Migraines are very painful headaches sometimes involving nausea, vomiting, and changes in vision. They usually begin on only one side of the head and may become worse with exposure to light.

Migraines can be triggered by allergies and may be relieved by identifying and avoiding the problem foods.^{3 4 5 6} Uncovering these food allergies with the help of a doctor is often a useful way to prevent migraines. In children suffering migraines who also have epilepsy, there is evidence that eliminating offending foods will also reduce the frequency of seizures.⁷

Some people who suffer from migraines also react to salt, and reducing intake of salt is helpful for some of these people.⁸ Lactose-intolerant individuals may experience an improvement in migraines by avoiding milk and ice cream.⁹ In addition, some migraine sufferers have an impaired capacity to break down tyramine, a substance found in many foods¹⁰ that is known to trigger migraines in some people.¹¹ Individuals with this defect are presumably more sensitive than others to the effects of tyramine.¹² Ingestion of the artificial sweetener aspartame has also been reported to trigger migraines in a small proportion of people.^{13 14}

L-tryptophan, an amino acid found in protein-rich foods, is converted to serotonin, a substance that might worsen some migraines. For that reason, two studies have investigated the effect of a low-protein diet on migraines; in these studies some individuals experienced a reduction in migraine symptoms.^{15 16} On the other hand, in a small double-blind study, four of eight individuals had marked improvement in their migraine symptoms while receiving L-tryptophan (500 mg every six hours).¹⁷

Infection with Helicobacter pylori (an organism that causes stomach ulcers) may predispose individuals to migraine headaches. In a preliminary trial, 40% of migraine sufferers were found to have H. pylori infection. Intensity, duration, and frequency of attacks of migraine were significantly reduced in all participants in whom the H. pylori was eradicated.¹⁸ Controlled clinical trials are needed to confirm these preliminary results.

Compared with healthy people, individuals with migraines have been found to have lower levels of magnesium in their blood and brain.^{21 22 23 24} Preliminary research in a group of women (mostly pre-menopausal women) showed that supplementing with magnesium (usually 200 mg per day) reduced the frequency of migraines in 80% of those treated.²⁵ In a double-blind study of 81 people with migraines, magnesium (600 mg per day) was significantly more effective than a placebo at reducing the frequency of migraines.²⁶ Another double-blind study showed that taking 360 mg of magnesium per day decreased the number of days on which premenstrual migraines occurred.²⁷ One double-blind trial found no benefit from 486 mg per day of magnesium for three months. However, the high incidence of diarrhea and loose stools among participants in this study suggests that the unusual form of magnesium used may not have been well-absorbed.²⁸ Intravenous magnesium has been reported to produce marked and sometimes complete symptom relief during acute migraines, usually within 15 minutes or less.²⁹

Taking large amounts of the combination of calcium (1,000 to 2,000 mg per day) and vitamin D has been reported to produce a marked reduction in the incidence of migraines in several female patients.^{30 31} However, the amount of vitamin D given to these women (usually 50,000 IU once a week), can cause adverse reactions, particularly when used in combination with calcium. These amounts of calcium and vitamin D should therefore be used only under medical supervision. Doctors often recommend that people take 800 to 1,200 mg of calcium and 400 IU of vitamin D per day. However, it is not known whether theses amounts would have an effect on migraines.

One group of researchers treated 49 migraine patients with large amounts of vitamin B2 (riboflavin; 400 mg per day). Both the frequency and severity of migraines decreased by more than two-thirds.³² In a follow-up three-month, double-blind study, the same researchers found that 59% of patients assigned to receive vitamin B2 had at least a 50% reduction in the number of headache days, whereas only 15% of those assigned to receive a placebo experienced that degree of improvement.³³ The effects of vitamin B2 were most pronounced during the final month of the study.³⁴

Preliminary research also suggests that oral supplements of SAMe (S-adenosyl-L-methionine) are helpful in some cases of migraine headaches.³⁵

The cause of migraine headaches is believed to be related to abnormal serotonin function in blood vessels,³⁶ and 5-hydroxytryptophan (5-HTP, which is converted by the body into serotonin) may help correct this abnormality. In one study, 40 individuals with recurrent migraines received either 5-HTP (200 mg per day) or methysergide (a drug used to prevent migraines) for 40 days. Both compounds reduced the frequency of migraines by about 50%.³⁷ Larger amounts of 5-HTP (600 mg per day) were also found to be as effective as medications for reducing migraine headache attacks in adults in two double-blind studies.^{38 39} Migraine attacks were reduced in frequency, severity, and duration in 90% of those taking 400 mg per day of 5-HTP in a double-blind placebo-controlled trial,⁴⁰ though another trial found no benefit of 5-HTP.⁴¹ In another controlled study, 400 mg of dl-5-HTP (another form of 5-HTP) led to reduced analgesic consumption and pain scores after one to two months.⁴² Children who suffered from migraines and had problems sleeping responded well to a daily amount of 5-HTP equal to 20 milligrams for every 10 pounds of body weight in a controlled study,⁴³ though an earlier study showed 5-HTP had no better effect than placebo for children with migraines.⁴⁴

The function of the pineal gland and its cyclic secretion of melatonin may be disturbed in people with migraine headaches.⁴⁵ There is a report of melatonin supplementation significantly reducing the frequency of migraine attacks. In a double-blind study, a 57-year- old man who had suffered disabling migraine headaches twice a week since childhood took 5 mg of melatonin per day for two weeks, and then placebo for two weeks.⁴⁶ During the melatonin supplementation period, he experienced no migraine attacks and his sleep was significantly improved. Migraine attacks recurred during the placebo phase. When returned to melatonin supplementation, his symptoms again resolved. In the 12-month period of melatonin supplementation that followed, he experienced only three migraine attacks.

Herbs that may be helpful: The most frequently used herb for the long-term prevention of migraines is feverfew. Feverfew inhibits both hyperaggregation of platelets and the release of serotonin and some inflammatory mediators.⁴⁷ Double-blind studies have shown that continuous use of feverfew leads to a reduction in the severity, duration, and frequency of migraine headaches.^{48 49 50}

Studies suggest that taking standardized feverfew leaf extracts that supply a minimum of 250 mcg of parthenolide per day is best. Results may not be evident for at least four to six weeks. Although there has been recent debate about the relevance of parthenolide as an active constituent,⁵¹ it is best to use standardized extracts of feverfew until research proves otherwise.

One case report suggested success using 4–6 grams per day of powdered ginger for migraines and the accompanying nausea.⁵² Ginger may also be taken as a tincture in the amount of 1.5–3 ml three times daily. Ginkgo biloba extract may also help because it inhibits the action of a substance known as platelet-activating factor,⁵³ which may contribute to migraines.

There is preliminary evidence that capsaicin, the active constituent of cayenne, can be applied inside the nose as a treatment for acute migraine.⁵⁴ However, as intranasal application of capsaicin can burn, it should be used only under the supervision of a doctor familiar with its use.

Other integrative approaches that may be helpful: Many reports have shown acupuncture to be useful in the treatment of migraines. In a preliminary trial, 18 of 26 patients suffering from migraine headaches demonstrated an improvement in symptoms following therapy with acupuncture, accompanied by a 50% reduction in the use of pain medication.⁵⁵ Previous preliminary studies have demonstrated similar results,^{56 57 58} which have also been confirmed in placebo-controlled trials.^{59 60} Improvement has been maintained at one⁶¹ and three⁶² years of follow-up. In preliminary research, patients suffering from chronic headaches of various types (including migraine, cluster, or tension headaches) have also experienced an improvement in symptoms following acupuncture treatment.⁶³ In a study comparing acupuncture to traditional drug therapy, a significantly greater cure rate was achieved in the acupuncture group relative to the drug treatment group (75% vs. 34%).⁶⁴

Dry needling is a form of acupuncture that does not utilize traditional Chinese medicine diagnosis or traditional acupuncture points for treatment. Instead, acupuncture needles are inserted into painful muscle areas (trigger points). A study of 85 patients comparing dry needle acupuncture to conventional drug therapy found a similar reduction in frequency and duration of migraine attacks in both treatment groups.⁶⁵

Information about the effects of a particular supplement or herb on a particular condition has been qualified in terms of the methodology or source of supporting data (for example: clinical, double blind, meta-analysis, or traditional use). For the convenience of the reader, the information in the table listing the supplements for particular conditions is also categorized. The criteria for the categorizations are: "Primary" indicates there are reliable and relatively consistent scientific data showing a health benefit. "Secondary" indicates there are conflicting, insufficient, or only preliminary studies suggesting a health benefit or that the health benefit is minimal. "Other" indicates that an herb is primarily supported by traditional use or that the herb or supplement has little scientific support and/or minimal proven health benefit.

1. Wilkinson CF Jr. Recurrent migrainoid headaches associated with spontaneous hypoglycemia. Am J Med Sci 1949;218:209–12.

2. Dexter JD, Roberts J, Byer JA. The five hour glucose tolerance test and effect of low sucrose diet in migraine. Headache 1978;18:91–4.

3. Grant EC. Food allergies and migraine. Lancet 1979;i:966–9.

4. Monro J, Brostoff J, Carini C, Zilkha K. Food allergy in migraine. Lancet 1980;ii:1–4.

5. Egger J, Carter CM, Wilson J, et al. Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment. Lancet 1983;ii:865–9.

6. Hughs EC, Gott PS, Weinstein RC, Binggeli R. Migraine: a diagnostic test for etiology of food sensitivity by a nutritionally supported fast and confirmed by long-term report. Ann Allergy 1985;55:28–32.

7. Egger J, Carter CM, Soothill JF, Wilson J. Oligoantigenic diet treatment of children with epilepsy and migraine. J Pediatr 1989;114:51–8.

8. Brainard JB. Angiotensin and aldosterone elevation in salt-induced migraine. Headache 1981;21:222–6.

9. Ratner D, Shoshani E, Dubnov B. Milk protein-free diet for nonseasonal asthma and migraine in lactase-deficient patients. Isr J Med Sci 1983;19:806–9.

10. Hanington E. Preliminary report on tyramine headache. Br Med J 1967;2:550–1.

11. Smith I, Kellow AH, Hanington E. A clinical and biochemical correlation between tyramine and migraine headache. Headache 1970;10:43–51.

12. Perkine JE, Hartje J. Diet and migraine: a review of the literature. J Am Diet Assoc 1983;83:459–63.

13. Koehler SM, Glaros A. The effect of aspartame on migraine headache. Headache 1988;28:10–3.

14. Lipton RB, Newman LC, Solomon S. Aspartame and headache. N Engl J Med 1988;318:1200–1.

15. Hasselmark L, Malmgren R, Hannerz J. Effect of a carbohydrate-rich diet, low in protein-tryptophan, in classic and common migraine. Cephalalgia 1987;7:87–92.

16. Unge G, Malmgren R, Olsson P, et al. Effects of dietary protein-tryptophan restriction upon 5-HT uptake by platelets and clinical symptoms in migraine-like headache. Cephalalgia 1983;3:213–8.

17. Kangasniemi P, Falck B, Langvik V-A, Hyyppa MT. Levotryptophan treatment in migraine. Headache 1978;18:161–6.

18. Gasbarrini A, De Luca A, Fiore G, et al. Beneficial effects of Helicobacter pylori eradication on migraine. Hepatogastroenterology 1998;45:765–70.

21. Gallai V, Sarchielli P, Coata G, et al. Serum and salivary magnesium levels in migraine. Results in a group of juvenile patients. Headache 1992;32:132–5.

22. Baker B. New research approach helps clarify magnesium/migraine link. Family Pract News 1993, August 15, p. 16.

23. Barbiroli B, Lodi R, Cortelli P, et al. Low brain free magnesium in migraine and cluster headache: an interictal study by in vivo phosphorus magnetic resonance spectroscopy on 86 patients. Cephalalgia 1997;17:254.

24. Mazzotta G, Sarchielli P, Alberti A, Gallai V. Intracellular Mg++ concentration and electromyographical ischemic test in juvenile headache. Cephalalgia 1999;19:802–9.

25. Weaver K. Magnesium and migraine. Headache 1990;30:168 [letter].

26. Peikert A, Wilimzig C, Kohne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia 1996;16:257–63.

27. Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache 1991;31:298–301.

28. Pfaffenrath V, Wessely P, Meyer C, et al. Magnesium in the prophylaxis of migraine—a double-blind placebo-controlled study. Cephalalgia 1996;16:436–40.

29. Mauskop A, Altura BT, Cracco RQ, Altura BM. Intravenous magnesium sulphate relieves migraine attacks in patients with low serum ionized magnesium levels: a pilot study. Clin Sci 1995;89:633–6.

30. Thys-Jacobs S. Vitamin D and calcium in menstrual migraine. Headache 1994;34:544–6.

31. Thys-Jacobs S. Alleviation of migraines with therapeutic vitamin D and calcium. Headache 1994;34:590–2.

32. Schoenen J, Lenaerts M, Bastings E. High-dose riboflavin as a prophylactic treatment of migraine: results of an open pilot study. Cephalalgia 1994;14:328–9.

33. Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology 1998;50:466–70.

34. Schoenen J, Jacquy, Lenaerts M. High-dose riboflavin as a novel prophylactic antimigraine therapy: results from a double-blind, randomized, placebo-controlled trial. Cephalalgia 1997;17:244 [abstr].

35. Gatto G et al. Analgesizing effect of a methyl donor (S-adenosylmethionine) in migraine: an open clinical trial. Int J Clin Pharmacol Res 1986;6:15–7.

36. Kimball RW, Friedman AP, Vallejo E. Effect of serotonin in migraine patients. Neurology 1960;10:107–11.

37. Sicuteri F. The ingestion of serotonin precursors (L-5-hydroxytryptophan and L-tryptophan) improves migraine headache. Headache 1973;13:19–22.

38. Titus F, Davalos A, Alom J, Codina A. 5-hydroxytryptophan versus methysergide in the prophylaxis of migraine. Eur Neurol 1986;25:327–9.

39. Maissen CP, Ludin HP. Comparison of the effect of 5-hydroxytryptophan and propranolol in the interval treatment of migraine . Schweizerische Medizinische Wochenschrift /Journal Suisse de Medecine 1991;121:1585–90 [in German].

40. De Benedittis G, Massei R. 5-HT precursors in migraine prophylaxis: A double-blind cross-over study with L-5-hydroxytryptophan versus placebo. Clin J Pain 1986;3:123–9.

41. Mathew NT. 5-hydroxytryptophan in the prophylaxis of migraine. Headache 1978;18:111–3.

42. Bono G, Criscuoli M, Martignoni E, et al. Serotonin precursors in migraine prophylaxis. Advances in Neurology 1982;33:357–63.

43. De Giorgis G, Miletto R, Iannuccelli M, Camuffo M, Scerni S. Headache in association with sleep disorders in children: A psychodiagnostic evaluation and controlled clinical study ñ L-5-HTP versus placebo. Drugs Exptl Clin Res 1987;13:425–33.

44. Santucci M, Cortelli P, Rossi PG, et al. L-5-Hydroxytryptophan versus placebo in childhood migraine prophylaxis: a double-blind crossover study. Cephalalgia 1986;6:155–7.

45. Claustrat B, Brun J, Geoffriau M, et al. Nocturnal plasma melatonin profile and melatonin kinetics during infusion in status migrainosus. Cephalalgia 1997;17:511–7; discussion 487.

46. Nagtegaal JE, Smits MG, Swart AC, et al. Melatonin-responsive headache in delayed sleep phase syndrome: preliminary observations. Headache 1998;38:303–7.

47. Hepinstall S, White A, et al. Extracts of feverfew inhibit granule secretion in blood platelets and polymorphonuclear leukocytes. Lancet 1985; i:1071–4.

48. Murphy JJ, Hepinstall S, Mitchell JRA. Randomized double-blind placebo controlled trial of feverfew in migraine prevention. Lancet 1988;ii:189–92.

49. Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J 1985;291:569–73.

50. Palevitch D, Earon G, Carasso R. Feverfew(Tanacetum parthenium) as a prophylactic treatment for migraine: A double-blind placebo-controlled study. Phytother Res 1997;11:508–11.

51. Awang DVC. Parthenolide: The demise of a facile theory of feverfew activity. J Herbs Spices Medicinal Plants 1998;5:95–8.

52. Srivasta KC, Mustafa T. Ginger (Zingiber officinale) in migraine headache. J Ethnopharmacol 1992;39:267–73.

53. Chung KF, McCusker M, Page CP, et al. Effect of a ginkgolide mixture (BN 52063) in antagonising skin and platelet responses to platelet activating factor in man. Lancet 1987;i:248–51.

54. Levy RL. Intranasal capsaicin for acute abortive treatment of migraine without aura. Headache 1995;35:277 [letter].

55. Baischer W. Acupuncture in migraine: long-term outcome and predicting factors. Headache 1995 Sep;35:472–4.

56. Boivie J, Brattberg G Are there long lasting effects on migraine headache after one series of acupuncture treatments? Am J Chin Med 1987;15:69–75.

57. Loh L, Nathan PW, Schott GD, Zilkha KJ. Acupuncture versus medical treatment for migraine and muscle tension headaches. J Neurol Neurosurg Psychiatry 1984;47:333–7.

58. Spoerel WE, Varkey M, Leung CY. Acupuncture in chronic pain. Am J Chin Med 1976;4:267–79.

59. Vincent CA. A controlled trial of the treatment of migraine by acupuncture. Clin J Pain 1989;5:305–12.

60. Lenhard L, Waite PME. Acupuncture in the prophylactic treatment of migraine headaches: pilot study. NZ Med J 1983;96:663–6.

61. Vincent CA. A controlled trial of the treatment of migraine by acupuncture. Clin J Pain 1989;5:305–12.

62. Baischer W. Acupuncture in migraine: long-term outcome and predicting factors. Headache 1995 Sep;35:472–4.

63. Cheng AC. The treatment of headaches employing acupuncture. Am J Chin Med 1975;3:181–5.

64. Shuyuan G, Donglan Z, Yanguang X. A comparative study on the treatment of migraine headache with combined distant and local acupuncture points versus conventional drug therapy. Am J Acupuncture 1999;27:27–30.

65. Hesse J, Mogelvang B, Simonsen H. Acupuncture versus metoprolol in migraine prophylaxis: a randomized trial of trigger point inactivation. J Intern Med 1994;235:451–6.