(This is a slight retooling of an article originally published in 2017).

Migraines aren’t just bad headaches. They’re “special” headaches. In addition to the headache itself, migraine sufferers can experience neurologic symptoms like sensitivity to smell and sound, digestive distress, mood disturbances, and stiff neck. These symptoms may occur hours or days before the headache; when the headache comes, these symptoms may go away, or they may get worse, amplified by physical activity, light and sound.

To further complicate things, some people have all these other neurologic symptoms without a headache. These “silent migraines” can be scary if you don’t know what’s happening. 

Anyways, after the episode passes, it’s common to feel tired and have difficulty concentrating for a day or two. Some people have one or two migraines their entire lives, often after periods of sustained, intense stress. Others may have four or five migraines a month.

For all the pain they cause, migraines are still poorly understood. We used to think that migraines were caused by blood vessels in the brain constricting, and then bouncing back. Now researchers believe this is a symptom of underlying brain dysfunction, where waves of activity sweep through the brain. And as to why it happens… still, poorly understood.

SO – let’s talk natural medicine. Bear in mind, everything I’m going to write about works differently than the others; everything is potentially complementary. You can try one or two, or all of the suggestions together if you need to.   

CAFFEINE: It’s natural, and it works

The headline says it all. Just because it’s in over-the-counter medications doesn’t mean it’s not natural! You can read about caffeine elsewhere. Try a big cup of coffee when you sense a migraine coming on. Combines well with CBD, too. See below for CBD. 

MELATONIN: MORE THAN JUST THE “SLEEP HORMONE”

Melatonin is a hormone produced in the pineal gland at the base of the brain when light stops hitting our eyes. Basically, it tells you when to sleep. But its effects are farther reaching than just that. Sleep is when the body repairs itself, and it turns out there’s research connecting melatonin supplementation with improvements in everything from irritable bowel syndrome and reflux to immune function and even cancer.

AND migraines. In one of the more impressive trials, 196 adults, averaging 7.3 migraine days per month, were randomized to receive either placebo, 25 mg of the drug amitriptyline, or 3 mg melatonin at night.

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 fewer in the placebo group. The entire melatonin group reported 16 total side effects 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 been studied in children as young as five.  

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 many refined and processed foods. Diets high in calcium also increase the need for magnesium. So, it’s easy to be deficient.

Magnesium has been reasonably well researched with migraines. Results have been mixed, with most trials showing slight or moderate benefit.
I’d argue that magnesium is pretty effective at preventing migraines – more so than 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 highly bioavailable magnesium glycinate or magnesium threonate. A good regimen is 600-1,200 mg of magnesium as glycinate per day, in divided doses. Or 150-300 mg as threonate.   

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 it starts to work. Be aware that high-dose magnesium may cause loose stools – although less likely with the 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 mitochondrial function. Vitamin B2 can help. 

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 nine best ones. (“Best” as in best-designed, not necessarily best results.) In all five trials with adults, B2 was effective. In the four with children, it was a mixed bag (but mostly effective). 

A standard dose is around 400-500 mg a day in divided doses. You generally take it for a number of weeks before it starts to work. 

BUTTERBUR: the herb for allergies, migraines, and more 

Butterbur is used for two things. First, it blocks the allergic response. We’ve written about that elsewhere. It also relaxes smooth muscle spasms, especially when caused by overactive nerves. Smooth muscle is the kind of muscle that lines the 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 also involved in migraines.

 In the largest study to date, 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 used medicinally. But it contains pyrrolizidine 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 PAs. A standard dose is 50 mg extract standardized to 15% petasins (so 7.5 of petasins), three times a day. This is another one we take for two-three months.    

TWO BRAND-NAME PRODUCTS  

I try not to endorse brand-name products in writing. But there are exceptions.

Butterbur Extra. from the Vitanica company, is a simple product in the sense it’s not very “creative.” It simply takes most of what I’ve talked about (which is to say, most of what has been researched) and combines it 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 from Clear Products 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 the net effect is something that actually works. At least for many people it does. The nice thing about it is, if it does work, it works relatively quickly. You take it when you’ve got one. You’ll know soon enough.

Debra asked me to share this email she received from a customer about Clear Migraine: “The Clear Migraine capsules worked. Within hours my son was up and around and actually asked me to go on a walk OUTSIDE with him (which is unusual even when he’s feeling well). If it were socially-distancing-acceptable, I’d come give you the biggest, squeeziest hug! Thank you thank you thank you! A miracle, for sure. (We’ve been to specialists, to doctors, none of whom helped one iota. This is like magic.)”

CBD and Cannabinoids: Pain and Stress

  If you have typical, headache-oriented migraines with pain, it’s really worth looking at CBD. CBD reduces stress, and it reduces pain. I tend to recommend 20-30 mg of CBD per dose for garden-variety pain and garden-variety stress.  Here I’ll suggest more.

The people I speak with who use CBD for migraines tend to use 50-150 mg, all at once. The idea is, you don’t just take CBD throughout the day to manage the pain. You take a lot all at once to sort of intercept or “head off” the pain. My suggestion is, start with 20 or 30 mg. Take another 20-30 in 2 hours. Take another 20-30 in two hours… until it works. Once you figure out the total dose that works, next time a migraine is coming on, jump into that total dose right away.