What supplements are safe for children to prevent migraines?

Safe Supplements for Migraine Prevention in Children

Oral magnesium is the only supplement with sufficient evidence to be recommended for migraine prevention in children. 1, 2

Evidence-Based Supplement Options

First-Line Option:

• Magnesium
  • Recommended by the Department of Veterans Affairs and Department of Defense with a "weak for" recommendation 1
  • Considered safe and effective for pediatric migraine prevention 2
  • Has relatively few adverse effects and good evidence for improvement of migraine symptoms 3
  • Magnesium deficiency is common and may be linked to migraine pathophysiology through mechanisms including cortical depression, vascular changes, oxidative stress, and neurotransmitter release 4

Insufficient Evidence:

The 2024 VA/DoD Clinical Practice Guideline states there is insufficient evidence to recommend for or against the following supplements for headache prevention 1:

• Coenzyme Q10
• Feverfew
• Melatonin
• Omega-3
• Vitamin B2 (riboflavin)
• Vitamin B6

Considerations for Pediatric Use

Safety Profile:

• Magnesium has a favorable risk-to-benefit ratio in children 3
• When considering supplements, safety should be prioritized over limited efficacy data
• Magnesium supplementation is generally well-tolerated in children, with mild gastrointestinal effects being the most common side effect

Dosing:

While specific pediatric dosing is not provided in the guidelines, magnesium supplementation should be administered at age-appropriate doses.

Implementation:

• Supplements should be considered as part of a comprehensive approach that includes:
  • Regular sleep schedule
  • Regular meal times
  • Adequate hydration
  • Trigger identification and avoidance
  • Limited consumption of caffeine 2

Monitoring and Follow-up

• Use headache calendars to track frequency, severity, and response to supplements 2
• Allow 6-8 weeks to evaluate efficacy of preventive interventions 2
• Evaluate treatment response within 2-3 months after initiation 2

Clinical Perspective

The American Academy of Neurology guidelines note that despite the inclusion of recommendations on lifestyle modifications in their guidelines, these were not held to the same standard of evidence as pharmacologic therapies 1. They expressed surprise at the decision to exclude non-pharmacologic therapies and nutraceuticals from their full review and hoped these would be included in future guidelines 1.

Pitfalls and Caveats

1. Limited evidence base: The evidence for supplements in pediatric migraine prevention is less robust than for pharmacologic options.

2. Quality control concerns: Supplements are not regulated as strictly as medications, so product quality and consistency may vary.

3. Parental expectations: Parents may prefer "natural" treatments like supplements over prescription medications due to perceived safety, but should be counseled about the limited evidence.

4. Delayed efficacy: Unlike acute treatments, preventive supplements may take weeks to show benefit, which should be clearly communicated to families.

5. Supplement interactions: Always check for potential interactions with other medications the child may be taking.

In conclusion, while magnesium is the only supplement with sufficient evidence to recommend for pediatric migraine prevention, it represents a relatively safe option with a favorable risk-benefit profile. Other supplements lack sufficient evidence to recommend their use at this time.