4 Supplements That Can Help Prevent Adult Migraines

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Whether you're exploring supplements for migraine prevention because you prefer a more natural treatment, you haven't had success with other options, or some other reason, you're in good company. Supplements are becoming popular as either sole migraine therapies or ones that are used in combination with migraine medications. 

While supplements are not approved by the U.S. Food and Drug Administration (FDA)—for this or any other purpose—professional groups like the American Headache Society (AHS), the American Academy of Neurology (AAN), and the Canadian Headache Society (CHS) do provide some recommendations based on the limited scientific evidence available. 

These recommendations are helpful to doctors and migraineurs, providing guidance as to whether supplements are even worth trying. 

Riboflavin

Riboflavin (vitamin B2) plays an important role in the mitochondria—tiny structures located within the cells in your body that produce the energy needed for cells to survive. If these structures are damaged or not functioning properly, cells either work improperly or die.

Some experts suspect that a mitochondrial defect may contribute to the development of migraines by reducing a person's threshold to migraine triggers. By taking riboflavin, experts believe the body can overcome this mitochondrial defect.

The evidence on its efficacy, however, is limited, with only two small randomized controlled trials available. With that, though, the CHS gave riboflavin a strong recommendation, suggesting 400 milligrams (mg) daily. The AAN/AHS gave riboflavin a level B recommendation, noting that it's "probably effective" in reducing migraines. 

The good news is that if your doctor recommends riboflavin, it is generally well-tolerated. Some people do develop diarrhea or excessive urination, but this is not common. Also, riboflavin does turn your urine a fluorescent yellow color, so don't be surprised when this happens.

Coenzyme Q10 

Coenzyme Q10 (CoQ10) is also found in the mitochondria of cells. It has antioxidant properties and may play a critical role in preventing oxidative stress—a metabolic abnormality that may occur in the brains of some migraineurs. 

There is one small randomized controlled study examining the benefit of coenzyme Q10 in preventing migraines. In this 2005 study in Neurology, there was a reduction in the number of migraine attacks after taking coenzyme Q10 for three months. Coenzyme Q10 was well-tolerated, with only one person dropping out of the study due to a skin allergy.

Like riboflavin, the CHS gave coenzyme Q10 a strong recommendation in preventing migraines, suggesting a dose of 100 mg three times daily. The AAN/AHS gave coenzyme Q10 a level C recommendation, meaning it's "possibly effective" in preventing migraines.

Magnesium

Magnesium is an important mineral involved in many systems in your body including your muscular and skeletal system, cardiovascular system, and nervous system. While a deficiency in magnesium does not usually cause symptoms, early symptoms may include fatigue, weakness, nausea, or a loss of appetite. As the deficiency progresses, symptoms may include muscle spasms, tremors, irregular or rapid heartbeat, and/or personality changes.

Scientific studies suggest that a link exists between magnesium deficiency and migraines. This is why some migraine specialists recommend checking a magnesium level in their patients with migraines. If low, doctors will commonly recommend either a magnesium supplement or even a magnesium-rich diet.

There are a number of different magnesium supplements, and how well they are absorbed in the body varies. In terms of a diet rich in magnesium, high-fiber foods are also generally high in magnesium, whereas processed or refined foods are not. Examples of foods rich in magnesium include:

  • Whole grains
  • Nuts (e.g. almonds, cashews, peanuts)
  • Green leafy vegetables (e.g. spinach)
  • Legumes

While magnesium supplements may cause diarrhea or abdominal cramping when taken in high doses, magnesium-rich foods will not cause this adverse effect. 

Like riboflavin and coenzyme Q10, the CHS makes a strong recommendation for taking magnesium as a supplement for preventing migraines, suggesting a dose of 600 mg daily. The AAN/AHS gave magnesium a level B recommendation ("probably effective") in migraine prevention.

Butterbur

Butterbur (Petasites hybridus) is a perennial shrub and herbal therapy used throughout history to prevent migraines. It's been deemed both an effective and well-tolerated alternative therapy, with the dominant side effect being stomach upset with belching. 

That being said, the use of butterbur is now surrounded in controversy due to safety concerns. The Petadolex formulation, as well as others, have been linked to 40 cases of liver toxicity, with two people requiring liver transplants.

The CHS guidelines still cite a strong recommendation for using butterbur at a dose of 75 mg twice daily. But consumers are cautioned to only use certain commercially available license butterbur products; these products have been tested and found not to contain the liver-toxic pyrrolizidine alkaloids.

Based on 2012 guidelines from the AHS and AAN, Petasites hybridus or butterbur is listed as a level A drug ("effective") for preventing migraines. They have not revised their guidelines in light of these new findings regarding liver toxicity. Many doctors are holding off on recommending butterbur until societies like American Headache Society make new recommendations. 

Butterbur are rated as level A drugs in the 2012 guidelines. This rating is given to treatments for which there are at least two high‐quality randomized, controlled trials (RCTs) demonstrating efficacy. The guideline authors suggest that:

  • Level A and B drugs be offered to patients who require prophylaxis for migraine.
  • Level C treatments “may” be considered for patients requiring migraine prophylaxis.

The Bottom Line

While generally low risk and well-tolerated, these four supplements may interact with other medications you are on. This is why it's important you do not take any vitamin or supplement without your doctor's advice and guidance. Your doctor too may want to check your blood level before taking a supplement to follow your progress or determine if you even need it. 

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