What supplements can help with migraines?

Supplements for Migraine Prevention and Treatment

Oral magnesium is the most evidence-supported supplement for migraine prevention, with a weak but positive recommendation from clinical guidelines. 1, 2

Evidence-Based Supplement Options

First-Line Supplement:

• Magnesium
  • Dosage: 400-600mg daily 2, 3
  • Evidence level: Weak positive recommendation 1
  • Mechanism: Helps prevent cortical spreading depression, regulates neurotransmitter release, and reduces platelet aggregation 4
  • Best for: May be particularly effective in certain patient subgroups 4

Other Supplements with Limited Evidence:

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

• Riboflavin (Vitamin B2)

  • Dosage: 400mg daily 2, 5
  • Evidence: Insufficient to recommend for or against 1

• Coenzyme Q10

  • Evidence: Insufficient to recommend for or against 1
  • May have therapeutic potential based on open clinical trials 6

• Feverfew

  • Evidence: Insufficient to recommend for or against 1
  • Listed as a consideration by some experts 5

• Vitamin B6

  • Evidence: Insufficient to recommend for or against 1

• Melatonin

  • Evidence: Insufficient to recommend for or against 1

• Omega-3 fatty acids

  • Evidence: Insufficient to recommend for or against 1

Important Considerations

Effectiveness Hierarchy

Based on available evidence, supplements for migraine can be prioritized as follows (from strongest to weakest evidence):

1. Magnesium
2. Riboflavin (Vitamin B2)
3. Coenzyme Q10
4. Feverfew
5. Other supplements (melatonin, omega-3, vitamin B6)

Clinical Context

• Supplements should be viewed as adjuncts to conventional treatments
• The 2023 VA/DoD Clinical Practice Guideline notes insufficient evidence for most supplements except magnesium 1
• Allow 2-3 months to assess efficacy of preventive treatments 2
• Track response using headache diaries 2

Caveats and Limitations

• Most supplement studies have small sample sizes or methodological limitations 3
• Individual response to supplements varies significantly
• Quality and bioavailability of supplements can vary between manufacturers
• Dietary magnesium intake may be an alternative to supplementation for patients willing to make dietary changes 3

Beyond Supplements: Evidence-Based Pharmacological Options

For context, the following medications have stronger evidence for migraine prevention than supplements:

• Strong recommendations:

  • CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) 1, 2
  • Candesartan or telmisartan 1

• Weak recommendations:

  • Topiramate, propranolol, valproate, lisinopril 1, 2
  • OnabotulinumtoxinA (for chronic migraine only) 1, 2

For acute treatment, NSAIDs, triptans, and combination therapies have stronger evidence than supplements 2.

Practical Application

When considering supplements for migraine:

1. Start with magnesium as it has the strongest evidence
2. Use high-quality supplements at recommended dosages
3. Continue for at least 2-3 months before assessing efficacy
4. Consider adding other supplements only if magnesium alone is insufficient
5. Maintain realistic expectations about the modest benefits compared to prescription medications

Remember that identifying and avoiding food triggers through food diaries is an inexpensive complementary approach to reduce migraine frequency 5.