4 Supplements That Prevent Adult Migraines

Are These Natural Medicines Safe, and Do They Work?

Supplements to stop your migraines
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Supplements are becoming popular as either sole migraine therapies or in combination with other migraine medications. 

While these natural therapies are not approved by the United States Food and Drug Administration (FDA), headache societies like the Canadian Headache Society (CHS), the American Headache Society (AHS), and the American Academy of Neurology (AAN) do provide recommendations based on the limited scientific evidence available.

 These recommendations are helpful to doctors and migraineurs, providing guidance as to whether these supplements are even worth trying. 

Riboflavin

Riboflavin is part of the vitamin B family and plays an important role in the mitochondria (teeny structures located within the cells in your body). Mitochondria produce the energy needed for cells to survive, so if damaged or not functioning properly, cells either work improperly or die.

Some experts suspect that a mitochondrial defect may contribute to the development of migraines by reducing a person's threshold to migraine triggers. So, by taking riboflavin, experts believe the body can overcome this mitochondrial defect.

Does riboflavin really work? The evidence is limited, with only two small randomized controlled trials available. With that, though, the Canadian Headache Society (CHS) gave riboflavin a strong recommendation, suggesting 400mg daily.

The American Academy of Neurology and American Headache Society (AAN/AHS), gave riboflavin a Level B recommendation, believing it's "probably effective" in reducing migraines. 

The good news is that if your doctor recommends riboflavin, it is generally well-tolerated. Some people do develop diarrhea or excessive urination, but this is not common.

Also, riboflavin does turn your urine a fluorescent yellow color, so don't be surprised when this happens. 

Coenzyme Q10 

CoEnzyme Q10, or CoQ10, is also found in the mitochondria of cells. It has antioxidant properties and may play a critical role in preventing oxidative stress—a metabolic abnormality that may occur in the brains of some migraineurs. 

There is one small randomized controlled study examining the benefit of Coenzyme Q10 in preventing migraines. In this 2005 study in Neurology, there was a reduction in the number of migraine attacks after taking Coenzyme Q10 for 3 months. The good news is that Coenzyme Q10 was well-tolerated, with only one person dropping out of the study due to a skin allergy.

Like riboflavin, the CHS gave Coenzyme Q10 a strong recommendation in preventing migraines, suggesting a dose of 100mg three times daily. The AAN/AHS gave coenzyme Q10 a Level C recommendation, meaning it's "possibly effective" in preventing migraines. 

Magnesium

Magnesium is an important mineral involved in many systems in your body including your muscular and skeletal system, cardiovascular system, and nervous system.

While a deficiency in magnesium does not usually cause symptoms, early symptoms may include fatigue, weakness, nausea, or a loss of appetite. As the deficiency progresses, symptoms may include muscle spasms, tremors, irregular or rapid heartbeat, and/or personality changes.

Scientific studies suggest that a link exists between magnesium deficiency and migraines. This is why some migraine specialists recommend checking a magnesium level in their patients with migraines. If low, doctors will commonly recommend either a magnesium supplement or even a magnesium-rich diet.

There are a number of different magnesium supplements, and how well they are absorbed in the body varies. In terms of a diet rich in magnesium, high-fiber foods are also generally high in magnesium whereas processed or refined foods are not. Examples of foods rich in magnesium include:

  • whole grains
  • nuts (e.g. almonds, cashews, peanuts)
  • green leafy vegetables (e.g. spinach)
  • legumes

While magnesium supplements may cause diarrhea or abdominal cramping when taken in high doses, magnesium-rich foods will not cause this adverse effect. 

Like riboflavin and Coenzyme Q10, the CHS makes a strong recommendation for taking magnesium as a supplement for preventing migraines, suggesting a dose of 600mg daily. The AAN/AHS gave magnesium a Level B recommendation ("probably effective") in migraine prevention. 

Butterbur

Butterbur, the technical name being Petasites hybridus, is a perennial shrub and herbal therapy used throughout history to prevent migraines. It's been deemed both an effective and well-tolerated alternative therapy, with the dominant side effect being stomach upset with belching. 

That being said, the use of butterbur is now surrounded in controversy due to safety concerns. The Petadolex formulation and other butterbur formulations have been linked to 40 cases of liver toxicity, two people requiring liver transplants.

The CHS guidelines still cite a strong recommendation for using Butterbur at a dose of 75mg twice daily. But Canada does caution consumers to only use certain commercially available license butterbur products—these products that have been tested and found not to contain the liver-toxic pyrrolizidine alkaloids.

Based on 2012 guidelines from the AHS and AAN, Petasites hybridus or butterbur is listed as a  a Level A drug ("effective") for preventing migraines. They have not revised their guidelines in light of these new findings regarding liver toxicity. Many doctors are holding off on recommending Butterbur until societies like American Headache Society make new recommendations. 

The Bottom Line

While generally low risk and well-tolerated, these four supplements may interact with other medications you are on. This is why it's important you do not take any vitamin or supplement without your doctor's advice and guidance.

Your doctor too may want to check your blood level (mostly magnesium or Coenzyme Q10) before taking a supplement to follow your progress or determine if you even need it. 

Sources:

Loder E, Burch R, Rizzoli P.  The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelinesHeadache, 2012 52:930-45

Raiapakse T & Pringsheim T. Nutraceuticals in Migraine: A Summary of Existing Guidelines for Use. Headache. 2016 Apr;56(4):808-16.

Sándor PS, et al. (2005). Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trialNeurology. 2005 22;64(4):713-5.

Teigen L & Boes CJ. An evidence-based review of oral magnesium supplementation in the preventive treatment of migraine. Cephalalgia. 2015 Sep;35(10):912-22.

Wider B, Pittler MH, Ernst E. Feverfew for preventing migraine. Cochraine Database Syst Rev. 2015 Apr 20;4:CD002286. 

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