Nutritional supplements may help prevent migraines

Q: I've suffered with migraines for years, and my doctor wants to give me a daily medication to prevent them. I'm reluctant to rely too heavily on drugs. Aren't there any vitamins or nonprescription medications I can take to prevent migraines?

A: The short answer is yes: You can reduce your risk of migraines through nonprescription methods - and you're not alone in trying to do so. Migraines affect about 12 percent of people in the United States, occurring more often in women, in people between the ages of 30 and 39, and within families.

The headaches can last for hours or up to three days, causing an inability to focus and significant lost productivity. A retrospective analysis of migraine sufferers found that emotional stress was a trigger for 80 percent of them; missing a meal was a trigger for 57 percent; and lack of sleep was a trigger for 50 percent.

When it comes to behavioral interventions, relaxation techniques, cognitive therapy, consistent aerobic exercise and good sleep hygiene can all decrease the frequency of migraines.

Now let's look at the data on nutritional supplements.

We'll start with coenzyme CoQ10. In a small 2005 study, patients who experienced migraine headaches two to eight times per month were randomly assigned to take either a placebo or 100 milligrams of CoQ10 three times per day for at least three months.

The authors measured success as a greater than 50 percent reduction in the frequency of migraines. Only 14.4 percent of those who took the placebo showed this level of reduction, but 47.6 percent of those who took CoQ10 reduced their frequency of migraines by that amount.

Then there's the B vitamin riboflavin. A small 1998 study found that 59 percent of people who took a daily dose of 400 milligrams had a greater than 50 percent reduction in the frequency of migraines, compared to 15 percent of those who took a placebo. However, it took three months for riboflavin to show this benefit.

Knowing that sleep problems increase the risk of migraines, researchers in a 2016 study compared the effects of 3 milligrams of melatonin to the effects of the antidepressant amitriptyline or of a placebo.

After three months, 54.4 percent of people who took melatonin had a 50 percent or greater reduction in frequency of headaches compared to 39.1 percent in the amitriptyline group and 20 percent in the placebo group. That seems promising, but note that a 2010 study of people who took 2 milligrams of melatonin for a two-month period did not show significant benefit when compared with a placebo.

Now let's move on to botanicals.

Small studies have suggested that the root of the butterbur plant, Petasites hybridus, can decrease migraine frequency, but the plant can be toxic to the liver and, in animal studies, has led to genetic changes that could lead to cancer.

Feverfew is another potential treatment. A combined analysis of six trials of the herb yielded conflicting results. Overall, the studies showed that feverfew can decrease the frequency of migraines by 0.6 times per month compared to placebo. Note that it can cause rebound headaches if abruptly stopped, however.

In short, more studies are needed. That said, CoQ10, riboflavin and melatonin all seem like reasonable approaches to help prevent migraines.

• Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles. Send your questions to askthedoctors@mednet.ucla.edu