Shoot down migraines by pulling their triggers

Q: I have lived with chronic migraines since puberty, and they usually come with my cycle. Any ideas on how to manage, endure or reduce them?

A: First, it's good to figure out what triggers them. Some people will do this by keeping a diary and writing down what they were doing and eating before they got the migraine. Knowing your triggers helps you to prevent problems, rather than playing catch-up later.

In your case, it sounds as though menses are a trigger, which is true for many women. Researchers think it might be because estrogen levels drop in the last half of the menstrual cycle, and some women are more sensitive to this decrease than others.

In conventional medicine, there are several ways we approach menstrual migraines. One is to use magnesium — 360 mg per day — from the 15th day of the cycle to the time you get your period. Another is to use a triptan, a prescription medication used to stop migraines, around the time of your cycle when you normally get migraines. A third is to use a birth-control pill with fairly steady levels of estrogen and progesterone in it to prevent the ups and downs of hormones that can trigger a headache.

In addition, if you are getting migraines frequently, some doctors will recommend that you use a preventive medication every day, such as verapamil and propranolol.

However, none of these recommendations, including those below, should be done without seeing your doctor, because there are potential side effects to any supplement or medication.

From a holistic point of view, we will often try the following:

Elimination diet. Some people will notice that foods trigger their migraines. The list of potential culprits is long, but some of the more common ones include milk products, wheat, chocolate, alcohol and eggs.

In addition, many people react to additives in the food, such as MSG or nitrates. One way to figure this out is to go on a very bland diet that eliminates many of the common food triggers and then, after several weeks, add them back one by one.

Remember that some people will not notice a problem with a food until several days after they ate it, or unless they have a large amount of the food. If you want help with this approach, I recommend seeing a holistic provider.

Riboflavin (Vitamin B2). In one small study, 400 mg per day of riboflavin helped people who had more than two migraines per month. It took three months before people saw results.

Coenzyme Q10. This is a fat-soluble, vitamin-like compound that helps your cells make energy. In a small, peer-reviewed study using coenzyme Q10, 100 mg three times per day dropped the number of migraines over three months.

Butterbur root (Petadolex). An extract made from the root of this plant has been beneficial to prevent migraines in two small studies. However, you should use only a standardized product that eliminates chemicals called pyrrolizidine alkaloids. These chemicals may cause cancer.

Dr. Astrid Pujari is a Seattle M.D. with an additional degree as a medical herbalist; she practices at the Pujari Center and teaches as part of the residency programs at Virginia Mason and Swedish/Cherry Hill hospitals. Her column is a weekly feature in Sunday Northwest Life. Send questions to apujari@seattletimes.com for possible use in future columns.