Treatment of Atypical Migraine

We think we know what a migraine is: a pounding headache that relegates you to a bed in a dark room for hours at a time. And that is definitely one common form of migraine. But migraine can show up in many forms, some of which are surprising. Sinus (rhinogenic) migraine, balance (vestibular) migraine, and ear-related (otic) migraine are three common forms of atypical migraine that we see in ENT. In fact, 9 out of 10 patients with self-diagnosed “sinus headaches” are suffering from migraine. In addition to pain, migraine can lead to other sinonasal symptoms, including facial swelling, red/puffy eyes, runny nose, and stuffy nose. They can also cause vertigo, imbalance, and ear fullness. They are commonly triggered by changes in weather and season, allergies, diet, and many other factors related to our lifestyles.

Lifestyle Modifications

Lifestyle Modifications are just as important as medicine in the treatment of migraine.

• Sleep: Maintain a regular sleep pattern of 7-8 hours per day at the same time every day.
• Eating: Avoid migraine trigger foods. See the list of foods to avoid below.
• Exercise: 30 minutes of moderate exercise at least 3x/week will reduce headaches.
• Drink: Stay well hydrated. Aim for at least 64 oz of water per day.
• Stress Avoidance: Try to do something for yourself to de-stress on a daily basis. Go for a walk, practice yoga, stretch, meditate.
• Caffeine and Aspartame Avoidance: These are the primary migraine triggers for many patients. If patients can cut out caffeine and aspartame, after 2-6 weeks they generally discover that their migraine symptoms improve significantly or even disappear.

Supplements

Supplements can also be quite beneficial for migraine patients of all types. We recommend starting with:

• Magnesium glycinate (or magnesium citrate): 400mg at bedtime - This supplement can cause diarrhea. If this occurs, take ½ dose or even ¼ .
• Riboflavin (Vitamin B2): 200mg 2x/day

Medications

Medications are sometimes required for symptom control. If required, your doctor will talk to you about the best options.

Sometimes symptoms take 6-8 weeks to respond to these interventions, so don’t give up before hitting that two-month mark!

Migraine Diet

Below are foods and drinks to limit or avoid in order to better control migraine symptoms.

• Caffeine: Causes constriction of blood vessels in the brain. This can lead to rebound headaches. Caffeine-withdrawal symptoms can reduce efficacy of migraine medications.
• Chocolate: Contains 10mg caffeine/oz and has other migraine-triggering chemicals. White chocolate without cocoa is safe.
• MSG/glutamate: Hidden under multiple names such as hydrolyzed protein, yeast extract, natural flavorings, textured protein, whey protein, malt extract, maltodextrin, carrageenan, kombu, sodium or calcium caseinate, glutamic acid, gelatin.
• Artificial Sweeteners: aka Nutrasweet (aspartame) or Splenda; Stevia is okay.
• Alcohol: Red wine is the most likely trigger and vodka is the least likely.
• Foods High in Tyramine: Tyramine is produced in food from the natural breakdown of the amino acid tyrosine. Levels increase when foods are aged, fermented, or are not fresh.
  1. Processed meats and fish: Aged, dried, fermented, salted, smoked - or preserved with nitrates or nitrites. Examples are hot dogs, sausage, salami, pepperoni, packaged sandwich meats, bacon, caviar, anchovies, etc.
  2. Nuts: Avoid all kinds including walnuts, pecans, almonds, and peanut butter. Seeds are okay.
  3. Dairy: Avoid aged cheeses such as Colby, Roquefort, Brie, Gruyere, Cheddar, Bleu, Mozzarella, Parmesan, Boursalt, Romano, Provolone. Limit yogurt, buttermilk and sour cream to ½ cup per day.
  4. Certain Vegetables: Avoid onions, sauerkraut, snow peas, pickles, olives and certain beans (broad, lima, fava, navy, and lentils).
  5. Certain Fruits: Avoid bananas, avocados (guacamole), figs, raisins, dried fruit, papaya, passion fruit, red plums, raspberries. Limit citrus fruits to ½ cup per day: (orange, grapefruit, tangerine, pineapple, lemons, limes).