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Feverfew is an herbal supplement with significant anti-inflammatory properties.

The science behind it: It is well established that an attack of migraine initiates a cascade of events ultimately resulting in a process called sterile inflammatory reaction in a specific area of the brain known as the trigeminovascular complex. Feverfew binds and inhibits the kinase complex which plays an important role in pro-inflammatory cytokine mediated signaling, especially in the brain. This compound also decreases inflammation by inhibiting smooth muscle spasms and prostaglandin synthesis. Feverfew inhibits platelet serotonin secretion and may produce anti-migraine effects similar to methysergide.

Research assessment: Feverfew has level B evidence for efficacy in preventing migraine headaches by the American Academy of Neurology (AAN) and the American Headache Society (AHS).

Alpha-lipoic acid is naturally produced in our bodies and is a powerful antioxidant

The science behind it: Alpha-Lipoic Acid (ALA) is an 8-carbon sulfur-containing compound and is a powerful antioxidant and coenzyme in energy metabolism. It is very important to point out that ALA levels are very low in 90% of individuals suffering from higher frequency of migraine headache attacks. Research into human brain activity reveals that migraine is a metabolic abnormality of the brain with increased oxidative stress and decreased antioxidant capacity. This abnormality is due to an energy deficiency syndrome at the mitochondrial level in the brain. The increase in oxidative stress causes the activation of TRP channels on nerve receptors resulting in the throbbing pain of migraine headaches. ALA is also able to regenerate other antioxidants such as Coenzyme Q10. By restoring the antioxidative capacity at the mitochondrial levels, ALA supplementation can significantly reduce migraine attack, frequency, severity, and duration. ALA levels might represent a potential biomarker for gauging the predisposition to migraines. ALA may help with weight loss and it may also decrease blood lipid levels as it increases insulin sensitivity and promotes normal metabolic activity.

Vitamin B2 (also known as riboflavin) is an essential antioxidant vitamin which can maintain healthy cell activity.

The science behind it: Vitamin B2 can help maintain healthy mitochondrial energy reserves. Mitochondria is where energy is produced through a process of electron transport in a chain of reactions called the Krebs cycle. It has been demonstrated that in people who suffer from migraines, there is a deficiency of mitochondrial energy reserves. High doses of vitamin B2 can help maintain healthy mitochondrial energy reserves and decrease oxidative stress. Vitamin B2 is a cofactor in Krebs cycle, producing energy and also is an antioxidant.

Research assessment: Vitamin B2 is a promising therapeutic modality as it pertains to migraine pathophysiology and has level B evidence for efficacy in preventing migraine headaches by the American Academy of Neurology (AAN) and the American Headache Society (AHS).

Ginger is an herbal supplement with significant antioxidant and anti-inflammatory properties.

The science behind it: Ginger is a flowering plant and the root of this plant has been used for centuries for its medicinal properties. Ginger has significant antioxidant and anti-inflammatory properties and may significantly decrease CGRP release, a neurotransmitter that plays a crucial role in inducing neurogenic inflammation and sensitization of the meningeal nerve fibers during an attack of migraine. The antiemetic properties of ginger can also treat the symptoms of nausea and vomiting during an attack of migraine. By increasing serotonin levels and the resulting vasoconstriction, ginger may be as effective as Sumatriptan, an abortive migraine medication, without the adverse side effects experienced by some patients.

Coenzyme Q10 is an antioxidant and anti-inflammatory substance and is naturally produced in our body.

The science behind it:Unfortunately, as we age there is a gradual decrease in the levels of this very important antioxidant. During normal metabolic processes, reactive oxidative substances are produced which are harmful to human cells. Oxidative stress at a cellular level is central to migraine pathophysiology. It is the antioxidant properties of substances such as Coenzyme Q10 that protect the cellular structures against harmful substances. Coenzyme Q10 also decreases the levels of tumor-necrosis factor alpha and therefore possesses anti-inflammatory properties. One important function of Coenzyme Q10 is that it improves endothelial functions and it also may lower the levels of CGRP, which has been shown to be one of the most important neurotransmitters in the pathophysiology of migraine headaches.

Research assessment: Coenzyme Q10 enjoys a level C evidence for efficacy in preventing migraine headaches by the American Academy of Neurology (AAN) and the American Headache Society (AHS). Coenzyme Q10 supplementation has level 2 evidence in decreasing the fatigue in patients suffering from Fibromyalgia Syndrome.

Magnesium is an essential mineral with significant anti-inflammatory properties.

The science behind it: Low levels of ionized Magnesium have been demonstrated in the serum, red blood cells, and cerebrospinal fluid of people who suffer from migraines. Magnesium prevents neurogenic inflammation and stabilizes the nerve membranes, reducing their excitability during migraine attacks. Magnesium is a powerful blocker of NMDA receptors and also decreases nitric oxide levels, which in turn may modulate glutaminergic transmission (glutamate is one of the most important neurochemicals implicated in the pathophysiology of migraines). This may result in interruption or prevention of cortical spreading depression or CSD. Cortical spreading depression, which is a slowly progressing cortical ischemic event, is believed to be the main event in the start of migraine headaches. Magnesium, especially when administered intravenously, significantly decreases circulating Calcitonin Gene Related Peptide (CGRP) levels. CGRP is a neurotransmitter and is released by the activated trigeminal somatosensory fibers and results in dilation of intracranial blood vessels and increases nociceptive transmission centrally in the brainstem and spinal cord. A number of double-blind, randomized, placebo-controlled trials have shown the efficacy of magnesium supplementation in relieving headaches, especially migraine headaches.

Research assessment: Magnesium enjoys level B evidence for efficacy in preventing migraine headaches by the American Academy of Neurology (AAN) and the American Headache Society (AHS).