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Open Source Apothecary At Home / Muscles, joints and nerves
Butterbur, feverfew, riboflavin and magnesium all have trial evidence. Butterbur also has a liver warning and a supply problem.
remedyMigraine prophylaxis has an unusual concentration of plant and nutrient evidence, and all of it is modest: a reduction in attack frequency of roughly one attack a month over placebo in the better trials. For someone having six attacks a month that is worth having; for someone having two it is marginal.
Butterbur (Petasites hybridus) has the best trial evidence of the herbs for migraine prophylaxis, in a randomised trial using a standardised extract. It also has a serious problem: the plant naturally contains pyrrolizidine alkaloids, hepatotoxic and carcinogenic, and only extracts certified as PA-free are acceptable. Reports of liver injury, along with supply and regulatory problems, mean the correct advice is: if you use it, use only a PA-free certified product, and discuss it with a clinician given that several better-studied prescription options exist.
Feverfew has multiple trials, of mixed and generally modest quality, showing a reduction in attack frequency and severity. Its active is parthenolide, a sesquiterpene lactone, whose concentration in a given leaf varies a great deal. Feverfew commonly causes mouth ulcers and GI upset, and stopping it abruptly can cause rebound headache.
Riboflavin (vitamin B2), at high dose (400 mg daily in the trials), reduces migraine frequency and is very safe. It is the easiest recommendation on this page because of the safety profile.
Magnesium has trials showing modest prophylaxis benefit at around 400-600 mg daily. Note that this is a different indication from muscle cramp, where the trials were negative — the same mineral, two different evidence bases.
Coenzyme Q10 has small trials with a positive signal. Ginger has small trials for acute migraine treatment, taken at onset.
What has the best evidence of all is not on this list: prescription prophylaxis (propranolol, topiramate, amitriptyline, and the CGRP monoclonal antibodies), acute treatment with a triptan or an NSAID, and trigger management including sleep regularity and caffeine consistency. A person with frequent or disabling migraine should be managed by a clinician, and the herbs here are additions to that conversation.
The use of certain dietary supplements has resulted in a significant decrease in migraine prophylaxis.PubMed 39404918 ↗
Psychological interventions effectively reduce the number of headache days, headache intensity, and improve response rates in TTH.PubMed 41315905 ↗
In this network meta-analysis of randomized clinical trials, topiramate and pregabalin were associated with reduction in headache frequency and intensity.PubMed 39388181 ↗
A pooled analysis of available randomized controlled clinical trials demonstrated that Vitamin B2 400 mg/day for three months supplementation had significant effect on days, duration, frequency, and pain score of migraine attacks.PubMed 33779525 ↗
There is low- and moderate-quality evidence that neuromodulation, acupuncture, and aerobic exercises are associated with attenuated headache symptoms in patients with episodic migraine or TTH.PubMed 36397322 ↗
CoQ10 appears to have beneficial effects in reducing duration and frequency of migraine attack.PubMed 33402403 ↗
Riboflavin (the safest option)
Magnesium
Feverfew
Butterbur
Coenzyme Q10
Ginger for an attack
The interventions with the most evidence