Many natural products, vitamins, vitamin like chemicals and plant remedies have been tried in order to prevent migraine.  The ones we discuss in this factsheet are those which have at least some research studies to justify their use. This doesn’t mean that other things don’t work, but we often lack research evidence for them.  Unfortunately with limited funding for research available, the studies that have been done are often both small and few in number.  This means we do not have as much information as we need in order to make firm treatment recommendations. The advice in this guide is based on the research that is available, but inevitably this limits the quality of advice we are able to give.

In this factsheet we consider plant remedies Feverfew and Butterbur and the chemicals Magnesium, Coenzyme Q10 and Riboflavin (Vitamin B2).

How are these substances used?

There are two main approaches to treating migraine; treatment of the migraine attack when it happens, and taking regular medications to prevent attacks. Neither of these work 100%, and most people with more severe migraine need to take a combination of the two for best results. All of the substances discussed in this article are used mainly for prevention. Some have been used to treat an acute attack, but this is not discussed further in this factsheet, as there are no research studies for that kind of use.

Magnesium

Magnesium is one of the chemical elements and plays a vital role in the body’s chemistry. A healthy diet contains magnesium and provides as much of this as we need for everyday activities. Natural sources of magnesium in our diet come from leafy vegetables, spices, nuts, cereals, coffee, cocoa and tea.

Of all the available supplements, magnesium has been the one most studied. Research has shown that migraine sufferers may be deficient in magnesium, and that levels of magnesium in the brain can be low during attacks. Supplements can restore the balance and help prevent attacks. It may be that a “high dose” taken for at least 3 to 4 months is necessary to achieve results.

Of 3 research studies giving patients magnesium supplements, 2 found that a proportion of patients benefited. The study that failed to show this might have done so because the magnesium preparation they used was poorly absorbed by the body. Overall the research is not conclusive, but it points to magnesium being helpful in menstrual migraine and migraine with aura in particular.

How much magnesium should I take?
The successful research studies use a daily dose of 600 mg of magnesium citrate. This is a reasonably well absorbed preparation, but with all magnesium salts there is a risk of diarrhoea. If you find you get diarrhoea it would be worth starting with a lower dose and gradually building up to 600 mg or to the maximum dose which doesn’t produce side-effects. The best recommendation is to take it for 3 to 4 months and use a diary to monitor the extent to which it is (or isn’t) helping your migraine.

Magnesium citrate 100 mg tablets can be obtained from Holland and Barrett. Taking 2 tablets 3 times a day would give the required dose.

Boots stock magnesium tablets, but from their (unclear) website they use magnesium oxide which is more likely to produce diarrhoea.

Eating a healthy diet to improve your magnesium levels is never likely to result in side-effects. Magnesium tablets have few side-effects except diarrhoea. Let your GP know if you are taking magnesium as it might interfere with other medications. In particular it can decrease blood pressure and relax muscles and so could amplify the effect of other drugs which do this. Potentially it could also interfere with antibiotic absorption.

Riboflavin (Vitamin B2)

Riboflavin, also known as vitamin B2, is found in many foods.  It aids red blood cell formation and respiration, antibody production, and regulates human growth and reproduction. It is essential for healthy skin, nails, hair growth and general good health, including thyroid activity.

It is found naturally in Lean meats, eggs, legumes, nuts, green leafy vegetables, dairy products, and milk. Breads and cereals are often fortified with riboflavin.

There has only been one research study looking at riboflavin alone. It reported that just over half of those who took 400 mg/day riboflavin for 3 months experienced at least 50% reduction in migraine. Significant reductions in both migraine frequency and number of headache days were reported. This sounds a fantastically good result, but we should be cautious as we really need repeated studies by other people before we can be confident this is accurate.

How much Riboflavin should I take?
Following the research study you should take 400mg daily, for at least 3 months and again, track the effects by completing a migraine diary (downloadable from our website). 100mg tablets can be obtained online, (eg Amazon) from manufacturers like “Solgar” and “Nature’s Bounty”. Take 2 twice daily. Neither Boots nor Holland and Barrett stock pure vitamin B2. Avoid multivitamin preparations as the dose of Riboflavin is usually tiny in these.

Side effects are unusual but both diarrhoea and excessive urination have been reported. Your urine may be coloured yellow (and will fluoresce under ultraviolet light if you are looking for entertainment in the bathroom!). It is not known to be harmful in pregnancy but as with all drugs in pregnancy it is worth avoiding anything not essential.

Let your GP know that you are taking this especially if you are on other drugs as there is some potential for interference.

Coenzyme Q10 (CoQ10)

Coenzyme Q10 (CoQ10) is a vitamin-like substance, involved in the creation of adenosine triphosphate (ATP), which is the major energy source for all the cells in the human body.  It is present in small but adequate amounts in our everyday diet. Oily fish, liver and whole grains are particularly rich natural sources (but provide substantially less than the tablets).

Research in 2 studies showed that about half the patients benefitted from a decrease in their migraine of around 50% over 3 months of use. This reduction was shown in both the severity and frequency of attacks. A further study showed that it seemed to work well in children and adolescents.

How much Co-enzyme Q-10 should I take?
300mg a day is recommended (although one of the successful experiments used half that dose). Take it for at least 3 months to get any benefits and chart your progress on a migraine diary.  It is available in 100mg or 125mg tablets (such as from Boots or Holland and Barrett. It is also available online, for instance via Amazon, but take care with online suppliers that they are a reputable source – there are few rules to protect quality in this area). Take 1 tablet 3 times daily.

Co-enzyme Q10 seems remarkably free from side-effects even when huge doses are used. Very occasionally it causes an upset tummy, burning sensation in the mouth or loss of appetite. As usual let your doctor know you are taking it if you are on any other drugs. Although there is no evidence that it is not safe, it is best avoided in pregnancy.

Feverfew (Tanacetum parthenium)

Feverfew (Tanacetum parthenium) is a plant closely related to chrysanthemums, which the crushed leaves smell of. It is frequently found in gardens and herb beds (though there seem to be no culinary uses). It is a plant with a history: Nicolas Culpeper recorded it in the first edition of his 1649 Herbal, saying “It is very effectual for all pains in the head…”  Modern research gives at least some support to that point of view.

There have been a couple of studies, both of which have shown a modest improvement in migraine symptoms after taking regular feverfew. In the larger study symptoms were reduced by about a quarter, which is useful, but less than reported with other preventative drugs and supplements. The studies where benefit has been greatest have used the dried leaves, so that is probably the best preparation to use.

How much Feverfew should I take?
This is not so easy to answer: the Canadian Drug protection agency recommends 125mg daily. A migraine trust article says “250mg a day should be enough”. Part of the problem is that preparations vary in composition and the plant itself may vary in the strength of parthenolide it contains (the active ingredient). Capsules with dried leaf extract can be bought from Boots, Holland and Barrett and online, each containing 100mg of leaves. Perhaps start with 2 daily and increase to 3 a day if they suit you. Again a decent duration is needed to see if they are helping – 3 months with monitoring by diary is recommended. If you grow the herb you can eat the raw leaves, but bear in mind they are very bitter (I tried it just once!) and make sure you have correctly identified the plant first.

Stopping Feverfew
Some patients report a withdrawal reaction on stopping the herb. Reduce by one tablet every 2 weeks to minimize this effect.

Mouth ulceration and skin irritation have been reported as side effects and it is not recommended in pregnancy or whilst breast feeding. Some patients have reported a racing heart after taking the leaves.

Butterbur (Petasites hybridus)

Like Feverfew, Butterbur has a centuries old history as a folk remedy for headaches. It is a perennial shrub found in marshy areas of northern Europe and elsewhere.  The butterbur root contains compounds which can poison the liver. For safety these need to be removed before use. Whilst various commercial preparations are available there is concern about how well the toxic substances have been removed.

There have been a small number of research trials of butterbur of varying quality, but all of which show encouraging results, particularly in children and adolescents.  In the first adult trial nearly three quarters of patients responded with a nearly 60% reduction in attacks. The effect in children and adolescents was broadly similar.

How much Butterbur should I take?
The studies used “Petadolex®” tablets – 75mg taken twice a day for at least 3 months.

Currently Petadolex is difficult to obtain. The company making it changed their manufacturing procedures and didn’t submit the new product to the same safety testing. The German government has refused to allow it to be sold there. It is still marketed in the USA, but without the requisite safety testing. I suggest that until a product is available which meets safety standards, it is safer to choose one of the other approaches to migraine control. If you do decide to take it, inform your doctor and get regular liver function tests.

When the poisonous liver damaging chemicals are removed the active ingredient, Petasin, seem remarkably free of side effects, at least in the short term – long term studies have not been done.

Which should I choose?

Butterbur should probably be off the list for the time being, until a proven safe preparation is available, but when this is sorted, it looks to have encouraging potential.

Feverfew has a less attractive success record than the other substances discussed here.

Of the three supplements, Magnesium, Co-enzyme Q10 and Riboflavin, all seem to give broadly similar results. Co-enzyme Q10 has the least potential side effects so that would be a good one to start with. Remember you need to give each a decent trial period (3 or 4 months) and it is best to keep a daily diary of your headaches so you can accurately chart the effect of the medication. Unfortunately there is no way to predict which medication will be successful for any particular person, so a process of trial and error is necessary. Another approach to choosing is to go for a medication which might also help another condition. So in the case of these supplements, Magnesium may have benefits for people with fibromyalgia – which commonly co-exists with migraine.

I’ve quoted availability and dosages from Boots the Chemist, Holland and Barrett, Amazon and the internet. I chose these as they are widely available throughout the country, not because they offer any special benefit, or because I wish to endorse these companies in any way. None of these products are available on NHS prescription, so you will have to purchase them if you want to try them – but do let your doctor know you are using them.

This information is provided as a general guide only and is not a comprehensive overview of prescribing information. If you have any queries or concerns about your headaches or medications please discuss them with your GP or the doctor you see at the National Migraine Centre.