ACHES & CLAIMS
Herbs to Stave Off Migraines

By ROBERT DAVIS
Special to THE WALL STREET JOURNAL
April 12, 2005; Page D4

Proponents of "natural" remedies have long claimed that everything from vitamin B2 to ginger can help prevent migraine headaches. As the list continues to grow, so does the array of anti-migraine dietary supplements containing various combinations of ingredients. While there's solid evidence behind some of these herbs, vitamins and minerals, many are unproven, and a few may even make migraines worse.

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Most migraine products contain feverfew, an herb that has been used as a headache remedy for centuries. It has been put to the test in several randomized studies -- the gold standard of research. While some have found that regular consumption of feverfew decreases the frequency and severity of migraines, not all have, leading many experts to conclude the research is promising but not conclusive.

The herb can be taken either in whole leaf or capsule (extract) form, and some researchers say the mixed results may be due to differences in the forms used and the ingredients that the extracts contain. Many -- though not all -- extracts have the feverfew constituent parthenolide, theorized to work against migraines by decreasing the clumping of blood platelets and reducing inflammation. But no one is sure whether parthenolide or other ingredients are responsible for feverfew's possible benefits. The main side effects are mouth ulcers from the whole leaf form.

Solid research also shows that taking the mineral magnesium, which is deficient in some people with migraines, can help prevent the headaches. Likewise, the vitamin B2, also known as riboflavin, has been found to be effective when used in high doses of 400 mg a day. (The recommended daily level is under 2 mg.) Both substances are considered safe, though magnesium can cause diarrhea and stomach upset in some people.

More limited research recently suggested that two other substances -- coenzyme Q10 (or CoQ10) and the herb butterbur -- may also head off migraines. While CoQ10 has no known serious side effects, butterbur in its natural state contains substances that can be toxic and cause cancer. As a result, products need to be adequately purified during manufacturing, something that isn't guaranteed because supplements made in the U.S. are only loosely regulated by the Food and Drug Administration. However, published research shows that one brand, Petadolex, is safe.

Claims that fish oil and melatonin can prevent migraines are supported only by preliminary studies.

As for other common ingredients in migraine supplements, such as ginkgo, ginger and valerian root, there's little or no evidence for their effectiveness. Yet there is reason to believe that ginkgo and valerian root, as well as ginseng and St. John's wort, can actually cause migraines or make them worse, according to one study. What's more, the researchers say that ginkgo, ginseng, St. John's wort, echinacea and large amounts of garlic may interact with prescription migraine medications and even make them toxic.

That's why it's especially important to talk to your doctor before trying migraine supplements. Read labels carefully to make sure they contain only ingredients for which there's solid evidence. And don't expect instant relief: Some products must be used daily for up to three months before they work.