacco, fever and exposure to pollution, perfume or after-shaves.Headache sufferers may be allergic to certain foods such as: wheat, chocolate, MSG, sulfites, sugar, hot dogs, luncheon meats, dairy products, nuts, citric acid, cheese, sour cream, yogurt, alcohol and vinegar.Other possible causes of headaches are: anemia, bowel problems, brain disorders, tooth-grinding, high blood pressure, low blood sugar and sinusitis.Vitamin B6 deficiency, which can cause headaches and migraines, may result from the use of oral contraceptives.

Almonds, almond milk, watercress, parsley, fennel, garlic, ginger, cherries and fresh pineapple.

Omit foods which contain the amino acid tyramine including alcohol, aged meats, fermented sausages, aged cheeses, sour cream, avocados, bananas, beer, cabbage, canned fish, dairy products, eggplant, chicken, chocolate, potatoes, cold cuts, herring, onions, peanut butter, pork, smoked fish, vinegar, raspberries, red plums, citrus fruits, tomatoes, wine and yeast.Avoid aspirin, MSG, nitrites (the preservative used in foods) and spicy foods.

Avoid salt and acid-forming foods such as meat, cereal, bread and grains. Avoid fried, fatty and greasy foods, and any food that is aged, cured, pickled, soured, yeasty or fermented.

Also avoid red wine, figs, dates, raisins, hard cheeses, yogurt, sour cream, herring and sauerkraut.

Foods which contain high amounts of copper (such as chocolate, nuts, wheat germ and shellfish) or which increase the intestinal absorption of copper (such as citrus) are potential migraine headache triggering agents.

Avoid foods which contain sulfites such as white wine and foods that use sulfites as preservatives such as beer, cider, apple juice, mashed potatoes and dried apricots.

Avoid milk chocolate as it is more migrainogenic than dark chocolate.

Estrogen level has been correlated with triggering of migraines. The headache coincides with the drop in estrogen just before the onset of menstruation. Estrogen causes swelling in the brain.  The enlarged blood vessels in the brain cause most migraine headaches. Estrogen can also deplete magnesium levels, which makes arteries more susceptible to spasm, a common cause of other types of headaches. According to Dr. John Lee if you have premenstrual headaches, progesterone cream and magnesium will usually cure them within three menstrual cycles.

To find out about some of the side effects of migraine drugs please read our article entitled Pain Management.

• Tyramine causes the blood pressure to rise, resulting in a dull headache Therefore, try eliminating foods containing tyramine and the amino acid phenylalanine Then reintroduce one food at a time and see which one produces headaches. Phenylalanine is found in aspartame (Equal, NutraSweet), MSG, and nitrites. Foods that contain tyramine are listed above under “Foods to Avoid for Migraines”.

NUTRITIONAL & BOTANICAL SUPPORT FOR MIGRAINES

· Feverfew* (Tanacetum parthenium) – has anti-inflammatory properties

· Boswellia* – has anti-inflammatory properties.  It is a LOX-5 inhibitor as well as a COX-2, 5, 12 and 15 inhibitor.

· Parthenolide* – inhibits certain pro-inflammatory pathways such as NF-kappaB

· Andrographis* – is anti-inflammatory. It downregulates the pro-inflammatory cytokines NF-kappaB and IL-1 beta

.· Omega 3 Fatty Acids – have anti-inflammatory properties

· Willow Bark – has anti-inflammatory properties

· Resveratrol  – has anti-inflammatory properties

· Turmeric (Curcumin) – has anti-inflammatory properties

· CoQ10 – increases blood flow to the brain and improves circulation.

· Magnesium and Calcium help to regulate muscular tone; magnesium supplementation may be beneficial for migraines.

· Quercetin – has anti-inflammatory properties

· Cat’s Claw – has anti-inflammatory properties

· Atractylodes – has anti-inflammatory properties

· Grape Seed proanthocyanidins – have anti-inflammatory properties

· Green Tea Extract – has anti-inflammatory properties

· Honokiol* – has anti-inflammatory properties

· Magnolol* – has anti-inflammatory properties

· Milk Thistle (Silymarin) – has anti-inflammatory properties

· Panax ginseng & Panax notoginseng – have anti-inflammatory properties

· Holy Basil & Rosemary – have anti-inflammatory properties

· Chamomile, peppermint & lemon balm tea – are very relaxing

· Reishi mushrooms – have anti-inflammatory properties

· Chinese skullcap* – has anti-inflammatory properties

· Royal Jelly extract – has anti-inflammatory properties

Butterbur  A double-blind, placebo-controlled study showed that the total number of days of migraine pain were significantly reduced by butterbur compared to the placebo group. (Grossmann, 2000)  Another study showed a 56% reduction in migraines using butterbur. (Eaton 1998)

Feverfew  In a systematic review by Ernst & Pittler (2000) they concluded that feverfew is likely to be effective in the prevention of migraine and that there are no major safety problems.

Calcium & Magnesium – help to regulate muscular tone and to transmit nerve impulses throughout the body and to the brain. Use chelate forms. Magnesium may be beneficial for FMS migraines. Magnesium supplementation may be beneficial for migraines.

Cayenne, chamomile. ginger, peppermint, rosemary, valerian and willow bark – are effective herbs in the treatment of migraines.

Coenzyme Q10 – Increases blood flow to the brain and improves circulation.  CoQ10 has shown promise as a migraine preventive agent. (Rozen, 2000)

Essential fatty acids – needed for brain cells and for fat metabolism. Take Vit. E when taking EFAs.

Ginkgo biloba extract – enhances cerebral circulation.

Lecithin – helps to reduce the frequency and severity of migraines.

Natural progesterone cream – may benefit women who suffer from migraines.

Vitamin B2 – (Riboflavin) – at a dose of 400 mg per day can significantly reduce the frequency and duration of migraines according to preliminary research. This dose, which appears to be safe, is much higher than what you’ll find in either foods or a vitamin supplement so you should discuss B2 therapy with your physician. (Dr. Andrew Weil’s Self Healing Newsletter. April 2000).

For general information on herbs and supplements which can relieve pain please read our article entitled Pain Management.

Bromelain – helps to regulate the inflammatory response.

5-HTP is useful for tension headache prophylaxis. (Songo et al, 1984)

Calcium and magnesium – help to alleviate muscular tension. Use chelate forms.

Coenzyme Ql0 – increases blood flow to the brain and improves circulation.

Ginkgo biloba extract – enhances cerebral circulation.

Feverfew, ginger, brigham, burdock root. fenugreek, lavender, marshmallow, mint, rosemary, skullcap and thyme – are herbs which may relieve headache pain.

Primrose oil – supplies essential fatty acids which promote healthy circulation, help regulate the inflammatory response and relieve pain.

LIFESTYLE RECOMMENDATIONS FOR MIGRAINE & HEADACHE SUFFERERS
Get regular moderate exercise. Do not smoke and avoid secondhand smoke.

Eat small meals, and eat small, nutritious snacks between meals if needed, to help stabilize wide swings in blood sugar that may precipitate a migraine.

Especially avoid missing meals. Elimination of allergenic foods from the diet may help.

The frequent use of over-the-counter painkillers may actually increase the likelihood of migraines.

REFERENCES
Balch, James F, M.D., and Balch, Phyllis A, C.N.C, Prescription for Nutritional Healing Garden City Park: Avery Publishing Group, 1997
Barral, Jean-Pierre, Croibier, Alain, Trauma, An Osteopathic Approach, Seattle: Eastland Press, 1999
Ernst, E & MH Pittler, “The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review” Public Health Nutr 2000 Dec;3(4A):509-14
Flaws, Bob, Curing Headaches Naturally with Chinese Medicine, Boulder, CO: Blue Poppy Press, 1998
Kirschmann, Gayla J., and Kirschmann, John D., Nutrition Almanac, New York: McGraw-Hill 1996
Lee, John R. M.D.,Hanley, Jesse, M.D., & Hopkins Virginia, What Your Doctor May Not Tell You About Premenopause, New York: Warner Books, 1999
Maciocia, Giovanni, The Practice of Chinese Medicine, Edinburgh: Churchill Livingstone, 1994
Milne, Hugh, The Heart of Listening, A Visionary Approach to Craniosacral Work, Berkeley North Atlantic Books. 1995
Mindell, Earl, R.Ph, Ph.D. & Hopkins, Virginia, Prescription Alternatives. New Canaan, CT: Keats Publ, 1998
Sensenig, James, ND, Jeffrey Marrongelle, DC, CCN, Mark Johnson, BS, Thomas Staverosky, BS, “Treatment of Migraine with Targeted Nutrition Focused on Improved Assimilation and Elimination” Alternative Medicine Review, Vol 6, No. 5, 2001:488-494
Upledger, John E., D.O, F.A.A.O., & Vredevoogd, Jon, D., M.F.A, Craniosacral Therapy, Seattle: Eastland Press, 1995
Werbach, Melvyn R., M.D., Nutritional Influences on Illness, Tarzana. Third Line Press, 1996