Question on Guidelines: Are There Additional Complementary Treatments for the Prevention of Episodic Migraine?
LarryCharleston IV, Physician, Director SHMG's Comprehensive Headache Care Center
Published May 07, 2012
Silberstein et al. highlighted the evidence of complementary treatments for the prevention of episodic migraine. [1] There are a few natural supplements used in the prevention of migraine or its associated symptoms that were not classified in these guidelines. A review of additional natural supplements may be worthy of examination and classification based on their respective evidence.
• Alpha Lipoic Acid (Thioctic Acid): One underpowered randomized control trial 600mg/day strong trend for decrease monthly attack frequency (p=0.06). Within group analysis showed significant reduction in attack frequency, headache days, and headache severity in the treatment group. [2]
• Vitamin E: It has been demonstrated that Vitamin E effectively reduced the severity of headache pain, abortive headache medication usage, functional disability, and associated migraine symptoms (phonophobia, photophobia, and nausea) in pure menstrual migraine in a randomized controlled trial. [3] The authors recommended a dosage of 400IU for five days starting two days prior to menses.
• Ginko Biloba: In an open, preliminary trial, a combination of 60 mg ginkgo biloba terpenes phytosome, 11 mg coenzyme Q 10, and 8.7 mg vitamin B2 (Migrasoll) was effective in reducing both aura frequency and duration in the study population. [4]
1. Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman, E. Evidence-Based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults. Neurology 2012;78;1346-1353.
2. Magis D, Ambrosini A, S'andor P, Jacquy J. Laloux P, Schoenen, J.
A Randomized Double-Blind Placebo-Controlled Trial of Thioctic Acid in Migraine Prophylaxis. Headache 2007; 47:52-57.
3.Ziaei S, Kazemnejad A, Sedighi A, The effect of vitamin E on the treatment of menstrual Migraine. Med Sci Monit, 2009; 15(1):CR16-19 Available at: www.medscimonit.com/fulltxt.php?ICID=869523 Accessed on August 23, 2009.
4. D'Andrea G, Bussone G, Allais G, et al. Efficacy of Ginkgolide B in the prophylaxis of migraine with aura. Neurol Sci, 2009; 30(Suppl 1):S121-S124.
For disclosures, contact editorial office at journal@neurology.org.
Silberstein et al. highlighted the evidence of complementary treatments for the prevention of episodic migraine. [1] There are a few natural supplements used in the prevention of migraine or its associated symptoms that were not classified in these guidelines. A review of additional natural supplements may be worthy of examination and classification based on their respective evidence.
• Alpha Lipoic Acid (Thioctic Acid): One underpowered randomized control trial 600mg/day strong trend for decrease monthly attack frequency (p=0.06). Within group analysis showed significant reduction in attack frequency, headache days, and headache severity in the treatment group. [2]
• Vitamin E: It has been demonstrated that Vitamin E effectively reduced the severity of headache pain, abortive headache medication usage, functional disability, and associated migraine symptoms (phonophobia, photophobia, and nausea) in pure menstrual migraine in a randomized controlled trial. [3] The authors recommended a dosage of 400IU for five days starting two days prior to menses.
• Ginko Biloba: In an open, preliminary trial, a combination of 60 mg ginkgo biloba terpenes phytosome, 11 mg coenzyme Q 10, and 8.7 mg vitamin B2 (Migrasoll) was effective in reducing both aura frequency and duration in the study population. [4]
1. Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman, E. Evidence-Based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults. Neurology 2012;78;1346-1353.
2. Magis D, Ambrosini A, S'andor P, Jacquy J. Laloux P, Schoenen, J. A Randomized Double-Blind Placebo-Controlled Trial of Thioctic Acid in Migraine Prophylaxis. Headache 2007; 47:52-57.
3.Ziaei S, Kazemnejad A, Sedighi A, The effect of vitamin E on the treatment of menstrual Migraine. Med Sci Monit, 2009; 15(1):CR16-19 Available at: www.medscimonit.com/fulltxt.php?ICID=869523 Accessed on August 23, 2009.
4. D'Andrea G, Bussone G, Allais G, et al. Efficacy of Ginkgolide B in the prophylaxis of migraine with aura. Neurol Sci, 2009; 30(Suppl 1):S121-S124.
For disclosures, contact editorial office at journal@neurology.org.