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 and 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 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 over 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 (so-called vascular headaches). Most likely, several factors are involved, and more than one stimulus can light the fuse that leads to a full-blown migraine attack.
Conventional treatment of acute migraines has lately been revolutionized by drugs in the triptan family. These medications can completely abort a migraine headache in many individuals. They work by imitating the action of serotonin on blood vessels, causing them to contract. However, while 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 but not all people can find some medication that will work.
Several herbs and supplements have shown considerable promise for helping to prevent migraines. Keep in mind that serious diseases may occasionally first present themselves as migraine-type headaches. If you suddenly start having migraines without a previous history, or if the pattern of your migraines changes significantly, it is essential to seek medical evaluation.
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 60 men and women who experienced at least three migraines per month. 34 After 4 weeks without any conventional medications, participants were randomly assigned to take either 50 mg of butterbur extract or placebo twice daily for 3 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 as compared to the placebo group. Three out of four individuals taking butterbur reported improvement, as compared to only one out 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. 60 Over the 3 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.
For more information, including dosage and safety issues, see the full Butterbur article.
Five meaningful double-blind, placebo-controlled studies have been performed to evaluate 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 16-week, double-blind, placebo-controlled study of 170 people with migraines, use of a feverfew product made via liquid carbon-dioxide extraction resulted in a significant decrease in headache frequency as compared to the effect of the placebo treatment. 63 In the treatment group, headache frequency decreased by 1.9 headaches per month, as compared to a reduction of 1.3 headaches per month in the placebo group. The average number of headaches per month prior to treatment was 4.76 headaches. A previous study using the same extract had failed to find benefit, but it primarily enrolled people who were less prone to migraines. 10 A review of 6 randomized trials including some the above trials, supported that feverfew has mixed, inconclusive evidence as treatment for preventing migraine headaches.95
Two other studies used whole feverfew leaf, and found benefit. The first followed 59 people for 8 months. 2 For 4 months, half received a daily capsule of feverfew leaf, and the other half received placebo. The groups were then switched and followed for an additional 4 months. Treatment with feverfew produced a 24% reduction in the number of migraines and a significant decrease in nausea and vomiting during the headaches. A subsequent double-blind study of 57 people with migraines found that use of feverfew leaf could decrease the severity of migraine headaches. 3 Unfortunately, this trial did not report whether there was any change in the frequency of migraines.
One study using an alcohol extract failed to find benefit. 4,10
Some migraine sufferers experience a mild headache before the onset of their full blown migraine. A randomized trial involving 60 such patients found that a sublingual (placed under the toungue for rapid absorption) combination of feverfew and ginger taken at the onset of this early hedache helped to reduce or eliminate pain for at least 2 hours. 77
For more information, including dosage and safety issues, see the full Feverfew article.
Magnesium is another natural treatment that has shown promise for the prevention of migraine headaches. A 12-week, double-blind study followed 81 people with recurrent migraines. 19 Half received 600 mg of magnesium daily (in the rather unusual form of trimagnesium dicitrate), and the other half received placebo. By the last 3 weeks of the study, the frequency of migraine attacks was reduced by 41.6% in the treated group, compared to 15.8% in the placebo group. The only side effects observed were diarrhea (18.6%) and digestive irritation (4.7%).
Preliminary studies also suggest that magnesium may be helpful for migraines triggered by hormonal changes occurring with the menstrual cycle. 21,42
For more information, including dosage and safety issues, see the full Magnesium article.
The body manufactures 5-HTP on its way to making serotonin. When 5-HTP is taken as a supplement, the net result may be increased serotonin production. Since a number of drugs that affect serotonin are used to prevent migraine headaches, 5-HTP has been tried as well. Some evidence suggests that it may work when taken at a dosage of 400 mg to 600 mg daily. Lower doses may not be effective.
In a 6-month trial of 124 people, 5-HTP (600 mg daily) proved equally effective as the standard drug methysergide. 24 The most dramatic benefits seen were a reduction in the intensity and duration of migraines. Since 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, using a different medication and 5-HTP (at a dose of 400 mg daily). 25
However, in one study, 5-HTP (up to 300 mg daily) was less effective than the drug propranolol. 26 Also, in a study involving children, 5-HTP failed to demonstrate benefit. 27 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). 28-30
Putting all this evidence together, it appears possible that 5-HTP can help people with frequent migraine headaches if taken in sufficient doses, but further research needs to be done. In particular, we need a large double-blind study that compares 5-HTP against placebo over a period of several months.
For more information, including dosage and safety issues, see the full 5-HTP article.
Mitochondria are the energy-producing subunits of cells. Based on a the highly speculative theory that mitochondrial dysfunction may play a role in migraines, three substances have been tried for migraine prevention: vitamin B 2 (riboflavin), coenzyme Q 10 (CoQ 10 ), and lipoic acid . Results, thus far, have been a bit promising.
A 3-month, double-blind, placebo-controlled study of 55 people with migraines found that vitamin B 2 (at a daily dose of 400 mg) significantly reduced the frequency and duration of migraine attacks. 33 The majority of the participants experienced a greater than 50% decrease in the number of migraine attacks as well as the total days with headache pain. A subsequent study failed to find benefit with a combination of vitamin B 2 , magnesium, and feverfew; however, it is possible that the 25 mg daily dose of vitamin B 2 used as the placebo confused the issue by providing some benefits on its own. 64
Another small double-blind, placebo-controlled trial found benefit with CoQ 10 (100 mg 3x daily). 62 In this study, about 50% of the people taking this supplement had a significant decrease in migraine frequency, as compared to only 15% in the placebo group.
Despite promising results in an earlier and widely publicized study, 31 a much larger and longer study of fish oil for migraines failed to find benefit. 31 In this 16-week, double-blind, placebo-controlled study of 167 individuals with recurrent migraines, use of fish oil did not significantly reduce headache frequency or severity. 39 Another small double-blind, placebo-controlled study failed to find statistically significant evidence of benefit. 40
Acupuncture has shown some promise for various types of headaches, including migraines; however, the research record remains mixed, and the best designed studies have generally failed to find benefit. 78-90
One study, though, found more persuasive evidence for migraines. 78 In this study, 140 migraine sufferers were randomized to receive acupuncture plus placebo or sham acupuncture plus flunarizine (a medication used to prevent migraines). At 16 weeks, those in the acupuncture and placebo group experienced more migraine-free days than the sham acupuncture and medication group. A drawback of this study is that flunarizine is not a commonly used medication for migraine prevention.
In a review of five randomized trials with 3,962 patients, acupuncture was effective in reducing migraine and tension-type headache pain when compared to patients receiving no acupuncture. However, four randomized trials comparing acupunture to sham acupuncture among 1,414 patients showed mixed results. Two trials found significant pain reduction and two did not. 91
In a single blind randomized trial of 480 adults with migraine headaches, 20 sessions of real acupuncture over 4 weeks reduced the number of headache days compared to sham acupuncture 12 weeks after treatment. However, this effect was delayed: there were no significant differences between the groups after 4 weeks after treatment. 92
Acupuncture was combined with migraine prophylaxis in a randomized trial of 100 patients who did not have success with standard prophylaxis treatment. Patients continued prophylaxis treatment and were randomized to acupuncture or sham acupuncture for 4 months. Although there were significant reductions in migraine attacks per month in the acupuncture group, the effects of the acupuncture treatment declined after 2 months.94
In a 24-week, double-blind study, 49 women with menstrual migraines received either placebo or soy isoflavones combined with dong quai and black cohosh extracts. 43 Beginning at the twentieth week, use of the herbal supplement resulted in decreased severity and frequency of headaches as compared to placebo. It is not clear which of the ingredients in the combination was helpful; contrary to what is stated in this research report, the current consensus is that neither black cohosh nor dong quai are phytoestrogens, but they may have other effects.
Ginger powder taken at the onset of a migraine headache (without aura) had the same effect as sumatriptan in a randomized trial of 100 adults. People in both groups saw more than a 90% reduction in headache severity within 2 hours. 93
In a small, 8-week study involving 48 people with migraines, those that took melatonin did not experience a reduction in the frequency of their migraines. 76
Biofeedback , 56-58,74massage , 55,67yoga , 69 and a form of magnet therapy called PEMF have shown some promise for migraines. 59 A careful review of 29 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 to placebo, standard treatment, waiting list control, or other active treatments. 75
Osteopathic manipulative treatment (OMT) is a collection of several therapeutic techniques focusing on the musculoskeletal system. In a randomized trial of 105 adults with chronic migraines (average 22.5 headaches per month), OMT with medication was associated with a significant reduction in rescue medication, migraine days per month, severity of pain, and functional disability compared to sham OMT with medication, and a control group taking medication only. Patients had eight 30-minute sessions using a combination techniques.96 Further information onthis therapy can be found on OMT page.
For a discussion of homeopathic approaches to migraine headaches, see the Homeopathy Database .
Various herbs and supplements may interact adversely with drugs used to treat migraine headaches. For more information on this potential risk, see the individual drug article in the Drug Interactions section of this database.
10. Pfaffenrath V, Diener H, Fischer M, et al. The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis-a double-blind, multicentre, randomized placebo-controlled dose-response study. Cephalalgia. 2002;22:523-532.
19. Peikert A, Wilimzig C, Kohne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia. 1996;16:257-263.
28. De Giorgis G, Miletto R, Iannuccelli M, et al. Headache in association with sleep disorders in children: a psychodiagnostic evaluation and controlled clinical study-L-5-HTP versus placebo. Drugs Exp Clin Res. 1987;13:425-433.
29. Longo G, Rudoi I, Iannuccelli M, et al. Treatment of essential headache in developmental age with L-5-HTP (cross over double-blind study versus placebo) [in Italian; English abstract]. Pediatr Med Chir. 1984;6:241-246.
45. Nelson CF, Bronfort G, Evans R, et al. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther. 1998;21:511-519.
61. Wang F, Van Den Eeden SK, Ackerson LM, et al. Oral magnesium oxide prophylaxis of frequent migrainous headache in children: a randomized, double-blind, placebo-controlled trial. Headache. 2003;43:601-610.
63. Diener H, Pfaffenrath V, Schnitker J, et al. Efficacy and safety of 6.25 mg t.i.d. feverfew CO-extract (MIG-99) in migraine prevention—a randomized, double-blind, multicentre, placebo-controlled study. Cephalalgia. 2005;25:1031-1041.
75. Eccleston C, Palermo T, Williams A, Lewandowski A, Morley S. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews . 2009;CD003968.
77. Cady RK, Goldstein J, Nett R, Mitchell R, Beach ME, Browning R. A double-blind placebo-controlled pilot study of sublingual feverfew and ginger (LipiGesic) in the treatment of migraine. Headache. 2011;51(7):1078-1086.
Last reviewed September 2014 by EBSCO CAM Review Board
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