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 root – 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 – 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 –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 – 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 – 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). A dosage of 600 mg of magnesium daily has been shown to be effective for the prevention of migraine attacks (Koseoglu 2008), and is inexpensive and well-tolerated (Sun-Edelstein 2009b). In combination with CoQ10, vitamin B2, and ginkgo, magnesium has been shown to significantly decrease the amount of migraine headaches (Esposito 2011). Although not yet proven in clinical trials, a form of magnesium called magnesium-L-threonate may be ideal for people with migraine because experimental data indicate that it enters the central nervous system more efficiently than other forms of magnesium (Slutsky 2010).
Melatonin – 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).
S-adenosylmethionine (SAMe) – 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).
L-tryptophan – 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)