For this article, I have excerpted part of the section on addressing migraines from my book "Pain Free 1-2-3!—A Proven Program to Get You Pain Free." The book teaches a Comprehensive Medicine approach to overall pain management.
These headaches can be very severe and often leave people crippled for days. They may afflict as many as 28 million Americans. Migraines are often preceded by an "aura," which may consist of visual disturbances such as flashing lights. The headaches are often associated with nausea, sweats, dizziness and slurred speech. Light and sound sensitivity can also be severe.
There is still marked debate over the cause of migraines. For decades, researchers thought that these occurred because of excessive contraction and expansion of the blood vessels in the brain. Others thought that this blood vessel problem occurred because of inadequate serotonin, the neurotransmitter that controls sleep and mood, which also plays a role in how blood vessels expand. Low serotonin also amplifies pain by increasing the pain neurotransmitter called "substance P". Muscle spasm and nutritional imbalances and deficiencies can also contribute to migraines as can food sensitivities. Most likely, it is a common endpoint for many different underlying problems.
Effective migraine therapy is important. Not only are migraines horribly painful for many people, but they are expensive as well. The average amount of work missed by those with migraines is 19.6 days a year, costing employers $3,000 per year per employee. It is also under-addressed, with 31 percent of migraine patients never having sought therapy.6
What Natural Remedies Can I Use to Knock Out an Acute Migraine?
Two natural therapies can knock out an acute migraine. The first, which you can take at home on your own, is butterbur. This herb can both prevent and eliminate migraines. Take 50 mg 3 times a day for 1 month and then 50 mg twice a day to prevent migraines. You can take 100 mg every 3 hours to eliminate an acute migraine. Use only high quality brands. Many low-quality brands that were tested had impurities and did not contain the amount of butterbur the label claimed (i.e., they don't work).
In a hospital emergency room (if you get an open minded doctor—take this article with the research references below. They won't know about magnesium for migraines because the magnesium costs 10 cents, so no one has told them about the research) or a Holistic doctor's office (see www.HolisticBoard.org to find one near you), intravenous magnesium can effectively eliminate an acute migraine. In one study of 30 patients with moderate or severe migraine attacks, half received 1 g of magnesium sulfate IV over 15 minutes and the other half placebo. Those in the placebo group who were not better at a one half-hour interval were then given the magnesium. Immediately after therapy, at 30 minutes, and at 2 hours, 86 percent in the magnesium group were pain-free with the other 14 percent showed a reduction in pain. Associated symptoms such as nausea, light sensitivity, and irritability also resolved, and none of the patients in the magnesium group had a recurrence of pain within 24 hours. In the placebo group, no patient became pain-free, and only one had a reduction in pain. When patients in the placebo group were later given the magnesium, responses were similar to subjects in the other magnesium-treated group. Mild side effects, which are a normal effect of magnesium working to open blood vessels (such as a burning sensation in the face and neck, flushing, and a drop in blood pressure of 5 to 10 mm systolic) occurred in 86 percent of the patients. None of these side effects was serious, and no patient had to discontinue the therapy.13 These results were similar to those in previous reports.14-15
I’m Happy I Can Eliminate an Acute Migraine Headache, but How Can I Prevent Them?
Fortunately, natural remedies are even more effective in preventing migraines. They may take up to 3 months to start working, however, so the medications discussed below can be used while you're waiting for the natural preventives to take effect. Magnesium by mouth has been found to be effective for migraine prevention and is as effective as the medication Elavil®.18 Magnesium serves in an enormous number of functions in the body, including the relaxation of muscles and arteries. Most Americans get nowhere near the optimum amount of magnesium in their diet, getting less than 250 mg a day as opposed to the 650 mg that the average Chinese diet supplies. Blood testing to check magnesium levels are horribly unreliable and may not detect magnesium deficiency until it is severe.
A leading authority on natural prevention of migraine headaches is Dr. Alexander Mauskop, author of What Your Doctor May Not Tell You about Migraines. As discussed above, in 1995 Dr. Mauskop published a study showing that intravenous magnesium could abort a migraine headache.19 He also found that intravenous magnesium could knock out other types of headaches as well.20 This powerful data spurred researchers to see whether magnesium could also prevent migraines. As noted above, the answer was yes. In one German placebo-controlled study patients were given 600 mg of magnesium daily for 12 weeks or a placebo; there was a significant drop in migraine frequency in the magnesium group.21 Another study shows similar effects in women with menstrual migraine (see below).22 It is a good idea for most migraine patients to take 150 to 200 mg of magnesium in the morning (present in a good multivitamin powder) and again with dinner or at bedtime (less if diarrhea is a problem).
Riboflavin (vitamin B2) assists in the production of energy. In one study, migraine patients were given riboflavin 400 mg with breakfast every day for at least 3 months. By the end of the study they had a 67 percent decrease in migraine attacks as well as a decrease in attack severity. This was later repeated in a placebo-controlled study.23 Note that it can take 3 months for the riboflavin to start working. A recent study suggests that 100 mg a day may be enough to have the same effect, so the amount in a multivitamin powder is often adequate for maintenance after 3-4 months on the higher amount.
Vitamin B12 can also decrease migraine frequency. In one study in which patients received 1000 micrograms a day as a nasal spray, migraine frequencies decreased by an average of 43 percent after 3 months (the vitamin powder/B-complex contains 500 micrograms a day).24
Feverfew is another helpful herb for migraine prevention.25 Using Feverfew has resulted in a significant reduction in migraines in one-third of patients. It was also found to be very safe.26 However, other therapies are effective enough that I rarely use this anymore.
Butterbur is a shrub which grows in Europe, Asia, and Africa. Although 100 mg a day is effective, 75 mg twice a day with food may be the optimal dose for some.27
Fish oil has also been found to decrease the frequency of migraines. In two placebo-controlled studies of patients with frequent severe migraines that did not respond to medication, fish oil was found to be effective. Use 1 to 2 tbsp a day and give the therapy 6 weeks to see the effect. Then you can decrease it to the lowest dose that maintains benefit.28-29
Other natural compounds that may be helpful include glucosamine 1500 to 2000 mg a day (this compound was found to be helpful in a small study of 10 patients over 4 to 6 weeks). Coenzyme Q10, 150-200 mg daily, decreased the average number of migraine attacks per month from 4.8 to 2.8 in an open study.30
All this suggests that many, if not most, migraines can be prevented naturally. I would begin by taking a vitamin powder plus 300 mg of Vitamin B2 in the morning, plus 200 mg of magnesium at night. If the cost is not prohibitive, I would add butterbur as well. Also check for food allergies, as noted below, and follow the advice for hormones if the migraines are predominately around your periods or associated with taking estrogen. I have seen this approach commonly eliminate frequent and horribly severe migraine problems, but remember that it may take 3 months to see the effect.
What Else Can I Do to Eliminate the Underlying Cause of the Migraines?
Acupuncture is another option to consider for chronic migraine and tension headaches. It results in reduced pain, reduced frequency of headaches, and improved function, energy and health. In two studies conducted in New York City and London, acupuncture was found to be cost-effective. In a randomized controlled study of 401 patients with chronic headaches (the majority having migraines), patients received up to 12 acupuncture therapies over a 3-month period vs. a control group that received standard care. The acupuncture patients had 22 fewer headache days per year, 15 percent fewer sick days, and 25 percent fewer visits to the doctor.31
Food allergies are also very important to consider. Approximately 30 to 50 percent of migraine patients get marked improvement by avoiding certain foods, and most people with migraines are not aware of what foods are triggering their headaches. This has now been demonstrated in at least four placebo-controlled studies. Food sensitivities are an even bigger problem in children with migraines.32-35 To determine if foods are playing a role in causing your headache, it is helpful to do an elimination diet. This requires eating a limited diet for five days. The link will give you instructions for a gentler and easier elimination diet, or you can do a very strict one if you prefer, eating only pears and lamb, and drink only bottled spring or distilled water. This kind of strict elimination diet will make it easier to tell if food allergies/sensitivities are present and triggering your migraines when you reintroduce foods into your diet. In one study, by avoiding the ten most common food triggers, subjects exhibited a dramatic reduction in the number of headaches per month, with 85 percent becoming headache-free. Twenty-five percent of the patients with high blood pressure also had their blood pressure reduce to normal. The most common reactive foods were wheat in 78 percent of patients, oranges in 65 percent, eggs in 45 percent, tea and coffee in 40 percent each, chocolate and milk in 37 percent each, beef in 35 percent, and corn, cane sugar, and yeast in 33 percent each. Some studies also suggest that the artificial sweetener aspartame (NutraSweet®) can trigger migraines and other headaches, although this is controversial.36-37 If you have severe and frequent migraines, it is definitely worth exploring food sensitivities.38 You may find that instead of avoiding foods that trigger your migraines for the rest of your life, you can eliminate the sensitivities/allergies using a powerfully effective acupressure technique called NAET.
What Medications Can I Take to Get Rid of an Acute Migraine Headache?
In the U.S., medications in the Imitrex® family still remain the first choice that physicians use for addressing acute migraines. No one is paying to give them the research showing that the old combo of aspirin, Tylenol and caffeine (cost ~ 20 cents vs. $10-25/dose) is equally effective, so don't forget that you can use these if needed (e.g. 1-3 Excedrin Migraine or Excedrin Extra strength—can take up to 8 spread through the day if the caffeine doesn't make you hyper—the dose recommendations on the bottle are fairly low). Midrin®, which is a prescription mix of three medications, can be effective. Two capsules are taken immediately followed by 1 capsule every hour until the headache is relieved (to a maximum of 5 capsules within a 12 hour period).
A fascinating study can guide you on when to use Imitrex family medications vs. when to go with other therapies. 75 percent of migraine patients get painful sensitivity to normal touch around their eyes (e.g. wearing eyeglasses). If you use Imitrex before you get the tenderness/pain around the eyes, it will knock out the migraine 93 percent of the time. If the pain/tenderness around the eyes had already set in, Imitrex only eliminated the migraine 13 percent of the time (although it still helped the throbbing).12 In other words, if you are one of the lucky ones who does not get pain around the eyes, the Imitrex can knock out your migraine at any time. If you are one of those who do get pain/tenderness around the eyes, it is a race against the clock to take the Imitrex before that pain starts. This means that you should take the Imitrex early in the attack (the first 5 to 20 minutes) before the skin hypersensitivity gets established.
For the few of you where all else fails, prescription medications can reduce the number of headache days per month by an average of 50 percent.17 These include Neurontin®, beta-blockers (Inderal®—avoid this if you have asthma or fatigue), calcium channel blockers, Depakote®, Topamax®, Elavil® and Doxepin®. The good news, though, is that migraines can be prevented naturally in most cases.
- Migraine headaches can be very severe and usually last for several days. Migraines are often preceded by an “aura,” which may consist of visual disturbances such as flashing lights. The headaches are often associated with nausea, sweats, dizziness, and light and sound sensitivity.
- There are two natural therapies that can knock out an acute migraine. Butterbur can both prevent and eliminate migraines. Take 50 mg 3 times a day for 1 month and then 1 twice a day to prevent migraines. You can take 100 mg every 3 hours (for a maximum of 300 mg in a 24 hour period) to eliminate an acute migraine. In the hospital emergency room or Holistic doctor’s office, 1-2 grams of intravenous magnesium over 15 minutes can effectively eliminate an acute migraine within minutes (to find a Holistic physician, see www.HolisticBoard.org).
- Many, if not most, migraines can be prevented naturally. I recommend taking:
A) a good multivitamin powder, plus
B) 300 mg of Vitamin B2 (Riboflavin) in the morning, plus
C) 200 mg of magnesium at night.
D) If the cost is not prohibitive, I would add butterbur 50 mg 3 times a day for 1 month, then 2x day (you can use 100 mg once a day but it is not as effective).
For many of you, the vitamin powder alone may be enough to prevent your migraines after 3 months of being on the regimen above. Natural approaches can commonly eliminate even frequent and horribly severe migraine problems, but remember that it usually takes 2 to 3 months to see the effect. So give them time to work.
Avoiding hidden food allergies can reduce or eliminate migraines in 30 to 85 percent of patients. In one study, the most common reactive foods were wheat in 78 percent of patients, oranges in 65 percent, eggs in 45 percent, tea and coffee in 40 percent each, chocolate and milk in 37 percent each, beef in 35 percent and corn, cane sugar and yeast in 33 percent each. Clinical experience also suggests that the artificial sweetener aspartame (NutraSweet®) can trigger migraines and other headaches (although this is controversial). You may find that instead of avoiding foods that trigger your migraines for the rest of your life, you can eliminate the sensitivities/allergies using a powerfully effective acupressure technique called NAET.
If the migraines are predominately around the time of the period or associated with taking estrogen, the key is to prevent the fluctuating estrogen level. One way to do this is to use an estrogen patch for one week beginning a few days before the period is expected (e.g., a Climara® .025 patch).
In the U.S., medications in the Imitrex® family still remain the first choice that physicians use for addressing acute migraines. No one is paying to give them the research showing that the old combo of aspirin, Tylenol and caffeine (cost ~ 20 cents vs. $10-25/dose) is equally effective, so don’t forget that you can use these if needed (e.g., 1-3 Excedrin Migraine or Excedrin Extra strength—the dose recommendations on the bottle are fairly low). Midrin®, which is a prescription mix of three medications, can be effective. Two capsules are taken immediately followed by 1 capsule every hour until the headache is relieved (to a maximum of 5 capsules within a 12 hour period).
A fascinating study can guide you on when to use Imitrex family medications vs. when to go with other therapies. 75 percent of migraine patients get painful sensitivity to normal touch around their eyes (e.g. wearing eyeglasses). If you use Imitrex before you get the tenderness/pain around the eyes, it will knock out the migraine 93 percent of the time. If the pain/tenderness around the eyes had already set in, Imitrex only eliminated the migraine 13 percent of the time (although it still helped the throbbing). In other words, if you are one of the lucky ones who does not get pain around the eyes, the Imitrex can knock out your migraine at any time. If you are one of those who do get pain/tenderness around the eyes, it is a race against the clock to take the Imitrex before that pain starts. This means that you should take the Imitrex early in the attack (the first 5 to 20 minutes) before the skin hypersensitivity gets established.
For the few of you where all else fails, prescription medications can reduce the number of headache days per month by an average of 50 percent. These include Neurontin®, beta-blockers (Inderal®—avoid this if you have asthma or fatigue), calcium channel blockers, Depakote®, Topamax®, Elavil® and Doxepin®.
1. Marcus DA. Headache and Pain Nov 2003. p. 180-185
2. Oliver RL. Choosing the right triptan. Practical Pain Management. January/February 2003; Page 15-18.
3. Headache 2003 Sep; 43(8):835-844
4. Lancet 1995; 346:923-926.
5. Functional Neurology 2000; 15 supplement 3:196-201.
11. Wilner AN. Pain Medicine News. Vol 1 #4 p1&5, 2003).
12. Wilner AN. Pain Medicine News. Vol 1 #4 p1&5, 2003
13. Demirkaya, S et al. Efficacy of Intravenous Magnesium Sulfate in the
Treatment of Acute Migraine Attacks. Headache 2001; 41:171-177.
14. Clin Sci 1995;89:633-6
15. Dora B. Migraine Headache and Magnesium Sulfate. Clinical Pearls News, April 2002
16. Singer RS et al. Oral Transmucosal Fentanyl Citrate in the Outpatient Treatment of Severe Pain from Migraine Headache. The Pain Clinic. Jan/Feb 2004.P10-13.
17. Singer RS et al. The Pain Clinic. Jan/Feb 2004.P10-13
18. Dora B. The Journal of Headache and Pain, 2000; 1:179-186
19. Clin Sci[lond]1995 December; 89 (6): 633-6
20. Headache 1996 March; 36 (3): 154 -60
21. Peikert A,et al. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalgia 1996 June; 16 (4): 257-63
22. Facchinetti F, et al. magnesium prophylaxis of mention migraine: effects on intracellular magnesium. Headache 1991 May; 31 (5): 298- 301
23. Schoenen J,et al. High-dose riboflavin as a prophylactic treatment of migraine: results of an open pilot study. Cephalgia 1994 October; 14 (5): 328-9. & Schoenen J, et al. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology 1998 February; 50 (2): 466-70.
24. Van Der Kuy PHM,et al. Hydroxycobalamin, a nitric oxide scavenger, in the prophylaxis of migraine: an open, pilot study. Cephalgia 2002; 22:513-519.
25. Murphy JJ, et al. Randomized double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet 1988 July 23; 2May (8604); 189-92.
26. Prusinski A,et al. Feverfew as prophylactic treatment of migraine. Neurol Neurochir Pol 1999;33 supplement 5:89-95.
27. Brown DJ. Standardized butterbur extract Petadolex – herbal approach to migraine prophylaxis. Townsend Letter for Doctors and Patients, October 2002
28. Glueck CJ et al. Amelioration of severe migraine with omega-3 fatty acids: a double-blind placebo-controlled clinical trial. Abstract. American Journal of Clinical Nutrition 43:710, 1986.
29. McCarren T. et al. Amelioration of severe migraine by fish oils. Abstract. American Journal of Clinical Nutrition 41:874 a, 1985.
30. Rozen TD, et al. Open label trial of coenzyme Q10 as a migraine preventive. Cephalgia 2002 March; 22 (2): 137 –41.
31. British Medical Journal Online 2004:10.1136/bmj.38029.421863.EB
32. Mansfield L. E., Food allergy and migraine. Postgraduate Medicine 83 (7): 46-55, 1988
33. Mansfield L. E. et al. Food allergy and adult migraine. Annals of Allergy 55:126, 1985
34. Monroe J. et al. Migraine is a food allergic disease. Lancet 2: 719 – 21, 1984
35. Egger J et al. Is migraine food allergy? Lancet 2: 865-9, 1983
36. Lipton R et al. aspartame as a dietary trigger of headache. Headache 29:90-92, 1989.
37. Koehler SM, et al. the effect of aspartame on migraine headaches. Headache 28 (1): 10-14, 1988
38. Grant ECG . Food Allergies and Migraines, Lancet, May 5, 1979; 966-969
Jacob Teitelbaum, M.D. is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of four research studies on their treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia and chronic fatigue syndrome From Fatigued to Fantastic! and his newer The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.