Nearly everyone has had a headache at some time, but those who suffer from migraines endure something much more intense. It’s an excruciating, and often debilitating experience that can disrupt an entire day. However, research has shown progress in the management of migraines through the use of chiropractic manual therapy and the addition of dietary nutritional supplements.
Migraines are not only a painful inconvenience, they are also a very common neurologic disease. Globally, they are the third most common disease, and the sixth most disabling. In the U.S., approximately one in seven adults reported having severe headaches, or a migraine within the last few months. More than 30 million Americans have one or more migraine episodes per year, and 75% of the headaches are experienced by females.
Headaches also have a direct impact on the U.S. economy. There is absenteeism from the workplace and medical costs, as well as disruptions in social activities and childcare. In addition, young people who are afflicted miss school, sporting activities and club events that are key to their development. With this in mind, the search is on to find a way to lessen morbidity associated with headaches.
Typically, migraine treatment involves acute (abortive) treatment and preventive (prophylactic) therapy. Patients with frequent headaches often require both interventions. Measures directed toward reducing headaches, and headache triggers are also recommended. A variety of pharmacological approaches are typically used including abortive and preventive medications.
However, medications do not always work, and some are cost prohibitive. Moreover, the overuse of abortive medication is considered one of the most important risk factors for the worsening of migraines. Headache caused by medication overuse can occur with any analgesic, including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and aspirin.
Another option for patients with migraines is to employ a trial of non-pharmacologic approaches including addressing known migraine triggers such as poor sleep, fatigue, stress, certain foods, and alcohol, as well as such options as biofeedback, cognitive-behavioral therapy, or other complimentary approaches such as chiropractic care (manual therapy) and nutritional supplementation.
Cleveland University-Kansas City Director of Research, Dr. Mark Pfefer, is a chiropractor who has reviewed different options for those seeking relief from migraines. He has seen results that indicate it may be possible to manage, or co-manage these headaches, by incorporating chiropractic care. Pfefer has seen patients who come to him seeking help with migraines after trying many medications that are sometimes only partially helpful.
“By adding manual therapy and nutritional interventions in addition to drug therapy, some patients have functional improvement with decreased morbidity,” Pfefer said. “In some cases, the need for medication is also reduced.”
Pfefer went on to say that his personal observations align with the research which indicates chiropractic can be effective.
“My clinical experience as a chiropractor matches the published research in that many patients benefit from, sometimes dramatically, the intervention of manual therapy approaches including chiropractic spinal manipulative therapy, soft tissue techniques, and exercise recommendations,” Pfefer said. “Trials of nonpharmacologic management have produced an average reduction in migraines of 40% to 50%, closely paralleling results obtained in trials of preventive drugs. Biofeedback, cognitive-behavioral therapy, and relaxation therapy are frequently effective against migraine headaches.”
Many patients can benefit from an evidence-based, manual therapy approach by a chiropractor. A recent review of evidence-based headache guidelines concluded that chiropractic care, including spinal manipulation, lessens the incidence of migraine and cervicogenic headaches. Researchers recommend that the type, frequency, dosage, and duration of care should be based on guideline recommendations, clinical experience, and individual findings and response to treatment.
Additionally, an earlier study demonstrated that chiropractic spinal manipulation seemed to be as effective as a well-established and efficacious drug treatment (amitriptyline), and on the basis of a benign side effects profile, should be considered a treatment option for patients with frequent migraine headaches.
The use of nutritional supplements may also have a positive impact for those managing painful headache episodes.
“Some patients also respond well to the addition of nutritional supplements such as magnesium, coenzyme Q10, riboflavin, and feverfew,” Pfefer said. “Chiropractors can play a role in providing an evidence-based, manual-therapy approach, while also recommending other non-pharmacologic interventions.”
In reviewing the use of nutritional supplements for reduction of migraine attacks, Pfefer has found that many are safe, are typically not overly expensive, and have few if any side effects. While most can be used without hesitation, it’s important to note that not all supplements are safe for all patients. A health assessment may be needed prior to use, to make certain there are no pre-existing conditions that could be exacerbated.
Recent research demonstrated that oral magnesium reduced incidence of migraine attacks from 22% to 43%. Low magnesium levels in the serum, and low intracellular concentration in various cells and the brain, have been linked to migraine. It is postulated that stress may deplete magnesium, which in turn, potentiates vascular changes associated with migraine. Magnesium supplements should not be used in patients with renal failure.
Riboflavin (Vitamin B2) is an important co-factor for enzymes involved in cellular energy production. It is a safe and inexpensive migraine prophylactic intervention. Some studies have shown a decrease in migraine attacks compared to placebo when taken for a minimum of three months (Recommended dose 400 mg/day).
Coenzyme Q10 is also involved in cellular energy production, and may have some anti-inflammatory properties that are helpful in migraine mitigation. Recently, CoQ10 doses of 100 to 150 mg per day in combination with magnesium, riboflavin, and feverfew were effective in reducing intensity and days with headache, compared with placebo.
Low melatonin levels have been found in serum and urine of patients with migraine, theoretically associated with hypothalamic dysfunction. Melatonin is an endogenous hormone which plays a role in regulation of circadian rhythm. It is thought to have some anti-inflammatory effects against calcitonin gene-related peptide, and other pro-inflammatory mediators implicated in migraine. The overall quality of research using melatonin for migraine is low, and there is some concern related to long-term use.
Ultimately, if there are safe and conservative options available to reduce the frequency and intensity of migraine headaches, they should be considered. By maintaining overall good health and stress management, along with the use of interventions such as chiropractic and nutritional supplements, perhaps the morbidity of migraines can be reduced.