Causes of migraines:
- Reduced serotonin levels – when serotonin levels drop, blood vessels become more swollen and inflamed. This can link with a drop in oestrogen levels associated with menstrual migraines.
- Vessel changes– initially vasoconstriction followed by vasodilation and stretching of blood vessels which might activate nociceptors and trigger migraines.
- Increased cerebral blood flow– prior to a migraine it has been suggested there is a large increase in cerebral blood flow however once the migraine has occurred blood flow is normal.
- Sensitisation of the trigemino-cervical nucleus
- Brain stem– certain regions of the brain stem have been shown to be more active during and after migraine even when blood flow is normal, and vessels are normal patency)
- Mutation of dysfunction of certain genes– clearly a complex topic in itself
- Some have described migraine like Chronic Regional Pain Syndrome of the brain with ^ levels of Substance P and CGRP (neuropeptides) and neurogenic inflammation.
- Many starts at puberty, peaks 35-45 years, lowers >60 years.
- Affects 10-14% of the population.
- Increased prevalence in women (5-25% vs 2-10%)
Types of Migraines
Common migraine triggers:
- Example of Food or drinks
- Dairy esp pasteurized, including cheese
- Sugar esp refined
- Artificial preservatives and sweeteners and processed foods
- Chemical additives
- Cured/processed meats
- Aspartame (artificial sweetener)
- Allergies e.g. to food or chemicals
- Dehydration and/or hunger
- Changes in sleep cycle e.g. insufficient sleep or oversleeping (potentially linked with dehydration)
- Physical exertion esp intense exercise
- Hormones e.g. menstrual cycle (pre-menstrual, mid cycle), during pregnancy, menopause, related to use of OCP or HRT
- External stimuli e.g. bright lights, loud noises, strong smells
- Changes in weather, seasons, altitude
Typical Medication (note can have side effects):
- B-blockers e.g. propranolol
- Calcium channel blockers e.g. flunarizine
- Anticonvulsants e.g. topiramate or valproic acid
- Selective serotonin reuptake inhibitors
What does this have to do Vitamin B supplementation?
- Certain gene mutations (MTHFR) can lead to increase production of homocysteine (an amino acid)
- Higher levels associated with migraine sufferers (also associated with heart attack and stroke risk)
- Possibly as it is involved in vasodilation or temporary thrombosis of cerebral blood vessels, others think it is due to oxidative stress.
- Vit B6, B12 and folic acid are involved in breakdown of homocysteine so supplementation can reduce homocysteine levels.
- Note the evidence to support increase homocysteine levels in migraine sufferers is weak, so if Vit B supplementation assists migraine sufferers perhaps it works in other ways not currently well understood.
Vit B12 – What does it do?
- Make red blood cells, nerve, DNA and lots of other functions
- Normal recommended daily intake = 2.4micrograms
- Need to get this from food/supplements (not synthesised by the body)
- Vit B12 deficiency common esp amongst older people as they might not consume enough or absorb enough from their diet v gastric acid production in older age, which is needed to absorb Vit B12)
- Estimated 3% those >50 years
Causes of Vit B12 deficiency:
- Strict vegetarian diet- they need to eat grains fortified with Vit B12 or take supplements
- Weight-loss surgery (it interferes with ability to absorb Vit B12)
- Celiac disease
- Crohn’s disease
- Reflux medications (need gastric acid to absorb Vit B12)
Other symptoms of Vit B12 deficiency:
- Numbness, tingling in hands, legs, feet
- Ataxia, balance problems
- Swollen tongue
- Memory loss, poor cognition
Foods containing Vit B12:
- Other animal foods
- No plant-based foods
- An observational study showed that 42% of patients with chronic migraine were Vit D deficient.
- Note this is just an observational study, it does not mean causation and understand that if Vit D deficiency is common in the population anyway (23% in Australia, 2011-12) then it might not be relevant just yet so watch this space.
- It has been linked with menstrual migraine as it inhibits release of arachidonic acid and conversion to Prostaglandin.
- Some of the theories related to menstrual migraine relate it to prostaglandin release so Vit E supplementation might assist to reduce Prostaglandin levels.
- Typically used for 5 days during menstruation (400IU/daily) and there is some evidence to support its efficacy to reduce migraine attacks- further studies with larger subjects needed.
- It is an antioxidant that has been associated with reduced CRPS levels la neuropeptide found in higher doses in chronic pain states including migraines)
- Not tested in the research to date
- An RCT looked at 52 patients with migraines randomised to either Vit B supplementation (B6, B9, B12) or placebo. They found the Vit B group had a twofold reduction in migraine disability after 6 months (frequency and severity were also reduced). However, they were given 2X recommended daily intake.
- A 2004 study showed Vit B2 supplementation can help prevent migraines- but participants were taking 400mg daily (200x > recommended daily intake) so needs medical discussion.
- Vit supplementation offers alternate options for migraine suffers with fewer side effects.
- More research needed to understand how they work, how well they work in a large population and what is the ideal dose.
Goh Weng Yee
Your Physio Penang
Teh Qi Shun
Your Physio Alam Damai