Migraines can be debilitating, causing interruptions in work, sleep, and daily activities. Each attack has different causes, severity, and duration. More patients are coming to the emergency department for migraine treatments as a result of episodes lasting up to 72 hours and failure of conventional methods. Providers need to individualize treatment per patient to prevent the occurrence of migraines, address underlying deficiencies or comorbidities, and the patient’s overall current medications. Most importantly, consider the overuse of medications that could potentially worsen migraines or lead to gastrointestinal disorders or ulcers.
We must seek alternative methods to prevent and treat migraine sufferers. Taking vitamins orally or through diet is only as beneficial as what can be absorbed or through patient compliance. But taking a multivitamin may not always be enough, especially in patients with chronic diseases or taking medications that are depleting essential nutrients. IV nutritional therapy allows these nutrients to be immediately available for cells to pick up in the bloodstream.
When first lines of migraine defense, NSAIDs or triptans, no longer provide relief, IV magnesium can promote muscle relaxation, reduce anxiety, and create a rapid disappearance of nausea, vomiting, and photophobia. Patients who experience frequent migraines are usually diagnosed with a magnesium deficiency. Some patients are able to increase their magnesium levels by oral supplementation but for those who are unable, IV magnesium is beneficial.
When infusing IV magnesium, it is critical to monitor for symptoms of hypotension, such as lightheadedness or syncope. Patients with normal blood pressure tolerate magnesium much more than those with low blood pressure or taking a medication that lowers it. If a patient reports excessive heat from the infusion, this is usually a precursor for lightheadedness and hypotension. At this point, the infusion must be discontinued and the patient’s blood pressure monitored until it is back to the patient’s normal range.
Increased homocysteine serum levels, a common amino acid, can trigger migraines. Catalyzation of homocysteine and treatment of hyperhomocysteinemia requires the presence of B-vitamins: B6, B9, and B12 (Shaik & Gan, 2015). The most common causes of hyperhomocysteinemia are B-vitamin deficiencies, hypothyroidism, alcoholism, and certain medications.
With the goal of decreasing the frequency, severity, and/or duration which a patient suffers from a migraine, riboflavin (B2) can be used as a preventative but has a tendency to increase light sensitivity. Riboflavin has many disadvantages; small maximum absorption rate, short half-life, and the therapeutic effect may not be seen for two months or longer. Sodium valproate and vitamin B2 have similar effects on the reduction of migraine attacks, but vitamin B2 has fever complications and fewer adverse effects; therefore, vitamin B2 can be administered to patients who are prohibited from taking sodium valproate or who have adverse side effects when they take it (Rahimdel, Zeinali, Yazdian-anari, Hajizadeh & Arefnia, 2015).
During a migraine, brain energy metabolism is disturbed, however, riboflavin is vital in mitochondrial energy production. This normal production of ATP allows metabolism stability which diminishes and prevents migraines.
Other medications or nutrients can be administered with IV nutritional therapy for treating migraines to help ease the symptoms. Traditional medications such as Zofran or Toradol to help ease nausea, vomiting, and pain can be mixed in. Intravenous fluids should be piggybacked to replace fluids lost from severe nausea and vomiting. The severity of the migraine should be considered as additional medications may not be necessary when administering the nutritional infusion. It is possible that the infusion alone will reside or improve the migraine.
A deficiency of another B-vitamin, niacin (B3), can contribute to migraines. Flushing caused by niacin shunts blood away from the patient’s head which results in a reduction of vascular pain. Niacin can act as a negative feedback mechanism to shunt tryptophan back into the serotonin pathway (Velling, Dodick & Mulr, 2003). Tryptophan is an essential building block for B3 and of serotonin or serotonin deficiency. Low levels of serotonin dilate blood vessels that can initiate a migraine. A vitamin B6 deficiency can impair the conversion of tryptophan to serotonin. Remember, migraines can be triggered by hyperhomocysteinemia, as a result of a vitamin B6 deficiency. The combination of tryptophan, B3, B6, and magnesium has a tremendous impact on relieving migraines. In some situations where the patient feels a sense that the migraine has lessened after vomiting, withholding an antiemetic such as Zofran should be considered since serotonin levels increase after vomiting.
The cause of migraines can be multifactorial or difficult to determine but as medical providers, we have a breadth of knowledge and a wide array of successful treatments. As we know, treatments can be standardized or individualistic but a surge of patients are preferring treatments to be more naturalistic or holistic. Having dozens and dozens of medications to treat many ailments can be frustrating and confusing. Unnecessary side effects from polypharmacy can be eliminated if the right combination of nutrients can be administered in prevention and treatment.
Rahimdel, A., Zeinali, A., Yazdian-anari, P., Hajizadeh, R., & Arefnia, E. (2015, October 19). Effectiveness of Vitamin B2 versus Sodium Valproate in Migraine Prophylaxis: a randomized clinical trial. Retrieved July 19, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623793/
Shaik, M. M., & Gan, H. S. (2015, February 28). Vitamin Supplementation as Possible Prophylactic Treatment against Migraine with Aura and Menstrual Migraine. Retrieved July 19, 2019, from https://www.ncbi.nih.gov/pmc/articles/PMC4359851/
Velling, D.A., Dodick, D.W., & Mulr, J.J. (2003, June). Sustained-Release Niacin for Prevention of Migraine Headache. Retrieved July 19, 2019, from https://www.mayoclinicproceedings.org/article/S0025-6196(11)62470-1/fulltext