Affecting 15–23% of the UK population, migraine is an episodic and chronic neurological disorder that typically manifests as headache, aura, or both.
Understanding migraine
Migraine is an episodic and chronic neurological disorder, characterised by moderate to severe headache on one side, which may last between 4 to 72 hours and is associated with certain features such as sensitivity to light, sound, movement, temperature and smell (1,2). In severe cases it can be considered a disabling condition and can present with a range of symptoms, usually involving a throbbing or pulsating pain on one side of the head (3).
The World Health Organisation (WHO) identifies several types of migraine, the most common types being migraine with aura, migraine without aura, and migraine aura without headache. In this case the word aura refers to visual disturbances (3), numbness or tingling, feeling dizzy or difficulty speaking (4).
One of the ways that migraine is different to headache is the intensity of pain and incapacity that sufferers experience (3).
If migraine symptoms happen 14 or less days in the month it can be classed as episodic and if symptoms occur 15 or more days a month then it is classified as the chronic form (3).
It is estimated that in the UK there are between 15% and 23% of the adult population (around 10 million) who suffer with migraine (3). Rates of diagnosis are higher in people of working age and it is more commonly diagnosed in women than men (3). It is unclear the level of incidence there is in the child population (3).
How does migraine work?
Migraine is thought to be activated by nerves in the head, causing a spasm of the blood vessels that supply the brain, impairing that blood supply and changing the way in which the central nervous system, including the brain stem, processes inputs such as vision (1). When the blood vessels then subsequently dilate you then get the bounding headache (4). It can also involve one of the cranial nerves, the trigeminal nerve (plus its blood supply), which innervates part of the superficial area of each side of the face and head around the cheek and jaw, causing inflammation of the dura mater, which is thick membrane of connective tissue covering the brain, and in the blood vessels of the head.
Understanding the root
It is currently unclear what causes migraine and why. However, many potential triggers have been identified across the migraine-suffering population, including drinking red wine or coffee, eating chocolate, skipping meals, excessive stimuli such as flashing lights, weather changes, sleep deprivation, and stress (1). It can be exacerbated by normal physical activity (6).
Fluctuating oestrogen levels can also be a potent cause of migraines, where migraines may coincide with the onset or during a menstrual period, and can worsen during perimenopause. These are known as menstrual or hormonal migraines, and if you suffer with them, they can lessen or worsen during pregnancy. Hormone therapy, such as the oral contraceptive pill can also worsen migraine incidents in women and have been associated with stroke in women who have migraines with aura (1). In these cases, it would be worth reassessing contraception options.
There is also a familial link for migraine sufferers meaning that you are more likely to suffer with them if another close family member also suffers from them (1). It is estimated that up to 60% of the reason people experience migraine is because of their genetics (5).
Muscle tension around the neck, back, shoulders and head may contribute to migraine triggers through nerve and blood vessel involvement.
If you suffer with migraine, understanding your triggers can be helpful in the management of them.
Signs and symptoms
While there is still a lot of debate around what causes migraine, signs and symptoms are well documented. For clarity, symptoms are the things that you experience because of the condition, whereas signs are the things that can be determined through clinical investigations.
As mentioned above, the World Health Organisation (WHO) has defined several types of migraine. In general, migraine symptoms include a moderate or severe one-sided headache that can be behind an eye. It can have a pulsating quality about it, and have a duration from several hours up to 2 to 3 days. It may include being sensitive to light, sound and or temperature and can include a feeling of nausea and or vomiting. This is the most common type of migraine.
Some people may also experience an aura (also known as a prodrome) minutes or an hour before the onset of the migraine. Aura can also exist on its own without a migraine occurring. Symptoms of aura include, visual disturbance such as blind spots, seeing coloured spots or lines, flashing lights, zig-zag patterns or temporary loss of sight (7). One out of six migraine sufferers will experience visual disturbance (4).
Other symptoms of aura may include numbness or tingling sensation in part of the body, muscle weakness or feeling dizzy (7).
One in 10 people experiencing migraine will experience a sub-type known as migraine with brainstem aura that usually will be accompanied by at least two of the following symptoms: slurring of speech, vertigo, tinnitus, double vision, unsteadiness when talking, temporary decreased consciousness, pins and needles or numbness affection both arms and or legs (8). People are more likely to experience their first migraine with brainstem aura in adult life. However, if this occurs over the age of 50 further investigation is needed to rule out other causes (8).
Herbal solutions
Feverfew (Tanacetum parthenium)
A cooling, bitter tasting herb that is part of the Asteraceae family, feverfew has long been known as the migraine herb, helping to reduce both severity and frequency, which has been supported through clinical trials (9). The traditional way to take it was to have one leaf between two pieces of bread, as a sandwich. Having a leaf or two a day this way was considered the way to prevent migraines, especially if caught early on, and wrapping the leaf in bread helped to prevent the leaf causing mouth ulcers if chewed on its own (10). The esteemed herbalist Thomas Bartram reports that in particular, feverfew is specifically effective for migraines that are relieved by hot packs (10). This may be due to its vasodilatory action.
Feverfew is also a carminative, diuretic, febrifuge, anti-inflammatory, emmenagogue and anti-spasmodic actions (11) and contains sesquiterpene lactones (including parthenolides), flavonoids, monoterpenes and essential oils (12).
Aside from taking the fresh plant as mentioned above (please ensure you confirm plant ID), a fresh plant tincture of 1 to 2 ml, up to three times a day may be a typical dosage (12).
As its name may suggest, feverfew is also used in fever reduction and to bring inflammation and temperatures down, and can be used in neuralgia, arthritis, vertigo and ear pain (10).
It is important not to use in pregnancy due to its emmenagogic action, and ensure you get professional advice from a medical herbalist if you are taking anticoagulation medication such as warfarin (10).
German chamomile (Matricaria recutita)
Widely regarded as a wonderful herb for migraines and headaches, Chamomile is a great place to start and can be drunk freely as a tea as well as using the fresh herb as a compress. Known as the ‘mother of the gut’, chamomile is also a member of the Asteraceae family and is a relaxing nervine herb that has an anti-inflammatory effect.
Its constituents include volatile oils which have a carminative, anti-inflammatory and antispasmodic action, flavonoids, including apigenin and quercetin, which exert anti-inflammatory effects, and sesquiterpene lactones (12).
Chamomile is considered a very safe herb and it can be drunk daily. If making as a tea use 10 g of fresh herb or two tea bags per cup, ensuring you cover the cup so that you don’t lose too much of the essential oils in the steam. Of a fresh plant tincture, 10 ml (1:2) gives swift relief for headaches (10) and may provide some relief for the constrictive stage of a migraine attack.
Chamomile is considered a very safe herb, though is not suitable for those who have an allergy to members of the Asteraceae family.
Wood betony (Stachys betonica)
Wood betony, found growing in the open woodland and grasslands of Europe and beyond is a member of the mint or Lamiaceae family and is a nervine that has an affinity for conditions of the head, especially pain conditions such as headache and migraine.
Alongside migraine, wood betony can also be helpful for dizziness, loss of memory, sinus congestion (11), vertigo, night terrors and insomnia due to anxiety (10).
It also has an affinity for the liver (11), having a bitter taste (10), which many liver herbs have. These two qualities make it useful in cases of poor digestion due to anxiety, sluggish digestion and a general feeling of ‘liverishness (10).
As much of the nervous system is in the gut, and migraine can be linked to digestive upsets, Wood betony can be a useful addition to mixes both to prevent and deal with attacks.
Wood betony is also a wound herb and can be used topically for bruises and grazes (10).
Dosage can be 2–6 ml daily of a 1:5 tincture (11).
Caution should be adhered to in pregnancy where professional help should be sought (10).
Skullcap (Scutellaria laterifolia)
A member of the Lamiaceae, or mint, family, skullcap is a herb native to North America, that is well known for its effective action on the nervous system. Energetically speaking it has a cooling effect and like its common name alludes to, it’s good for ‘keeping your head on’ (10).
Its constituents include, flavonoid glycosides, diterpenoids and bitter irioids (12), and it is often used in mixes for nervous exhaustion, insomnia, anxiety, muscle tightness, exerting antispasmodic action (12).
As a calming, relaxing nervine, it can be used in a mix to help prevent the constrictive stage of migraine due to its anti-spasmodic action.
Dosage would be around 3–6 ml a day as a fresh plant tincture, or it can be taken as a tea.
Ensure you source your herbs from a reputable source as adulteration has been known for this herb (10) and ensure you do not take more than the given dosage (12).
As ever, always get advice from a professional medical herbalist for an individualised prescription that is tailored to you, especially if you have any other medical conditions, you are pregnant, or you are taking any medication.
Holistic solutions
There are many pieces in the puzzle for helping to manage and possibly overcome the occurrence of migraines and like all things in life, there isn’t a one size fits all answer. While wanting to effectively reduce severity of symptoms during an attack is important, raising your migraine threshold is also considered an important part of effective management. Several important approaches may help you to achieve this.
Finding your particular triggers and making changes in nutrition and lifestyle. Reducing stress if you are able can all contribute to raising your threshold, as may reducing caffeine, chocolate or red wine if you notice a trigger correlation.
Physiotherapy and chiropractic
These therapies may be helpful if there is a neuro-muscular component to your trigger such as tight shoulders and neck muscles, poor posture and other issues such as tooth grinding.
Acupuncture
Working with an acupuncturist for migraines can be helpful across a range of triggers including hormonal. Along with specific points that address migraine, a treatment will include the points of acupuncture that attend to conjunctive aspects of your health to help treat you as a full person not just your condition.
Mindset and brain retraining through pain reprocessing therapy — retaining the way your brain processes the perception of pain and your expectations around experiences that normally result in you experiencing painful episodes can be a beneficial way to increase your migraine threshold. Always seek out a practitioner who is fully trained in pain reprocessing therapy to support this method.
Magnesium supplementation
Magnesium is used by the body in cellular energy changes, enzymatic actions and to maintain the electrical balance across cell membranes. It also affects nerve conduction and muscle relaxation, and it is thought that this may be the reason that magnesium supplementation may improve migraine outcomes (13). When choosing a magnesium supplement also look for a bioavailable form, such as magnesium malate or magnesium citrate and a dose of around 200 mg (14).
Hydration levels
Optimal hydration levels may help reduce occurrence. While most people in daily life are not clinically dehydrated, we often underestimate the amount of water intake needed daily to provide optimal hydration levels. Eight glasses of water a day are considered the optimal amount, which is around 1.5–1.8 litres. It is important to state that tea (even herbal), coffee or juices, squashes or fizzy drinks cannot contribute to this volume, as often they contain ingredients or constituents such as caffeine which may have a diuretic, and therefore overall net dehydrating, effect.
Trigeminal neurostimulation devices
These devices (such as Cefaly) generate electrical micro-pulses to stimulate the nerve endings of the trigeminal nerve. This produces a sedative effect and regular use is thought to help reduce the number of migraine attacks (15).
References
- Beers M H,. Porter R S., Jones T V. Kaplan J L., The Merck Manual of Diagnosis and Therapy: Eighteenth Edition. Merck Research Laboratories; 2006
- Amiri P, Kazeminasab S, Nejadghaderi SA, Mohammadinasab R, Pourfathi H, Araj-Khodaei M, Sullman MJM, Kolahi AA, Safiri S. Migraine: A Review on Its History, Global Epidemiology, Risk Factors, and Comorbidities. Front Neurol. 2022 Feb 23;12:800605. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904749/
- Baldwin G. The State of the Migraine Nation.Who is living with migraine in the UK?: Rapid research review. Migraine Trust. Published January 2020. Accessed September 25 2024. https://migrainetrust.org/wp-content/uploads/2021/08/State-of-the-Migraine-Nation-population-rapid-review.pdf
- NHS. Migraine. NHS. Published September 15, 2022. Accessed September 25, 2024. https://www.nhs.uk/conditions/migraine/
- Migraine Trust. Genetics and Migraine. Accessed September 25, 2024. https://migrainetrust.org/understand-migraine/genetics-and-migraine/
- World Health Organization. Migraine and other headache disorders. Published March 6, 2024. Accessed September 25, 2024. https://www.who.int/news-room/fact-sheets/detail/headache-disorders
- Migraine Trust. Migraine with Aura. Accessed September 25, 2024. https://migrainetrust.org/understand-migraine/types-of-migraine/migraine-with-aura/
- Migraine Trust. Migraine with Brainstem Aura. Accessed September 25, 2024. https://migrainetrust.org/understand-migraine/types-of-migraine/migraine-with-brainstem-aura/
- Mills S. And Bone K., The Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone; 2007
- Hedley C. And Shaw N. Ed. Waddell G. Plant Medicine: A Collection of the teachings of the teachings of herbalists Christopher Hedley & Non Shaw. Aeon: 2023.
- Bartram T. Bartram’s Encyclopaedia of Herbal medicine: The definitive guide to the herbal treatment of diseases. Robinson: 1998.
- Kuhn M A. and Winston D. Herbal Therapy and Supplements: A Scientific & Traditional Approach. Lippincott: 2001.
- Domitrz I, Cegielska J. Magnesium as an Important Factor in the Pathogenesis and Treatment of Migraine-From Theory to Practice. Nutrients. 2022 Mar 5;14(5):1089. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8912646/
- Lamberts: The Practitioner’s Guide to Supplements (2004)
- Cefaly. How does Cefaly work?. Accessed October 4, 2024. https://www.cefaly.co.uk/en/how-it-works
