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synergy · 2
In the Sándor 2005 double-blind randomized trial (42 people), CoQ10 300 mg a day halved attacks or better by month 3 in 47.6% vs 14.4% on placebo. The 2012 guideline of the American Academy of Neurology and American Headache Society rates it possibly effective for prevention, one tier below magnesium and riboflavin (probably effective). It works slowly: it takes months to tell whether it helps.
In Peikert 1996, a double-blind randomized trial, a fairly high daily dose of oral magnesium cut migraine frequency more than placebo did. Possible mechanisms are magnesium's blocking of NMDA receptors and relaxation of the smooth muscle in brain blood vessels. The 2012 guideline of the American Academy of Neurology and American Headache Society rates magnesium probably effective for preventing migraine. The trial dose was above the tolerable upper intake level (UL) for supplemental magnesium, 350 mg a day, so it should be used under medical guidance.
regulates · 5
The current model of migraine: the trigeminal nerve and the blood vessels of the brain's coverings are activated and release calcitonin gene-related peptide (CGRP), which carries pain signals inward and makes the central nervous system more sensitive. Monoclonal antibodies against CGRP or its receptor, and small-molecule drugs called gepants, have reached the market since 2018 and changed both prevention and acute treatment of migraine.
Riboflavin (vitamin B2) is one of the better-supported supplements for preventing migraine: in the body it becomes coenzymes such as FAD that take part in energy production in mitochondria. In a randomized trial, high-dose riboflavin reduced attacks more than placebo; it is cheap and safe, though the effect is not large.
Poor sleep is a common migraine trigger; in turn, waking at night with migraine and living with chronic pain can cause insomnia, and the two often occur together. Cognitive behavioral therapy for insomnia (CBT-I) has some indirect evidence for reducing migraine attacks, and treating one often helps the other.
A sharp drop in estrogen is one of the main triggers of menstrual and perimenopausal migraine. In early perimenopause, when hormones swing widely, attacks may become more frequent and more severe; after menopause, when hormones settle, many people improve. Anyone with migraine who is considering menopausal hormone therapy should discuss the form and the way of taking it with a doctor.
Dehydration may trigger migraine in some people, but migraine itself is a neurovascular disorder in which a signaling molecule called CGRP is a key link, and a newer class of drugs for preventing and treating attacks is designed to target it. Relying on drinking more water alone misses the treatments that actually work.