Integrative Approach Using Natural Evidence Based Treatments
Almost everyone has experienced the pain of headaches and 38 million Americans experiences debilitating migraines. Migraines are the 6th highest cause worldwide of years lost due to disability (YLD) and headache disorders collectively were 3rd highest. (The Global Burden of Disease Study (2013))
What is a Migraine?
Migraines are a neurovascular disorder that is caused by the activation of a mechanism deep in the brain that leads to release of pain-producing inflammatory substances around the nerves and blood vessels of the head. (WHO)
Migraines affects women 3 X more than men:
Women are disproportionately affected by migraines, 18% of women to 6 % of men (United States population). Women are more likely to experience migraines during reproductive years around 18-44 years old. The main reason is hormonal influences. The current perspective is that women’s unique menstrual physiology with changing hormones and blood loss plays a key role.
Western medical perspective
The current findings show that the following affect menstrual related migraines.
1. Abrupt drop in estrogen prior to menstruation
2. Release of prostaglandin during the menstrual cycle
3. Iron deficiency anemia induced from blood loss after the menstrual cycle
Drop in estrogen
Hormonal levels ebb and flow during the different stages of the menstrual cycle. Migraines induced by onset of menstruation are related to the sudden fall in estrogen. Recent study shows that migraineurs show a faster estrogen decline compared to controls (Jelena M. Pavlović, 2016). This migraine-specific hormone profile may be an indication of neurological hormonal sensitivity (Jelena M. Pavlović, 2016).
Release of prostaglandins
Prostaglandins are hormone-like substances that get released at the site of injury. Before and during menstruation there is an increase of prostaglandins from the shedding endometrium. In Antonova et al. (2013) research, it shows that prostaglandins are found in smooth muscles of cranial arteries, and functional studies showed that prostaglandins induced dilatation of cranial vessels. Certain prostaglandins triggered migraine-like attacks in migraine patients accompanied by dilatation of the intra-cerebral and extra-cerebral arteries (Antonova M, 2013).
Iron Deficiency Anemia
New research shows a non-hormonal correlation between iron deficiency anemia and end of the menstruation migraines (Calhoun, 2016). In this study, out of the selected population of women with migraines, 30 had end-menstrual migraine (EMM) and 28 out of 30 had ferritin (iron) levels that fell below generally accepted lower desirable limit. The EMM are not hormonally related, however are believed to be related to menstrual blood loss, resulting in a brief relative anemia triggering migraines (Calhoun, 2016).
Eastern medical perspective
Chinese Medicine was developed thousands of years ago before the ability to explore inside the body with imaging and autopsy existed. Observation was a key component in understanding the normal and abnormal changes in the body. Chinese medicine uses observation and asking of detail questions to look at patterns of imbalances in the body.
Chinese Medicine perspective looks at changes during menstrual cycles that affect migraines. The three main patterns of imbalances for menstrual-related migraines are yang rising, blood deficiency and qi & blood stagnation.
Traditional Chinese Medicine categorizes the menstrual cycle into four phases:
Menstrual Phase
In this phase there is downward movement of qi (physiological processes) and blood to help discharge blood. If there is an imbalance in the movement of qi and blood the energy can rise to the head causing yang rising migraines.
Yang Rising Symptoms:
Occurs during the menstruation
Throbbing headache in temples, eyes or sides
Irritability
Dizziness
Flashing lights in the eyes
Post-menstrual phase
This phase is after blood loss and women who have heavy periods or tend to be anemic already are prone to blood deficiency.
Blood Deficiency Symptoms:
Dull headache on vertex of head
Dizziness
Palpitations
Insomnia
Fatigue
Blurred vision
Ovulation
In this phase the egg is released
Pre-menstrual Phase
Qi and blood are moving in preparation for the period, if the movement is inhibited this can cause qi and blood to become stuck causing qi and blood stagnation.
Symptoms:
Stabbing headache in temples,
eyes or sides
Dark menstrual blood with clots
Painful period
Abdominal pain
Sleep disturbances Irritability
Integrative approach to treat migraines
More research is being done to pinpoint why women experience migraines 3 times more than men. Western biomedical research has given us a clearer picture of what is happening during menstrual cycle that may lead to migraines. Chinese Medicine model correlates with the hormonal and menstrual changes and gives a framework for treatment. There is a growing body of natural evidence based treatments that can be added to create an integrative treatment plan for menstrual related migraines.
An integrative approach aims to treat the whole person body, mind, emotional, spiritual and social using lifestyle actions and professional care from different modalities.
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