Herbal supplements may serve as potential alternative treatments for migraine headaches.
Headaches can be classified into primary or secondary cause. Primary headaches can result from chemical overactivity in the brain, nerves or blood vessels surrounding the skull. Secondary headaches can arise from a blunt trauma or present as a symptom of an underlying disease. This article will highlight evidences on herbal supplements as alternative treatments for migraine headaches.
Primary headaches can be sorted as migraine, tension-type, and cluster headaches. These three types of primary headaches differ based on duration and specific features.
- Migraine headache features include throbbing pain, pressure in the eye region, nausea, light sensitivity, and inability to perform usual activities. An ‘aura’ is experienced about 10 to 30 minutes before the migraine occurs. Migraines can last from several hours to a few days.
- Tension-type headache features include absent to mild nausea, band-like pressure around the forehead, no throbbing pain, and mild to moderate muscle tensions and aches can radiate to the neck and back. Tension-type headaches can last for hours to days but can linger for up to a week.
- Cluster headache features piercing pain, pain behind the eye, and possible aura. These headaches may be accompanied by tears and nasal drips. Cluster headaches can last for less than three hours.
Primary headache management revolves around the prevention and treatment of migraines. Over-the-counter medications, such as acetaminophen and ibuprofen, are effective, but should not be used for more than 15 days per month. Medication overuse can worsen headaches. If over-the-counter medicine is not effective and migraine is not well-controlled, then professional help is needed. A healthcare provider or specialist can prescribe specialized medications to abort and prevent further migraines.
Self-management treatment plans can also help reduce frequency of headaches. The four basics of self-management involve managing and minimizing triggers, stress, emotions, and intensity.
- Manage triggers by tracking headaches in a diary and identifying triggers, such as alcohol or lifestyle changes.
- Manage stress by identifying stressors, then creating a plan to avoid them through exercise, relaxation techniques, diet, or adhering to a sleep schedule.
- Manage emotions by identifying feelings, then learn how to best respond.
- Minimize intensity by performing and avoiding activities to prevent migraine onset.
Alternative treatments for migraine prevention exist, but there is not enough research to conclude their safety and effectiveness.
Herbal supplements for migraine prevention
- Its active chemical, known as parthenolide, appears to have multiple actions in the central nervous system that suggests a potential to aid in migraine prevention.
- A review of five studies with 343 adults found that there is no conclusive evidence to determine feverfew’s effectiveness.
- Six studies with a total of 437 adults with migraine found that combination products and add-on treatments with feverfew reduced migraine pain frequency and score.
- The American Academy of Neurology concluded that feverfew is probably effective for migraine prevention. Feverfew might be effective for migraine prophylaxis in adults, but its preparations and dosages need further studies to make a definite conclusion.
- Its anti-inflammatory and vasodilatory actions make butterbur a good candidate for migraine prevention.
- Unfortunately, European health authorities, such as the Swiss Agency for Therapeutic Products, have banned butterbur due to its possible link to liver toxicity. Butterbur and its inclusion in combination products should not be recommended for use in migraine prevention and treatment.
Riboflavin (Vitamin B2)
- Studies have pointed to depleted cellular energy in migraines. Riboflavin plays an important role in cellular energy production, which suggests its possible effectiveness in migraine treatment.
- Eight studies with 340 adults with migraine found that migraine severity score and frequency improved.
- Two studies with 90 children with migraine found that there was no difference in reduction of migraine frequency.
- The American Academy of Neurology concluded that riboflavin’s safe and effective results in adults suggest potential for migraine prevention.
- Further studies are needed to determine riboflavin’s effectiveness in the pediatric population.
- Research has revealed magnesium deficiency in migraine sufferers.
- Intravenous and oral magnesium are available and have been studied for migraine treatment.
- Two reviews with a combined total of nine studies and 542 adults with migraine found that intravenous magnesium was neither effective nor beneficial in providing migraine relief.
- Four studies with 152 adult patients with migraine found intravenous magnesium provided headache relief and reduced pain scores.
- One study with 23 pediatric patients found intravenous magnesium provided improvement for refractory headaches.
- Seven studies with 621 adult patients with migraine found oral magnesium used alone, or in combination treatments, reduced headache pain and frequency.
- Two studies with 49 pediatric patients with migraine and tension-type headache found oral magnesium to reduce headache frequency.
- Evidence from studies has provided more support for oral magnesium for migraine prevention. However, more research is needed to confirm magnesium’s effectiveness, especially in patients who may benefit from magnesium supplements or increased dietary intake.
- Side effects linked to oral magnesium include soft stools and diarrhea.
- Just like riboflavin, coenzyme Q10 helps with cellular energy production. Which possibly aids in migraine treatment.
- Two studies with 75 adult patients with migraine found coenzyme Q10 reduced headache frequency.
- Two studies with 372 pediatric patients with migraine found coenzyme Q10 reduced headache frequency.
- The American Academy of Neurology concluded that coenzyme Q10 is possibly safe and effective in adults for migraine prevention, but high-quality studies are still needed to further consider coenzyme Q10’s use.
Linolenic acid, Ginkgo biloba, and Omega-3 fatty acids in combination with some of the above alternatives have also been studied for migraine prevention. However, their low-quality evidence limits their effectiveness.
Herbal supplements are perceived as safe and readily available, but it is important to be cautious and skeptical of their limited evidences and effectiveness. It is important to report any herbal supplement use to a healthcare provider to prevent unwanted drug interactions.
Written by Manuel Bangsil, PharmD, MBA, BCMAS
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