Primary preventive measures to reduce migraine, such as the healthy headache lifestyle, are key to keeping migraine frequency to a minimum. But even though your patient is really working hard with the multidisciplinary approach, your patient is still having frequent migraines which significantly impact their functioning. When do you consider adding a daily medication to prevent migraines? The mark I use is one migraine/week. That is when the conversation needs to start. Any less than that, the kids may be unnecessarily exposed to medication effects and side effects.
Not every youngster needs to take a daily preventive medication, even when they have 1 migraine per week. It really depends on the impact of those migraines. Are they missing school with every migraine? Does the migraine last for several days, leading to even more missed school? Are they missing out on desired activities, like sports, scouts, music or dance? Are they missing out on time with friends and family? Does the patient want to try a daily medication? Is the family in favor or opposed to it? Everyone involved needs to be in the conversation.
However, when the patient is having more than 1 migraine per week, it is a good idea to consider a daily medication, as it is likely that migraine is taking a toll of the patient and family. Do you start with a prescribed medication or supplements/vitamins?
Supplements: If you and/or the family are on the fence about starting a medication, a nice intervention to add is a supplement known to help headaches. I always advocate for using a single product at a time, taking it for at least 3 months and evaluating effectiveness. A good quality supplement, which can be obtained at the local pharmacy, is totally adequate to try and there are often opportunities to save money on them. These supplements are generally well tolerated and can be effective.
Here are the most commonly used supplements for headache and migraine:
Magnesium is an important mineral responsible for building/strengthening bones and teeth, relaxing muscles, transmitting nerve signals, strengthening the immune system, energizing metabolism, supporting vascular tone, and regulating blood pressure. People with frequent headaches often have low magnesium levels. Research has shown that magnesium also can reduce the frequency and severity of migraine headaches, particularly menstrual migraine. It can also be used a rescue medication during migraine episodes. Those with bleeding disorders, diabetes, kidney or heart problems should talk with their provider before starting magnesium.
Possible side effects: GI-related, such as nausea, vomiting and diarrhea.
The best forms of magnesium are magnesium glycinate or magnesium citrate, which are the most bioavailable and best absorbed. Magnesium oxide is much less bioavailable. Usual dosing used to reduce the severity and frequency of migraines is 200-500mg/day. It may take up to three months to get best results.
Riboflavin is a water-soluble B-complex vitamin that is used by every cell in the body to produce energy, to repair and maintain the health of skin, hair, eyes and to convert carbohydrates, protein and fat into energy. Research has shown that Riboflavin can decrease both the frequency and intensity of migraine headaches.
Possible side effects are: bright yellow or orange urine, GI upset or diarrhea.
Usual dosing used to reduce the severity and frequency of migraines is 100mg-200mg per day. It may take up to three months to get best results.
Coenzyme Q10 is an essential nutrient to overall health, found in every cell of the body. It helps to prevent cholesterol build up in the arteries to prevent heart disease, relaxes vascular tone to treat and prevent high blood pressure, and helps to slow the progression of neurological diseases, like Parkinson’s disease. Taking coenzyme Q-10 by mouth seems to help prevent migraine headaches, decreasing frequency by 30% and reducing headache-related nausea by 45%.
Possible side effects include stomach upset, loss of appetite, nausea, vomiting, and/or diarrhea; allergic skin rash; decreased blood pressure.
Usual dosing for preventing migraine headache: CoQ10 100mg 1-3 times daily. It may take up to three months for significant benefit.
Essential Fatty Acids (Omega-3), such as fish oil supplements,, may be useful for decreasing headaches. They are generally well tolerated, particularly the molecularly distilled formulations that minimize fishy taste and belching, common with these products. Following an anti-inflammatory diet rich in Omega-3 fatty acids is also a way to support headache and overall health.
Feverfew (tanacetun parthenium) is made from the dried leaves of a type of chrysanthemum. There is little scientific data to support its effectiveness, but it has a long history of use for migraine prevention. There is also a large variation in dosage strength. It is a component of the product Migrelief (magnesium, riboflavin and feverfew), and other supplement blends.
There are many combination products on the market. I have seen one which contains 10 supplements in one tab! The problem with combination products is that you are unable to figure out what exactly is helping, therefore are ‘married’ to a particular supplement formulation. And you know that’s going to be expensive.
Next up, preventive medications revisited
HeadFirst PNP 