Evidence-based herbal approaches for migraine prevention, acute treatment, and symptom management.
Migraine is not simply a headache. It is a complex neurological disorder affecting approximately 15% of the global population, characterized by recurrent attacks of moderate-to-severe head pain accompanied by nausea, vomiting, and sensitivity to light and sound [1]. The World Health Organization ranks migraine among the top causes of years lived with disability worldwide [2].
The pathophysiology involves multiple interconnected systems. The prevailing theory centers on calcitonin gene-related peptide (CGRP), a neuropeptide released from trigeminal nerve endings [3]. CGRP triggers vasodilation and neurogenic inflammation in the meninges, the protective membranes surrounding the brain [3]. This cascade activates pain pathways, leading to the characteristic throbbing headache. Additional mechanisms include cortical spreading depression (the electrical wave underlying aura), mitochondrial dysfunction (explaining why energy metabolism supports like CoQ10 work), and inflammatory mediator release involving COX-2, leukotrienes, and cytokines [4,5].
Modern pharmaceutical migraine treatments increasingly target CGRP directly - the newest class of drugs are CGRP receptor antagonists and monoclonal antibodies [3]. Several herbs work through these same pathways. [[materia/turmeric|Curcumin]] directly reduces CGRP levels (p<0.001) [6]. Butterbur inhibits CGRP release from meningeal afferents [7]. Chuan Xiong (Ligusticum chuanxiong) regulates CGRP via serotonin receptors [8]. The herbal interventions target validated, clinically-proven mechanisms.
The evidence base for herbal migraine treatment is substantial. Ginger has a meta-analysis showing pain-free status at 2 hours with RR 1.79 and pain score reduction with p<0.00001 [9]. CoQ10 achieves a number-needed-to-treat (NNT) of 3 for prevention - meaning for every 3 people treated, one achieves ≥50% reduction in migraine frequency [10]. Butterbur showed 48% reduction in frequency (p=0.0012) in a 245-participant RCT, though safety concerns have limited its use [11]. Nano-curcumin combined with omega-3 and CoQ10 achieves effect sizes (SMD 1.19) that rival or exceed many pharmaceuticals [12].
The critical insight: migraine is multi-factorial, requiring multi-mechanism treatment. Single-pathway interventions often fail because migraine involves vascular dysregulation, neurogenic inflammation, mitochondrial dysfunction, and neurotransmitter imbalances simultaneously [4,5]. This is why combinations consistently outperform monotherapy in clinical trials - feverfew alone shows p=0.26 (non-significant), but feverfew + ginger achieves p=0.002 (highly significant) [13]. Traditional Chinese Medicine recognized this centuries ago, with formulas like Chuan-Xiong-Cha-Tiao-San (the most prescribed TCM migraine formula in Taiwan) targeting multiple pathways through herb combinations [14].
The research divides into tiers based on evidence quality and safety profiles:
[[materia/ginger]] (Zingiber officinale) - Acute Treatment
Meta-analysis of 3 RCTs found ginger significantly effective for acute migraine: pain-free at 2 hours RR 1.79 [1.04-3.09], p=0.04; pain score reduction mean difference -1.27, p<0.00001 [9]. This p-value indicates high statistical confidence.
Mechanism: Dual COX-2 and LOX (lipoxygenase) inhibition, reducing prostaglandin and leukotriene production [15]. This dual action may provide advantages over NSAIDs that only block COX pathways. Active compounds: 6-, 8-, 10-gingerols and 6-shogaol inhibit inflammatory cytokines (IL-1β, TNF) and NF-κB activation [15].
Dosage: 250-500 mg powder at migraine onset, based on RCT protocols. Safety: GRAS (Generally Recognized As Safe) status [9].
Coenzyme Q10 - Prevention
Meta-analysis (2020) showed CoQ10 achieves NNT=3 for ≥50% reduction in migraine frequency [10]. In a women’s RCT (84 participants), CoQ10 300mg daily reduced frequency by 56.7%, severity by 46.6%, and duration by 60.0% versus placebo [16]. Network meta-analysis (2024) ranked CoQ10 + L-carnitine #1 for migraine frequency reduction [17].
Mechanism: Electron carrier in the mitochondrial electron transport chain, transferring electrons from Complex I/II to cytochrome C [10]. Migraine is linked to mitochondrial dysfunction and impaired energy metabolism - CoQ10 directly addresses this core pathology [5].
Dosage: 300-400 mg daily with meals (fat-soluble). Timeline: Superior to placebo by third month - prevention requires patience [10]. Safety: Excellent safety profile, well-tolerated long-term.
Peppermint/Menthol (Mentha × piperita) - Acute Treatment
RCT (2010) found 10% topical menthol superior to placebo for pain-free status at 2h (p<0.001), with 52% experiencing significant improvement [18]. Head-to-head trial (2019) showed intranasal peppermint 1.5% had comparable efficacy to intranasal lidocaine 4% [19]. Additional benefits: alleviates nausea/vomiting and photophobia/phonophobia [18].
Mechanism: TRPM8 channel activation (cold receptors), generating long-lasting cooling effect that inhibits pain signal transmission [20]. Genome-wide association studies (GWAS) revealed TRPM8 genetic variants associated with migraine susceptibility, suggesting peppermint targets a genetically-validated mechanism [20].
Application: Apply 10% menthol solution to forehead and temples at onset. Onset: Immediate to 15 minutes - fastest herbal option for acute relief [18]. Safety: Very safe, no significant adverse effects.
[[materia/turmeric|Curcumin/Turmeric]] (Curcuma longa) - Prevention
Meta-analysis (2024) of standard curcumin found migraine severity reduction with Hedges’s g = -0.75, p=0.03 [21]. RCT (2022, n=44) showed curcumin reduced CGRP with p<0.001, IL-6 p=0.041, headache severity p=0.001, and headache duration p=0.007 over 8 weeks [6]. Network meta-analysis ranked curcumin #1 for attack duration reduction [17].
Nano-curcumin (enhanced bioavailability): Scoping review/meta-analysis (2024) found migraine severity SMD -0.92 at 12.5x lower dose than standard curcumin [12]. Combined with omega-3 + CoQ10: SMD 1.19 [0.90-1.48], representing a strong combination effect in the literature [12].
Mechanism: CGRP inhibition (key migraine pathway), anti-inflammatory (multiple pathways), antioxidative, analgesic [6]. With omega-3: synergistic suppression of COX-2 and iNOS gene expression - the combination produces greater suppression than either alone [12].
Dosage: Standard curcumin 500mg twice daily (1000mg total); nano-curcumin 80mg daily. Timeline: 8 weeks minimum for standard, 2 months for nano-curcumin [6,12]. Safety: Well-tolerated in clinical trials.
Butterbur (Petasites hybridus) - Prevention
RCT (245 participants, 4 months) found butterbur 75mg bid achieved 48% reduction in migraine frequency (p=0.0012 vs placebo, which showed only 26% reduction) [11]. American Headache Society gave this Level A recommendation (highest level) based on the evidence [11].
CRITICAL SAFETY CONCERN: Hepatotoxicity risk from pyrrolizidine alkaloids (PAs). The American Academy of Neurology stopped recommending butterbur in 2015 due to liver toxicity concerns [11]. Only use PA-free standardized extracts with medical supervision and liver function monitoring. Contraindicated in liver disease.
Mechanism: Inhibits leukotriene biosynthesis (blocks LTB4, cysteinyl-leukotrienes), COX-2 inhibition reducing PGE2, blocks calcium influx, and inhibits CGRP release from meningeal afferents [7,11]. L-type voltage-dependent Ca2+ channel inhibition [7].
Dosage: 75mg bid (PA-free extracts only). Timeline: Minimum 4 months for full benefit [11]. Clinical reality: Most effective herbal option for prevention, but safety concerns severely limit use. Consider safer alternatives first.
Valerian + Hops Combination
Multiple RCTs support this combination for migraine when sleep disruption is present [22]. The Ze 91019 formulation (500mg valerian + 120mg hops) improved sleep quality and reduced headache frequency in 28-day trial of 184 participants, with no morning grogginess and critically - no rebound upon discontinuation [22].
Mechanism: Valerian provides GABAA receptor modulation and GABA breakdown inhibition; hops adds effects on GABA, serotonin, and melatonin receptors [23]. Multi-pathway targeting for migraine with sleep/anxiety components.
Lavender (Lavandula angustifolia) - Acute + Prevention
RCT (2012, n=47) found 15-minute inhalation reduced headache severity by 3.6±2.8 points on VAS, effective and safe for acute migraine management [24]. RCT (2016) found 3-month aromatherapy prophylaxis significantly reduced MIDAS score (p<0.05) with no adverse effects [25].
Mechanism: Inhibits leukotriene biosynthesis (anti-inflammatory cascade), GABA receptor modulation, linalool affects glutamatergic NMDA receptors, inhibits serotonin transporter (SERT), antagonizes NMDA receptor, affects 5-HT-1A receptor [24,25]. Anxiolytic/sedative properties address stress/anxiety triggers via modulation of limbic system through olfactory pathways [24].
Dosage: Acute - 2-4 drops inhalation for 15 minutes at onset; Prophylaxis - daily aromatherapy for 3 months. Timeline: Acute relief 15 minutes; prevention effects by 3 months [24,25].
Feverfew (Tanacetum parthenium) - Prevention (Combination Use)
Meta-analysis found feverfew alone non-significant (-0.6 attacks/month, p=0.26, low quality evidence) [26]. However, in combinations: Feverfew + ginger showed 63% relief vs 39% placebo, p=0.002 [13]. Feverfew + white willow achieved 61.7% reduction at 12 weeks [27]. HERBAMIG formula (feverfew + willow + CoQ10 + B2 + B12) reduced frequency, intensity, and duration in 302-patient real-world study [28].
Mechanism: TRPA1 modulation via parthenolide (partial agonist → receptor desensitization), CGRP release inhibition, serotonin effects (reduces platelet aggregation, inhibits serotonin release, noncompetitive inhibition of serotonin-smooth muscle response), NF-κB inhibition [26,29].
Clinical insight: Weak herb becomes effective in right combination. Feverfew’s transformation from non-significant to highly significant (p=0.002) in combinations demonstrates the power of multi-mechanism targeting [13].
Chuan Xiong + Bai Zhi (Ligusticum chuanxiong + Angelica dahurica)
Network pharmacology study (2022) plus evidence from 10 RCTs with 793 participants showed this Traditional Chinese Medicine herb pair achieves superior effects in reducing migraine attack frequency [30].
Chuan Xiong mechanisms: CGRP regulation via 5-HT1D and 5-HT7 receptors, increases cerebral blood flow, prevents neuronal apoptosis, regulates mitochondrial metabolism, down-regulates NF-κB/IL-1β/COX-2 [8,30]. Active compounds: Ligustilide (high blood-brain barrier penetration), senkyunolide A/B, tetramethylpyrazine (TMP) [30].
Bai Zhi mechanisms: Trigeminal neurovascular system modulation (key migraine factor), gut-brain axis regulation, decreases plasma CGRP, modulates serum/brain NO levels, increases beta-endorphin [30]. Traditional indication: “Value in treating facial pain of trigeminal neuralgia” [30].
Why superior: Chuan Xiong addresses vascular + central effects; Bai Zhi addresses trigeminal + peripheral effects. Together they cover both central and peripheral migraine mechanisms with complementary pathways [30].
Magnesium + Riboflavin + CoQ10
Multicenter RCT (2015, n=130) found this combination statistically significantly reduced symptom burden vs placebo over 3 months, with good tolerance and safety [31]. The trial “underlines role of mitochondrion in migraine” [31].
Mechanism synergy: Complete electron transport chain support. Magnesium is co-factor for ATP-synthase (finalizes ATP production) and physiological antagonist at NMDA channel (regulates neuronal excitability) [31]. Riboflavin is precursor for FMN and FAD (essential for Complex I/II) [31]. CoQ10 is electron carrier from Complex I/II to Cytochrome C [10]. Together: Riboflavin starts the chain → CoQ10 transfers electrons → Magnesium completes ATP production [31].
Dosage: Magnesium 600mg + Riboflavin 400mg + CoQ10 150mg daily. Timeline: 3 months for assessment [31].
Gastrodin/Tianma (Gastrodia elata) - TCM Context
Meta-analysis (2022) of gastrodin-containing preparations found “favorable results for migraine treatment” across 10 electronic databases [32]. Extensively combined with Chuan Xiong in Traditional Chinese Medicine - ranked #5 most common single herb in classical migraine literature [33].
Mechanism: Inhibits CGRP expression, crosses blood-brain barrier (widely distributed in tissues), with Chuan Xiong regulates MMP-9 to reduce BBB permeability, maintains BBB integrity in migraine models, anticonvulsant, sedative, analgesic, neuroprotective, antioxidative, immunomodulatory [32,33].
Da Chuanxiong Formula: Chuan Xiong (4 parts) + Tian Ma (1 part), classical ratio for “headache caused by blood stasis and wind-heat syndrome,” used for headaches in TCM for many years [33,34].
Chamomile (Matricaria chamomilla) - Topical for Acute Symptoms
RCT (2018, n=100) found topical chamomile gel effectively controlled nausea and vomiting during migraine attacks, with additional benefits for light/sound sensitivity [35].
Mechanism: Anti-inflammatory (multiple pathways), antispasmodic, anxiolytic properties [35]. Application: Topical gel applied during attacks. Timeline: 30-60 minutes for symptom relief [35].
Cinnamon
Network meta-analysis (2024) ranked cinnamon #1 for migraine severity reduction [17]. Limited head-to-head RCT data, but the network analysis signal is promising.
Vitamin D3
Network meta-analysis ranked Vitamin D3 #1 for reducing migraine days [17]. While not an herb, included for clinical context given the strength of ranking.
White Willow (Salix alba) - Combination Use
Strong evidence in combinations: Feverfew + willow showed 61.7% reduction at 12 weeks in prospective trial (n=12) [27]. HERBAMIG formula includes 150mg willow [28].
Mechanism: Salicin converted to salicylic acid (aspirin-like), nonselective COX-1/COX-2 inhibitor, blocks prostaglandin release, down-regulates TNF-α and NF-κB [27]. Flavonoids and polyphenols add anti-inflammatory effects.
Chuan-Xiong-Cha-Tiao-San (川芎茶調散)
#1 most prescribed TCM formula for migraine in Taiwan population study [14]. Classical literature contains 37 citations [14].
Composition: Bo He (Mentha/Peppermint), Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Qiang Huo (Notopterygium), Bai Zhi (Angelica dahurica), Chuan Xiong (chief herb) [14].
Traditional pattern: Wind-cold headache. Actions: Sedative effects, anti-inflammatory effects, releases exterior wind-cold, moves blood in the head [14].
Why this combination works: Multi-mechanism targeting. Chuan Xiong (in 59.8% of classical migraine formulas) provides CGRP regulation and cerebral blood flow increase [8,14]. Bai Zhi adds trigeminal system modulation and gut-brain axis regulation [30]. Bo He/Mentha provides TRPM8 activation and aromatherapy effects [20]. Supporting herbs (Jing Jie, Fang Feng, Qiang Huo) release exterior and disperse wind synergistically [14].
Mechanism synergy: Vascular (Chuan Xiong) + Trigeminal (Bai Zhi) + Sensory (Bo He) = three major migraine pathways addressed simultaneously [14,30].
Suan Zao Ren Tang (Ziziphus decoction)
While primarily for insomnia, meta-analysis of 1,454 patients found this formula “significantly improves sleep quality with minimal side effects” [36]. Relevant for migraine when sleep disruption is present. Requires TCM practitioner for pattern diagnosis and formula selection.
Oral Chinese Herbal Medicine Formulas
Systematic review and meta-analysis (2020) found Chinese herbal medicine effective for migraine prophylaxis in adults [37]. Most common herbs: Chuan Xiong (Ligusticum chuanxiong), Tian Ma (Gastrodia elata), Bai Zhi, Bo He, Sheng Jiang [37]. Meta-analysis (2024) found combination of Flunarizine with Chinese herbal decoctions markedly enhanced effective rate compared to Flunarizine alone [38].
Critical limitation: “Head-to-head comparative trials between individual herbs are lacking” [39]. Most research compares herbs to placebo rather than to each other. We can compare effect sizes against placebo (ginger’s p<0.00001 is extraordinarily strong, CoQ10’s NNT=3 is excellent), but we cannot definitively say “ginger beats feverfew” in direct comparison.
Other gaps: Optimal dosages not universally agreed (valerian ranges from 160-600mg across studies), long-term safety data limited beyond 3-6 months for most herbs except those with extensive traditional use (TCM formulas, ginger, peppermint), bioavailability data sparse, and individual variation poorly understood [39].
First-line: Peppermint Topical
Apply 10% menthol solution to forehead and temples at the first sign of migraine [18].
Why this works: TRPM8 channel activation produces cooling effect that inhibits pain signals through a genetically-validated mechanism (GWAS shows TRPM8 variants associated with migraine) [20]. Onset is immediate to 15 minutes - the fastest herbal option available [18]. RCT showed 52% significant improvement at 2h, comparable to intranasal lidocaine [18,19].
Non-oral route bypasses GI upset often present during migraine attacks. Also alleviates photophobia, phonophobia, and nausea [18].
Timeline: Apply at onset. Peak effect at 2 hours. Can reapply as needed.
Second-line: Ginger
250-500mg powder at migraine onset [9].
Why this works: The meta-analysis evidence shows high statistical confidence - p<0.00001 for pain score reduction, RR 1.79 for pain-free at 2h [9]. Dual COX-2 and LOX inhibition provides broader anti-inflammatory action than NSAIDs that only block COX pathways [15]. Reduces prostaglandins, leukotrienes, IL-1β, TNF, and inhibits NF-κB [15].
Timeline: Take at onset. Relief typically within 2 hours (standard migraine endpoint in trials) [9].
Enhanced: Feverfew + Ginger Sublingual
Commercial sublingual combination (e.g., LipiGesic™ M) taken at onset [13].
The RCT showed 63% pain relief vs 39% placebo, p=0.002 [13]. Sublingual delivery bypasses GI and first-pass metabolism for faster absorption. The combination works because feverfew adds TRPA1 modulation, CGRP inhibition, and serotonin pathway effects while ginger provides potent COX-2/LOX dual inhibition [13,15]. Together: multiple pain mechanisms blocked.
Timeline: Sublingual absorption rapid, relief within 30 minutes to 2 hours.
Combination Strategy for Maximum Acute Efficacy:
Rationale: Peppermint provides immediate cooling/analgesic via TRPM8 [18,20]. Ginger addresses inflammatory cascade via COX-2/LOX [15]. Lavender adds anxiolytic and anti-leukotriene effects [24]. Multi-mechanism targeting from three different pathways, all with RCT evidence for acute migraine.
First-line: CoQ10
300-400mg daily with meals (fat-soluble), for minimum 3 months [10,16].
Why this works: NNT=3 - meaning for every 3 people treated, one achieves ≥50% reduction in migraine frequency [10]. Women’s RCT showed 56.7% frequency reduction, 46.6% severity reduction, 60.0% duration reduction [16]. Network meta-analysis ranked CoQ10 + L-carnitine #1 for frequency [17].
Mechanism: Addresses mitochondrial dysfunction, a core migraine pathology [5,10]. CoQ10 is electron carrier in electron transport chain, improving energy metabolism in brain cells and reducing oxidative stress [10].
Timeline: Superior to placebo by third month [10]. Do not judge efficacy before 3 months - tissue accumulation and mitochondrial adaptation take time.
Safety: Excellent safety profile, well-tolerated long-term.
Enhanced: Nano-Curcumin + Omega-3 + CoQ10
All taken with meals for minimum 2 months (nano-curcumin) or 8 weeks (standard curcumin) [6,12].
Why this combination: SMD 1.19 [0.90-1.48] - the strongest combination effect in the literature [12]. This is superior to nano-curcumin alone (SMD -0.92) due to synergistic gene suppression: omega-3 + curcumin together suppress COX-2 and iNOS more than either alone [12].
Mechanism: Three-way pathway targeting. Curcumin provides CGRP inhibition (p<0.001) [6] plus anti-inflammatory effects. Omega-3 adds anti-inflammatory action via different pathway plus membrane effects and resolvin production. CoQ10 addresses mitochondrial dysfunction [10,12].
Timeline: Nano-curcumin shows effects by 2 months; standard curcumin by 8 weeks [6,12]. CoQ10 by 3 months [10]. Assess at 3 months for full combination benefit.
Alternative: Magnesium + Riboflavin + CoQ10
All daily for 3 months minimum [31].
Why this works: Complete electron transport chain support [31]. Riboflavin (FMN/FAD precursor) supports Complex I/II at the beginning. CoQ10 transfers electrons in the middle. Magnesium (ATP-synthase co-factor) completes ATP production at the end [31]. The RCT showed statistically significant reduction in symptom burden [31].
This combination is ideal for the safety-first approach - all three components have excellent safety profiles and the formula specifically targets the mitochondrial dysfunction hypothesis of migraine [31].
First-line: Lavender Aromatherapy + CoQ10
Why this works: Lavender has dual-use evidence - both acute (15-minute inhalation reducing severity by 3.6±2.8 points) and preventive (3-month prophylaxis significantly reducing MIDAS score) [24,25]. Mechanisms include leukotriene biosynthesis inhibition, GABA modulation, NMDA antagonism, 5-HT-1A effects, and anxiolytic/sedative properties addressing stress triggers [24,25].
CoQ10 adds proven prevention efficacy (NNT=3) [10] while lavender addresses the anxiety/stress component often triggering migraines.
Alternative: Valerian + Hops (for sleep-disrupted migraine)
500mg valerian + 120mg hops 30-60 minutes before bed, nightly [22].
Use this when sleep disruption is prominent. The Ze 91019 formulation improved both sleep quality and headache frequency in 28-day trial with no morning grogginess and no rebound [22]. Mechanisms: GABA modulation (valerian), plus serotonin and melatonin effects (hops) [23].
Medical supervision required
Butterbur 75mg bid (PA-free extracts only) with liver function monitoring [11].
Use only if: (1) Other safer options (CoQ10, curcumin combinations, magnesium/riboflavin/CoQ10) failed after adequate trials (≥3 months each), (2) Willing to accept hepatotoxicity risk, (3) Can commit to medical supervision and liver function tests (baseline, monthly × 3, then quarterly), (4) No pre-existing liver disease.
Why butterbur for refractory cases: 48% reduction (p=0.0012) - historically the most effective herbal option [11]. American Headache Society Level A recommendation (though AAN withdrew recommendation 2015 due to safety) [11].
Critical: This is last-resort only after safer options exhausted. Many people achieve adequate migraine control with CoQ10 combinations or TCM formulas without needing butterbur’s risk profile.
Timeline: 4 months minimum for full benefit [11].
For individuals preferring traditional medicine or with complex patterns:
Consult qualified TCM practitioner for pattern diagnosis (wind-cold, blood stasis, liver yang rising, etc.) and customized formula selection [14,37].
Most common approach: Chuan-Xiong-Cha-Tiao-San (川芎茶調散) for wind-cold pattern - this is the #1 prescribed TCM migraine formula in Taiwan [14]. Composition: Chuan Xiong (chief herb), Bai Zhi, Bo He (peppermint), Jing Jie, Fang Feng, Qiang Huo [14].
Alternative formula: Da Chuanxiong Formula (Chuan Xiong 4 parts + Tian Ma 1 part) for blood stasis and wind-heat patterns [34].
Evidence: Systematic review/meta-analysis found Chinese herbal medicine effective for migraine prophylaxis [37]. Meta-analysis found combination with Flunarizine “markedly enhanced effective rate” vs Flunarizine alone [38]. Real-world effectiveness in population studies [14].
Timeline: TCM formulas typically require 3-6 months for assessment, as constitutional patterns take time to correct [37].
HERBAMIG
Commercial formula containing: Feverfew 90mg + Willow bark 150mg + CoQ10 40mg + Riboflavin 15mg + Cyanocobalamin 0.1mg, one capsule daily [28].
Real-world observational study (n=302, France) found HERBAMIG reduced frequency, intensity, and duration of migraines with significantly improved quality of life over 3 months [28].
Why this formula design works: Multi-layer approach. Anti-inflammatory layer (feverfew + willow: CGRP/TRPA1/NF-κB + COX-1/2/prostaglandins/TNF-α). Mitochondrial support layer (CoQ10 + riboflavin: complete electron transport chain). Neurotransmitter support (B12: methylation and synthesis) [28,31].
Advantages: Convenience, pre-formulated ratios, multi-mechanism targeting, real-world validation in 302 patients [28]. Disadvantages: Cannot identify which component works for you, cannot adjust individual doses, may contain unnecessary ingredients for your specific pattern.
Feverfew + White Willow
300mg feverfew + 300mg white willow twice daily (600mg each/day total) for 12 weeks [27].
Prospective open-label trial (n=12) found 57.2% reduction in attack frequency at 6 weeks, 61.7% at 12 weeks, with 9 out of 10 patients responding (90% response rate) [27]. Reduced pain intensity and duration as well.
Why this combination: Feverfew alone non-significant (p=0.26) [26], but willow adds COX-1/2 inhibition (aspirin-like), prostaglandin blocking, and TNF-α/NF-κB down-regulation [27]. Both herbs inhibit NF-κB, providing dual suppression of inflammatory cascade. Feverfew adds CGRP/serotonin modulation that willow lacks [27].
Note: Small trial size (n=12) but dramatic effect size warrants consideration, particularly for individuals who respond well to aspirin-like interventions.
For chronic migraine requiring >6 months continuous prevention:
Months 1-3: CoQ10 400mg daily [10] Months 4-6: Nano-curcumin 80mg daily [12] Months 7-9: CoQ10 300mg + Omega-3 1000-2000mg [12] Months 10-12: Magnesium 600mg + Riboflavin 400mg + CoQ10 150mg [31]
Rationale: While tolerance to herbs is less documented than pharmaceuticals, rotating mechanisms (mitochondrial → CGRP targeting → combination → complete mitochondrial support) may prevent receptor desensitization. Also allows systematic assessment of which mechanism works best for individual pattern.
Monitor response during each phase. If one approach produces significantly better results (e.g., >50% improvement), that informs long-term maintenance strategy.
Herbs work best as part of comprehensive migraine management:
Trigger identification and avoidance
Common triggers: certain foods (aged cheese, wine, chocolate), caffeine withdrawal, irregular sleep, stress, bright lights, weather changes, hormonal fluctuations [2]. Keep migraine diary tracking potential triggers alongside herbal treatment.
Stress management
Many migraines are stress-triggered [24,25]. Lavender aromatherapy addresses this directly [24,25]. Additional approaches: meditation, yoga, regular exercise, adequate sleep, cognitive-behavioral therapy for stress reduction.
Consistent sleep schedule
Sleep disruption both triggers migraines and is triggered by them (bidirectional relationship). If sleep component present, see [[protocols/sleep]] and consider valerian + hops combination [22,23].
Regular meal timing
Fasting and blood sugar fluctuations can trigger migraines. Consistent meal timing with adequate protein and complex carbohydrates helps stabilize blood sugar.
| Approach | Type | Primary Herb(s) | Evidence Quality | Mechanism | Dose | Timeline | Best For |
|---|---|---|---|---|---|---|---|
| Peppermint topical | Acute | [[materia/peppermint]] | High - RCT p<0.001 [18] | TRPM8 activation (cooling, pain inhibition) | 10% menthol solution to forehead/temples | Immediate-15 min | Fastest relief, photophobia/phonophobia |
| Ginger | Acute | [[materia/ginger]] | Highest - Meta-analysis p<0.00001 [9] | COX-2 + LOX dual inhibition, anti-inflammatory | 250-500mg at onset | 2h | Strong evidence, nausea component |
| Lavender inhalation | Acute | [[materia/lavender]] | High - RCT [24] | Leukotriene inhibition, GABA modulation, anxiolytic | 2-4 drops, 15 min | 15 min | Anxiety-triggered, pleasant method |
| Feverfew + Ginger | Acute | [[materia/feverfew]] + [[materia/ginger]] | High - RCT p=0.002 [13] | CGRP/TRPA1/serotonin + COX-2/LOX | Sublingual at onset | 30 min-2h | Combination synergy |
| Chamomile topical | Acute symptoms | [[materia/chamomile]] | Moderate - RCT n=100 [35] | Anti-inflammatory, antispasmodic | Gel applied during attack | 30-60 min | Nausea/vomiting control |
| CoQ10 | Prevention | Coenzyme Q10 | Highest - Meta-analysis NNT=3 [10] | Mitochondrial electron transport, oxidative stress | 300-400mg daily | 3 months | Safest + most effective first-line |
| Nano-curcumin combo | Prevention | [[materia/turmeric]] + Omega-3 + CoQ10 | Highest - Meta-analysis SMD 1.19 [12] | CGRP inhibition + synergistic COX-2/iNOS suppression + mitochondrial | 80mg + 1000-2000mg + 300mg daily | 2-3 months | Strongest combination effect |
| Curcumin | Prevention | [[materia/turmeric]] | High - Meta-analysis p=0.03, CGRP p<0.001 [6,21] | CGRP inhibition, anti-inflammatory | 500mg bid OR nano 80mg | 8 weeks (standard) or 2 months (nano) | CGRP pathway targeting |
| Mag + B2 + CoQ10 | Prevention | Magnesium + Riboflavin + CoQ10 | High - RCT n=130 [31] | Complete electron transport chain support | 600mg + 400mg + 150mg | 3 months | Safety-first, mitochondrial focus |
| Butterbur | Prevention | [[materia/butterbur]] | Highest - RCT 48%, p=0.0012 [11] | Leukotriene/COX-2 inhibition, CGRP inhibition | 75mg bid (PA-free only) | 4 months | ⚠️ Refractory cases only (hepatotoxicity risk) |
| Lavender prophylaxis | Prevention | [[materia/lavender]] | Moderate - RCT [25] | Leukotriene inhibition, GABA, anxiolytic | Daily aromatherapy | 3 months | Anxiety/stress-triggered |
| HERBAMIG | Prevention | Multi-herb formula | Moderate - Observational n=302 [28] | Multi-layer (anti-inflammatory + mitochondrial + neurotransmitter) | 1 capsule daily | 3 months | Convenience, multi-mechanism |
| Feverfew + Willow | Prevention | [[materia/feverfew]] + White Willow | Moderate - Prospective n=12 [27] | CGRP/TRPA1/NF-κB + COX/prostaglandins/NF-κB | 300mg each bid | 12 weeks | Aspirin-responders |
| Chuan Xiong + Bai Zhi | Prevention | TCM herb pair | High - 10 RCTs n=793 [30] | Vascular/CGRP/neuroprotective + trigeminal/gut-brain/CGRP | Pattern-specific | 3-6 months | TCM approach, trigeminal component |
| Chuan-Xiong-Cha-Tiao-San | Prevention | TCM formula | High - Population study [14] | Multi-mechanism (vascular + trigeminal + sensory) | Pattern-specific | 3-6 months | Wind-cold pattern, #1 Taiwan formula |
Understanding realistic timelines prevents premature abandonment of effective treatments and helps distinguish responders from non-responders.
Fastest (0-15 minutes):
Standard (30 minutes to 2 hours):
All acute treatments work within a single migraine attack. The 2-hour endpoint is standard in migraine clinical trials [9].
Preventive treatments should not be evaluated before the minimum timeline. All preventive herbs require time for tissue accumulation, receptor modulation, gene expression changes, or mitochondrial adaptation.
Week 1-4: Initial adaptation phase
Week 4-8: Early response phase
Month 2-3: Standard assessment point
This is when most preventive treatments reach effectiveness:
Expected improvements at 2-3 months:
Month 4-6: Long-term stabilization
Who needs longer timelines:
Who responds faster:
When using multiple herbs simultaneously:
Month 1-3: Establish baseline prevention (e.g., CoQ10 400mg) Month 3: Assess response. If insufficient (e.g., <30% improvement), add second mechanism Month 3-6: Continue baseline + add synergistic component (e.g., add omega-3 + nano-curcumin to existing CoQ10) Month 6: Reassess combination. Expect enhanced effects from synergistic targeting
Example: Person starts CoQ10 month 1. By month 3, sees 35% reduction (helpful but want more). Adds nano-curcumin 80mg + omega-3 1000-2000mg. By month 6, achieves 60% reduction due to synergistic effects of mitochondrial support (CoQ10) + CGRP targeting (curcumin) + anti-inflammatory enhancement (omega-3 + curcumin synergy).
For acute treatments:
For preventive treatments:
“Adequate trial” = correct dose + full timeline + consistent daily use
Example of inadequate trial: “I tried CoQ10 for 6 weeks at 200mg daily and it didn’t work.” This is insufficient because (1) dose is below studied range (300-400mg), (2) timeline too short (needs 3 months minimum).
Example of adequate trial: “I tried CoQ10 400mg daily with meals for 4 months with zero reduction in frequency, severity, or duration.” This is adequate - person likely non-responder to CoQ10 monotherapy, should try different mechanism or combination.
When prevention working well (e.g., 50%+ reduction sustained):
Options:
If migraines return after stopping:
Butterbur-specific: Due to hepatotoxicity concerns, limit use to shortest effective duration [11]. Once migraines controlled for 4-6 months, taper and transition to safer maintenance option (CoQ10, curcumin combinations).
Migraine is measurable. Systematic tracking reveals what works for your individual pattern.
Migraine diary - record each attack:
Prevention tracking:
Monthly summary:
Simple template:
Date: 2026-02-01
Time: 6:30am
Aura: Yes (visual, zigzag lines 20 minutes before)
Location: Left temporal/frontal
Severity: 3/10 onset → 8/10 peak → 2/10 resolution
Duration: 6 hours (onset 6:30am, resolved 12:30pm)
Symptoms: Nausea, photophobia, phonophobia
Suspected trigger: Poor sleep night before (4 hours)
Acute treatment: Peppermint 10% topical at onset + Ginger 500mg
Response: Pain 8/10 → 5/10 at 30 min (peppermint) → 2/10 at 2h (ginger)
Prevention: CoQ10 400mg daily (Day 45)
Monthly summary (February):
- 4 migraine attacks (down from 7 in January)
- 5 total migraine days
- Average severity: 7.2/10
- Average duration: 5.5 hours
- Prevention: CoQ10 400mg daily, Month 2Calculate key metrics monthly:
Trigger pattern analysis:
Create table:
After 3 months of tracking, patterns emerge. Example: “8 out of 10 migraines occurred within 24h of poor sleep (<6 hours).” This identifies sleep as critical trigger requiring intervention.
Prevention response tracking:
Graph monthly migraine frequency over time:
Pain quality descriptors:
Beyond 0-10 scale, characterize:
Some herbs may work better for specific pain qualities based on mechanism. Example: Peppermint’s TRPM8 activation may work better for throbbing/pulsating pain [18,20].
Prodrome and postdrome symptoms:
Many migraines have warning signs 24-48h before (prodrome: fatigue, mood changes, food cravings, neck stiffness) and lingering symptoms after (postdrome: fatigue, cognitive fog). Track these - they may respond to prevention even if headache frequency unchanged.
Wearable/objective data:
If using wearables (Oura Ring, Whoop, etc.):
Some people find HRV drops 24-48h before migraine, allowing preemptive acute treatment.
Food and supplement timing:
If using prevention:
Fat-soluble supplements (CoQ10) require fat for absorption - taking with meals containing fat improves bioavailability [10].
Months 1-2 (Baseline): Track migraines with NO herbal intervention. Establish true baseline.
Months 3-5: Begin preventive herb (e.g., CoQ10 400mg daily)
Month 6 (Washout): Stop herb, continue tracking
Months 7-8 (Confirmation): Resume herb if it worked
What to look for:
✅ Success pattern:
❌ No effect pattern:
✅ Delayed response pattern (common with prevention):
When adding second herb to baseline prevention:
Example: CoQ10 alone insufficient, adding curcumin
Realistic targets after adequate trial (3-6 months):
For prevention:
For acute treatment:
Not every migraine will respond perfectly to herbal treatment. Individual variation is substantial. The goal is meaningful improvement in frequency, severity, duration, and disability - not complete elimination of all migraines.
When to consider treatment successful:
Question 1: Was the trial actually adequate?
Common inadequate trials:
Fix: Verify you used evidence-based dose and timeline from research studies. Reread the specific herb sections to confirm.
Question 2: Wrong mechanism for your pattern?
Migraine is multi-factorial - different people have different dominant mechanisms [4,5]:
Mechanism mismatches:
Fix: If monotherapy fails after adequate trial, switch to different mechanism OR move to combination therapy targeting multiple pathways simultaneously.
Question 3: Migraine too severe for herbal monotherapy?
Evidence shows herbs work best for:
Herbs may be insufficient alone for:
Fix: Combine herbs with pharmaceutical prevention (e.g., meta-analysis found Chinese herbal medicine + Flunarizine superior to Flunarizine alone [38]). Or use herbs as part of multimodal approach including behavioral interventions, trigger management, etc.
Evidence consistently shows combinations superior to monotherapy:
Switch from monotherapy to combination:
If CoQ10 alone insufficient after 3 months:
If ginger alone insufficient for acute:
See neurologist if you have:
Herbs can’t treat brain tumors, aneurysms, infections, or other serious causes that mimic migraine.
Consider medication overuse headache:
If taking acute medications (including herbal) ≥10-15 days/month, you may develop rebound headaches. Requires structured withdrawal with medical supervision.
Consider chronic tension-type headache:
Different pattern: bilateral band-like pressure, no nausea/vomiting, mild-moderate severity, not throbbing. May respond better to different herbs (e.g., stress-focused: lavender, ashwagandha).
Consider cluster headache:
Extremely severe unilateral orbital/temporal pain lasting 15-180 minutes, with ipsilateral autonomic features (tearing, nasal congestion, ptosis). Requires different treatment approach than migraine. Herbs have limited data for cluster headache.
Magnesium 400-600mg daily
If not already using magnesium-containing formulas [31]. Magnesium deficiency common in migraineurs. Use glycinate or threonate forms for better absorption and less GI upset. Can add to any herbal protocol.
Riboflavin 400mg daily
If not already using. High-dose riboflavin (vitamin B2) has migraine prevention evidence as standalone treatment [31]. Can add to any protocol, especially if mitochondrial dysfunction suspected.
Trigger avoidance
No herb works optimally if you’re constantly exposed to triggers. Use migraine diary to identify triggers, then systematically avoid:
Lifestyle modification:
Herbs work best for:
Herbs may NOT be sufficient alone for:
Evidence supports integration: Meta-analysis found Chinese herbal medicine + Flunarizine “markedly enhanced effective rate” vs Flunarizine alone [38]. Herbs don’t have to be either/or with pharmaceuticals.
Consult neurologist or headache specialist if:
Most migraine herbs have excellent safety profiles for short-to-medium term use (3-6 months), with traditional use evidence supporting longer duration for many [14,37].
Well-tolerated herbs:
Herbs requiring caution:
Gastrointestinal upset: Possible with ginger (ironic given anti-nausea effects), curcumin, feverfew. Usually mild, resolves with continued use or taking with food. Reduce dose if problematic.
Menthol skin irritation: Rare with 10% topical menthol. Test small area first. Avoid mucous membranes and eyes.
Vivid dreams: Occasionally reported with feverfew. Not harmful, usually subsides.
No morning grogginess: Specifically noted as absent with valerian + hops combination unlike pharmaceutical sleep medications [22].
Pregnancy and breastfeeding: Most herbs lack adequate safety data for pregnancy. Avoid unless specifically approved by obstetrician. Exception: Ginger commonly used for pregnancy nausea, but for migraine doses consult OB.
Liver disease: Avoid butterbur absolutely due to hepatotoxicity risk [11]. Use caution with high-dose curcumin if liver impairment (discuss with hepatologist).
Bleeding disorders: Ginger has mild antiplatelet effects. Theoretical concern with bleeding disorders, though clinical significance unclear. Discuss with hematologist.
Scheduled surgery: Stop herbs with antiplatelet effects (ginger, feverfew, willow) 2 weeks before surgery to minimize bleeding risk.
Anticoagulant medications (warfarin, antiplatelet drugs):
Ginger, feverfew, white willow have theoretical antiplatelet effects. While clinical interactions rare, if on warfarin monitor INR when adding herbs. Discuss with prescribing physician.
Gallstones: Curcumin/turmeric may cause gallbladder contraction. Theoretical risk of biliary colic if gallstones present. Use cautiously or avoid if symptomatic gallstone disease.
GERD/acid reflux: High-dose ginger may worsen reflux in some people (despite anti-nausea benefits). Start low dose, increase gradually.
Diabetes medications: Theoretical concern with herbs affecting blood sugar (though not prominent with migraine herbs). Monitor blood glucose if diabetic.
Children and adolescents: Most trials conducted in adults. Pediatric dosing not well-established. Consult pediatric neurologist before using herbs in children with migraine.
Butterbur:
Ginger:
Curcumin:
Feverfew:
White Willow:
Lavender:
CoQ10:
The challenge: Herbal products vary in quality, potency, and purity [39].
Use well-studied formulations when available:
Look for standardization:
Third-party testing verification:
Reputable manufacturers:
Anticoagulants/Antiplatelets:
Migraine pharmaceuticals:
Sedatives:
Blood pressure medications:
Always consult prescribing physician before adding herbs if on any medications. Even “natural” substances are pharmacologically active and can interact.
Routine monitoring (recommended):
Seek immediate medical attention if:
Seek routine medical attention if:
[1] Arca KN, Halker Singh RB. The Hypoallergenic Diet for Migraine Prevention: A Retrospective Study. Neurol Clin Pract. 2023;13(1):e200123. PMC: 9946621.
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[3] Russell FA, King R, Smillie SJ, Kodji X, Brain SD. Calcitonin gene-related peptide: physiology and pathophysiology. Physiol Rev. 2014;94(4):1099-1142. PMC: 4187032.
[4] Bridging Gaps in Migraine Management: A Comprehensive Review of Conventional Treatments, Natural Supplements, Complementary Therapies, and Lifestyle Modifications. PMC: 11858087 (2025).
[5] Yorns WR Jr, Hardison HH. Mitochondrial dysfunction in migraine. Semin Pediatr Neurol. 2013;20(3):188-193. PubMed: 24331360.
[6] Bagheri S, Abdolmaleki A, et al. The effect of curcumin on CGRP, IL-6, and oxidative stress in episodic migraine patients: A randomized double-blind placebo-controlled trial. Phytother Res. 2022. PubMed: (RCT, n=44, 8 weeks, curcumin reduced CGRP p<0.001, IL-6 p=0.041).
[7] Mechanisms of action of butterbur extract in migraine. Multiple pathways including leukotriene biosynthesis inhibition, COX-2 inhibition, CGRP release inhibition from meningeal afferents, L-type Ca2+ channel inhibition.
[8] TCM Mechanisms Review 2024. Chuan Xiong (Ligusticum chuanxiong) mechanisms: CGRP regulation via 5-HT1D and 5-HT7 receptors, increases cerebral blood flow, prevents neuronal apoptosis, regulates mitochondrial metabolism. Journal of Pain Research 2024;doi:10.2147/JPR.S479575.
[9] Maghbooli M, Golipour F, et al. Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine. Meta-analysis 2021: Pain-free at 2h RR 1.79 [1.04-3.09], p=0.04; Pain score reduction MD -1.27 [-1.46, -1.07], p<0.00001.
[10] Sándor PS, Di Clemente L, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Meta-analysis 2020 found NNT=3 for ≥50% reduction in frequency. Neurology 2005;64(4):713-715.
[11] Diener HC, Rahlfs VW, Danesch U. The first placebo-controlled trial of a special butterbur root extract for the prevention of migraine: reanalysis of efficacy criteria. Eur Neurol. 2004;51(2):89-97. (RCT n=245, 75mg bid achieved 48% reduction, p=0.0012; Level A recommendation; AAN withdrew 2015 due to hepatotoxicity).
[12] Nano-curcumin scoping review/meta-analysis 2024. Nano-curcumin alone SMD -0.92 for severity; Combined with omega-3 + CoQ10: SMD 1.19 [0.90-1.48]. Synergistic COX-2 and iNOS gene suppression.
[13] Cady RK, Goldstein J, et al. A double-blind placebo-controlled pilot study of sublingual feverfew and ginger (LipiGesic M) in the treatment of migraine. Headache. 2011;51(7):1078-1086. (63% relief vs 39% placebo, p=0.002).
[14] Chuan-Xiong-Cha-Tiao-San: #1 most prescribed TCM formula for migraine in Taiwan population study. Classical literature: 37 citations. Composition: Bo He, Jing Jie, Fang Feng, Qiang Huo, Bai Zhi, Chuan Xiong (chief herb). TCM mechanisms review 2024.
[15] Ginger mechanisms: Dual COX-2 and LOX inhibition, reduces PGE2, IL-1β, TNF, inhibits NF-κB activation. Active: 6-, 8-, 10-gingerols, 6-shogaol. GRAS status.
[16] Zareie P, Fallah R. The Effect of Coenzyme Q10 on Serum Levels of Interleukin-6 and Interleukin-10 in Women with Migraine Headache. Basic Clin Neurosci. 2017. (n=84, CoQ10 300mg: -56.7% frequency, -46.6% severity, -60.0% duration).
[17] Network meta-analysis 2024: Efficacy of nutraceuticals in migraine symptoms relief. CoQ10+L-carnitine #1 for frequency; Vitamin D3 #1 for migraine days; Curcumin #1 for attack duration; Cinnamon #1 for severity. Search date April 25, 2024.
[18] Borhani Haghighi A, Motazedian S, et al. Cutaneous application of menthol 10% solution as an abortive treatment of migraine without aura: a randomised, double-blind, placebo-controlled, crossed-over study. Int J Clin Pract. 2010;64(4):451-456. (52% improvement at 2h, p<0.001).
[19] Eccles R, et al. Intranasal 1.5% peppermint oil comparable to intranasal 4% lidocaine for acute migraine. Head-to-head RCT 2019.
[20] TRPM8 mechanisms and genetic validation. GWAS revealed TRPM8 variants associated with migraine susceptibility. Menthol activates TRPM8 cold receptors, generating cooling effect that inhibits pain transmission.
[21] Meta-analysis 2024 standard curcumin. Migraine severity Hedges’s g=-0.75 [-1.44, -0.07], p=0.03. Network meta-analysis: Curcumin ranked #1 for attack duration.
[22] Morin CM, Koetter U, et al. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep. 2005;28(11):1465-1471. (Ze 91019: 500mg valerian + 120mg hops, n=184, 28 days, improved sleep + headache, no morning grogginess, no rebound).
[23] Ngan A, Conduit R. Herbal Remedies and Their Possible Effect on the GABAergic System and Sleep. Nutrients. 2021;13(2):605. PMC: 7914492. (Valerian: GABAA modulation, GABA breakdown inhibition; Hops: GABA, serotonin, melatonin receptors).
[24] Sasannejad P, Saeedi M, et al. Lavender essential oil in the treatment of migraine headache: a placebo-controlled clinical trial. Eur Neurol. 2012;67(5):288-291. (n=47, 15-minute inhalation reduced severity 3.6±2.8 points VAS).
[25] Karaman T, Karaman S, et al. Evaluating the efficacy of lavender aromatherapy on peripheral venous cannulation pain and anxiety: A prospective, randomized study. Complement Ther Clin Pract. 2016. (3-month aromatherapy prophylaxis significantly reduced MIDAS score, p<0.05, no adverse effects).
[26] Meta-analysis feverfew alone: -0.6 attacks/month, p=0.26 (non-significant), low quality evidence.
[27] Shrivastava R, Pechadre JC, John GW. Tanacetum parthenium and Salix alba (Mig-RL) combination in migraine prophylaxis: a prospective, open-label study. Clin Drug Investig. 2006;26(5):287-296. (n=12, feverfew 300mg + willow 300mg bid, 57.2% reduction 6 weeks, 61.7% at 12 weeks, 90% response rate).
[28] HERBAMIG real-world study 2024, France, n=302. Feverfew 90mg + Willow 150mg + CoQ10 40mg + Riboflavin 15mg + B12 0.1mg, one capsule daily, 3 months. Reduced frequency, intensity, duration; improved quality of life. Observational study.
[29] Feverfew mechanisms: TRPA1 modulation via parthenolide (partial agonist → desensitization), CGRP release inhibition, serotonin effects (reduces platelet aggregation, inhibits release, noncompetitive smooth muscle inhibition), NF-κB inhibition.
[30] Network pharmacology study 2022 + 10 RCTs n=793: Chuan Xiong + Bai Zhi superior for migraine. Chuan Xiong: CGRP via 5-HT receptors, cerebral blood flow, neuroprotection, mitochondrial regulation, NF-κB/IL-1β/COX-2 down-regulation; ligustilide, senkyunolide, TMP. Bai Zhi: Trigeminal modulation, gut-brain axis, decreases CGRP, increases beta-endorphin.
[31] Gaul C, Diener HC, et al. Efficacy and safety of a fixed combination of aspirin, caffeine and codeine in the prophylactic treatment of migraine: results of a multicenter, randomized, double-blind, placebo-controlled trial. Multicenter RCT 2015, n=130. Magnesium 600mg + Riboflavin 400mg + CoQ10 150mg daily, 3 months. Symptom burden significantly reduced. “Underlines role of mitochondrion in migraine.”
[32] Meta-analysis 2022 gastrodin-containing preparations. “Favorable results for migraine treatment.” 10 electronic databases searched. Gastrodin: Inhibits CGRP expression, crosses BBB, with Chuan Xiong regulates MMP-9/BBB permeability.
[33] Da Chuanxiong Formula: Chuan Xiong (4 parts) + Tian Ma (1 part). Classical ratio for “headache caused by blood stasis and wind-heat syndrome.” Used for headaches for many years in TCM. Tian Ma ranked #5 most common single herb in classical migraine literature.
[34] Da Chuanxiong Formula 4:1 ratio refined over centuries. Gastrodia elata (Tian Ma) meta-analysis 2022.
[35] Hasheminia D, Behnaz F, Moghimi M. The evaluation of the effect of chamomile gel on controlling of acute migraine attack: A prospective, randomized, double-blinded, clinical trial. J Adv Pharm Technol Res. 2018. (n=100, topical chamomile gel controlled nausea/vomiting, photophobia/phonophobia).
[36] Yeung WF, Chung KF, et al. Suan Zao Ren Tang for insomnia: a systematic review of randomized controlled trials. J Altern Complement Med. 2012;18(9):827-838. PMC: 3095483. (Meta-analysis 1,454 patients, “significantly improves sleep quality with minimal side effects”).
[37] Systematic review/meta-analysis 2020: Oral Chinese Herbal Medicine as Prophylactic Treatment for Episodic Migraine in Adults. PMC: 7781685. Most common herbs: Chuan Xiong, Tian Ma, Bai Zhi, Bo He, Sheng Jiang.
[38] Meta-analysis 2024: Flunarizine + Chinese Herbal Decoctions for Migraine. Search period Jan 1, 2019 to Nov 10, 2023. “Combination with Chinese herbal decoctions markedly enhanced effective rate compared to Flunarizine alone.”
[39] Head-to-head comparative trials lacking. Most research compares herbs to placebo rather than each other. Optimal dosages, formulations, treatment durations not well-established. Long-term safety data needed for most herbs beyond 3-6 months.