For MIGRAINES, our clinic patients enjoy significantly fewer headaches over years taking a mixed natural vitamin E family that includes alpha, beta, gamma, and delta tocopherols and the four tocotrienols. The benefits for improving blood flow are well documented: The vitamin E family including all four tocopherols helps reduce migraine by making the LDL “bad” cholesterol molecule less “sticky” and by reducing platelet clumping via its antioxidant action. Tocotrienols, the other main four vitamin E family members, have specific blood flow benefits: they have been found to promote healthy artery function and improve protective vital brain circuitry. The vitamin E family including tocotrienols reduces levels of C-reactive protein and cytokines, preventing inflammatory damage to blood vessels.

What is the vitamin E “family”?

The vitamin E family is made up of a group of eight constituents: every one of them has specific and important actions, and they work together in nature to enhance each other’s benefits. There are two chemically related categories known as tocopherols and tocotrienols, each of which has important antioxidant, cardiovascular, hormone, and immune activity in the body. The vitamin E family members include d-alpha, d-beta, d-gamma, and d-delta tocopherols, and alpha, beta, gamma, and delta tocotrienols. These eight forms of vitamin E need each other to work effectively, and their efficacy and bioavailability to the body are greater than if only simple d-alpha vitamin E is used.

While the natural tocopherols have documented health benefits for migraine relief and as hormone modulators, antioxidants, and immune supporters, the alpha, beta, gamma, and delta tocotrienols bring additional brain circulation, heart, and blood sugar benefits that tocopherols lack. Studies that showed little effect from vitamin E supplementation too often used only alpha tocopherol, rather than including the other important tocopherols and tocotrienols. The synthetic dl-type of tocopherols have no health benefits, may not even be safe, and resulted in even more ineffective studies. We caution patients to avoid unnatural dl-vitamin E.

What causes migraines?

Vascular instability and neurological dysfunction are both likely to play roles in causing migraines. Inflammation can trigger vasodilation–where blood vessels dilate and blood rushes in with a drop of pressure; or vasoconstriction–where blood vessels are narrowed, blood flow slows, and pressure inside arteries and veins increases. Sudden narrowing and then dilation of blood vessels is common with migraines.

Inflammation and oxidative damage can also injure neurons by increasing free radicals. An imbalance of neurotransmitters including GABA, serotonin, and acetylcholine affects blood flow. Likewise, hormones are linked with either vasodilation or vasoconstriction, and imbalances of cortisol, melatonin, testosterone, and estrogen can disturb brain blood flow and aggravate migraines.

How does the vitamin E family help relieve migraines?

The vitamin E family has powerful antioxidant actions without which our tissues would be very vulnerable to free radical damage. This is particularly important in brain function since oxidative stress triggers migraines. The brain is especially vulnerable to free radical injury because of its high oxygen consumption rate, its abundance of lipid membranes that can too easily become oxidized, and its relative lack of its own innate antioxidants. A potent brain and nerve cell protector, the vitamin E family promotes healthy blood vessel function that in turn supports healthy neurotransmitter activity.

Experts consider vitamin E to be one of the most potent antioxidants, bringing important migraine preventive and relieving benefits. Antioxidants protect cell membranes and prevent damage to their enzymes and all other contents within. Without this antioxidant protection, our tissues would be very vulnerable to the harmful effects of free radical damage, which is a known migraine trigger. Free radicals are rogue molecules with an unpaired electron that seek out electrons from bodily tissues and cells. In the oxidizing process, tissues are damaged by disruption of their normal structure.

What is the mechanism of action of the vitamin E family?

For migraines and protecting essential organs like the brain, the vitamin E family of mixed natural tocopherols and tocotrienols has several mechanisms of action:

• As a key antioxidant, the vitamin E family helps prevent the oxidation of cells and hormones. It is protective of cell lipids and helpful fatty acids throughout the body, while maintaining the integrity of hormones released by the pituitary and adrenal glands.
• The vitamin E family recharges the antioxidant vitamin C for further tissue protection, stabilizing cell membranes, and inhibiting platelet clumping, all of which enhance healthy blood flow and reduce migraine incidence.
• As a vascular tonic, these nutrients work together to improve blood flow, prevent clots, and open blood vessels, all contributing to better perfusion and oxygenation of tissues.
• The vitamin E family helps to prevent tiny clots of red cells or clumps of platelets, and stabilizes blood vessel cell membranes, to ensure good steady brain blood flow and enhance healthy blood pressure. Tocotrienols have particular cardiovascular benefits that tocopherols alone lack: The tocotrienol group promotes new artery formation in tissues whose blood flow was compromised and protects nerves and vital brain circuitry. The vitamin E family also stabilizes atherosclerotic plaques, if they do form, so they are less likely to burst or block an artery.
• It helps to maintain cognitive sharpness and mental acuity.
• The mixed natural vitamin E family can calm inflammation, which in turn can ease migraines: The tocotrienols in particular reduce levels of C-reactive protein and cytokines, which cause inflammatory damage to blood vessels and impede healthy circulation.

Tocotrienols independently work to protect against migraines in several ways:

• The vitamin E family and especially tocotrienols are blood thinners, reducing clot risk.
• They slow the breakdown of arachidonic acid (the brain’s most abundant brain fatty acid) into inflammatory molecules, that could otherwise cause inflammation and tissue injury.
• Vitamin E and the tocotrienols protect against widespread oxidative damage to neurons, peripheral nerves, heart tissue, and organs.
• Additionally, the vitamin E family and particularly tocotrienols encourage the formation of new arterioles to bring blood flow to all tissues including brain tissue and any oxygen-deprived areas.

The cardiovascular system including blood flow in the brain benefits greatly from the vitamin E family. If a clot does block a blood vessel, then alpha- and gamma-tocotrienols particularly can protect the heart, brain, and any tissues that lose blood flow and are at risk of injury and cell death from oxygen lack. Tissues that are deprived of blood flow, known as ischemia, suffer less tissue injury and death in the presence of tocopherols.  

The science behind vitamin E and migraines

Oxidative stress has been proposed as a relevant factor in the pathogenesis of migraines. Oxidative stress is determined by measuring coenzyme Q10, catalase, and lipid peroxidation (LPO) levels. Oxidative stress and LPO play a role in migraine by regulating cerebral blood flow and energy metabolism. If either of these are compromised that can constitute a trigger threshold for migraine attacks. In an important 2009 study, 50 migraineurs, 50 patients with tension-type headaches, and 50 control subjects were included. Migraineurs had worse measured indicators of oxidative stress than the subjects in the other two groups, even between headache episodes. This indicates a benefit of the Vitamin E family for ongoing protection to reduce oxidative stress and migraine severity.¹

Recognizing that the cause of migraines is multifactorial with genetic components and environmental interactions as the main causal factors, a 2015 study looked at the Vitamin E family for preventing migraine with aura and menstrual migraine. Menstrual migraine is associated with increased prostaglandin levels in the endometrium indicating a role for vitamin E, which is a progesterone antagonist, especially for the progesterone fluctuations that occur during the menstrual cycle.²

The vitamin E family is an anti-prostaglandin agent with no or minimal side effects which can effectively relieve migraine headache pain and associated symptoms. Research shows that the vitamin E family significantly helps menstrual migraine symptoms. During a placebo-controlled double-blinded trial, 72 women with menstrual migraine received placebo daily for 5 days, 2 days before to 3 days after menstruation for 2 cycles; this was followed by a 1-month wash-out and one mixed vitamin E (400 IU) daily for 5 days in the next 2 cycles. The women receiving vitamin E had statistically significant reduced migraine severity and less functional disability compared to the placebo group. The Vitamin E effect was also superior to placebo regarding photophobia, phonophobia, and nausea; typical side-effects for migraineurs. Additionally, with the use of vitamin E therapy (400 IU daily for 5 days during menstruation for 3 cycles), there were no reported breakthrough headaches.^3,4

The evolution of a migraine starts with a trigger: When your brain perceives the trigger, it begins a cascade of events. The headache will start developing within two hours or two days. In the beginning, blood vessels in your forehead start to swell. This causes nerve fibers, which are coiled around the blood vessels, to release chemicals causing pain and inflammation.

A vicious cycle develops: The inflammation makes the blood vessels enlarge even more, making the pain only worse. When this chain-reaction process goes on for an hour or two, it achieves a new threshold.

“It’s called ‘central sensitization,’ and it tends to perpetuate the headache,” explains Seymour Solomon, MD, director of the Montefiore Headache Unit at Albert Einstein College of Medicine.  At that point, the chain reaction of pain begins traveling along nerve pathways throughout the head, to the base of the neck, and the spine. The vitamin E family stops this chain reaction before it reaches this point, making it especially helpful.

Research presented at the 2016 Annual Scientific Meeting of the American Headache Society in San Diego revealed that a significant portion of kids, teens, and young adults who suffer from migraines are mildly deficient in essential vitamins, which could include the vitamin E family. Blood samples from a database of 7,420 patients at the hospital’s headache center confirmed which nutrient or vitamin deficiencies have been linked to migraine risk in past research.

Researchers believed that the finding of several vitamin deficiencies in patients with migraine suggests an underlying gut absorption issue, most likely related to inflammation. Although it was concluded from a large, randomized, and controlled trial among migraine sufferers that specific vitamins can reduce migraines, it was indicated that, unlike new pharmaceutical drugs with their risks, most vitamin supplements are very safe to take.⁵ Thus we feel that a therapeutic trial of the mixed natural vitamin E family, or any relevant nutrients, is always worthwhile for migraine sufferers.

The vitamin E family’s tocopherols and tocotrienols are also antioxidants for the cholesterol molecule, protecting it against becoming damaged and sticky. If it is less likely to adhere to artery walls, then even a higher total cholesterol is less risky for blocking arteries or potentially triggering migraines.

Our patients’ experience with the vitamin E family

Our clinic patients report fewer migraines with lower pain severity over years of taking the mixed natural Vitamin E family with all eight tocopherol and tocotrienol members. For preventative benefits from migraines, we see the best results with all the tocopherols and tocotrienols that work synergistically together, as they occur in nature. This blend offers the best brain, cardiovascular, nervous system, and immune protection. Regarding occasional media reports about safety concerns for ‘vitamin E,’ our view is that these concerns apply solely to the synthetic dl-form, a mirror image of naturally occurring vitamin E, which does not exist in nature, e.g., dl-alpha tocopherol. This unnatural isomer may actually be detrimental if it blocks the beneficial d-form from entering cells. We recommend only the eight-constituent mixed natural form, preferably with generous amounts of the tocotrienols. We look for a guaranteed non-GMO formula in an absorbable and gentle natural base such as sunflower oil.

Recommendation: Mixed natural vitamin E family, including proportions such as d-alpha tocopherol 400 IU, d-Gamma tocopherol 100mg, d-Beta and d-Delta tocopherol 40mg. Ideally, we also like to have tocotrienols of 20mg, including proportions like gamma tocotrienol 12mg or more, alpha tocotrienol 5 to 8mg, beta and delta tocotrienols 2 to 4mg. Take 400 IU once or twice daily with any meals, or as directed by your healthcare provider.

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