Natural treatments for migraines

• DEFINITION: Treatment of a class of severe headaches that share characteristic symptoms, including visual disturbances.
• PRINCIPAL PROPOSED NATURAL TREATMENTS: Butterbur, feverfew, 5-hydroxytryptophan, magnesium
• OTHER PROPOSED NATURAL TREATMENTS: Acupuncture, biofeedback, chiropractic, coenzyme Q₁₀, fish oil, food allergen avoidance, lipoic acid, magnet therapy, massage, relaxation therapies, soy isoflavones (combined with black cohosh and dong quai), vitamin B₂ (riboflavin), yoga

Introduction

The term migraine refers to a class of headaches sharing certain characteristic symptoms. Headache pain usually occurs in the forehead or temples, often on one side only, and is typically accompanied by nausea and a preference for a darkened room. Headache attacks last for several hours, up to a day or more. Completely pain-free intervals usually separate them. Headache pain is sometimes accompanied by a visual (or occasionally nonvisual) disturbance known as an aura. Migraines are classified as migraine with aura or migraine without aura.

Migraines can be set off by a variety of triggers, including fatigue, stress, hormonal changes, and foods, such as alcoholic beverages, chocolate, peanuts, and avocados. When people with migraine headaches first consult a physician, they are generally advised to identify such triggers and to avoid them if possible. However, migraines quite frequently occur with no obvious avoidable triggering factor.

The underlying cause of migraine headaches has been a subject of continuing controversy for more than a century. Opinion has swung back and forth between two primary beliefs: that migraines are related to epileptic seizures and originate in the nervous tissue of the brain or that blood vessels in the skull cause headache pain when they dilate or contract (vascular headaches). Most likely, several factors are involved, and more than one stimulus can trigger a migraine attack.

Drugs from the triptan family, also known as 5HT1-receptor agonists, have revolutionized the conventional treatment of acute migraines. These medications can completely abort a migraine headache in many persons. They work by imitating the action of serotonin on blood vessels, causing them to contract. However, although they are dramatically effective for the majority of people with migraines, a substantial minority do not respond for reasons that are unclear. However, people with post-traumatic migraines caused by head injuries are one group that often do not respond to triptans. In general, around 30 to 60 percent of people who use triptan do not respond within two hours, and up to 40 percent experience a recurrence after initial pain relief.

People interested in prevention of migraines have a great variety of options, including ergot drugs, antidepressants, beta-blockers, calcium channel blockers, and antiseizure medications. Picking the best one is mostly a matter of trial and error. Most people can find some medication that will work.

Serious diseases may occasionally first present themselves as migraine-type headaches, so if a person suddenly starts having migraines without a previous history, or if the pattern of the migraines changes significantly, it is essential to seek medical evaluation.

Principal Proposed Natural Treatments

Several herbs and supplements have shown considerable promise for helping to prevent migraines.

Butterbur. Two double-blind, placebo-controlled studies suggest that an extract of the herb butterbur may be helpful for preventing migraines. Butterbur extract was tested as a migraine preventive in a double-blind, placebo-controlled study involving sixty men and women who experienced at least three migraines per month. After four weeks without any conventional medications, participants were randomly assigned to take either 50 milligrams (mg) of butterbur extract or placebo twice daily for three months. The results were positive. Both the number of migraine attacks and the total number of days of migraine pain were significantly reduced in the treatment group compared with the placebo group. Three of four persons taking butterbur reported improvement, compared to one of four in the placebo group. No significant side effects were noted.

In another double-blind, placebo-controlled study performed by different researchers, 202 people with migraine headaches received either 50 mg of butterbur extract or 75 mg twice daily, or a placebo In the three months of the study, the frequency of migraine attacks gradually decreased in all three groups. However, the group receiving the higher dose of butterbur extract showed significantly greater improvement than those in the placebo group. The lower dose of butterbur failed to prove significantly more effective than placebo.

Based on these two studies, it does appear that butterbur extract is helpful for preventing migraines, and that 75 mg twice daily is more effective than 50 mg twice daily. However, further research is necessary to establish this with certainty.

Feverfew. Five meaningful, double-blind, placebo-controlled studies have evaluated feverfew’s effectiveness as a preventive treatment for migraines, but the results have been inconsistent. The best of the positive trials used a feverfew extract made by extracting the herb with liquid carbon dioxide. Two other trials that used whole feverfew leaf also found it effective; however, two studies that used feverfew extracts did not find benefit.

In a well-conducted, sixteen-week, double-blind, placebo-controlled study of 170 people with migraines, the use of a feverfew product made via liquid carbon dioxide extraction resulted in a significant decrease in headache frequency compared to the effect of the placebo treatment. In the treatment group, headache frequency decreased by 1.9 headaches per month, compared to a reduction of 1.3 headaches per month in the placebo group. The average number of headaches per month before treatment was 4.76. An earlier study using the same extract had failed to find a benefit, but it primarily enrolled people who were less prone to migraines.

Two other studies used whole feverfew leaf and found benefit. The first followed fifty-nine people for eight months. For four months, one-half received a daily capsule of feverfew leaf and the other half received placebo. The groups were then switched and followed for an additional four months. Treatment with feverfew produced a 24 percent reduction in the number of migraines and a significant decrease in nausea and vomiting during the headaches. A subsequent double-blind study of fifty-seven people with migraines found that the use of feverfew leaf could decrease the severity of migraine headaches. This trial did not report whether there was any change in the frequency of migraines. Another study used an alcohol extract but failed to find benefit.

Magnesium. Magnesium is another natural treatment that has shown promise for preventing migraine headaches. A twelve-week double-blind study followed eighty-one people with recurrent migraines. One-half received 600 mg of magnesium daily (in the rather unusual form of trimagnesium dicitrate), and the other half received placebo. By the final three weeks of the study, the frequency of migraine attacks was reduced by 41.6 percent in the treated group, compared to 15.8 percent in the placebo group. The only side effects observed were diarrhea (18.6 percent) and digestive irritation (4.7 percent). Preliminary studies also suggest that magnesium may be helpful for migraines triggered by hormonal changes occurring with the menstrual cycle.

5-hydroxytryptophan. The body manufactures 5-hydroxytryptophan (5-HTP) on its way to making serotonin. When 5-HTP is taken as a supplement, the net result may be increased serotonin production. Because a number of drugs that affect serotonin are used to prevent migraine headaches, 5-HTP has been tried too. Some evidence suggests that it may work when taken at a dosage of 400 to 600 mg daily. Lower doses may not be effective.

In a six-month trial of 124 people, 5-HTP (600 mg daily) proved just as effective as the standard drug methysergide. The most dramatic benefit seen was a reduction in the intensity and duration of migraines. Because methysergide has been proven better than placebo for migraine headaches in earlier studies, the study results provide meaningful, although not airtight, evidence that 5-HTP is also effective.

Similarly good results were seen in another comparative study that used a different medication and 5-HTP (at a dose of 400 mg daily). However, in another study, 5-HTP (up to 300 mg daily) was less effective than the drug propranolol. Also, in a study involving children, 5-HTP failed to demonstrate benefit. Other studies that are sometimes quoted as evidence that 5-HTP is effective for migraines actually enrolled adults or children with many different types of headaches (including migraines).

Putting all this evidence together, it appears that 5-HTP can help people with frequent migraine headaches if taken in sufficient doses, but further research needs to be done. In particular, a large double-blind study is needed that compares 5-HTP with placebo over a period of several months.

Mitochondrial enhancers. Mitochondria are the energy-producing subunits of cells. Based on the highly speculative theory that mitochondrial dysfunction may play a role in migraines, three substances have been tried for migraine prevention: vitamin B₂ (riboflavin), coenzyme Q₁₀ (CoQ₁₀), and lipoic acid. Results have been a bit promising.

A three-month, double-blind, placebo-controlled study of fifty-five people with migraines found that vitamin B₂ (at a daily dose of 400 mg) significantly reduced the frequency and duration of migraine attacks. The majority of the participants experienced a greater than 50 percent decrease in the number of migraine attacks and in the total days with headache pain. A subsequent study failed to find benefit with a combination of vitamin B₂, magnesium, and feverfew; however, it is possible that the 25-mg daily dose of vitamin B₂ used as the placebo confused the issue by providing some benefits on its own.

Another small, double-blind, placebo-controlled trial found benefit with CoQ₁₀ (100 mg three times daily). In this study, about 50 percent of the people taking this supplement had a significant decrease in migraine frequency, compared to 15 percent in the placebo group. A similar study of lipoic acid hinted at benefit, but the results failed to pass tests of statistical significance.

OnabotulinumtoxinA. OnabotulinumtoxinA, also known as Botox, is a natural protein produced by the bacterium Clostridium botulinum. A systematic literature review of fifty-five studies evaluating onabotulinumtoxinA for the use of migraines found that it is effective in reducing the frequency, number, and pain of chronic migraines. A study published in 2019 in Australia studied 211 patients who received onabotulinumtoxinA for chronic migraines. Of them, 74 percent had fewer headaches after two treatment cycles of onabotulinumtoxinA.

Other Proposed Natural Treatments

In a twenty-four-week double-blind study, forty-nine women with menstrual migraines received either placebo or soy isoflavones combined with dong quai and black cohosh extracts. Beginning at the twentieth week, the use of the herbal supplement resulted in decreased severity and frequency of headaches compared with placebo. It is unclear which of the ingredients in the combination was helpful; contrary to what is stated in this research report, the newest consensus is that neither black cohosh nor dong quai is a phytoestrogen, but that they may have other effects.

Despite promising results in an earlier and widely publicized study, a much larger and longer study of fish oil for migraines failed to find benefit. In this sixteen-week, double-blind, placebo-controlled study of 167 persons with recurrent migraines, the use of fish oil did not significantly reduce headache frequency or severity. Another small, double-blind, placebo-controlled study failed to find statistically significant evidence of benefit. Calcium, chromium, folate, ginger, and vitamin C have also been reported to be helpful for migraines, but there is no meaningful scientific evidence for any of these natural products. Identifying and eliminating allergenic foods from one’s diet might be helpful for reducing the frequency of migraine attacks.

Evidence is inconsistent or incomplete regarding the potential benefit of chiropractic manipulation or acupuncture for the treatment and prevention of migraines. Biofeedback, massage, yoga, and a form of magnet treatment called pulsed electromagnetic field therapy have shown some promise for migraines. A careful review of twenty-nine trials found psychological interventions such as cognitive behavioral therapy, biofeedback, relaxation, and coping associated with reduced chronic headache or migraine pain in 589 children. These treatments were compared with placebo, standard treatment, waiting list control, or other active treatments.

In addition to physical activities and dietary supplements, a reduction in migraines may call for changes in lifestyle or daily behaviors. For example, this may mean increased exercise, more sleep, or eliminating stressors. This may entail reducing the time spent in front of a computer or an electronic device. Modification to one’s diet may also prove beneficial. One suggestion is for a migraine sufferer to eat more often to stabilize blood sugar but to reduce the food intake in each meal. A diet focused on fruits, vegetables, beans, and lean proteins may help reduce migraines. The avoidance of other foods may do likewise. These include nitrates that are commonly found in processed meats, such as hot dogs, salami, and pepperoni. Alcohol can trigger migraines as well as excessive caffeine.

Herbs and Supplements to Use with Caution

Various herbs and supplements may interact adversely with drugs used to treat migraine headaches, so one should be cautious when considering the use of herbs and supplements.

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