We have already discussed many of the most common over the counter supplements that many people are using to control or reduce their migraine symptoms. This discussion would be incomplete without mentioning a couple more of the most popular herbal remedies.
Feverfew (Tanacetum parthenium L.) is a medicinal plant traditionally used for a variety of illnesses including migraine prevention. It has many active compounds and is believed to have many different pharmacologic effects including anti-inflammatory and anti-carcinogenic properties. There are many different active compounds, with the most important one being parthenolide.
Fever few exerts an anti-inflammatory effect by binding to and blocking pro-inflammatory cytokine-mediated signals. It also suppresses prostaglandin activity and decreases vascular smooth muscle spasm. It also inhibits release of serotonin from platelets which may help to explain its effects on migraine.
There have been many studies performed on feverfew to establish whether this has shown improvement in migraine headaches. A 2015 systematic review found six randomized controlled trials that included 561 patients. Four of the trials found a beneficial effect of feverfew on migraine reduction while two trials found no clinical significant effect.
The recommended dosage is 100-300mg up to 4 times daily for migraine prevention. As this is an herb, concentrations are not standardized. You want to make sure that it contains at least 0.2-0.4% of parthenolides. Patients usually need to take this for at least several months before migraine improvement may be noticed.
As feverfew has been shown to inhibit platelet aggregation, it should not be taken by people who are taking blood thinners such as aspirin, Coumadin, or Xarelto. It should also not be taken by pregnant patients as it does exhibit some smooth muscle relaxation.
While most trials showed no significant side effects of those taking this herb, there have been studies that showed adverse symptoms in patients who abruptly stopped taking this herb after taking it for many years. In some people this can be quite severe and cause severe exacerbation of headaches, insomnia, joint stiffness or pain and nausea and vomiting and is referred to as post feverfew syndrome. More mild symptoms have been reported such as abdominal bloating, constipation or diarrhea.
Butterbur is a shrub (petasites hybridus) that grows in parts of Europe, Asia and North America. There are active ingredients that appear to have anti-inflammatory and anti-spasm effects that appear to prevent symptoms of migraine.
Several studies showed significant reduction of migraine frequency when taking at least 75mg twice daily for 12 weeks.
Raw, unprocessed butterbur contains chemicals called pyrrolizidine alkaloids (PA’s), which can cause liver damage and result in serious illness. There are some commercial butterbur products that contain extracts from the root of the plant or rhizome that appear safe in studies. Only butterbur products that have been processed to remove the PAs and are labeled as PA free should be used.
PA free butterbur appears to be safe and well tolerated but studies on long term usage are lacking. Some mild adverse side effects have been reported such as itchy eyes, diarrhea or fatigue due to some antihistamine activity. Both butterbur and feverfew can cause allergic reactions in people who are sensitive to plants such as ragweed, chrysanthemums, marigolds and daisies.
Unfortunately, recent data shows that a significant number of commercial butterbur products still have PAs present. Due to the unregulated nature of this compound and the potential for adverse liver toxicity due to PA contamination, this herb is no longer routinely recommended by the neurologic and headache societies.
These are just a few natural supplements that can be tried in your overall migraine tool kit. Some may work for you and others may not. And some used in conjunction with your other prophylactic medications and lessen frequency and severity of your migraine symptoms. Best of luck in your migraine journey.
Dr. Camille, M.D.
The Migraine Doctor