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Neutraceuticals: Effective for Migraines?

Neutraceuticals: Effective for Migraines?

  • Studies suggest that magnesium, riboflavin, butterbur, coenzyme Q10, and certain nutraceutical combinations may have efficacy in preventing migraine. This slideshow reviews the evidence.
  • Nutraceutical: Marketing term without regulatory definition[1]
    -Includes vitamins, supplements, herbal preparations
    Use related to dissatisfaction with conventional medicine
    -Belief that natural medicines are good, pharmaceuticals are bad
    Some studies do suggest efficacy for certain neutraceuticals in migraine prophylaxis
    Awareness of potential benefits and harms of neutraceuticals is important for the clinician-patient relationship

  • Magnesium
    Fairly good evidence for decreased attack frequency:
    -IV magnesium sulfate 1-2 mg daily: decrease in attacks
    -IV magnesium chloride 32 mg daily:  decrease in attacks
    -Oral magnesium citrate 400-600 mg daily: decrease in frequency and severity of attacks
    BUT: Recent review suggests limited evidence supports oral magnesium for migraine prevention; recommends increased dietary intake of magnesium[2]

  • Riboflavin
    Fairly good evidence for decreased attack frequency
    Riboflavin 400 mg: decreased frequency and severity of attacks
    No evidence for efficacy in preventing pediatric migraine
    Improves energy metabolism
    -Possible mechanism: corrects abnormal mitochondrial energy processing and cortical information processing possibly involved in migraine pathogenesis
    Excellent tolerability

  • Butterbur (Petasites hybridus)
    Fairly good evidence in children and adults:
    - Butterbur 50-150 mg: decreased frequency and severity of attacks
    Anti-spasmodic, anti-inflammatory, blocks calcium channels
    Concern for hepatotoxicity

  • Feverfew
    Inconsistent evidence for benefits:
    -Feverfew 50-300 mg: controversial results
    Preparation strength and stability differs between products
    Cochrane Review: insufficient evidence that feverfew is more effective than placebo in migraine prevention[3]
    No major safety concerns noted

  • Coenzyme Q10
    Evidence in adults:
    -Coenzyme Q10 300 mg: decreased frequency, duration, intensity of attacks
    -Not replicated in pediatric patients
    Improves energy metabolism

  • Nutraceutical Combinations
    Combinations that have shown some efficacy:
    -Fixed combination of magnesium, riboflavin, and coenzyme Q10
    -Feverfew plus ginger
    -Ginkgo biloba, coenzyme Q10, Vitamin B2

  • Take Home Points
    Nutraceuticals are non-regulated vitamins, supplements, and herbal preparations that are often perceived as benign and safe
    Studies suggest the following may have efficacy in preventing migraine: magnesium, riboflavin, butterbur, coenzyme Q10, and certain nutraceutical combinations
    Nutraceuticals are associated with mild, transient adverse effects; there is concern for hepatotoxicity with butterbur
    Long-term safety monitoring is needed

  • References:
    1. D'Onofrio F, Raimo S, Spitaleri D, et al. Usefulness of nutraceuticals in migraine prophylaxis. Neurol Sci. 2017 May;38(Suppl 1):117-120.
    2. Teigen L, Boes CJ. An evidence-based review of oral magnesium supplementation in the preventive treatment of migraine. Cephalalgia. 2015 Sep;35(10):912-22.
    3. Wider B, Pittler MH, Ernst E. Feverfew for preventing migraine. Cochrane Database Syst Rev. 2015 Apr 20;4:CD002286.

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