Migraine is a chronic neurological disorder characterized by recurrent attacks of moderate to severe headache, often pulsatile and unilateral, lasting 4-72 hours, associated with nausea, vomiting, photophobia and phonophobia, and sometimes sensory aura… Read more.
5 factors with evidence, ordered from highest to lowest effectiveness. Information, not medical advice.
⏱ 2 min read
Migraine is a chronic neurological disorder characterized by recurrent attacks of moderate to severe headache, often throbbing and unilateral, lasting 4–72 hours, associated with nausea, vomiting, photophobia and phonophobia, and sometimes sensory aura; it affects approximately 15% of the world's population with a female predominance, and is one of the leading causes of years lost to disability. The good news is that there are both pharmacological options for acute and prophylactic treatment and nutritional and lifestyle interventions with real clinical support.
Some common triggers (they vary between individuals): - Stress and abrupt relief from stress (weekend migraine). - Changes in sleep schedules (deprivation or excess). - Skipping meals, hypoglycemia, prolonged fasting. - Dehydration. - Hormonal cycles (catamenial migraine). - Specific foods: alcohol (especially red wine), chocolate, aged cheeses, monosodium glutamate, nitrates/nitrites in processed meats, artificial sweeteners (in some people). Food sensitivity is highly individual. - Caffeine: both excess and abrupt withdrawal. - Weather changes, low atmospheric pressure. - Bright or flickering light, loud noise, strong odors. - Extreme physical exertion in susceptible people.
Keeping a headache diary for 1–2 months helps identify individual patterns.
Riboflavin (vitamin B2) (400 mg/day for 3 months): solid clinical support in migraine prophylaxis. Included in neurology guidelines. The Schoenen 1998 trial showed reductions of 50%+ in attack frequency in 59% of the active group vs. 15% of the placebo group.
Magnesium (400–600 mg/day as glycinate or citrate): support in prophylaxis, especially useful in people with subclinical deficiency and in catamenial migraine.
Coenzyme Q10 (100 mg 3 times a day): support in prophylaxis.
Feverfew (50–150 mg/day of standardized extract): modest support.
Petasites (butterbur): it had robust support but has been practically withdrawn because of hepatotoxicity concerns even with purified products.
Vitamin D: correct deficiencies.
Combinations (B2 + Mg + CoQ10) are common and reasonable.
Acute attack treatment: - NSAIDs (ibuprofen, naproxen, etoricoxib). - Acetaminophen with or without caffeine. - Triptans (sumatriptan, rizatriptan, eletriptan, others): specific for migraine. - Antiemetics when there is nausea (metoclopramide, domperidone). - Gepants (ubrogepant, rimegepant): new class. - Lasmiditan.
Prophylaxis (when there are > 4 attacks/month or highly disabling attacks): - Beta-blockers (propranolol, metoprolol). - Topiramate. - Amitriptyline. - Flunarizine, candesartan. - Anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab): a recent therapeutic revolution. - Botulinum toxin (in chronic migraine).
Headache of sudden, explosive onset ("the worst headache of my life"), headache with fever and neck stiffness, headache with new focal neurological deficits, progressive headache without remission, and headache beginning after age 50 are warning signs that require urgent evaluation. Refractory chronic migraine or severely disabling migraine should be evaluated by neurology to consider advanced prophylactic options (anti-CGRP, botulinum toxin).
Migraine responds best to a comprehensive approach: identifying and managing individual triggers, regular habits (sleep, meals, exercise), stress management, prophylaxis with baseline supplements (riboflavin + magnesium + CoQ10) with good support and a low adverse-effect profile, and appropriate acute and prophylactic drug treatment when needed. Anti-CGRP drugs have transformed the landscape in refractory migraine.
⏱ 2 min read
Migraine is a chronic neurological disorder characterized by recurrent attacks of moderate to severe headache, often throbbing and unilateral, lasting 4–72 hours, associated with nausea, vomiting, photophobia and phonophobia, and sometimes sensory aura; it affects approximately 15% of the world's population with a female predominance, and is one of the leading causes of years lost to disability. The good news is that there are both pharmacological options for acute and prophylactic treatment and nutritional and lifestyle interventions with real clinical support.
Some common triggers (they vary between individuals): - Stress and abrupt relief from stress (weekend migraine). - Changes in sleep schedules (deprivation or excess). - Skipping meals, hypoglycemia, prolonged fasting. - Dehydration. - Hormonal cycles (catamenial migraine). - Specific foods: alcohol (especially red wine), chocolate, aged cheeses, monosodium glutamate, nitrates/nitrites in processed meats, artificial sweeteners (in some people). Food sensitivity is highly individual. - Caffeine: both excess and abrupt withdrawal. - Weather changes, low atmospheric pressure. - Bright or flickering light, loud noise, strong odors. - Extreme physical exertion in susceptible people.
Keeping a headache diary for 1–2 months helps identify individual patterns.
Riboflavin (vitamin B2) (400 mg/day for 3 months): solid clinical support in migraine prophylaxis. Included in neurology guidelines. The Schoenen 1998 trial showed reductions of 50%+ in attack frequency in 59% of the active group vs. 15% of the placebo group.
Magnesium (400–600 mg/day as glycinate or citrate): support in prophylaxis, especially useful in people with subclinical deficiency and in catamenial migraine.
Coenzyme Q10 (100 mg 3 times a day): support in prophylaxis.
Feverfew (50–150 mg/day of standardized extract): modest support.
Petasites (butterbur): it had robust support but has been practically withdrawn because of hepatotoxicity concerns even with purified products.
Vitamin D: correct deficiencies.
Combinations (B2 + Mg + CoQ10) are common and reasonable.
Acute attack treatment: - NSAIDs (ibuprofen, naproxen, etoricoxib). - Acetaminophen with or without caffeine. - Triptans (sumatriptan, rizatriptan, eletriptan, others): specific for migraine. - Antiemetics when there is nausea (metoclopramide, domperidone). - Gepants (ubrogepant, rimegepant): new class. - Lasmiditan.
Prophylaxis (when there are > 4 attacks/month or highly disabling attacks): - Beta-blockers (propranolol, metoprolol). - Topiramate. - Amitriptyline. - Flunarizine, candesartan. - Anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab): a recent therapeutic revolution. - Botulinum toxin (in chronic migraine).
Headache of sudden, explosive onset ("the worst headache of my life"), headache with fever and neck stiffness, headache with new focal neurological deficits, progressive headache without remission, and headache beginning after age 50 are warning signs that require urgent evaluation. Refractory chronic migraine or severely disabling migraine should be evaluated by neurology to consider advanced prophylactic options (anti-CGRP, botulinum toxin).
Migraine responds best to a comprehensive approach: identifying and managing individual triggers, regular habits (sleep, meals, exercise), stress management, prophylaxis with baseline supplements (riboflavin + magnesium + CoQ10) with good support and a low adverse-effect profile, and appropriate acute and prophylactic drug treatment when needed. Anti-CGRP drugs have transformed the landscape in refractory migraine.