II. Resetting the Pineal Gland

It may only be the size of a pea, but the pineal gland, located deep in the brain, plays a major role in both the development and elimination of migraine. That is because this tiny gland is the body's primary source of melatonin, a hormone that orchestrates the body's circadian (daily) rhythm, including and especially sleep patterns.

Melatonin

Research findings support the idea that pineal gland irregularity, and thus melatonin imbalance, is involved in the development of migraine.

Melatonin is an important piece in the migraine and sleep disturbance puzzle. Restoration of balanced pineal gland function and healthy sleep patterns are critical components in The Migraine Cure treatment program.

Melatonin supplements are widely available, in grocery stores, pharmacies, health food stores, department stores, and by mail order. As part of the pineal restoration segment of The Migraine Cure, I recommend a combination product that contains melatonin (3 mg), vitamin B6, and kava kava, with one or two capsules taken at bedtime, depending on individual needs.

In most cases, patients need to take melatonin for only a few months, until the pineal circadian cycle is restored. Then they may take it periodically for a few days per month or every few months if their sleep becomes disturbed.

Kava Kava

In addition to melatonin, we recommend kava kava as part of the restoration program for pineal function. Kava root extract, which is derived from the root of Piper methysticum, has a calming effect, promotes sleep, and relaxes deep muscles, abilities attributed to components called kavalactones.

Patients who follow The Migraine Cure plan as recommended typically take melatonin and kava at the beginning of the program, but once they are migraine-free—which usually happens within two to four weeks—they can reduce their use of melatonin and kava to a minimal dose and discontinue them later, depending on how well their sleep problems have resolved.

The most common side effect from kava use is mild gastrointestinal disturbances in some people. Kava has also been associated with skin rashes and enlargement of the pupils. Kava should not be combined with drugs or substances that act on the central nervous system, such as alcohol or benzodiazepines. Individuals with liver problems should not use kava. Use of kava should generally be limited to three months.

Vitamin B6

Vitamin B6 (pyridoxine) is an important part of the migraine treatment program for several reasons. When it comes to restoring pineal function, vitamin B6 is necessary for the production of serotonin, the brain neurotransmitter that has a major role in the sleep-wake cycle, chronic pain, mood, and appetite. I also recommend it because, like kava kava, it has a calming effect. The typical dose is 10-20 mg taken 30 minutes before bedtime.

III. Achieving Metabolic Balance

The link between migraine and gastrointestinal (GI) disorders, and especially between GI disorders and the gut (intestinal tract), has been confirmed by numerous studies and clinical observations.

Successful elimination of migraine depends on a healthy gut, and fortunately, you have a great deal of control over that environment. One of the most important things you can do to ensure a healthy intestinal tract is to maintain a balance between friendly and unfriendly bacteria—the intestinal flora—in the gut. Friendly bacteria are those that provide health-promoting or health-maintaining properties, while the unfriendly varieties can significantly harm your health. When the balance tips in favor of the bad bacteria, the gut becomes damaged and inflamed. This condition, often called dysbiosis, is characterized by symptoms such as diarrhea, constipation, gas, abdominal pain, cramping, and bloating.

As a person with migraine, when your gut feels like it is in knots—when you have symptoms of diarrhea, constipation, irritable bowel, or abdominal pain—you need to restore balance to your intestinal flora if you want to rid yourself not only of your gut pain but of your migraine as well. I have found an excellent way to accomplish this goal is through supplementation with probiotics.

Probiotics

Probiotics are supplements of live, friendly bacteria that you can take to enhance or restore the balance of bacterial flora in your intestinal tract. The most common and essential of the friendly bacteria are the bifidobacteria, streptococcus, and lactobacilli species, which perform many functions essential for health and well-being. For example, they can:

• Assist in the absorption of nutrients into the bloodstream
• Form a barrier against harmful bacteria that can cause diarrhea
• Manufacture food for your intestinal cells so they can function optimally
• Help prevent harmful bacteria from causing damage
• Prevent symptoms caused by use of antibiotics, which can destroy the majority of the friendly bacteria in the intestinal tract.

After much research and experimentation, the probiotic supplement I recommend is a powdered formula that contains 3.5 billion of lactobacillus group, 1 billion of bifidobacterium group, and 0.5 billion of streptococcus thermophilus per dose. It is well tolerated, easy to use, and has helped a great many people. After several months of taking this supplement on a daily basis, most people find that occasional use, perhaps once a month, is sufficient to maintain a healthy gut and overall health and well-being.

IV. Ion Balancing Act

Critical for the success of The Migraine Cure is restoration of the balance between two minerals, ionized magnesium and ionized calcium. The precarious balance between these two elements is intimately connected with the activity of the steroid hormones, the function of the pineal gland, proper functioning of the digestive system, and, by extension, balance between the sympathetic and parasympathetic nervous systems.

The Calcium-to-Magnesium Ratio

The relationship between the calcium-to-magnesium ratio and migraine has been known for some time. In 1993, for example, researchers noted that low levels of ionized magnesium and a high ionized-calcium-to-ionized magnesium ratio are both associated with migraine, as these two conditions cause cerebral vasospasm and reduced blood flow to the brain.

A balanced ratio of calcium to magnesium also is necessary to help prevent fatigue and regulate the sleep cycle, two factors common among migraineurs. Again, this balance also reflects a balance between the sympathetic nervous system (which calcium has an impact on) and the parasympathetic nervous system (which magnesium influences).

Magnesium

If a magnesium deficiency is part of the recipe for migraine, then it follows that supplementation should be beneficial. Research and experience indicate that this is true. Several studies have shown that supplementation with magnesium relieves migraine in people who have low serum ionized magnesium levels. We also know that supplementation with magnesium relieves symptoms of PMS, including migraine, bloating, and edema, and that magnesium supplementation can be an effective prophylactic (preventive agent) and treatment for migraine.

Although magnesium supplements are available in a variety of types and forms (e.g., magnesium sulfate, oxide, gluconate, carbonate, and chloride), the form I recommend to everyone who participates in The Migraine Cure is magnesium citrate. This is the type the body is best able to absorb. I especially recommend a powdered, water-soluble magnesium supplement, 400-800 mg taken at bedtime, or 200-400 mg taken in the morning followed by 400 mg at bedtime, depending on individual needs. If you have any type of heart or kidney disease, talk to your doctor before taking magnesium.

Additional Benefits of The Migraine Cure

One of the most gratifying experiences in writing The Migraine Cure book, besides the fact that it eliminates migraine, is that it will also help people alleviate many other symptoms and conditions. This is good news, because most people who live with migraine also struggle with one or more other health problems, including depression, insomnia, high cholesterol, constipation, irritable bowel syndrome, chronic fatigue, fibromyalgia, mood swings, menstrual difficulties, or sleep disturbances. So while we were busy recommending hormone restoration, pineal resetting, calcium-magnesium rebalancing, and digestive realignment, and getting excellent results when it came to eliminating migraine, patients were reporting—and we were noting—that other health concerns were disappearing as well.

My research and experience have shown me that the basics of The Migraine Cure are the recipe for successful treatment and often complete elimination of many other physical and psychological conditions, including high cholesterol, heart disease, and fibromyalgia.

Ruthanne's Story

Ruthanne first contacted us in October 2004. "The migraines actually started when I was about 15," she says, "and in the last 10 years or so they got worse, until I was having one every day." She remembers that her teenage years were plagued by symptoms of premenstrual syndrome, including migraine, depression, and mood swings. At 19, she began to take birth control pills to help deal with the PMS. That is when she noticed that although she still got migraines when she was taking the pills, they were much worse during the one week per month that she was off the hormones. Ruthanne says that over the years, she tried various medications to cope with the migraines, including naratriptan (Amerge®), sumatriptan (Imitrex®), topiramate (Topamax®, an anticonvulsant), various muscle relaxants, several different antidepressants, ergotamine injections, and a few different hormone replacement formulations, all of which provided little or no relief. At the time she contacted us, her other health concerns included allergies, high blood pressure, and being overweight. Ruthanne's lipid and hormone levels were as follows (reference ranges appear in parentheses): Cholesterol: 296 mg/dL (<200 mg/dL) Total estrogen: 146 pg/mL (61-437 pg/mL) Progesterone: 0.3 ng/mL (0.2-28.0 ng/mL) Pregnenolone: 37 ng/dL (10-230 ng/dL) DHEA-S: 76 ug/dL (65-380 ug/dL) Total testosterone: 32 ng/dL (14-75 ng/dL). Based on these results and our discussion with Ruthanne, we recommended the following initial program: DHEA: 50 mg in the morning and 25 mg at noon 7-Keto DHEA: 100 mg in the morning Pregnenolone: 200 mg in the morning Estrogens: Triest gel, formulated to 90% estriol, 7% estradiol, and 3% estrone, taken on a cyclical basis: 1 mL in the morning on days 1 through 10 following menstruation, then 0.8 mL in the morning until the start of menstruation, then 0.4 mL in the morning during menses Progesterone: micronized progesterone (50 mg/mL), 0.8 mL in the morning and 0.4 mL in the evening on days 1 through 10 following menstruation, then 1.0 mL in the morning and 0.4 mL in the evening until the start of menstruation, then 0.6 mL in the morning and 0.2 mL in the evening during menses Testosterone: micronized testosterone (50 mg/mL) gel, 0.2 mL in the morning on days 1 through 10 following menstruation, then 0.1 mL every day Probiotic formula containing 3.5 billion lactobacillus group, 1.0 billion bifidobacterium group, and 0.5 billion streptococcus thermophilus Melatonin formula containing 3 mg of melatonin, 250 mg of kava root extract, and 10 mg of vitamin B6, one capsule at bedtime Magnesium citrate formula: one scoop (containing 420 mg) at bedtime Saw palmetto: 160 mg in the morning Zinc: 50 mg before bedtime. We also recommended that Ruthanne stop taking her supplements (including calcium and a multi-vitamin/mineral) and birth control pills until her hormone levels were restored. While Ruthanne wrestled with her anxiety about stopping her birth control pills, another issue came up: her gynecologist would not prescribe the bioidentical estrogens she needed. In the end, she found a nurse practitioner who was not only happy to provide the prescription, but also interested in the program herself, as she suffered from migraines as well. Ruthanne remembers the exact day that she started The Migraine Cure program, and for good reason. "From day 1, I didn't have any more migraines," she says. "It worked immediately. I can't remember when I was migraine-free like this!" Ruthanne also had this to say about some other benefits of the program: "With all the medications I used to take just to get by, I was 'fuzzy' all the time, to the point that I believed that was my normal state. Now, I feel sharper than I have for a long, long time, and I attribute it to not being on migraine drugs and painkillers, and to finally getting my hormones into balance." As of February 2006, Ruthanne had been migraine-free for three full months and reported having much more energy, improved sleep, a positive mood, and a big improvement in her allergies. Her blood pressure was a healthy 112/84, and she was looking into incorporating more healthy foods in her diet.