Migraine headaches wreak havoc in the lives of many people. Migraines are more than just a headache; they are generally more painful and there may be clear phases including the aura along with nausea and severe sensitivity to light and or noise. A migraine can cause a patient to cancel plans, miss work and be absent from family and other personal engagements. For some, a migraine can last for days; strong allopathic medicines may or may not be effective. In a portion of my migraine sufferers, there is a clear cause to the headache or known triggers, for others there seems to be no rhyme or reason and attacks come on randomly. Over the years it has been suggested that migraines were due to problems with circulation to the head and brain, more recently a neurologic cause has been posited. It might be that there is an etiology related to brain stem malfunctioning. There are writings and historical artifacts letting us know that migraines have been around for millennia, but this ailment is still not well understood and there are some for whom allopathic approaches prove ineffective or not effective enough. That said, medical approaches continue to develop and frustrated patients who have not sought care for some time, should be encouraged to try again, perhaps a medication now exists that could help. I generally tend to aim low and aim long with my patients. What I am looking for with my migraine patients is fewer attacks of less severity and shorter duration. If a patient can go months without incident, better yet. I have had the uncommon patient over the course of the past 27 years in practice who has never had another headache after treatment, but that is uncommon, with the exception of women who have premenstrual migraine. In this subset, where I have worked with a woman earlier in life to reduce the migraine incident and severity, where the years have passed and the menses eventually stopped, sometimes there is total cessation of migraine which is accurately attributed to the shift in hormones.

Unfortunately, this is not the case with Becky, a 58 year old kindergarten teacher when I first saw her; she had had migraines for over 40 years. She had always assumed they would resolve with menopause, as they had been worse before her periods, in fact she could count on one, like clockwork, premenstrually. But when her periods ceased in her late 40’s she found no relief. An otherwise upbeat and positive person, the migraines were getting Becky down, she could be struck at any time and without warning. A small flash of light, a slight wave of nausea were the only fleeting signs she would experience right before a headache was to begin. The unpredictable nature of the headaches alongside the pain and suffering was having a negative impact on her overall quality of life. She felt she could not make plans and could not reliably be available to friends and family. She sought my help out of desperation.

An otherwise robust, health-conscious woman, the headaches were an anomaly. When she felt well, she exercised regularly. She was active in her community and enjoyed a wide circle of friends. She had been the person in the family who oversaw food shopping and preparation and had always enjoyed offering healthy meals to her family of four. Her two sons were grown by this time and doing well on their own; Becky had planned to retire in the coming years.

At this point she was using Imitrex injections at the first sign of a headache, which sometimes would shorten a headache, but not always. However, Becky was growing concerned about the use of Imitrex because since menopause, her blood pressure had become slightly elevated. It was still in the normal range but it was higher than it had been, and she knew that Imitrex was contraindicated for those with hypertension. She also knew her blood pressure was up in part because she had put on weight in the past decade and was have a hard time loosing the 20 or so extra pounds she was carrying.

If a headache struck during work, Becky would have to leave school, go home, lie still in a dark and quiet room and sleep the headache off. She experienced a terrible crushing kind of pain all around her head; she had never found anything that helped her symptoms once the headache took hold except unreliably, the Imitrex. Through the raising of her two sons, she would lean on her mother and husband to step in on days when she could not function, often 2 days at a time 2-3x/month. Though she dearly appreciated their love and support, she also hated being reliant on others.

All naturopathic doctors have the occasion to treat people with migraine headache. When a patient presents with the chief complaint of migraine, I assume it means other things have been ruled out. If there has not been a thorough work-up, I will be sure we get that done. There are other things that may cause challenging headaches including: chronic sinus issues and sinus infection, issues with the teeth and TMJ, visual issues and eye problems and structural issues related to being out of alignment in the neck, back or shoulders. Our sedentary lifestyle and many hours in front of computer screens likely does not help with this aspect. Another big category is environmental, seasonal or food allergens which can cause or worsen migraines. Allergies can be a trigger for migraines and many who suffer, during allergy seasons or if exposed to other sorts of environmental or food allergies, will be triggered. We also see patients present with headaches related to other physical body issues such as digestive, endocrinological (i.e. hormones, more common in women…) and those related to blood sugar imbalance. Stress is likely the most common culprit, and certainly there’s enough of that to go around! Lastly—and of course most disturbingly- migraine-like headaches can be due to some sort of lesion in the brain, cancerous or benign.

Here is a special note about foods. Those items I will ask my migraine patients to avoid are: alcohol, in particular, beer and red wine, the additive monosodium glutamate, which is sometimes found in prepared Asian foods, chocolate, aged cheeses, foods containing aspartame, and the excessive use of caffeine. For some, very salty foods and those that are overly processed can also be troubling. I always take a careful history to see if there are any known triggers but even if there are not, I might suggest a trial off of some of the items listed above, which are commonly associated with migraine headache.

Occasionally a patient comes my way where it is thought that they have migraines, this might be either a child or an adult, but in the end we find that it is something else causing the headaches. I am of course, happy to treat the patient alongside other appropriate providers, regardless of the ultimate diagnosis.

If all the other issues have been ruled out, and we have determined that someone has true migraines, there are many approaches a naturopathic doctor might employ to prevention and/or treat. Most recommendations are individualized to the person and should be recommended- both the item and the dosages- by a reputable provider. Here are some of the approaches I recommend:

Proper hydration can be essential, the actual amount of fluid necessary varies from person to person based on constitutional type, activity level and other dietary considerations, but for many people, being adequately hydrated can help.

A study in the December 28, 2004 issue of Neurology reported that the herb Butterbur (Petasites hybridus) was an effective preventive measure. “Patients who took two 75 mg tablets of Butterbur extract cut headache occurrence by an average of 48 percent (compared to 26 percent among patients who received a placebo.) When buying Butterbur, be careful to choose extracts guaranteed to be free of pyrrolizidine alkaloids, compounds that are toxic to the liver. Take Butterbur with meals.”

I also work with high doses of B 6—100mg/day as a preventive. This vitamin is water soluble, so I am comfortable using this kind of dosage, and usually I will suggest taking it alongside a B complex vitamin.

I suggest trying techniques like biofeedback and massage and other stress reduction approaches. Some will do well with mindfulness meditation. Regular aerobic exercise should not be forgotten. These are not suggested strictly for use at the time of the headache but rather as a way to reduce the overall stress level for the patient and for some, as applicable tools to use during a migraine.

When there is a very strong family history of migraines and they are long standing for a patient, I am less optimistic about treating them, which is true for a number of pathologies; that said, I certainly give it my best shot and at very least we can look for a reduction in frequency, and severity of migraine and a shortening of the duration of the headache.

I also use homeopathy with my migraine patients. I look for what is called a constitutional remedy for the patient, a medicine for the whole person. During the intake and assessment I will want to understand the headache in all its minutiae, i.e. what their headaches feels like, where the pain is on the head, what brings the pain on, what if anything helps, and whether there are any concomitant symptoms on other systems of the body, (i.e. nausea, muscle aches, visual disturbances, aura etc.). And I strive to understand the headache in the context of the rest of the patient’s life.

In Becky’s story, she could expect to be down for the count 2-3x per month with a migraine. She did have some nausea with the headache, though only rarely vomited. She experienced the pain all over her head, perhaps a bit more on the left side.

She had a few other ailments which we reviewed including mild arthritis in the hands, a tendency for constipation and frustration with carrying around the extra 20 pounds. She felt the stiffness in her hands, mostly in the morning and seemingly getting worse over the years. It did not stop her from doing anything and by lunchtime it was usually gone. Beyond that, her skin, urinary tract, respiratory tract, and cardiovascular system were all in good shape. She tended to be a bit chilly and sweat easily; her overall energy level was good. Her screening lab work, which she brought in with her at our first visit, revealed no other underlying concerns.

Becky did complain of insomnia; if she had worries about her husband or her extended family she would have trouble both falling and staying asleep. This had always been true for her but at the time we first met, she was struggling. Her husband had lost his job a year before and though they had diligently saved for retirement, much of his retirement money had been tied up in the business that had failed, so they were not sitting too well. And this was before the economy really went south.

For Becky and her husband, retirement any time soon was out of the question. The disturbances of sleep she would attribute to over activity of her mind, making lists, worrying about what she forgot to do the day before or fretting over what she had to do the next day. This low grade anxiety, which mostly manifested at night, was ameliorated during the day by work, by being involved in her life and by taking care of business. Becky was not bothered by other kinds of anxiety and she reported not have any issue with overwhelming sadness or depression. She was starting to feel a bit desperate about he migraines, which had led her to my door.

Her mind was quite clear. She did complain about her memory, which seemed of late to be impacted. She didn’t know if it was just her age, her constant multitasking or the financial stress she was under. I asked if it was impacting her work as a teacher and she replied no, it was more the kind of thing where she would mislay her keys or forget why she had walked into a room.

She loved her work with small children, had enjoyed raising her own and had been anticipating a less hectic time of life. But with her husband work issues and their retirement funds dwindled, this was becoming less of a reality. The sense I got from Becky was that she would just plod onward. She really didn’t have a choice, so she turned her vision to getting the job done. She enjoyed the people and families she worked with and felt valued as a teacher.

When I first treat a patient, I like to give a homeopathic remedy that has the widest possible application for the patient, instead of focusing narrowly on a small set of symptoms. I wanted to prescribe a remedy for a person who is responsible, forthcoming and organized. It needed to be a remedy that would address her kind of headache, in a person who tended for constipation and mild joint inflammation in a e chilly person So in the end I was left deciding between two fairly common remedies: Calcarea carbonica and Silica.

With Silica I expect to see more of any underlying weakness, almost toward fragility, which can make the patient become rigid, as a way to protect themselves. In Becky’s case I did not see either weakness or rigidity, rather someone who was ameliorated by hard work and communicative connection. The fact that she had trouble losing weight, was chilly and perspired freely confirmed the constitutional homeopathic remedy, Calcarea carbonica, which I ultimately gave to her after our first visit. She was also asked to take the Butterbur and B vitamins alongside fish oil to help with the mild joint discomfort she had. She was already following the dietary recommendations I would have given.

When she returned 6 weeks later, she lit up in the waiting room and I knew before we went into my exam room that she’d had a good month. She’d had one headache that the Imitrex took care of and she was feeling well. She seemed to be sleeping better and her mild joint discomfort was gone. She also said that for the first time in her life she felt like she had normal, easy bowel movements.

This was a wonderful first report and it is difficult to know what was doing what. In such patients, it is looking back over a year or two that we can say more definitively what is going on. In Becky’s case, I did not much care. I just wanted her to have fewer, less impactful headaches. She stayed with the same plan.

When I saw her for another follow up two months later, she had not had any headaches at all. This was good report indeed. In the following several months, financial bad news hit her family, as it hit many others, and the stress was taking its toll. She’d had 3 headaches in 3 weeks and felt she was slipping. Two of the headaches were not helped with her allopathic medication and days simply fell off the calendar while she rested in her darkened bedroom.

I assume for the most part that people respond to stress in predictable and patterned ways (often according to their homeopathic constitutional type,) and that is what was happening with Becky. I encouraged her to stay with the other supplement and meanwhile prescribed a stronger dose of Calcarea carbonica.

I spoke with her by phone 2 months later when she reported having had one headache, helped by her meds. Many students ask me if there might be a place to use the constitutional remedy at the moment of the headache or if it makes sense to try a different homeopathic remedy at the time of the headache. I have not found these approaches to be especially helpful though I have tried with many patients over the years. I have found the best approach is to treat broadly and constitutionally and work to reducing the overall number of migraines a patient has. Some patients will benefit from a short (5 minute) very, hot footbath at the onset of a migraine, and I have recommended that. Others do well with ice packs to the head; a combination of these treatments also is sometimes effective.

I continue to work with Becky in the treatment of her migraines. Overall she feels she is moving in the right directions: fewer headaches which are less severe and less long lasting and are more predictably helped by her medication. She is finding ways of working with her stress and supporting her husband during his difficult times professionally and is eager to send me patients. Migraine headaches are one of those diagnoses where many patients will do well by combining both allopathic and naturopathic medical approaches.