Herbs for Migraine - The Evidence

In recent years there has been a growing interest and demand from the public for ‘natural’ treatments such as vitamins and supplements in trying to control migraine headaches. A variety of natural supplements, vitamins and herbal preparations have been promoted as having efficacy (being helpful) for migraine prophylaxis (prevention).

Among the most commonly recommended vitamins and supplements are magnesium, riboflavin, and Coenzyme Q10 (CoQ10) while the most common herbal preparations are feverfew and butterbur.

Each of these compounds has a theoretical mechanism or reason for the effect on migraine, and has had at least one placebo-controlled trial that has demonstrated efficacy.

You can also view Blessed Necessities medicinal essential oil blends in 5mm roller bottles for Migraines here.

Feverfew

Feverfew (Tanacetum parthenium) is an herb that is available as an off-the-shelf remedy. Its yellow-green leaves and yellow flowers resemble those of chamomile (Matricaria chamomilla), with which it is sometimes confused.

The herb feverfew has had a long history of use in traditional and folk medicine. Recently it has become a popular prophylactic treatment for migraine headaches and its extracts have been claimed to relieve menstrual pain, asthma, dermatitis, and arthritis. Traditionally, the herb has been used as an antipyretic (fever reducer), from which its common name is derived.

Human safety data

If you have any health problems that may be treated with feverfew, consult your doctor before use. Caution is advised if you have diabetes, alcohol dependence or liver disease. Liquid tincture preparations of this product may contain alcohol, and feverfew is not recommended for use in children under 2 years of age. Because of the potential risk to the infant, breast-feeding while using this product is not recommended, and feverfew is contraindicated during pregnancy.

Potential side effects

Most adverse effects of treatment with feverfew are mild, although some people have experienced increased heart rate. Feverfew possibly may interact with anticoagulants. A small percentage of people may experience mild stomach upset from feverfew, although this is rare. 

Interaction with other drugs

It is advised to avoid use of feverfew when taking anticoagulant drugs. Feverfew is contraindicated to those allergic to other members of the family Compositae (Asteraceae) such as chamomile, ragweed, or yarrow.

Use for migraine

Seventeen migraine patients who already used feverfew daily as migraine prophylaxis enrolled in a controlled trial in which 8 patients continued to receive feverfew while 9 stopped taking their feverfew and received placebo treatment instead (i.e. untreated patients) (8). Those who received placebo had a significant increase in the frequency and severity of headache (an average of 3.13 headaches every 6 months when taking placebo vs. only 1.69 headaches every 6 months when taking feverfew), nausea, and vomiting, whereas there was no change in the group receiving feverfew. In a larger study of 72 patients, feverfew was associated with a 44% reduction in the mean number and severity of attacks although the duration of the individual attacks was unaltered (9).

Butterbur (Petasites hybridus)

Butterbur is a perennial shrub, found throughout Europe as well as parts of Asia and North America. It is usually found in wet, marshy ground, in damp forests, and adjacent to rivers or streams. The common name is attributed to the large leaves being used to wrap butter during warm weather.

Human safety data

For many centuries the butterbur was used as an herbal remedy for conditions like pain, fever and spasms. Today, butterbur is mainly used for migraine prevention, but also for treating headaches and asthma. The butterbur plant also contains liver-toxic pyrrolizidine alkaloids, which are removed by a special patented treatment and only marketed under the name Petadolex®.

Potential side effects

Studies have reported safety and good tolerability of commercially available butterbur products that are free of potentially carcinogenic pyrrolizidine alkaloid constituents, when used short-term, orally and in recommended doses. Raw, unprocessed butterbur plant should not be eaten due to the potential for liver damage of pyrrolizidine alkaloids with long-term use. This includes any teas, capsules of raw herb, or unprocessed tinctures or extracts. Use should be limited to commercially available products free of pyrrolizidine alkaloids, and is not recommended in women who are pregnant or breastfeeding due to a lack of safety studies.

Interaction with other drugs

Long-term health effects and interaction with other drugs have not been studied so we don’t know if there are any side effects from long term use.

Use for migraine

According to the first trial published by Lipton in 2004 (14) and conducted in the USA and Germany with 245 migraine patients with and without aura, the participants found relief from migraine symptoms with butterbur. The participants were treated for 4 months twice daily with either placebo or 50 mg or 75 mg commercial butterbur. Maximum response was achieved after 3 months resulting in an attack reduction of 58% with a 2x75 mg/day dosing. This was statistically significant compared to the placebo response of 28%. The percentage of patients responding to the therapy was 71% after treatment with butterbur. Two randomized, placebo-controlled migraine prevention trials with a total of 289 patients demonstrated the safety and efficacy of the butterbur root extract in adults (15, 16), prompting an exploration of the prevention of migraine in children also.

Use for migraine in children

Between April 1998 and July 2002, a total of 112 patients entered an open-label trial (17), consisting of 29 children between the ages of 6 and 9 years and 79 adolescents between the ages of 10 and 17 years. The attack reduction in the total sample population was 63%. About 86% (18 out of 21) of the younger and 74% (43 out of 58) of the older patients responded. Prophylactic (preventative) treatment with butterbur extract also reduced the duration of migraine attacks from about 10 hours on average before the study to about 7 hours during treatment. However, approximately 25% of patients still experienced a prolonged attack under treatment. About 82% (71 out of 87) of all patients reported substantial improvement of their migraine compared to the situation prior to the study. None of the patients reported worsening of migraine, but one patient each per age group reported that they had stopped the treatment early due to lack of efficacy. About 92% (78 out of 85) of all patients felt as well as or even better than before the study. Only one migraine patient in both age groups felt much worse because of the treatment.

References

1. Ramadan NM, Halvorson H, Vande-Linde A. Low brain magnesium in migraine. Headache. 1989;29:590–593.
2. Trauinger A, Pfund Z, Koszegi T, et al. Oral magnesium load test in patients with migraine. Headache. 2002;42: 114–119.
3. Mauskop A, Altura BM. Role of magnesium in the pathogenesis and treatment of migraine. Clin Neurosci. 1998; 5:24–27.
4. Mauskop A, Altura BT, Altura BM. Serum ionized magnesium in serum ionized calcium/ionized magnesium ratios in women with menstrual migraine. Headache. 2001;42:242–248.
5. Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache. 1991; 31:298–301.
6. Peikert A, Wilimzig C, Kohne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multicenter, placebo-controlled and double-blind randomized study. Cephalalgia. 1996;16:257–263.