Studies suggest that magnesium, riboflavin, butterbur, coenzyme Q10, and certain nutraceutical combinations may have efficacy in preventing migraine. This slideshow reviews the evidence.
Studies suggest that magnesium, riboflavin, butterbur, coenzyme Q10, and certain nutraceutical combinations may have efficacy in preventing migraine. This slideshow reviews the evidence.
Nutraceutical: Marketing term without regulatory definition[1] -Includes vitamins, supplements, herbal preparations Use related to dissatisfaction with conventional medicine -Belief that natural medicines are good, pharmaceuticals are bad Some studies do suggest efficacy for certain neutraceuticals in migraine prophylaxis Awareness of potential benefits and harms of neutraceuticals is important for the clinician-patient relationship
Magnesium Fairly good evidence for decreased attack frequency: -IV magnesium sulfate 1-2 mg daily: decrease in attacks -IV magnesium chloride 32 mg daily: decrease in attacks -Oral magnesium citrate 400-600 mg daily: decrease in frequency and severity of attacks BUT: Recent review suggests limited evidence supports oral magnesium for migraine prevention; recommends increased dietary intake of magnesium[2]
Riboflavin Fairly good evidence for decreased attack frequency Riboflavin 400 mg: decreased frequency and severity of attacks No evidence for efficacy in preventing pediatric migraine Improves energy metabolism -Possible mechanism: corrects abnormal mitochondrial energy processing and cortical information processing possibly involved in migraine pathogenesis Excellent tolerability
Butterbur (Petasites hybridus) Fairly good evidence in children and adults: - Butterbur 50-150 mg: decreased frequency and severity of attacks Anti-spasmodic, anti-inflammatory, blocks calcium channels Concern for hepatotoxicity
Feverfew Inconsistent evidence for benefits: -Feverfew 50-300 mg: controversial results Preparation strength and stability differs between products Cochrane Review: insufficient evidence that feverfew is more effective than placebo in migraine prevention[3] No major safety concerns noted
Coenzyme Q10 Evidence in adults: -Coenzyme Q10 300 mg: decreased frequency, duration, intensity of attacks -Not replicated in pediatric patients Improves energy metabolism
Nutraceutical Combinations Combinations that have shown some efficacy: -Fixed combination of magnesium, riboflavin, and coenzyme Q10 -Feverfew plus ginger -Ginkgo biloba, coenzyme Q10, Vitamin B2
Take Home Points Nutraceuticals are non-regulated vitamins, supplements, and herbal preparations that are often perceived as benign and safe Studies suggest the following may have efficacy in preventing migraine: magnesium, riboflavin, butterbur, coenzyme Q10, and certain nutraceutical combinations Nutraceuticals are associated with mild, transient adverse effects; there is concern for hepatotoxicity with butterbur Long-term safety monitoring is needed