I find migraine headaches to be one of the most satisfying conditions to treat in family practice, because there are so many options for prevention, and treatment can be tailored to the patient's health conditions and preferences. For example, I have many patients who prefer to avoid a daily preventative medication, and instead I recommend one of the options below.
I recommend keeping a headache diary, which may point to triggers. In medicine we have historically advised people to avoid their triggers. On the surface this is intuitive, but this approach is being questioned, as avoiding certain things may lead to you becoming more sensitive to the trigger. An approach called "learning to cope with triggers" involves gradual exposure to certain triggers and has been shown in one randomized controlled trial to reduce headaches. It's yet to be seen how we should incorporate this into clinical practice. If you are interested in this approach, I recommend finding a therapist who does cognitive-behavioural therapy.
I recommend a variety of options for preventative therapy and for treatment of migraine, including prescription medications. There are many prescription and non-prescription treatments that have some benefit. No one treatment is effective for everyone, but these non-prescription options may be worth a try. As always, speak with your health care provider to ensure any supplement you take doesn't interfere with your health conditions or current medications.
Here are four non-prescription options that may help your migraines:
- A magnesium supplement. Magnesium 300-600 mg daily can reduce the frequency of migraine. Health Canada considers a dose of up to 350 mg of magnesium to be safe in pregnancy, so this is an ideal option for pregnant women who suffer from migraines. Some people (up to 40%) get bothersome diarrhea with it, but it might be helpful in people who suffer with chronic constipation. You might want to start with a low dose first, to see how it affects you. Food sources of magnesium can be found here.
- Coenzyme Q10 (CoQ10), 100 mg three times daily. In a small study, taking CoQ10 reduced migraine frequency, and it was well tolerated.
- Acupuncture. There is good evidence that acupuncture provides similar effectiveness to preventative medication. The main downside is the time and expense required to get treated.
- Riboflavin (Vitamin B2) 400 mg daily. Food sources are listed here, but you can see that they contain very small amounts compared to the 400 mg dose studied for prevention of migraine.
Have you tried any of these options for migraine? Are there other strategies that have helped you?