Migraines are pounding or throbbing headaches that start suddenly, last for hours and usually occur with other symptoms such as nausea. The headaches usually occur between ages 10 and 30, often vanishing after age 50 or, in women, after menopause. More women than men have migraines.

• Throbbing or pounding pain on one side of your head (or both)
• Nausea and vomiting
• Disturbances in your hearing or vision (such as flashes of light) that often start 10 to 30 minutes before the headache
• Parts of your body may feel numb, weak, or tingly
• Light, noise, and movement—especially bending over—make your head hurt worse; you want to lie down in a dark, quiet room
• Your feet and hands feel cold and may look bluish

No one knows for certain what causes migraine. They can run in families. Researchers do know that something triggers blood vessels in the head to tighten and then expand, a process that irritates the nerves surrounding those blood vessels. Things that can trigger migraine include the following.

• Abnormal blood levels of the neurotransmitter serotonin
• Medicines for high blood pressure, angina, and arthritis
• Certain foods and alcohol; missing meals; too much sun; sleeping too little or too much
• Hormones and menstruation
• Certain odors, such as perfume or cigarette smoke
• Stress

Your health care provider will ask questions to help identify the cause of your headaches. He or she will teach you how to use painkillers so the medicine doesn't cause a "rebound headache."

• Avoid known migraine triggers if possible.
• Put an ice pack on your forehead when headache strikes.
• Regular aerobic exercise can reduce the frequency and intensity of migraine episodes.

There is no simple drug of choice for migraines.

• For mild migraines: aspirin (600 to 1,000 mg every four hours), ibuprofen (800 mg followed by 400 mg every 4 hours), naproxen (500 mg), and codeine may be sufficient if taken early in attack.

• For moderate migraines: NSAIDs, ergotamines (particularly ergotamine combined with a medication to reduce nausea), and/or ergotamine suppositories (1/2 up to 2 suppositories per attack) may relieve symptoms.

• For severe migraines: intravenous medications may be given and intranasal lidocaine may also be used.

A combination of drugs for pain relief and complementary therapies to reduce recurrence can offer effective management of migraines. Biofeedback may help to control vascular contraction and stress management may influence the frequency and intensity of attacks.

• Avoid food allergens. Some common allergens are alcohol (especially red wine), cheese, chocolate, citrus, cow's milk, wheat, eggs, coffee, tea, beef, pork, corn, tomato, rye, yeast, shellfish, food additives (preservatives and coloring), and nitrates.
• Avoid caffeine because it is a vasodilator.
• Essential fatty acids (1,500 to 3,000 mg per day) may be helpful. Supplementing with fish oil or flaxseed oil (1 to 3 mg twice a day) may also be helpful.
• Magnesium (500 mg per day) increases muscle relaxation.
• Injection of 1,000 mg of magnesium by a physician can terminate an acute migraine headache within minutes.
• Injection of folic acid (15 mg) in one study achieved total relief of acute headache within one hour in 60 percent of patients.
• Omega-3 oils (EPA and DHA, average dose 14 g daily) greatly reduce intensity and frequency of migraines.
• Vitamin B2 (riboflavin) (400 mg/day for three months) has been shown to reduce migraine frequency by two-thirds.
• Vitamin C (250 to 500 mg twice a day), vitamin E (400 to 600 IU per day), vitamin B6 (100 mg per day), choline (100 to 300 mg per day) and mixed flavonoids (1,000 mg per day).
• 5-hydroxytryptophan (300 mg twice a day) for migraine prevention, enhanced by taking with 25 mg of vitamin B6.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Feverfew (Tanacetum parthenium) can help with both frequency and intensity of migraines. Take two fresh leaves daily, 250 to 300 mg dried herb (capsules) twice a day, or 30 drops of tincture three times per day. Use feverfew by itself.

Use the following herbs in combination: Jamaica dogwood (Piscidia piscipula); skullcap (Scutellaria lateriflora); gingko (Gingko biloba); ginger (Zingiber officinale); meadowsweet (Filipendula ulmaria). Put 1 tsp. of each herb in one cup of water; steep for 10 minutes, and take two to four times a day. For tinctures, use 60 drops of each herb, two to four times a day.

One of the most common reasons people seek homeopathic care is to relieve the pain associated with chronic headaches. Interestingly however, only one out of four studies included in a recent review concluded that individually prescribed homeopathic remedies significantly reduces the frequency, severity, and duration of migraine symptoms. Some of these effective remedies are listed below. Professional homeopaths may also recommend various treatments based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account the individual's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following are some of the remedies found to be effective in the previously mentioned studies:

• Belladonna — for throbbing headaches that come on suddenly; these types of headaches tend to worsen with motion and light, but are partially relieved by pressure, standing, sitting, or leaning backwards
• Bryonia — for headaches with a steady, sharp pain in the forehead that may radiate to the back of the head; these types of headaches worsen with movement and light touch, but improve with firm pressure; this remedy is most appropriate for individuals who are irritable and may also experience nausea, vomiting, and constipation
• Gelsemium — for pain that extends around the head and feels like a tight band of constriction; pain usually originates in the back of the head and may be relieved following urination; this remedy is most appropriate for individuals who feel extremely weak and have difficulty keeping their eyes open�
• Ignatia — for pain that may be described as a feeling of something being driven into the skull; these types of headaches tend to be triggered by emotion, including grief or anxiety, and the treatment is appropriate for both children and adults�
• Iris versicolor — for periodic migraines that begin with blurred vision, especially after eating sweets; pain usually occurs on one side of the head and may be partially relieved by gentle movement and/or fresh air
• Kali bichromicum — for aching and pressing pains on the forehead (particularly between and behind the eyes); may be accompanied by sinus congestion or nausea and vomiting; this remedy is most appropriate for individuals who prefer to lie down in a dark room and who experience relief from warmth and eating�
• Lachesis — for migraines on the left side of the head that are typically worse in the mornings and before menstruation; this type of headache is aggravated by warmth and sunlight and relieved by open air and firm pressure
• Natrum muriaticum — one of the most common remedies used for migraine headaches, particularly those that are described as "hammers beating the head;" pain is relieved when the individual is lying down, alone, in a quiet dark room; these migraines may be associated with either menstruation or a grieving experience and are worse in the middle of the day; this remedy is most appropriate for children who look pale and feel nauseated, nervous, and emotional
• Nux vomica — for headaches that are described as a "nail being driving into the head;" often accompanied by nausea and/or dizziness; this remedy is most appropriate for individuals who are constipated and irritable
• Sanguinaria — for right-sided headaches that begin in the neck and move upwards, recur in a predictable pattern (such as every seven days), and are accompanied by nausea and vomiting; pain is aggravated by motion, light or sun exposure, odors, and noise; this remedy is appropriate for children who may have a craving for spicy or acidic foods, despite having a general aversion to eating due to the headache
• Sepia — for migraines that are accompanied by nausea and are relieved when the individual is lying down; light and movement tend to worsen symptoms; this remedy is most appropriate for individuals who are moody and don't like being alone, but worry about being with others

Homeopaths may also prescribe the following remedies based on their knowledge and clinical experience:

• Pulsatilla — for headaches triggered by eating rich, fatty foods, particularly ice cream; pain tends to move but may be concentrated in the forehead or on one side of the head; may be accompanied by digestive problems or occur around the time of menstruation; children for whom this remedy is appropriate often develop these symptoms while at school�
• Spigelia — for migraines described as a stinging, burning, or throbbing pain, often on the left side of the head; symptoms tend to worsen with exposure to cold weather and with motion, but are temporarily relieved by cold compresses and when the individual is lying on the right side with the head propped up�

An acupuncturist diagnoses headaches not as migraine, tension, or sinus, but rather as conditions deriving from "energetic" imbalances. Headaches are commonly seen and often successfully treated by acupuncturists.

Acupuncture has been studied as a treatment for migraine headache for over 20 years, and the National Institutes of Health, as well as other groups of experts, recommend acupuncture as a treatment for headache. While not all studies have shown benefit with acupuncture, researchers do agree that acupuncture appears to be safe and that headache patients who wish to try this therapy should not be discouraged from doing so. In addition to needling treatment, acupuncturists may recommend lifestyle changes, such as suggestions for specific breathing, qi gong exercise, and dietary modifications.

Two well-designed trials support the effectiveness of spinal manipulation therapy in the treatment of migraine headaches.

In one study including 127 people with migraine headaches, 22% of those who received chiropractic manipulation reported more than a 90% reduction of migraines, 49% reported a significant reduction of the intensity of each episode, and 59% reported a significant reduction in neck pain.

In the second study, 218 individuals with migraine headaches were randomly assigned to receive spinal manipulation, a daily medication (amitryptilene—a drug used to prevent pain in chronic conditions such as migraine headache), or a combination of both. Spinal manipulation was as effective as the medication and had fewer side effects. There was no added benefit to combining the two therapies.

Massage may help release chronic neck and shoulder tension and maintain an even blood flow to the head.

Craniosacral therapy may be helpful.

Call your provider if you suddenly develop new symptoms.

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