a self portrait of Vincent Van Gogh

Detail of a self-portrait by Vincent Van Gogh, painted while he was institutionalized. Historians now believe the trademark swirls in the background and on the artist’s face were less “artistic statement” and more literal representation of the visual disturbances he experienced during his frequent, crippling migraine headaches.

Migraines aren’t just bad headaches — worse than other kinds of headaches — they’re also different.   Migraine sufferers may experience odd symptoms for hours or days before the headache strikes: sensitivity to smell and sound, digestive distress, mood disturbances, stiff neck.  When the headaches lands, these symptoms may go away, or get even worse, amplified by physical activity, light and sound.  After the headache passes, people may feel fatigue and have difficulty concentrating for a few days.

Migraines can be debilitating. And it’s not uncommon to have 4, 5, or even more a month.

And yet for all the damage they do, migraines are still poorly understood. We used to think that migraines were caused by blood vessels in the brain constricting, restricting blood flow and oxygen; and then bouncing back all of a sudden. Now most researchers believe the blood vessels are a symptom of underlying brain dysfunction, where waves of activity and inactivity sweep over the surface of the brain.  It’s kind of complicated, and kind of fascinating (if you’re in the mood for it).  And at the end of the day, not nearly as relevant as figuring out something to do about them.

So let’s talk natural medicine, where there are a lot of solutions, literally dozens of herbs and supplements that have been used traditionally and in positive clinical trials.

I’m going to talk about four.

Please bear in mind, all four of these herbs and supplements work differently, and in complementary ways.  In other words, they can be combined safely and effectively if any one isn’t cutting it. I’m also going to share a protocol Debra used, in her own words. Finally, I’m going to close with a few words about diet, in particular foods that can trigger migraines, and how to avoid them.

Melatonin: More than Just The “Sleep Hormone”

Melatonin is a hormone produced in the pineal gland at the base of the brain.  When light hits our eyes, we stop producing it.  When light stops hitting our eyes, we start producing it again.  Melatonin’s effects are far-reaching, but basically, it tells the body it’s time to sleep.  But that’s more than just shutting your eyes.  Sleep is when the body repairs itself, mends itself, etc.

So of course melatonin is one of our go-to remedies for sleep. But as the years go by, we see more and more research where moderate doses of melatonin (still taken at night, of course!) benefit certain disease states. Irritable bowel syndrome. Autoimmunity. Even cancer.

And migraines. In some clinical trials, melatonin works a little better than mainline drugs for migraine; in others the drugs work a little better (albeit with more side effects). We almost never see a trial where melatonin doesn’t work.

One of the more impressive trials involved 196 adults, averaging 7.3 migraine days per month when the study began. They were randomized to receive either placebo, 25 mg a day of the drug amitriptyline, or 3 mg a night of melatonin.

After 3 months, the melatonin group had 2.7 fewer migraines days per month, vs. 2.2 fewer in the amitriptyline group, and 1.1 in the placebo group. The entire melatonin group reported 16 side effects, which was one fewer than the placebo group; vs. 46 in the amitriptyline group. And – nobody is sure why this happened – patients in the amitriptyline group gained a little more than 2 pounds over the course of the study versus a very slight weight loss in the melatonin group.

Melatonin should be taken nightly, not just when you feel a migraine coming on.  Melatonin has also been studied in children as young as 5.

Magnesium: Essential Mineral to Relax Muscles & Mind

Magnesium is found in whole grains, beans, nuts, seeds, fruits, and vegetables. In other words, in whole, unrefined foods. It is almost absent in most refined and processed foods. Diets high in calcium also increase the need for magnesium. So unless you eat right, it’s easy to be deficient.

Magnesium has been reasonably well researched in regards to migraines, with dozens of published trials. Results have been mixed, with most showing slight or moderate benefit, and some showing none1.

I’d argue that magnesium is actually quite effective at preventing migraines – more so than the a quick glance at the research would suggest.  That’s because the published trials tend to use less bioavailable forms of magnesium such as magnesium chloride or magnesium sulfate. Or, at best, magnesium citrate (average, but not very good).

My suggestion is to use a nice, robust dose of magnesium glycinate or magnesium threonate. A good regimen is 600-1,200 mg of magnesium as magnesium glycinate per day, in divided doses.  Or 150-300 mg as threanate.   In my experience, these doses of magnesium usually help.

And ladyfolk rejoice: magnesium is safe during pregnancy, and may be especially valuable for migraines associated with your period.

It may take 2-3 months of regular use before you see it start to work. Be aware that high-dose magnesium may cause loose stools – although this is less of an issue with the more bioavailable forms.

Riboflavin: Vitamin B2 for Mitochondrial Energy and Neurologic Function

Mitochondria are the energy-generating power plants of our cells. Often, migraine sufferers have abnormalities in how these mitochondria work. Vitamin B2, or riboflavin, helps our mitochondria generate energy. So, in theory, it might help.

Fortunately, we have more here than just theory. Vitamin B2 has been the subject of clinical trials with migraines going back decades. A 2017 review published in the Journal of Clinical Pharmacy and Therapeutics compiled data from the 9 best ones.  (And by “best” I mean the best-designed, not the best results).  In all 5 trial with adults, B2 was effective. In the 4 with children and teenagers, it was a mixed bag (but mostly effective).

A standard dose is around 400 mg a day in divided doses. You generally take it for a number of weeks before it starts to work.

Butterbur: the British Herb for Storing Butter (and also allergies, migraines, and more)

butterbur plant

Butterbur (petasites hybridus)

Butterbur is used for two things. (Three, if you include wrapping butter in its giant leaves before the industrial age, which is how it got its name).

Medicinally, butterbur does two things. First, it blocks the allergic response. We’ve written about that elsewhere. It also relaxes smooth muscle spasms catalyzed by overactive nerves. Smooth muscle is the kind that lines organs and tubes in the body (as opposed to skeletal muscle, which moves our limbs). Smooth muscle spasm is key to asthma, urinary incontinence (“overactive bladder”), and migraines. Butterbur helps here.

In the largest study, 245 adults who averaged at least six migraines per month were randomized to receive either 100 mg or 150 mg of butterbur extract a day, or placebo. After four months, the people on 150 mg a day were experiencing 48% fewer attacks vs. 36% fewer at 100 mg a day, and 26% fewer with placebo. The most common side effect was burping.

The root is the part of the plant we use medicinally. But it also contains traces of pyrollizidine alkaloids (PAs). The data here are controversial, but there is some indication that PAs may be rough on the liver. Until this is fully resolved, it is probably wise to use store-bought products that are extracted to remove the PA. A standard dose is 50 mg extract standardized to 15% petasins (so 7.5 of petasins), 3 times a day. This is another one we take for 2-3 months before we start to notice it.

We’ve written more about butterbur here

Two Brand-Name Products: Clear Migraine by Clear Products, and Butterbur Extra from Vitanica.

I don’t normally endorse brand-name products. But these are going to be exceptions.

Butterbur Extra is a simple product in the sense it’s not very creative. It simply takes most of what I’ve already talked about and combines it all in one bottle. A serving has 400 mg of high quality magnesium,

400 mg of vitamin B2, a standard dose of butterbur, plus additional herbs feverfew and ginger. It’s a great formula for everyday use.

Clear Migraine is different. It combines herbs from the Chinese tradition with remedies from the homeopathic medical system to address pain, spasm, inflammation, and blood vessel constriction. I’m not sure if anything here is actually researched. But regardless, the net effect is something that actually works. At least for many people. The nice thing about it is, if it does work, it works relatively quickly. You’ll know soon enough.

Debra’s Protocol: Worked for Her!

“Years ago, an old German doctor  told me to take one 100 mg niacin and one capsule feverfew each night before bed, for three months. He said while faithfully following this three-month protocol, the combo wouldn’t stop a migraine, but that they would lessen in intensity over the three months. The time between migraines would gradually grow longer. My migraines did magically stop after three months, just as my doctor said they would. I didn’t have another one for years, but when they started coming back I repeated the protocol, and it’s been over 40 years since I’ve had another.

“Over the years I’ve passed this method on to many people. It’s worked for most. What I also always say is that the niacin that works is the kind that makes you flush, and sometimes, not every time, the niacin flush does hit. I would fall asleep (remember, this gets taken at bed time) and sometimes wake up scratching and itchy. I would say, ‘Oh, it’s the niacin,’ and fall back asleep.

“The niacin can make the heart beat fast, too. As long as you know, you won’t be scared. All reactions stop in about five minutes.”

Other nutrients for consideration:

I really, really hope and expect people using some or all of the recommendations above will not need to try anything else.  But also worth consideration are Coenzyme Q10, 5-HTP, fish oil, and the herbs feverfew and corydalis.  I’d look at CoQ10 especially for people with high blood pressure and/or on statins.  Or if the vitamin B2 appears to help you – just not quite enough.  A good dose is 100 mg 2-3 times a day. 5-HTP for people who have a hard time sleeping, or general lowered mood.  Fish oil for people with a lot of inflammation going on… Corydalis as a painkiller.

Diet: Trigger Foods to (Potentially) Avoid

Estimates have it that anywhere from 10-50% of migraine sufferers are sensitive to certain “trigger foods” that can bring on or potentiate attacks.

Foods that are most likely to be problems include chocolate, cheese (especially aged or sharp cheese), alcohol (especially red wine and dark beer), citrus fruits, cured meats, MSG, caffeine, and artificial sweeteners.

Unfortunately, traditional allergy testing will not identify your trigger foods for you. Your best bet is to keep a migraine food journal. Next time you feel an attack coming on, write down everything you ate in the last 12-24 hours. Break foods down into their component ingredients. For example, don’t write “chocolate cake.” Write “wheat flour, chocolate, sugar.” After a few attacks, you might start to see patterns. Maybe before 7 out of your last 8 attacks, you had something that contained chocolate. Or cured meat. Or whatever.