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Sharron's book is now available at Amazon www.amazon.com, Barnes and Noble www.barnesandnoble.com, and wherever books are sold. The book can be purchased in print form or ebook format.

Conari Press, an imprint of Red Wheel/Weiser, LLC  is the publisher of Sharron's book, Migraine: Identify Your Triggers, Break your Dependence on Medication, Take Back Your Life -  An Integrative Self-Care Plan for Wellness," released June, 2013. Follow Sharron on Twitter @murraysharron, and her page Sharron Murray, MS, RN on Facebook, for tips to help you battle your migraines and achieve wellness.

 

Monday
Apr142014

The Hypothalamus, Homeostasis, and Migraine -"Rock steady down the line"  

 

There is no cure for migraine. However, the more we know about our disease, the more we are able to gain control over our attacks and our lives. 

A number of studies have associated migraine with several areas in the brain including the brainstem, the cortex, the thalamus, and most recently the hypothalamus. In this article, to gain more knowledge about the vulnerability of our "migraine brain" and how this sensitivity to change affects the frequency of our attacks, we explore

  • the hypothalamus and homeostasis, and
  • hypothalamic activity and migraine. 

HYPOTHALAMUS AND HOMEOSTASIS   

The hypothalamus is an endocrine gland located deep within the brain above the brainstem. The main function of the hypothalamus is to regulate homeostasis, or our bodies' equilibrium (balance). To maintain homeostasis, the hypothalamus controls and integrates the overlapping functions of our endocrine system and the sympathetic and parasympathetic branches of our autonomic nervous system (ANS). In addition, it is responsive to, and regulated by, transmissions from the neurotransmitters, norepinephrine (noradrenaline), dopamine, and serotonin.

Through these mechanisms, the hypothalamus regulates a number of our bodies' functions including

  • blood pressure and heart rate, 
  • fluid and electrolyte balance, 
  • body temperature, 
  • metabolism, 
  • digestion, 
  • hunger,
  • thirst, 
  • sleep-wake cycles, 
  • alertness, 
  • ovarian and testicular function, 
  • sex drive, 
  • emotions like anger and joy, and 
  • behaviors such as aggression. 

For example, take hunger. When our stomach is empty it releases the hormone ghrelin, which activates parts of the hypothalamus that makes us feel hungry. When we have eaten, the hormone leptin is released by the body's fat stores and causes the hypothalamus to inhibit hunger and create a feeling of fullness.

Another example of how the hypothalamus maintains homeostasis, and one that is critical to our survival, is our bodies' response to a real or perceived threat (stressor). In this instance, the hypothalamus takes charge and through the sympathetic branch of our ANS and the hypothalamic-pituitary-adrenal axis (HPA), tells our adrenal glands to release a flood of hormones including, but not limited to, epinephrine (adrenaline), norepinephrine (noradrenaline), and cortisol. Our heart rate, blood pressure, and respirations increase, our skeletal muscles tighten and get ready for action, and almost all of our other body systems gear up to fight the challenger. We feel focused, energetic, and alert and sleep is inhibited. We know this as the "fight or flight" stress response. When the threat has passed without harm, levels of our stress hormones, and in turn our bodies' systems, return to normal.

HYPOTHALAMIC ACTIVITY AND MIGRAINE

Recent studies and reports (Denuelle et al, 2007, Charles, 2013 and Maniyar et al, 2013) have shown hypothalamic activation with migraine. This hypothalamic activity is thought to be especially important in the premonitory (prodrome) phase of our migraine attacks and could explain many of the symptoms we experience including 

  • changes in mood,
  • alterations in wakefulness and alertness,
  • fatigue
  • food cravings,
  • yawning,
  • fluid retention, and
  • thirst.

Other arguments for hypothalamic involvement include

  • the circadian rhythmicity of the onset of migraine attacks, with a peak incidence in the early morning,
  • the fact that sleep disturbances like insomnia and prolonged sleep are migraine triggers, and,
  • the correlation of hormonal fluctuations with migraine frequency in females  (Denuelle, 2007).

Triggers

Although more research is necessary to determine where, how, and why our migraine attacks are triggered, it has been suggested that the key may lie in the hypothalamus as migraine is commonly activated by a change in homeostasis (Alstadhaug, 2009 and Maniyar et al, 2013). Given the number of body functions the hypothalamus regulates to maintain homeostasis, some examples of migraine triggers that may fall into this category include

  • magnesium deficiency,
  • hormonal fluctuations,
  • dehydration,
  • hunger- dieting, fasting, skipped meals (hypoglycemia),
  • change in sleep patterns (oversleeping, disrupted, inadequate),
  • fatigue (exhaustion) 
  • emotions,
  • fever,
  • allergies, illnesses like flu and colds, 
  • foods and beverages (Many of these can affect neurotransmiters like serotonin and glutamate. Those with additives, dyes, chemicals, MSG, and other artificial ingredients may cause sensitivities and inflammatory or immune reactions), and
  • stress*.

*Stress may contribute to the initial onset of migraine attacks in those of us with a predisposition to the disease. Other potential effects of stress on migraine are thought to include: can act as a trigger for migraine attacks, increase our susceptibility to other triggers; amplify attack duration and severity; increase attack frequency and the risk for progression to chronic migraine; and, as migraine itself can be a stressor, create a vicious cycle. We should know that recent studies have shown "increasing stress resulted in increasing headache days" and "there is a striking association between reduction in stress and the occurrence of migraine headaches".

Stressors

Given the stress response is an adaptive mechanism regulated by the hypothalamus to maintain homeostasis in the face of a real or perceived stressor, we need to take a closer look at stressors. In an in-depth report from the University of Maryland (Seekers, 2013) on the causes, diagnosis, treatment, and prevention of stress, common stressors are listed as: 

  • noise,
  • video games,
  • cell phones,
  • crowding,
  • loneliness,
  • hunger,
  • danger,
  • infection,
  • pain,
  • work pressures,
  • relationship problems, and
  • financial worries.

Health- related problems

The report goes on to say that if these stressors are persistent (chronic), they can wear out the HPA axis and increase our susceptibility to a number of diseases and disorders like heart disease, hypertension, asthma, obesity, diabetes, cancer, erectile dysfunction, decreased libido in women, menstrual irregularities, sleep disturbances, depression, anxiety and panic disorders, allergies, infections, and immune disorders like colds and flu. 

*For those of us with migraine, we need to be aware that some of these health-related problems can make us more susceptible to our migraine triggers. For example:

  • Persistent emotions like worry and fear related to job pressures, or unhappy relationships, can lead to alterations in our sleep patterns, fatigue,
  • Colds and flu can make us susceptible to dehydration and hypoglycemia, and
  • Menstrual irregularities can aggravate hormonal fluctuations and exacerbate our hormonal migraines.

Conditions and factors that may make us more likely to have health-related problems, influence our response to stress and make us at higher risk for stress

Conditions most likely to produce health-related problems are thought to include:

  • persistent stressors that a person cannot easily control such as work pressures and unhappy relationships,
  • persistent stress after an acute traumatic event, and 
  • persistent stress accompanying a serious illness.   

 Factors  that may influence a person's response to stress are thought to include:

  • people who have been abused in childhood - they may have long-term abnormalities in the HPA axis,
  • people who may over-respond to stressful events,
  • genetic factors that effect the relaxation response of stress, and 
  • immune regulated diseases such as rheumatoid arthritis may weaken the response to stress.

 Factors  that may make individuals at higher risk for stress are thought to include:

  • older age as the stress response may become less efficient, and there may be an increase in stressors like medical problems, loneliness with loss of spouse and friends, change in living situations and financial worries,
  • women, in particular working women whether married or single,
  • financial strain, especially with long-term unemployment and if there is no health insurance,
  • people who are targets of racial or sex discrimination, and
  • people who are less educated, divorced, widowed, isolated, lonely, and those who live in cities.   

*For those of us with migraine, additional conditions and factors to consider include 

  • fear of pain associated with a migraine attack,
  • whether one has enough medication to handle the pain,
  • whether insurance will cover the cost of medication,
  • fear of when an attack may occur, for example the first day of a new job or the onset of a vacation,
  • decrease in productivity because of migraines can increase work pressure,
  • loss of jobs because of the frequency of attacks can not only interfere with relationships, but  lead to persistent financial worries, and 
  • comorbid diseases and disorders.

Rock steady down the line

In an editorial, "Stress and migraine"  by Peter J. Goadsby, M.D., PhD, (2014), he says, "There is an emerging consensus that the migraine brain is vulnerable to change, such as sleep and stress, and therefore best kept stable."  In the study, "Reduction in perceived stress as a migraine trigger" (Lipton et al, 2014), the study co-author Dawn Buse, PhD, says "This study highlights the importance of stress management and healthy lifestyle habits for people who live with migraine". 

As I think about these statements, a quote by Dr. Alvin Augustus Jones comes to mind. "In the Soul Train Life, your daily routine is your rhythm for success. Never permit unscheduled events or unorganized passengers to derail your soundtrack. Rock steady down the line and always stay in beat with your heart."  

While researchers continue to define the exact relationship between the hypothalamus, homeostasis, and migraine, to help me understand my migraine brain, I think of it as the "Soul Train Life". Consistency in my daily routine is paramount to a successful wellness plan. Healthy lifestyle habits (e.g., eating and sleeping patterns, exercise) and stress reduction practices (e.g., biofeedback, meditation, guided imagery, and breathing techniques) help me keep "unscheduled events or unorganized passengers" (triggers and stressors) from derailing my soundtrack, or in other words setting off a migraine attack.

I hope, along with the information in this article, this analogy helps you understand more about your migraine brain, decrease the frequency of your migraines, and experience a more full, happy, and healthy life with migraine.   

Rock steady down the line.

References:

Alstadhaug, K. B. (2009). "Migraine and the Hypothalamus". Cephalalgia.29(8): 809-17. doi: 10.1111/j.1468-2982.2008.01814.x http://www.ncbi.nlm.nih.gov/pubmed/19604254

Anderson, P. (2013, July 02): Migraine Really Is a Brain Disorder". Medscape Medical News.   http://www.medscape.com/viewarticle/807274?nlid=31945_1049&src=wnl_edit_dail&uac=206244BX

Charles, A. (2013). Migraine: A Brain State". Current Opinion in Neurology 26(3): 235-239. Retrieved July 5, 2013 from http://www.medscape.com/viewarticle/805027_3  

Chrousos, G. P. (2009). "Stress and Disorders of the Stress Syndrome". Nature Reviews Endocrinology. 5(7): 374-381. Retrieved June 30, 2013 from http://www.medscape.com/viewarticle/704866_print

Denuelle, M., MD., et al (2007). "Hypothalamic Activation in Spontaneous Migraine Attacks". Headache. 47(10):1418-1426. Retrieved April 4, 2014 from http://www.medscape.com/viewarticle/568627_print

Goadsby, P.J. (2014). "Stress and migraine". Editorial. Neurology. Published online before print March 26. as 10.1212/WNL.0000000000000349. http://www.neurology.org/content/82/16/1388.short  

Hypothalamus/Endocrine Awareness Center for Health. "The Hypothalamus Gland". Retrieved August, 2013 from https://eaware.org/hypothalamus-gland/

Lipton,R.L., M.D., Buse, D.C., PhD., et al (2014). "Reduction in percevied stress as a migraine trigger." Neurology. Published online before print March 26. http://www.neurology.org/content/early/2014/03/26/WNL.0000000000000332.short?rss=1

Maniyar, F.H., et al (2013). "Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks". Brain. 137(1):232-241. doi.1093/brain/awt320. First published online before print November 25, 2013. Retrieved April 12, 2014 from http://brain.oxfordjournals.org/content/137/1/232.short?rss=1 

Seekers, J. "Stress". ( 2013, June 26). University of Maryland Medical Center. Retrieved from http://umm.edu/health/medical/reports/articles/stress  

Sharron Murray, MS, RN is a Health and Wellness Author. Her most recent book, "Migraine: Identify Your Triggers, Break Your Dependence On Medication, Take Back Your Life- An Integrative Self-Care Plan For Wellness" (2013), is a Conari Press publication.

Follow Sharron on twitter @murraysharron, her Facebook page: Sharron Murray, MS, RN and her website www.sharronmurray.com. 

This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please consult a qualified health care professional.

Copyright 2014, Sharron E. Murray

 

 

 

Saturday
Mar292014

MIGRAINE: What's Stress "Let-Down" got to do with it? And, did someone say-Stress management? 

 

"It isn't stress that makes us fall - it's how we respond to stressful events." Wayne Goodall 

To begin with, stress does not cause migraine. However, a number of studies have shown stress plays an important role in our migraine attacks, which are the episodic manifestations of our neurological disease. It is thought that stress is a contributing factor in the onset of our attacks, exacerbation and frequency of our attacks, and the progression of our episodic attacks to chronic migraine. As well, the headache associated with our migraine attack itself has been shown to be a stressor.

We need to be aware that a recent study, "Association Between Stress and Headache Frequency" (Schramm et al, 2014), showed, "increasing stress resulted in increasing headache days". The participants in this study experienced tension-type headache, headache in migraine, and headache in migraine with coexisting tension-type headache.

What is Let-Down Migraine?

Some studies have shown a reduction in stress to be responsible for the migraine attack known as a "let-down" or "weekend" migraine. In this instance, we need to know that a new study, "Reduction in perceived stress as a migraine trigger" (Lipton et al, 2014), shows reduction in stress from one day to the next is associated with migraine onset the next day.

In a report released by Albert Einstein College of Medicine (2014), the study lead author, Richard Lipton, M.D. stated, "This study demonstrates a striking association between reduction in perceived stress and the occurrence of migraine headaches." That said, to understand how a decline in perceived stress can trigger our migraine attacks, it is wise to be familiar with the stress response. 

Stress Response

To help me understand the stress response, I prefer to think of it in three phases:

  • Alarm,
  • Response, and
  • Relaxation. 

Let's take a look at each of these phases in a bit more detail.

Alarm phase

When we perceive a threat, environmental, chemical, physical, or emotional, our hypothalamus, an endocrine gland deep within the brain that controls and integrates the overlapping functions of the endocrine and autonomic nervous systems, takes charge.

Response Phase

If the threat does not go away, the sympathetic branch of the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal axis (HPA) are activated and a flood of hormones are released from the adrenal glands to fight the "challenger" (stressor). These hormones include, but are not limited to, epinephrine (adrenaline), norepinephrine (noradrenaline), and cortisol. Our heart rate, blood pressure, respirations, and alertness increase; our senses become sharper; and, glucose and fats are released from storage sites in our bodies to provide energy. The function of our immune systems is enhanced and ant-inflammatory actions are increased to fight infection. As well, an increase in endorphins, our bodies' natural pain relievers, decreases our perception of pain. We know this as the "fight or flight" response, or acute phase, of stress. As long as the threat is perceived as dangerous, levels of these hormones stay elevated and we remain energized and on high alert. 

Relaxation phase

Once the threat has passed without harm, our parasympathetic branch of the (ANS) dampens our stress response and levels of our hormones return to normal. We may find ourselves fatigued, our minds and bodies exhausted. It is in this phase that our complaints show up. For example, if a stressor such as a traumatic injury has caused us pain and the sensation has been diminished, we feel it now.

For those of with migraine, we need to be aware that it is here, over 6 to 24 hours, when acute stress ends, HPA activation declines, and cortisol (glucocorticoid) and other hormone levels fall, a let-down migraine has been shown to occur. In addition, we should know that other factors and triggers may be responsible for an increased probability of a migraine in this phase. These include missed medications, skipped meals, dehydration, or disturbed sleep during the stressful event.

As I reflect on my forties, let-down migraines were the pattern of my life. I would power through a stressful event and the day after experience incredible fatigue, unexplained irritability and a debilitating headache phase accompanied by nausea and vomiting and several other associated symptoms. As the years passed, the stressful events, followed by the migraine attacks, increased. Without effective intervention, I rapidly progressed from episodic to chronic migraine and medication overuse headaches (Imitrex). 

"Hope is beng able to see that there is light despite all of the darkness." -  Desmond Tutu

Stress Management

To appreciate the necessity of stress management in our treatment programs, we need to know that migraine attacks with recurrent episodes of pain, central sensitization, and accompanying hormonal and inflammatory changes may alter our brain structure and function. The more frequent our attacks are, the more we are at risk for these changes.

In the study, "Association Between Stress and Headache Frequency", the authors mention in the conclusion  that their findings are important for tailored anti-stress treatment approaches in headache patients. In the study "Reduction in perceived stress as a migraine trigger", according to a report by Albert Einstein College of Medicine, the study co-author Dawn Buse, Ph.D., stated, "This study highlights the importance of stress management and healthy lifestyle habits for people who live with migraine".

Given this information, it is in our best interest to include stress management strategies in our migraine treatment programs to help reduce stress and decrease the frequency of our attacks. Techniques and therapies that helped me achieve these goals, and that I continue to practice daily to control my stress level and keep it from building up, include: positive thinking, prayer, daily biofeedback exercises, deep breathing techniques, diaphragmatic breathing, guided imagery, meditation, and healing touch (energy healing technique). As well, regular exercise (moderate) and acupuncture sessions are beneficial. Along with these, others that may assist you, include: cognitive behavioral therapy, yoga, tai chi, massage, physical therapy, chiropractic, reflexology and, energy healing techniques like Reiki. 

Although more research is necessary to provide evidence of effectiveness for some of these strategies, many of them have been shown to be effective by

  • relaxing tense muscles in our neck and shoulders,
  • reducing muscle spasm and inflammation and relieving pressure on adjacent nerves,
  • balancing the sympathetic and parasympathetic branches of our ANS and promoting calmness,
  • quieting our mind and calming our bodies,
  • stabilizing our stress hormones and neurotransmitters like serotonin,
  • increasing our endorphin levels,
  • balancing the flow of energy in our bodies,
  • increasing self-awareness, and
  • balancing our emotions.

We need to be be aware that these techniques and therapies have an even better effect when they are practiced at regular intervals over time; combined with trigger management, a healthy diet and lifestyle practices; and, for some people, with a preventive medication. As well, it is great for us to know that after initial instruction, a number of them can be practiced in the comfort of our own homes or offices to protect against increases in stress and keep our attacks at bay. 

Sharron :).

References

Albert Einstein College of Medicine (2014, March 27). "Migraine attacks Increase Following Stress Let-Down". Albert Einstein College of Medicine.

Lipton, R. L., M.D., Buse, D. C., PhD., et al (2014). "Reduction in perceived stress as a migraine trigger". Neurology. Published online before print March 26.

Schramm, S., Lehmann,N., Bock, E., Katsarava, Z., & Moebus, S. (2014). "Association Between Stress and Headache Frequency". Neurology. April 8, vol. 82 no. 10 Supplement S41.007.

Sharron is a health and wellness author. A migraine sufferer herself, her most recent book, "Migraine: Identify Your Triggers, Break Your Dependence on Medication, Take Back your Life-An Integrative Self-Care Plan For Wellness" (2013), is a Conari Press Publication.

Follow Sharron on twitter @murraysharron, her Facebook page: Sharron Murray, M.S., R.N. and her website: www.sharronmurray.com   

This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please consult a qualified health professional.

Copyright March 29th, 2014, Sharron E. Murray

Sunday
Mar162014

EFFECTIVE SUPPLEMENTS FOR MIGRAINE RELIEF

 

In general, our nutritional needs should be met through a healthy diet. However, for many of us with migraine, maintaining a healthy diet that meets our nutritional needs is a challenge. Food and beverage triggers, food cravings, nausea and vomiting, and comorbid diseases with diet restrictions of their own can limit our selection of items and absorption of nutrients.

You might want to ask your doctor for a referral to a nutritionist to help plan your diet and recommend appropriate supplements to avoid nutritional deficiencies if you

  • Find the task of selecting items suitable for your needs overwhelming
  • Have a number of comorbid diseases, and/or
  • Have poor renal or liver function.

That said, many of us seek help for migraine and headache relief through supplements, along with herbs and other complementary therapies, for additional reasons, including 

  • Dissatisfaction with our conventional medical treatment,
  • Unpleasant side effects from medications, and
  • The expense of medications.  

The most common supplements (nutraceutical options) we use to prevent and treat our migraine attacks are

  • Magnesium,*
  • Riboflavin (Vitamin B2),*
  • Coenzyme Q10 (CoQ10),* and
  • Fish oil.  

Keep in mind, while evidence for the effectiveness (efficacy) of some of these supplements is increasing, more research is necessary to establish evidence-based guidelines for others. That said, let's take a closer look at each of them.

Magnesium

Magnesium is a mineral in our bodies that is important for a number of functions, including

  • Protein synthesis,
  • Neuromuscular function,
  • Regulation of nerve cells (calms our nervous system)
  • Regulation of blood sugar
  • Maintenance of vessel tone (keeps our blood vessels from going into spasm), and
  • Regulation of the neurotransmitter, serotonin.

A number of studies have shown that people with migraine have low levels of brain magnesium during attacks. As well, many sources report that we may have lower levels of serum magnesium than others. Additional reasons that may be associated with magnesium deficiency are

  • A diet lacking in magnesium (foods high in magnesium include whole, unprocessed foods such as green, leafy vegetables, nuts, wheat germ, bananas, soy products, milk, and unrefined grains),
  • Alcohol intake as may deplete magnesium from the body,
  • Caffeine intake as may deplete magnesium from the body,
  • Menstruation as levels drop right before onset, and
  • Comorbidities that may also exhibit magnesium deficiency such as mitral valve prolapse, anxiety disorders, and epilepsy.

Symptoms of magnesium deficiency include irritability, agitation, anxiety,confusion, insomnia, restless leg syndrome, muscle spasms, twitching, seizures, weakness, poor coordination, nausea and vomiting, irregular heart rate and rapid heart rate.

Although the most common side effect of magnesium replacement is diarrhea, you should be aware that too much magnesium can lead to toxicity. Symptoms may include hypotension, flushing, slow heart rate, lethargy, drowsiness, respiratory paralysis and death.

As well, you need to know that many medications can interfere with blood levels of magnesium such as diuretics, some antibiotics, calcium channel blockers and other blood pressure medications, chemotherapy drugs, steroids, hormone replacement therapy, and digoxin. In addition, if you have poor renal function you must be careful with magnesium intake as you are unable to excrete excessive amounts via your kidneys. 

Riboflavin (Vitamin B2)

Riboflavin is a water-soluble vitamin that is important for a number of functions in our body, including

  • The breakdown of proteins, fats, and carbohydrates, and
  • Maintenance of the body's energy supply.

It is thought that mitochondrial dysfunction (mitochondria generate the energy for other cells to do their jobs, including those in the brain) and impairment of energy production, may play a role in migraine pathophysiology (Sun-Edelstein and Mauskop, 2011). Some studies have shown that riboflavin, through enhancing mitochondrial function, may help decrease the frequency and severity of migraine attacks. 

Foods high in riboflavin include milk, cheese, eggs, nuts, enriched breads and cereals, whole grains, mushrooms, sweet potatoes, and leafy green vegetables.

Side effects of riboflavin replacement are thought to be minimal. Apart from bright yellow urine, diarrhea may occur.

Coenzyme Q10 (CoQ10)

Coenzyme Q10 is a vitamin-like substance found throughout the body that is thought to

  • Provide energy to cells, and
  • Have antioxidant effects.

Because of its role in mitochondrial function and energy generation, it is believed to work against migraine in much the same way as riboflavin.

Mild side effects of CoQ10 replacement may include loss of appetite, nausea, vomiting, diarrhea, and rash.

Because some sources report that CoQ10 may decrease blood pressure, you should discuss the use of this supplement with your doctor if you are taking

  • High blood pressure (antihypertensives) medications like captopril, diltiazem, and many others.
  • Preventive medications for migraine like beta blockers and calcium channel blockers that may affect your blood pressure.

Because some sources indicate CoQ10 may  increase the risk of bleeding when taken with drugs that increase bleeding, you should discuss this supplement with your doctor if you are taking drugs like advil, ibuprofen, and naproxen. As well, you should discuss this supplement with your doctor if you are taking Coumadin, which is used to slow blood clotting, since CoQ10 may interfere with the effectiveness.

Fish Oil (Omega-3)

Fish oils come from fatty fish. Fatty fish are believed to contain omega-3 (Eicosapentaenoic acid). EPA is thought to

  • Reduce inflammation and swelling,
  • Relax blood vessels, and
  • Inhibit platelet clumping (blood clotting).

Fish richest in EPA are those that inhabit deep, cold water such as tuna, salmon, trout, sardines, herring, and mackeral.

Some studies have suggested that omega-3 may help to decrease the frequency and severity of migraine attacks by affecting prostaglandin levels and serotonin activity.

Because EPA is thought to inhibit platelet clumping, it should not be taken with other blood thinning herbs and medications without your doctors approval. As well, it should be discontinued one-two weeks prior to surgery, or other invasive procedures that may cause bleeding. Please check with your doctor for specific directions.

*You should know that the evidence-based guidelines for NDAIDS and other complementary treatments for episodic migraine prevention in adults have been retired by the AAN Board of Directors on September 16, 2015, due to serious concerns with a preventive treatment butterbur, recommended by this guideline.  Retired guidelines are no longer considered valid and are not supported by the AAN. Retired guidelines remain on their website for reference use only.

Note:

This article is part of the series "Bridging The Gap Between East and West: Principle II: Herbs, Supplements, and Medications For Maintaining and Restoring Optimal Health With Migraine." 

Sharron :).

References:

Murray, S., M.S., R.N. Migraine:Identify Your Triggers, Break Your Dependence on Medication, Take Back Your Life. San Francisco: Conari Presss, 2013.

NIH  National Institute of Health. (2011, October 21). Co-enzyme Q-10: MedlinePlus Supplements. Retrieved March 18, 2014 from http://www.nlm.nih.gov/medlineplus/druginfo/natural/938.html.

Sun-Edelstein, C., M.D., & Mauskop, A., M.D. (2009). "Foods and Supplements in the Management of Migraine Headaches". Clin J Pain. Volume 25, Number 5. pp 446-452. Retrieved from www.clinicalpain.com.

Sun-Edelstein, C., M.D., & Mauskop, A. M.D. (2011). "Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments". Headache. March, 2011. pp 469-483.

Sharron is a health and wellness author. A person with migraine herself, her most recent book is "Migraine (see references)".

Follow Sharron on twitter @murraysharron, her Facebook page: Sharron Murray, MS, RN and her website www.sharronmurray.com.

This article is not intended as a substitute for medical advice. If you have specific concerns about your health or nutrition, please consult a qulaified health professional.

Updated February, 8th, 2016

Copyright 2014, Sharron E. Murray 

Sunday
Mar092014

EFFECTIVE HERBS FOR MIGRAINE RELIEF


"Attack is often a word associated with migraine, and for good reason. If you suffer from headaches or know someone who does, you are well aware of its crippling nature" (Ahn and Goadsby, 2013).

It is this "crippling nature" of the headache phase of the migraine attack, which may or may not respond to medications, or as in my case cause us to take too much medication, that drives several of us to seek out complementary therapies like herbs and supplements. Because many of us use herbs and supplements in combination with medications, we need to be aware of interactions between the three and how to use them safely and effectively. 

Keep in mind, that while studies about the benefits of a number of herbs and supplements for migraine treatment and prevention are increasing, information about herb-supplement-drug interactions is limited. If you are pregnant or breast-feeding, have comorbid diseases or chronic conditions, and/or are taking over-the-counter (OTC) or prescription medications, you should always consult with your doctor before augmenting your migraine treatment program. As well, you need to be aware that any herbs or supplements that affect blood clotting should be discontinued at least one-two weeks prior to surgery or other invasive procedures that may cause bleeding, such as extensive dental work. Please check with your doctor for specific directions. For more information about how to use herbs safely, please see "Herbal supplements: What to know before you buy".

As well, remember that herbs, supplements and medications are only one part of an effective treatment plan for migraine. Many sources indicate that the foundation of any approach to migraine management, holistic or otherwise, should include trigger management, a healthy diet and nutrition, exercise, and healthy lifestyle habits to be successful. Perhaps Dr. Steven Herzog, M.D., member of the American Academy of Neurology (AAN) and medical director of the Headache Insitute at Texas Neurology in Dallas says it best when speaking about the migraine management puzzle. In an article in Neurolgy Now (Shaw, 2012) he is quoted as saying, "Lifestyle modifications such as exercise, good nutrition, and avoiding triggers-along with complementary therapies such as certain vitamins and supplements all have their place."

HERBS

Herbal medicine has been practiced for centuries in numerous cultures throughout the world. Today, there are a number of herbal preparations available OTC as tablets, capsules, gels, sprays, ointments, tinctures, elixirs (essential oils) and teas that are used to prevent and treat migraine attacks. Some of the more common ones, include:

Butterbur (Petasites hybridus)*

  • Thought to have anti-inflammatory properties
  • Believed to have an effect on vessel spasm and blood flow to the brain.
  • Side effects may include headache, indigestion, fatigue, nausea and vomiting, constipation or diarrhea.
  • Should not be used if you have kidney or liver disease, without your doctor's approval (butterbur plant contains pyrrolizidine alkaloids, which are carcinogenic and hepatotoxic so best to use products that are certified and labeled "PA-free").

Feverfew (Tancetum parthenium)*

  • Believed to have anti-inflammatory properties. 
  • Thought to inhibit platelet clumping (blood clotting), influence serotonin levels, and affect vessel tone.
  • Side effects may include abdominal pain, gas, nausea and vomiting, diarrhea, and nervousness.
  • May increase bleeding times so should not be taken with other blood thinning herbs and medications such as aspirin and Coumadin, without your doctor's approval.

Ginkgo Biloba

  • Thought to inhibit platelet clumping and affect blood flow to the brain.
  • May also have ant-inflammatory properties.
  • Side effects may include dizziness, upset stomach, diarrhea, mouth sores, or irritation around the mouth.
  • May affect insulin and blood sugar levels so should not be taken if you are diabetic, without your doctor's approval.
  • Like feverfew, it should not be taken with other blood thinning herbs and medications, without your doctor's approval.

White willow bark (Salix alba)

  • An analgesic with anti-inflammatory properties similar to aspirin.
  • Side effects are similar to aspirin and include stomach upset, ulcers, bleeding, ringing in the ears, and inflammation of the kidney.
  • Should not be taken with other analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs), without your doctor's approval.
  • Should not be taken with other drugs or herbs with blood thinning properties, without your doctor's approval.
  • May make beta blockers and diuretics less effective.
  • May increase blood levels of phenytoin (Dilantin).
  • Should not be taken if you are allergic to aspirin.
  • Should not be given to children as they may develop Reye's syndrome (a disorder that damages the liver and the brain).

Turmeric (Circuma longa)

  • Thought to have anti-inflammatory properties.
  • Thought to inhibit platelet clumping and affect blood flow to the brain.
  • Should not be taken with any other blood thinning herbs and medications without your doctor's approval. 

Ginger (Gan Jiang)

  • Is a calming herb with ant-inflammatory properties like aspirin.
  • May inhibit platelet clumping and affect blood flow to the brain.
  • Thought to help with nausea.
  • Should not be taken with other blood thinning herbs and medications, without your doctor's approval. 

Cayenne (Capsicum frutescens)

  • The main ingredient, capsaicin, is believed to have anti-inflammatory properties that may interfere with sustance P  (a neuropeptide thought to be involved in the pathophysiology of migraine).
  • Thought to affect blood flow to the brain.
  • Should not be taken with other blood thinning  herbs and medications, without your doctor's approval.

 Peppermint (Mentha piperita)

  • Is a calming herb with anti-inflammatory properties.
  • Is also a nasal decongestant and may relieve the sinus congestion associated with migraine.
  • May help with nausea and vomiting.

Lemon balm (Melissa officinalis), Valerian (Valeriana officinalis), and Skull cap (Scutellaria lateriflora)

  • Thought to help with muscle relaxation and sedation.
  • Should not be taken with opioids (narcotic), combination drugs that contain opiods and/or barbiturates, muscle relaxants, or other CNS depressants without your doctor's permission as can increase your risk for respiratory depression, hypotension, coma, and accidental overdose.

*You should know that the "Evidence-based guidelines update: NSAIDs and other complementary treatments for episodic migraine prevention in adults" have been retired by the AAN Board of Directors on September16, 2015, due to safety concerns with a preventive treatment, butterbur, recommended by this guideline. Retired guidelines are considered to be no longer valid and no longer supported by the AAN. Retired guidelines will remain available on their website for reference only. 

Chinese Herbs

Chinese herbs are classified as balancing, cleansing, or regenerating tonics, medicinal herbs, and potent medicinal herbs. Tonic herbs are used to support organ network functioning and prevent imbalances. Medicinal herbs are used to correct organ network imbalances and alleviate illnesses. Potent medicinal herbs are powerful healing agents used by licensed practitioners to treat more serious illnesses.

Herbs that may be used by a licensed practitioner to treat migraine may include chrysanthemum, angelica sinensis (Don Quai), gardenia, skullcap, motherwort, abalone shell, gamber vine, gastrodia, and China root. It is important for you to know that a variety of herbs are often combined into formulas unique to the individual. Therefore, they should not be transferred from one person to another as a combination that does not match your individual diagnosis and symptoms can be harmful. As well, to avoid interactions, your doctor should be aware of all the prescribed herbs you are taking and your practitioner should have a list of your medications.

Sharron:).

Note:

This article is part of the series "Bridging The Gap Between East and West: Priciniple II: Herbs, Supplements, and Medications For Maintaining and Restoring Optimal Health With Migraine". 

References:

Ahn, A.,H., M.D., PhD. & Goadsby, M.D., Ph.D. (2013). "Migraine and Sleep: New Connections." Cerebrum. Nov-Dec; 2013: 15 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997296/ 

Bravo, T.P., & Vargas, B.B. (2015). "Migraine Preventative Has Safety concerns" Neurology Times". January 28th.  http://www.neurologytimes.com/headache-and-migraine/migraine-preventative-butterbur-has-safety-concerns 

Murray, S.,M.S., R.N. Migraine: Identify Your Triggers, Break Your Dependence on Medication, Take Back Your Life. San Francisco: Conari Press, 2013.

Shaw, G. (2012). "Heading Off Migraine: What's the evidence for non-pharmaceutical approaches?" Neurology Now, Volume 8 -Issue3 - p 23-30. doi: 10.1097/01.NNN.0000415690.22156.f6 from http://journals.lww.com/neurologynow/Fulltext/2012/08030/Heading_Off_Migraine__What_s_the_evidence_for.17.aspx

Sharron is a health and wellness author. A person with migraines, her most recent book, "Migraine: Identify Your Triggers, Break Your Dependence on Medication, Take Back Your Life-An integrative Self-Care Plan For Wellness" (2013), is a Conari Press publication.

Follow Sharron on twitter @murraysharron, her Facebook page: Sharron Murray, MS, RN and her website: www.sharronmurray.com.

This article is not intended as a aubstitute for medical advice. If you have specific concerns about your health or nutrition, please see a qualified health care professional.

Updated February 8th, 2016

Copyright 2014, Sharron E. Murray

 

 


 

 

 

 

 

 

Friday
Nov222013

AHA/ACC DIETARY GUIDELINES TO REDUCE CARDIOVASCULAR RISK: APPENDIX FOR PRINCIPLE I -DIET AND NUTRITION FOR OPTIMAL HEALTH WITH MIGRAINE

 

"Let food be thy medicine and medicine be thy food." Hippocrates 

November 12, 2013, the American College of Cardiology/American Task Force on Practice Guidelines published the AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. These guidelines include lifestyle recommendations for diet.

Because recent studies have shown a correlation between migraine, cardiovascular disease, and hypertension, along with an increased risk of stroke, these guidelines are important for us to know. But, before we get to them, let's refresh our knowledge and take a brief look at the definitions of cardiovascular disease and hypertension.

CARDIOVASCULAR DISEASE (CVD)

The American Heart Association (AHA) defines cardiovascular disease as heart and blood vessel disease. Also called heart disease, many of the disorders involved are related to atherosclerosis. Atherosclerosis develops when plaque builds up in our arterial walls. Plaque consists of fat, cholesterol, calcium and other substances found in our blood. Accumulation of plaque is believed to narrow our arteries and make it difficult for blood to flow through. Eventually, an area of plaque can rupture and cause a blood clot to form. If the clot is large enough, it blocks the flow of blood.

Heart Attack

When a clot forms and blocks a blood vessel in the heart, it is called a heart attack. If the clot completely blocks off a vessel, the portion of heart muscle supplied by that artery starts to die. A large amount of damage to the heart muscle can affect the pumping action of the heart. This can lead to heart failure. Without treatment, the bodys' need for oxygen and nutrients may be compromised.   

Stroke

If blood flow to the brain is blocked, an ischemic stroke can occur. In this case, the portion of the brain supplied by the vessel involved will begin to die. A hemorrhagic stroke happens when a blood vessel in the brain breaks (ruptures). According to the National Stoke Association, hypertension is the most important risk factor for stroke.

It is important to know that although brain cells that die from lack of oxygen cannot be replaced, injured brain cells can be repaired with rehabilitation. In this way, functions like speech, memory and motor power can improve.

Hypertension

To understand hypertension, we need to take a brief look at the physiology of blood pressure. Blood pressure is the force of blood pushing against our arterial walls. For a person over 18, an optimal blood pressure is considered to be 120/80 or lower. The top, or systolic, number is a measurement of the force our blood exerts on our arterial walls when our heart pumps. The bottom, or diastolic, number is the force our blood exerts on our arterial walls when it rests between beats.

Hypertension, or high blood pressure (stage one hypertension) is a measurement of 140/90 or higher. High blood pressure makes our hearts work harder to pump blood through our bodies. This can cause our blood vessel walls to thicken and deteriorate. Besides stroke, it can lead to a number of other problems like heart attack, heart failure, and kidney failure.

Relationship between cardiovascular disease, hypertension and migraine

Although more research is necessary, endothelial dysfunction and hypercoagualability, as well as pathological reactivity, have been reported as important findings in people with migraine. We should know that endothelial cells form the inner lining of our blood vessels and provide an anticoagulant barrier between our vessel walls and our blood. In addition, these cells react with physical and chemical stimuli in our circulation and help regulate homeostasis, vasomotor tone, and immune and inflammatory responses. Injury of these cells results in many pathologic states including atherosclerosis, loss of membrane function and clot formation.

Dietary Recommendations to Reduce Cardiovascular Risk

Keeping all of these things in mind, let's take a look at the dietary recommendations to reduce cardiovascular risk. Overall, dietary patterns, rather than individual dietary components, are emphasized as foods are typically consumed in combinations rather than individually. Two dietary patterns, along with their relationship to health outcomes, that have been identified based on expert evidence are the DASH (Dietary approaches to stop hypertension) and Mediterranean (Med)  patterns

That said, let's examine the diet recommendations for lowering low-density lipoprotein (LDL) cholesterol, and the diet recommendations to lower blood pressure.

Diet recommendations for lowering (LDL) cholesterol are:

  • Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats.
  • Adapt this dietary pattern to appropriate calorie requirements, personal and cultural food preferences, and nutrition therapy for other conditions including diabetes mellitus (type 2 diabetes). *For those of us with migraine, we would add migraine disease here.
  • Achieve this pattern by following plans such as the DASH* dietary pattern, the USDA* (US Department of Agriculture)) Food Pattern, or the AHA* (American Heart Association) Diet.

 *The DASH diet is high in vegetables, fruits, low-fat dairy products, whole grains, poultry, fish, and nuts; and low in sweets, sugar-sweetened beverages, and red meats. It is also low in saturated fat, total fat, and cholesterol and rich in potassium, magnesium, calcium, protein, and fiber.

*The USDA diet suggests choosing a variety of foods from the five major groups: grains, vegetables, fruits, protein foods, and dairy products and limiting oils, solid fats, and added sugars.

*The AHA diet suggests an overall healthy dietary pattern that includes a variety of fruits and vegetables, whole-grain products, low-fat dairy products, skinless poultry and fish, nuts and legumes, and nontropical vegetable oils. As well, saturated fat, trans fat, sodium, red meat (the leanest cuts possible), sweets and sugar-sweetened beverages should be limited.

Diet recommendations for lowering BP are the same as those for lowering LDL cholesterol with the addition of lower sodium intake:

  • Choose foods with less sodium and prepare foods with little or no salt.
  • Consume no more than 2,400 mg/day of sodium.
  • Further reduction of sodium intake to 1,500 mg/day is desirable since it is associated with an even greater reduction in BP.
  • If you can't meet these goals at the moment, reducing sodium intake by at least 100 mg/day can lower BP.

*Most of the sodium we consume is in processed foods. Therefore, it seems best to avoid them.

Maintaining a healthy diet is one of the most difficult, but important, things we can do to help decrease the frequency of our migraine attacks and reduce our risk for the development of cardiovascular disease, hypertension, and stroke (if we have a family history of these disorders, our risk is even greater). If you find the task of selecting foods suitable for your needs overwhelming, have a number of comorbid diseases, or have poor renal or liver function, you might want to ask your doctor for a referral to a nutritionist to help plan your diet and recommend appropriate supplements to avoid nutritional deficiencies and further organ damage. 

References:

American Heart Association. (2011)."What is Cardiovascular Disease?" https://www.heart.org/HEARTORG/Caregiver/Resources/WhatisCardiovascularDisease/What-is-Cardiovacular-Disease_UCM_301852_Article.jsp#.VrOTUr 

Eckel, H.,E., et al. (2013, November 12). "2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: a Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation.  http://circ.ahajournals.org/

National Stroke Association. (2013). "High Blood Pressure (Hypertension)". http://www.stroke.org/

Mancia, G., et al (2011). "Hypertension and migraine comorbidity: prevalence and risk of cerebrovascular events: evidence from a large, multicenter, cross-sectional survey in Italy (MIRACLES study)." Journal of Hypertension, Vol 29, No 2. Lippincott Williams & Wilkins. DOI:10.1097/HJH.0b013e3283410404  

Schurks, M., S., et al. (2009). "Migraine and cardiovascular disease: systematic review and meta-analysis."  BMJ. 2009;339:b3914.  http://www.bmj.com/content/339/bmj.b3914.long

Sumpio, B., E., Riley, J.,T., and Dardik A. (2002). " Cells in focus:endothelial cell." Int. J. Biochem Cell Biol. Dec;34(12): 1508-12. http://www.ncbi.nlm.nih.gov/pubmed/12379270 

Sharron is a health and wellness author. A person with migraines herself, her most recent book is "Migraine: Identify Your Triggers, Break Your Dependence On Medication, Take Back Your Life-an integrative self-care plan for wellness: San Francisco: Conari Press, 2013

Follow Sharron on twitter @murraysharron her Facebook page: Sharron Murray MS, RN and her website www.sharronmurray.com 

This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please consult a qualified health care professional.

Updated February 4th, 2016

Copyright 2013, Sharron E. Murray