Migraine Headache

Double-blind trials have demonstrated that butterbur extract can reduce the frequency of migraine attacks significantly better than placebo.^1,2 One study has also shown it helps reduce the frequency of migraine headaches in children and adolescents, though there was no control group so it is not as clear just how effective butterbur extract is in this population.³ In a double-blind trial, supplementing with an extract of butterbur (Petasites hybridus) for four months was significantly more effective than a placebo at reducing the frequency of migraine attacks.⁴ The amount of butterbur found to be effective was 75 mg twice a day of an extract standardized to contain at least 15% petasins. A smaller amount (50 mg twice a day) was ineffective. The most common side effect was burping.

The most frequently used herb for the long-term prevention of migraines is feverfew.⁵ Four double-blind trials have reported that continuous use of feverfew leads to a reduction in the severity, duration, and frequency of migraine headaches,^6,7,8,9 although one double-blind trial found feverfew to be ineffective.¹⁰

Studies suggest that taking standardized feverfew leaf extracts that supply a minimum of 250 mcg of parthenolide per day is most effective. Results may not be evident for at least four to six weeks. Although there has been recent debate about the relevance of parthenolide as an active constituent,¹¹ it is best to use standardized extracts of feverfew until research proves otherwise.

A double-blind study found that a combination of feverfew and ginger may be effective for acute treatment of migraines. In that study, 63% of patients taking the herbal preparation experienced pain relief within 2 hours, whereas only 39% taking placebo experienced relief, a statistically significant difference. The product used in this study was a proprietary preparation called LipiGesic M (PuraMed BioScience, Inc., Schofield, WI). The liquid from 1-unit dose applicator was administered sublingually, held under the tongue for 60 seconds, and then swallowed. A second dose was given 5 minutes later. If pain persisted after 1 hour, a second treatment of 2-unit doses could be given.¹² 

Compared with healthy people, people with migraines have been found to have lower blood and brain levels of magnesium.^13,14,15,16 Preliminary research in a group of women (mostly premenopausal) showed that supplementing with magnesium (usually 200 mg per day) reduced the frequency of migraines in 80% of those treated.¹⁷ In a double-blind trial of 81 people with migraines, 600 mg of magnesium per day was significantly more effective than placebo at reducing the frequency of migraines.¹⁸ Another double-blind trial found that taking 360 mg of magnesium per day decreased the number of days on which premenstrual migraines occurred.¹⁹ One double-blind trial found no benefit from 486 mg of magnesium per day for three months. However, that study defined improvement according to extremely strict criteria, and even some known anti-migraine drugs have failed to show benefit when tested using those criteria.²⁰ Intravenous magnesium has been reported to produce marked and sometimes complete symptom relief during acute migraines, usually within 15 minutes or less.²¹

One group of researchers treated 49 migraine patients with large amounts of vitamin B2 (400 mg per day). Both the frequency and severity of migraines decreased by more than two-thirds.²² In a follow-up three-month, double-blind trial, the same researchers reported that 59% of patients assigned to receive vitamin B2 had at least a 50% reduction in the number of headache days, whereas only 15% of those assigned to receive a placebo experienced that degree of improvement.²³ The effects of vitamin B2 were most pronounced during the final month of the trial.²⁴ In a preliminary study, a much smaller amount of vitamin B2 (25 mg per day for three months) reduced the frequency of migraines by about one-third in chronic migraine sufferers.²⁵

All of the studies that found riboflavin to be effective for preventing migraine were conducted in adults. In a double-blind trial, supplementation with 200 mg per day of riboflavin did not decrease the frequency or severity of migraines in children whose average age was 11 years.²⁶

The cause of migraine headache is believed to be related to abnormal serotonin function in blood vessels,²⁷ and 5-HTP (5-hydroxytryptophan, which is converted by the body into serotonin) may affect this abnormality. In one study, 40 people with recurrent migraines received either 5-HTP (200 mg per day) or methysergide (a drug used to prevent migraines) for 40 days. Both compounds reduced the frequency of migraines by about 50%.²⁸ Larger amounts of 5-HTP (600 mg per day) were also found to be as effective as medications for reducing migraine headache attacks in adults in two double-blind trials.^29,30 Migraine attacks were reduced in frequency, severity, and duration in 90% of those taking 400 mg per day of 5-HTP in a double-blind placebo-controlled trial,³¹ though another trial found no benefit of 5-HTP.³² In another controlled study, 400 mg of dl-5-HTP (another form of 5-HTP) led to reduced consumption of pain-killing drugs and pain scores after one to two months.³³ Children who suffered from migraines and had problems sleeping responded well to a daily amount of 5-HTP equal to 20 mg for every 10 pounds of body weight in a controlled trial,³⁴ though an earlier study showed 5-HTP had no better effect than placebo for children with migraines.³⁵

In a small double-blind trial, supplementation with 600 mg of alpha-lipoic acid once a day for three months significantly reduced the frequency of migraine attacks. However, this improvement was not statistically significant when compared with the change in the placebo group.³⁶ Additional research is needed to determine whether alpha-lipoic acid is effective for preventing migraines.

Blood levels of coenzyme Q10 have been found to be low in about one-third of migraine sufferers.³⁷ In a preliminary trial, supplementation of migraine sufferers with 150 mg per day of coenzyme Q10 for three months reduced the average number of days with migraine headaches by 60%.³⁸ The beneficial effect of coenzyme Q10 was confirmed in a four-month double-blind study. By the fourth month of treatment, a reduction in migraine frequency of 50% or greater occurred in 47.6% of people receiving 100 mg of coenzyme Q10 three times a day, but in only 14.4% of those receiving a placebo (a statistically significant difference).³⁹ However, another double-blind trial found that coenzyme Q10 was not more effective than a placebo in children with recurrent migraines, although children receiving coenzyme Q10 appeared to improve faster than those given the placebo.⁴⁰

The function of the pineal gland and its cyclic secretion of melatonin may be disturbed in people with migraine headaches.⁴⁴ Preliminary evidence suggests that 5 mg per day of melatonin, taken 30 minutes before bedtime, may reduce symptoms of migraine headache.⁴⁵ A double-blind trial found that taking 3 mg of melatonin at bedtime each day for 12 weeks significantly decreased the frequency of migraines in people suffering from recurrent migraines.⁴⁶ Another double-blind trial found that taking 2 mg of melatonin 1 hour before bedtime each day for 8 weeks was not more effective than a placebo for decreasing migraine frequency.⁴⁷

In the positive study described above, the reduction in migraine frequency was assessed only in the third month of treatment. It is possible that it takes a few months for melatonin to start working. The negative results in the other study cited above could have been due either to the shorter duration of treatment or to the lower amount of melatonin given.

In a preliminary trial, administration of 1 mg of vitamin B12 per day (by the intranasal route) for 3 months reduced the frequency of migraine attacks by at least 50% in 10 of 19 people with recurrent migraines.⁴⁸ A placebo-controlled study is needed to determine how much of this improvement was due to a placebo effect.

Caution: Calcium supplements should be avoided by prostate cancer patients.

Taking large amounts of the combination of calcium (1,000 to 2,000 mg per day) and vitamin D has been reported to produce a marked reduction in the incidence of migraines in several women.^49,50 However, the amount of vitamin D given to these women (usually 50,000 IU once a week), can cause adverse reactions, particularly when used in combination with calcium. This amount of vitamin D should be used only under medical supervision. Doctors often recommend that people take 800 to 1,200 mg of calcium and 400 IU of vitamin D per day. However, it is not known whether theses amounts would have an effect on migraines.

There is preliminary evidence that capsaicin, the active constituent of cayenne, can be applied inside the nose as a treatment for acute migraine.⁵¹ However, as intranasal application of capsaicin produces a burning sensation, it should be used only under the supervision of a doctor familiar with its use.

Fish oil containing EPA and DHA has been reported to reduce the symptoms of migraine headache in a double-blind trial using 1 gram of fish oil per 10 pounds of body weight.^52,53 Fish oil may help because of its effects in modifying prostaglandins (hormone-like substances made by the body).

Ginkgo biloba extract may also help because it inhibits the action of a substance known as platelet-activating factor,⁵⁴ which may contribute to migraines. No clinical trials have examined its effectiveness in treating migraines, however.

Interest in the effects of serotonin on the mechanisms of migraine has led to therapeutic trials using serotonin precursors such as L-tryptophan and 5-hydroxytryptophan (5-HTP).⁵⁵ Preliminary research has found abnormally low levels of serotonin in the brains of people suffering a migraine attack, which was reversed with L-tryptophan supplements.⁵⁶ A small double-blind trial found that four of eight people had fewer and less intense migraines while receiving L-tryptophan (500 mg every six hours).⁵⁷ Larger double-blind trials are needed to better evaluate L-tryptophan as a migraine prevention supplement.

In one study, 40 people with recurrent migraines received either 5-HTP (200 mg per day) or methysergide (a drug used to prevent migraines) for 40 days. Both compounds reduced the frequency of migraines by about 50%.⁵⁸ Larger amounts of 5-HTP (600 mg per day) were also found to be as effective as medications for reducing migraine headache attacks in adults in two double-blind trials.^59,60 Migraine attacks were reduced in frequency, severity, and duration in 90% of those taking 400 mg per day of 5-HTP in a double-blind placebo-controlled trial,⁶¹ though another trial found no benefit of 5-HTP.⁶² In another controlled study, 400 mg per day of DL-5-HTP (another form of 5-HTP, equivalent to 200 mg per day of 5-HTP per day led to reduced consumption of pain-killing drugs and pain scores after one to two months.⁶³ Children who suffered from migraines and had problems sleeping had an improvement in both migraines and sleep disorders after taking 5-HTP in the amount of 20 mg for every 10 pounds of body weight in a controlled trial,⁶⁴ though an earlier study showed 5-HTP had no better effect than placebo for children with migraines.⁶⁵

Preliminary research also suggests that oral supplements of SAMe (S-adenosyl-L-methionine) may reduce symptoms for some migraine sufferers.⁶⁶

Taking large amounts of the combination of calcium (1,000 to 2,000 mg per day) and vitamin D has been reported to produce a marked reduction in the incidence of migraines in several women.^67,68 However, the amount of vitamin D given to these women (usually 50,000 IU once a week), can cause adverse reactions, particularly when used in combination with calcium. This amount of vitamin D should be used only under medical supervision. Doctors often recommend that people take 800 to 1,200 mg of calcium and 400 IU of vitamin D per day. However, it is not known whether theses amounts would have an effect on migraines.