Nutritional supplements for Migraine

Marcello Cherchi, M.D., Ph.D. and Timothy C. Hain, MD • see also: treatment index

Page last modified: June 2, 2021

There are several vitamins and nutritional supplements that have a small literature supporting their use in prevention of migraine. There are also many other alternative approaches to migraine, outlined here. Holland et al (2012) reviewed most of these and presented the evidence according to the American Academy of Neurology. Some of these may be placebos. Well, whatever works and is safe is fine.

Our bottom line is that considering the nutritional treatments, only magnesium has a reasonable chance of being helpful. The rest usually are temporary trials that fail.

Vitamin D.

A recent article by Prakash and Rathore suggested that vitamin D deficiency is more common in patients with tension headache (Prakash et al, 2017). As vitamin D deficiency is common in Chicago during the winter months, for most patients, we advise supplementation not only for headache but for a variety other positive effects.

Dosing: 2000 units/day.

Coenzyme Q10

Data: One open-label study of adolescents with migraine who had low levels of coenzyme Q10, and who were given supplements of coenzyme Q10, found improvement in migraine frequency and in disability resulting from migraines (1).This vitamin (100 mg three times/day) was compared in a randomized double-blind trial and found to be well tolerated for reducing attack frequency, headache-days, and days with nausea. (Standor et al, 2005). The effect was strongest for attack frequency and nausea days.
Mechanism of action: Thought to influence mitochondrial metabolism.
Dosing:;Start at 1-3 mg/kg/day.

Magnesium oxide

Data:    One randomized, double-blind, placebo-controlled, parallel-group study suggested a trend towards reduced frequency and severity of migraine headaches in children (6).  Another randomized, double-blind, placebo-controlled study showed a significant decrease in frequency of migraines, but no change in intensity or duration of attacks (Peikert et al, 1996).  Another trial showed no difference from placebo (Pfaffenrath et al, 1996). Review
Mechanism of action:; Unknown.
Dosing:   Start at 300-600 mg/day. Our patients most often take "Cal-mag" twice/day, or "Calm".
Advantages:  Low side-effect profile.
Adverse effects:  Diarrhea.  Usually this is easily counteracted by taking calcium supplementation (which would normally cause mild constipation).

Riboflavin (vitamin B2)

Data:   One randomized, placebo-controlled trial found efficacy of riboflavin (5).  One trial found an effect “greater than would be expected for placebo” (although there was no pure placebo arm in the study) of riboflavin for migraine prophylaxis (2).

More specifically, It has been reported that riboflavin taken in a dose of 400 mg/day was effective in improving migraine by at least 50% in 59% of 55 patients with predominantly common migraine (Schoenen et al, 1998). The therapeutic "gain" over placebo was 37% for attack frequency.  Adverse effects were rare. This is an extremely high dose, 200 times higher than the RDA. While generally thought to be safe, this safety of this particular dose has not been well established. At this writing (2009), Riboflavin is rarely used for treatment of migraine
Dosing:    Start at 400 mg/day.
Adverse effects:   There is no known toxicity of riboflavin.