Foods and Supplements in the Management of Migraine Headaches

The New York Headache Center, New York, NY 10021, USA.
The Clinical journal of pain (Impact Factor: 2.53). 07/2009; 25(5):446-52. DOI: 10.1097/AJP.0b013e31819a6f65
Source: PubMed


Although a wide range of acute and preventative medications are now available for the treatment of migraine headaches, many patients will not have a significant improvement in the frequency and severity of their headaches unless lifestyle modifications are made. Also, given the myriad side effects of traditional prescription medications, there is an increasing demand for "natural" treatment like vitamins and supplements for common ailments such as headaches. Here, we discuss the role of food triggers in the management of migraines, and review the evidence for supplements in migraine treatment.
A review of the English language literature on preclinical and clinical studies of any type on food triggers, vitamins, supplements, and migraine headaches was conducted.
A detailed nutritional history is helpful in identifying food triggers. Although the data surrounding the role of certain foods and substances in triggering headaches is controversial, certain subsets of patients may be sensitive to phenylethylamine, tyramine, aspartame, monosodium glutamate, nitrates, nitrites, alcohol, and caffeine. The available evidence for the efficacy of certain vitamins and supplements in preventing migraines supports the use of these agents in the migraine treatment.
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, Petasites hybridus, feverfew, coenzyme Q10, riboflavin, and alpha lipoic acid.

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Available from: Alexander Mauskop, Jun 11, 2015
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    • "One small trial of 30 patients with migraine without aura does support food avoidance based on detection of circulating serum immunoglobulins against specific foods; however, larger studies are required to determine the efficacy of this technique (Alpay et al., 2010). Four non-prescription supplements, including magnesium, Petasites hybridus, coenzyme Q10, and riboflavin, have been found to be effective migraine preventive agents based on double-blind placebo-controlled trials (Sun-Edelstein and Mauskop, 2009). However, supplementation is not intended exclusively for the obese population. "
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    ABSTRACT: Migraine and metabolic syndrome are highly prevalent and costly conditions. The two conditions coexist, but it is unclear what relationship may exist between the two processes. Metabolic syndrome involves a number of findings, including insulin resistance, systemic hypertension, obesity, a proinflammatory state, and a prothrombotic state. Only one study addresses migraine in metabolic syndrome, finding significant differences in the presentation of metabolic syndrome in migraineurs. However, controversy exists regarding the contribution of each individual risk factor to migraine pathogenesis and prevalence. It is unclear what treatment implications, if any, exist as a result of the concomitant diagnosis of migraine and metabolic syndrome. The cornerstone of migraine and metabolic syndrome treatments is prevention, relying heavily on diet modification, sleep hygiene, medication use, and exercise.
    Frontiers in Neurology 11/2012; 3(article 161):161. DOI:10.3389/fneur.2012.00161
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    • "Some patients with migraine, be it VM or other variants, appear to have dietary or environmental triggers, and avoiding such triggers can result in relief of symptoms. Both the use of caffeine and caffeine withdrawal have been suggested to be triggers of migraine for some patients, yet caffeine is a component of over-the-counter migraine medications and has also been used in clinical trials as a therapy against migraines [4] [5] [6] [7] [8] [9]. In an effort to resolve the ambiguity currently in the literature regarding the role of caffeine in migraine and to identify an effective method to treat patients with VM and CDUE, the authors retrospectively reviewed the records of patients presenting to the clinic with the primary complaint of dizziness to evaluate the efficacy of a therapeutic pathway to VM and CDUE with long-term caffeine cessation as a first step and pharmacotherapy with nortriptyline or topiramate as the second step. "
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    ABSTRACT: The aim of this study was to evaluate the efficacy of a therapeutic pathway for vestibular migraine (VM) and complex dizziness of undetermined etiology (CDUE) with caffeine cessation and pharmacotherapy. This study is a retrospective chart review. Patients were recommended to stop intake of caffeine and other putative migraine-triggering agents. Pharmacotherapy was initiated with nortriptyline or topiramate if symptoms persisted despite diet modification. Self-reported dizziness is the main outcome measure. Vestibular migraine and CDUE were considered contributing factors to dizziness in 34 and 10, respectively, of 156 patients. Fourteen percent of patients reported improvement in symptoms upon caffeine cessation, whereas 46% of patients reported a reduction in dizziness after nortriptyline therapy (P = .007). Topiramate reduced symptoms in 25% of patients. In total, 75% of VM patients and 56% of patients with CDUE received sufficient benefit from this therapeutic pathway to not progress to other treatments. Vestibular migraine and CDUE can be treated effectively with a therapeutic pathway consisting of caffeine cessation followed by pharmacotherapy.
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