How to Get Rid of Migraine Headaches with Natural Treatments

Introduction: How to Get Rid of Migraine Headaches with Natural Treatments

Learn how to get rid of migraine headaches with natural treatments by reviewing these options published in research. Most headaches are not serious and tend to come and go, but unfortunately are responsible for pain, suffering, and lost work. Any headache described by a patient as the worse headache of their life, relentless headache, headache with vision problems such as a shade over the visual field or double vision, headache with weakness, headache with facial droop, or headache with seizure should call their physician or emergency medical services immediately.

Diagnosis of headache type is important in order to treat the underlying cause, but headaches may include characteristics and features of several different headache types. It is important to follow the directions of the primary care physician or Neurologist for a traditional headache treatment approach which usually includes both abortive and prophylactic (preventive) medications. Preventive Health Advisor will discuss potential natural cures for headaches and natural migraine remedies. This will include non-pharmaceutical interventions for headache prevention which may require lifestyle change, foods and supplements to reduce the number and duration of these episodes. Find out the multiple options to get rid of migraine headaches with natural treatments which may require lifestyle change, foods and supplements.

How to tell the difference between migraines and other headaches…

Learning the difference between the different types of headaches is important. This will help you understand options for how to get rid of migraine headaches and other types of headaches with natural treatments. A migraine is a severe, painful headache that is often unilateral and sometimes preceded by an aura, which is a sensory warning sign that headache is about to appear. Aura includes flashes of light, blind spots, and tingling in the arms and legs. 10-15% of the population is affected by migraines. Migraines may be associated with nausea, vomiting, and increased sensitivity to light and sound. The excruciating pain that migraines bring can last for hours or even days. A migraine headache causes the sympathetic nervous system to respond with symptoms of nausea, diarrhea, and vomiting. Triggers of migraines include anxiety, stress, bright light, hormones, hunger, and lack of sleep. If treatment by the primary physician has not made progress for the patient in aborting or preventing migraine attacks, a consultation with a Neurologist may greatly benefit patients.

What is a cluster headache and the difference between cluster headaches and migraines…

Cluster headaches are less common than other types of headaches, and usually occur unilaterally, around one eye. Cluster headaches tend to occur at the same time daily for as long as 2-3 months, and may occur during a specific season, but then may remain absent for weeks to years. They may be associated with nasal drainage and tearing of the affected eye.

Does stress cause tension headaches?

Tension headaches usually affect patients later in the day and come on slowly. They are usually a result of stress, are often on both sides of the headache, and are described as a tight band around the head. Patients with these headaches often have tight muscles of the back of the neck or jaw.

Exertional Headaches From Physical Activity:

This type of headache is caused by physical activity. In general, exertional headaches are a throbbing or pulsating type headache present on both sides of the head which last up to 2 days. If this type of headache is present frequently or is becoming severe, the physician should evaluate should evaluate the headache for intracranial disease. Preventive pre-medications may benefit patients with this type of headache.

Sinus Headaches From Nasal Allergies or Sinus Infections

These headaches are associated with any type of acute or chronic sinus disease such as allergic rhinitis, vasomotor rhinitis, colds, and acute viral or bacterial sinusitis. Sinus headache relief should be done by focusing on the underlying sinus disease. For headaches due to suspected allergic rhinitis, common cold or influenza, please see those sections in Preventive Health Advisor.

Sexual Activity May Precipitate Headaches

Headaches may be related to sexual activity, and preventive measures with foods and supplements, or certain pre-medications may be an option.

Headache Treatment Resource

The Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society outlines migraine therapies which may be accessed here (1).

Headache Prevention Basics

Common precipitating factors for many types of headaches include sleep pattern disruption, medications, stress, supplements, caffeine use, caffeine withdrawal, smoke exposure, odors, and chemical or gas fumes.

Sleep Pattern Often Requires Adjustments

Headaches are associated with sleep deprivation and irregular sleep pattern. Patients should make an effort to maintain a regular sleep and awakening cycle to improve headache free intervals. Caffeine consumption is a common reason for disruption of sleep.

Sleep More to Reduce Headaches:

Adequate duration of rest may prevent migraines or reduce their severity.

Stress Reduction and Headaches:

Reduction of stress by the use of meditation may reduce the frequency of headaches, improve pain tolerance, reduce anxiety, and improve well-being (2).

Food Triggers of Headaches:

There some known triggers of headaches in food. It is important to start a food diary which will help reveal these food triggers. Avoidance of food triggers is just as important as using supplements to get rid of migraine headaches with natural treatments. It has been found that some individuals are susceptible to the following triggers. Tyramine contained in dried meats, smoked fish, cheeses (especially aged), and beer has been known to trigger headaches. Artificial sweeteners have been known to trigger headaches. Aspartame and sucralose (Splenda) have both been found to be associated with headaches (3,4). Flavor enhancers are also known to cause headaches. In a double-blind, placebo-controlled, randomized study, over 36% of patients in a group exposed to monosodium glutamate had reactions of headache, numbness/tingling, general weakness, and flushing with higher frequency than the placebo group (5). Nitrates and nitrites have been found to be known precipitants of headaches (6). They are present in medications used to treat angina and they are used as food preservatives. Potassium nitrate, sodium nitrate, as well as other nitrates and nitrites are used mainly to preserve meats. Consumption of these preservatives also has been associated with an increase in risk of certain cancers in cohort studies (as described elsewhere in Preventive Health Advisor).

Commonly Used Substances Cause or Worsen Headaches:

Alcohol, caffeine, and caffeine withdrawal are known precipitants for migraines and tension headaches (7). A cross-sectional Australian study of 4558 participants revealed that as the intake of caffeine increased so did the reported risk of headache and sleep difficulty in both men and women (8). Compared to non-coffee drinkers, men consuming 240 mg of caffeine (about 4-5 cups of coffee or tea) per day had a 30% and 40% greater risk of headache and insomnia respectively, while women had a 20% and 40% higher risk of headache and insomnia respectively (8). Caffeine used as treatment for headaches is known to reduce headache severity in the short term (9). In patients with migraines, try to wean regular use of caffeine containing beverages over the course of 1-2 weeks to reach the goal of eliminating caffeinated drinks entirely.

Don’t Get Too Hot

A study of 200 individuals found that an increase in body temperature (from exercise, hot bath, or weather) can cause cluster headache attacks within 1 hour in about 38% of individuals (10).

Traditional Medications for Headaches:

It is important to follow the directions of the primary care physician or Neurologist for abortive and prophylactic (preventive) medications for headaches. Smaller doses of over the counter and prescription medications (such as acetylsalicylic acid, paracetamol and caffeine) combined together have been determined in general, to result in better relief over higher doses of single agents.

Over the Counter Medication Combinations for Migraines:

When you are able to get rid of migraine headaches with natural treatments, you will be able to reduce the use of other commonly used medications. When using medication, research supports the use of smaller doses of multiple medications in combination. A study of 1743 patients (76% women) found that combination therapy for the treatment of headache or migraine provides faster pain relief than drugs taken separately. Patients were randomized to receive two tablets containing either: 1) 250 mg acetylsalicylic acid (ASA) + 200 mg paracetamol (PAR) + 50 mg caffeine (Thomapyrin) (CAF); 2) 250 mg ASA + 200 mg PAR; 3) 500 mg ASA; 4) 500 mg PAR; 5) 50 mg CAF; or 6) placebo. Researchers found that combination ASA + PAR+ CAF was significantly superior in time to 50% pain relief compared to the combination without caffeine, ASA, paracetamol, and caffeine alone, and placebo. (11)

A double-blind, randomized clinical study was performed on nonprescription pain medication for the treatment of headaches. The researchers compared the effectiveness of a fixed combination of acetylsalicylic acid (ASA), paracetamol (PAR, also known as acetaminophen), and caffeine (CAF) over single substances in 1734 patients. Pain intensity difference from the start of the study was compared to after treatment. Results show caffeine was not effective when used alone for headaches but was effective in combination with other analgesics. Patients who took ASA+PAR+CAF in this triple combination were found to have a significantly better mean pain reduction than single agents. (12)

Supplements with Evidence for Natural Headache Relief and Prevention

How Feverfew Has Been Used for Migraines:

Consider feverfew, scientific name Tanacetum parthenium to get rid of migraine headaches, Chrysanthemum parthenium, and Pyrethrum parthenium is a small plant with flowers that resemble small daisies. Feverfew has shown to be effective at preventing migraines at doses between 50 and 150 mg oral daily, and research has been done for a duration of up to 3 months. Feverfew shouldn’t be taken any longer than this due to lack of data in long term studies. Although most studies have not shown any major adverse reactions, an increase in bleeding risk is present (19,21,22), and feverfew should not be taken along with non-steroidal anti-inflammatory drugs (NSAIDs), warfarin (Coumadin), heparin, and aspirin. NSAIDs refer to naproxen, Aleve, ibuprofen, Advil, indomethacin, Indocin, and many others. Tylenol is safe to take with feverfew. It is important to avoid feverfew for 2 weeks prior to any surgical procedure (13). Feverfew should be avoided in children, pregnancy, and lactating women since this herbal agent has not been researched well. Feverfew should be avoided by patients with allergies to this plant or similar species. Supporting research is provided below:

• A systematic review of five randomized, placebo-controlled, double-blind trials looking at the effectiveness of feverfew for the prevention of migraine reported that the majority of trials found feverfew superior to placebo in migraine prevention (14).
• Monthly migraine frequency and severity, nausea, and vomiting were reduced in patients taking feverfew in a randomized, placebo-controlled study of 72 individuals suffering from migraine with no reports of serious side effects (15).
• Use of feverfew in a study of 60 patients suffering from migraine headaches was shown to reduce the average number of migraines as well as the severity of the headaches. Pain, measured by visual analogue scores, was significantly improved with feverfew. No serious adverse effects were reported. (16)
• The effectiveness of a carbon dioxide extract of feverfew (CO 2 extract, MIG-99) in 170 patients suffering from migraine headaches was examined. Participants receive feverfew 6.25 mg 3 times daily or placebo for 16 weeks. Migraine frequency declined from 4.76 attacks to 2.86 attacks (−1.9) in patients treated with feverfew compared with 3.5 attacks (−1.3 ) with placebo. Both groups reported adverse events possibly related to medication (8.4% with MIG-99 vs 10.2% with placebo). (17)
• A sublingual (under the tongue) oil based feverfew plus ginger medication called LipiGesic M, available in community pharmacies, helped reduce pain in patients with migraines as well as helped ease throbbing, nausea and sensitivity to noise. This study reported that 63% of subjects experienced pain relief within two hours of taking LipiGesic M (compared to only 39% of placebo). (18)

Feverfew Adverse Reactions and Interactions:

• Feverfew has been reported to inhibit the formation of platelets which may increase the risk of bleeding (19).
• Aphthous ulcers, lip and tongue irritation, and swelling have been associated with the use of other herbal supplements with feverfew, and gingival bleeding with feverfew has been reported (20)
• Feverfew has been found to reduce the platelets ability to form blood clots by preventing platelet aggregation (21)
• Feverfew has antiplatelet effects and may interact with non-steroidal anti-inflammatory drugs (NSAIDs), warfarin (Coumadin), heparin, and aspirin to increase risk of bleeding (22).

Does riboflavin work for migraines?

Consider riboflavin supplementation as another way to get rid of migraine headaches with natural treatments. Some of the research including riboflavin as a supplement for prevention of migraines in adults, children, and adolescents has shown riboflavin to be effective. However other studies studies have demonstrated it to be ineffective, often with better results from a placebo. The dose commonly used in research has been 200-400 mg in patients from 11 months old up to 65 years of age for durations of up to 6 months. We suggest that the riboflavin dose for children under 12 years of age should be no more than 200 mg oral daily. Riboflavin dose for adolescents and adults is 200-400 mg oral daily. Riboflavin has not been studied well in pregnant women but it has been suggested as a good treatment option due to a lower possibility of adverse effects compared to pharmaceuticals.

A randomized placebo-controlled trial study using 400 mg of riboflavin or placebo taken by 55 subjects for 3 months reduced both the number of days on which a headache occurred, and reduced the number of headache occurrences. The percentage of patients which had a 50% improvement was 15% for subjects taking placebo, and 59% for those taking riboflavin. Side effects included diarrhea and excess urine production in the riboflavin group and one instance of crampy abdominal pain in the placebo group.(23)

An open study performed with 23 patients ages 20-65 taking 400 mg of riboflavin with a median of 4 headaches per month reduced the number of headaches by one half at 3 months and 6 months. Diarrhea, abdominal pain, and facial erythema were reported as adverse effects. (24)

In a retrospective study, 41 participants received either 200 or 400 mg/day of riboflavin orally for 3, 4, or 6 months. At the end of the study, the number and severity of migraine attacks significantly decreased during treatment with no significant difference seen between both doses administered. Additionally, during follow up, a reduction by at least 50% in the number of migraine headaches was reported in 68.4% of patients and in intensity in 21%. Adverse effects reported were vomiting, increase in appetite, and transient orange urine. (25)

A randomized, double-blind study of 48 children suggests that riboflavin, also known as vitamin B2, is not an effective treatment for migraine headaches. For 4 weeks, participants received either 200 mg/day of riboflavin or placebo. At the end of the study, a reduction by at least 50% in the number of migraine headaches was reported in about 44% of treatment participants and 67% in the placebo group. (26)

Melatonin for Cluster Headaches:

Melatonin may aid individuals suffering from cluster headache. Twenty participants were randomly assigned to receive nightly oral melatonin (10 mg) (n=10) or placebo (n=10) for 14 days. Headache frequency decreased and there was less use of analgesics in the melatonin group. Half of the patients in the treatment group responded to melatonin after 3-5 days, and had no further episodes until they stopped treatment. No effects were reported in the placebo group. (27)

There have been lower levels of melatonin found in subjects with migraine and cluster headaches. It was reported by the authors that the increased body temperature lowers melatonin levels and may explain the reason for cluster headaches to be precipitated by heat. (28)

Melatonin Adverse Reactions and Interactions:

• Caution in patients taking anti-convulsant medication (anti-seizure medication) since melatonin may result in an increased rate of seizure occurrence (29).
• Melatonin may enhance the effect of somnolence by other medications. Caution in patients taking other sleep aide medications, narcotic medications such as oxycodone and hydrocodone, benzodiazepines such as lorazepam, diazepam, alprazolam, or other sedatives such as Ambien, Restoril, Lunesta, or trazodone. Melatonin may affect the same GABA neurotransmitters as benzodiazepines in the brain producing a higher degree of somnolence (29).
• In patients with previously controlled hypertension, melatonin may increase systolic and diastolic pressure as well as heart rate (30).
• Caution of melatonin in patients taking anti-platelet or anticoagulant medications as melatonin may lower blood coagulation factor VIII and decrease fibrinogen levels (31). Melatonin did not appear to affect D-dimer and factor VII levels (31).

Is Butterbur Root Effective for Migraines?

Butterbur is a plant in the Asteraceae family, also called Compositae, or daisy family that grows in wetlands of the temperate regions in North America. Native Americans traditionally used butterbur for inflammation and headaches. Butterbur has been established as effective for migraine prevention according to a report by The Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society (1). The rhizomes and leaves of the plant contain the highest concentration of plant based compound called pyrrolizidine alkaloids which are toxic to the liver and are a known carcinogens which has caused cancer in animals and may cause cancer in humans (32, 33). It is therefore vitally important that a butterbur (Petasites hybridus) supplement has had the pyrrolizidine alkaloids removed. The label must state for instance that the product is “standardized to a guaranteed 15% petasins and certified free of pyrrolizidine alkaloids.” Butterbur without pyrrolizidine alkaloids removed was reported to cause liver enzyme elevation likely due to pyrrolizidine alkaloids found naturally in the herb. Adverse effects were reported in about 4% of patients with mostly gastrointestinal complaints.

The effectiveness of butterbur root extract (Petadolex®) for treatment of migraine headaches was examined in a study which randomized 33 participants to received 50 mg butterbur twice a day and 27 participants to placebo. After 3 months, the frequency of migraine attacks significantly decreased in the treatment group from an average of 3.4 at the beginning of the study to 1.8. The placebo group experienced a non-significant decrease from 2.9 to 2.6. Butterbur was shown to cut the frequency of migraine headaches by at least 50% in 45% of patients in treatment arm and only 15% in the placebo arm. (34)

Petasites hybridus (P. hybridus) a plant root extract, known as butterbur, has been shown to have beneficial effects for the treatment of migraine headaches in a review of two randomized-controlled trials (n=293) testing the effectiveness of Petadolex® a marketed version of P. hybridus. After treatment over 3-4 months, results indicate that compared to a low dose (100mg) of Petadolex®, individuals taking a higher dose of 150 mg reported a fewer number of migraines and a greater number of patients reported a more than 50% improvement in migraines. (35)

Researchers performed a study of the effectiveness of Petasites hybridus (P. hybridus) a plant root extract, known as butterbur, for the treatment of migraine headaches in 245 suffers. Participants received either 50 mg twice daily of P. hybridus, 75 mg twice daily, or placebo. Over the 4 months of the study, the frequency of migraine attacks decreased in all three groups: 36% in the 75 mg group, 48% in the 50 mg group, and 26% in the placebo group. However, the group receiving the higher dose of butterbur extract showed significantly greater improvement than those in the placebo group. The lower dose of butterbur failed to prove significantly more effective than placebo. Additionally, P. hybridus was shown to cut the frequency of migraine headaches by at least 50% in 68% of patients in the 75-mg arm and only 49% in the placebo arm. (36)

Ginger Used for Migraine Headaches

• Ginger and migraines: Maghbooli M et al (48) reported that ginger powder at a dose 250 mg was found in a double-blind randomized clinical trial to be as effective as sumatriptan (Imegraz capsulet), 50 mg in aborting migraines in 2 hours after the dose with fewer reported side effects. The authors found that both the ginger and sumatriptan relieved 44% of headaches.

Magnesium Used for Migraines:

• Magnesium appears to have a protective effect against migraines.
• Migraine sufferers were found to have significantly lower levels of magnesium than those who don’t suffer from migraines. In a study, researchers looked at 50 migraine patients and 50 healthy subjects with no history of migraine. The migraine patients had average magnesium levels of 1.86 mg/dl, while the healthy subjects had average magnesium levels of 2.10 mg/dl. The researchers didn’t find any variation in magnesium levels in patients during or between headache attacks. (38)
• The ideal source of magnesium used to increase intake for prevention of migraine headaches is by increasing magnesium containing foods in the diet. Dietary sources of magnesium include green leafy vegetables, milk, whole grains, nuts and meat.
• According to the Institute of Medicine, there is no upper limit on intake of magnesium within foods, and there has been no evidence for adverse effects related to magnesium intake from foods. The Institute of Medicine established an upper limit of magnesium for supplements only, at 350 mg per day for all individuals over 8 years old. This would also be the supplement intake limit for those seeking prevention of migraines. (37)
• The RDA for magnesium from foods ranges from 400-420 mg per day for adult males, and 310-360 mg per day for adult females, but this recommendation is variable based on age, gender, pregnancy, or lactation.
• For children age 1-3, 80 mg per day and for age 4-8, 130 mg per day of magnesium is recommended. RDA for magnesium in foods For more information, please see “Dietary Reference Intakes: Elements,” published by the Institute of Medicine which can be accessed here (37): http://www.iom.edu/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Elements.pdf

Common Highest Magnesium Containing Foods

Adapted from: Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. See here for magnesium content in foods:https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w304.pdf and http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/hg72/hg72_2002.pdf (46)

Magnesium Supplements Dosage for Migraines:

If a magnesium supplement is desired, select a magnesium supplement based upon the amount of desired elemental magnesium. Magnesium may be supplemented after determining the lack of magnesium consumed in the diet for any given day. Magnesium in the form of magnesium oxide at a dose of 400 mg contains 240 mg of elemental magnesium or 9.9 mmol of magnesium. Magnesium citrate at a dose of 100 mg contains 100 mg of elemental magnesium or 4 mmol of magnesium. Magnesium in the form of Mag-Tab SR at a dose of 84 mg contains 84 mg of elemental magnesium. Magnesium gluconate at a dose of 550 mg contains 30 mg of elemental magnesium.

Participants aged 18-65 suffering from migraine at least an average of 3.6 times per month were randomly assigned to receive either oral trimagnesium dicitrate, (a.k.a. magnesium citrate) at a dose of 600 mg (24 mmol) or placebo daily for 12 weeks. Compared to the start of the study, after 9-12 weeks, the frequency of migraine attacks decreased in both groups: 41.6% in the treatment group and 15.8% in the placebo group. According to the authors, oral magnesium appeared to have a protective effect against migraines. (39)

Magnesium is the only agent with a category-A pregnancy rating (highest safety rating) (45).

Magnesium supplement adverse reactions and interactions: A study reported that oral magnesium may cause diarrhea (18.6%) and gastric irritation (4.7%) (39). Avoid magnesium supplements in patients with kidney disease since magnesium is excreted by the kidneys and toxicity may occur.

Coenzyme Q10 May Reduce the Frequency of Migraines:

Coenzyme Q10 may be a useway way to get rid of migraine headaches with natural treatments. Coenzyme Q10 (CoQ10) (300 mg) was found to an effective treatment for migraines in 42 subjects who suffered an average of 4.4 migraine attacks per month. For a month, all subjects consumed a placebo, and then some of the patients were randomly assigned to receive 100 mg of a liquid, water-soluble form of CoQ10 three times a day. The remaining subjects continued to receive a placebo. Roughly 48 percent of the CQ10 group experienced a 50% reduction in migraine attacks during the 3-month study. Only about 14% of those taking a placebo experienced the same response rate. In addition, the patients treated with CoQ10 experienced fewer migraine attacks per month—3.2 after treatment compared to 4.4 before treatment—while the placebo group experienced no reduction in migraine frequency. CoQ10-treated subjects also experienced more headache-free days than the placebo group and fewer days with nausea. Adverse effects were minimal. (40)

Coenzyme Q10 Adverse Reactions and Interactions:

Coenzyme Q10 is not only a potential way to get rid of migraine headaches with natural treatments, the side-effects were minimal. Coenzyme Q10 has been considered safe to be used by many age groups, in children and in women who may become pregnant (40). Allergic skin rash after taking coenzyme Q10 has been reported (40). A study demonstrated that warfarin was cleared more rapidly by coenzyme Q10 which reduced the effect of anticoagulation (41), therefore if coenzyme Q10 is taken with warfarin, PT INR (prothrombin time international normalized ratio) will need to be monitored and warfarin may need to be increased.

Coenzyme Q10 Food Content in mg per Kilogram,

• Soybean oil, 54–280 mg/kg
• Olive oil, 4–160 mg/kg
• Beef, 26-40 mg/kg
• Pork, 14-45 mg/kg
• Sunflower oil, 4–15 mg/kg
• Peanuts, 27 mg/kg
• Walnuts, 19 mg/kg
• Sesame seeds, 18–23 mg/kg
• Pistachio nuts, 20 mg/kg
• Hazelnuts, 17 mg/kg
• Avocados, 10 mg/kg
• Parsley, 8–26 mg/kg
• Broccoli, 6–9 mg/kg
• Spinach, as high as 10 mg/kg
• Grapes, 6–7 mg/kg
• Sardines, wide range about 5 to 60 mg/kg
• Fish with white filet, 11–16 mg/kg
• Salmon, 4–8 mg/kg
• Tuna, 5 mg/kg
• Currants, 3 mg/kg
• Oranges, 1–2 mg/kg

(Adapted from Pravst, I et al. (42))

Supplements for Migraines During Pregnancy:

According to Airola G, et al, women suffering from migraine headaches during pregnancy may benefit from magnesium, riboflavin and coenzyme Q10. In addition to relaxation techniques and acupuncture these supplements are considered safe during pregnancy for the treatment of migraine headaches. Magnesium is the only agent with a category-A pregnancy rating, and is therefore an appropriate choice for women who are pregnant or trying to conceive. (43)

Should I Exercise or Not for Migraines?

The research performed on exercise and its relationship to headaches is controversial, complex and difficult to understand. Studies have included many variables and are inconsistent on the outcomes making it difficult to draw reliable conclusions. On one hand, it appears that light to moderate exercise in general reduces the frequency, intensity and duration of headaches. On the other hand, exercise may precipitate headaches. Exercise using extreme amounts of exertion may result in exertional headaches. There is good evidence that Yoga is effective for migraines. Sándor, PS et al (44), investigated yoga’s effectiveness as a migraine therapy in 72 patients suffering from migraine headaches. For 3 months, the patients either practiced yoga on a regular basis or continued with their usual self-care. By the study’s end, members of the yoga group had experienced a significantly greater decrease in migraine intensity, frequency, and duration compared to the self-care group. What’s more, the yoga-practicing participants reported less anxiety and depression than the other study members, better functional status and less use of medication.

Summary: Research Shows How to Get Rid of Migraine Headaches with Natural Treatments

• Headache prevention basics for how to get rid of migraine headaches with natural treatments:
  • Patients should make an effort to maintain a regular sleep and awakening cycle to improve headache free intervals.
  • Caffeine consumption is a common reason for disruption of sleep.
  • Adequate rest may prevent migraines or reduce their severity.
  • Forms of stress reduction may reduce the frequency of headaches, improve pain tolerance, reduce anxiety, and improve well-being (2).
  • Food triggers of headaches: Patients should use a “headache diary” to follow foods and correlate these with headache occurrences. Patients should record in detail the foods they eat, the time they eat it, and the time of headache attacks over the course of 3 months to investigate food triggers. Common food triggers of headache include:
    • Tyramine in dried meats, smoked fish, cheeses (especially aged), and beer.
    • Aspartame and sucralose (Splenda), (both artificial sweeteners)(3,4).
    • Monosodium glutamate, a flavor enhancer (5).
    • Nitrates and nitrites used as medications (nitroglycerin) and used as food preservatives (potassium nitrate, sodium nitrate).
  • Alcohol, caffeine, and caffeine withdrawal are known precipitants for migraines and tension headaches (7). Preventive Health Advisor recommends weaning regular use of caffeine containing beverages over the course of 1-2 weeks to reach the goal of eliminating caffeinated drinks entirely.
  • For headaches due to suspected allergic rhinitis, common cold or influenza, please see those sections in Preventive Health Advisor.

• Headache treatment resource: The Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society outlines migraine therapies which may be accessed at (1): http://guideline.gov/content.aspx?f=rss&id=36897

• Body temperature and headaches: An increase in body temperature (from exercise, hot bath, or weather) can cause cluster headache attacks within 1 hour in about 38% of individuals (10)

• Abortive medications for headaches: It is important to follow the directions of the primary care physician or Neurologist for abortive and prophylactic (preventive) medications for headaches. Smaller doses of over the counter and prescription medications such as acetylsalicylic acid, paracetamol and caffeine combined together have been determined in general, to result in better relief over higher doses of single agents (11,12).

• Supplements with evidence for relief and prevention of headaches:
  • Feverfew and migraines:
    • Feverfew has shown to be effective at preventing migraines (14-18). Doses between 50 and 150 mg oral daily are typically used, and trials have been done for a duration of up to 3 months.
    • Sublingual LipiGesic M, available over the counter helped reduce pain in patients with migraines as well as helped ease throbbing, nausea and sensitivity to noise with 63% of subjects experienced pain relief within two hours compared to 39% of placebo (18).
  • Feverfew precautions, adverse reactions and interactions:
    • Feverfew may inhibit the formation of platelets (19), and should not be taken along with non-steroidal anti-inflammatory drugs (NSAIDs), warfarin (Coumadin), heparin, and aspirin (22).
    • Avoid feverfew for 2 weeks prior to any surgical procedure (13).
    • Feverfew should be avoided in children, pregnancy, and lactating women since this herbal agent has not been researched well.
    • Feverfew should be avoided by patients with allergies to this plant or similar species.
    • Aphthous ulcers, lip and tongue irritation, gingival bleeding is not common but has been reported (20).
  • Riboflavin and prevention of migraines:
    • Some of the research including riboflavin as a supplement for prevention of migraines in adults, children, and adolescents has shown riboflavin to be effective. Other studies have found it to be ineffective. Riboflavin must be obtained in supplement form since a typical 200-400 mg dose is not obtainable by consuming foods.
  • Results from some of the riboflavin studies include:
    • Negative results from some riboflavin studies include lower rate of headaches in the placebo group compared to the treatment group (26).
    • Lower number of days on which a headache occurred, and less headache occurrences (23).
    • 59% of subjects showed a 50% improvement in migraines (23).
    • Reduced number of headaches by one half at 3 months and 6 months (24).
    • Number and severity of migraine attacks significantly decreased (25).
    • 50% less migraines in 68.4% of patients and lowered migraine intensity in 21% of patients (25).
    • The dose commonly used in research has been 200-400 mg in patients from 11 months old up to 65 years of age for durations of up to 6 months.
    • The riboflavin dose studied for children, adolescents and adults is 200-400 mg oral daily, but we suggest that the riboflavin dose for children under 12 years of age should be no more than 200 mg oral daily.
    • Riboflavin has not been studied well in pregnant women but it has been suggested as a good treatment option due to a lower possibility of adverse effects compared to pharmaceuticals (37).
  • Riboflavin adverse reactions, interactions, and precautions:
    • In some research, the placebo group experienced less headaches than the riboflavin group (26).
    • Diarrhea, abdominal pain, and facial erythema were reported (24).
    • Increase in appetite and transient orange urine has occurred (25).
  • Melatonin and cluster headaches: Melatonin is believed to relieve headaches by treating lower melatonin levels found in patients with migraine headaches, cluster headaches, and in those with higher body temperature (28).
    • Melatonin, 10 mg oral daily taken for 14 days by a small group in a randomized trial showed that headache frequency was decreased (27). There was also less use of analgesics in melatonin subjects over placebo, with half of the group responding after 3-5 days without further headaches until after they stopped treatment (27).

• • Melatonin adverse reactions and interactions:
    • Caution in patients taking anti-convulsant medication (anti-seizure medication) since melatonin may result in an increased rate of seizure occurrence (29).
    • Melatonin may enhance the effect of somnolence by other medications. Caution in patients taking other sleep aide medications, narcotic medications such as oxycodone and hydrocodone, benzodiazepines such as lorazepam, diazepam, alprazolam, or other sedatives such as Ambien, Restoril, Lunesta, or trazodone. Melatonin may affect the same GABA neurotransmitters as benzodiazepines in the brain producing a higher degree of somnolence (29).
    • In patients with previously controlled hypertension, melatonin may increase systolic and diastolic pressure as well as heart rate (30).
    • Caution of melatonin in patients taking anti-platelet or anticoagulant medications as melatonin may lower blood coagulation factor VIII and decrease fibrinogen levels (31). Melatonin did not appear to affect D-dimer and factor VII levels (31).
  • Butterbur root for migraines:
    • Butterbur has been established as effective for migraine prevention according to a report by The Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society (1).
    • Butterbur contains pyrrolizidine alkaloids which are toxic to the liver and are known carcinogens, has caused cancer in animals and may cause cancer in humans (32,33). It is therefore vitally important that a butterbur (Petasites hybridus) supplement has had the pyrrolizidine alkaloids removed. The label must state for instance that the product is “standardized to a guaranteed 15% petasins and certified free of pyrrolizidine alkaloids.
    • The manufacturing process of Petadolex® removes pyrrolizidine alkaloids that are potentially hepatotoxic and carcinogenic.
    • Butterbur without pyrrolizidine alkaloids removed was reported to cause liver enzyme elevation likely due to pyrrolizidine alkaloids found naturally in the herb.
    • Adverse effects were reported in about 4% of patients with mostly gastrointestinal complaints.

• • As a viable option to get rid of migraine headaches with natural treatments, butterbur root extract (Petadolex®) was found to (34):
    • Decreased migraines from an average of 3.4 at the beginning of the study to 1.8, with a non-significant decrease from 2.9 to 2.6 in the placebo group (34).
    • Cut the frequency of migraine headaches by at least 50% in 45% of patients vs. 15% in the placebo arm (34).
    • Reduce migraines at a dose of 150 mg compared with a lower dose, resulted in a fewer number of migraines and some reported a more than 50% improvement in migraines (35).
  • Petasites hybridus extract at a dose of 50 mg twice daily was compared to 75 mg twice daily and after 4 months, the frequency of migraine attacks decreased in all three groups as follows (36):
    • A decrease of 36% in the 75 mg group
    • A decrease of 48% in the 50 mg group
    • A decrease of 26% in the placebo group
    • Lowered the frequency of migraine headaches by at least 50% in 68% in the 75-mg arm, but only 49% in the placebo arm.
  • Magnesium and migraines: Magnesium appears to have a protective effect against migraines and is a safe option to get rid of migraine headaches with natural treatments. A study showed that subjects with migraines had average magnesium levels of 1.86 mg/dl, while the healthy subjects had average magnesium levels of 2.10 mg/dl but without evidence of variation during or between headache attacks (38).
    • The ideal source of magnesium used to increase intake for prevention of migraine headaches is by increasing magnesium containing foods in the diet. This strategy avoids toxicity and adverse effects especially in patients with kidney disease. Dietary sources of magnesium include green leafy vegetables, milk, whole grains, nuts and meat.
    • According to the Institute of Medicine, there is no upper limit on intake of magnesium within foods, and there has been no evidence for adverse effects related to magnesium intake from foods.
    • The Institute of Medicine established an upper limit of magnesium for supplements only, at 350 mg per day for all individuals over 8 years old. This would also be the supplement intake limit for those seeking prevention of migraines.
    • The RDA for magnesium from foods ranges from 400-420 mg per day for adult males, and 310-360 mg per day for adult females. This recommendation varies based on age, gender, pregnancy, or lactation.
    • For children age 1-3, 80 mg per day and for age 4-8, 130 mg per day of magnesium is recommended.
    • RDA for magnesium in foods: For more information, please see “Dietary Reference Intakes: Elements,” published by the Institute of Medicine which can be accessed here (37): http://www.iom.edu/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Elements.pdf
    • See here for magnesium content in foods: Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at (46): https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w304.pdf and http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/hg72/hg72_2002.pdf
    • Magnesium supplementation for migraines: If a magnesium supplement is desired, select a magnesium supplement based upon the amount of desired elemental magnesium the supplement contains. Magnesium may be supplemented based upon the lack of magnesium consumed in the diet for any given day. Magnesium in the form of magnesium oxide at a dose of 400 mg contains 240 mg of elemental magnesium or 9.9 mmol of magnesium. Magnesium citrate at a dose of 100 mg contains 100 mg of elemental magnesium or 4 mmol of magnesium. Magnesium in the form of Mag-Tab SR at a dose of 84 mg contains 84 mg of elemental magnesium. Magnesium gluconate at a dose of 550 mg contains 30 mg of elemental magnesium.
    • Patients aged 18-65 with about 3.6 migraines per month randomized to a high dose of trimagnesium dicitrate, a.k.a. magnesium citrate at 600 mg (24 mmol) of oral magnesium or placebo daily for 9-12 weeks reduced migraine attacks by 41.6% in the treatment group and 15.8% in the placebo group (39).
    • Magnesium is the only agent with a category-A pregnancy rating (45).
    • Magnesium supplement adverse reactions and interactions: A study reported that oral magnesium may cause diarrhea (18.6%) and gastric irritation (4.7%) (39).
    • Avoid magnesium supplements in patients with kidney disease since magnesium is excreted by the kidneys and toxicity may occur.
  • Coenzyme and migraines:
    • About 48 percent of migraine sufferers treated with coenzyme Q10 (CoQ10) at a dose of 100 mg three times a day experienced a 50% reduction in migraine attacks over 3 months, compared to 14% of those taking a placebo (40). The subjects also experienced 3.2 attacks after treatment compared to 4.4 attacks before treatment, and CoQ10-treated subjects had more headache-free days than the placebo (40).
    • Coenzyme Q10 Adverse Reactions and Interactions: According to Sándor PS et al, coenzyme Q10 side-effects were minimal when used by many age groups and may safely be used in children and in women who may become pregnant (40). However, Preventive Health Advisor recommends against the use of coenzyme Q10 in infants and children until adequate research has been performed. Allergic skin rash after taking coenzyme Q10 has been reported (40). A study demonstrated that warfarin was cleared more rapidly by coenzyme Q10 which reduced the effect of anticoagulation (41), therefore if coenzyme Q10 is taken with warfarin, PT INR (prothrombin time international normalized ratio) will need to be monitored and warfarin may need to be increased.
    • Please see coenzyme Q10 food content in mg per kilogram, adapted from Pravst, I et al (42). However, high enough doses of coenzyme Q10 are not obtainable from food sources. A supplement is necessary to achieve the doses seen in research.

• • Ginger and migraines: Maghbooli M et al (48) reported that ginger powder at a dose 250 mg was found in a double-blind randomized clinical trial to be as effective as sumatriptan (Imegraz capsulet), 50 mg in aborting migraines in 2 hours after the dose with fewer reported side effects. The authors found that both the ginger and sumatriptan relieved 44% of headaches.

• Options for women to get rid of migraine headaches with natural treatments while suffering from migraine headaches during pregnancy include magnesium, riboflavin and coenzyme Q10. All have a good safety profile, but magnesium is established as the only agent with a category-A pregnancy rating (43).

• Exercise and migraines: Exercise is not considered an option to get rid of migraine headaches with natural treatments. The research performed on exercise and its relationship to headaches is controversial, complex and difficult to understand, but Yoga and relaxation techniques appear effective for migraines. Subjects who performed Yoga experienced a significantly greater decrease in migraine intensity, frequency, and duration compared to a self-care group (44). Those practicing Yoga have been found to use less medication for migraines (44).

References: Research Shows How to Get Rid of Migraine Headaches with Natural Treatments

1.Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2012 Apr 24;78(17):1346-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335449/

2.Wachholtz AB1, Pargament KI. Migraines and meditation: does spirituality matter? J Behav Med. 2008 Aug;31(4):351-66. http://www.ncbi.nlm.nih.gov/pubmed/18551362

3.Butchko HH1, Stargel WW, Comer CP, Mayhew DA, Benninger C, Blackburn GL, de Sonneville LM, Geha RS, Hertelendy Z, Koestner A, Leon AS, Liepa GU, McMartin KE, Mendenhall CL, Munro IC, Novotny EJ, Renwick AG, Schiffman SS, Schomer DL, Shaywitz BA, Spiers PA, Tephly TR, Thomas JA, Trefz FK. Aspartame: review of safety. Regul Toxicol Pharmacol. 2002 Apr;35(2 Pt 2):S1-93. http://www.ncbi.nlm.nih.gov/pubmed/12180494

4.Bigal ME1, Krymchantowski AV. Migraine triggered by sucralose–a case report. Headache. 2006 Mar;46(3):515-7. http://www.ncbi.nlm.nih.gov/pubmed/16618274

5.Yang WH1, Drouin MA, Herbert M, Mao Y, Karsh J. The monosodium glutamate symptom complex: assessment in a double-blind, placebo-controlled, randomized study. J Allergy Clin Immunol. 1997 Jun;99(6 Pt 1):757-62. http://www.ncbi.nlm.nih.gov/pubmed/9215242

6.Sun-Edelstein C1, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009 Jun;25(5):446-52. http://www.ncbi.nlm.nih.gov/pubmed/19454881

7.Holzhammer J1, Wöber C. [Alimentary trigger factors that provoke migraine and tension-type headache]. [Article in German]. Schmerz. 2006 Apr;20(2):151-9. http://www.ncbi.nlm.nih.gov/pubmed/15806385

8.Shirlow MJ, Mathers CD. A study of caffeine consumption and symptoms; indigestion, palpitations, tremor, headache and insomnia. Int J Epidemiol. 1985 Jun;14(2):239-48. http://www.ncbi.nlm.nih.gov/pubmed/3874838

9.Haskell CF, Kennedy DO, Milne AL, Wesnes KA, Scholey AB. The effects of L-theanine, caffeine and their combination on cognition and mood. Biol Psychol. 2008 Feb;77(2):113-22. Epub 2007 Sep 26. http://www.ncbi.nlm.nih.gov/pubmed?term=18006208

10.Blau JN, Engel HO. A new cluster headache precipitant: increased body heat. Lancet. 1999 Sep 18;354(9183):1001-2. http://www.ncbi.nlm.nih.gov/pubmed/10501368

11.Diener HC, Pfaffenrath V, Pageler L, Peil H, Aicher B. The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. Cephalalgia. 2005 Oct;25(10):776-87. http://www.ncbi.nlm.nih.gov/pubmed/16162254

12.Pfaffenrath V, Diener HC, Pageler L, Peil H, Aicher B. OTC analgesics in headache treatment: open-label phase vs randomized double-blind phase of a large clinical trial. Headache 2009;49(5):638–45. http://www.ncbi.nlm.nih.gov/pubmed/19472437

13.Leak JA. Herbal medicines: what do we need to know? Internet J Anesthesiol 2000;4(3).

14.Vogler BK, Pittler MH, Ernst E. Feverfew as a preventive treatment for migraine: a systematic review. Cephalalgia. 1998 Dec;18(10):704-8. http://www.ncbi.nlm.nih.gov/pubmed/9950629

15.Murphy JJ, Heptinstall S, Mitchell JR. Randomixed double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet. 1988 July 23;2(8604):189-192. http://www.ncbi.nlm.nih.gov/pubmed/2899663

16.Murphy JJ, Heptinstall S, Mitchell JR. Lancet. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention.1988 Jul 23;2(8604):189-92. http://www.ncbi.nlm.nih.gov/pubmed/2899663

17.Diener HC, Pfaffenrath V, Schnitker J, Friede M, Henneicke-von Zepelin HH. Efficacy and safety of 6.25 mg t.i.d. feverfew CO2-extract (MIG-99) in migraine prevention — a randomized, double-blind, multicentre, placebo-controlled study. Cephalalgia. 2005 Nov;25(11):1031-41. http://www.ncbi.nlm.nih.gov/pubmed/16232154

18.Cady RK, Goldstein J, Nett R, Mitchell R, Beach ME, Browning R. A double-blind placebo-controlled pilot study of sublingual feverfew and ginger (LipiGesic™ M) in the treatment of migraine. Headache. 2011 Jul-Aug;51(7):1078-86. Epub 2011 Jun 1. http://www.ncbi.nlm.nih.gov/pubmed/21631494

19.Heptinstall S, Groenewegen WA, Spangenberg P, Lösche W. Inhibition of platelet behaviour by feverfew: a mechanism of action involving sulphydryl groups. Folia Haematol Int Mag Klin Morphol Blutforsch. 1988;115(4):447-9. http://www.ncbi.nlm.nih.gov/pubmed/2465950

20.Abebe W. An overview of herbal supplement utilization with particular emphasis on possible interactions with dental drugs and oral manifestations. J Dent Hyg. 2003 Winter;77(1):37-46. http://www.ncbi.nlm.nih.gov/pubmed/12704968

21.Losche W, Mazurov AV, Heptinstall S, et al. An extract of feverfew inhibits interactions of human platelets with collagen substrates. Thromb Res 1987;48:511-518.

22.Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002 Dec;27(6):391-401. http://www.ncbi.nlm.nih.gov/pubmed/12472978

23.Schoenen J1, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology. 1998 Feb;50(2):466-70. http://www.ncbi.nlm.nih.gov/pubmed/9484373

24.Boehnke C1, Reuter U, Flach U, Schuh-Hofer S, Einhäupl KM, Arnold G. High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol. 2004 Jul;11(7):475-7. http://www.ncbi.nlm.nih.gov/pubmed/15257686

25.Condò M, Posar A, Arbizzani A, Parmeggiani A. Riboflavin prophylaxis in pediatric and adolescent migraine. J Headache Pain. 2009 Oct;10(5):361-5. http://www.ncbi.nlm.nih.gov/pubmed/19649688

26.MacLennan SC, Wade FM, Forrest KM, Ratanayake PD, Fagan E, Antony J. High-dose riboflavin for migraine prophylaxis in children: a double-blind, randomized, placebo-controlled trial. J Child Neurol. 2008 Nov;23(11):1300-4. http://www.ncbi.nlm.nih.gov/pubmed/18984840

27.Leone M, D’Amico D, Moschiano F, Fraschini F, Bussone G. Melatonin versus placebo in the prophylaxis of cluster headache: a double-blind pilot study with parallel groups. Cephalalgia. 1996 Nov;16(7):494-6. http://www.ncbi.nlm.nih.gov/pubmed/8933994

28.Peres MF, Seabra ML, Zukerman E, Tufik S, PeresMF, SeabraML, ZukermanE, TufikS. Cluster headache and melatonin. Lancet2000; 355:147. http://www.ncbi.nlm.nih.gov/pubmed/16548786

29.Muñoz-Hoyos A, Sánchez-Forte M, Molina-Carballo A, et al. Melatonin’s role as an anticonvulsant and neuronal protector: experimental and clinical evidence. J Child Neurol. 1998 Oct;13(10):501-9. http://www.ncbi.nlm.nih.gov/pubmed/9796757

30.Lusardi P, Piazza E, Fogari R. Cardiovascular effects of melatonin in hypertensive patients well controlled by nifedipine: a 24-hour study. Br J Clin Pharmacol. 2000 May;49(5):423-7. http://www.ncbi.nlm.nih.gov/pubmed/10792199

31.Wirtz PH, Spillmann M, Bärtschi C, Ehlert U, von Känel R.Oral melatonin reduces blood coagulation activity: a placebo-controlled study in healthy young men. J Pineal Res. 2008 Mar;44(2):127-33. http://www.ncbi.nlm.nih.gov/pubmed/18289163

32.Wildi E, Langer T, Schaffner W, Büter KB.Quantitative analysis of petasin and pyrrolizidine alkaloids in leaves and rhizomes of in situ grown Petasites hybridus plants. Planta Med. 1998 Apr;64(3):264-7. http://www.ncbi.nlm.nih.gov/pubmed/17253240

33.Aydın AA, Zerbes V, Parlar H, Letzel T.The medical plant butterbur (Petasites): analytical and physiological (re)view. J Pharm Biomed Anal. 2013 Mar 5;75:220-9. http://www.ncbi.nlm.nih.gov/pubmed/23277154

34.Diener HC, Rahlfs VW, Danesch U. The first placebo-controlled trial of a special butterbur root extract for the prevention of migraine: reanalysis of efficacy criteria. Eur Neurol. 2004;51(2):89-97. http://www.ncbi.nlm.nih.gov/pubmed/14752215

35.Agosti R, Duke RK, Chrubasik JE, Chrubasik S. Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review. Phytomedicine. 2006 Nov;13(9-10):743-6. Epub 2006 Sep 20. http://www.ncbi.nlm.nih.gov/pubmed/16987643

36.Lipton RB, Gobel H, Einhaupl KM, Wilks K, Mauskop A. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology. 2004 Dec 28;63(12):2240-4. http://www.ncbi.nlm.nih.gov/pubmed/15623680

37.“Dietary Reference Intakes: Elements,” published by the Institute of Medicine which can be accessed here: http://www.iom.edu/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Elements.pdf

38.Samaie A, Asghari N, Ghorbani R, Arda J. Blood Magnesium levels in migraineurs within and between the headache attacks: a case control study. Pan African Medical Journal 2012. 11:46. http://www.ncbi.nlm.nih.gov/pubmed/22593782

39.Peikert A, Wilimzig C, Köhne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia. 1996 Jun; 16(4): 257-63. http://www.ncbi.nlm.nih.gov/pubmed/8792038

40.Sándor PS, Di Clemente L, Coppola G, Saenger U, Fumal A, Magis D, Seidel L, Agosti RM, Schoenen J. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology. 2005 Feb 22;64(4):713-5. http://paininmybrain.com/wp-content/uploads/2012/03/efficacy-of-coenzyme-q10.pdf

41.Zhou Q, Zhou S, Chan E. Effect of coenzyme Q10 on warfarin hydroxylation in rat and human liver microsomes. Curr Drug Metab. 2005 Apr;6(2):67-81. http://www.ncbi.nlm.nih.gov/pubmed/15853759

42.Pravst I, Zmitek K, Zmitek J. Coenzyme Q10 contents in foods and fortification strategies. Crit Rev Food Sci Nutr. 2010 Apr;50(4):269-80. http://www.ncbi.nlm.nih.gov/pubmed/20301015

43.Airola G, Allais G, Castagnoli Gabellari I, Rolando S, Mana O, Benedetto C. Non-pharmacological management of migraine during pregnancy. Neurol Sci. 2010 Jun;31 Suppl 1:S63-5. http://www.ncbi.nlm.nih.gov/pubmed/20464586

44.John PJ, Sharma N, Sharma CM, Kankane A. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache. 2007 May;47(5):654-61. http://www.ncbi.nlm.nih.gov/pubmed/17501846

45.Airola G1, Allais G, Castagnoli Gabellari I, Rolando S, Mana O, Benedetto C. Non-pharmacological management of migraine during pregnancy. Neurol Sci. 2010 Jun;31 Suppl 1:S63-5. http://www.ncbi.nlm.nih.gov/pubmed/20464586

46.Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w304.pdf or http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/hg72/hg72_2002.pdf

47.Sun-Edelstein C, Mauskop A., Foods and supplements in the management of migraine headaches. Clinical Journal of Pain. 2009 Jun;25(5):446-52. http://www.ncbi.nlm.nih.gov/pubmed/19454881

48.Maghbooli M, Golipour F, Moghimi Esfandabadi A, Yousefi M. Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine. Phytother Res. 2014 Mar;28(3):412-5. https://www.ncbi.nlm.nih.gov/pubmed/23657930