Most people have experienced a headache at some point during their life, making headaches one of the most common complaints that brings people to see naturopathic doctors. Where headaches can resolve and recur, for some they become a persistent issue that impairs daily function.
Headaches come in many forms and common types of primary headaches include migraines, tension headaches, and cluster headaches. Headaches can also present as the result of a certain condition (i.e. TMJ, osteoarthritis of the spine, sinusitis, eye disorders, etc.) or long-term medication use.(1)
In cases primary headaches, there is almost always a trigger that can be identified that perpetuates the headache.
Common triggers include (2,3):
Nutrient deficiencies – Vitamin B12, Vitamin D, magnesium, riboflavin, niacin, etc.
Dietary Sulfites &/or Nitrates – diary, processed meats, beets, spinach, wine, beer, dried fruits, etc.
Food sensitivities – gluten, dairy, eggs, nuts, etc.
Caffeine – Coffee, tea, chocolate
Dehydration
Hormone fluctuations
Bacterial or fungal overgrowth
Environmental stimuli – atmospheric pressure changes, light stimuli, air quality, odors
Physical stress, tension or posture
Sleep disturbance & deprivation
Emotional stress
Naturopathic Approach
My goal as a naturopathic doctor is to help my patients identify triggers and employ individualized management strategies which could include dietary & lifestyle counseling, physical medicine (i.e. stretching, exercise), herbal medicines, nutritional supplementation and/or stress management.
Testing:
Laboratory testing can help to identify headache triggers. Often I will discuss the following labs with my patients:
Serum nutrient testing (ie. Vitamin D, iron, B12, zinc, etc.)
Serum or salivary hormone testing (ie. reproductive hormones, insulin, thyroid, etc.)
Food sensitivity testing
Stool testing to screen for dysbiosis
Nutrients:
As oxidative stress is a key factor in the pathology of headaches, a number of antioxidants can ease the pain. This includes:
CoQ10 (4)
Magnesium
Melatonin
Niacin
Vitamin C (5)
Botanicals:
A number of botanicals have literature to support their use in alleviating headaches. Some work by effecting blood flow and the integrity of the cardiovascular system. Others reduce inflammation, relax the nervous system, support the liver in detoxification, or regulate hormonal imbalances.
Some of my go-to's include:
Butterbur (Petasites hybridus)(6)
Chaste tree berry (Vitex agnus-castus)(7)
Feverfew (Tanacetum parthenium)(6)
Ginger (Zingiber officinalis)(8)
Ginkgo (Ginkgo biloba)(9,10)
Lavender (Lavendula officinalis)(11)
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References:
1. Headache classification committee of the international headache society (Ihs) the international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
2. Andress-Rothrock D, King W, Rothrock J. An analysis of migraine triggers in a clinic-based population. Headache. 2010;50(8):1366-1370.
3. Nattagh-Eshtivani E, Sani MA, Dahri M, et al. The role of nutrients in the pathogenesis and treatment of migraine headaches: Review. Biomed Pharmacother. 2018;102:317-325.
4. Goschorska M, Gutowska I, Baranowska-Bosiacka I, Barczak K, Chlubek D. The Use of Antioxidants in the Treatment of Migraine. Antioxidants (Basel). 2020 Jan 28;9(2):116. doi: 10.3390/antiox9020116. PMID: 32012936; PMCID: PMC7070237.
5. Zheng Y, Jin J, Wei C, Huang C. Association of dietary vitamin C consumption with severe headache or migraine among adults: a cross-sectional study of NHANES 1999-2004. Front Nutr. 2024 Jun 18;11:1412031. doi: 10.3389/fnut.2024.1412031. PMID: 38962437; PMCID: PMC11221565.
6. Holland S, Silberstein SD, Freitag F, et al. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346-1353.
7. Ambrosini A, Di Lorenzo C, Coppola G, Pierelli F. Use of Vitex agnus-castus in migrainous women with premenstrual syndrome: an open-label clinical observation. Acta Neurol Belg. 2013;113(1):25-29.
8. Martins LB, Rodrigues AMDS, Rodrigues DF, Dos Santos LC, Teixeira AL, Ferreira AVM. Double-blind placebo-controlled randomized clinical trial of ginger ( Zingiber officinale Rosc.) addition in migraine acute treatment. Cephalalgia. 2019;39(1):68-76.
9. Usai S, Grazzi L, Bussone G. Gingkolide B as migraine preventive treatment in young age: results at 1-year follow-up. Neurol Sci. 2011;32 Suppl 1:S197-199.
10. Guo SG, Guan SH, Wang GM, et al. Clinical research of persimmon leaf extract and ginkgo biloba extract in the treatment of vertebrobasilar insufficiency. J Biol Regul Homeost Agents. 2015;29(1):151-157.
11. Sasannejad P, Saeedi M, Shoeibi A, Gorji A, Abbasi M, Foroughipour M. Lavender essential oil in the treatment of migraine headache: a placebo-controlled clinical trial. Eur Neurol. 2012;67(5):288-291.
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