Dietary Factors
Avoiding Food Triggers. Avoiding foods that trigger migraine is important in people who are susceptible to these triggers. Keeping a headache diary that includes tracking diet and headache onset can help identify them. [ See Table Foods That May Trigger Migraines.]
Healthy Diet. One study indicates that a diet low in fat and high in complex carbohydrates may significantly reduce the frequency, severity, and duration of migraine headaches. Such a diet is healthy in general in any case.
Eating Regularly. Eating regularly is important to prevent low blood sugar. People with migraines who fast periodically for religious reasons might consider taking preventive medications.
Vitamin B2 Supplements. There is reasonable evidence on the benefits of vitamin B2 for migraine sufferers. In one study, patients who took 400 mg of vitamin B2 (riboflavin) reduced their migraine attacks by half, although the vitamin had no effect on the severity or duration of migraines that did occur. In another study, it helped increase the effectiveness of beta-blockers, drugs used to prevent migraines in some people. Vitamin B2 is generally safe, although some people taking high doses develop diarrhea.
Smelling Pleasurable Foods. One interesting study suggested that smelling certain pleasurable foods may reduce migraine pain. (The study used green apples as part of the experiment; patients with headaches who liked the smell of green apples had less pain. The scent had no effect on those who didn't like the fruit.)
| Foods That May Trigger Migraines |
| Foods and Additives | Responsible Chemical |
| Beers, wines, certain liquors, cheese and cheese-food products, fresh and processed meat, seafood products, peas, pickles, olives, and sauerkraut. | Tyramine and phenylethylamine. (These chemicals tend to become more potent in foods that are stored improperly.)
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| Apple juice, coffee, red wine, and tea.
| Tannin.
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| Preservatives in wines, dried fruits, and other products.
| Sulfites. |
A common seasoning, most notably found in food prepared by Chinese restaurants but also contained in many commercial products. | Monosodium glutamate. |
Sleep Hygiene
Improving sleep habits is important for everyone, and especially those with headaches.
Aerobic Exercise
Exercise is certainly helpful for relieving stress and an analysis of several studies reported that aerobic exercise might help prevent migraines. It is important, however, to warm up gradually before beginning a session, since sudden, vigorous exercise might actually precipitate or aggravate a migraine attack.
Behavioral Treatments
Behavioral techniques that reduce stress and empower the patient may help some people with migraines. These methods generally include the following:
This approach may help counteract the tendency for muscle contraction and uneven blood flow associated with some headaches. They may be particularly beneficial for pregnant and nursing women, who cannot take most medications.
Biofeedback. Studies have demonstrated some effectiveness from biofeedback for migraine headaches. Biofeedback training teaches the patient to monitor and modify physical responses, such as muscle tension, using special instruments for feedback.
Cognitive Behavioral Therapy. Behavioral therapy may be useful alone but is particularly beneficial for patients who are on preventive drug treatments. It typically employs the headache diary to track activities and headaches. The patient then works with the therapist to change or add behaviors or medications that will reduce the frequency and severity of attacks.
Alternative Treatments
Non-Drug Therapies. Alternative non-drug therapies used for headache management include hypnosis, meditation, visualization and guided imagery, acupuncture, acupressure, yoga, and other relaxation exercises. There is no clear evidence that any of these techniques have specific value for migraines. Some studies report the following:
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Relaxation Techniques. Muscle relaxation techniques may be helpful. One interesting 2001 study reported that relaxation treatments appeared to help adolescents with migraine but not tension headaches.
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Electrical Stimulation. Small studies have found that therapy with transcutaneous electrical stimulation (TENS) may reduce migraine headache episodes. The procedure involves a very mild electrical sensation across the skin. One course of TENS takes about a half hour. One report suggests that using TENS with acupuncture points, along with self-hypnosis and relaxation techniques, may be an effective management option among patients with migraine headaches, but long-term and well-conducted studies are needed to confirm this.
Feverfew. There is some clinical evidence that the herbal medicine feverfew helps prevent migraines and even help reduce their severity. It should be noted, however, that, like all effective headache remedies over use can cause a rebound effect. Some experts recommend purchasing feverfew in dried leaf form. It appears to be safe, but side effects can be distressing, particularly canker sores in the mouth (5% to 15% of cases) and stomach distress. This agent should not be taken during pregnancy or in women hoping to become pregnant. People with any blood clotting disorders should not take it. As with most alternative medications, herbal products are not government tested or controlled. Many brands do not have enough of the active ingredient to be effective. Be sure to let your doctor know if you are taking an herbal preparation to treat your migraines.
Glucosamine. Glucosamine is a natural substance being used with some success for patients with osteoarthritis. Anecdotal reports are suggesting that the use of this agent may prevent migraines. As with other natural remedies, products are not regulated by the FDA. It is being well studied for arthritis, however, and to date has few side effects. Many available brands (e.g., CVS, Walgreens, Wal-Mart) are manufactured with appropriate ingredients.
Coenzyme Q10. Coenzyme Q10 is a natural substance that is important for the transport of electrons. One study reported that patients who took it experienced a significant reduction in migraine headaches after three months.
Magnesium. Studies have reported that some migraine patients, such as women with menstrual migraine, may have a magnesium deficiency. Intravenous magnesium sulfate has been useful for migraine relief in people with low levels of magnesium, although it does not appear to have any benefits for people with normal levels of magnesium. Over-the-counter supplements are of uneven quality and costly, and many magnesium salts are not absorbed well and may cause diarrhea. Studies are underway to determine the most effective magnesium preparation and its benefits, if any, in menstrual migraines.
