From The Pain Practitioner, Fall 2015 issue. Join the Academy to receive The Pain Practitioner.
By Trupti Gokani, MD
Migraine is more common than asthma and diabetes combined (1), with 36 million sufferers in the United States. Moderate to severe episodes of pain are often associated with nausea and sensitivities to light, sound, and/or smell. While abortive and preventative medications are available, many seek non-medication approaches such as natural supplements, herbals, and/or homeopathy in hopes of avoiding stronger medications.
As pain practitioners, we must learn integrative approaches so we can advise our patients on the best options for their headache. In my practice, I find the science of Ayurveda, which is 5,000 years old, to be a unique framework that allows me to offer a more systematic, non-pharmaceutical approach to treat pain.
The basic premise of Ayurveda is that each of us comprises five elements of nature—air, space, fire, earth, and water. These elements create our physiological state and dictate how our mind operates. When considering these elements, it is best to think of the quality of each element to help us understand how we may possess them in our physiological constitution. Air types have the quality of air, which may be light, moving and mobile. Some of us have a constitution with more air and space elements at birth, thus creating a mind-body, or dosha, type called Vata dosha. Some have a constitution of fire and water elements, thus creating a Pitta dosha type. Others have more earth and water elements thus creating a Kapha dosha type. Your dosha is your nature at birth, and some are combinations, such as Vata-Pitta or Pitta-Kapha. When we live our lives in balance with our nature, symptoms such as pain will not appear.
Eating for your Dosha Type to Balance Headaches
When addressing migraines, it is important to first evaluate the diet and add in foods and certain spices to balance digestion, which will then balance the mind. In Ayurvedic cooking, foods are often used to ease neurological imbalances among the three doshas and therefore reduce headaches or migraines. Ideally, all Ayurvedic meals should incorporate six tastes: sweet, salty, sour, bitter, astringent, and pungent for good digestion. However, the specific tastes that each person should focus on differ because of what aggravates or pacifies his or her dosha type.
Vata dosha types tend to be built with a smaller frame and have cold, dry skin. They may be restless and are always on the move. When a Vata type has a headache, the pain usually plants itself at the occipital area or base of the skull and throbs. Often, digestive issues such as gas, constipation, and bloating arise with the headache, as well as anxiety and difficulty in focusing. In order to avoid having headaches, Vata patients must avoid light, dry, and crunchy foods, as these can amplify their imbalanced state. Vatas must also try to avoid any cold drinks or frozen foods such as ice cream, and instead drink room temperature or hot drinks and eat warm foods. In general, individuals in the Vata dosha should eat more sweet, salty, and sour foods and limit bitter, astringent, or spicy foods.
While the Vata doshas remind us of wind (cold, dry, and moving), the Pitta doshas resemble fire with their medium build, competitiveness, and tendency to speak directly and to the point. Their headaches form behind the eyes and consist of a sharp, intense pain. In some cases, patients will become nauseous. Therefore, they would have a very different diet to prevent them from experiencing headaches and/or migraines. Overall, those with a Pitta dosha imbalance should avoid hot, sour, and salty foods and acidic beverages because these foods can increase body temperature. They should also steer away from alcohol, coffee, and soda. In terms of the six tastes always incorporated in Ayurvedic meals, Pittas tend to fare better with sweet, astringent, and bitter tastes, while they should try to minimize spicy, sour, and salty tastes. One can only imagine how “fired up” a Pitta can become after a cup or two of coffee!
Finally, the Kapha dosha types, typically compared to earth or water, are generally on the heavier side and are more grounded. Since they tend to have trouble with too much mucus forming in their bodies, they need to be careful to not overindulge in certain food groups. Doing so will create a headache with the pain located in the frontal area of their head. While the pain is generally only mild to moderate, it can often come along with congestion, allergies, and weight gain. To avoid this, Kapha dosha types should not consume cold, heavy foods that lead to the creation of mucus, such as ice cream, as well as other dairy products (especially yogurt, cream, and butter) and tropical fruits high in sugar and carbohydrates such as melon and pineapple. Instead, foods that calm the Kapha dosha include bitter, astringent, spicy, warm, dry, and light foods cooked with as little fat as possible.
Whatever one’s dosha, individuals must always listen to their body. If eating a certain food multiple times causes discomfort or bloating it should be discontinued because it is also likely to throw their dosha type out of balance.
Foods to Avoid
With this eating strategy in mind, it is important to know that there is also a general list of items that all sufferers of migraines should avoid because they can increase the chances of experiencing symptoms. One of these is tyramine, an amino acid that is found in aged and fermented foods, such as aged cheeses, alcohol, processed meats, canned, or pickled foods, citrus fruits, soy products, and even chocolate. Alcohol is especially harmful to migraine sufferers because it expands blood vessels and increases liver toxicity. Once blood vessels expand, headaches occur, usually within an hour of drinking alcohol.
Additionally, ingredients in packaged foods often cause headaches. Food additive such as nitrates, food coloring, or MSG (monosodium glutamate) should be avoided as much as possible because they can cause pain on the front or side of the head that is different from migraine symptoms. Similarly, cold foods such as ice cream lead to “brainfreeze” headaches, the sharp pain in the middle of the forehead that lasts for a few minutes after eating. For some, this can be the start of a migraine that may last up to several hours.
Caffeine can also cause headaches or migraines and should be avoided by patients with chronic headaches to avoid rebound headaches. While caffeine will relieve headache pain for a short time, patients develop a tolerance and withdrawal causes pain starting behind the eyes and moving toward the front of the head. Caffeine can also negatively affect the adrenal glands, interfering with production of a variety of hormones essential to the body’s harmony.
Lastly, dairy products, specifically milk, yogurt, sour cream, and cottage cheese, can cause headaches because of their pro-inflammatory effects. People with allergies to dairy will likely become congested and obtain a pressure headache in their frontal area because of the histamine produced during an allergic reaction.
Supplements to Balance the Brain
With these specific diets in mind, it is also important to note that there are a variety of nutrients that are beneficial to all dosha types. These supplements are well recognized to be helpful for those suffering with headaches.
Omega-3 Fatty Acids. The rationale for the use of omega-3 fatty acids in migraine includes their antiinflammatory properties, vascular relaxation effects, and inhibition of serotonin release from platelets (2). However, results of studies of their effectiveness in reducing headache frequency are mixed.
Magnesium. Deficiencies in magnesium may play an important role in the pathogenesis of migraine headaches by promoting cortical spreading depression, alteration of neurotransmitter release, and hyperaggregation of platelets (3). Studies have shown that oral magnesium may be helpful in migraine prevention (4,5), but doses over 600 mg daily may be needed for a minimum of three to four months to achieve maximum preventative benefits (6).
Vitamin B2. Riboflavin, also known as vitamin B2, is found in small amounts in many foods. It is needed for converting food to energy, and like coenzyme Q10 also works as an antioxidant by mopping up the damaging free radicals. In one study of 55 migraine patients, 59% of the participants who took 400 mg/day of riboflavin for three months experienced at least a 50% reduction in migraine attacks compared with 15% for placebo (7). In another open-label study, the same dose of riboflavin reduced the frequency of attacks and reduced the use of abortive drugs (8).
Niacin. Niacin may have a therapeutic effect on migraine. Although niacin’s mechanisms of action have not been substantiated from controlled clinical trials, this agent may have beneficial effects upon migraine and tension-type headaches. Adequately designed randomized trials are required to determine its clinical implications. (9)
Vitamins B6, B12, and Folic Acid. Some researchers postulate that deficits in mitochondrial energy reserves can cause migraine or an increase in homocysteine levels can lead to migraine attacks. In one study of 52 migraine sufferers, the combination of vitamins B6, B12, and folic acid resulted in fewer attacks and less severe migraines by lowering homocysteine levels. (10)
Coenzyme Q10. Coenzyme Q10 is involved in ATP creation and works as an antioxidant. Studies show that supplementation for several months can reduce the average number of days with migraine (11,12).
Alpha-lipoic Acid. Like riboflavin and coenzyme Q10, alpha-lipoic acid is a mitochondrial cofactor directly involved in energy production, while additionally being a potent antioxidant. One study found that daily use for three months was associated with reduced frequency of migraine and a significant decrease in headache severity and headache days (13).
Petadolex (butterbur). Since 1972, this plant has been used to prevent migraines by acting as an antiinflammatory agent, muscle relaxant, and pain reliever. Not only has it been successful in reducing migraines for adults, but it has been shown to be safe and effective in children as well. (14-16)
Several Ayurvedic herbs are used to balance the minds of all dosha types: Vata, Pitta, and Kapha. Using these herbs allows patients to have a deeper level of treatment:
Ayurvedic Herbs for Balancing the Mind:
|Vata Balancing Herbs
|Pitta Balancing Herbs
|Kapha Balancing Herbs
By combining traditional western approaches of medications and injectables with a systems-based model of Ayurveda, we can offer migraineurs another model to help them understand and treat their head pain condition. Using the concept of the dosha, one can understand how migraine patients have become misaligned and take steps to create a more balanced physiology. Utilizing foods and nutrients, this can be done in conjunction with medications to create an optimal mind and body.
Trupti Gokani, MD, is an award-winning, board-certified neurologist best known for her innovative and integrative approach to treating headache pain. Dr. Gokani is the founder of the North Shore Headache Clinic and the Zira Mind and Body Center in Chicago, Illinois. Dr. Gokani is the author of The Mysterious Mind: How to Use Ancient Wisdom and Modern Science to Heal Your Headaches and Reclaim Your Health, available on Amazon.com
Contributions to the article also made by Nina Leutz.
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