Migraine

Alternative Remedies for Migraine

 

Alternative Remedies for Migraine

By THE NEW YORK TIMES

Captura de ecrã - 2010-08-17, 00.03.30

 

Aviva Goldfarb of Chevy Chase, Md., uses butterbur plant extract to help reduce the frequency and intensity of her migraines; she is among those featured in Patient Voices: Migraine.

 

A number of readers had questions for the Consults blog about magnesium, feverfew and other alternative and nutritional therapies for the prevention or treatment of migraine symptoms. Dr. David Dodick of the Mayo Clinic responds.

Nutrients and Herbs for Migraine Attacks

Q. These days I get one or two migraines a month. They are not the awful, debilitating experience others describe; the worst part is the aura, which is mostly just distressing — but if I then take a take a Fiorinal with codeine and lie down in a dark room for about 40 minutes, the ensuing headache is pretty minor. (If I don’t do those things, the headache can be nasty, but goes away overnight.)

My question is this: I used to get migraines much more frequently. At some point, my doctor prescribed niacin for other reasons (cholesterol control), and I decided to do some research to see if that would be a trigger for more. What I found was a short paper from someone at the Mayo Clinic saying that there is anecdotal evidence that niacin can prevent migraines, but no studies had been done. After I started taking niacin (and magnesium) daily, the frequency of attacks dropped radically.

So: has anyone gotten around to studying the effects of niacin (or magnesium) on migraines? Do you have any particular opinion about this? Is my experience just a positive placebo effect? Thanks. aj kutchins, berkeley, calif.

Q. Does the herbal remedy feverfew help to alleviate some forms of migraines? Cathy, Sterling, Mass.

A. Dr. Dodick responds:

Thank you for your questions. Although case reports suggest that the B vitamin niacin is effective in reducing the frequency of migraine attacks, it has not been formally studied in rigorous placebo-controlled trials.

Regarding the effectiveness of other nonprescription alternative therapies, new evidence-based guidelines from the American Academy of Neurology, which will be published soon in the journal Neurology, indicate that several nutritional and alternative remedies may be effective. The guidelines state that Petasites, the purified extract from the butterbur plant, is effective at a dosage of 75 milligrams twice daily and should be offered for migraine prevention.

The guidelines also say that several other remedies are “probably” effective and should be considered for migraine prevention. These remedies are magnesium (at a daily dose of 300 milligrams), MIG-99 (an extract of the herb feverfew) and riboflavin (400 milligrams daily). They say that coenzyme Q10, or CoQ10 (300 milligrams daily), is “possibly” effective and may be considered for migraine prevention.

Combinations of these therapies are commercially available, but the effectiveness of the combination products has not been definitively demonstrated in studies.

There is a scientific rationale for why these products were studied for migraine prevention, and a plausible explanation for a mechanism of action that is relevant to the biology of migraine. For example, some studies suggest that the metabolic capacity of the brain cells in migraine sufferers may not be sufficient to meet the demands of a migraine attack. Therefore, nutrients like CoQ10 and riboflavin, which are “metabolic enhancers” that increase the capacity for each cell in the body, and presumably the brain, to manufacture energy more efficiently, may be helpful. In addition, in placebo-controlled studies, several of these therapies were found to be superior to placebo. So, the sustained response to niacin noted above, and the response of other patients to that and other therapies, is probably not just a placebo effect.

It is important to recognize that all of these treatments are meant to be taken daily to prevent or reduce the occurrence of attacks. None of these treatments are effective for the acute treatment of an attack after it has begun.

Head Wraps for Migraine Pain?

Q. Any quick comments on 1) why pressing the eyeballs seems to provide some relief for headaches, and 2) whether wrapping the head to apply pressure is known to have any clinical benefits (and if so, why)? I often want to tightly hold my head when in pain and recently noticed commercial wraps that can be heated and chilled. Appreciate your thoughts on any of these therapies. Thank you. Lisa R., Los Angeles

A. Dr. Dodick responds:

The relief of pain experienced by applying pressure to the painful area of the head, or binding or wrapping the head (with or without heat or cold) is a trick migraine sufferers have observed since ancient times. Certainly this is something I hear commonly from patients.

While the reasons for this are unclear, applying pressure appears to reduce the firing of pain cells in an area within the brain that is important for relaying pain signals during a migraine attack. If it works, it is a benign treatment that may add relief to whatever other strategies, like relaxation, biofeedback or medications, a patient has found to be helpful.

For more on migraines, see Dr. Dodick’s responses in the Related Posts section, below, and The Times Health Guide: Migraine, which includes discussion of additional remedies like biofeedback, acupuncture, fish oil, ginger and more.


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