Nutraceuticals in Acute and Prophylactic Treatment of Migraine

Opinion statement

People who suffer from headaches often prefer nutraceutical treatment over traditional pharmacological approaches, due to fear of possible side effects, drug dependence, or addiction. Since treatment with nutraceuticals does not require a doctor’s prescription, many patients rely on their own judgment as to when and which one to take, often without consultation or guidance from their physician. Some physicians could provide information about potential efficacy and side effects of various products, but many are not familiar with the nutraceuticals. Widespread skepticism persists among doctors about the effectiveness of these treatments. This is largely due to the lack of rigorous clinical studies. However, even when incontrovertible scientific evidence exists, many physicians remain distrustful of the evidence. The following review summarizes randomized controlled trials of some of the most commonly used non-pharmacological treatments, including magnesium, coenzyme Q10, riboflavin (vitamin B2), petasites, and feverfew (Table 1).

This is a preview of subscription content, log in to check access.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Victor TW, Hu X, Campbell JC, Buse DC, Lipton RB. Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia. 2010;30:065–1072.

    Article  Google Scholar 

  2. 2.

    Steiner TJ, Birbeck GL, Jensen RH, Katsarava Z, Stovner LJ, Martelletti P. Headache disorders are third cause of disability worldwide. J Headache Pain. 2015;16(1):1–3.

    Article  Google Scholar 

  3. 3.

    Diener HC, Solbach K, Holle D, Gaul C. Integrated care for chronic migraine patients: epidemiology, burden, diagnosis and treatment options. Clin Med. 2015;15(4):344–50.

    Google Scholar 

  4. 4.

    Bigal ME, Serrano D, Reed M, Lipton RB. Chronic migraine in the population Burden, diagnosis, and satisfaction with treatment. Neurology. 2008;71(8):559–66.

    Article  PubMed  Google Scholar 

  5. 5.

    GöKSEL BK. The use of complementary and alternative medicine in patients with migraine. Arch Neuropsychiatr. 2013;50 Suppl 1:S41–6.

    Article  Google Scholar 

  6. 6.•

    Tepper SJ. Nutraceutical and other modalities for the treatment of headache. CONTINUUM: Lifelong Learn Neurol. 2015;21(4, Headache):1018–31. A very comprehensive review on complementary treatment modalities for migraine (not only nutraceuticals).

    Google Scholar 

  7. 7.

    Sun‐Edelstein C, Mauskop A. Alternative headache treatments: nutraceuticals, behavioral and physical treatments. Headache: J Head Face Pain. 2011;51(3):469–83.

    Article  Google Scholar 

  8. 8.

    Mauskop A. Nonmedication, alternative, and complementary treatments for migraine. CONTINUUM: Lifelong Learn Neurol. 2012;18(4, Headache):796–806.

    Google Scholar 

  9. 9.

    Pfaffenrath V, Wessely P, Meyer C, Isler HR, Evers S, Grotemeyer KH, et al. Magnesium in the prophylaxis of migraine—a double-blind, placebo-controlled study. Cephalalgia. 1996;16(6):436–40.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Peikert A, Wilimzig C, Köhne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia. 1996;16(4):257–63.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Bigal ME, Bordini CA, Tepper SJ, Speciali JG. Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura. A randomized, double-blind, placebo-controlled study. Cephalalgia. 2002;22(5):345–53.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Hershey AD, Powers SW, Vockell AB, et al. Coenzyme Q10 deficiency and response to supplementation in pediatric and adolescent migraine. Headache. 2007;47:73–80.

    Article  PubMed  Google Scholar 

  13. 13.

    Schoenen J, Jacquy J, Lanaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. Neurology. 1998;50:466–70.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Pothmann R, Danesch U. Migraine prevention in children and adolescents: results of an open study with a special butterbur root extract. Headache. 2005;45:196–203.

    Article  PubMed  Google Scholar 

  15. 15.

    Grossmann M, Schmidramsl H. An extract of Petasites hybridus is effective in the prophylaxis of migraine. Int J Clin Pharmacol Ther. 2000;38(9):430–5.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Lipton RB, Gobel H, Einhaupl KM, Wilks K, Mauskop A. Petsites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology. 2004;63:2240–4.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Diener HC, Pfaffenrath V, Schnitker J, Friede M, Henneicke‐von Zepelin HH. Efficacy and safety of 6.25 mg tid feverfew CO2‐extract (MIG‐99) in migraine prevention—a randomized, double‐blind, multicentre, Placebo‐controlled study. Cephalalgia. 2005;25(11):1031–41.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Pfaffenrath V, Diener HC, Fisher M, Friede M, Henneicke-von Zepelin HH. The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis— a double-blind, multicentre, randomized placebo-controlled dose–response study. Cephalalgia. 2002;22:523–5322.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Lea R, Colson N, Quinlan S, Macmillan J, Griffiths L. The effects of vitamin supplementation and MTHFR (C677T) genotype on homocysteine-lowering and migraine disability. Pharmacogenet Genomics. 2009;19(6):422–8.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Schimatschek HF, Rempis R. Prevalence of hypomagnesemia in an unselected German population of 16,000 individuals. Magnes Res: Off Organ Int Soc Dev Res Magnes. 2001;14(4):283–90.

    CAS  Google Scholar 

  21. 21.

    Ramadan NM, Halvorson H, Vande-Linde A, et al. Low brain magnesium in migraine. Headache. 1989;29:590–3.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Mauskop A, Altura BT, Cracco RQ, Altura BM. Intravenous magnesium sulfate relieves acute migraine in patients with low serum ionized magnesium levels. Clin Sci. 1995;89:633–6.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Gallai V, Sarchielli P, Morucci P, Abbritti G. Red blood cell magnesium levels in migraine patients. Cephalalgia. 1993;13(2):94–8.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Gallai V, Sarchielli P, Morucci P, Abbritti G. Magnesium content of mononuclear blood cells in migraine patients. Headache: J Head Face Pain. 1994;34(3):160–5.

    CAS  Article  Google Scholar 

  25. 25.

    Trauninger A, Pfund Z, Koszegi T, Czopf J. Oral magnesium load test in patients with migraine. Headache. 2002;42:114–9.

    Article  PubMed  Google Scholar 

  26. 26.

    Storer RJ, Goadsby PJ. N-Methyl-D-Aspartate receptor channel complex blockers including memantine and magnesium inhibit nociceptive traffic in the trigeminocervical complex of the rat. Cephalalgia. 2009;29:135.

    Article  Google Scholar 

  27. 27.••

    Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346–53. An extensive analysis of published studies from June 1999 to May 2009 that provides evidenced based recommendations for the preventive treatment of migraines.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Choi H, Parmar N. The use of intravenous magnesium sulphate for acute migraine: meta-analysis of randomized controlled trials. Eur J Emerg Med. 2014;21(1):2–9.

    PubMed  Google Scholar 

  29. 29.

    Rozen TD, Oshinsky ML, Gebeline CA, Bradley KC, Young WB, Schechter AL, et al. Open label trial of Coenzyme Q10 as a migraine preventive. Cephalalgia. 2002;22:137–41.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Sandor PS, Di Clemente L, Coppola G, Saenger U, Fumal A, Magis, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology. 2005;64(4):713–5.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Di Lorenzo C, Pierelli F, Coppola G, Grieco GS, Rengo C, Ciccolella, et al. Mitochondrial DNA haplogroups influence the therapeutic response to riboflavin in migraineurs. Neurology. 2009;72(18):1588–94.

    Article  PubMed  Google Scholar 

  32. 32.

    Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie, et al. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012;39(2 Suppl 2):S1–59.

    PubMed  Google Scholar 

  33. 33.

    Heptinstall S, Williamson L, White A, Mitchell JRA. Extracts of feverfew inhibit granule secretion in blood platelets and polymorphonuclear leucocytes. Lancet. 1985;325(8437):1071–4.

    Article  Google Scholar 

  34. 34.

    Heptinstall S, Goenewegen WA, Spangenberg P, Loesche W. Extracts of feverfew may inhibit platelet behaviour via neutralisation of suphydryl groups. J Pharm Pharmacol. 1987;39:459–65.

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Pugh WH, Sambo K. Prostaglandin synthetase inhibitors in feverfew. J Pharm Pharmacol. 1988;40:743–5.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Makheja AM, Bailey JM. A platelet phospholipase inhibitor from the medicinal herb feverfew (Tanacetum parthenium). Prostaglandins Leukot Med. 1982;8:653–60.

    CAS  PubMed  Google Scholar 

  37. 37.

    Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J. 1985;291:569–73.

    CAS  Article  Google Scholar 

  38. 38.

    Murphy JJ, Heptinstall S, Mitchell JR. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet. 1988;2:189–92.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Kuritzky A, Elhacham Y, Yerushalmi Z, Hering R. Feverfew in the treatment of migraine: its effect on serotonin uptake and platelet activity. Neurology. 1994;44 Suppl 2:293.

    Google Scholar 

  40. 40.

    De Weerdt CJ, Bootsma HPR, Hendriks H. Herbal medicines in migraine prevention: randomized double-blind placebo-controlled crossover trial of a feverfew preparation. Phytomedicine. 1996;3(3):225–30.

    Article  PubMed  Google Scholar 

  41. 41.

    Palevitch D, Earon G, Carasso R. Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: a placebo-controlled doulbe-blind study. Phytother Res. 1997;11:508–11.

    Article  Google Scholar 

  42. 42.

    Vogler BK, Pittler BK, Ernst E. Feverfew as a preventive treatment for migraine: a systematic review. Cephalalgia. 1998;18:704–8.

    CAS  Article  PubMed  Google Scholar 

  43. 43.

    Draves AH, Walker SE. Parthenolide content of Canadian commercial feverfew preparations: label claims are misleading in most cases. CPJ, Can Pharm J. 2003;136(10):23–30.

    Google Scholar 

  44. 44.

    Abdel-Tawab M, Werz O, Schubert-Zsilavecz M. Boswellia serrata. Clin Pharmacokinet. 2011;50(6):349–69.

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Lampl C, Haider B, Schweiger C. Long-term efficacy of Boswellia serrata in four patients with chronic cluster headache. Cephalalgia. 2012;32(9):719–22.

    Article  PubMed  Google Scholar 

  46. 46.

    Plaza HRC. Late-Breaking Abstracts. 2014.

  47. 47.

    Bekkelund SI, Alstadhaug KB. Migraine prophylactic drugs-something new under the sun. Expert Opin Investig Drugs. 2011;20(9):1201–10.

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Peres M, Goncalves A. Double-blind, placebo controlled, randomized clinical trial comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention. Neurology. 2013;80(Meeting Abstracts 1):S40–005.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Oved Daniel MD.

Ethics declarations

Conflict of Interest

Oved Daniel and Alexander Mauskop declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Headache

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Daniel, O., Mauskop, A. Nutraceuticals in Acute and Prophylactic Treatment of Migraine. Curr Treat Options Neurol 18, 14 (2016). https://doi.org/10.1007/s11940-016-0398-1

Download citation

Keywords

  • Nutraceuticals
  • Headache
  • Migraine
  • Vitamins
  • Minerals
  • Herbal preparation