SEPTEMBER 2000 MEETING NOTES
TOPIC:  “5-HTP FOR TREATMENT OF MIGRAINE HEADACHES”

Richard I. Gracer, M.D., introduced 5-HTP as an alternative therapy for headaches at the September 12, 2000 meeting of the East Bay Headache Support Group.  The meeting was held in the Ball Auditorium at John Muir Medical Center with 24 in attendance.

Dr. Gracer has been practicing orthopedic medicine since 1979.  He is also board certified in Family Practice and Chronic Pain Management.  His practice in Lafayette, CA offers a full range of medical services, from immunizations to geriatric care.  He has also served as chief of Family Practice at the San Ramon Regional Medical Center, and currently is an Assistant Clinical Professor of Community and Family Medicine at UC San Francisco School of Medicine. 

When Dr. Gracer noticed that people were “falling through the cracks,” he started using alternative practices.  Dr. Saputo’s Health Medicine Forum further piqued his interest in chronic pain management and nutritional aspects.  He has come across many various treatments and considers all inputs.  Dr. Gracer said, “It isn’t a migraine headache, it is a person with a migraine headache.”  He stressed that treatment of headaches should be individualized, and he commented that he has been fairly successful in his approach.

Dr. Gracer reviewed a significant amount of literature about 5-HTP, which stands for “5-Hydroxytryptophan.”  5-HTP is a metabolite in the chain of reactions that takes L-tryptophan, an amino acid, and converts it to serotonin.  The final metabolite of serotonin is 5-HIAA and others (which can be measured in the urine).  The conversion of 5-HTP to serotonin is catalyzed by Vitamin B6.  There had been a prior use of L-tryptophan, but it contained a contaminant which caused a myalgia syndrome.  Nowadays, people use 5-HTP.  When it is given orally it raises levels of serotonin in the brain.  Vitamin B6, because of its role in the conversion of 5-HTP to serotonin, is very important.  It also requires magnesium.

Studies on 5-HTP are mainly “open studies.”   The patients know that they are getting the actual medicine/chemical.  This causes a very high placebo response.  Conversely, “controlled studies” employ a placebo and the actual drug with neither the investigator nor the patient knowing they are getting the placebo or drug.  When 5-HTP is given for depression, 5 out of 7 studies show some improvement.  This is about equal to the response seen with the pharmacological agents.  Studies using SSRI’s for chronic pain have not been that positive.  This may be because adjusting levels of epinephrine in the brain might be more important. 

Dr. Gracer mentioned one headache study of 15 patients who received 5-HTP daily.  The conclusion was that it showed no benefit.  In a study using it for tension-type headache, published in "Headache," there was no difference in the headache frequency or severity, but there was a decrease in use of concomitant pain medications.  Yet another study showed an improvement in headache frequency, but the numbers were not statistically significant.  This study suggested using it along with another medication.  When compared to Propranolol it seemed to be somewhat effective.  One study showed that it may help those patients who have “mood triggers.”  Dr. Gracer feels that it may be helpful. 

Caution should be exercised when 5-HTP is given along with SSRI’s, but it likely can be given safely along with “triptans.”  He said that it likely will be used as a second medication or supplement along with other medications.  Side effects are usually mild and affect the gastrointestinal system.  The quality of 5-HTP may vary widely:  Certain brands such as “Thorn” are uniformly high quality.

Riboflavin, or Vitamin B2, is important in energy production.  There have been reports that a high dose riboflavin (200 mg twice a day) is helpful, but exactly how it helps migraine isn’t known.  The patient should try taking it 1-2 months at least to be sure it is or isn’t helping.

Magnesium is an important element.  The body pumps magnesium into cells and calcium out of cells.  When there is a disparity in the ratio of magnesium to calcium in the cells, the energy of the cell may change.  This might lead to migraine.  When magnesium is given intravenously, it can help headaches.  Measures of serum magnesium do not tell the state of intracellular magnesium.  To get oral magnesium, Dr. Gracer recommends taking multivitamins with magnesium.

Dr. Gracer’s overall approach to migraine is to look at the entire individual, and to individualize therapy.

The intention of the East Bay Headache Support Group is to provide information and resources.  It does not provide medical advice, which should be obtained directly from a physician.