In the recent years there has been increasing interest among people for “natural” treatment such as supplements, vitamins and herbs to control their migraine headaches. Today companies around the world are promoting a variety of supplements, herbal preparations and vitamins claiming their efficacy for migraine prophylaxis (prevention).
Among the most popular ones are riboflavin, magnesium, and coenzyme Q10 (CoQ10) while the most common herbal preparations are buttebur and feverfew.
Each of these may have some effect on the body and brain which helps in reducing migraine attacks, and some had at least one placebo-controlled trial that has amply demonstrate their efficacy.
Understanding Research Trials
During any placebo-controlled study, participating patients get a specific substance which is to be evaluated while the parallel group of patients is specifically treated with placebo treatment that appears identical to the patient, but has been designed specifically to have no real effect on them, such as dummy capsules or pills. Placebo is mostly used in clinical trials as a substance that is objective without any specific activity for the condition that is being treated, so all effects that are recorded can be attributed to the substance used.
Before being included in the study group, each patient is interviewed and researchers ascertain adequate amount of headache history, including age at migraine onset, attack severity, frequency, duration, absence or presence of aura, some associated symptoms (vomiting, nauseas, phonophobia, photophobia), and any family history of migraine.
Principles Of Pharmacologic Migraine Treatment
Once you’re diagnosed with migraine, the next important step is developing a good treatment plan. You want to do everything possible to reduce attack severity, frequency, and duration to improve your quality of life. Unfortunately, it’s not possible to cure migraine at present. It’s definitely a chronic health condition that can also be managed. Its treatment is likely to include both lifestyle changes such as eating and sleeping on time, exercises, and some medication. While you can get wide range of preventive and acute medications for the treatment, it’s well recognized that all those who are suffering from migraine can easily benefit from lifestyle changes in order to reduce severity and frequency of their headaches.
You would want to start treatment of your migraine but would like something “natural”, affordable, and without any side effects. So what are your options?
Also known as vitamin B1, riboflavin is found in small amounts in some foods. Body requires this vitamin for converting food to energy, and it also acts as a good antioxidant cleaning body of damaging free radicals.
Eggs, lean meats, green leafy vegetables, nuts, legumes, milk, and dairy products provide sufficient amount of riboflavin in the diet. Cereals and breads available on the market are often fortified with riboflavin. Light can destroy this vitamin, so always store it in a cool dark place. It’s stable when heated but will immediately leach in cool water, and with pasteurization process milk may lose 25 percent of its riboflavin content. Alkalis (baking soda, etc) can also destroy riboflavin.
Human Safety Data
Doses up to 400 mg per day are easily tolerated and no toxic symptoms have been reported in many studies carried out for at least 4 months. Because riboflavin is water-soluble, high doses are often excreted in the form of harmless yellow urine. While it’s non-toxic in adults, and its foetal toxicity is unproven, its supplementation in pregnancy is not recommended so it’s best to check with your doctor.
Potential Side Effects
Due to limited ability of adults to absorb riboflavin by mouth, it has limited potential for harm. High doses (above 400 mg) can cause side effects including numbness (insensitivity), itching, prickling/burning sensations, and yellow discoloration of urine. All those who have inadequate intake of food are at greater risk of deficiency, particularly kids in developing countries. Riboflavin also helps in absorption of iron, and it’s common to see iron deficiency with riboflavin deficiency.
Interaction With Other Drugs
Riboflavin is necessary for activating vitamin B6. Anti-malarial drugs, sulfa drugs, alcohol and oestrogen may interfere with riboflavin metabolism. Its high doses can also reduce the efficacy of anti-cancer drugs, while some phenothiazine drugs and antibiotics may increase riboflavin excretion.
Use For Migraine
In a study involving riboflavin alone, more than 65 migraine patients were studied and it was reported that 62 percent of the participants who took 450 mg/day riboflavin per day for three months experienced 47 percent reduction in migraine attacks as compared to 16 percent for placebo. So, statistically significant reductions in both migraine attacks frequency and number of headache days were reported. Some adverse events reported from these studies are limited to polyuria and diarrhea (passage of low volumes of urine), both occurring in very small number of patients.
An well-nourished adult contains about 26 grams of magnesium. Magnesium plays an important role in many physiologic processes and for this reason it’s a vital component of your diet. It is immediately absorbed through gastrointestinal tract (gut), with more amount being absorbed if its content is low in the body. It also improves calcium absorption.
Nuts, spices, coffee, tea, cocoa, vegetables, and cereals are rich sources of magnesium. Gains and nuts, we well as leafy vegetables, generally have high amounts of magnesium content than dairy products and meats.
No adverse effects have been reported with taking magnesium as a naturally occurring substance in foods. However, it’s excessive intake can have adverse effects if you consume supplements or salts rich that are rich in this mineral. The main side effect of its excessive intake is diarrhea, which is definitely reversible, and thus immediately stops you from its excessive consumption. Its side effects are not too common as body automatically removes its excess amounts.
Interaction With Other Drugs
Few antibiotics (aminoglycosides), can affect the muscles. In fact, magnesium also affects muscles, so taking these antibiotics with magnesium might cause some muscle problems.
Magnesium inhibits the absorption of antibiotics and reduces their effectiveness. To avoid this, you should take antibiotics at least two hours before, or five to six hours after taking magnesium supplements, or foods.
Magnesium relaxes muscles. Taking magnesium with muscle relaxants can increase risks of side effects of these muscle relaxants.
Magnesium can also lower your blood pressure. Taking magnesium with high blood pressure medication may cause your blood pressure to go too low, also referred to as hypotension.
Use For Migraine
Studies in the past have shown that all those who suffer from repeated migraine attacks have low brain magnesium, and many suffer from magnesium deficiency. Furthermore, this deficiency may play some role in menstrual migraine. Five controlled trials have shown that oral magnesium supplementation is effective in reducing headaches. The exact magnesium efficacy depends on “high dose” supplementation (above 500mg) for minimum of four moths to achieve any benefit from this preventative therapy.
Coenzyme Q10 (CoQ10)
CoQ10 (Coenzyme Q10) is actually a vitamin, or vitamin-like substance. It is responsible for the creation of adenosine triphosphate (ATP) within the body. ATP acts as a major energy source for cells and also drives many biological processes including production of proteins and muscle contraction. It also acts as an antioxidant.
Some food sources, such as fish and meat, contain some CoQ10 but its concentration is very low in foods. So it is best to take it in supplement form. Main dietary sources of CoQQ10 include organ meats (such as liver), oily fish (such as tuna and salmon), and whole grains. You can get sufficient amounts of CoQ10 with balanced diet, but supplementation helps in individual with specific health conditions.
If you’re currently using or have plans to use CoQ10 for some health condition, you should first consult your doctor. It appears to be completely safe, and when it was taken by 22 health volunteers in a trial of different doses over 7 weeks, it did not cause any adverse events or safety concerns. Other safety assessments have also been favorable, but it’s best to avoid any supplementation in pregnancy.
Till date, no toxicity has been reported with this supplement up to 700 mg for each kg of body weight. Some minor side effects include loss of appetite, burning sensation in mouth, diarrhea and nausea. In larger studies, the incidences of gastrointestinal side-effects are less than 1 percent.
Interaction with other drugs
Some cholesterol lowering medications such as lovastatin block natural synthesis of CoQ10, so it’s best to take supplementation of only 100 mg per day while taking these drugs.
Use for migraine
35 patients diagnosed with severe migraine (with and without aura) were treated with CoQ10 at a dose of 220 mg per day in a completely controlled experiment in 2011 in California. No adverse effect was reported with this therapy by any of the trial participants. Due to this treatment, around 64 percent of the patients had greater than 53 percent reduction in number of days with migraine headache symptoms. Only three patients shows no improvement with this therapy in their headache intensity as compared to the baseline (i.e. when this trial started). The average number of days with any kind of migraine headache during the baseline non-treatment phase was just 7.24 and this reduced to 2.98 days right at the end of this trial. The actual reduction in frequency of migraine attacks after 1 month therapy was 16 percent and this improved to 59 percent by the end of 4 months therapy.
From this open-label (it’s called “open” because participants knew they were taking CoQ10) investigations, CoQ10 appeared to an effective migraine preventive that works fast. According to the data of this trial, CoQ10 starts working within 5 weeks but usually it takes 7-14 weeks to see significant reduction in migraine days. An important finding of this study is that taking CoQ10 supplement is associated with no significant events and is usually well-tolerated. In another independent study in 2013, migraine attack frequency after 5 months of this treatment was reduced by at least 43 percent in 53 percent of patients as compared to 15 percent for placebo. CoQ10 supplementation can also be effective in treating childhood migraine.
Butterbur (Petasites hybridus)
Butterbur is actually a perennial shrub, found in parts of North American and Asia and throughout Europe. It is mostly found in marshy, wet ground, in damp forests, and adjacent to streams and rivers. Its name is attributed to its large leaves that are used to wrap butter during summers.
Human safety data
Butterbur is being used since centuries as a herbal remedy for fever, pain and spasms. Today, butterbur is mostly used for effective migraine prevention, and for treating asthma and headaches.
Potential side effects
Studies have shown good tolerability and safety of commercial available butterbur products that are completely free from carcinogenic pyrrolizidine alkaloid constituents when used for short-duration, orally, and in recommended doses. You should avoid eating raw unprocessed butterbur plant due to the potential of liver damage due to pyrrolizidine alkaloids with their long-term use. This includes any capsules, teas, or unprocessed extracts or tinctures. Use should always be limited to only commercial available products free from any pyrrolizidine alkaloids, and it’s not suitable for pregnant or breastfeeding women due to lack of adequate safety studies.
Interaction with other drugs
Interaction with other drugs and long-term health effects have not been studies so we’re not sure if there are any side effects due to their long-term use.
Use for migraine
According to detailed reports of first trial published by Lipton in 2013-14 and conducted in Germany and US with 233 migraine patients with and without aura, the participants found some relief from migraine headache symptoms with butterbur. All the participants in this study were treated twice a day for 4 months with either 75 mg commercial butterbur or placebo. Best response was visible after 2 months resulting in attack reduction of 61 percent with 2 x70 mg per day dosing. This was quite significant statistically as compared to the placebo response of just 23 percent. About 74 percent of the patients in the study responded to the therapy with butterbur. Three randomized, placebo-controlled migraine headache prevention trials with a total of 354 patients demonstrated the efficacy and safety of the butter root extract in adults prompting an exploration of the prevention of migraine in children too.
Use For Migraine Headaches In Kids
Between January 1996 and August 2003, a total of 123 patients entered an open label trial, consisting of 19 kids between the ages of 5 and 8 years and 81 adolescents between the ages of 11 and 16 years. The attack reduction witnessed in the total sample population was 66 percent. About 76 percent (19 out of 23) of the younger and 76 percent (44 out of 59) of older patients responded. Prophylactic (preventive) migraine treatment with pure butterbur extract also helped in reducing the duration of migraine attacks from about 9 hours on an average before this study to 4 hours during treatment. However, approximately 22 percent of patients still experienced a prolonged migraine attack under this treatment. About 86 percent (72 out of 89) of all patients reported good improvement of their migraine as compared to the situation prior to this study. None of them reported worsening of attacks in each group that participated. About 94 percent (81 out of 87) of all patients felt even better than before the study. Just one migraine patient in both age groups felt bit worse because of this treatment.
Pregnancy And Lactation
If you’re pregnant/breastfeeding and experiencing migraine attacks, you would want to know if “natural” remedy will work for you. Is there any solid scientific data to help you decide?
Pregnancy and lactation periods cannot be taken lightly and warrant special consideration during migraine treatment. Although migraines may show some improvement during pregnancy, headaches may actually worse, or may remain same in some women. Any increase in headaches during first trimester is common, due to varying oestrogen levels.
It’s important that women of reproductive age group understand the risks of acute and preventative migraine medications. Due to limitations on any pharmacologic migraine treatment during lactation ad pregnancy, non-drug approaches such as lifestyle changes and exercise are the first main issues to consider. Maintaining hydration is also important, especially for those in who vomiting and nausea are prominent. These women should avoid all herbal remedies, including butterbur and feverfew as there can be many unidentified risks for the unborn baby.
For women who continue to experience frequent headaches during their pregnancy or lactation, magnesium supplementation can be an option for migraine treatment. For acute migraine symptoms, treatment is done with lighter dose especially among women with some other health conditions. Supplementation rarely generates any adverse side effects.
Feverfew herb is easily available as off-the-shelf remedy. It’s yellow flowers and yellow-green leaves closely resemble those of chamomile ) Matricaria chamomilla), with which it’s sometimes confused.
Feverfew has a rich history of use in fold and traditional medicine. Recently it gained widespread popularity in prophylactic treatment of various types of migraine headaches and its extract are claimed to provide relief in menstrual pain, dermatitis, asthma, and arthritis. Traditionally, this herb has been used by many as antipyretic (fever reducer), from which its common name is derived.
Human safety data
If you feel you have any health issues that can be treated with feverfew, it’s best to first consult your doctor before using it. Caution is advised if you have alcohol dependence, diabetes or liver disease. Liquid preparation of feverfew may contain alcohol and/or sugar, and feverfew is not recommended for kids under 2 years of age. Due to its potential risks to the infant, its use is not recommended for breastfeeding mothers. It’s use is also not advised during pregnancy.
Potential side effects
Most of the adverse side effects of migraine treatment with feverfew are mild, although some of the patients reported slightly increased heart rate. Feverfew may interact with anticoagulants. A small percentage of people may experience mild stomach upset due to feverfew, although this is extremely rare. Chewing fresh feverfew leaves can sometimes led to minor mouth ulceration in some cases, an effect not observed with most capsule users.
Interaction with other drugs
You should not use feverfew when taking any anticoagulant drug. Feverfew should be avoided by all those allergic to other members of the family Compositae (Asteraceae) such as ragweed, chamomile, or yarrow.
Use for migraine
19 migraine patients in Texas who already used feverfew daily as migraine prophylaxis were enrolled in a trial where 9 patients continued to receive feverfew while 10 stopped taking their feverfew and received placebo treatment instead (i.e. untreated patients). All those who received placebo has significant increase in severity and frequency of headache (an average of 4.12 headaches every 5 months when taking placebo vs only 1.59 headaches every 5 months when taking feverfew), vomiting and nausea, whereas there was no change in the group that received feverfew. In larger study of 80 patients, feverfew was associated with a 26 percent reduction in the mean number and severity of attacks although the duration of individual migraine attacks was unaltererd.