Tracy is a 45-year-old professional photographer who was troubled by chronic “head banging” migraines several times a week. She also had tension-type headaches, neck related headaches, sinus headaches, and jaw joint pain.

She came to me seeking relief for these problems that had lasted over 20 years. She wanted to avoid addictive medications though and had been prescribed multiple medications over the years, they either did not work or had intolerable side effects. The most disabling part of her complex headache syndrome were the migraines as they prevented her from working. We decided to address those first.

Migraine headaches are a serious impairment to those that get them. Genetically linked, more common in females, they can start in early childhood. The typical presentation in an adult is a headache on one side of the head that is throbbing and accompanied by symptoms like nausea, vomiting, and irritation by light and sound. In children, migraines may present early as abdominal rather than headache symptoms, and can occur on both sides of the head.

Treatments to treat and stop migraines have evolved enormously over the past few decades, but how can we prevent them from occurring in the first place. Know that the earlier you treat a headache, the less likely it is going to progress into a serious migraine. Anti-inflammatories, triptans, ergotamines and other drugs are often highly effective in aborting the early migraine headache. When left to fully develop these headaches just get worse. Lying down in a dark room and taking stronger painkillers is often the only option left.

Many natural approaches can help reduce the frequency and intensity of migraines. A recent research report found that melatonin, usually used for insomnia, is statistically better with less side effects than amitriptyline, a standard drug for migraine prevention. Melatonin 3 mg dosed at bedtime reduced migraine attacks by over 50 percent while improving sleep. Surprisingly, it helped patients lose weight. It is inexpensive, available over the counter, with few if any side effects or drug interactions.

Chelated Magnesium at 350 to 500 mg daily (fumarate, glycinate), Butterbur 100 to 150 mg daily, CoEnzyme Q 10 150 to 300 mg a day, Vitamin B2 (riboflavin) 200 mg twice a day have all been clinically shown to reduce frequency of migraine headaches. Both olive oil and fish oil have also been found to reduce headache frequency.

Other non-pharmacological approaches include avoiding dietary triggers like red wine, dark beers, aged cheese, some nuts, onions, chocolate, aspartame, processed meats containing nitrates, or other food sensitivities. Caffeine provokes headache in some folks but for others, a stout dose of caffeine can treat a migraine. Some migraine medicines include caffeine because of this.

Improving how you manage stress, improving sleep, utilizing biofeedback, cognitive behavioral therapy, self-hypnosis, mindfulness meditation, bodywork, bioenergetics, chiropractic, massage and acupuncture can all be useful in migraine prevention.

So back to Tracy. We started her on acupuncture, melatonin, an anti-inflammatory diet, and magnesium to treat her frequent migraine headaches. Over the period of a few months, her migraine frequency dropped from 3 to 4 times weekly to a couple times a month. Her other headache conditions also improved and she reports a significant improvement in her quality of life. She no longer misses days of work due to migraine headaches and is able to take photographs as much as she wants.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.