Supplements and Herbs to Prevent Migraine
Roger K. Cady, MD
Approximately 50% of migraineurs self-manage attacks of migraine, relying on combinations of over-the-counter (OTC) medications, herbal or homeopathic remedies. Even though these products are not prescribed, they are often effective and useful in managing migraine. Like prescription medications they can be classified into two categories: acute or preventive. Acute treatment is used to stop a migraine after it has started. Preventive treatment protects the migraine nervous system and the migraine threshold, to lessen the likelihood of future migraine attacks. Herbal and supplemental products can enhance prescription medication to treat, prevent, and manage migraine. They are also frequently used as alternatives to prescription medications to assist sleep and increase vitality. OTCs, herbal medications, and supplements are popular because they are readily accessible and often less expensive then prescription medications. They should however be considered medications and reported to your healthcare provider.
The following is a list of proven supplements and herbal products used for migraine.
Melatonin is produced naturally in the brain, mainly by the pineal gland. Melatonin tablets are usually produced synthetically. It is a neurohormone synthesized from an essential amino acid called tryptophan and is involved in the regulation of bodily rhythms such as temperature and sleep. Within the brain, it is released by darkness and suppressed by light. For this reason, tablets should be taken 1 to 2 hours before bedtime. Because melatonin promotes a healthy sleep pattern and sleep disturbance often increases the frequency of attacks in migraineurs, it often is an effective way to facilitate sleep and protect the nervous system and the migraine threshold from becoming overly stressed. There have been no studies to support this principle. Higher doses of melatonin are used to prevent cluster headache but this should be discussed with your healthcare provider.
Historically feverfew was used to reduce fever; its effectiveness is captured in its name. A formulation of species-specific dried chrysanthemum leaves, its active ingredient is parthenolide, but the product also contains melatonin. Parthenolide is known to block inflammationand reduce pain. Taken daily, feverfew has been shown to reduce the number and severity of migraine attacks by 24% in one study. It has been used to both prevent and treat migraine and some studies but not all demonstrate effectiveness in these roles. Read the label carefully because the dosage strength has been shown to vary by 400% based on the brand you buy. Advantages include cost and it will not generate medication overuse or rebound headache. It is contraindicated during pregnancy and while breast-feeding.
While adults without migraine contain about 24 grams of magnesium in their bodies, studies have shown that migraineurs often have low levels of magnesium in the brain during migraine attacks. Magnesium plays a vital role in the physiological processes of the body and is an important component in a healthy diet. Rich sources of magnesium are nuts, cereals, grains, coffee, cocoa, tea, and vegetables. Magnesium is considered nature’s brake pedal. It can reduce muscle tension, quiet nerve activity, and lower blood pressure.
Even though clinical trials have resulted in mixed results, clinical experience has demonstrated that a long-term dose of 400 to 600 mg per day for 3 to 4 months may be required to achieve benefit as a migraine preventive. A major issue with magnesium is that it is not always absorbed well. Some suggest using chelated magnesium or a slow-magnesium product as these have better absorption. There have been no studies that compared the effectiveness of different magnesium formulations. If too much magnesium is ingested, diarrhea often occurs but stops when the magnesium dose is lessened. Magnesium is safe unless a person has kidney disease.
Riboflavin is water-soluble essential vitamin B2 and is found in small amounts in foods such as lean meats, eggs, legumes, nuts, green leafy vegetables, and dairy products.
In one study, a dose of 400 mg per day for 3 months was reported to reduce the frequency of migraine by 50%. As a daily dose, riboflavin may reduce the frequency of migraine attacks. It is readily excreted from the body and not associated with toxicity.
Petasitescomes from the root of a perennial shrub that grows wild throughout Europe as well as in parts of Asia and North America. Historically, its large leaves wrapped butter to keep it congealed during warm weather and was nicknamed butterbur. For centuries it was a remedy for pain, fever, and muscle spasms.Because the plant contains liver-toxic pyrrolizidine alkaloids, the German Health Authority uses a special patented treatment that removes the toxin and certifies the brand name Petadolex as nontoxic. There have been two studies with adult subjects that have demonstrated effectiveness of petasites to prevent migraine. Maximum response was achieved by 71% of 289 subjects after 3 months of 75 mg twice a day (bid) that resulted in reducing the frequency of attacks by 58%. Over a 4-year period, 29 children and 79 adolescents participated in a study that demonstrated migraine attacks were reduced by 63% while taking butterbur.
Coenzyme Q10 (CoQ10)
Coenzyme Q10 is produced by the body and is present in most cells with highest concentration in the heart, liver, kidneys, and pancreas. It is involved in the creation of adenosine triphosphate (ATP), which is the cells’ major energy source and drives biological processes such as muscle contraction and the production of protein. It also is an antioxidant.Food sources include meat (especially liver), oily fish (salmon and tuna), and grains.
As a food supplement, it is synthesized by fermenting sugar beets and sugar cane with special strains of yeast according to a Japanese patent and marketed for a wide range of conditions. The compound is thought to enhance cell function by boosting their energy production.
In one study, 32 migraineurs were treated with CoQ10 at a dose of 150 mg per day over a 3-month period. As a result, 61% of them had a greater than 50% reduction in number of days with migraine. There was also a reduction of days with nausea.Researchers believe it holds promise for the treatment of pediatric migraine. It is contraindicated for pregnant women and those breast feeding.
Table 1.Herbal/Natural Migraine Therapies
Melatonin 0.3 mg to 10 mg
Feverfew tablets 50 mg to 82 mg/day
Magnesium tablets 400 mg to 600 mg/day
Riboflavin tablets 400 mg/day
Petasites 75 mg*
Coenzyme Q10 (CoQ10)
75 mg bid
50 mg to 300 mg
* Evidence for moderate efficacy from at least two well-designed placebo-controlled trials.
Successful management of migraine is a journey of fine-tuning the unique hyperexcitable nervous system of the migraineur and discovering how the environment interacts with this system to produce attacks.Even though there is no cure for migraine, there are tools to control the system’s reactivity.Finding the right supplement, herb, or combination may help desensitize the system and open up a more predictable lifestyle.When selecting herbal products and supplements, it is wise to look for products with high manufacturing standards. Usually your pharmacist or health food assistant can advise you in this regard.