by Deena Kuruvilla, MD
by Deena Kuruvilla, MD
Welcome to Ask the Migraine Expert, a column about managing life with migraine from Deena E. Kuruvilla, MD. Dr. Kuruvilla is a board certified neurologist and director of the Westport Headache Institute in Fairfield County, Connecticut. Got a question for the migraine expert? Submit your question via this form.
Dear Migraine Expert,
Can natural supplements help my migraine symptoms?
— Bezzy Migraine community member
While mainstream pharmaceutical medications have been studied robustly and are regularly recommended for the preventive and acute treatment of migraine, some people with migraine prefer to try natural options. These natural treatments fall under the official title of “integrative medicine” because they are added in addition to more mainstream treatments.
I am often asked which supplements, mind-body exercises, or body-based exercises are recommended for migraine. A few reasons people with migraine may opt for a nonpharmaceutical option include:
Supplements have been specifically studied for migraine prevention.
There are pros and cons when it comes to supplements. Supplements have a generally favorable side effect profile and may increase a person’s overall well-being. However, research on supplements for migraine has limitations, such as a lack of randomization, and often people with a low frequency of migraine attacks are included in these studies.
Supplements have not specifically been studied for people with a higher frequency of migraine attacks, such as those with chronic migraine. However, migraine doctors often add supplements to mainstream treatments.
Our ultimate goal in treating migraine disease is to reduce the frequency, duration, and severity of attacks. Different management treatments, such as mainstream pharmacological therapies, lifestyle counseling, neuromodulation, and complementary and integrative medicine should be used together to attain this goal.
Here are some of the common supplements recommended for the prevention of migraine. Before taking new supplements, please review them with your doctor to make sure they don’t interact with medications you take and to see if the supplement is the right fit.
Magnesium is a mineral abundant throughout the body that is important for different things, such as energy production and nerve and muscle function. Magnesium has also been found to play a key role in cortical spreading depression, an altered brain activity believed to be a cause of migraine.
Magnesium can cause upset stomach and diarrhea, and so I generally advise patients to start at a low dose of 100 to 200 milligrams (mg) and increase each week slowly until they reach around 600 mg per day (the dose studied in clinical trials). If you experience diarrhea, you can always cut down on the dose or stop the treatment with the help of your doctor.
Riboflavin, also known as vitamin B2, is important for energy production.
Clinical trials have shown that a dose of 400 mg a day could be helpful for the prevention of migraine. Heads up: You may experience changes in the color of your urine or diarrhea when taking riboflavin supplements.
Coenzyme Q10, also known as ubiquinone, is an antioxidant that acts against the inflammation of migraine. It is also involved in energy production.
Some of the possible side effects include trouble sleeping, fatigue, nausea, and diarrhea. In rare cases, it may elevate your liver enzymes. A common dose is 150 mg per day.
The scientific term for butterbur is Petasites hybridus. It is a shrub that is present in Europe, Asia, and North America.
While butterbur has been found to be very helpful for migraine prevention, it comes with risks. Butterbur has been found to cause liver damage serious enough to require a transplant. Therefore, its use is limited due to safety.
Liver function tests should be monitored closely in patients taking this treatment, with the help of a doctor. The studied doses are 50 or 75 mg twice per day.
Feverfew, also known as Tanacetum parthenium, is an herbaceous perennial native to Asia Minor and is prevalent in the Balkans. It is a daisy-like plant used in the first century for inflammation.
The active ingredient, parthenolide, may impede migraine through its vascular smooth muscle relaxation and anti-inflammatory properties. The recommended dosage is 100 to 300 mg up to 4 times per day.
The most frequent adverse effects include mouth ulcers and gastrointestinal symptoms. There is also evidence of post-feverfew syndrome, which occurred after patients stopped feverfew. You shouldn’t stop taking feverfew abruptly, or withdrawal symptoms will occur, such as trouble sleeping, anxiety, and muscle pain. Feverfew also has the potential to cause uterine contractions and is not recommended during pregnancy.
Omega-3 has anti-inflammatory properties, making it a supplement of interest for migraine prevention. Omega-3 fatty acids help to keep the cell walls in our bodies intact and help to treat pain by blocking inflammation. A study showed that 2 months of supplementation with 1 gram of omega-3 fatty acids decreased migraine frequency.
Side effects of omega-3 supplements may include heartburn, loose stools, and nosebleeds.
Vitamin D deficiency is associated with musculoskeletal disorders, thyroid cancer, autoimmune disorders, cardiovascular disorders, kidney disorders, mental health disorders, and skin disorders. Low levels of vitamin D have also been linked to headache.
A 2012 study of vitamin D levels in children and adolescents found that people with migraine had lower levels of vitamin D compared to their people without migraine.
High levels of calcium in the blood because of vitamin D supplementation may lead to side effects. These may include arrhythmias, hypercalcemia, metallic taste in the mouth, constipation, and dry mouth.
Melatonin is responsible for controlling our body’s sleep and wake cycle. It is known as the circadian pacemaker for sleep, in addition to acting as an antioxidant, antihypertensive, anxiolytic, and sedative.
Melatonin levels have been found to be low in people with migraine and cluster headache. Women with migraine have decreased nighttime blood melatonin levels both overall and during migraine attacks.
In one small 2016 study, 49 people with migraine and chronic tension-type headache took a 4-mg oral melatonin supplement 30 minutes before bedtime for 6 months. In both groups, headache frequency decreased and quality of life improved.
The adverse effects of melatonin include drowsiness, fatigue, increased libido, dizziness, anxiety, nightmares, itching, dry mouth, constipation, and hair loss. Newer research shows more severe side effects such as liver damage, and issues with the reproductive system.
Many supplements may help to reduce migraine frequency and severity, especially if added to mainstream migraine preventive medications. Other natural approaches to migraine treatment include meditation and mindfulness, acupuncture, yoga, regular exercise, and physical therapy.
It’s important to discuss your individual migraine disease with your doctor in order to come up with a customized plan that works for you.
Fact checked on February 08, 2022
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About the author
Deena Kuruvilla, MD
Dr. Deena Kuruvilla is an ABMS board certified neurologist and a United Council for Neurologic Subspecialties (UCNS) certified headache and facial pain specialist. Dr. Kuruvilla has special interests in procedural and complementary and integrative medicine.