Migraine is a condition which is still largely under diagnosed and poorly treated. Most patients with headaches are dissatisfied with current treatment options and suffer needlessly. Trupti Gokani MD, is Board Certified in Neurology and is the founder and director of the ZIRA Mind and Body Center. She has spent the last few years working in headache clinics and understanding the complexities of treating the headache prone individual. This background allows a broad understanding of the role medications and non-medication approaches play in headache relief. The success of treating a headache patient is based on the understanding that headache is potentially a manifestation of multiple systems gone awry. Thus healing the system with “cocktails” of medications, supplements, herbs and injections allows patients achieve an optimal state of health. The key is understanding the root cause of pain and identify all underlying causes of pain, rather than just treating the pain alone. Hidden sources of pain such as sub clinical thyroid issues, vitamin deficiencies, gut issues often corrected may help decrease or eliminate the headaches all together. Combining this with Yoga, Chiropractic treatments, Massage, Acupuncture, PT, and /or Cognitive therapy often leads to success.
According to Ayurvedic literature, there exist three energies (doshas) that govern the functions in the body. Traditional medicine looks at the structure of the body. Ayurvedic medicine takes into account the energy behind the physical structure. I will briefly explain the three doshas. We are often governed by one lead dosha along with another that is secondary.

Think of MOVEMENT. An individual with Vata governance tends to be always moving, going, traveling. These individuals enjoy change. In balance, an individual governed by Vata tends to be vivacious, talkative, quick thinking and active, with a small bone structure and thin body. But, with wind blowing through your body, imbalance can occur. Imbalanced Vata can lead to dry skin, cold hands/feet, restless mind, ADHD, neck and body pain, tension headaches, adrenal issues, insomnia, anxiety and/or constipation. Vata headaches tend to be occipital and neck in location, often in a ‘tight band’ configuration.
Think of SHARPNESS and HEAT. Pitta fuels the body’s metabolism. An individual with Pitta governance tends to be very direct, Type A, organized. These individuals are clear and confident. In balance, a Pitta individual is detailed, reliable, a good speaker with a medium build and bone structure. But, if the fire is too high, then imbalance can occur. Imbalanced Pitta can lead to anger, irritability, acid reflux, diarrhea, skin rashes, hormonal issues, and MIGRAINES. These headaches have more light sensitivity and nausea associated with them, along with a temple location.
Think of Stability and Adherence. Kapha gives us the lubrication and structure our system needs to stay grounded. An individual with Kapha governance tends to be calm and grounded with a larger body frame and size. In balance, Kapha individuals are very loyal, deep thinkers, loving and methodical. Imbalanced Kapha can lead to a feeling of slowness, sluggishness, congestion and allergies. Kapha headaches tend to be located in the sinus areas and are associated with congestion. The key is to understand your doshic composition (aka Prakriti) and your current state of imbalance (aka Vikruti). If you are a Pitta individual (Prakriti) undergoing sinus congestion and headaches, it may be that your Kapha system is imbalanced (Vikruti). Kapha pacifying diet, herbs and oil massages may help balance that state.
Most headaches are blamed on the usual culprits: stress, lack of sleep, the weather, or hormonal changes. But for many sufferers, the trigger may be as benign as their bowl of cereal at breakfast. Researchers are finding an increasing number of links between food sensitivities and chronic illness, including headaches.

Hypersensitivity to food can be either allergic or nonallergic. Nonallergic reactions are normally either (i) a response to enzyme deficiencies in the body (such as lactose intolerance) or (ii) an adverse reaction to food components and additives, such as MSG or artificial food colorings. Allergic reactions, in contrast, involve the immune system and affect the body in more complex ways.

Food allergies are antigen-antibody responses in the body’s immune system that lead to inflammation, and there are two main types: IgE and IgG. The difference between the two is mainly the timing and type of reaction. Allergists typically recognize only one as a classic allergy—the type I immunoglobulin E (IgE), an immediate-response allergy that causes hives, rash, swelling, or difficulty breathing. If you have an allergy of this type, you probably discovered it as a child.

Delayed-response allergies (also called type IV IgG allergies) are harder to pin down because they affect the body on a more subtle level. Though researchers still disagree on the long-term effect of high IgG antibody levels in the system, a growing number believe that like their IgE cousins, they cause inflammation, and a host of related problems, such as headaches. But because the inflammation is delayed (as much as 72 hours or more after exposure to the allergen), and often cumulative, it is sometimes difficult to make a connection between the food and the response.

An important study on migraines and IgG allergies was published last year in the journal Revista Alergia Mexico. Researchers measured the allergen-specific IgG to 108 foods in 56 patients with refractory migraine and compared their findings with a control group without migraine. What they found was significant differences in the number of positive IgG food allergens in the migraine group versus the control group. The good news to come out of this study, however, was that elimination diets proved successful for controlling pain in the successful for controlling pain in the migraine group, without the need for medications. The authors’ recommendation: serum IgG antibody testing to common foods in patients with migraine.

A single ELISA blood test can measure IgG antibodies to roughly 100 different foods, though the most common allergens are dairy, eggs, wheat, and gluten. For those who show a marked IgG response to a particular food, an elimination diet will help determine what effect it may be having on the body. In general, the triggering food is eliminated from the diet for at least 7 days, or up to a month, and then reintroduced.

For those who show a positive response to wheat and/or gluten, a blood test to screen for celiac disease (an autoimmune disorder) is also recommended.

Note from Dr. Gokani:

This testing allows us to have a “bird’s-eye view” into the inner workings of our digestive tract. If, for example, the dairy group leads to an elevated IgG antibody response, we may recommend holding that group to see if there is an improvement of headache or other neurological/non-neurological symptoms. We often add probiotics, digestive enzymes and other gut healing supplements if needed. Sometimes it is not the specific food, but the toxicity in the food group (pesticides, hormone content, preservatives, etc.) that is truly triggering the antibody response. Simple measures such boiling the milk may help digestability when it is reintroduced. Also, making sure you understand your dosha is key. If you are a Vata individual, eating foods that are Vata aggravating would be discouraged (raw foods, cold items, etc). We are familiar with the phrase “You are what you Eat.” I prefer “You are what you Digest.” If you eat healthy foods but do not digest them well, the healthy diet is not serving you well!

Maintaining a healthy digestive system is key to good health, as we now know that the gut plays a far greater role in the body than simply digesting food. It is, among other things, a vast nerve center and home to more than 100 billion neurons that help control digestion, aid the immune system, and trigger stress. Keeping your gut happy should be a priority for many reasons. The intestinal wall is the largest component of the immune system, and the place where pathogens, toxins, and waste are filtered out of the body. If the gut lining becomes hyperpermeable (that is, porous), these invaders often make it into the bloodstream, where they cause inflammation and, sometimes, autoimmune disorders. Leaky gut syndrome, as it is known, can result from medication use, vitamin deficiencies, stress, yeast overgrowth, and environmental toxins.

Eating a healthy diet is your first line of defense against leaky gut, but to further improve the balance of gut flora and calm intestinal inflammation, consider the following three supplements:

Omega 3

Essential fatty acids (EFAs) are necessary for the body to function properly, and they come from a variety of sources. There are two types of EFAs: omega 6 and omega 3. The so-called Western diet is rich in omega 6 oils, which are derived from seeds and grains, such as wheat, corn, and soy. Omega 3 oils are found in green plants and the meat of animals that eat green plants (such as fish that feed on algae or cattle that are wholly grass-fed). It can also be found in walnuts, flaxseed, and olive oil.

Unfortunately, the Western diet lacks a healthy balance between omega 3 and omega 6 oils, and most Americans are lacking vital omega 3. The American Institute for Cancer Research reports that Americans eat an average of 10-15 times more omega 6 fats than omega 3, and that this imbalance can lead to inflammation in the body. It may also be a major reason why heart disease, dementia, cancer, diabetes, and autoimmune disorders are more common here than in many Asian and Mediterranean countries where omega 3 consumption is higher. Most experts consider an ideal ratio of omega 6 to omega 3 to be 4:1.

Balance your consumption of the two oils by avoiding packaged and processed foods heavy in omega 6 oils, choosing wild-caught fish and pastured meats, and taking a quality omega-3 fish oil supplement containing alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoisc acid (DHA), the three most important omega-3 fatty acids. Current recommendations suggest aiming for a combined 500 mg per day of EPA and DHA, the long-chain fatty acids that are harder to come by through diet. Check the label before buying—higher-quality brands of fish oil will meet these targets, but many brands do not.

Probiotics

Healthy gut flora contains a wide array of “good” bacteria, and the role of these bacteria in overall health has been widely studied for the past 20 years. Based on these studies, here’s what we know: probiotics help alleviate intestinal inflammation, strengthen mucosal (gut lining) function, and reduce hypersensitivity in the digestive system–all factors related to improving the body’s immune response and bowel function. A 2005 study in the journal Environmental Health found that Swedish employees given a daily dose of Lactobacillus reuteri took fewer than half of the sick days than did those employees given a placebo. A similar study was recently published in the August issue of Pediatrics. In this study, 300 preschool children were divided into three groups: one group received a daily placebo, one received Lactobacillus, and one received a combination of Lactobacillus and Bifidobacterium, two different strains of helpful bacteria. The group receiving the combined strain of bacteria fared the best, with use-of-antibiotic rates a full 84% lower than the placebo group. Fever, coughing, and nasal congestion duration was also markedly lower in the groups receiving probiotics.

Digestive Enzymes

From the mouth to the large intestine, the body excretes a variety of digestive enzymes, each playing a specific role in the digestive process: proteases break down protein, amylases carbohydrates, and lipases fats. The goal of each is to help the body convert the food you eat into microparticles from which you can absorb vital nutrients. If this finely tuned process is disrupted (e.g., through poor diet, illness, stress, or simply aging), the body falls short of certain enzymes, and the result can be bloating, gas, nausea, or fatigue. Left untreated, chronic conditions such as acid reflux, irritable bowel syndrome (IBS), ulcers, and Crohn’s disease can result.

One of the easiest ways to help your body break down food is to simply eat more slowly. Eating a variety of raw (uncooked) foods also helps. But many people, especially those over 40, find that supplementing with digestive enzymes is needed to ensure proper digestion. There are a variety of enzyme formulas on the market, so if you’re not sure which one is right for you, consider a broad-spectrum supplement. Consult your health care practitioner for advice, and opt for a high-quality brand for best results.

Note from Dr. Gokani:

I have been amazed how powerful the simple addition of a daily probiotics, digestive enzymes with meals and/or omega 3 fatty acids have helped so many of my patients. Many migraneurs who have untreated digestive complaints many years respond beautifully to some of these supplements. We are very dedicated to providing our patients with only medical grade, well-studied supplements that have been backed with USP and GMP certification. My favorite combination of probiotic and digestive enzyme is Ther-Biotic with Similase. I will recommend dosing of each based on dosha imbalance. With our stressful life that many of us lead, remember to take time to chew and eat in a peaceful environment. NEVER eat standing up! Turn off your cell phone and just focus on the environment of your meal. Ayurvedic medicine speaks to mindful eating. Lunch should always be your biggest meal and one should take at least 30 minutes to have lunch. Unfortunately in the US, this is likely one of the most skipped meals!

For some, enjoying a glass of wine is not worth the headache sure to follow. Theories abound on the source of the problem—tannins, histamines, yeast, phenolic flavanoids (leached out of grapeskins during fermentation), tyramine, sulfites (a theory long debunked by research), biogenic amines, and even the natural sugars in wine have all been implicated. And for every study that has found a link with one substance, another has come along to disprove it. Anecdotal evidence from fellow sufferers, however, suggests the following:

Try “Old World” wines—those from countries that have been producing wine the longest, such as Spain, France, and Italy. Production standards are stricter than those in the U.S. and other “New World” countries.Spend a little more on a smaller-vintage wine; mass-produced wines are more likely to contain additives that speed fermentation and maturation.Try taking a nonsedating antihistamine (such as Claritin) an hour before drinking.And, as with all alcohol, snack on low-sugar, higher-fat foods such as nuts or cheese while drinking, and drink plenty of water. This will slow absorption of the alcohol and prevent a spike in blood sugar.

Note from Dr. Gokani:

What can I say? Life just isn’t fair, is it? The rationale for the alcohol-induced headache is likely the vasodilatation triggers a pitta-type migraine. The less vasodilitation, the less likelihood of migraine. I am having some of my patients sip on coconut juice and eat Rose petal jam if they are planning on having a drink to see if it lessens their pitta symptoms. Also, as blood sugars surge with some of the beverages, one may be triggering an adrenal response, which can lead to a drop in glucose and emergence of a migraine. I promise to keep you all posted if any further insight is obtained on preventing these attacks naturally!