There are several type of headaches. 90% of all headaches are either migraine, tension, or a combination of the two.1 Typical symptoms of migraine headaches include throbbing head pain, sometimes associated with nausea and vomiting, as well as sensitivity to bright lights or loud noises. These symptoms usually last more than four hours, at times upwards of 72 hours.2 The exact cause of migraine pain remains unclear. It is believed that vasodilators released by certain nerve endings many cause nearby blood vessels to become inflamed, increasing nerve-sensitivity to mechanical stimulation, resulting in pain.3 Genetic influences are evident in a majority of patients with family members experiencing migraine headaches.

Effective management of migraines requires a thorough assessment of lifestyle issues related to sleep, nutrition, exercise, psychological stress, and relationship to others. Regularizing meal times, developing an exercise routine, and correcting poor sleep can reduce the frequency of migraine attacks.4 Red wines, dark beers, aged cheese, some nuts, onions, chocolate, aspartame, and processed meats containing nitrates (such as hot dogs and pepperoni) are common offenders.5

Caffeine withdrawal can exacerbate migraines whereas intake during a migraine attack can reduce pain. Oral supplementation with magnesium may be a factor in the prevention of migraines.6 The exact mechanism may have to do with reduction in cerebral cortical neuronal excitability.7 Other dietary supplements that may also be helpful include riboflavin (vitamin B2)8, coenzyme Q 109, and fish oil.10

As with most complex conditions, we address chronic recurrent headaches through a multifaceted approach, emphasizing diet, exercise, lifestyle factors, etc. In most cases, these simple measures prove successful. In the event that further treatment is warranted, we have the ability to employ repeat rounds of intravenous lidocaine or ketamine to help resolve symptoms.

  1. W.F. Stewart, C. Wood, M.L. Reed, J. Roy, R.B. Lipton: AMPP Advisory Group. Cumulative lifetime migraine incidence in women and men. Cephalalgia. 28:1170-11782008
  2. Headache Classification Committee of the International Headache Society: The international classification of headache disorders. 3rd edition (beta version)Cephalalgia. 33 (9):629-680 2013
  3. P. Tfekt-Hansen, H. Le: Calcitonin gene-related peptide in blood: is it increased in the external jugular view during migraine and cluster headache? A review. J Headache Pain. 10:137-142 2009
  4. J. Adams, G. Barbery, C.W. Lui: Complementary and alternative medicine use for headache and migraine: a critical review of the literature. Headache. 53 (3):459-4732013
  5. J.G. Millichap, M.M. Yee: The diet factor in pediatric and adolescent migraine. Ped Neurol. 28:9-15 2003
  6. L. Teigen, C.J. Boes: An evidence-based review of oral magnesium supplementation in the preventive treatment of migraine. Cephalalgia. 2014 Dec 22 (Epub ahead of print
  7. M.D. Boska, K.M. Welch, P.B. Barker, et al.: Contrasts in cortical magnesium, phospholipid, and energy metabolism between migraine syndromes. Neurology.58:1227-1233 2002
  8. C. Boehnke, U. Reuter, U. Flach, S. Schuh-Hofer, K.M. Einhaupl, G. Arnold: High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol. 11:475-477 2004
  9. G.P. Littarru, L. Tiano: Clinical aspects of coenzyme Q10: an update. Curr Opin Clin Nutr Metab Care. 8:641-646 2005
  10. Z. Harel, G. Gascon, S. Riggs, et al.: Supplementation with omega-3 polyunsaturated fatty acids in the management of recurrent migraines in adolescents. J Adolesc Health.31:154-161 2002
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