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Clinician’s Corner: Over the counter options to treat headaches

Many of our patients are looking for “natural” over the counter options to treat their headaches.  Let’s take a look at some herbs (which we don’t often recommend) and some supplements that might be a safe and affordable choice to prevent your migraine headaches.

Complementary Medications for Migraine Prevention

Butterbur: well-studied natural medicine. Treatment of both allergic rhinitis and for preventing migraine headache.

Side effects: May cause GI upset, primarily burping as well as headache, itchy eyes, diarrhea, breathing difficulties, fatigue, and drowsiness.

Caution: The raw, unprocessed butterbur plant contains chemicals called pyrrolizidine alkaloids (PAs). PAs can cause liver damage and can possibly cancer. Only butterbur products that have been processed to remove PAs and are labeled or certified as PA-free should be used, for up to 16 weeks.

  • Feverfew: reduces the frequency of migraines, and when migraines do occur, they tend to have less severe symptoms of pain, nausea, vomiting, and sensitivity to light and noise. AVOID if allergic to ragweedThere is conflicting evidence about the efficacy of feverfew for migraine prevention.

Side effects: nausea, digestive problems, and bloating; if the fresh leaves are chewed, sores and irritation of the mouth may occur. Avoid if pregnant. May interact with anticoagulants.

  • Riboflavin: migraine prevention is its role in mitochondrial function because migraines could be partly due to mitochondrial dysfunction. Riboflavin is required as a precursor for factors needed for electron transport in mitochondria. Needs to be dosed at 400mg per day and takes at least 3 months to show efficacy. Vitamin B-2 is available in 100mg tablets, over the counter. Well tolerated, discolors urine bright yellow.
  • Magnesium: has been used for treatment and prevention. Some research shows that taking high-dose oral magnesium reduces the frequency and severity of migraine. Magnesium deficiency is related to factors that promote headaches, and people who get migraines seem to have lower levels of magnesium. The strongest evidence for magnesium’s effectiveness is in patients who have migraines with aura. Good choice for menstrual migraine.

Dose is 400mg by mouth of Magnesium Oxide per day.

Side effect: No surprise that diarrhea was the most common side effect.

  • Coenzyme Q10 also affects mitochondrial function. Impaired oxygen metabolism and low cellular energy levels caused by faulty mitochondrial function might play a role in migraine headache pathogenesis. Coenzyme Q10 taken in a dose of 100 mg of three times daily appears to reduce migraine attack frequency, headache-days, and days-with-nausea. Depending on brand may cost up to $30 per month.

Feverfew and butterbur the two herbs mentioned above are rarely recommended.  Because the United States does not have standardization of herbal products there is variance between the products.  Your Thompson Pharmacist can work with your neurologist to help guide your migraine prevention therapy.

Magnesium and Riboflavin seem to be effective, but it takes at least three months to see results.  Your Thompson Pharmacist is an expert when it comes to choosing safe and effective drug therapies. Go Ahead and ASK… at Thompson Pharmacy it’s ALL for YOU!