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Dietary Supplements and Botanicals for Migraine Headaches

What Works? What Doesn't?

By Rosalyn Carson-DeWitt

Updated February 15, 2009

(LifeWire) - In recent years, various alternative therapies have been touted for their ability to prevent or treat migraine headaches. There has also been increasing research on this subject. Some of these studies suggest that dietary supplements and botanicals may indeed have a therapeutic role in preventing or treating migraines.

However, it's important to remember that even though these products are available over-the-counter (OTC) and may be found in nature, they still carry a risk for harm. Therefore, first check with your doctor before you put them into your body and mix them with any other supplements or medications you're taking, whether prescription or OTC. Your doctor can advise you to be sure that you're not at any risk for dangerous side effects or drug interactions.

Be sure to take only the recommended dosage. Too much of a good thing can be very bad with medicine.

Finally, if you are pregnant or nursing, never use any kind of medication, whether supplement, prescription or OTC, without the prior approval of your doctor.

Some of the more commonly used and reasonably well-studied dietary supplements and botanicals include the following six types:


1. Magnesium

This is the fourth most abundant mineral in the body. It's found mainly in the bones, but also in many other tissues. Magnesium plays an essential role in more than 300 biochemical reactions.

What can it do? According to some research, people who have migraine headaches, particularly those associated with the menstrual cycle, may have low magnesium levels. Magnesium supplements may help avert such migraines.

How does it work? Magnesium may lower the excitability of nerves in the brain and help normalize the rhythm of the 24-hour "biological clock" that controls sleep, temperature, blood pressure, hormone production and other functions.

Typical dosage? Potassium magnesium aspartate tablets, 500 to 1,000 mg at bedtime. Avoid the harder-to-absorb magnesium oxide form, especially if you're taking calcium, zinc or iron supplements.

What can I expect while taking magnesium? If you're taking magnesium for menstrual migraines, be sure to continue taking the supplements for at least three full cycles. It may take this long to notice a beneficial effect. Some people get diarrhea from magnesium supplements. If this side effect happens to you, try the preparation called "magnesium gluconate."

Special uses: Sometimes used for the prevention and treatment of migraine headaches during pregnancy.

Any safety issues? With typical dosages, magnesium should not present any safety issues. However, some people do experience diarrhea.


2. Vitamin B2 (riboflavin)

This is a water-soluble vitamin. It involves energy production, red blood cell synthesis and body growth.

What can it do? It may help prevent migraines. Taking vitamin B2 with a beta-blocker (a class of drugs, including atenolol, propranolol and metoprolol, which are used for migraine prevention and controlling high blood pressure) may be even more effective than taking either one alone.

How does it work? Vitamin B2 may work by allowing cells to store energy without increasing the excitability of nerve cells.

Typical dosage? Vitamin B2 tablets, 200 mg twice a day with meals.

What can I expect while taking vitamin B2? Don't worry if your urine turns bright yellow, as this is not a cause for concern. Continue taking the vitamin as directed.

Any safety issues? Vitamin B2 isn't stored in the body. Excess amounts are eliminated in the urine. There are no known cases of riboflavin poisoning.


3. Coenzyme Q10

A compound centrally involved in the energy production process of the cells, which was first identified in 1957.

What can it do? Coenzyme Q10 may decrease migraine frequency. In a 2005 study, migraine attacks decreased by 48% in people who took the supplement three times daily. Users also reported fewer days each month with headaches or nausea. Although this trial was well-designed, it involved only 42 people.

How does it work? Coenzyme Q10 is believed to work by boosting the brain's energy reserves.

Typical dosage? Capsules, 150 to 300 mg, in either one single daily dose or divided into three doses per day.

What can I expect while taking coenzyme Q10 It may take three months before you observe any beneficial effect.

Any safety issues? In rare cases, people taking this supplement experience nausea or diarrhea.


4. Fish oil

This is a rich source of omega-3 fatty acids that are heart-healthy and may provide other benefits as well.

What can it do? Omega-3 fatty acids may decrease migraine frequency, duration and severity.

How does it work? The exact way in which fish oil affects migraines is not known. Omega-3 fatty acids do decrease inflammation and relax blood vessels. These may also reduce the tendency of platelets -- blood cell fragments that play an important role in clotting -- to clump together or aggregate. Some studies link platelet clumping to the migraine process, and many standard migraine drugs serve to decrease the tendency of platelets to aggregate.

Typical dosage? Fish oil capsules, 2 to 6 g per day.

What can I expect while taking fish oil? Some people notice burping, bad breath and gas while taking fish oil supplements. A higher-quality, pharmaceutical-grade fish oil preparation may remedy these side effects.

Any safety issues? If you have a history of bleeding, high "bad cholesterol" (LDL) levels or diabetes, ask your doctor before you start taking fish oil supplements. If you notice bruising or bleeding, discontinue use and talk to your doctor.


5. Feverfew

This is a flowering plant in the daisy family. It is native to the Balkans and is now found across Europe and North America. This traditional remedy is used for fevers, headaches and toothaches, among other uses.

What can it do? Use of Feverfew may decrease migraine headache frequency and severity.

How does it work? Feverfew may decrease inflammation and stabilize blood vessels by decreasing their reactivity. It may also interfere with platelet contribution to migraine pain.

Typical dosage? Feverfew capsules, maximum of 125 mg per day. Look for capsules labeled "dried leaf standardized to a minimum of 0.2% parthenolide," which is the compound believed to be active against migraine headaches and other conditions.

What can I expect while taking Feverfew? It may take weeks to notice the beneficial effects of Feverfew. Some people develop mouth ulcers and an upset stomach when taking this product.

Any safety issues? If you're taking a blood thinner or have any history of bleeding problems, check with your doctor before using Feverfew. Also, a sudden stop in the use of Feverfew may increase your headaches, cause sleep problems or make you feel irritable. If you do decide to stop using it, be sure to wean yourself off gradually.

If you're allergic to ragweed, daisies, marigolds or chrysanthemums, check with your doctor before starting Feverfew. All of these are in the same plant family.

Pregnant women are advised not to use Feverfew.


6. Butterbur

A broad-leafed European shrub, another member of the daisy family, has long been used for medicinal purposes.

What can it do? Some research suggests that it can nearly cut the frequency of migraine headaches in half for some individuals. In one study, this effect continued over the course of four months.

How does it work? Butterbur is believed to decrease inflammation, although the exact mechanism is unknown.

Typical dosage? Butterbar capsules or tablets, 50 mg three times a day for the first month, then 50 mg two times a day. Look for standardized extract of the root with 15% of marker molecules present.

What can I expect while taking Butterbur? It may cause belching.

Any safety issues? Naturally-occurring Butterbur contains potentially toxic compounds, so don't try to make your own. Only use pharmaceutical-grade Butterbur, which has had the dangerous compounds removed.

Pregnant and nursing women, young children and also individuals with liver or kidney disease should not use Butterbur.

If you're allergic to ragweed, daisies, marigolds or chrysanthemums, talk to your doctor before using Butterbur. All of these are in the same plant family.

Summary

Before trying any of these alternative therapies, keep in mind that the evidence for their effectiveness remains inconclusive. The reports with beneficial effects have generally been only in small-scale and short-term studies.

On the other hand, some research and various anecdotal accounts suggest that these alternative therapies could be helpful for some individuals. On that basis, if your current migraine treatment plan isn't satisfactory, you may want to consult with your doctor about trying one of these alternative approaches.

Sources:

Harel Z .et al. "Supplementation with Omega-Polyunsaturated Fatty Acids in the Management of Recurrent Migraines in Adolescents." The Journal of Adolescent Health 31.2 (2002): 154-61. 
<http://journals.elsevierhealth.com/periodicals/jah/issues/com>

"Herbs at a Glance: Feverfew." National Center for Complementary and Alternative Medicine. 6 Dec. 2006. National Institutes of Health. 25 Mar. 2008 <http://nccam.nih.gov/health/feverfew/>.

Mann J.D. and R.R. Coeytaux. "Migraine and Tension-Type Headache." Integrative Medicine. Second ed. Ed. David Rakel. Philadelphia: Saunders Elsevier, 2007. 144-52. 

Modi S. and D.M. Lowder. "Medications for Migraine Prophylaxis." American Family Physician 73.1 (2006): 72-8.
<http://www.aafp.org/afp/20060101/72.html>

Parsekyan D. "Migraine Prophylaxis in Adult Patients." Western Journal of Medicine 173.5 (2000): 341-5.
<http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1071161>

Sándor PS et al. "Efficacy of Coenzyme Q10 in Migraine Prophylaxis: A Randomized Controlled Trial." Neurology 64 (2005): 713-15.
LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Rosalyn Carson-DeWitt, MD, works as a medical writer, editor, and consultant in Durham, NC. She served as editor-in-chief for two, multi-volume MacMillan encyclopedias: "The Encyclopedia of Drugs, Alcohol, and Addictive Behavior" and "Drugs, Alcohol and Tobacco: Learning About Addictive Behavior." 
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