Many can sense its impending arrival. Light becomes whiter, more intense. Words on the page disappear behind blind spots and zigzagging lines. It’s the lightning that signals the coming mental maelstrom – the migraine.
Even though only 20% of migraine sufferers experience visual disturbances or aura that can precede a migraine, a full 100% of sufferers will testify to the pounding, lop-sided pain that has the power to shut them down for the day, or sometimes days.
Migraine comes from the Greek, hemikrania, meaning “half a head.” Yet while this severe one-sided headache has been around for thousands of years, the true cause of migraine is still unknown. That’s why doctors prefer the word “triggers” to “causes” when referring to the common stimuli that can launch a migraine episode. Triggers include food, hormonal changes, stress, and sudden weather changes.
Research shows that almost 90% of migraineurs have an older generation relative who suffers from migraine. Thus, some people seem genetically more susceptible to the neurotransmitter disturbances — changing levels of serotonin, endorphin and noradrenaline in the brain – considered responsible for the constriction and dilation of blood vessels that cause the aura and headache phases of migraine. Neurologists also believe the hypothalamus and brain stem have leading roles in defining the symptoms, cyclical nature and pain of migraine.
Determining and then minimizing triggers are typically the first pieces of advice offered by most medical doctors in regards to decreasing the frequency of migraine attacks. But with dozens of potential triggers, pinpointing them in our complex lives isn’t easy. (Besides, how to avoid rapidly falling barometric pressure or ovulation?) As a result, the migraine occurs and the common defence is to pop some pills, seek dark cover, and have Mr. Sandman chase away the brainstorm.
But sleep and medication are reactive and don’t spare migraineurs the pain and lost time. So it’s not surprising that many of the more than three million Canadian migraineurs have turned to all-natural therapies that are more proactive and long-lasting.
Feverfew as Prevention
Feverfew (Tanacetum parthenium) has a long tradition as a leafy cure for migraines. Migraineurs have been chomping on it since the Middle Ages. Though it’s native to Europe, the aromatic, yellow-centred flower with stubby white petals now grows across Ontario and Quebec. Yet this perennial herb seems to know no bounds. Over the past decade — with clinical studies advocating feverfew’s efficacy, and Health Canada recognizing it as a “traditional herbal medicine to help prevent recurring migraine headaches” – feverfew has spread its commercial roots across the country and is now commonplace on drug store shelves.
Unlike abortive prescription medications, feverfew does not relieve migraine pain in mid-attack – it works to prevent it. As a result, daily doses are required. Shopping for commercial feverfew preparations will yield a host of options in the form of capsules, tablets, and extracts. In the fight against migraine, Health Canada allows for a daily dosage of 125 mg of dried feverfew containing a minimum of 0.2% parthenolide. Parthenolide is the active anti-migraine chemical ingredient in feverfew. Unfortunately, several feverfew products contain no parthenolide at all.
The problems with packaged feverfew don’t end there. Last year, a study published in The Canadian Pharmaceutical Journal analyzed parthenolide levels in available feverfew products and concluded “the majority of products deviated significantly from their stated label claim [of parthenolide content].” Only 20% of the products tested contained parthenolide close to (90-111%) the level claimed, while others unleashed 16 times the daily minimum.
This doesn’t mean feverfew is bad – the problems with feverfew products result from manufacturing shortcomings. Health Canada has initiated new regulations that respond to this issue, but full implementation is years away.
Chewing fresh leaves or having feverfew tea are alternative methods of getting the herb into your diet. But then controlling the chemical intake is not much easier and side effects like mouth ulcers and loss of taste can result. In fact, feverfew in any form is not safe for pregnant women. So while feverfew can be beneficial, it’s no panacea. It’s best to consult a doctor or pharmacist before selecting any feverfew product.
Yoga Restores Internal Balance
It took a while, but like feverfew, Yoga has been discovered by North Americans and continues to attract new devotees daily. Yoga’s purpose “is to serve the needs of the individual,” says Kathryn Beet, owner/teacher at YogaSpace in downtown Toronto. Beet sits barefoot on a black mat, her blonde hair tied up behind her head. An assortment of plants frame Beet’s position: some hang from the pipes above while other tall greenery sits in pots to her right and left.
“So the first thing to do is find out why you have a migraine. What tends to be causing the migraine? What tends to be the pattern?” This is key because different triggers (hormones, allergies) require different therapeutic approaches.
There are yoga stretches that are helpful in the beginning or middle of an attack, but Beet is wary of simply rhyming off positions for those seeking instant gratification. She cringes at the so-called sure-fire anti-migraine exercises plastered across the media.
“Yoga is not a thing like this,” says Beet, folding her legs into the familiar ‘lotus,’ or cross-legged, position. “It’s not this external thing. For me to get this, I’m doing this whole internal leveraging.”
Beet describes yoga as a holistic practice that is less interested in “shooting symptoms” and more interested in taking control of your body and putting things back in balance. “On the surface, the way yoga is useful to migraine is that it will relieve the tightness in the back of the neck,” says the forty-something instructor. “But there is also the reality that yoga is not just about muscles and bones. You are working on the organs and the nervous system. You’re working on a deep cellular level.” This makes sense, says Beet, since certain postures activate the thyroid and parathyroid glands. Plus, who knows, targeting the “back of the neck” may be stimulating the brain stem, which contains an anti-pain system.
The light from the window behind Beet traces a golden fringe around her head. “Regular yoga practice is ultimately part of a way of life. And if you maintain that relationship to your body – because that’s what yoga is, a union between mind and body – your chances of getting migraine go down.”
Biofeedback is also built upon the natural union of mind and body. It operates on the premise that humans can influence automatic physiologic functions like blood pressure and heart rate through the power of concentration and wonder of relaxation. But don’t be fooled – it takes more than positive thinking to work. It takes time, training, and often money, to become proficient in the technique. With the aid of experts and machines, migraineurs are taught to read, respond to and control specific internal processes. Managing body temperature, or “thermal control” is the preferred method for controlling migraine. Migraineurs learn to elevate the temperature in their fingers to stave off migraine attacks.
Research published last year in the journal Headache found that biofeedback benefits patients by reducing the frequency, duration and intensity of attacks. The study also concluded that a positive response to biofeedback “is not related to the presence of aura.” This is important because it means biofeedback works despite differences in blood flow experienced by migraineurs with and without visual warning signs.
Some may feel biofeedback has a sixth sense quality, the stuff of Hollywood flicks. But it is one of those rare complementary practices that has been well-studied and proven effective as a prophylactic for migraine. How it works, on the other hand, is not so clear. Skeptics say the placebo effect may be involved.
Whatever the case, biofeedback is not for everyone. Learning the techniques involved is difficult and takes discipline. In that way, despite the machines, its premise is similar to that of yoga: You have control – a disciplined approach to your health involving relaxation, listening to your body and making controlled adjustments, can put your body back in balance.
In a small room at the Ontario Migraine Clinic in Georgetown, Ont., four patients sit quietly. Brendan Cleary, owner and acupuncturist, steps up to a middle-aged man seated in the far-right corner. “I’ll try not to scream,” the patient says dryly, looking askew from behind his glasses. Some giggles and smirks colour the room. Within 10 seconds Cleary inserts six one-inch needles into the man: five in his head and one in his hand. The patient never flinches and continues to read his newspaper. He’s already had several treatments and says he’s been migraine-free for over two weeks.
Like many acupuncturists, Cleary uses a method called Chinese pulse diagnosis to assess each patient. He checks different pulse points on the body to get “a snapshot of health.” But it’s the quality, not tempo in which Cleary is interested. “Quality of pulse tells me where to put the needles.”
Each needle stimulates a particular nerve in order to affect a response in the central nervous system. “There may be a stimulation to release chemicals in the brain to regulate blood pressure or to regulate blood flow in the brain itself,” explains Cleary. Each treatment builds upon the last, slowly improving the nervous system so that it’s faster in adapting to stimuli, like common migraine triggers. The goal is to speed up the adaptation process so much that migraine triggers are no longer bothersome.
Defeating migraine with acupuncture is not rare, but success depends on the practitioner, as well as the patient’s willingness to complete a long and expensive program. Cleary boasts that in a three-year study, 93% of his patients (who completed a full treatment program) didn’t suffer from migraine after the final treatment. A 40-session program (approximately 12 weeks) with Cleary will cost over $2,600. Yet, for many migraineurs who pay thousands annually on prescription drugs, the treatment can look economical.
Cleary admits “about 2% of people can faint” during acupuncture. “It seems to only happen on the first treatment.” But he puts a positive spin on it, saying it denotes a high receptiveness to the needles and ultimately those patients “always do very well.”
Everything about acupuncture seems marvellous and strange: needles, pulse quality, and big price tags. And the open-concept environment at Cleary’s clinic is no exception. Four patients face each other with needles sticking out of their heads. They don’t wince or whine. Their relaxed attitude would make any dentist envious.
The Writer’s Experiences
Until I experienced my first attack in my mid-20s, I never fully appreciated migraine’s debilitating capacity. A neurologist once told me that migraine was “manageable with difficulty.” Of course, any disorder that has the power to knock you off your game for 72 hours with so much throbbing discomfort is something most people want to eliminate, not just manage.
I never fully appreciated its prevalence either. Sitting down for dinner with friends one night, I was amazed that all six of us suffered from migraine. Statistics actually suggest that 50% of migraine sufferers remain undiagnosed.
Today traditional western medicine can’t cure, or even fully explain migraine. As a result, alternative therapies are thriving. My sister takes B2 supplements as part of her migraine prevention regimen. My uncle, who once popped over 100 acetaminophen tablets a week, found peace after visiting an acupuncturist in Waterloo. He’s been migraine-free for five years.
As for me, I haven’t experimented with any of the therapies detailed here – mainly because I only suffer from two to three attacks a year. I’m fairly confident, however, that I’ve identified my main triggers: seasonal weather changes, missed meals, and insidiously creeping stress. And despite the fact that I can no longer touch my toes – or maybe because of my lost flexibility – I just might give yoga a try. Surely seeking extra help makes sense, for I may be able to control my bad eating habits, and stress can be somewhat managed, but there’s not much I can do to change the harsh cycles of mother nature.
Originally printed in Vitality Magazine, September 2004.