anti-inflammatory

7 December 2022

More on Melatonin for Migraine (and a recipe thrown in)

James Discoveries & Stats, Resources, Treatments 1

Last month a meta-study was published in the Journal of Oral & Facial Pain and Headache, focusing on the use of melatonin supplements for migraine. The results are pretty encouraging for a supplement that is generally considered safe in small doses.

The helpful thing about this new study is that it didn’t just evaluate if melatonin “helped”, but it got specific into the “how”. Researchers found the following benefits:

Less frequent migraine attacks
Shorter migraine attacks
Less severe migraine attacks
Less use of “painkillers”

Why exactly melatonin works so well is not entirely understood. Obviously, if melatonin helps you sleep, improved sleep will certainly help fight migraine. But there may be more to it than that.

Melatonin is also an antioxidant, which may provide a number of benefits. Headache researchers have especially honed in on the anti-inflammatory powers of melatonin. More recently, melatonin gained traction as part of the COVID-19 fighting toolbox (see for example this study).

Melatonin is, of course, produced naturally in your body. At a 2019 Migraine World Summit event, migraine expert Dr. Christine Lay provided some very helpful advice for migraine patients:

I think there are ways to promote your own melatonin. When we come home after a busy day, I encourage patients to keep their room dim. And so not to have every single light on in the house, every, you know, television going, but rather to keep the room fairly dim and to use lamp lighting, perhaps, rather than overhead lighting so our own natural melatonin will kick in. But for some patients supplements can be very effective. I think we have to be mindful as migraine patients that you’re not spending all of your money on the most expensive one but you’re not buying the cheapest one because we know these things are not really mandated. We don’t know about quality control, necessarily. So you want to make sure you’re buying a good product.

The other thing I think is important: there are sometimes what we call sublingual, or melt-in-your-mouth, melatonin. I tend to tell patients to avoid those because they usually have additives in them or they may have an artificial sweetener which could then provoke a migraine attack. So they need to stick, primarily, with tablets or pills. In terms of amounts, it’s quite variable. There’s a lot of research showing that melatonin can help patients with chronic migraine, even chronic migraine people who feel like they don’t have a sleep problem. There’s something positive about melatonin. It may actually have even an antiinflammatory benefit to some degree. So melatonin can be very effective. I usually have patients start at a lower dose, perhaps three milligrams, and then work slowly to build up depending on how they tolerate it. I don’t think patients, without discussing with their doctor, should go beyond 10 milligrams because you have to be mindful of how much you’re taking. And most experts will say you need a melatonin break. It’s something that’s naturally produced in our brains by the pineal gland, and so, if you’re continually supplementing the melatonin, your brain might get used to not making its own. So you do need to take periodic breaks every few weeks or couple of months.
Dr. Christine Lay

Dr. Lay also recommends foods with melatonin, such as walnuts. (Make yourself some Morning Glory Muffins. Seriously.)

For a highly-rated melatonin without a lot of the additives that Dr. Lay talks about, try Natrol Melatonin. It’s very inexpensive right now, and has even bigger savings with Subscribe & Save. Be sure to get this particular version – Natrol has various others, such as the fast dissolve version that has additives that you’ll want to avoid.

ConsumerLabs has tested and recommends Source Naturals Time Released Melatonin, also a good price but a little more than Natrol.

More information on melatonin at the Mayo Clinic.

Read the study abstract here: Efficacy and Safety of Melatonin as Prophylaxis for Migraine in Adults: A Meta-analysis.

7 June 2022

Dexamethasone in a Migraine Emergency

James Information, Medications 0

One migraine emergency room treatment that has become a lot more common is dexamethasone. But what exactly is it, and why is it used?

Dexamethasone is a type of steroid called a corticosteroid (not to be confused with the other type – anabolic steroids are the ones that are sometimes used illegally by athletes). Corticosteroids are similar to cortisol, which your body produces naturally.

Like other corticosteroids, dexamethasone is used as an anti-inflammatory. We know that inflammation can be a good tool that your body uses, but inflammation can also get out of control. Dexamethasone can actually be life-saving when inflammation threatens your body’s organs, such as kidneys. It may also be used for less serious situations, such as to lessen inflammation when you’re having your wisdom teeth removed.

In the case of headache and migraine, anti-inflammatories are of course very common, helping to decrease that hot swollen pain. But as doctors began to give it to patients, they started to notice another benefit. Patients who were given dexamethasone were less likely to get another migraine / headache in the near future.

Once a migraine attack is serious enough to land you in emergency, doctors are concerned about a couple of things. First, they don’t want the symptoms to go on and on – they want to see the migraine attack stop. But they also don’t want to see you back in emergency a day or two later.

Dexamethasone is by no means a silver bullet – it would probably only stop that new headache in a minority of patients. But that minority is important, and along with its other benefits, there’s a good reason why many doctors are using it as a part of their treatment.

Avoiding another headache will also help you avoid taking more medication. But of course researchers are concerned that some patients will end up taking too much of the corticosteroid instead. In other words, no problem if we help that patient who has a one-time emergency room visit. But what if they come often? Too many doses of corticosteroids can cause problems. It can weaken your immune system. It can lead to osteonecrosis (a loss of bone tissue).

But used with care, doctors are finding dexamethasone to be useful. In fact, researchers in Canada are investigating its use in children with migraine as well (if you’re interested in taking part in this trial, here’s more information).

Learn more about some of the treatments you may find in the emergency room here.

28 September 2021

PEA Supplements for Migraine?

James Discoveries & Stats, Treatments 0

Supplements don’t tend to have the rigorous and expensive testing behind them that drugs have, but there is a growing interest in PEA, or palmitoylethanolamide, for migraine pain.

PEA is a fatty acid amid which is naturally found in the body. You also get it in your diet, especially if you eat eggs (eggs really are an amazing food). It has been specifically studied for over 60 years, showing a lot of promise as an anti-inflammatory and a pain killer, among many other possible applications.

It’s widely available, and is often recommended for joint pain. And, at least in the short term, it appears to be very safe. These days, it’s even being studied as a treatment for COVID-19 induced lung inflammation.

Long-term studies are lacking, and that is an issue because of its possible application as a headache and migraine preventative. However, because of its excellent safety profile so far, it’s even being studied in children (see this study – 600mg/day).

A study in Australia is looking for participants as I write, to study PEA as an abortive. Patients will take 700mg at the first signs of a migraine attack, and then another 700mg dose if the pain doesn’t go away. If you’re in the area and eligible, you might want to take part in this trial.

It’s always interesting to look at other possible applications of a medication or supplement, especially if you’re taking something as a preventative. PEA has a long list of “possible” benefits, but again, they mostly lack large, high-quality studies. (As I’ve said many times before, this is not necessarily a big strike against a supplement, especially if it seems to be quite safe. Large clinical trials take a lot of money, so a company needs to know they’ll get their money back when they invest. PEA is already widely available and relatively inexpensive, which means there is less monetary motivation for large long term trials. However, there is a lot of interest in PEA, and at least quite a few smaller trials, so there’s actually a fair bit of evidence out there, especially for pain management.)

One benefit that will interest many is its anti-viral and immunity benefits. It may also help fight depression, promote brain health, and fight menstrual pain. Read more here in this 2021 report – Palmitoylethanolamide: A Natural Compound for Health Management.

So although it may not top the list of migraine fighting supplements, if, for example, you’re also struggling with joint pain, or menstrual pain, you might want to give it a try (although I always recommend you talk to your doctor first). You can try it as they’re using it in the Australian study – to take when you start getting a headache or migraine attack. Or, you might want to try it as a preventative.

If you’re trying it as a preventative, it would be good to give it a test run of three months. But remember, we don’t have long-term studies, so do your research, watch for possible side effects, and talk to your doctor.

600-700mg a day is often recommended, but you’ll see anything from 300-1200 daily. For a good summary, see this information at WebMD – Palmitoylethanolamide (Pea). For more in-depth information of how PEA works, this information is a few years old, but still useful (though very technical): Palmitoylethanolamide for the treatment of pain: pharmacokinetics, safety and efficacy

27 January 2020

Tulsi Tea for Migraine

James Tips, Treatments 0

Tulsi tea*, a common tea in India, is a traditional headache remedy. But what is it?

Tulsi is a type of basil. Not exactly the kind you typically cook with, which is sweet basil, but a different variety called holy basil (ocimum tenuiflorum). It is sweet and aromatic, and can be used in hot tea or iced tea.

Using basil for migraine is actually fairly common. You may remember that Drs Young and Silberstein mentioned a basil oil massage in their book Migraine and Other Headaches. Some people use it in diffusers, and yes, some cook with it.

Aside from headaches, holy basil may have other benefits that migraine and headache patients may be interested in. It may help decrease inflammation, and help with stress and anxiety. There is even some evidence that it could help prevent cancer. (Read more: 10 Holy Basil Benefits: Tulsi Helps Anxiety, Acne & More and Holy Basil)

You may have noticed this post at Migraine.com of someone recommending tulsi tea as well.

There is some concern that the plant may absorb chromium from the soil, so it’s recommended that you start with an organic leaf, which can easily be purchased in bulk on amazon (also in bags here).

To make tulsi tea*, use about a tablespoon of dried leaves per cup, and pour freshly boiled water over. Brew for 5-10 minutes, or longer. For an iced tea, use double the leaves, let it cool, and add ice.

* Yes, I’m aware that “tulsi tea” is not actually a tea, but a tisane. But it is commonly known as tulsi tea. Which does have a ring to it, even if it’s wrong. However, maybe you should tell your friends that you’re making a tulsi tisane, and impress them with your smarts (which may be another benefit of tulsi tisane – increased mental powers).

21 August 2012

Is Boswellia the new Butterbur for Migraine and Cluster?

James Information, Treatments 4

Butterbur rose quickly to be one of the most recommended herbal treatments for migraine, though recent concerns have lowered it on some people’s lists. However, a new herb may be edging its way into the conversation – something called Boswellia (bosellia serrata).

Boswellia, also known as Indian Frankincense, has actually been around for a long time. It’s actually a tree – but it’s the resin of the tree that we’re interested in for our purposes.

The resin’s anti-inflammatory benefits have been helpful to those with pain conditions such as headache, asthma, menstrual cramps, and arthritis.

At his blog at the New York Headache Center, Dr. Alexander Mauskop recently wrote about evidence in favour of the herbal treatment.

Actually, there are not a lot of studies related to headache conditions, but there have been some interesting reports, that Boswellia may relieve not only migraine but also cluster and indomethacin-responsive headache.

One recent study reported improvements in cluster patients who took 350 to 700 mg three times a day. Another doctor tried 250 mg three times a day and up for patients with indomethacin-responsive headache syndrome.

The advantage over indomethacin and many other anti-inflammatory drugs is that boswellia doesn’t have the strong gastro-intestinal side effects. Regarding the mechanism of boswellia, Dr. Mauskop writes:

Unlike butterbur, Boswellia has no toxic ingredients and is safe to consume in any form. The mechanism of action of Boswellia is not entirely clear, but it seems to have anti-inflammatory properties similar to aspirin. Obviously, it does more than that since aspirin is usually ineffective for cluster or indomethacin-responsive headaches.

Reading about those who have tried boswellia, it does seem that there is a wide difference in the quality of supplements available. Be sure to find a brand name you trust and check for detailed information on the label.

One of the studies mentioned used Gliacin. Vitacost also has some good standardized brands of boswellia.