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Twenty-five million Americans are crippled by nausea, intolerance to light and sound, sweating, double vision, numbness and tingling in the face and hands, confused thinking, slurred speech, weakness of the limbs, diarrhea, chills, and excruciating pain that lasts for hours, days, and sometimes even weeks.
Recognize the symptoms? Migraine sufferers have been plagued with this kind of pain, many of them throughout their lifetimes. The personal cost is too high to calculate, but they’re willing to spend $20 billion a year in their desperate search for relief. Most of the pain is borne by women, who comprise 70% of migraine sufferers, at least in part due to hormonal cycling.
Despite the appearance on the market of numerous migraine medications that can be effective, many patients prefer to use a natural approach. Unfortunately, the new pharmaceuticals have overshadowed some old standbys that can be very effective, says neurologist Alexander Mauskop, MD, director of the New York (City) Headache Center.
At less than $1 a dose, natural migraine remedies such as old-fashioned magnesium, riboflavin, and feverfew are far less expensive than Imitrex (currently about $13 a pill) or other migraine pharmaceuticals. "[In addition], natural methods may actually prevent the onset of a migraine attack if taken on a regular basis," he says.
Mauskop is the first to point the finger at health care professionals for not knowing enough about migraines. Defining headaches is a complicated diagnosis, he concedes, but offers 17 symptoms of a migraine, any two or three indicative the headache may indeed be a migraine. He also adds the possibility that a headache may still be migraine even if none of these symptoms occur:
Sometimes headaches that begin as tension, sinus, or cluster headaches may "cross the line," and become migraines, says Mauskop. And there is a relatively new classification of migraines called menstrual migraine, which appear to be hormonally induced, often just prior to menstruation. "Migraine is not a problem of hysterical women as some old-timers would have it. It’s a real disease, and it’s very treatable," he adds. Yet it’s a complex disease that carries individual characteristics in each sufferer, so blanket therapies are rarely effective. And although Imitrex, Zomig, and Maxalt are "very specific and very efficient, they just don’t work for everybody," he says.
Mauskop and many colleagues, remembering the wide, prophylactic use of magnesium and riboflavin and the traditional use of feverfew, advocate a return to the old therapy with a new twist.1-3 "There’s good solid scientific evidence that each of these three substances is effective for some people with migraines," he says. In addition, Mauskop has published several papers on the use of intravenous magnesium to successfully treat acute migraine attacks.4
Estimates from Third National Health and Nutrition Examination Survey (NHANES III) (1988-91) indicate that magnesium intake was lower than the recommended daily allowance of 400 mg per day in members of both sexes in all racial and ethnic groups of adults (except non-Hispanic white males) ages 12-60 years. The most common dietary sources of magnesium are nuts, oats, and legumes. There have been estimates that 15-20% of the population is chronically deficient, and Mauskop’s research shows that many migraine sufferers are magnesium-deficient.
In his own studies, Mauskop found that 42% of women with migraines have low magnesium levels. He speculates that magnesium deficiencies are triggered by stress and alcohol use, both known to deplete magnesium stores. In another study, he found that 87.5% of patients reduced their pain by 50% with 1 g of intravenous magnesium sulfate, while patients receiving placebo received no relief. Other studies have shown that patients receiving 600 mg of magnesium daily for 12 weeks had significant reductions in the numbers and severity of migraine attacks.
Riboflavin (vitamin B2) given at a dosage of 400 mg a day for 12 weeks has been shown to reduce the number of migraine attacks by 67% and their severity by 68% in three months.5 A double-blind, placebo-controlled study validated those results in 1998.6
Riboflavin works well as a prophylactic because of its antispasmodic effects, says Danette Taylor, DO, staff neurologist at the Michigan Head Pain and Neurology Institute in Ann Arbor. "Riboflavin helps keep blood vessels at their proper dilation, since some headaches are caused by too little blood flow and others are caused by too much," says Taylor. She recommends a riboflavin dosage of 400 mg daily and says it works well when combined with an equal dosage of magnesium. Taylor also advocates the use of caffeine as an accelerant when combined with other medications during an acute migraine attack. "As little as a cup of coffee can help relieve the pain."
And finally, feverfew (Tanacetum parthenium), has been used as a folk remedy against migraines and "women’s maladies" for centuries. The Murphy study shows a 24% drop in the frequency of attacks and diminishing symptoms.3
Paul Schulick, a master herbalist in Brattleboro, VT, says chewing on two or three fresh feverfew leaves a day can result in a 50-60% reduction in the occurrence of migraines. The active ingredients in feverfew, known as parthenolides, have been shown in many studies to contain anti-inflammatory properties. This member of the chrysanthemum family also has long been used as an antispasmodic to address menstrual camps and other types of headaches, he says.
A recent study from Yale University suggests that the parthenolides in feverfew target IkappaB kinase protein molecules and stop the protein’s role in the inflammatory process.7 In addition, animal studies suggest the parthenolides in feverfew inhibit prostaglandin, thromboxane, and leukotriene synthesis and also inhibit platelet aggregation and histamine release.
Now Mauskop is making a leap — as yet not based on scientific evidence — that the three substances, when taken together, may have synergistic effects. "At the least, it will save time, so if one of the three therapies is not effective for a patient, she will not spend three months trying it out with no results and then go on to another. It gives them all three at once, and we know in fairly short order if there are good results," says Mauskop.
He recommends 300-400 mg of magnesium, 400 mg of riboflavin, and 100 mg of feverfew for a triple whammy against migraines. The ingredients are inexpensive and readily available in vitamin and health food stores and even in some supermarkets for as little as $20 for a month’s supply of each. He recommends breaking the total dosage in half and taking it twice a day with meals.
Mauskop also recommends assisting patients in identifying triggers and helping them avoid the following: cheese, bacon, nuts, avocados, chocolate, red wine, yeast, spices, hot dogs, corn, fermented products, and caffeinated beverages. Among the most common environmental triggers are: missing a meal, stress, fatigue, bright lights, certain medications, odors, air pollution, changes in the weather, and hormonal changes. Mauskop recommends exercises to strengthen overall health and help relieve stress that can contribute to migraines.
Adrian Fugh-Berman, MD, a women’s natural health specialist at George Washington University in Washington, DC, reviewed literature supporting the use of riboflavin and magnesium in the February 1999 issue of Alternative Therapies in Women’s Health and concluded, "Magnesium may be effective in preventing both menstrual and nonmenstrual migraine. High doses of riboflavin also may be helpful in migraine prophylaxis. Although clinical trial evidence is limited, both nutrients have low toxicity profiles and may be worth trying in patients with migraine."
The use of feverfew was reviewed in Alternative Medicine Alert in April 1999 by Harley Goldberg, DO, coordinator of complementary medicine at The Permanente Medical Group on Oakland, CA. "Evidence from two limited clinical trials suggests that feverfew, taken daily for three to eight months, can be effectively and safely used in migraine prophylaxis." He notes that feverfew is contraindicated in pregnancy and for patients on antithrombotic and antiplatelet agents. There are no data for its use in children.
1. Facchinetti F, et al. Magnesium prophylaxis of menstrual migraine: Effects on intracellular magnesium. Headache 1991; 31:298-301.
2. Peikert A, et al. Prophylaxis of migraine with oral magnesium: Results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia 1996; 16:257-263.
3. Murphy JJ, et al. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet 1988; 2:189-192.
4. Mauskop A, et al. Intravenous magnesium sulphate relieves migraine attacks in patients with low serum ionized magnesium levels: A pilot study. Clin Sci 1995; 89:633-636.
5. Schoenen J, et al. High dose riboflavin as a prophylactic treatment of migraine: Results of an open pilot study. Cehphal-algia 1994; 14:328-329.
6. Schoenen J, et al. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology 1998; 50:466-470.
7. Kwok BH, et al. The anti-inflammatory natural product parthenolide from the medicinal herb feverfew directly binds to and inhibit IkappaB kinase. Chem Biol 2001; 8:759-766.