Are supplements really effective for fighting persistent migraines?

Q: My doctor suggested I start taking supplements to help with my migraines. Do they really work, and if so, which ones should I buy?

A: If you suffer from migraine headaches and are considering supplements, you may want to look at these three, which research suggests might be helpful:

  • Feverfew. Of all the herbs and botanicals touted for migraine relief, feverfew is by far the most promising and well-studied. Feverfew is a traditional medicinal herb that shares the same family as marigolds and chrysanthemums. A few trials, but not all, have shown that feverfew reduces the frequency and severity of headaches in chronic migraine sufferers, presumably by relaxing blood vessels and decreasing inflammation to improve circulation in the brain. Although the evidence is by no means watertight, feverfew has limited side effects and may be worth trying. However, choosing a quality formulation is critical. A common dose is 100 to 125 milligrams of powdered feverfew leaves, standardized to 0.2 percent parthenolide, which is believed to be the active ingredient in feverfew. Feverfew is also found in combination with riboflavin and magnesium in supplements formulated specifically for migraine prevention. Women who are pregnant or trying to become pregnant and individuals taking blood thinners should not take feverfew due to undetermined safety in these populations.
  • Omega-3 fish oil.Omega-3 fats are natural anti-inflammatories and may help to reduce the frequency, duration, and severity of migraine headaches. If you can’t get enough omega-3 fats through diet alone, try fish-oil supplements. I recommend 1,000 mg coming from a combination of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), the two most beneficial types of omega-3 fats. Because the amount of EPA+DHA per capsule varies widely among brands, you’ll need to read the label and add up the individual milligrams yourself to determine how many pills it will take to reach 1,000 mg total EPA+DHA. Store these supplements in the fridge to keep them from going rancid. To prevent fishy burps, take with food and choose enteric-coated varieties, which are designed to dissolve in the intestines instead of the stomach. Because fish oil acts as a blood thinner, it should not be taken by people who have hemophilia, platelet disorders, or who are already taking blood-thinning medications or aspirin.
  • Coenzyme Q10 (CoQ10). CoQ10 is a vitamin-like substance produced by the body that helps enzymes create energy at the cellular level. Without it, cells can’t work properly. A handful of studies have shown that CoQ10 reduces the frequency and severity of migraines. If you’re looking to try CoQ10, I recommend a daily dose of 100 to 200 milligrams. Although there are very few side effects from CoQ10, some people may experience flulike symptoms, itching, rashes, heartburn, lack of appetite, or gastrointestinal distress. If you have liver disease, diabetes, or thyroid disease, talk with your doctor before trying CoQ10.