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 typically accompanied by nausea and a preference for a
darkened room. Headache attacks last for several hours, up to a day or more. They
are usually separated by completely pain-free intervals. In some cases, headache
pain is 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.
Conventional treatment of acute migraines has been revolutionized by drugs in the
triptan family. 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.
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 twice daily of butterbur extract, 75 mg twice daily, or 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 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 the prevention of 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.
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 not clear 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.
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.
Bibliography
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