Melatonin

 

How melatonin works:  Melatonin is a relatively new migraine therapy. Melatonin is a chemical in the brain that lets the brain know it’s time to go to sleep. It became popular as a migraine treatment after some studies showed that on migraine days, people had lower levels of melatonin in their brain compared to days people did not get a migraine. Also, other studies have shown that people who get migraines have lower levels of melatonin in their brains compared with people who don’t get migraines.  1 Sleep is strongly associated with migraine and getting too much or too little can be a trigger for people.

 

Evidence in children: There has currently been some research that suggests melatonin might help reduce the number of headache days in children. 2–4 However, the studies that showed melatonin might help reduce headache days in children with migraine were not designed to rule out other explanations for the results (double-blind, placebo-controlled research). Meaning there were reasons to believe that things other than the melatonin alone might have been why children were having fewer headaches.

 

Cautions: Right now, it can be said that melatonin might help reduce headache days in children and that it is possibly safe for adults to take melatonin for short periods of time 5 but the safety for children taking melatonin is unknown. If you’re considering melatonin as a therapy, it is something to discuss with your doctor.  If you and your doctor decide melatonin is a good option for your child one note would be that one of the side effects of melatonin is a headache. A good way to see if melatonin is working for your child would be to keep track of migraines with an app or journal before and during a trial period of melatonin.

 

 

Magnesium

 

How magnesium works: There have been several studies that showed in the brains and bodies of people with migraine there is less magnesium. 6 There is a theory of migraine that says this lower level of magnesium creates an energy deficit that is responsible for the pain in migraine. Taking magnesium supplements is thought to bring magnesium levels back up such that migraines are reduced.

 

Evidence in children: In adults, taking magnesium supplements seems to reduce the number of headache days according to several studies, although one study did not find this. Magnesium may be a good option for preventative treatment of pediatric migraine, given its relative safety and tolerability. However, only one study has investigated magnesium supplementation for children who have migraines.  This study found that magnesium reduced headache days for children with migraines but not more than placebo. 7 This means that there is not conclusive evidence that magnesium is helpful for children with migraines because it has not been studied enough.

 

Cautions: Diarrhea is generally the first symptom of too much magnesium in the body. Too much magnesium can be a very serious issue. It can cause muscle weakness, this muscle weakness can also affect the muscles that aid in breathing and the heart. The body is generally highly efficient at clearing magnesium and preventing magnesium from building up but in some people, this ability is impaired, for example, people with kidney disease. People with kidney disease should not take magnesium supplementation 7

 

 

Feverfew

 

How feverfew works: Feverfew is a weed plant that has anti-inflammatory properties. Inflammation is thought to be one of the reasons migraine pain is felt. Reducing inflammation also reduces the migraine pain.

 

Evidence in children: Feverfew has not been studied in child or adolescents as a treatment for migraine. There are studies in adults and some show feverfew improves symptoms for people with migraine and other studies do not show feverfew is effective in reducing migraines. 8

 

Cautions: Because feverfew has not been studied in children it is not suggested that children use it, as is unclear how safe or effective it is for children.  It has been studied in teens over 16 years old and in adult trials. As such, teenagers may wish to use feverfew. People who have an allergy to ragweed and related plants should not use feverfew. Feverfew may also slow blood clotting and should be avoided by people with clotting disorders or who have an upcoming surgery. In adults, some reported side effects of feverfew are nervousness, dizziness, headache, trouble sleeping, joint stiffness, tiredness, menstrual changes, rash, pounding heart and weight gain. 8

 

 

Coenzyme Q10

 

How Coenzyme Q10 works: Coenzyme Q10 is a nutrient that parts of cells (the mitochondria) use to help convert food into energy for the body (read more about this in migraine theories).  In this theory of migraine pain, there is an energy deficit in the brain that causes pain because the cells aren’t working properly and need help producing energy. Adding more coenzyme Q10 theoretically helps correct this deficiency. Also, more recent research has suggested that coenzyme Q10 may reduce CGRP (calcitonin gene-related peptide) levels. CGRP blockers are the first treatment developed specifically to prevent migraines. 12

 

Evidence in children: Currently two studies have investigated coenzyme Q10 in preventing migraine in children.  Both studies saw coenzyme Q10 helped reduce the number of headache days but these studies were not designed to rule out other explanations for the results (double-blind, placebo-controlled research). Meaning there were reasons to believe that things other then coenzyme Q10 alone might have been why children were having less headaches. Therefore, it is difficult to say definitely that coenzyme Q10 is the reason headache days were reduced.  12

 

Cautions:  In one large study of coenzyme Q10 there were no negative side effects recorded but coenzyme Q10 can be expensive as a treatment. 12

 

 

Riboflavin (Vitamin B2)

 

How riboflavin works: Riboflavin is also nutrient that mitochondria use to help convert food into energy for the body (read more about this in migraine theories). In this theory of migraine pain, there is an energy deficit in the brain that causes pain because the mitochondria aren’t working properly and need help. Adding more riboflavin theoretically helps correct this.

 

Evidence in children: Evidence for use of riboflavin in children is very limited. One recent randomized, double-blind, placebo-controlled trial (what is considered the gold-standard of drug research) did find that headache days were reduced and the length of a migraine when children did have them was reduced. 9 However, in three previous double-blind placebo-controlled trials there was not a difference in the number of headache days or headache pain between the groups of children with migraines receiving riboflavin and the groups of children with migraines who received placebo.  One other study did find riboflavin reduced headache pain and frequency in children but this study was done retrospectively, meaning people were asked after taking riboflavin if they thought their headaches were less frequent or less painful. 10 This way of conducting research means that people can unintentionally misremember what things were like before and is considered biased.

 

Cautions: Riboflavin is well tolerated without reports of serious toxicity. People taking riboflavin take about 100x more than normal dietary intake and sometimes experience diarrhea, orange-coloured urine or vomiting. 10

 

 

Butterbur (petasites hybridus)

 

How butterbur works: Butterbur is a natural painkiller that has been used for over 2000 years. It is thought to have anti-inflammatory activities, similar to ibuprofen.

 

Evidence in children: Butterbur has been established as an effective migraine prevention therapy. 11

 

Cautions: Butterbur has a compound in it that is toxic to the liver. In Petadolex the formulation of butterbur studied in pediatric studies it is said to contain undetectable levels of the toxic compound.  The FDA and Health Canada have not put restrictions on butterbur because of this compound but European health agencies have banned it because of the potential toxicity. 12

 

 

Vitamin D

 

How Vitamin D works: It is unclear how vitamin D might play a role in migraine prevention. Vitamin D does however, play a large role in brain development, and preventing brain cell death, along with other roles in the brain. 12

 

Evidence in children: There is limited evidence for vitamin D supplementation for children with migraine. Two studies have shown that in children who have migraines and are deficient in vitamin D, taking vitamin D can help reduce the number of headache days. One issue is that both of these studies were done in a way that researchers would say isn’t “good science” what this means is that from the study other things may have been the reason why the number of headaches were reduced and vitamin D might not be the reason. 12

 

Cautions: At reasonable doses (for example one or two 1000 IU vitamin D supplements per day) vitamin D is safe for children to take. Toxic effects from vitamin D are possible but generally needs to be at very high doses (such as 200,00 IU per day). 12