Incorporating Nutraceuticals for Migraine Prevention
What primary care practitioners should know about nutraceuticals for migraine
Certain supplements have been found to be helpful in migraine prevention. These nutraceuticals can play a role in an effective preventative strategy for migraine. Nada Hindiyeh, MD, Neurologist at Stanford Medicine, provides insight into the most commonly used nutraceuticals for migraine prevention, their benefits and recommended doses.
What are nutraceuticals?
Nutraceuticals are food or dietary supplements that can provide a medicinal or therapeutic benefit. Generally, these supplements are inexpensive, have minimal side effects and do not require a prescription. However, it’s important for patients and providers to have a conversation about nutraceuticals as part of an overall treatment plan.
Who’s a good candidate for nutraceuticals?
Many people with migraine can benefit from nutraceuticals. Nutraceuticals can be a good option for patients looking for a more natural approach or as a first step in migraine prevention. Many patients use nutraceuticals in combination with prescription medication and lifestyle modifications such as sleep, nutrition and exercise.
“A lot of patients will come in and be pretty wary of taking a prescription medicine or just don’t want to—or don’t want to yet and want to first work on lifestyle modifications,” says Dr. Hindiyeh. “Adding in some natural supplements [can] enhance all of that.” It is important to discuss your patient’s goals and preferences and then build a plan that is individualized to their needs.
What are commonly used nutraceuticals for migraine?
The most common nutraceuticals used for migraine include riboflavin, coenzyme Q10, magnesium, melatonin and feverfew. While you may have also heard of butterbur as an effective option, it is no longer recommended. When creating a preventative strategy for your patients, consider combining nutraceuticals with medications and lifestyle modifications.
Riboflavin, also known as vitamin B2, is frequently used for migraine prevention. A common dose is 400 milligrams a day. “We think riboflavin plays an important role in energy production inside the mitochondria,” says Dr. Hindiyeh. According to some imaging studies, there may be mitochondrial dysfunction in the brains of people with migraine, so riboflavin can help regulate this imbalance.
CoQ10, or Coenzyme Q10
Coenzyme Q10, often called CoQ10, is also considered an essential player in mitochondrial electron transport chain and energy metabolism in the brain. Research has found that 300 milligrams a day of CoQ10 can reduce migraine frequency in adults.
One of the most common nutraceuticals used for migraine prevention is magnesium. “We’ve seen it be helpful for people with migraine and people with migraine with aura,” says Dr. Hindiyeh. Studies have reported decreased magnesium levels in people with migraine. At adequate levels, magnesium can inhibit glutamate, an excitatory neurotransmitter. “When thinking about migraine pathophysiology, we think about a hyper-excitable brain,” says Dr. Hindiyeh. “So [magnesium] can certainly stabilize the brain in that sense.”
Magnesium can be used in different forms, such as magnesium sulfate given intravenously, or magnesium oxide or magnesium citrate taken orally. The American Headache Society recommends a dose of 400-500 milligrams a day for magnesium oxide.
Feverfew leaves contain parthenolide and other ingredients that can inhibit the release of serotonin and prostaglandin. Serotonin and prostaglandin are naturally occurring substances that dilate blood vessels and can trigger migraine. Studies have shown that feverfew may help reduce the frequency and duration of migraine attacks. It can also help reduce symptoms of migraine, such as pain, nausea, vomiting, and light or noise sensitivity.
People often use melatonin to help them sleep. A study in Headache found that people with chronic migraine had low levels of melatonin. Other studies have found melatonin effective for preventing migraine attacks while others have shown no effect. Typical treatment is 3 milligrams of melatonin before bed every day.
Butterbur is no longer a recommended treatment for migraine. While butterbur has been shown to reduce migraine frequency over time, this herbal extract has been linked to safety concerns of liver toxicity.
How can patients track efficacy of nutraceuticals?
As with many forms of migraine management, a headache diary is the best way to track the efficacy of nutraceuticals. “It doesn’t have to be complicated,” says. Dr. Hindiyeh. “Just, did you have a headache? Yes or no. And maybe a pain scale of how severe it was that day and that’s it.” When incorporating nutraceuticals into migraine prevention, encourage your patients to keep a simple record of headache frequency and severity to see whether there is a reduction over time.
Primary care practitioners are essential to identifying and treating headache disorders. The American Headache Society’s First Contact – Headache in Primary Care program provides educational resources to empower healthcare professionals and improve headache and migraine care. Learn more about the program here.