Feverfew, Petadolex (butterbur), and magnesium oxide have all proven effective in double-blind studies as migraine preventives. Of these, Petadolex has been the most effective. Omega-3 fatty acids may help headaches, and are an excellent supplement for general good health.
Petadolex is commonly used in Europe, and has been successful in preventing migraines in several well-designed blind studies. The usual dose is 50 mg., twice a day. Earlier concerns about carcinogenesis with this family of herbs have decreased with Petadolex, which is a purified form of the herb butterbur. Patients have occasionally experienced GI upset or a bad taste in the mouth, but its usually well tolerated.
Magnesium is a naturally occurring mineral which helps many systems in the body to function, especially the muscles and nerves. Magnesium oxide is used as a supplement to maintain adequate magnesium in the body. A dose of 400 or 500 mg. per day can be used as a preventive. However, mild GI side effects may limit use. There are also complications from drug interactions, and kidney and other diseases.
Feverfew has been demonstrated to be mildly effective in some patients for prevention of migraine headache. Fevefew can cause a mild tendency toward bleeding, and should be discontinued two weeks prior to any surgery. The problem with many herbal supplements is quality control. The amount of parthenolide (the active ingredient in feverfew) varies widely from farm to farm; certain farms consistently have better quality than others. Eclectic Institute uses a process that freeze-dries the herbs, making the product highly reliable. It is available in health food stores and at Whole Foods. The usual dose is 2 capsules each morning. Patients occasionally will be allergic to feverfew, and it should not be used during pregnancy.
Long Chain Fatty Acids (Omega-3 fatty acids) may play a role in headache prevention, and possibly be useful against anxiety, hypertension, arthritis, high lipids, depression and heart disease. We usually recommend fish oil or flaxseed oil, 1000mg. capsules, two to four per day. Fish oil capsules may be more effective than flaxseed oil. Fatty fishes such as salmon and tuna contain more oil than others. Look for the brands with the highest amounts of EPA/DHA listed on the label.
