A migraine is an intense and prolonged headache, which usually lasts from between 4 and 72 hours (1). They can be accompanied by other symptoms, such as nausea, vomiting, sensitivity to light, sound and odor. They can also occur with or without aura (a short period of visual disturbance indicating headache occurrence). Physical activity can also increase the severity of the pain (2).
Migraines are socially and financially debilitating, for both individuals and society as a whole (3). They occur more often in women as a result of hormonal influences (4). The main cause of migraines is unknown but a variety of genetic and environmental factors are involved in their development (5).
There are a number of drug treatments that can help in preventing migraines, as well as lessening the frequency and duration of migraine attacks. Lifestyle changes can also be influential, such as moderating caffeine consumption, avoiding skipping meals, removing food triggers from the diet and performing regular exercise. In addition to these medications and lifestyle modifications, there are a number of nutritional supplements that can help (6).
Types of Headache Pain
Most Helpful Supplements for Migraine Sufferers
Vitamin B2 (Riboflavin)
Vitamin B2, also known as riboﬂavin, plays a key role in the metabolism of carbohydrates, fats, and proteins. It can produce two cofactors called Flavin mononucleotide (FMN) and Flavin adenine dinucleotide (FAD). Several proteins in the body are dependent on these cofactors to function optimally.
How does vitamin B2 help migraines?
Vitamin B2 is essential because it cannot be made by the body and thus needs to be obtained from food. It is recommended as a supplement for migraine prevention by both the American Academy of Neurology (AAN) and the Canadian Headache Society because it is well tolerated and the side eﬀects are minimal (7, 8).
A randomised controlled trial found that daily use of 400mg riboﬂavin for 3 months resulted in a 50% reduction in migraine attacks in 59% of patients, compared with 15% for placebo (8). There were only two minor adverse effects reported in the study, diarrhea and polyuria.
How do I take vitamin B2 for migraines?
To obtain the benefits for migraine prevention, it is recommended to consume 400mg daily (in split doses) (8). Intake can be boosted through consuming foods high in vitamin B2, such as wheat germ, bran, sesame seeds and mushrooms.
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Magnesium has a number of different functions in the human body. It plays a role in intracellular energy storage and expenditure, acts as a cofactor in many enzymes, is required for nucleic acid synthesis and is involved in cell division and growth, as well as regulation of ion channels, receptors and the transport system (9).
How does magnesium help migraines?
Magnesium is thought to play in migraines by counteracting vasospasm, inhibiting platelet aggregation and stabilizing cell membranes (10).
Studies have shown that people who suffer with migraines have low levels of brain magnesium during attacks (11) and may also have a systemic magnesium deﬁciency (12, 13).
One double-blind, placebo controlled study found that 600mg magnesium taken daily for 12 weeks reduced migraine attack frequency by 41.6% (15). The number of days where a migraine was experienced, and the amount of pain medication taken was also significantly decreased over the treatment period. Adverse events were rare but included diarrhea in 18.6% of participants and gastric irritation in 4.7%.
How do I take magnesium for migraines?
The suggested dose of magnesium supplement is 400mg per day for migraine prevention, which and can be raised up to 1200mg, if tolerated (16). Possible gastrointestinal adverse eﬀects of magnesium supplementation are abdominal pain, nausea and diarrhea. It is best to take magnesium oxide, chelated magnesium, or slow release magnesium because this improves absorption and has a lower risk of gastrointestinal issues. Intake can also be boosted through food, such as nuts and green leafy vegetables.
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Coenzyme Q10, which is also known as ubiquinone, is a potent lipid phase antioxidant. It is a free radical scavenger, reduces oxidative stress; regenerates other vitamins and antioxidants and reduces the oxidation of low-density lipoprotein.
How does CoQ10 help migraines?
In an open label study in which 31 patients with migraine used 150mg daily of CoQ10 for 3 months, 61% had at least a 50% reduction in the number of days where they experienced a migraine and did not experience any adverse effects (17).
A small randomized controlled trial found that 100mg of CoQ10 taken three times per day signiﬁcantly decreased migraine attack frequency, days where a migraine was experienced and days with nausea (18). Gastrointestinal disturbances and ‘cutaneous allergy’ were reported in the study but were rare.
How do I take coenzyme Q10 for migraines?
1–3mg/kg per day is recommended for migraine prevention (19). It is a fat-soluble compound, so it is recommended to take it with food for better absorption.
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Vitamin D is a fat-soluble vitamin responsible for a number of different functions in the body, including increasing calcium absorption, maintaining healthy bones, reducing inflammation and boosting the immune system. It is found in small amounts in food but is often added as a supplement. In addition, when skin is exposed to sunlight, vitamin D is produced in the body.
How does vitamin D help migraines?
Several case studies have reported positive effects of vitamin D supplementation on reducing both headaches and migraines (20, 21). A case study performed on two groups of women with migraine found that initially they had low vitamin D levels but after supplementing with vitamin D and calcium supplementation (1600-1200 IU per day), migraine attacks were significantly reduced (22, 23).
How do I take vitamin D for migraines?
To obtain the benefits of vitamin D for helping to prevent migraines, it is recommended to supplement with a minimum of 1500 IU per day (24). However, it is advisable to test your existing levels before beginning supplementation to determine whether or not you are deficient and therefore may need a higher amount.
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Alpha Lipoic Acid
Alpha-lipoic acid (ALA) is a nutritional coenzyme that is involved in the energy metabolism of proteins, carbohydrates and fats, plays a role in blood glucose disposal and is able to scavenge free radicals. It also enhances mitochondrial oxygen metabolism and ATP production (25).
How does ALA help migraines?
In a randomised controlled trial, 54 participants received either 600mg of alpha lipoic acid or placebo daily for 3 months. Although the results were not significant for migraine frequency but were for number of headache days and headache severity (26).
How do I take alpha lipoic acid for migraines?
More research is needed on the optimal dose of alpha lipoic acid but based on existing evidence, it is recommended to take 600mg per day to help prevent migraine attacks.
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Feverfew is a herbal supplement that is based upon the dried leaves of the weed plant tanacetum pathenium. It was used to treat headache, inflammation, and fever several centuries ago, and was then rediscovered in the late 20th century.
How does feverfew help migraines?
The parthenolides within the leaves are hypothesised to be the mechanism that is related to migraine prevention. These are thought to inhibit serotonin release from platelets and white blood cells and inhibit platelet aggregation. Feverfew may also have anti-inflammatory activity via the inhibition of prostaglandin synthesis and phospholipase A (27, 28, 29, 30).
Feverfew seems to be particularly effective in reducing migraines in people who experience them frequently, especially when they are accompanied by auras.
A randomized, double-blind, multicentre, placebo-controlled study involving 170 participants found that 6.25mg of feverfew thrice a day was significantly better than placebo in reducing the occurrence of migraines. The migraine frequency decreased from 4.76 by 1.9 attacks per month in the treatment group and by 1.3 attacks in the placebo group, with no significant side effects recorded (31).
How do I take feverfew for migraines?
To obtain the benefits of feverfew for preventing migraines is 100mg per day (6). It is important to note that pregnant women should not take the supplement.
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Carnitine plays a key role in energy production, transportation of long-chain fatty acids across the inner mitochondrial membrane for β-oxidation and ATP production.
L-carnitine deficiency changes the oxidation of fatty acids and increases toxins generated from nociceptive triggers (32). Carnitine deficiency decreases beta-oxidation and thus is thought to influence migraines by mitigating oxidative stress (33).
How does l-carnitine help migraines?
One single-blinded clinical trial investigated the effects of magnesium, L-carnitine, and concurrent magnesium–L-carnitine supplementation in people who suffer from migraines. Participants were assigned into four groups: 500 mg per day of magnesium oxide, 500mg per day of L-carnitine, 500 mg per day of magnesium oxide and 500 mg/day L-carnitine concurrently, or the control group. It was found that L-carnitine significantly decreased migraine frequency, severity, index and migraine days (34).
How do I take L-carnitine for migraines?
More research is needed to determine the optimal dose of L-carnitine for migraine prevention. Based on current evidence, a daily dose of 500mg is recommended.
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Vitamin B12 (Cobalamin)
Vitamin B12, also called cobalamin, has a number of different functions in the body. Methyl cobalamin and adenosyl cobalamin are the two active forms of vitamin B12 in humans. Circulating vitamin B12 is also present in the body as hydroxycobalamin, which influences migraines by several pathways. One of these is scavenging action against nitric oxide (NO) (35, 36). Nitric oxide is involved in pain transmission, hyperalgesia, chronic pain and inflammation (37, 38).
How does vitamin b12 help migraines?
In a study investigating the effect of hydroxycobalamin in preventing migraine, intranasal administration of hydroxycobalamin decreased the frequency of migraine attacks by about 50% in 53% of people who experience migraines (39). Research has also found an association between vitamin B12 pathway dysfunction and migraines (40).
How do I take vitamin B12 for migraines?
It is recommended to take 1,000mcg (1mg) of supplemental vitamin B12 to obtain the migraine prevention benefits. Additional vitamin B12 can be obtained from fortified foods, such as breakfast cereals.
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Over the last few years, butterbur, also known as Petasites hybridus root extract, has emerged as a potential new treatment for migraines. This is a perennial shrub that was used in ancient times that was used for a range of medicinal uses.
It is thought to act via calcium channel regulation and inhibition of peptide-leukotriene biosynthesis. Leukotrienes and other inflammatory mediators may have a role in the inflammatory cascade associated with migraine (41, 42).
How does butterbur help migraines?
A randomized, double-blind, placebo-controlled trial using 50 mg of butterbur twice daily, demonstrated a significantly reduced number of migraine attacks and migraine days per month in participants (43).
Another study compared the effectiveness of 75mg twice daily with 50mg twice daily in a 3-arm, parallel-group, randomized trial of 245 participants. It was found that the higher dose was more effective in preventing migraines than placebo in reducing the number of migraines per month (44).
The supplement has also been used effectively to prevent migraines in children and adolescents. A multicenter prospective open-label study of butterbur in 109 people found that migraine frequency was reduced by at least 50% in 77% of participants (45).
In all 3 of these studies, butterbur was well tolerated by participants and no serious adverse events were reported. However, there were rare incidences of mild gastrointestinal events, particularly eructation (burping).
How do I take butterbur for migraines?
To obtain the benefits of butterbur, it is recommended to take 75mg twice daily (44). This can be reduced to 50mg daily if gastrointestinal effects are experienced.
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Ginger is a tropical plant which grows a fragrant underground stem called a rhizome. It has been used for its medicinal qualities in China for centuries, for treating pain, inflammation, and musculoskeletal symptoms. It has anti-inflammatory properties, which could be related to the reduction of platelet aggregation and the inhibition of prostaglandin and leukotriene biosynthesis (46).
How does ginger help migraines?
A double-blinded, randomized, controlled trial with 100 participants compared ginger to sumatriptan, one of the main drugs used to treat migraines (47). Researchers used one-eighth of a teaspoon of powdered ginger versus a standard dose of the drug. Time of headache onset, severity, time interval from headache beginning to taking drug and patient self-estimation about response for five subsequent migraine attacks were recorded by participants.
Two hours after using either treatment, headache severity was significantly reduced. Effectiveness was similar between ginger and sumatriptan, but ginger was associated with fewer side effects. With sumatriptan, participants reported dizziness, a sedative effect, vertigo, and heartburn. The only adverse side effect reported for ginger was an upset stomach, but this only occurred in a small proportion of participants.
How do I take ginger for migraines?
Further research is needed to determine the optimal dose of ginger for migraine treatment. However, based on current evidence, it is recommended to take 1g per day of ginger extract. Intake can also be boosted by adding powdered ginger to food or drinks.
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Eicosapentaenoic Acid (EPA)
Eicosapentaenoic acid (EPA) is one of the body’s natural omega-3 fatty acids and can help to prevent migraines. Along with docosahexaenoic acid (DHA), EPA is involved with regulating various biological processes such as the inflammatory response, various metabolic signaling pathways and maintaining brain function. They can be synthesized in the body from alpha-linolenic acid (ALA), but only in small amounts for most people.
How does EPA help migraines?
Small-scale studies have suggested that headache severity and frequency can be reduced by adding EPA to the diet (48). This is thought to the result of EPA lowering prostaglandin levels and serotonin activity.
How do I take EPA for migraines?
Although the FDA has not established a recommended daily allowance for EPA, based on available evidence, a dose of 600 mg per day divided into 3 doses seems to be most effective for headache prevention. However, EPA should not be taken in by diabetic patients or people at risk of stroke, nosebleeds or bleeding disorders.
Although there are a number of nutritional supplements that can help prevent, and in some cases treat, migraines, they cannot be taken by all individuals. Both pregnancy and lactation require special treatment of migraines.
Interestingly, migraines tend to improve during pregnancy but in some women, they can remain the same or worsen (49). Women are also limited in their ability to take prescribed medications during this time and therefore lifestyle approaches, such as biofeedback and regular exercise, are recommended at this time (50).
However, for women experiencing migraines during pregnancy and lactation, magnesium supplementation is an option for both acute and preventative treatment.
The Bottom Line
Migraines are a primary headache disorder diagnosed by recurrent and moderate to severe headaches, which can be hugely debilitating for the people who experience them. Although the main cause of migraines is unknown, a number of influences, including genetics and environmental factors, are involved in the onset of migraine attacks.
There are a number of drugs are available to treat migraines, these are associated with a number of side effects and thus nutritional supplements can provide an adjunct to these treatments, which have minimal adverse effects. Using effective nutrients along with drugs can lead to decreased dosage of medications and may reduce the side effects associated with the drugs.
There is a wide range of acute and preventative treatments for migraine available, which can be used alongside making lifestyle changes. Influential lifestyle changes include moderating caffeine consumption, avoiding skipping meals, removing food triggers from the diet and taking regular exercise. Supplementation can prevent migraines or reduce the severity and frequency of migraine attacks. The nutrients in these supplements improve migraines via positive effects on mitochondrial function, reducing inflammatory factors and improving antioxidant status.
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