What over-the-counter (OTC) supplements can help with headaches?

Over-the-Counter Supplements for Headaches

Oral magnesium is the most evidence-supported OTC supplement for headache prevention, particularly for migraines, with a weak but positive recommendation from clinical guidelines. 1

Evidence-Based OTC Supplements for Headache Management

First-Line Options:

1. Magnesium
   • Recommended with a "weak for" rating in the 2024 VA/DoD Clinical Practice Guideline for headache management 1
   • Specifically helpful for migraine prevention
   • Plays a role in mitochondrial energy metabolism 2
   • Dosage: Not specified in guidelines, but typically 400-600mg daily

Other Supplements with Some Evidence:

The following supplements have insufficient evidence for a formal recommendation but may be considered:

• Coenzyme Q10

  • May help with mitochondrial function
  • Some studies show reduction in migraine frequency 3, 2

• Riboflavin (Vitamin B2)

  • May reduce migraine frequency
  • Some studies report >50% reduction in migraine attacks with 400mg daily for 3 months 2

• Feverfew

  • Traditional herbal remedy for migraines
  • Mixed results in clinical studies 4

• Vitamin D

  • Some evidence suggests a correlation between vitamin D levels and migraine frequency
  • Every 5 ng/ml rise in serum vitamin D may be associated with 22% reduction in migraine occurrence 2

• Omega-3 fatty acids

  • May have anti-inflammatory properties beneficial for headache management 2

Important Considerations

Medication Overuse Risk

• Be cautious about frequent use of any headache treatments, as medication overuse can lead to rebound headaches 1, 5
• High-risk factors for medication overuse headache include:
  • Headache frequency ≥7 days/month
  • Migraine diagnosis
  • Frequent use of anxiolytics, analgesics, or sedative hypnotics 1

When to Consider Preventive Treatment

• If headaches occur ≥2 days per month despite optimized acute treatment 5
• If headaches significantly impact quality of life

Red Flags Requiring Medical Attention

• Abrupt onset of severe headache
• Headaches that worsen with Valsalva maneuver or wake you from sleep
• New-onset headache in older individuals
• Progressively worsening headaches
• Headaches with neurological symptoms 1

Lifestyle Modifications to Complement Supplements

• Regular physical exercise 5
• Maintaining regular sleep patterns and meal times 5
• Adequate hydration 5
• Limiting caffeine intake 5
• Stress management techniques 5
• Identifying and avoiding food triggers through food diaries 3

Algorithm for Supplement Selection

1. For migraine prevention: Start with magnesium (most evidence-supported)
2. If magnesium alone is insufficient: Consider adding riboflavin or CoQ10
3. For patients preferring herbal options: Feverfew may be considered
4. For patients with known vitamin D deficiency: Add vitamin D supplementation
5. For all patients: Implement lifestyle modifications alongside supplements

While these supplements may help reduce the frequency of headaches, they typically show mixed results regarding severity and duration 4. The advantage is that they generally have minimal side effects compared to pharmaceutical options 4.