[SIDE EFFECTS]  11/07/2008: Cindy from Silver Spring, MD writes: "MSM & Migraine Headaches:

I tried MSM after reading in several places it helps w/joint deterioration & pain, & also seeing that it is a component of several glucosamine & chondroitin supplements.

Years earlier, my orthopedic surgeon (a Johns Hopkins University professor) recommended Cosamin DS (a brand of glucosamine & chondroitin w/no added MSM), which he also takes, because it's purity & dosage accuracy were verified in (independent, double blind, placebo controlled) research trials. I took the it for years w/no side effects, & w/much pain relief & improved function. I saw other brands of glucosamine & chondroitin w/MSM, which Cosamin DS does not contain.

My doctor was not opposed to my trying MSM, but he was adamant I stick w/Cosamin DS, although it costs more than most other brands. My pets' vets also insisted I use the same company's pet formulation (Cosequin) & not switch their brand. I decided to stick with it, but add in MSM separately, which my doctors did not oppose.

Within a couple of days after starting MSM, I developed a migraine. Initially mild, it worsened over the next 10 days, becoming severe. I'm prone to both muscle spasm & migraine type headaches, & can distinguish clearly between them. I didn't initially attribute the migraine to MSM, since so many other things can trigger migraines, including stress, irregular sleep, hormonal cycles (especially during peak estrogen levels), as well as certain foods/beverages, medications, smoke, fragrances, & chemical odors/fumes.
I'd learned I must stay on a preventative medication (in my case Verapamil), which enables me to avoid most migraines. With it, I can get away w/some things which otherwise trigger my migraines, including certain favorite foods (in small amounts) & unavoidable whiffs of problem scents & tobacco smoke. (See list of common migraine triggers at end, if interested).

I stayed on the MSM, regulated my sleep cycles (no late nights or sleeping in), avoided stressors, & avoided known migraine triggers--including the foods I sometimes 'cheated' on & places where I could be exposed to problem scents or smoke (malls, rest rooms, smokers, crowds, etc.). Friends & family helped by not exposing me to perfumes or scented products & staying across the room if they had tobacco smoke on their clothes.

These measures had always worked in the past, but this migraine did not lessen. An increase to the maximum dose of Verapamil did not help. I temporarily went on a diet of unprocessed foods w/simple ingredient lists, began stress reduction techniques, & avoided new medications & household or personal products, to no avail. After a 5 week period in which I should have been through a full female hormonal cycle (& into the next one) w/no reduction or fluctuation in severity of the migraine, I was concerned. By week 6 I was spending a lot of time in a dark, quiet room, & getting a little desperate. Lights were like daggers & sounds were like bomb blasts. I considered a trip to downtown Washington, DC, to see a trusted migraine specialist, but couldn't imagine making the trip.

As I looked back for what was new in my regimen since onset of the migraine, I considered the MSM. It seemed so innocuous, but it was the only truly new variable I could identify. No literature available to me at the time I first considered taking it had mentioned anything about MSM & headaches. There was little mention of side effects at all, other than sulfa allergy, at the time. I asked two pharmacists, but neither had heard of MSM triggering headaches, nor had my doctors.

It made sense to all of us that I stop the MSM immediately, but if the migraine ceased, we knew it could be coincidence. The migraine DID cease within about a week of stopping the MSM, & I went back down to my original dose of Verapamil a week later. My primary doctor suggested I just stay off MSM.

However, MSM was enough help for my joint pain that I wanted to be as sure as possible that it was not coincidence that the migraine ceased after stopping MSM. I waited a month, during which I stayed on my migraine reduction/avoidance routine & had NO migraines. Then, while continuing this routine, being careful to add in no new foods, products, medications, or other supplements, I restarted the MSM.

Unfortunately, the migraine returned again, about a week after restarting the MSM while eliminating all other variables that I could control. Of course, there were variables I could not control outside a research setting, including my own knowledge of whether I resumed taking the MSM & when. However, there have been so many times I thought things would cause me a migraine but they did not do so (or conversely I thought they would not cause a migraine but they did), that I strongly suspected the MSM was the cause of my protracted status migrainosis.

About 4 years later, I was diagnosed w/a more severe joint disease, which eventually causes destruction of the entire affected joint. With 8 major weight-bearing joints involved & few treatment options, I decided to try MSM one more time. I had been nearly migraine-free for the better part of a year. With my doctors' agreement, I went doubled my Verapamil (to the maximum dose), went back on my strict migraine avoidance/reduction routine, waited 10 days so my body had the full benefit of these measures, & restarted MSM.

This was my third trial of MSM. I took what I was told was likely the minimum effective dose. On this trial, I intentionally chose a different brand of MSM, in hope that any additive or contaminant in the first brand which might potentially have caused the first 2 migraines would not be present in this new brand.
This time, I developed a migraine 3 days after starting MSM. (Usually, things that trigger migraines in me most strongly do so overnight if ingested orally, but fragrances/fumes/smoke do so w/in minutes, via the nasal route. Things less "migrainogenic" for me take 2 to several days at 1 serving/day, but act more quickly w/several servings daily. While I wish there was an environmentally controlled, double blind, placebo-controlled study of MSM side effects, so most other variables could be eliminated, after 3 trials I consider it very likely that MSM caused my migraines, despite use of a migraine-reducing medication, & consider it likely it would do so in others who are prone to migraine headaches.

Migraine triggers:
This is somewhat individual, & doctors don't all agree on items, such as tomatoes.
-Foods: For me, migraine triggers include all foods & beverages high in tyramine (an amino acid), so I eat a low tyramine diet, eliminating or reducing foods such as tomatoes (fresh are less of a problem than tomato sauce, catsup, or paste), some fruits including bananas & all citrus fruits, a few veges & beans including avocados & fava beans, processed or organ meats including liver, hot dogs, balogna, & salami, cultured dairy products such as yogurt, buttermilk (regular milk is OK), & aged cheeses (fresh cheeses such as cottage & farmer cheeses are about all that are OK), fermented products including all alcoholic beverages (red wines are notorious), soy sauce, chocolate, monosodiumglutamate, abbreviated "MSG", (which legally can be hidden on food package ingredient lists in the U.S. under the term "natural flavoring"), etc.
-Caffeine* (including in coffee, tea, & some medications including some headache medicines)--ironically, caffeine can both help treat migraines & can trigger migraines, so avoid it unless you have a migraine already, but if you get one & have no other remedy available, it is worth a try to have a cup or two of tea.
-Estrogens in food or medicine: Foods high in natural estrogen-like compounds such as sweet potatoes & soy beans, plus medications w/estrogen (even w/low-dose estrogen, such as some birth control pills & hormone replacement therapy), & including the estrogen-like compounds now known to leach out of plastic food & beverage containers such as milk or water jugs
-NSAIDs, or nonsteroidal anti-inflammatory drugs: such as Motrin (Ibuprofen), Alleve/Naprosyn (Naproxen sodium), Feldene, Clinoril, Indocin, etc. which are said to cause a rebound effect, intially helping, but making migraine worse w/continued use (but Tylenol, which is not an NSAID, seems to be OK)
-Other medications: Variable. (According to at least one specialist, narcotic pain medications make migraines worse, though in my experience this is NOT the case if the person is on a stable, long-term dose. Rapid increases, reductions, or fluctuations in dose DO trigger migraines, in my experience.
-Smoke: Tobacco smoke(including second-hand), & other smoke including wood smoke, & incense
-Perfumes, Colognes, & Scented Products: highly individual but includes air freshener products in all forms, scented soap or laundry detergent, fabric softener, scented oils (including for aromatherapy), scented candles, scented personal products, such as shampoo, conditioner, hair spray, scented lotions, etc., & scented household cleaning products, including scented air or surface disinfectant sprays
Chemical odors: including unscented household cleaning products w/fumes, freshly printed newspapers, nail polish remover (acetone), "liquid bandages", many disinfectant sprays, moth balls, dry cleaning chemicals, gasoline, diesel fuel, kerosene, propane, natural gas, "bug sprays" (insecticides), "weed killers" (herbicides), fungicides, formaldehyde (including in plywood, & as preservative for animals used for dissection in biology labs such as in high schools & colleges), paint fumes, glues (white glue is usually OK), various solvents

Hint: If you smell a problem scent unexpectedly when out in public, try breathing through your mouth until out of range. If it is just a matter of a few steps to get out of range of the scent, hold your breath & walk rapidly upwind (if outside) & away. Apparently it is the short, direct route from the nasal nerves to the brain (&/or blood supply to the blood-brain barrier) which allows such rapid migraines induction from scents. When one inhales the same substance through the mouth to the lungs, avoiding nasal exposure, these substances do not seem to trigger rapid-onset migraines. They can still trigger breathing problems in those w/asthma."