Targeted Nutritional Intervention
Natural therapies (e.g., dietary supplements) are well tolerated, and many have been shown to reduce migraine symptoms (O'Brien 2010; Schiapparelli 2010).
Butterbur (Petasites hybridus) is a plant that flourishes in moist conditions, and has been used for a wide range of medicinal purposes in Europe since ancient times (Pothmann 2005). Butterbur extracts possess analgesic, anti-inflammatory, anti-spasmodic, and vasodilatatory properties, which may explain their efficacy for migraine prevention (Pothmann 2005; Oelkers-Ax 2008). Butterbur root extract (standardized to 15% petasins) has been shown to be both safe and effective for the prevention of migraines (Diener 2004; Lipton 2004; Pothmann 2005). In one study, researchers split 245 patients into three groups to receive: 75 mg of butterbur extract twice a day, 50 mg of butterbur extract twice a day, or placebo. At the end of a four-month treatment period, those taking the 75 mg dosage experienced a whopping 48% reduction, on average, in the frequency of migraine attacks (Lipton 2004).
Butterbur is so effective for reducing the frequency and severity of migraine attacks, that the American Academy of Neurology (AAN) and the American Headache Society (AHS) have recommend it as an effective treatment for migraine (Holland 2012).
Coenzyme Q10 (CoQ10) is a potent antioxidant (Ross 2007) and an important component of cellular energy production. Researchers have found that organs with high metabolic rate, such as the brain, appear to quickly deplete CoQ10 stores, potentially leading to a deficiency (Ross 2011).
CoQ10 (at doses of 100-300 mg daily) has been shown to be beneficial for preventing and reducing the frequency of migraine attacks among adults (Schiapparelli 2010; Slater 2011). These actions are attributed to CoQ10's potential to interfere with inflammatory mechanisms and mitochondrial dysfunction, both of which have been implicated in the migraine process (Slater 2011).
Riboflavin (i.e., Vitamin B2) contributes to cell growth, enzyme function, and energy production (AMR 2008). High quality data indicate that riboflavin is effective for the prevention of migraine among both children and adults (Condo 2009; Boehnke 2004), and may decrease the need for traditional rescue medications (Boehnke 2004). It is believed that riboflavin's beneficial effects are due to its ability to enhance mitochondrial energy production (Brenner 2010), this is based on data indicating that riboflavin is especially effective among migraine patients with mitochondrial genetic abnormalities (DiLorenzo 2009).
One study involving 23 participants showed that supplementation with 400 mg riboflavin daily reduced headache frequency by an impressive 50% at three months, with improvement persisting through six months (Boehnke 2004). Riboflavin is also cost-effective and has a minimal side effect profile (Condo 2009).
Feverfew (Tanacetum parthenium) is a small, daisy-like flower with a distinctively strong, bitter odor (Goodyear-Smith 2010). Recent evidence has revealed that feverfew inhibits the production of several inflammatory mediators that may be involved in migraine including arachidonic acid, cyclooxygenase-2, TNF-α, IL-1, MCP-1. Due to these anti-inflammatory properties, feverfew's use in the management of migraine attacks is promising (Goodyear-Smith 2010; Saranitzky 2009; Chen 2007). However, a review of randomized controlled trials revealed mixed results for the effectiveness of feverfew (Pittler 2004). For example, a study that used dried leaf revealed a decrease in the frequency of migraines while another using a CO2 extract did not show significant benefit (Pittler 2004). A combination of ginger and feverfew has also been shown to be effective for migraine prevention with minimal side effetcs (Cady 2011; Ernst 2000). A dosage of 100-300 mg up to 4 times daily is recommended (Pareek 2011).
Magnesium modulates many important neural and vascular processes involved in the development of a typical migraine attack. Migraine patients commonly exhibit low magnesium levels (in the serum, tissue, and lymphocytes), especially during an attack (Qujeq 2012; Talebi 2011; Sun-Edelstein 2009b). Furthermore, magnesium deficiency can trigger cortical spreading depression (CSD), platelet aggregation, vasoconstriction, and substance P release; all of which are have been implicated in migraine pathology (Sun-Edelstein 2009b).
Magnesium citrate – In a study of 40 patients with migraine without aura, oral magnesium citrate (600 mg daily) decreased the frequency of attacks by about 45% and severity of attacks by about 40% (Koseoglu 2008). In a multi-center crossover study that enrolled 43 participants with migraine, magnesium citrate, 600 mg/day, led to a significant reduction in incidence of migraine attacks (Taubert 1994). In another multi-center, randomized, double-blind study that enrolled 81 participants with migraine, 600 mg trimagnesium dicitrate daily for 12 weeks led to significant reductions in the mean number of migraine attacks (Peikert 1996). In a guideline to practitioners published in 2012, the Canadian Headache Society included magnesium citrate on their list of preventive drugs that received a strong recommendation for migraine prophylaxis (Pringsheim 2012).
Magnesium oxide – In a clinical trial, oral magnesium oxide (500 mg daily) given to 77 adults for preventing migraines significantly reduced the severity of headaches and led to a statistically non-significant decrease in the number of migraine days. Supplementation significantly increased serum magnesium concentration in the treatment group with no difference noted in the control group (Talebi 2013).
In two patients with headaches that did not respond to other treatments, intravenous magnesium followed by 200 mg oral magnesium oxide daily was reported to help their headaches (Mijalski 2016). In another study, daily use of a supplement containing 600 mg magnesium oxide, 400 mg riboflavin, 150 mg coenzyme Q10, and several vitamins and trace elements for three months improved migraine frequency, with a trend towards but without reaching statistical significance (Gaul 2015). A 23-year-old woman with migraines for three months, who did not respond to musculoskeletal or pharmaceutical therapies, was given a multivitamin, magnesium oxide, and Ulmus rubra. She showed a reduction in frequency of migraines after one week with three migraines in the first month; after one year of supplementation, she reported not having anymore migraines (Martin 2015).
Magnesium-L-threonate – In rats, oral magnesium L-threonate, but not other forms of magnesium, raised the concentration of magnesium in the cerebrospinal fluid, and improved learning, short- and long-term memory, and working memory (Slutsky 2010). In another rat study, oral magnesium L-threonate also helped neuropathic pain induced by chemotherapy (Xu 2017). In a mouse model of neuroinflammation, magnesium L-threonate injection into the brain cavity inhibited neuroinflammation by suppressing IL-1β expression (Wang 2017). Magnesium L-threonate also improved spatial memory and reduced synaptic loss in mice with Alzheimer disease (Huang 2018). In another study on adult male rats, magnesium L-threonate administered orally, 609 mg/kg/day for two weeks, prevented and restored memory deficits associated with neuropathic pain (Wang 2013).
Melatonin is a natural compound produced by the pineal gland that helps regulate the sleep-wake cycle (i.e., circadian rhythms), and has been clinically shown to possess potent antioxidant and analgesic properties (Wilhelmsen 2011). Since melatonin is often found in lower-than-normal levels among migraine patients (especially during an attack), it is thought that it may play an important role in migraine pathology (Masruha 2008; Masruha 2010).
Some researchers hypothesize that migraines are triggered by an irregularity in pineal gland function (Gagnier 2001). When this imbalance is corrected through melatonin supplementation, some migraine patients experience an improvement in symptoms (Vogler 2006). In one clinical study, melatonin supplementation trended toward a two-thirds reduction in number of migraine attacks (Alstadhaug 2010). This response rate may have been more statistically significant if the researchers used a larger dose of melatonin (3 mg instead of 2 mg), and if treatment was extended for a longer period of time (12-16 weeks, instead of 8 weeks) (Peres 2011). Melatonin has been found to be safe and associated with little or no side effects (Gagnier 2001).
SAMe is a nutritional supplement derived from the amino acid methionine and adenosine triphosphate, a nucleic acid (De Silva 2010). It is a naturally occurring substance produced by the body to perform a variety of important biochemical processes, especially involving the central nervous system (CNS) (Carpenter 2011). Some data suggest that long-term supplementation with SAMe may relieve pain among migraine sufferers, possibly due to its ability to increase serotonin (Gatto 1986; Fetrow 2001).
The amino acid L-tryptophan is a precursor to serotonin. Several lines of evidence indicate that low serotonergic signaling within the brain may precipitate migraine (Hamel 2007). Therefore, supporting serotonin synthesis by providing precursors like L-tryptophan may help avoid physiological conditions that promote migraine headache. Indeed, in an older clinical trial, supplementation with 2 - 4 grams of L-tryptophan daily was as effective at preventing migraine attacks as the medication methysergide (Sicuteri 1973). Also, a more recent trial found that dietary tryptophan depletion caused exacerbation of migraine symptoms (Drummond 2006).
Miscellaneous Beneficial Ingredients
The following list of natural ingredients may also be useful for managing migraine symptoms, though definitive clinical data is lacking:
- Ginkgo Biloba (Schiapparelli 2010)
- Lipoic Acid (Sun-Edelstein 2009a)
- Vitamin B6 (Ross 2011)
- Ginger (Mustafa 1990)
Disclaimer and Safety Information
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