Migraine Headaches

The term migraine refers to a class of headaches sharing certain characteristic symptoms. Headache pain usually occurs in the forehead or temples, often on one side only and typically accompanied by nausea and a preference for a darkened room. Headache attacks last for several hours, up to a day or more. They are usually separated by completely pain-free intervals. In some cases, headache pain is accompanied by a visual (or occasionally nonvisual) disturbance known as an aura. Migraines are classified as migraine with aura and migraine without aura.

Migraines can be set off by a variety of triggers, including fatigue, stress, hormonal changes, and foods such as alcoholic beverages, chocolate, peanuts, and avocados. When people with migraine headaches first consult a physician, they are generally advised to identify such triggers, and avoid them if possible. However, migraines quite frequently occur with no obvious avoidable triggering factor.

The underlying cause of migraine headaches has been a subject of continuing controversy for over a century. Opinion has swung back and forth between two primary beliefs: that migraines are related to epileptic seizures and originate in the nervous tissue of the brain; or that blood vessels in the skull cause headache pain when they dilate or contract (so-called vascular headaches). Most likely, several factors are involved, and more than one stimulus can light the fuse that leads to a full-blown migraine attack.

Conventional treatment of acute migraines has lately been revolutionized by drugs in the triptan family. These medications can completely abort a migraine headache in many individuals. They work by imitating the action of serotonin on blood vessels, causing them to contract. However, while they are dramatically effective for the majority of people with migraines, a substantial minority do not respond, for reasons that are unclear.

People interested in prevention of migraines have a great variety of options, including ergot drugs, antidepressants, beta-blockers, calcium channel blockers, and antiseizure medications. Picking the best one is mostly a matter of trial and error. Most but not all people can find some medication that will work.

Principal Proposed Natural Treatments

Several herbs and supplements have shown considerable promise for helping to prevent migraines. Keep in mind that serious diseases may occasionally first present themselves as migraine-type headaches. If you suddenly start having migraines without a previous history, or if the pattern of your migraines changes significantly, it is essential to seek medical evaluation.


Two double-blind, placebo-controlled studies suggest that an extract of the herb butterbur may be helpful for preventing migraines.

Butterbur extract was tested as a migraine preventive in a double-blind, placebo-controlled study involving 60 men and women who experienced at least three migraines per month.34 After 4 weeks without any conventional medications, participants were randomly assigned to take either 50 mg of butterbur extract or placebo twice daily for 3 months. The results were positive: both the number of migraine attacks and the total number of days of migraine pain were significantly reduced in the treatment group as compared to the placebo group. Three out of four individuals taking butterbur reported improvement, as compared to only one out of four in the placebo group. No significant side effects were noted.

In another double-blind, placebo-controlled study performed by different researchers, 202 people with migraine headaches received either 50 mg twice daily of butterbur extract, 75 mg twice daily, or placebo.60 Over the 3 months of the study, the frequency of migraine attacks gradually decreased in all three groups. 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.

Based on these two studies, it does appear that butterbur extract is helpful for preventing migraines, and that 75 mg twice daily is more effective than 50 mg twice daily. However, further research is necessary to establish this with certainty.

For more information, including dosage and safety issues, see the full Butterbur article.


Five meaningful double-blind, placebo-controlled studies have been performed to evaluate feverfew's effectiveness as a preventive treatment for migraines, but the results have been inconsistent. The best of the positive trials used a feverfew extract made by extracting the herb with liquid carbon dioxide. Two other trials that used whole feverfew leaf also found it effective; however, two studies that used feverfew extracts did not find benefit.

In a well-conducted 16-week, double-blind, placebo-controlled study of 170 people with migraines, use of a feverfew product made via liquid carbon-dioxide extraction resulted in a significant decrease in headache frequency as compared to the effect of the placebo treatment.63 In the treatment group, headache frequency decreased by 1.9 headaches per month, as compared to a reduction of 1.3 headaches per month in the placebo group. The average number of headaches per month prior to treatment was 4.76 headaches. A previous study using the same extract had failed to find benefit, but it primarily enrolled people who were less prone to migraines.10

Two other studies used whole feverfew leaf, and found benefit. The first followed 59 people for 8 months.2 For 4 months, half received a daily capsule of feverfew leaf, and the other half received placebo. The groups were then switched and followed for an additional 4 months. Treatment with feverfew produced a 24% reduction in the number of migraines and a significant decrease in nausea and vomiting during the headaches. A subsequent double-blind study of 57 people with migraines found that use of feverfew leaf could decrease the severity of migraine headaches.3 Unfortunately, this trial did not report whether there was any change in the frequency of migraines.

One study using an alcohol extract failed to find benefit.4,10

For more information, including dosage and safety issues, see the full Feverfew article.


Magnesium is another natural treatment that has shown promise for the prevention of migraine headaches. A 12-week, double-blind study followed 81 people with recurrent migraines.19 Half received 600 mg of magnesium daily (in the rather unusual form of trimagnesium dicitrate), and the other half received placebo. By the last 3 weeks of the study, the frequency of migraine attacks was reduced by 41.6% in the treated group, compared to 15.8% in the placebo group. The only side effects observed were diarrhea (18.6%) and digestive irritation (4.7%).

Similar results have been seen in other double-blind studies.20,21,61 There was one study that did not find a benefit,22 but it had many problems in its design.23

Preliminary studies also suggest that magnesium may be helpful for migraines triggered by hormonal changes occurring with the menstrual cycle.21,42

For more information, including dosage and safety issues, see the full Magnesium article.

5-Hydroxytryptophan (5-HTP)

The body manufactures 5-HTP on its way to making serotonin. When 5-HTP is taken as a supplement, the net result may be increased serotonin production. Since a number of drugs that affect serotonin are used to prevent migraine headaches, 5-HTP has been tried as well. Some evidence suggests that it may work when taken at a dosage of 400 mg to 600 mg daily. Lower doses may not be effective.

In a 6-month trial of 124 people, 5-HTP (600 mg daily) proved equally effective as the standard drug methysergide.24 The most dramatic benefits seen were a reduction in the intensity and duration of migraines. Since methysergide has been proven better than placebo for migraine headaches in earlier studies, the study results provide meaningful, although not airtight, evidence that 5-HTP is also effective.

Similarly good results were seen in another comparative study, using a different medication and 5-HTP (at a dose of 400 mg daily).25

However, in one study, 5-HTP (up to 300 mg daily) was less effective than the drug propranolol.26 Also, in a study involving children, 5-HTP failed to demonstrate benefit.27 Other studies that are sometimes quoted as evidence that 5-HTP is effective for migraines actually enrolled adults or children with many different types of headaches (including migraines).28-30

Putting all this evidence together, it appears possible that 5-HTP can help people with frequent migraine headaches if taken in sufficient doses, but further research needs to be done. In particular, we need a large double-blind study that compares 5-HTP against placebo over a period of several months.

For more information, including dosage and safety issues, see the full 5-HTP article.

Mitochondrial Enhancers

Mitochondria are the energy-producing subunits of cells. Based on a the highly speculative theory that mitochondrial dysfunction may play a role in migraines, three substances have been tried for migraine prevention: vitamin B2 (riboflavin), coenzyme Q10 (CoQ10), and lipoic acid. Results, thus far, have been a bit promising.

A 3-month, double-blind, placebo-controlled study of 55 people with migraines found that vitamin B2 (at a daily dose of 400 mg) significantly reduced the frequency and duration of migraine attacks.33 The majority of the participants experienced a greater than 50% decrease in the number of migraine attacks as well as the total days with headache pain. A subsequent study failed to find benefit with a combination of vitamin B2, magnesium, and feverfew; however, it is possible that the 25 mg daily dose of vitamin B2 used as the placebo confused the issue by providing some benefits on its own.64

Another small double-blind, placebo-controlled trial found benefit with CoQ10 (100 mg 3x daily).62 In this study, about 50% of the people taking this supplement had a significant decrease in migraine frequency, as compared to only 15% in the placebo group.

A similar study of lipoic acid hinted at benefit, but the results failed to pass tests of statistical significance.68

Other Proposed Natural Treatments

In a 24-week, double-blind study, 49 women with menstrual migraines received either placebo or soy isoflavones combined with dong quai and black cohosh extracts.43 Beginning at the twentieth week, use of the herbal supplement resulted in decreased severity and frequency of headaches as compared to placebo. It is not clear which of the ingredients in the combination was helpful; contrary to what is stated in this research report, the current consensus is that neither black cohosh nor dong quai are phytoestrogens, but they may have other effects.

Despite promising results in an earlier and widely publicized study,31 a much larger and longer study of fish oil for migraines failed to find benefit.31 In this 16-week, double-blind, placebo-controlled study of 167 individuals with recurrent migraines, use of fish oil did not significantly reduce headache frequency or severity.39 Another small double-blind, placebo-controlled study failed to find statistically significant evidence of benefit.40

Calcium, chromium, folate, ginger, and vitamin C have also been reported to be helpful for migraines, but there is as yet no meaningful scientific evidence for any of these natural products.

Identifying and eliminating allergenic foods from your diet might be helpful for reducing the frequency of migraine attacks.37

Evidence is inconsistent and/or incomplete regarding the potential benefit of chiropractic manipulation44-46 or acupuncture38,41,47-54,65, 66,70,71-73 for the treatment or prevention of migraines.

Biofeedback,56-58massage,55,67yoga,69 and a form of magnet therapy called PEMF have shown a bit of promise for migraines.59

For a discussion of homeopathic approaches to migraine headaches, see the Homeopathy Database.

Herbs and Supplements to Use Only With Caution

Various herbs and supplements may interact adversely with drugs used to treat migraine headaches. For more information on this potential risk, see the individual drug article in the Drug Interactions section of this database.


1.   Johnson ES, Kadam NP, Hylands DM, et al. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J (Clin Res Ed). 1985;291:569-573.

2.   Murphy JJ, Heptinstall S, Mitchell JR. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet. 1988;23:189-192.

3.   Palevitch D, Earon G, Carasso R. Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: a double-blind placebo-controlled study. Phytother Res. 1997;11:508-511.

4.   De Weerdt CJ, Bootsma HP, Hendriks H. Herbal medicines in migraine prevention. Randomized double-blind placebo-controlled crossover trial of a feverfew preparation. Phytomedicine. 1996;3:225-230.

5.   Bohlmann F, Zdero C. Sesquiterpene lactones and other constituents from Tanacetum parthenium. Phytochemistry. 1982;21:2543-2549.

6.   Makheja AM, Bailey JM. The active principle in feverfew [letter]. Lancet. 1981;2:1054.

7.   Makheja AM, Bailey JM. A platelet phospholipase inhibitor from the medicinal herb feverfew (Tanacetum parthenium). Prostaglandins Leukot Med. 1982;8:653-660.

8.   Heptinstall S, White A, Williamson L, et al. Extracts from feverfew inhibit granule secretion in blood platelets and polymorphonuclear leucocytes. Lancet. 1985;71:1071-1074.

9.   Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York, NY: Pharmaceutical Products Press; 1994:127.

10.   Pfaffenrath V, Diener H, Fischer M, et al. The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis-a double-blind, multicentre, randomized placebo-controlled dose-response study. Cephalalgia. 2002;22:523-532.

19.   Peikert A, Wilimzig C, Kohne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia. 1996;16:257-263.

20.   Taubert K. Magnesium in migraine. Results of a multicenter pilot study [in German; English abstract]. Fortschr Med. 1994;112:328-330.

21.   Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache. 1991;31:298-301.

22.   Pfaffenrath V, Wessely P, Meyer C, et al. Magnesium in the prophylaxis of migraine—a double-blind, placebo-controlled study. Cephalalgia. 1996;16:436-440.

23.   Gaby AR. Research review. Nutr Healing. March 1997.

24.   Titus F, Davalos A, Alom J, et al. 5-hydroxytryptophan versus methysergide in the prophylaxis of migraine: randomized clinical trial. Eur Neurol. 1986;25:327-329.

25.   Bono G, Criscuoli M, Martignoni E, et al. Serotonin precursors in migraine prophylaxis. Adv Neurol. 1982;33:357-363.

26.   Maissen CP, Ludin HP. Comparison of the effect of 5-hydroxytryptophan and propranolol in the interval treatment of migraine [translated from German]. Schweiz Med Wochenschr. 1991;121:1585-1590.

27.   Santucci M, Cortelli P, Rossi PG, et al. L-5-hydroxytryptophan versus placebo in childhood migraine prophylaxis: a double-blind crossover study. Cephalalgia. 1986;6:155-157.

28.   De Giorgis G, Miletto R, Iannuccelli M, et al. Headache in association with sleep disorders in children: a psychodiagnostic evaluation and controlled clinical study-L-5-HTP versus placebo. Drugs Exp Clin Res. 1987;13:425-433.

29.   Longo G, Rudoi I, Iannuccelli M, et al. Treatment of essential headache in developmental age with L-5-HTP (cross over double-blind study versus placebo) [in Italian; English abstract]. Pediatr Med Chir. 1984;6:241-246.

30.   De Benedittis G, Massei R. Serotonin precursors in chronic primary headache. A double-blind cross-over study with L-5-Hydroxytryptophan vs. placebo. J Neurosurg Sci. 1985;29:239-248.

31.   Glueck CJ, McCarren T, Hitzemann R, et al. Amelioration of severe migraine with omega-3 fatty acids: a double-blind, placebo-controlled clinical trial. Am J Clin Nutr. 1986;43:710.

32.   McCarren T, Hitzemann R, Smith R, et al. Amelioration of severe migraine by fish oil (w-3) fatty acids. Am J Clin Nutr. 1985;41:874.

33.   Schoenen, J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology. 1998;50:466-470.

34.   Grossmann M, Schmidramsl H. An extract of Petasites hybridus is effective in the prophylaxis of migraine. Int J Clin Pharmacol Ther. 2000;38:430-435.

37.   Trotsky MB. Neurogenic vascular headaches, food and chemical triggers. Ear Nose Throat J. 1994;73:228-230, 235-236.

38.   Vincent CA. A controlled trial of the treatment of migraine by acupuncture. Clin J Pain. 1989;5:305-312.

39.   Pradalier A, Bakouche P, Baudesson G, et al. Failure of omega-3 polyunsaturated fatty acids in prevention of migraine: a double-blind study versus placebo. Cephalalgia. 2001;21:818-822.

40.   Harel Z, Gascon G, Riggs S, et al. Supplementation with omega-3 polyunsaturated fatty acids in the management of recurrent migraines in adolescents. J Adolesc Health. 2002;31:154-161.

41.   Dowson DI, Lewith GT, Machin D. The effects of acupuncture versus placebo in the treatment of headache. Pain. 1985;21:35-42.

42.   Facchinetti F, Borella P, Sances G, et al. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol. 1991;78:177-181.

43.   Burke BE, Olson RD, Cusack BJ.Randomized, controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine. Biomed Pharmacother. 2002;56:283-288.

44.   Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther. 2000;23:91-95.

45.   Nelson CF, Bronfort G, Evans R, et al. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther. 1998;21:511-519.

46.   Parker GB, Tupling H, Pryor DS. A controlled trial of cervical manipulation of migraine. Aust N Z J Med. 1978;8:589-593.

47.   Lenhard L, Waite PME. Acupuncture in the prophylactic treatment of migraine headaches: pilot study. NZ Med J. 1983;96:663-666.

48.   Carlsson J, Augustinsson LE, Blomstrand C, et al. Health status in patients with tension headache treated with acupuncture or physiotherapy. Headache. 1990;30:593-599.

49.   Loh L, Nathan PW, Schott GD, Zilkha KJ. Acupuncture versus medical treatment for migraine and muscle tension headaches. J Neurol Neurosurg Psychiatry. 1984;47:333-337.

50.   Ahonen E, Hakumaki M, Mahlamaki S, et al. Effectiveness of acupuncture and physiotherapy on myogenic headache: a comparative study. Acupunct Electrother Res. 1984;9:141-150.

51.   Tavola T, Gala C, Conte G, et al. Traditional Chinese acupuncture in tension-type headache: a controlled study. Pain. 1992;48:325-329.

52.   Melchart D, Thormaehlen J, Hager S, et al. Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks: a randomized controlled trial. J Intern Med. 2003;253:181-188.

53.   Allais G, De Lorenzo C, Quirico PE, et al. Acupuncture in the prophylactic treatment of migraine without aura: a comparison with flunarizine. Headache. 2002;42:855-861.

54.   Jensen LB, Melsen B, Jensen SB. Effect of acupuncture on headache measured by reduction in number of attacks and use of drugs. Scand J Dent Res. 1979;87:373-380.

55.   Hernandez-Reif M, Deiter J, Field T, et al. Migraine headaches are reduced by massage therapy. Int J Neurosci. 1998;96:1-11.

56.   Lake AE 3rd. Behavioral and nonpharmacologic treatments of headache. Med Clin North Am. 2001;85:1055-1075.

57.   Duckro PN, Cantwell-Simmons E. A review of studies evaluating biofeedback and relaxation training in the management of pediatric headache. Headache. 1989;29:428-433.

58.   Hermann C, Blanchard EB. Biofeedback in the treatment of headache and other childhood pain. Appl Psychophysiol Biofeedback. 2002;27:143-162.

59.   Sherman RA, Acosta NM, Robson L. Treatment of migraine with pulsing electromagnetic fields: a double-blind, placebo-controlled study. Headache. 1999;39:567-575.

60.   Lipton RB, Gobel H, Einhaupl KM, et al. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology. 2004;63:2240-2244.

61.   Wang F, Van Den Eeden SK, Ackerson LM, et al. Oral magnesium oxide prophylaxis of frequent migrainous headache in children: a randomized, double-blind, placebo-controlled trial. Headache. 2003;43:601-610.

62.   Sandor PS, Di Clemente L, Coppola G, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology. 2005;64:713-715.

63.   Diener H, Pfaffenrath V, Schnitker J, et al. Efficacy and safety of 6.25 mg t.i.d. feverfew CO-extract (MIG-99) in migraine prevention—a randomized, double-blind, multicentre, placebo-controlled study. Cephalalgia. 2005;25:1031-1041.

64.   Maizels M, Blumenfeld A, Burchette R, et al. A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: a randomized trial. Headache. 2004;44:885-890.

65.   Diener HC, Kronfeld K, Boewing G, et al. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial. Lancet Neurol. 2006;5:310-316.

66.   Alecrim-Andrade J, Maciel-Junior J, Cladellas X, et al. Acupuncture in migraine prophylaxis: a randomized sham-controlled trial. Cephalalgia. 2006;26:520-529.

67.   Lawler SP, Cameron LD. A randomized, controlled trial of massage therapy as a treatment for migraine. Ann Behav Med. 2006;32:50-59.

68.   Magis D, Ambrosini A, Sandor P, et al. A randomized, double-blind, placebo-controlled trial of thioctic acid in migraine prophylaxis. Headache. 2007;47:52-57.

69.   John PJ, Sharma N, Sharma CM, et al. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache. 2007;47:654-661.

70.   Facco E, Liguori A, Petti F, et al. Traditional acupuncture in migraine: a controlled, randomized study. Headache. 2007 Sep 14. [Epub ahead of print]

71.   Gottschling S, Meyer S, Gribova I, et al. Laser acupuncture in children with headache: A double-blind, randomized, bicenter, placebo-controlled trial. Pain. 2007 Nov 15. [Epub ahead of print]

72.   Alecrim-Andrade J, Maciel-Junior JA, Carne X, et al. Acupuncture in migraine prevention: a randomized sham controlled study with 6-months post-treatment follow-up. Clin J Pain. 2008;24:98-105.

73.   Jena S, Witt C, Brinkhaus B, et al. Acupuncture in patients with headache. Cephalalgia. 2008 Jul 2.

Last reviewed August 2008 by EBSCO CAM Review Board

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.