Lots of excellent recommendations starting from page 6 onward ("Theraputic studies")
An incomplete list of long term strategies presented in the paper:
- aerobic exercise
- b-vitamin supplementation (several different ones are mentioned), and magnesium supplementation
- ketogenic diet (train the brain to use non-glucose sources of energy)
- sleep management (are you getting enough?)
Given the root-cause analysis of migraines presented in the paper, there's one additional treatment which I'll experiment with: milk thistle supplementation. Milk thistle boosts levels of glutathione in the liver, which appears to have a bearing on migraines.
There is also a significant hormonal component to migraines. Women have 2-4x as many migraines as men — an effect that is also seen in trans women who are taking estrogen, which indicates that it’s probably hormones rather than genetic. Not ruling out a dietary component, but it’s obviously a complex set of symptoms with likely dozens of contributing factors.
I don't think it's a cure so much as a great way to manage the pain while the migraine is at its peak, unfortunately the migraine hangover still lasts for days.
I consider myself very fortunate to have found these, and I encourage anyone who experiences migraines to keep a food diary (write down what you ate and drank the day before, including all ingredients). You may be able to find trigger ingredients at some point, and then avoid them the rest of your life.
The connection to MSG is clearly controversial given how much the food industry loves using it to smooth out taste in prepared foods, but it seems to not affect most people, so it didn't bother me as long as I could identify its inclusion.
In the the past 30+ years they have decreased in frequency and severity; now other than the aura (20 minutes of weird vision) the headache is at most a simple Tylenol one.
Triggers can be almost anything that affects the brain in some way; given this research it's clear that what affects people with migraine potential does not affect those with different genetics. Very often genetics plays a large role in how your body reacts to stimulus and food and diseases, but also that many genetic adaptations have both good and bad sides, so perhaps migraines gave our ancestors some benefit, and we pay the price lying on the couch in the dark.
Oh, now you tell me...
"Cluster headache is among the most severe pains known to mankind." [1]
Cluster headaches to generally thought to be neurological compared to migraines which are generally considered vascular. I guess by this article, indirectly vascular.
Cluster headaches are significantly rarer than migraines. Only a very very few get both. You should have gotten a lottery ticket that month. Glad it faded.
[1] https://www.practicalpainmanagement.com/pain/headache/cluste...
The reason for all the "perfectly fine" "controversy" with MSG is that there's still no known allergy to it, and the early proponents of "MSG allergies" were quacks using bad science for racist reasons (despite it being a naturally occurring substance, and a required enzyme in the brain).
So overall it is much less controversial to say that MSG is a known migraine trigger in some people. It's still "safe", migraines so far as we know are rarely life-threatening even if sometimes you do feel like you are going to die. You mostly just need to acknowledge that as a trigger it varies greatly among people.
The analogy to caffeine is an extremely useful one as caffeine is also "generally recognized to be fine/safe/not an allergy", but too little caffeine and too much caffeine (and caffeine withdrawal) can all be migraine triggers or migraine relievers depending on what side of it you are on. (Most over-the-counter "migraine medication" if you check the ingredients is just a dose of generic Tylenol and a shot of caffeine because the most common migraines in America are often the withdrawal state or the too little state and it isn't likely to make it worse if you are in the too much state already, unless too much is on the edge of a caffeine OD and you have more life threatening problems.)
It plays the other way sometimes too: sometimes I crave foods high in MSG when I have a migraine and that will settle the migraine some.
https://onlinelibrary.wiley.com/doi/full/10.1111/jcpt.12548
The nausea is most likely from high serotonin which cannot be metabolized by MAOA when in riboflavin deficiency.
They recommend ketogenic food too (I never noticed an effect on my migraines though).
This also helps explain why hormones, especially oestrogen, can be a problem for migraine sufferers, as it's the liver-gut-gallbladder axis that detoxifies hormones from the body.