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Migraines are a debilitating neurological condition that affects millions of people worldwide. These headaches are often characterized by intense, throbbing pain and, in more severe cases, accompanied by nausea, vomiting, and sensitivity to light and sound.
According to the Migraine Research Foundation, migraines are the third most prevalent medical condition in the world, affecting an estimated 1 billion individuals globally. In the United States alone, over 39 million individuals suffer from migraines, with women being disproportionately affected and accounting for approximately 85% of migraine cases.
In this article, we will explore the different types of migraines, potential causes and triggers, and a range of possible remedies, including supplements, OTC medications, prescription drugs, and lifestyle modifications based on triggers, to help those who experience these debilitating headaches find some relief. So, let’s dive in.
MOST COMMON TYPES OF MIGRAINES:
While there are many different migraine types, we’ll focus on the three most prevalent forms:
Migraines without aura, migraines with aura, and chronic migraines.
1. Migraine without Aura (Common Migraine):
This is the most common type, affecting about 70-75% of people with migraines.
Symptoms include pulsing or throbbing pain on one side of the head and sensitivity to light and sound, with nausea and vomiting in more severe cases. Before the onset, one may experience things like food cravings, mood changes, and fatigue, followed by the headache phase, in which one may experience moderate to severe pain–either generalized or in a specific area.
2. Migraine with Aura (Classic Migraine):
Migraine with aura is a type of migraine that is characterized by the presence of transient visual, sensory, or other disturbances that occur before or during the headache phase. It typically affects about 25-30% of people with migraines.
These include sensory and visual changes (an "aura") like seeing spots, zigzags, or flashes of light and other symptoms like difficulty speaking, tingling/numbness, and vertigo.
3. Chronic Migraine:
This is considered the most debilitating form of migraine.
These migraines are characterized by the experience of headaches on at least 15 or more days per month for over three months, with at least 8 of those days having other classic migraine features. The transformation from episodic (the occasional) to chronic migraine is often driven by factors such as high baseline migraine attack frequency, acute overuse of medications, obesity, stress, and conditions such as anxiety and depression.
CAUSES & TRIGGERS
Diagnosing the causes of migraine triggers can be highly individualized. Seeking medical help and keeping a detailed diary to identify personal patterns is an excellent place to start. Below is a list of the most common triggers that may precipitate a migraine:
1. Magnesium deficiency:
A study on individuals with migraines found that while all had “normal” total magnesium levels, more than 50% of migraine sufferers had deficient ionized magnesium levels. What does this mean? Most routine lab tests that check for magnesium check the magnesium levels outside the cells, not inside. This is not an accurate measure since most internal cell functions rely heavily on magnesium, and the levels outside the cells only appear low in blood work when the magnesium deficiency is severe.
Magnesium is an essential mineral when it comes to the function of cells, as it helps with mitochondrial function. Additionally, women are more likely to suffer from magnesium deficiency, which may partly explain the increased incidence of migraines in women. Many theories have been proposed about the reason for this, and although more scientific data is needed, possible causes include:
● Use of oral contraceptives: some evidence points to these medications depleting magnesium levels.
● Nutrient deficiencies in general: Women usually have lower caloric requirements which may put them at higher risk of deficiencies.
● Menstruation: During menstruation, the uterus contracts to help expel its lining which can further deplete magnesium levels since it plays a large role in muscle contraction.
2. Stress
Stress is one of the most common triggers, affecting over 70% of people with migraines. Stress can cause tightening of the neck and shoulder muscles, leading to migraine pain.
3. Hormonal Changes
Hormonal fluctuations, especially around menstrual cycles, can trigger migraines in women. The drop in estrogen levels before a period is a common trigger for "menstrual migraines.” This may also be linked to the role magnesium has on uterine contractions.
4. Certain Foods and Drinks
Foods high in tyramine (aged cheeses, cured meats, alcohol), caffeine, and other additives can trigger migraines. Skipping meals or fasting can also be a trigger.
5. Environmental Factors
Changes in weather, bright/flickering lights, strong smells, and computer/screen use can all trigger migraines.
6. Sleep Disruptions
Both too little and too much sleep can be migraine triggers. Irregular sleep patterns, like those experienced by shift workers, can also contribute.
7. Medication Overuse
Taking migraine medications too frequently can lead to "medication overuse headaches".
MAGNESIUM L - THREONATE AS A NATURAL AID
Magnesium threonate is an effective option for alleviating migraines due to its unique properties. This form of magnesium is often used to aid deeper, more restful sleep. It is highly absorbable, making it a good choice for migraine management. Magnesium threonate has been shown to more readily cross the blood-brain barrier, making it an excellent choice for those suffering from migraines. Specifically, it can penetrate the mitochondrial membrane, crucial for its impact on neurological functions. By crossing the blood-brain barrier, magnesium threonate can directly affect the brain, potentially influencing neurotransmitter release and pain signaling pathways. Additionally, it is known for its calming qualities, attributed to its binding with glycine, an amino acid recognized for its relaxing properties, which can help reduce stress-related triggers for migraines.
COMMON PRESCRIPTION MEDICATIONS AND THEIR ROLE IN MIGRAINE MITIGATION
A migraine study published in the journal Neurology, which included self-reported data over a six-year period ended in July 2020, looked at 25 medications from seven drug classes to see which were most helpful for easing migraines. The results, based on the self-reported experiences of over 10 million users, suggest that a class of drugs called triptans is the most helpful option.
Triptans:
Triptans were 5-6 times more helpful than ibuprofen. The most effective triptan, eletriptan, helped 78% of the time. Other triptans like zolmitriptan (Zomig) and sumatriptan (Imitrex) were also highly effective, helping 74% and 72% of the time respectively.
● Almotriptan (Axert)
● Eletriptan (Relpax)
● Frovatriptan (Frova)
● Naratriptan (Amerge)
● Rizatriptan (Maxalt, Maxalt-MLT)
● Sumatriptan (Imitrex, Zecuity)
● Zolmitriptan (Zomig, Zomig Nasal Spray, Zomig Rapimelt ZMT)
Calcitonin Antagonists:
● Uprogepant (Ubrelvy)
Ubrelvy vs. Imitrex for Migraine Treatment: Which One Is Best for You in 2024?
Ergots:
Ergot medications were rated as 3 times more helpful than ibuprofen. Below are the common ergots prescribed.
● Ergotamine (Cafergot)
● Dihydroergotamine Mesylate (Migranal Nasal Spray)
Anti-emetics/Anti-nausea:
Anti-emetics (medications that treat nausea and vomiting) are about 2.5 times more effective than ibuprofen for treating migraine attacks.
● Metoclopramide (Reglan)
● Ondansetron (Zofran)
● Chlorpromazine (Thorazine)
● Prochlorperazine (Compazine)
● Promethazine (Phenargan)
● Trimeto-benzamidehydrochloride (Tigan)
● Ondansetron (Zofran)
● Promthazine
● Prochlorperazine (Compazine)
(OTC) OVER-THE-COUNTER:
The study found that over-the-counter pain relievers like ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) were among the least effective medications for treating acute migraine headaches.
Ibuprofen, the most commonly used medication in the study, was rated as "helpful" by participants only 42% of the time. Acetaminophen was even less effective, helping just 37% of the time.
A combination medication containing aspirin, acetaminophen, and caffeine (Excedrin) was slightly more effective than ibuprofen, helping about half the time. Over-the-counter migraine medications used to address pain include analgesics, NSAIDs, and caffeine, including:
● Naproxen (Aleve, Naprosyn, Anaprox, Anaprox DS)
● Ibuprofen (Advil, Motrin)
● Acetaminophen (Tylenol)
● Aspirin
● Or combinations of these
These findings provide valuable real-world insights into the comparative effectiveness of different migraine treatments, which can help inform decisions for people suffering from acute migraine attacks.
While migraines can be debilitating for many, there is reason for hope. By creating an effective treatment plan that includes a combination of lifestyle modifications, supplementation, and medications, many people can successfully manage their migraines and reclaim their quality of life.
The information in this article is intended for education purposes only. Please consult with your doctor before starting any medications or magnesium supplements. Magnesium supplementation is contraindicated in specific individuals and may not be an option. By working closely with your healthcare provider, experimenting to find the right treatment plan, and making adjustments as needed, you can take an active role in reducing the frequency and severity of your migraine attacks.
References:
https://magazine.medlineplus.gov/article/10-common-migraine-triggers-and-how-to-cope-with-them
https://migrainetrust.org/live-with-migraine/self-management/common-triggers/
https://migrainetrust.org/understand-migraine/types-of-migraine/
https://pubmed.ncbi.nlm.nih.gov/38030397/
https://regionalneurological.com/different-types-of-migraine/
https://www.healthline.com/health/migraine-rare-and-extreme-types-of-migraines
https://www.memorialhermann.org/services/conditions/headache/
https://www.ncbi.nlm.nih.gov/books/NBK507271/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024559/
https://www.ninds.nih.gov/health-information/disorders/migraine
https://www.webmd.com/migraines-headaches/avoiding-migraine-triggers
https://www.webmd.com/migraines-headaches/magnesium-migraine
https://www.webmd.com/migraines-headaches/rare-types-migraine
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