More Migraine Help

Re: CAM Remedies for Migraine Headaches Examined

Evans R, Taylor F. "Natural" or alternative medications for migraine prevention. Headache. June 2006;46(6):506-516.

Many people with migraines are concerned about the side effects of prescription medications and are interested in natural or alternative therapies to prevent migraine attacks. People who suffer from episodic migraine, in which they return to normal between migraines episodes, are at risk for progression to chronic (continuous) headaches. The overuse of medications to treat the symptoms of migraine may increase the risk of chronic headache conditions. Complementary and alternative medicine (CAM) can be a viable option in reducing the frequency of attacks and the risk of progression to a chronic condition. This "Expert Opinion" article reviews the effectiveness and safety of several CAM therapies for migraine prevention.

The leaves of feverfew (Tanacetum parthenium) are used to prevent migraines and to reduce migraine symptoms such as nausea and vomiting. A review of randomized, controlled trials (RCT) conducted before 1998 found five such trials involving 216 subjects. Two thirds of the subjects in these studies experienced greater benefit from feverfew than from placebo. A Cochrane review conducted in 2004 examined five double-blind trials involving 343 subjects and concluded that feverfew lacked convincing evidence of efficacy. Some of the inconsistent results may stem from different extraction techniques used for feverfew products and uncertainty regarding the active ingredients in the plant. A study published in 2005 reported that MIG-99, a highly enriched parthenolide extract, was more effective than placebo in reducing the number of migraine attacks per month. Feverfew side effects can include systematic sore mouth and tongue, swollen lips, loss of taste, abdominal pain, and intestinal disturbances. No long-term studies have been conducted to assess the safety of feverfew.

Butterbur (Petasites hybridus) is an herb native to Europe. Although parts of the butterbur plant contain toxic pyrrolizidine alkaloids, a patented, standardized extract of butterbur root (Petadolex®, Weber and Weber GmbH & Co. KG, Germany) is free of toxic substances and is marketed for the prevention of migraine headaches. Two RCTs have been published on Petadolex. In the first trial of 60 people, 45% of those taking 100 mg per day of Petadolex and 15% of those taking placebo experienced a 50% or greater reduction in migraine frequency. In the second trial of 245 people, the migraine frequency decreased an average of 48% in the group taking 150 mg per day of Petadolex while the migraine frequency decreased an average of 26% in the placebo group. The migraine frequency was not significantly different between the group taking 100 mg per day Petadolex and the placebo group. Side effects in the Petadolex groups and placebo group were comparable except for excess burping in people taking Petadolex. Short-term use of Petadolex appears to be safe; however, no long-term safety studies have been conducted.

Magnesium levels are reported to be lower in the brain, in the blood, or inside the cells of people who experience migraines. Several RCTs have been conducted to test the effects of magnesium supplements on migraine prevention. Two of the trials indicated a benefit for magnesium and the other two trials found no significant effect of magnesium over placebo. Magnesium is an essential mineral, and it is safe when consumed as a dietary supplement. However, diarrhea is a common side effect when magnesium is taken at very high doses.

Riboflavin (vitamin B2) is required for the production of energy in the cell. One RCT tested riboflavin in people with migraines. In this study, 55 subjects took 400 mg of riboflavin or a placebo daily for three months. Subjects taking riboflavin had significantly fewer migraines and fewer headache days than subjects taking placebo. In another study, subjects took a combination of 400 mg riboflavin, 300 mg magnesium, and 100 mg feverfew or a placebo (25 mg riboflavin) daily for 3 months. There were no significant differences in the frequency of migraine attacks or number of headache days between the two groups. It is possible that the riboflavin "placebo" (used to color the urine so subjects would not know which group they were in) had a treatment effect in this study. Riboflavin is safe and well tolerated even at very high doses.

Coenzyme Q10 is also essential for energy production in cells, and it is being tested in a variety of neurological conditions. One RCT involving 42 subjects found that by the fourth month of the study, migraine frequency had dropped by at least 50% in 48% of subjects taking coenzyme Q10 and 14% of subjects taking placebo. Side effects were similar between the two groups, and previous studies indicate coenzyme Q10 is safe and well tolerated.

Although several studies have reported an association between lower levels of melatonin and migraine, no RCTs have tested the effects of melatonin on migraine prevention or treatment.

The authors conclude by evaluating the strength of the evidence for these CAM therapies in migraine prevention. With the exception of melatonin, all the therapies are rated as "Grade B," which means there is limited evidence from a single randomized trial, from nonrandomized trials, or from multiple trials with inconsistent outcomes. Based on the evidence presented in the article, they rank Petadolex as the therapy with the relatively strongest evidence, followed by magnesium, feverfew, riboflavin, coenzyme Q10, and melatonin. This article reveals how few randomized, controlled trials have been conducted on CAM therapies for the prevention of migraine and points out the need for more well-designed trials in the future.

—Heather S. Oliff, PhD