Vitamin D seems to prevent relapses of multiple sclerosis, according to a large study by Dr. Ascherio and his colleagues at the Harvard School of Public Health. My previous posts mentioned that a high proportion of migraine sufferers have low vitamin D levels and that low vitamin D levels have been associated with Alzheimer’s disease, other dementias, and strokes. This latest study of patients with MS indicates that those with higher levels of vitamin D did better than those with lower, even if the lower level was still within normal range. Studies of vitamin D in other conditions also reported similar findings of progressive benefits with increasing levels. Many laboratories consider a level between 30 and 100 to be normal. However, even in the absence of definitive proof of benefit, it is probably prudent to aim for a level of at least 50. Just taking vitamin D, even at doses of 2,000 to 5,000 units a day does not guarantee a good level because many people do not absorb it well. Ideally, you should have your vitamin D level rechecked after taking vitamin D for a few months.

A study of 13,573 people by a Harvard physician Catherine Beuttner examined the role of nutrition in patients with migraines and severe headaches. Among these participants of the National Health and Nutrition Examination Survey who were 20 years old or older, 22% or 2,880 suffered from migraines or severe headaches. A large variety of factors that could influence headaches were examined, including age, sex, race/ethnicity, education, smoking, alcohol intake, physical activity, health status, body mass index, diabetes, and number of prescription medications used. Sophisticated statistical analysis established that carbohydrate intake as a percentage of energy consumption and caffeine use were associated with higher prevalence of migraine and severe headaches. On the other hand, fiber intake appeared to reduce the prevalence of migraines and severe headaches. Dr. Beuttner also discovered that intake of foods rich in folate (folic acid, or vitamin B9), thiamine (vitamin B1), and vitamin C was also associated with lower prevalence of migraines and severe headaches.

This large study confirms some of the previous reports about the role of carbohydrates and caffeine in the development of headaches. According to one small study, three out of four migraine sufferers have reactive hypoglycemia. Reactive hypoglycemia is a condition that causes blood sugar to drop too low after eating a carbohydrate-rich meal. This drop of sugar seems to trigger headaches. Many migraine sufferers figure this out on their own and reduce their carbohydrate intake, but some fail to make this connection. So, if you suffer from severe headaches try eating small frequent meals that are low in carbs.

Caffeine is a well-known and proven trigger of migraine headaches. Caffeine can sometimes cause headaches directly, but more often headaches occur due to caffeine withdrawal. This is why many people wake up in the morning with a headache – they’ve gone all night without caffeine. Since caffeine is a short-acting drug withdrawal can occur throughout the day leading people to consume more and more caffeine. Eventually the headache become constant with some improvement after each dose of caffeine, whether it is from coffee, soda, strong tea or medications, such as Excedrin, Anacin, Fioricet, and Fiorinal. Getting off caffeine is the only way to stop these headaches. It can be done gradually or “cold turkey”. Your doctor can prescribe medications to make this process less painful because headaches will get worse before they get better. These medications may include triptans (Imitrex, Maxalt, and other), Migralex, or naproxen (Aleve). Botox injections can also help. Many of my patients argue that caffeine is not the cause of their headaches since headaches started long before they were consuming any caffeine. It is true that caffeine does not cause headaches, but if you suffer from migraines and other headaches, caffeine can make them worse. And getting off caffeine may not eliminate all headaches, but will make them much more amenable to treatment.

As far as folic acid and vitamin B1, there have been some studies proving that B vitamins (including B12) can prevent migrianes, but fiber and vitamin C have not been reported to help headaches in the past.

In summary, if you suffer from migraines or severe headaches try to keep your carbohydrate intake low, eliminate caffeine, increase your intake of foods rich in fiber, B vitamins, and vitamin C. You may also want to consider taking a supplement of these vitamins, along with B12, magnesium, CoQ10, and possibly some herbal products mentioned earlier in my blog or on our main site, nyheadache.com.

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Omega-3 and omega-6 fatty acids are needed for our body to produce pain-relieving and pain-enhancing substances. Researchers at the University of North Carolina at Chapel Hill conducted a randomized, single-blinded, parallel-group clinical trial, which was published in the journal Pain, to assess clinical and biochemical effects of changing the dietary intake of omega-3 and omega-6 fatty acids on chronic headaches.

After a 4-week baseline, patients with chronic daily headaches undergoing usual care were randomized to 1 of 2 intensive, food-based 12-week dietary interventions: a high omega-3 plus low omega-6 intervention, or a low omega-6 intervention. Clinical outcomes included the Headache Impact Test, which measures headache-related disability, headache days per month, and headache hours per day. They also measured omega-3 and omega-6 levels in red blood cells. Fifty-six of 67 patients completed the intervention.

The first intervention (increasing omega-3 and lowering omega-6) produced significantly greater improvement in the Headache Impact Test score and the number of headache days per month compared to the second group (lowering omega-6). The first intervention also produced significantly greater reductions in headache hours per day. The authors concluded that dietary intervention increasing omega-3 and reducing omega-6 fatty acids reduced headache pain and improved quality-of-life in chronic headache sufferers.

The omega-3 fatty acids are generally considered good and the omega-6 are considered bad, but it appears that what is more important is the balance between the two types. The known beneficial effects of fish oil include their effect on the heart, brain, peripheral nerves, mood, inflammation, as well as headaches. There is little downside to taking omega-3 supplements, as long as you buy fish oil from a reputable store chain or a well-know brand, which is purified of mercury.

A variety of electrical devices have been tried for the treatment of headaches and have been mentioned in several of my previous blogs. One study showed that passing direct current through the head may help migraines and depression. Another study recently presented at the joint meeting of the International and American Headache Societies showed that passing alternating current, just like done by any TENS (transcutaneous electric nerve stimulation) machine, but using a proprietary device, Fisher Wallace Stimulator, did not provide relief. This study performed by Dr. Tietjen and her colleagues in Ohio was blinded and involved 50 patients. They applied the stimulator for 20 minutes every day for a month with one half receiving stimulation and the other half not. After a month both groups used real stimulation for another month. While this device did not cause any serious side effects, it also did not help. Hopefully, we will soon see results of large studies using direct current stimulation since this method appears to be more promising than alternating current used in TENS devices.

Fish oil supplements may protect the heart in stressful situations, according to a study conducted in Michigan with 67 healthy volunteers. The researchers, led by Jason Carter, looked at the effect of fish oil on body’s stress response. The volunteers were given either nine grams of fish oil pills or nine grams of olive oil as a placebo, over a two-month period. The heart rate, blood pressure and other parameters were measured before and after the study.

After two months, both groups took a math test, which involved adding and subtracting numbers in their head. Their stress response was measured. Those who took fish oil supplements had a milder response to mental stress, including heart rate and sympathetic nervous system activity, which is part of the “fight or flight” response, compared to those who took olive oil instead.

The author concluded that “these results show that fish oil could have a protective effect on cardiovascular function during mental stress, a finding that adds a piece to the puzzle on why taking fish oil helps the heart stay healthy,”

This study supports the evidence that the omega-3 fatty acids have positive health benefits on the nervous and cardiovascular systems.

The author concluded that “In today’s fast-paced society, stress is as certain as death and taxes,” he added. “Moreover, our eating habits have deteriorated. This study reinforces that fish oils may be beneficial for cardiovascular health, particularly when we are exposed to stressful conditions.”

He also suggested “If you don’t do it already, consider taking fish oil supplementation, or better yet, eat natural foods high in omega-3 fatty acids.” Such foods include Alaska salmon, rainbow trout and sardines.

As far as the effect of omega-3 fatty acids on headaches, there is only one small but blinded study of 15 patients that suggests that they might help prevent migraines. Considering that in addition to counteracting the effect of stress, a major migraine trigger, omega-3 fatty acids reduce inflammation (which is one of the underlying processes during a migraine attack), it is very likely that omega-3 fatty acids may help some migraine sufferers.

Most people do not eat enough fish, so it makes sense to supplement your diet with omega-3 fatty acids. It is important to make sure that the brand you take does not contain mercury and other impurities. One of the brands I came across recently, Omax3 was developed by physicians from Yale university. It is pure and concentrated, meaning that you need to take only 2 capsules a day to get 1,500 mg of omega-3s. Most people who do take a supplement often don’t take enough of it. The study mentioned above used 9 grams of fish oil daily, while the headache study used 15 capsules with each containing 300 mg of omega-3s. To get the same amount from Omax3 you’d have to take 6 instead of 15 capsules.

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The manufacturer of Petadolex brand of butterbur sent me an email saying that the FDA conducted an inspection of their manufacturing plant in Germany. However, my concerns about butterbur, which I mentioned in a previous blog post, has not been addressed. Here is my email response to the manufacturer:
“Thank you for this additional information. It is good to see that the FDA conducted a “comprehensive inspection” of the manufacturing facility in Germany. However, my concerns about the safety of Petadolex are not due to possible deficiencies in manufacturing, but are related to the extraction process. As far as I know, this is why German and UK governments still do not allow the sale of Petadolex and this is why I do not recommend Petadolex to my patients. I am also concerned that because Petadolex is fairly expensive, many patients will decide to buy a cheaper brand of butterbur, which can be truly dangerous. Once Petadolex is cleared for sale in Germany I will be happy to resume recommending it to my migraine patients”.

Nausea of migraines responds to an acupressure device, according to two German doctors who presented their findings last week at the International Headache Congress in Boston. I spoke to one of the authors, Dr. Zoltan Medgyessy about his study. The study included 41 patients, whose average age was 47 years. They had been suffering from migraines for on average 26 years and had experienced an average of 33 migraine
days over the previous three months. The average migraine pain intensity was 7 on a scale from 0 to 10; the average intensity of nausea was 6 on a 1-10 scale. Patients were instructed to use the device (Sea Band) instead of taking nausea medication during their next migraine attack and to complete and return a migraine attack diary. After using the acupressure band, 34 (83%) patients noticed a reduction of nausea and 18 (44%) reported a significant improvement in nausea. The average intensity of nausea after therapy was 3. The relief of nausea was reported after an average of 29 minutes. The average duration of the migraine attacks was 22 hours. The Sea Bands were worn on average for 18 hours. Forty patients (98%) reported that they would use Sea Band during migraine attacks again. The authors concluded that the use of an acupressure band can reduce migraine-related nausea. The advantage of this therapy is that it is drug-free and has no risks
or side-effects such as dizziness, fatigue, or restlessness seen with drugs. Its effect is rapid, and it is easy and it is inexpensive to use (in the US, $6 to $10). To prove that this method works beyond just placebo effect we need a blinded trial comparing anti-nausea medication with Sea Bands. I do recommend Sea Bands or a similar device, Psi Band for my migraine patients. A controlled trial in 60 women showed that Sea Bands relieve morning sickness of pregnancy (nausea and vomiting of pregnancy), which suggests that the relief we see in migraine patients is also real and not just due to placebo.

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Leeches are not pleasant to look at, but they have been used for medicinal purposes for hundreds of years. Growing up in the Ukraine in the 1960s I remember (this is hard to forget) seeing big jars with leeches in a corner pharmacy. Patients would bring in a prescription from the doctor for 4 leeches to be applied daily. The leeches would be placed into a small jar and taken home by the patient to treat swelling, high blood pressure and I don’t know what else. Leeches went out of fashion because of the advances in medicine and just because they are just disgusting. They are being used again in the US for removing extra blood around the scars after cosmetic surgery, arthritic pains, shingles, and other conditions.

British writer Emma Parker Bowles was recently in the news writing about how leeches cured her migraines. She decided on this unusual treatment because her headaches were so severe. She says, “the word headache doesn’t even begin to describe them”. She goes on with a vivid description, “Migraines are miserable with bells on – actually, the idea of listening to the sound of a bell with a migraine brings me out in a sweat. When I am suffering with one, I can’t even stand the sound of my sheets rustling. Apart from the intense throbbing, all-encompassing pain in my head, I also feel extremely nauseous and sensitive to light. I feel as if I am a vampire – a small sliver of daylight and POOF: I will spontaneously combust”.

Leeches do not hurt when they are applied because they first release a numbing substance, which along with a blood thinner and other chemicals released by the leech may be responsible for their beneficial effect. They do not have any known serious side effects. Leeches are used once and then destroyed to avoid transmitting diseases, although there is no reason why a person could not reuse them herself or himself. Several companies sell leeches to the public with instructions on how to use them. Although leeches have been used for the treatment of migraines for many years, there have been no good clinical trials or even reports of large series of cases, but someone should definitely undertake this research. Me? I am not sure I am ready.

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In my previous post I mentioned a TENS unit spcifically designed for the treatment of migraine headaches. It was available for a short time on Amazon.com, but no longer is. It is sold at COSTCO stores in Canada and in Europe. Howere, regular TENS units can be tried and they are less expensive.

Food sensitivities have been always suspected to be a trigger for migraine headaches. A group of Turkish neurologists published a study in the journal Headache in which they gave an elimination diet to 21 migraine sufferers who also had irritable bowel syndrome (IBS). The study was double-blind, randomized, controlled, and cross-over, which is the most reliable type of study. Depending on the results of blood tests against 270 potential food triggers each patient was given a diet that eliminated foods they tested positive for. On average, patients were sensitive to 23 items. Compared with baseline levels, elimination diet was associated with significant reductions in migraine attack count, maximum attack duration, maximum attack severity, and number of attacks requiring medication. There was a significant reduction in pain-bloating severity, pain-bloating within the last 10 days, and was a significant improvement in quality of life by the elimination diet as compared with provocation diet.
The authors concluded that food elimination based on IgG antibodies in migraine patients who suffer from concomitant IBS may effectively reduce symptoms of both disorders with a positive impact on the quality of life of patients.
A similar, but much larger double-blind study published in 2011 compared true and sham diets in 167 migraine sufferers. 84 patients received a diet that eliminated trigger foods identified by IgG testing and the other 83 a sham diet and neither the doctor nor the patients knew who received a true elimination diet and who was given a sham diet. After 12 weeks on these diets there was no difference between the true and the sham group, suggesting that IgG testing is not useful.

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