Headaches and Migraines - Functional Medicine Approach
Headaches and migraines are a common health problem and can be challenging for the practitioner to treat as most treatment options manage the symptoms rather than finding the cause and managing that aspect. A number of etiological factors such as food sensitivities and allergies, nutritional deficiences or neuroendocrine imbalances can be involved which is another reason why it is so difficult to find the root cause. Unless we aim to find the root cause, we as practitioners may miss the opportunity to effectively find a cure.
Effective management in the form of Functional Medicine has been proven a scientifically accurate approach to healing that focuses on the whole person (not just the disease and symptoms) and emphasizes health promotion. Careful assessment is made of lifestyle factors as they relate to sleep, nutrition, exercise and stress management.
Lets now look at dietary factors: allergies and food senstivities can trigger various types of headaches. There are several studies which link migraine episodes and food. If the patients avoided certain foods their migraines improved. As food is made up of several ingredients, chemicals etc it is difficult to conclude which component of foods cause a migraine. However, it is thought that vasoactive amines such as tyramine and other amines including phenylethylamine and histamine are responsible. Tyramine is found in cheese. Phenylethylamine is found in chocolate. Octopamine in citrus fruits and histamine in red wine, beer and fermented food. Histamine is degraded by the enzyme diamine oxidase in the small bowel. Therefore, a reduced level of activity or lack of this enzyme can trigger a headache when a histamine containing food is consumed. Other foods that cause headaches or migraines are alcohol, caffeine, fasting or skipping meals, cured hams, aspartame (artificial sweeteners) and gluten.
In some patients mitochondrial dysfunction resulting in impaired oxygen metobolism has been implicated in migraine pathogenesis. Coenzyme Q10 is a natural substance and essential in the electron transport chain. Many studies have shown that taking Coenzyme Q10 decreases attack frequency.
Magnesium and Fish Oil
Both magnesium and fish oil have been associated with inhibition of platelet aggregation and inhibition of vasospasm. Magnesium is also thought to stabilise cell membranes and reduce inflammatory eicosonoids. High doses of Magnesium appears to be effective in migraines.
During medical investigation if no other cause can be found for migraines and headaches then the cause may be toxic overload. Chronic and multiple agent overload is more common than single agent or acute toxicity. Proposed mechanisms by which toxicity can cause or contribute to headaches and migraines include interference with digestion, nutrient absorption, cellular transport, oxidative damage, enzyme interference and mimicking of hormones.
The gut connection
Poorly digested foods, by-products of digestion, altered gut bacterial populations caused by exogenous hormones and antibiotics can all interfere with the normal physiology and cause toxicity. Gastrointestinal tract infections, excess in take of alcohol, NSAID use, stress, antibiotics, corticostreoid hormones and chemical contamination of food/household products are some of the factors that can adversely affect the barrier function of the gastrointestinal tract resulting in increased permeability. These changes in permeability can stimulate hypersensitivity responses to food. This can cause non-specific inflammatory activation via the complement system and cytokines and hence increase the toxic load on the liver.
The Liver Connection
One of the primary functions of the liver is toxin management and removal know as detoxification. Repeated exposure to food-bourne toxic chemicals, environmental pollutants, endotoxins produced by bowel bacteria, prescription and other drugs can increase the detoxification burden. This overload leads to an increased production of free radicals and subsequent damage to various body systems. It is mine and many functional medicine practitioners opinion that headache and migraines can be reduced by addressing the body burden of toxins.
Toxic compounds can accumulate and damage various enzyme systems. Common symptoms include fatigue, migraines, poor concentration, nausea, hormonal imbalances and chemical sensitivities. Phase 1 and 2 enzymes need to be in balance for efficient detoxification.
- Elimination Diet with Reintroduction
- Stools test - assess the gut
- Organic Acids Test - assess the liver
- Apply test findings to patient through food and natural supplements.