While vitamin and mineral supplements are by no means the first line of treatment for migraines, there are a couple of therapies that just might work when all else fails. Here's what some experts recommend.
Magnesium: 3,000 milligrams (magnesium gluconate), taken as 3 divided doses
Riboflavin: 400 milligrams
Doses for these two therapies are extremely high. If you wish to try these supplements to treat migraines, you should discuss it with your doctor.
People who have kidney or heart problems should supplement magnesium only under medical supervision.
The hammering inside your head is utterly horrendous, as if someone were using your brain for a bongo. For what it's worth, you're not the only one with a built-in percussion section: Roughly 45 million Americans reportedly suffer from headaches each year.
Although tension headaches are by far the most common, chronic migraines are much more likely to send a desperate individual to the doctor seeking relief. "I use the term victim when I refer to chronic headache sufferers, because it's a very wicked syndrome," says Burton M. Altura, M.D., professor of physiology and medicine at the State University of New York Health Science Center at Brooklyn. "Besides the agonizing pain, these folks often have tremendous sensitivity to light and noise. Just snapping your fingers or clapping around them can be excruciating."
The one-sided, throbbing headache known as a migraine is actually more common in women; roughly 75 percent of those who get migraines are female. But what migraines lack in gender equality they make up for in severity. Some migraines are so extreme that they cause limb numbness, hallucinations, nausea and vomiting.
The good news is that medical research has come up with several vitamin and mineral therapies that might prove helpful for people who have been unable to find relief elsewhere.
Fifty-two quarts of chocolate syrup. Nine hundred bowls of cornflakes. These might prevent a migraine--if they weren't guaranteed to give you a stomachache first. They add up to a superhigh dose of riboflavin, which research hints may ward off the someone's-put-a-soccer-ball-in-my-head pain.
Fortunately for the 49 people in a Belgian headache study, they were able to take supplements to get the necessary 400-milligram daily dose. The migraine-prone people in the study received this high dose (it's about 235 times the Daily Value) every day for three months. In addition to the riboflavin, 23 of the people in the study took one low-dose aspirin a day.
By the end of the study, migraine severity decreased by nearly 70 percent in both groups compared with what it had been at the study's start. Aspirin had no added value.
Why would something like riboflavin work? Researchers have noticed a deficit in certain energy generators in the brain cells of some people with migraines. They suspect that flooding the system with riboflavin could indirectly help regenerate this flagging energy system and somehow short-circuit migraine pain.
What's attractive about riboflavin, if rigorous scientific studies support these preliminary findings, is that it's likely to have fewer side effects than current headache preventives (although no one knows for sure the long-term effects of this much riboflavin).
"I wouldn't use it as the first line of attack, because we have other agents of proven value," says Seymour Solomon, M.D., professor of neurology at Albert Einstein College of Medicine in New York City. "But since this appears to be a relatively harmless treatment, it would be worthwhile to explore it with patients who haven't responded well to standard therapy."
Although riboflavin generally is quite harmless, it's a good idea to check with your doctor before supplementing in such a high amount.
An increasing number of doctors believe that some of the most severe cases of migraines may actually be caused by an imbalance of key minerals such as magnesium and calcium.
"Not all headaches are produced by this imbalance, but we now know that 50 to 60 percent of migraines are magnesium-linked. And that's probably why no prescription therapy on the market successfully treats headaches across the board. They're simply not treating the cause," says Dr. Altura.
"Of the 17 people we've treated with magnesium, 13 have had complete improvement," says Herbert C. Mansmann, Jr., M.D., professor of pediatrics and associate professor of medicine at Jefferson Medical College of Thomas Jefferson University in Philadelphia.
The magnesium-migraine link still is not commonly accepted by headache experts. In fact, Dr. Altura says that one of his magnesium studies was rejected by a prominent medical journal at the suggestion of a top headache researcher. (Shortly thereafter, the study was published by another journal.) But the weight of evidence for magnesium's use in the treatment of migraines is building. "There's no question that the literature strongly supports it," says Dr. Mansmann. "The so-called headache experts don't believe the data because they don't know anything about the development of magnesium deficiencies within cells."
To understand why magnesium might do the trick, it helps to take a look at how migraines happen.
Migraines are thought to be caused by vascular changes, or changes in the blood vessels, that reduce blood or oxygen flow in the scalp and brain. What causes these vascular changes? Things such as muscle contractions during times of stress and biochemicals called catecholamines and serotonin, which are circulating in the blood. Too much serotonin can cause blood flow to slow; too little can cause blood to move through too rapidly, explains Dr. Altura.
While mainstream researchers have long known that changes in serotonin and catecholamine levels cause migraine pain, stopping these changes has been a hit-or-miss proposition, says Dr. Altura. An aspirin, for example, temporarily inhibits the effects of serotonin but does nothing to prevent a migraine from coming back, he says.
Dr. Altura says he's the first to prove that loss of magnesium from the brain is behind the problem. Without enough magnesium, serotonin flows unchecked, constricting blood vessels and releasing other pain-producing chemicals such as substance P and prostaglandins, he says. Normal magnesium levels not only prevent the release of these pain-producing substances but also stop their effects, says Dr. Altura.
It's very likely that magnesium deficiency is a widespread cause of migraines, maintains Dr. Mansmann. Studies show that many people don't even come close to getting the Daily Value of magnesium, which is 400 milligrams. "On a daily basis, 30 to 40 percent of American people take less than 75 percent of the Daily Value of magnesium," says Dr. Mansmann.
What's more, several different things, from the caffeine in just two cups of coffee a day to the chemicals in most asthma medications, remove some magnesium from your system. "We know that intake is low for a lot of people. We know that a lot of medications, such as diuretics (water pills) and a variety of cardiovascular medications, can increase magnesium losses. We know that people with diabetes who have high blood sugar lose a lot more magnesium in the urine and, as a result, run the risk of magnesium deficiency," says Karen Kubena, Ph.D., associate professor of nutrition at Texas A & M University in College Station. Even stress, a frequent cause of migraines, can remove magnesium from your system, says Dr. Mansmann.
According to his records, Dr. Altura says that about 50 to 60 percent of his migraine patients have low magnesium levels. But once they begin treatment, he says, they often experience immediate relief. "We can say that 85 to 90 percent of these patients are successfully treated, and that's pretty miraculous," says Dr. Altura.
So can getting more than your share of magnesium every day prevent migraines? Dr. Altura says it's still unclear. "I'd like to be able to answer that question. I can't at this point, but my guess is that it would," he says. In Dr. Mansmann's experience, a magnesium gluconate supplement works best. "The advantage is that dose for dose, magnesium gluconate causes one-third of the amount of diarrhea that magnesium oxide produces and one-half of the frequency of diarrhea that magnesium chloride produces," he says. It's also absorbed more quickly, he says.
The difference: Magnesium gluconate is more biologically active. "The active form of magnesium is ionized magnesium. When a substance is chemically bound, it's sort of neutralized, if you want to use a Star Trek term. When it's ionized, it is available to do what it is supposed to do, which in this case is possibly prevent constriction of blood vessels in your brain and scalp," explains Dr. Kubena.
Dr. Mansmann's migraine patients take two 500-milligram magnesium gluconate tablets at lunch, two in the afternoon and two at bedtime, upping the dosage each week until their stools become soft, an indication that there is enough magnesium in the body.
If you decide to give this therapy a try, you should be working with a doctor who is willing to monitor your progress. (People who have kidney or heart problems should supplement magnesium only under medical supervision.) You'll have to pay attention to your calcium intake as well.
Even if you monitor your magnesium level like a maniac, you're still at risk for migraines if your calcium level is out of whack. The reason: Magnesium and calcium interact with each other.
It seems that higher than normal blood levels of calcium cause the body to excrete the rest, which in turn triggers a loss of magnesium.
"Let's say you have just enough magnesium and too much calcium in your blood. If calcium is excreted, the magnesium goes with it. All of a sudden, you could be low in magnesium," says Dr. Kubena.
In fact, says Dr. Altura, people who have low magnesium and elevated calcium levels are among those who are most successfully treated with magnesium.
A host of foods contain chemicals that can cause severe headaches. Here's what nutrition experts say to avoid.
Say no to MSG. A flavor enhancer used in restaurants and in prepared foods such as soups, salad dressings and lunchmeats, monosodium glutamate (MSG), even in small amounts, can provoke severe headaches as well as flushing and tingling in headache-prone people, says Seymour Diamond, M.D., director of the National Headache Foundation and director of the Diamond Headache Clinic in Chicago. In fact, one study showed that roughly 30 percent of those who eat Chinese food suffer these same symptoms. Although more research needs to be done, MSG seems to act as a vasodilator, which means it opens and then closes the blood vessels in the head. This process is exactly what happens in a migraine.
Because of all of the bad press, spotting MSG on food labels is harder than ever. "Natural flavor" and "hydrolyzed vegetable protein," for example, substitute for MSG in everything from frozen dinners, potato chips and sauces to canned meats.
Nix the nitrites. Commonly used as a preservative in hot dogs, salami, bacon and other cured meats, nitrites have been known to provoke migraines, says Dr. Diamond.
Corral the caffeine. The experts are divided here. Coffee, cola and tea all contain caffeine, which can act as a vasoconstrictor and, as a result, limit blood flow through the blood vessels in your head.
"A little bit of caffeine may help a headache, but you get either withdrawal or a rebound phenomenon from having too much," says Herbert C. Mansmann, Jr., M.D., professor of pediatrics and associate professor of medicine at Jefferson Medical College of Thomas Jefferson University in Philadelphia. Still, even two cups of a caffeine-containing beverage a day removes precious magnesium from your system, he says.
The bottom line: If you're having a problem with migraines, try avoiding caffeine and see if it helps, advises Dr. Mansmann.
Consider aspartame. Although few studies show a direct link between this artificial sweetener and headaches, some people do report problems with it, says Dr. Diamond. "My advice to people is that it probably won't bother you, but if you can relate a headache to it, you should not use it," he says.
To test whether this or any other food is causing your headaches, keep a diary of your meals as well as any headaches for a month. If it looks like one of the foods you're eating is causing the problem, cut it out of your diet and see if it helps, advises Dr. Diamond.
Keep track of tyramine. A whopping 30 percent of migraine sufferers seem to have sensitivity to an amino acid called tyramine. Found in stronger aged cheeses, pickled herring, chicken livers, canned figs, fresh baked goods made with yeast, lima beans, Italian beans, lentils, snow peas, navy beans, pinto beans, peanuts, sunflower seeds, pumpkin seeds and sesame seeds, tyramine means migraine pain for many, says Dr. Diamond. Try eliminating these foods and see if it helps, he suggests.
Cut your kisses. Chocolate contains a chemical called phenylethylamine that, like tyramine, can cause headaches, says Dr. Diamond.
Ban the booze. The alcohol in drinks can dilate the blood vessels in your brain and cause a headache, warns Dr. Diamond. And drinking hard liquor can give you a double whammy. Chemicals known as congeners as well as impurities in scotch and other hard liquors have the same effect, he says.
This page was first uploaded to The Magnesium Web Site on November 23, 2002