The Neurologist Is In

Monthly insights and advice from a stroke specialist, a movement disorder expert, and a neuromuscular physician.

Thursday, October 20, 2016

Vitamins and Supplements for Migraine

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BY TESHAMAE MONTEITH, MD, FAHS

Many of my patients tell me they waited years before seeing a doctor for their migraine, thinking it wasn't a serious condition. They thought the best way to deal with it was to grit their teeth and muscle through it. Now, many are active participants in their care and often tell me they want a natural approach.

I explain that vitamins and supplements may decrease the number of attacks or reduce the side effects of prescription drugs, but they aren't cure-alls and can take time to become effective, as long as three months for some patients. For others, they may not work at all and may have side effects. With that in mind, here are some vitamins and supplements to discuss with your neurologist at your next visit, including some potential side effects.

VITAMIN B2

Also known as riboflavin, this vitamin and it's one of eight B vitamins that help convert food into fuel; it also helps metabolize fats and protein. We don't know exactly why B2 helps, but it could be because some people who are deficient in it are more prone to migraine. In a small study in the European Journal of Neurology, 23 people who took daily doses of 400 mg of riboflavin for six months reported half the number of headaches per month—from four to two—and reduced their use of medicines from seven pills per month to four and a half.

Recommended dose: 200 mg twice a day

Side effects: Bright yellow urine, which is a sign of excess riboflavin being excreted.

VITAMIN D

This nutrient is found in some foods and helps the body absorb calcium, which is needed to maintain strong bones. Researchers are investigating a link between vitamin D deficiency and migraine; Otherwise it isn't yet clear how vitamin D helps in migraines. A nine-month study in the December 2015 issue of Annals of Neurology that included people who had four to 14 migraines per month found that combining vitamin D3 and simvastatin, a cholesterol-lowering drug, reduced the number of migraines by eight or nine per month on average. Patients who took a placebo had one more migraine per month. The response rate was relatively low (25-29 percent), which should be taken in account given the potential side effects of simvastatin. Therefore, patients already on simvastatin may be the best candidates.

Recommended dose: 1,000 IU per twice per day.

Side effects: Generally considered safe, but could potentially cause numerous side effects, especially when taken in excess.

FEVERFEW

Feverfew is a member of the daisy family and has been used for centuries to treat headaches and other health problems. It's thought to reduce inflammation in blood vessels in the head, which is believed to be one of the features of migraine pain. The strongest evidence for feverfew comes from a 2002 study in Cephalalgia that evaluated three doses of the herb (2.08 mg; 6.25 mg; 18.75 mg) taken three times a day for 12 weeks and compared them to placebo in 147 migraine patients. Researchers found 6.24 mg of feverfew to be effective in a small group of patients with at least four migraines.

Recommended dose: 50 to 100 mg daily.

Side effects: Contractions in pregnancy; may cause bleeding, gastrointestinal symptoms, nervousness, dizziness, headache, trouble sleeping, joint stiffness, tiredness, menstrual changes, rash, pounding heart, and weight gain; can increase potency of nonsteroidal anti-inflammatory drugs such as ibuprofen and aspirin.

COENZYME Q10

This is a substance found in the body that cells use to produce energy needed for growth and maintenance. How it helps prevent migraines is not known, but a small trial published in Neurology in 2005 that compared 100 mg of coenzyme Q10 (CoQ10) taken three times daily to placebo showed that CoQ10 reduced migraine frequency in half of those who took it; only 14 percent in the placebo experienced fewer migraines.

Recommended dose: 100 mg three times a day

Side effects: Gastrointestinal symptoms or lowering blood pressure.

Caveat: There isn't as much evidence for its effectiveness compared to vitamin B2, which can be less expensive.

MAGNESIUM

This mineral, which is found in the body and in many foods, especially high-fiber ones, works by activating enzymes in the body and is crucial to nerve transmission and other important functions. People with migraines may have lower levels of magnesium than those who don't have migraines, which is why it may be effective. The best evidence comes from a 1996 study in Cephalalgia of 81 patients who were given either 600 mg of magnesium or a placebo every day for 12 weeks. In the magnesium group, the frequency of attacks was reduced by 41.6 percent during weeks 9 through 12 and by 15.8 percent in the placebo group. Those taking magnesium also had fewer migraine days and took fewer drugs to treat symptoms.

Recommended dose: 600 mg daily for prevention.

Side effects: Lower blood pressure, diarrhea.

MELATONIN

This hormone is naturally secreted by the pineal gland that signals the brain that it's time for sleep. Poor sleep has been linked to migraines in some people so improving sleep may explain why melatonin reduces migraine frequency. A 2016 article in the Journal of Neurology, Neurosurgery and Psychiatry reported on a trial with 178 men and women who had an average of two to eight migraines a month. Participants were randomly given 3 mg of melatonin, 25 mg of amitriptyline (Elavil), an antidepressant effective in treating migraines in some people, or a placebo daily for three months: 54 percent of people taking melatonin responded to treatment compared to 39 percent of those taking amitriptyline and 20 percent of those on placebo. Participants who received melatonin also reported fewer side effects than those taking amitriptyline.

Recommended dose: 3 mg at bedtime.

Side effects: Morning drowsiness and weight loss in some patients.

FOR PAIN

GINGER

The root of this plant has been used for medicinal purposes for centuries, most often to relieve stomach ailments. It may be effective because it helps relieve nausea, which often accompanies a migraine.

In a 2014 clinical trial published in the journal Phytotherapy Research, 100 patients who had acute migraine without aura were randomly assigned to be treated with either ginger powder or sumatriptan, a prescription drug used to treat migraine. Two hours after taking either treatment, headache severity decreased significantly, but the side effects of ginger were less than those of sumatriptan.

Recommended dose: A quarter teaspoon of ginger powder mixed with water; some patients find ginger candy effective.

Side effects: A slight tingly taste to some patients.

LAVENDER OIL

This essential oil is distilled from the lavender flower or herb and is used medicinally to treat pain and boost mood. Lavender produces slight calming, soothing, and sedative effects when the scent is inhaled, possibly because it reduces stress hormones. Studies have shown, however, that in some people lavender oil can actually trigger migraines. In a 2012 study in European Neurology, 47 patients were divided into two groups. Half inhaled lavender essential oil for 15 minutes while the control group inhaled liquid paraffin. Patients assessed their headache severity and symptoms in 30-minute intervals for a total of two hours. The lavender group reported 129 migraines during the intervals; 92 were alleviated somewhat or completely by lavender. The placebo group reported 68 migraines during the intervals; 32 of them were relieved.

Recommended dose: Two to four drops for every two to three cups of boiling water when inhaling; two to four drops without dilution when applying.

Side effects: Can trigger migraines in some people.

MENTHOL

The active ingredient in peppermint oil, menthol may have a cooling or soothing effect when applied to the neck and forehead. A small trial published in the International Journal of Clinical Practice in 2005 found using a 10 percent menthol solution was more effective than placebo in relieving migraine pain for two hours as well as in relieving nausea, vomiting, and sensitivity to pain.

Recommended dose: Available as 6 or 10 percent solution.

Side effects: Possible mild skin irritation or allergic reaction in some people at application site; avoid getting near eyes.

COMBINATION PRODUCTS

Some supplements are sold in combination such as a Dolovent, which includes magnesium, vitamin B2, and coenzyme Q10. Some patients find it easier to take one pill that combines three elements than three separate pills. The combination may also cost less than three supplements separately. One drawback is that the ingredients are supplied in fixed doses and cannot be changed if more or less of one would be better for a patient.​

Dr. Monteith is assistant professor of clinical neurology and director of the headache program at the University of Miami Health System.