As the author of a best-selling book on Alternative Medicine (Alternative Medicine: The options, the claims, the evidence, how to choose wisely), I’m often speak to healthcare professionals about natural medications (herbs, vitamins, and supplements) for a variety of conditions. For some conditions there are more options than for others — and, fortunately, those who suffer from migraines have a number of options.
This is a good thing, because people who suffer from frequent migraines are often drawn to herbal remedies and vitamin or mineral supplements, and understandably so.
These headaches themselves can be debilitating, and the prescription drugs sometimes used to prevent them — including certain antidepressants, beta blockers, and calcium channel blockers — don’t always work and often cause side effects.
Of course, natural medicines also pose their own risks. And, as with all dietary supplements, there’s no guarantee that what’s on the label is actually in the bottle, since oversight by the Food and Drug Administration is minimal at best.
To find safe products, either (1) look for products labeled “USP Verified,” which have been tested by the U.S. Pharmacopeia for purity and potency, or (2) look for products at the subscription website of a great independent quality testing lab — ConsumerLab.com.
Here’s a recent report on Consumer Reports’ take on five commonly used migraine supplements. By the way, all five of these substances are rated “possibly effective” by what I consider the best source of information on the web for natural medicines, the Natural Medicines Comprehensive Database.
- Butterbur. An extract made from the root of this plant has been used medicinally for centuries. A 2004 study found that 75 milligrams of it taken twice daily worked better than a placebo, and suggested it might even be as effective as prescription drugs in reducing the frequency, intensity and duration of migraines. Adverse reactions include burping, fatigue, itchiness and stomach problems. Some butterbur products contain chemicals called unsaturated pyrrolizidine alkaloids, which can harm the liver. So only use those labeled “hepatotoxic PA-free,” which claim not to include that substance.
- The Natural Medicines Comprehensive Database says, “Taking butterbur orally seems to prevent migraine headache. A specific butterbur rhizome extract standardized to 15% petasin and isopetasin (Petadolex, Weber&Weber, GmbH & Co, Germany), and hepatotoxic pyrrolizidine alkaloids (PA)-free, can reduce the frequency, intensity, and duration of migraine headache when used over a period of 16 weeks. This butterbur extract seems to reduce the frequency of migraine by about 48%. Doses of at least 75 mg twice daily seem to be necessary for significant benefit. Lower doses of 50 mg twice daily may not be effective in adults. There is also preliminary evidence that this butterbur extract can decrease the frequency of migraine headaches in children aged 6-17 years.”
- To dose butterbur, the NMCD says, “For migraine headache prophylaxis, a pyrrolizidine alkaloid free butterbur rhizome extract standardized to 15% petasin and isopetasin (Petadolex, Weber&Weber, GmbH & Co, Germany) has been used in doses of 50 to 100 mg twice daily with meals. Higher doses seem to be more effective. Lower doses of 50 mg twice daily may not be effective in adults. Some researchers suggest taking the extract for 4-6 months, then tapering the dose until migraine incidence begins to increase. In children with migraine, a dose of 25 mg twice daily has been used in children aged 6-9 years and 50 mg twice daily in older children. Three times daily dosing has been used in children who don’t respond to the twice daily dose.
- Coenzyme Q10. The body’s cells make this substance, often called CoQ10. In one small study, taking 150 milligrams per day cut the number of days with migraines in half in most of the patients. Another study found similar results with 100 milligrams taken three times daily.
- The Natural Medicines Comprehensive Database says, “Taking coenzyme Q-10 orally seems to help prevent migraine headaches. Coenzyme Q-10 decreases the frequency of headaches by about 30% and the number of days with headache-related nausea by about 45% in adults. Taking coenzyme Q-10 also appears to reduce migraine frequency in children who have low levels of coenzyme Q-10. For reducing migraine frequency in adults, the number needed to treat (NNT) using coenzyme Q-10 100 mg TID for 3 months is three. It can take up to 3 months for significant benefit. Taking coenzyme Q-10 prophylactically does not seem to reduce the duration or severity of migraine headaches when they develop in adults.”
- For dosing, the NMCD recommends, “For preventing migraine headache, 100 mg three times daily has been used. A dose of 1-3 mg/kg has also been used in pediatric and adolescent patients.”
- Feverfew. The dried leaves of this weed have been used to ease headaches for centuries. And some research suggests that extracts of it reduce the frequency of migraines and ease the nausea, pain, vomiting and sensitivity to light and sound that they can cause. But others have found that feverfew is no better than a placebo. Most studies have used 50 to 100 milligrams of feverfew extract daily. It seems to be generally well tolerated, though in a few cases it may cause stomach problems and joint stiffness.
- The Natural Medicines Comprehensive Database says, “There is some evidence that taking feverfew orally can reduce the frequency of migraine headaches and reduce symptoms of pain, nausea, vomiting, and sensitivity to light and noise. It may be more effective in patients with more frequent migraine attacks. But there is also evidence that feverfew does not improve migraine symptoms or reduce the occurrence of migraine headache. These conflicting findings may reflect differences in the harvested feverfew plants, extracts used, or differences in bioavailability of commercially prepared feverfew products. A combination product containing feverfew, riboflavin, and magnesium doesn’t seem to reduce the frequency or severity of migraine any better than placebo. However, some problems with study design suggest that more research should be conducted on this combination.”
- To dose feverfew, the NMCD says, “For migraine headache prophylaxis, clinical studies have used 50-100 mg of feverfew extract daily. Most extracts used in clinical studies were standardized to 0.2% to 0.35% parthenolide content, however, this standardization does not appear to be necessary for effectiveness. Other studies have used a specific supercritical carbon dioxide feverfew extract (MIG-99) enriched with parthenolide.
- Magnesium. Some research suggests that migraine sufferers have low levels of this mineral in their brain. But studies that have used magnesium supplements to treat or prevent attacks have yielded mixed results. Common side effects are gastrointestinal, mainly diarrhea. Foods high in magnesium include fish, leafy green vegetables, nuts and whole grains.
- The Natural Medicines Comprehensive Database says, “Taking high-dose magnesium citrate or trimagnesium dicitrate orally seems to reduce the frequency and severity of migraine headaches. However, other research suggests that magnesium doesn’t have any effect. In children, treatment with magnesium oxide may also reduce the frequency and severity of migraine headaches. Most patients who benefit seem to have low magnesium levels.
- To dose magnesium, the NMCD says, “For reducing the frequency and severity of migraine headaches, magnesium citrate 1830 mg in 3 divided doses has been used for up to 3 months. Trimagnesium dicitrate 600 mg (24 mmol) daily for up to 3 months has also been used. For reducing the frequency and severity of migraine headaches in children, magnesium oxide 9 mg per kg in 3 divided doses has been used for up to 16 weeks.
- Riboflavin (vitamin B2). In a trial of 55 people with migraines, researchers gave half of them a daily 400-milligram dose of this B vitamin and the other half a placebo. After three months, more than half of those taking the vitamin showed substantial improvements, compared with 15 percent of those taking the placebo. Side effects can include diarrhea and frequent urination. And high intakes may cause yellow-orange urine. Foods high in riboflavin include cheese, leafy green vegetables, meat, milk, yogurt and enriched grains.
- The Natural Medicines Comprehensive Database says, “Taking high dose riboflavin 400 mg/day seems to significantly reduce the frequency of migraine headache attacks. Some evidence suggests that riboflavin might be as effective for reducing migraine headache frequency as the beta-blockers, bisoprolol (Zebeta) and metoprolol (Lopressor). Taking riboflavin does not appear to reduce the severity or duration of an acute migraine headache.”
- For dosing, the NMCD says, “For preventing migraine headaches, a dose of 400 mg per day has been used, and maximum benefit might take up to three months to achieve.”
For most of my migraine patients who want to try a natural medication, I start first with magnesium and riboflavin. Anecdotally, I’ve found many patients pleased with the results. I just have to let them know it can take 8-12 weeks for the supplements to have their full effectiveness.
For more information on these and other dietary supplements, including medications they might interact with, go to the Consumer Reports site here and click on the “Natural Health” tab.