Migraine Prevention

Magnesium is the most-evidenced supplement for migraine prevention. Multiple randomized trials and a meta-analysis show reduction in migraine frequency. The American Headache Society lists oral magnesium as Level B (probably effective) for prevention. Mechanism involves suppression of cortical spreading depression and improvement in cerebrovascular tone. The glycinate form is gentler on the GI tract than oxide or citrate at higher doses.^{[1, 2, 3]}

Riboflavin is a cofactor in mitochondrial energy production. The landmark Schoenen 1998 trial in Neurology found a ~50% reduction in migraine attack frequency over 3 months at 400 mg/day. Subsequent trials and a Cochrane review have generally supported this finding. American Headache Society lists riboflavin as Level B for prevention. Harmless side effect: bright yellow urine.^{[4, 5, 6]}

CoQ10 supports mitochondrial energy production — migraines are increasingly understood as a mitochondrial disorder. Multiple randomized trials show reduced migraine frequency over 3 months. The ubiquinol form has better bioavailability than ubiquinone. American Headache Society lists CoQ10 as Level C (possibly effective) for prevention. Fat-soluble — take with a fat-containing meal.^{[7, 8, 9]}

Feverfew has been used for migraine prevention historically. A Cochrane review found mixed but generally positive evidence for reduced migraine frequency with standardized extracts. Effect is modest relative to magnesium and B2. Use a standardized extract (0.2-0.4% parthenolide).^{[10, 11, 12]}

Butterbur had Level A evidence (effective) for migraine prevention in older guidelines — strong efficacy in trials. However, pyrrolizidine alkaloids (PAs) in natural butterbur are hepatotoxic. American Headache Society removed butterbur from its recommendations in 2015 due to safety concerns. PA-FREE certified extracts may be safer, but use only for a 3-month course with liver function monitoring. Treat as the most speculative item in the stack — and worth discussing with your provider first.^{[13, 14]}