‘Natural’ remedies for headache

What’s the evidence for alternative therapies in treating migraine?

Should I try a natural remedy for migraine?

Many so-called natural products, vitamins, minerals and plant remedies have been tried for years in order to prevent migraine.

While research is often limited, some natural remedies for headache, like those discussed in this factsheet, may be effective to some degree.

This doesn’t mean that other natural remedies for headaches definitely don’t work, but there is often a lack of evidence.

Unfortunately, with limited funding for research into natural remedies for migraines, the studies that have been done are often both small scale and few in number. This means we don’t have enough information to make firm treatment recommendations.

In this factsheet, then, we consider so-called natural supplements for migraine and other headaches, including plant remedies feverfew and butterbur along with magnesium, coenzyme Q10 and riboflavin (vitamin B2).

How do I treat migraine naturally?

There are two main approaches to treating migraine: treatment of the migraine attack when it happens (acute treatments) and taking regular medications to stop attacks happening or reducing their severity (preventative treatments).

Neither of these will work alone in every case and most people with more severe migraine will need to take a combination of the two for best results.

All of the supplements for migraine 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 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 is the one most studied. Research has shown that migraine sufferers may be deficient in magnesium and that levels in the brain can be low during attacks. Supplements may restore the balance and help prevent attacks. It may be that a higher dose taken for at least three to four months is necessary to see results.

Of three research studies giving patients magnesium supplements, two found that some patients benefited. The study that failed to show a benefit might have done so because the magnesium preparation used was poorly absorbed by the body.

Overall, the research is not conclusive, but it points to magnesium being potentially helpful in menstrual migraine and migraine with aura in particular.

The successful research studies used a daily dose of 600mg 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 are predisposed to diarrhoea, it’s worth starting with a lower dose and gradually building up to 600mg, or to the maximum dose which doesn’t produce side-effects. Check the label on your supplement, as magnesium citrate is less likely than magnesium oxide to produce diarrhoea.

You can find magnesium widely available in high street shops and online. As with all the supplements in this factsheet:

• if you are unable to find the exact dose, buy a lower dose and take multiples throughout the day as directed (for instance, in the case of magnesium, two 100mg tablets three times a day)
• always buy from a reputable retailer and manufacturer, especially when buying online – supplements are far less regulated than medicines
• and always speak to your GP before you begin – this is particularly important if you are taking other medication, or you are either pregnant or breastfeeding

The best recommendation is to take magnesium for three to four months and use a diary to monitor the extent to which it is (or isn’t) helping your migraine. You can download a simple headache diary here.

While magnesium tablets have few side-effects except diarrhoea, eating a healthy diet to improve your magnesium levels is unlikely to result in any side-effects.

Let your GP know if you are taking magnesium as it might interfere with other medications. In particular, magnesium can reduce 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 breathing, antibody production, and regulates human growth and reproduction. It is essential for healthy skin, nails, hair growth and general good health, including thyroid activity.

Riboflavin is found naturally in lean meats, eggs, legumes, nuts, green leafy vegetables and dairy products. Breads and cereals are also often fortified with riboflavin.

There has only been one research study looking at riboflavin alone in the treatment of migraine. It reported that just over half of those who took a 400mg per day dose for three months experienced a 50 per cent or greater reduction in migraine, with a reduction in both frequency and number of headache days.

These results are very impressive, but it is important to be cautious until repeat studies confirm the results.

In line with dosage in the research study, you should take 400mg daily for at least three months. Once again, track the effects by completing a migraine diary.

100mg tablets can be widely obtained online. Avoid multivitamin preparations as the dose of riboflavin is usually very low in these.

Side effects are unusual but both diarrhoea and excessive or discoloured urination have been reported.

Riboflavin is not known to be harmful in pregnancy, but as with all drugs in pregnancy, it is worth avoiding anything not essential.

Always let your GP know that you are taking riboflavin, especially if you are taking other drugs as there is some potential for interference.

Coenzyme Q10 (CoQ10)

Coenzyme Q10 is a vitamin-like substance involved in the creation of adenosine triphosphate, 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 CoQ10 than is available through supplements.

Research in two studies showed that about half of the patients saw a decrease in their migraine symptoms of around 50 per cent over three months of use. This reduction was shown in both the severity and frequency of attacks.

A further study showed that CoQ10 supplementation also seems to work well in children and adolescents.

300mg a day is generally recommended – although one of the successful experiments used half that dose. Take CoQ10 for at least three months and chart your progress on a headache diary.

Co-enzyme Q10 seems largely free from side-effects, even at higher doses. Occasionally, it causes an upset stomach, a burning sensation in the mouth or a loss of appetite.

Although there is no evidence that it is not safe, it is best avoided in pregnancy.

Feverfew

Feverfew (Tanacetum parthenium) is a plant closely related to chrysanthemums. It is frequently found in gardens and herb beds and has a long history of use in reducing pain. Modern research suggests there may be some evidence to support its medicinal reputation.

There have very few studies, although there is limited evidence showing 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 that reported with other preventative drugs and supplements.

The studies where benefit has been greatest have used dried leaves, so that is probably the best preparation to use.

Feverfew is generally given for migraine headaches at a daily dosage of 50 to 150 mg of dried leaves, though since research is limited, it’s difficult to establish the best dose. Part of the problem is that supplements can have different compositions and the plant itself may also vary in how much parthenolide (the proposed active ingredient) it contains.

Again, a duration of three months, monitored with a headache diary is recommended.

If you grow the herb you can eat the raw leaves, but they are very bitter and it’s essential to make sure you have correctly identified the plant first.

Some patients report a withdrawal reaction on stopping feverfew, so it may be important to wean yourself off it gradually.

Mouth ulceration, skin irritation and a racing heart have also been reported as side effects and it is not recommended either in pregnancy or while breastfeeding.

Butterbur

Like feverfew, butterbur (Petasites hybridus) 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.

There have been a small number of research trials of butterbur. These studies are of varying quality, but all show encouraging results.

In the first adult trial, nearly three quarters of migraine patients saw an improvement, with a nearly 60 per cent reduction in attacks. The effect in children and adolescents was broadly similar.

The studies used Petadolex tablets, with 75mg taken twice a day for at least three months. However, the manufacturer changed their production procedures after the research was concluded and didn’t submit the new product for the same safety testing.

The butterbur root contains compounds which can poison the liver so it’s very important that these are removed before use. While various commercial preparations are available, there is concern about how well the toxic substances may have been removed.

The German government has refused to allow it to be sold there. It is still marketed in the United States, but safety regulation is far more lax.

Until safety has been established, a different approach to migraine control should be considered. If you do decide to take Petadolex, inform your doctor in advance and get regular liver function tests.

If the poisonous liver-damaging chemicals are correctly removed, the active ingredient, petasin, appears to be free of side effects, at least in the short term, although long term studies have not been conducted.

Which natural remedy for migraine should I choose?

Although butterbur looks promising, it should not be considered until a proven safe preparation is available.

Research into feverfew suggests it may be less effective than other options discussed here.

Of the three supplements, magnesium, co-enzyme Q10 and riboflavin, all seem to give broadly similar results.

CoQ10 appears to have the least potential side effects so would be a good place to start.

Remember, it’s important to allow a decent trial period (three months or more) and to keep a daily diary of your headaches so you can accurately chart the effects.

Unfortunately, there is no way to predict which option will be successful for any particular person, so a process of trial and error is necessary.

None of these products are available via NHS prescription and will need to be purchased through high street shops or online, through reputable retailers.

Book an appointment with the experts: review the best treatment medications and ‘natural’ treatment options for you with a leading headache specialist. Beat the misery of migraine and get back to living. Book your consultation through the National Migraine Centre now.