Spotlight On: Nutraceuticals

Exploring the value of vitamins and minerals in the treatment of migraine

By Adeel Zubair, MD, Deena Kuruvilla, MD

Current conventional treatments for migraine include a variety of different prescription medications and procedures which often provide significant benefit to patients by both preventing and treating migraine symptoms. While these conventional treatments are readily available, many patients turn to natural supplements as an adjunct or as a replacement for conventional therapies.

While a variety of complementary and alternative medicine (CAM) therapies exist, including acupuncture, massage, breathing exercises, meditation, and yoga, we will focus on supplements.

Viable supplement treatments for migraine

Common supplements used in migraine treatment include co-enzyme Q10, magnesium, feverfew, riboflavin, and omega-3 polyunsaturated fatty acids.

Magnesium

While oral magnesium, a mineral, is used to prevent migraine attacks, studies have shown mixed results regarding the effectiveness of magnesium. Some studies have shown that high dose magnesium daily led to decreased attack frequency. However, other studies have not shown this benefit. [1, 3-6]

Riboflavin

Riboflavin, also known as B2, is a vitamin that naturally appears in food. Studies have shown that high-dose riboflavin is effective in preventing migraine attacks. In a study in the journal Neurology, riboflavin was shown to reduce attack frequency and headache days. It has high efficacy and is tolerated well, making it a good candidate as a supplement. [1, 4, 7-10]

CoQ10

Co-enzyme Q10 is a naturally occurring substance which plays an important role in encouraging the effective functioning of mitochondria, the powerhouse of the cells. Studies have shown that there is reduction in frequency and intensity of migraines when co-enzyme Q10 is taken regularly as a preventative tactic. The studies showed that CoQ10 was better than the placebo and correlated with decreased attack frequency and fewer headache days, and was generally well tolerated. [1, 5, 9]

Feverfew

Feverfew (tanacetum parthenium) is a plant sometimes used in migraine treatment. Studies on feverfew are sparse and of low quality, which make it difficult to assess its role as a supplement. [1, 5, 11, 12]

Omega-3 fatty acids

Omega-3 fatty acids are also used for migraine treatment because they are believed to have anti-inflammatory properties. Clinical trials have shown that using omega-3 fatty acid versus placebo did not lead to a significant reduction in headache frequency. [13-15]

Of the supplements we discussed above, riboflavin and magnesium are most recommended given their clinically validated beneficial effects and limited side effect profile. CoQ10 is another good choice, and there is some evidence proving its efficacy. When choosing a supplement, is it important to discuss the risks and benefits with your healthcare provider and determine which product to use. It is also crucial to ensure the supplement you take is pure and not altered.

Living with migraine can sometimes seem overwhelming, but there are many diverse treatment options to explore if you’ve had limited success with medications alone. The American Migraine Foundation’s resource library has essential information about various strategies for managing your migraine, including a guide on what to do after your migraine diagnosis and a workbook to help you identify and avoid food triggers. Visit americanmigrainefoundation.org for more resources and information about living with migraine.

References:

  1. Mauskop, A., Nonmedication, alternative, and complementary treatments for migraine. Continuum (Minneap Minn), 2012. 18(4): p. 796-806.
  2. Millstine, D., C.Y. Chen, and B. Bauer, Complementary and integrative medicine in the management of headache. BMJ, 2017. 357: p. j1805.
  3. Delavar Kasmaei, H., et al., Ketorolac versus Magnesium Sulfate in Migraine Headache Pain Management; a Preliminary Study. Emerg (Tehran), 2017. 5(1): p. e2.
  4. Gaul, C., H.C. Diener, and U. Danesch, Improvement of migraine symptoms with a proprietary supplement containing riboflavin, magnesium and Q10: a randomized, placebo-controlled, double-blind, multicenter trial. J Headache Pain, 2015. 16: p. 516.
  5. Guilbot, A., et al., A combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study. BMC Complement Altern Med, 2017. 17(1): p. 433.
  6. Vink, R., Magnesium in the CNS: recent advances and developments. Magnes Res, 2016. 29(3): p. 95-101.
  7. Colombo, B., L. Saraceno, and G. Comi, Riboflavin and migraine: the bridge over troubled mitochondria. Neurol Sci, 2014. 35 Suppl 1: p. 141-4.
  8. Marashly, E.T. and S.A. Bohlega, Riboflavin Has Neuroprotective Potential: Focus on Parkinson’s Disease and Migraine. Front Neurol, 2017. 8: p. 333.
  9. Markley, H.G., CoEnzyme Q10 and riboflavin: the mitochondrial connection. Headache, 2012. 52 Suppl 2: p. 81-7.
  10. Thompson, D.F. and H.S. Saluja, Prophylaxis of migraine headaches with riboflavin: A systematic review. J Clin Pharm Ther, 2017. 42(4): p. 394-403.
  11. Cady, R.K., et al., A double-blind placebo-controlled pilot study of sublingual feverfew and ginger (LipiGesic M) in the treatment of migraine. Headache, 2011. 51(7): p. 1078-86.
  12. Diener, H.C., et al., Efficacy and safety of 6.25 mg t.i.d. feverfew CO2-extract (MIG-99) in migraine prevention–a randomized, double-blind, multicentre, placebo-controlled study. Cephalalgia, 2005. 25(11): p. 1031-41.
  13. Ramsden, C.E., et al., Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial. Pain, 2013. 154(11): p. 2441-51.
  14. Ramsden, C.E., et al., Low omega-6 vs. low omega-6 plus high omega-3 dietary intervention for chronic daily headache: protocol for a randomized clinical trial. Trials, 2011. 12: p. 97.
  15. Soares, A.A., et al., A double- blind, randomized, and placebo-controlled clinical trial with omega-3 polyunsaturated fatty acids (OPFA -3) for the prevention of migraine in chronic migraine patients using amitriptyline. Nutr Neurosci, 2017: p. 1-5.