Daily Supplements for Migraine
Of the supplements, Magnesium (600 mg), and Riboflavin (400 mg) per day are and .5 to 1 mg Melatonin before bed are the ones that I feel ready to recommend. We’ve discussed this topic before here and a previous list here
According to the following study, Vitamin D is not supported by the evidence.
I was alerted to this article from a piece in PainMedicineNews.com. The article is not yet available online.
Dietary Supplements & Herbs
Magnesium is an abundant mineral in the body, and is important for protein synthesis, energy production, muscle/nerve function, and may play a role in cortical spreading depression, an underlying migraine mechanism. Two large randomized controlled trials found 600 mg/day beneficial for migraine prevention. Magnesium may cause soft stools/diarrhea, but may help constipation. The magnesium citrate formulation is better absorbed than oxide or sulfate, but if diarrhea occurs, magnesium glycinate may help. Magnesium is not safe in kidney failure.
Riboflavin (Vitamin B2) is involved in energy production, and its deficiency can cause mitochondrial dysfunction, which may play a role in migraine. Of 11 clinical trials, 5 showed a positive effect, including a large randomized controlled trial of 400 mg/day that resulted in at least a 50% improvement in 60% of patients. Riboflavin turns urine bright yellow/orange and may cause diarrhea. Riboflavin is safe during pregnancy; riboflavin deficiency may increase the risk of pre‐eclampsia (especially in a diet without meat/dairy).
Coenzyme Q10 (CoQ10) is also involved in energy production and helps maintain mitochondrial integrity. As an antioxidant, it stimulates endothelial release of nitric oxide. Two randomized controlled trials showed benefit over placebo, with mild side effects (insomnia, fatigue, nausea, or diarrhea) and rare increases in liver function tests. CoQ10 should not be taken with warfarin (makes it less effective).
Feverfew is a daisy‐like plant used by the Greeks in the first century for inflammatory disorders. The dried leaves are a herbal supplement. Parthenolide, the active ingredient, may prevent migraine through its vascular smooth muscle relaxation and anti‐inflammatory properties. Of 6 studies, 4 had positive outcomes (including the largest study with 170 patients), and 2 were negative. The most common side effects were nausea, bloating, and mouth ulcers (if dried leaves chewed). Feverfew should not be discontinued abruptly, or withdrawal symptoms could occur (difficulty sleeping, anxiety, and stiff/painful muscles). Feverfew can cause uterine contractions and is not recommended during pregnancy.
Omega 3 fish oil is anti‐inflammatory, and thus there has been hope for benefit in migraine. A recent systematic review of 13 studies for migraine showed no overall benefit. A recent 2018 study showed benefit over placebo in those also on amitriptyline for chronic migraine.
Butterbur (Petasites hybridus) is a shrub with anti‐inflammatory properties and is involved in calcium regulation. Two large randomized controlled studies demonstrated benefit for migraine. However, preparations may contain pyrrolizidine alkaloids (PA), which are toxic to the liver. Due to safety concerns, butterbur was removed from the market in the United Kingdom and Europe. Butterbur should only be taken if labeled and certified as PA‐free and even then, liver function tests should be monitored.