What's in Your Toolbox? Migraine and OTC Supplements
I recently had the privilege of attending a physicians’ nutraceuticals conference and was fascinated by the depth of knowledge by the speakers. Bearing in mind that I’m neither a doctor nor a scientist, I’m not going to try and explain the details of everything that was taught there but rather focus on the most frequently asked questions:
Wild West OTC
Due to a lack of FDA regulation, it is kind of like the Wild West when looking into vitamins and other supplements. It can be challenging to know exactly what is in any given product, whether it is contaminated or not, and whether it includes what it claims on the list of ingredients.
Different options range in price from surprisingly affordable to shockingly outrageous. Some brands are only available through doctors’ offices, adding an additional middle-man markup. Others are commonly seen in “Buy One Get One” advertisements in local pharmacies and can include generic versions of unknown quality.
Walking down a vitamin and supplement aisle at a store can be enough to make anyone’s head spin, let alone someone with migraine! Information overload is very real, and every bottle has the added small print caveat: “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”
Hang on! What was that again? Yes, you read that right! In an industry that is unregulated, there is an abundance of thoughts, hopes and anecdotal reports, but there is surprisingly little evidence for much of what is on the market. Even more concerning is the lack of knowledge about how over-the-counter products might interact with medications or complicate pre-existing conditions.
Don't give up yet!
If that is enough to make you throw your hands up and run, rather than walk, away from the vitamin aisle it would be understandable. However, it’s actually not all bad, so before you give up… I encourage you to take a few moments to read on!
We’re going to look at the most commonly used vitamins and botanicals for migraine. These are the supplements which have had at least some kind of studies done on them and which may be worthwhile trying.
Before you start working your way through the maze of different options for each product, consider utilizing some of the independent verification companies to help. These companies evaluate different OTC products looking at contents, efficacy and contamination. Consumer Lab, the most popular one, charges for access, but Lab Door has no fee.
As with everything else, PLEASE talk to your doctor before starting something new, and let them know everything that you are taking. Please bear in mind that nothing contained here should be construed as medical advice, and since we are all different, none of these options may help any specific individual!
Vitamin and botanical supplements
That being said, let’s dig into some potential options for helping manage migraine prophylactically.
Riboflavin is a powerful antioxidant agent that can be very effective in migraine prevention for some people. The generally recommended daily dose is 400mg for adults and 200mg for children. One European study showed results within a month1 with another study showing results after 3 and 6 months.2
People with migraine or other chronic pain conditions often have low levels of CoQ10. Supplementing with 150-300mg per day may help with both migraine prevention and pain management in general. One study looked at 100mg given three times a day,3 while another had 150mg daily.4 Whichever dose your doctor suggests for you, one of the recommendations is to use the “ubiquinol” form which is more easily absorbed.
Some doctors believe that all migraine patients should be treated with magnesium.5 It impacts cortical spreading depression, platelet and serotonin function, and impacts various neurotransmitters. Supplementation is inexpensive and relatively easy, and the generally recommended daily dose ranges from 400-600mg.6 However, in selecting which magnesium to use to supplement it is important to be aware that some forms can be GI irritating or cause diarrhea and not all forms are equally well-absorbed.
This herb has been used for a long time for migraine prevention and studies show that 75mg has some prophylactic benefits. However, there are concerns about its safety, particularly for the long term.7 Despite those concerns butterbur continues to be utilized in several combination migraine products. If you are considering using it please ensure it is a PA-free version, such as petadolex, and consult with your doctor first.
Although this herb has been used for decades there is not a lot of clinical evidence of its efficacy.8 Having said that, as with many other things, it may be worth trying if your doctor approves it for you. Theories about its mechanism include CGRP modulation and mast cell stabilization. Bear in mind that it should be avoided during pregnancy and with those who have oral ulcers. Dosing appears to have a great deal of variation,9 however, feverfew is often included in combination migraine supplements.
Many people have found that ginger assists in managing nausea, but there are some studies which also indicate it can have somewhat of a prophylactic effect on migraine including helping reduce inflammation.10 It can be added to your diet in a variety of ways including tea, grated root, extract in capsules, crystallized ginger, and more. The recommendation appears to be titrating up slowly to minimize any GI issues, starting with 250mg per day and going as high as 3g daily. (For those who like to use the actual root, one tsp is approximately equivalent to 1g.)
Melatonin is an antioxidant that can help modulate circadian rhythms and opioid receptors. It is not certain yet whether this has a direct prophylactic effect on migraine or if this can help simply by improving quality of sleep. However, there are some promising studies, and this easily attainable supplement may be worth looking at.11 Generally, the recommended dose to start with is 3mg, but as always, please consult with a medical professional.
Besides the most popular supplements above, there are other options which may also have some impact on migraine. Those include vitamin D3, boswellia, and curcumin, and as with most other things-migraine, research is in the early stages and still somewhat limited.
One interesting study for those people who have a mutation of the MTHFR gene showed some benefit from treating with a combination of folic acid (2mg), vitamin B6 (25mg) and vitamin B12 (400mcg).12,13 If this is relevant to you then consider asking your doctor if this is an approach worth trying.
What about specialty "migraine formulas"?
With the increasing number of medications and supplements that many of us take on a daily basis, there is also an increasing amount of specialty “migraine formulas” available on the market. These include various cocktails of the most popular options and can be helpful but also very expensive.
In addition, some use the term “proprietary blend” for their ingredients which excludes dosage details and is concerning for treatment of a medical condition. In order to know what is and isn’t working it’s really important to know exactly what you’re taking. So if you’re looking at combination products considering focusing on those that give exact milligrams for each ingredient and avoid those that state “proprietary blend.”
What's in your toolbox?
So what's in your toolbox when it comes to vitamins and other supplements for migraine? Personally, I've found the jury to still be out on many of these options but there are some that I'm a huge believer in for myself. Bearing in mind that we're all different, and for each of us, our migraine responds differently, having an open attitude is a great way to start. If you haven't already, maybe talk with your doctor about what may be appropriate for you to try and who knows, maybe you'll end up with at least one more invaluable tool in your toolbox!
We'd love to hear from you, so let us know if you've found that any of the above options help you! Do you generally give it at least three months to see if it is working or give up before then? How much is cost a factor in your decisions about products, brands, and length of time?
Which are you most sensitive to?