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Examining Supplements for Chronic Daily Headache & Migraine Treatment

Dietary supplements feverfew, butterbur, magnesium, riboflavin, coenzyme Q10 and melatonin pop up frequently in the discussion of treatment for chronic daily headache and migraine. Do they work? According to headache specialist Stewart J. Tepper in the medical journal Consultant, “Although the data are relatively few, and sometimes weak, there is some evidence that so-called natural remedies may be effective at preventing or aborting migraine attacks.”

Even if the evidence is weak, many people with CDH and migraine are willing to try supplements because there’s a chance that it might work for them. That’s my approach too, unless there’s indication that the supplement might be harmful or there hasn’t been enough research to show the long-term effects of it.

The journal Headache published a detailed review of supplements in 2006.

“Natural” or Alternative Medications for Migraine Prevention, an article in the journal Headache in 2006, introduced the topic:

For preemptive prophylactic therapy, CAM [complementary and alternative medicine] is not only a viable option, but should be a major consideration. Patients often balk at the use of daily drugs due to the perception such treatment may frequently cause side-effects. So, why not a “natural” agent, mineral, vitamin, or bodily substance? The modern equivalent to the “wild, wild, west” (ie, the Internet) informs us that petasites…. [T]hese CAM therapies are not as strictly regulated by the Food and Drug Administration of the United States as are prescription therapies and devices; they are classified as dietary supplements and not drugs.

The article includes efficacy and safety details on the following supplements:

If the links take you to a sign-in page, you can get a login at BugMeNot.

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Mini-Medical School from UCSF’s Osher Center for Integrative Medicine

University of California San Francisco faculty members and other experts discuss current issues in health and science. Presentations from the last five years are available online. Some of particular interest include:

Coping With Stress

Brain, Mind and Behavior

Complementary & Alternative Medicine

UCSF’s Osher Center for Integrative Medicine runs the mini-medical school program.

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Debilitating Nausea Caused By High(ish) Magnesium Dose

white capsulesWoo hoo! I feel human again and it’s all because I stopped taking magnesium. Yep, magnesium, the wonder supplement that helps so many people with migraine and chronic daily headache. I don’t think magnesium itself is to blame, but that the dose was too high. Since I can’t even take a multivitamin without nausea, I was hyper-aware as I increased from my starting dose of 100 mg. Or so I thought.

At 333 mg per day, it was within the normal dose range for treating headaches of 200-500 mg per day. It was also within the recommended daily allowance of 350 mg. I’ve discovered that allowances and ranges are like speed limits: A guideline you’re not supposed to exceed, but that you don’t have to meet.

Practically every health care provider I’ve seen has recommended magnesium to me. I’ve taken it on and off over the last five years, although this is the first time I’ve taken it consistently for more than a few weeks. Because I’ve read so much about it and had it prescribed before, I thought I could adjust the dose myself just fine. I figured I’d be fine if I stayed at or under the RDA. I unwittingly fell for the myth that medications, vitamins and supplements sold over-the-counter are harmless.

The good and frustrating news: My overall head pain was less and I had fewer migraines during the time I was horribly nauseated. I’m guessing that means the magnesium helped some. I think once my system flushes the current round of magnesium, I’ll have my different vitamin and mineral levels tested. I’ll also make myself keep a diary of my symptoms and doses. I wouldn’t want to go through these last six weeks again. I felt horrible and was so scared of what might be wrong with me.

I haven’t had any blood tests, so I’m not positive the nausea was caused by excessive magnesium. But when debilitating nausea that began about the time I increased my dose goes away when I stop taking the pills, the evidence is strong enough for me.

What is your experience been with magnesium? Please leave a comment below or chime in on the online support group and forum.

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Alternative and Complementary Medicine: Evaluating Success Rates

Evaluating any medical claim carefully is crucial, no matter the source. With so many false or overblown claims about alternative and complementary treatments, I’m pretty skeptical. Alternative Medicine: Evaluate Claims of Treatment Success from the Mayo Clinic can help sort fact from fiction.

The section on avoiding internet misinformation is a must-read. Other topics in the article beware of health care scams and fraud, looking for solid scientific studies, evaluating providers and dietary supplements, and integrating Western medicine with complementary treatments.

Related articles from the Mayo Clinic include:

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Magnesium & Migraine

By Christina Peterson, MD

Should You Be Taking Magnesium?
Two doubleblind studies have shown that magnesium supplementation may reduce the frequency of migraine. In research studies, we have found that magnesium levels affect serotonin receptors, and also have an effect on nitric oxide synthesis and release, as well as on NMDA receptors—all brain structures and chemicals suspected to be important in migraine. In small studies, both migraine and cluster headache patients have responded acutely to intravenous magnesium. In a larger double-blind controlled study, the treatment group, receiving 600mg of magnesium for a 12 week period, experienced a 41.6% reduction in headaches as compared to only 15.8% reduction in migraine headaches in the placebo group.

What Does Magnesium Do?
It is responsible for over 300 essential metabolic reactions in the body. It is required for synthesizing proteins in the mitochondria, and for generating energy in most of the body’s basic cellular reactions. It is necessary for several steps in the synthesis of DNA and RNA. Magnesium is also present in a number of other important enzymes. As important as it is intracellularly, 60% of the body’s magnesium is present in bone, and 27% in muscle.

Magnesium Supplements
If you decide to take supplemental magnesium, start at 400-500 mg/day in divided doses. The limiting factor for most people is diarrhea. If you are on a migraine preventative medication that is constipating, like amitriptyline or verapamil, this might be a plus.

WARNING: If you have heart disease or kidney disease, or are prone to kidney stones, talk to your doctor before starting on calcium and/or magnesium.

To be metabolized effectively, magnesium must be taken with calcium. The amount of calcium should be no more than double the amount of magnesium— this is the ratio commonly recommended for women. Men may require less calcium, and sometimes take a ratio of calcium-magnesium that is equivalent mg/mg.

Many people take in only 60-70% of the recommended daily allowance in the first place, and then things like stress and caffeine can deplete that further throughout the day. Migraine sufferers have been found to have a relative magnesium deficiency in their bloodstream between migraine attacks, and intracellular magnesium levels drop even further during a migraine attack.

Magnesium oxide, magnesium citrate, and magnesium sulfate are bioavailable — look for mixed salts of these forms, or magnesium gluconate, which is ionized, and is biologically active; if you develop diarrhea from those forms of magnesium, look for chelated magnesium.

Magnesium carbonate dissolved in CO2- rich water is 30% more bioavailable than magnesium found in foods or in pill-format.

Foods Rich in Magnesium

  • Peanuts*
  • Almonds*
  • Brown rice
  • Hazel nuts*
  • Blackstrap molasses
  • Bananas*
  • Beans
  • Tofu*
  • Soy beans*
  • Avocado*
  • Broccoli
  • Spinach
  • Swiss chard
  • Tomato paste
  • Sweet potato
  • Pumpkin seeds
  • Peanut butter*
  • Chocolate*
  • Cocoa powder*
  • Succotash
  • Cooked artichoke
  • Black-eyed peas
  • Whole-grain cereals
  • Cooked okra
  • Beet greens
  • Acorn squash
  • Chickpeas
  • Split peas
  • Lentils
  • Kiwi fruit*
  • Apricots
  • Baked potato
  • Raisins
  • Yogurt*
  • Milk

*these can be migraine triggers for some people

Magnesium-Drug Interactions

  • Digoxin – Decreased absorption due to magnesium
  • Nitrofurantoin – Decreased absorption due to magnesium
  • Anti-malarials – Decreased absorption due to magnesium
  • May interfere with quinolone or tetracycline antibiotics
  • May interfere with anticoagulants
  • Diuretics such as furosemide (Lasix) or hydrochlorothiazide can result in magnesium depletion
  • Iron supplements may interfere with magnesium supplement absorption

This article appeared in the April/May 2006 of the Headquarters Migraine Management newsletter, Dr. Peterson’s bimonthly newsletter on migraine awareness and education. If you’re not signed up to receive this electronic newsletter, you’re missing out!