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Natural Agents Offer Relief from the Misery of Migraines

February 2004

By Romy Fox


Up to half of the people who suffer migraines are deficient in the free and active form of magnesium, which is known as serum ionized magnesium.4 If free magnesium levels fall too low, the vessels supplying blood to the head may “clamp down” inappropriately, hindering blood flow in the head and triggering a migraine. These vessels may become “stuck” in the contracted state, leaving the “pain switch” jammed in the “on” position. Inflammatory substances may be released that heighten pain sensations.

Through the 1990s, the relationship between migraines and magnesium was unclear. Some studies showed that magnesium prevents migraines, others did not. This confusion was due to problems involved in measuring magnesium—researchers were able to measure only the total magnesium in the blood, not the free form. When a technique for measuring free magnesium was finally developed, it became clear that a deficiency in free magnesium was a definite risk factor for migraines.

In 1993, two different studies were performed at the New York Headache Center by Alexander Mauskop, MD, one of the nation’s leading authorities on migraines and author of What Your Doctor May Not Tell You About Migraines.5,6 Mauskop and his team found that people in the throes of a migraine had lower levels of free magnesium in their blood.

Their next step was to determine whether replacing the missing magnesium would stop the headaches. In 1995, Mauskop and his colleagues gave intravenous injections of magnesium to patients who were in the throes of a migraine and also had low levels of free magnesium.7 The magnesium injections brought the migraines to a halt, sometimes in as little as 15 minutes. Mauskop found that the lower the initial level of free magnesium in migraine sufferers, the more substantial and long lasting was the relief offered by the injections. The following year, Mauskop published a study reporting equally good results among 40 people suffering from several types of severe headaches, not just migraines.8

After learning that an intravenous infusion of magnesium could halt a migraine in progress, researchers wondered whether taking daily magnesium supplements could keep migraines from striking in the first place. German researchers addressed that question in a study of 81 migraineurs.9 The volunteers in this randomized, double-blind, placebo-controlled study suffered an average of 3.6 migraines each month. For 12 weeks, half of the patients were given 600 mg of magnesium daily, while the other half received a placebo. The results were encouraging: among those taking the magnesium, the number of migraines, days lost to migraines, and anti-migraine medications required all dropped significantly. An earlier Italian study, performed exclusively on women suffering from menstrual migraines, also found that magnesium supplementation could prevent migraines from striking.10

Dr. Mauskop agreed that magnesium supplements could indeed make migraines less frequent, noting, “a trial of oral magnesium supplementation can be recommended to a majority of migraine sufferers.”4

Minor deficiencies of magnesium are widespread, and 15-20% of Americans suffer from chronic magnesium deficiency.11 Even minor magnesium deficiencies may be enough to trigger migraines in susceptible people. A daily dose of 300-400 mg of supplemental magnesium appears to be effective for many migraineurs. Some experts recommend splitting the dose and taking each half with a meal, one early in the day and the other later.

Alexander Mauskop, MD, Discusses Anti-Migraine Supplements

“As a physician specializing in treating headaches, I’ve been particularly impressed by the efficacy of magnesium, which I have been researching for the past 12 years. Fifty percent of those with migraines are deficient in magnesium and can enjoy dramatic improvement if they supplement their diet with this mineral. I know they can, because I’ve seen it happen over and over again.

“Although the results with riboflavin alone are not as impressive as those seen with magnesium, the combination of the vitamin and the mineral is potentially strong. You need to take megadoses of riboflavin, 400 mg, and should be prepared to wait two to three months to enjoy the benefits.

“Feverfew has been tested in five double-blind studies. There is a clear trend showing that it is better than placebo, which means it has definite benefits. As for butterbur, one of the two major studies on the butterbur root extract was centered here at my New York Headache Center. The test showed that it was much more effective than a placebo.

“We can always use more study, but it’s safe to say that a large percentage of migraine sufferers can be helped by supplements such as magnesium, riboflavin, feverfew, and butterbur.”

Alexander Mauskop, MD, is one of the nation’s leading authorities on migraines and other types of headache. A neurologist with 20 years’ experience treating patients, Dr. Mauskop is director of the New York Headache Center, and an associate professor of neurology at the State University of New York (SUNY) Downstate Medical Center in Brooklyn, NY.

Riboflavin for Migraines
Riboflavin, also known as vitamin B2, has a variety of functions, from aiding in the manufacture of red blood cells to assisting in the extraction of energy from carbohydrates, protein, and fat.

Riboflavin may be related to migraines via tiny “energy factories” in the brain cells called mitochondria. Low mitochondrial energy production in migraineurs may trigger the headaches, and having additional supplies of the vitamin on hand may help increase cellular energy production and reduce migraine risk.

In 1994, researchers from Belgium’s University of Liege studied 49 migraineurs.12 The volunteers were given 400 mg of riboflavin with breakfast every day for at least three months. By the end of the study period, participants reported an average of 67% fewer migraine attacks, as well as less-severe attacks.

Four years later, the same researchers conducted a second study in which 55 migraineurs were given either riboflavin or a placebo for three months.13 Those taking the vitamin saw a decrease in the frequency of attacks and number of days lost to migraines compared to those who received the placebo.

It apparently is necessary to take large doses of riboflavin—perhaps 400 mg daily—to obtain its anti-migraine benefits. A few months may pass before results are seen. Because many foods contain riboflavin, serious cases of deficiency are uncommon; however, for a large percentage of the population, riboflavin intake is either substandard or barely adequate, with elderly people and the poor especially likely to be deficient.14

Feverfew for Migraines
In the 17th century, a British herbalist wrote that an herb called feverfew (Tanacetum parthenium) was helpful in treating “all pains in the head.” Despite a centuries-old tradition of using this member of the aster family for headaches, fever, and other ailments, today it is mostly used as an ornamental shrub in gardens or along roadways. Nevertheless, several studies concerning feverfew’s ability to prevent migraines have appeared since the late 1970s.

In 1985, researchers looked at 17 migraineurs who were already using feverfew to prevent headaches.15 In this double-blind, placebo-controlled study, eight people continued to receive feverfew, while nine were given a placebo. Those who no longer received the feverfew reported having more, and more-serious, migraines. The study results suggest feverfew does indeed prevent migraines.

In 1988, an intriguing report appeared in the prestigious British medical journal The Lancet.16 Seventy-two migraineurs participated in a double-blind, placebo-controlled crossover study. When the volunteers took a daily capsule of dried feverfew leaves, the frequency and severity of their migraines fell, and they experienced less nausea and vomiting.

More recently, scientists in Poland studied 24 women, aged 19-61.17 After feverfew was administered for 1-2 months, one-third of the women reported a significant reduction in migraine severity, with only minor side effects.

In their review of the published literature on feverfew and migraines, researchers from England’s University of Exter concluded that feverfew is “likely to be effective in the prevention of migraine” headaches and presents no major safety issues.18