How Daily Habits and Nutrients Can Reduce Migraine Frequency

This question was submitted by Lisa, and it's about migraines. It says, "Hi, Rhonda. My physician recommended a blend of the following. He says it has scientific evidence to prevent recurring migraine headaches: B2, melatonin, magnesium, and CoQ10. Is this true? Are there other factors?"

It's been a while since we've talked about migraines, so I was happy to explore this topic more deeply. Quite a few people are affected by migraines, which aren't just typical headaches. They're a complex neurological disorder involving brain hyperexcitability, inflammation, and a neuropeptide called calcitonin gene-related peptide. These factors can contribute to pain and vascular changes during a migraine attack.

The good news is that many of these biological pathways are modifiable through lifestyle. A few small, consistent changes can raise the so-called migraine threshold, making it more difficult to trigger an attack.

Let's start with some lifestyle factors that do have a big effect, starting with sleep. Sleep disruption is one of the most commonly reported migraine triggers. Even one night of poor sleep can shift neurotransmitter balance, increase brain excitability, and suppress melatonin production. Treatment of insomnia in migraine patients has been shown to reduce headache frequency.

Melatonin is also interesting in this context because it has anti-inflammatory and pain-modulating effects. There was a randomized controlled trial that compared three milligrams of melatonin at bedtime with 25 milligrams of a prescription drug for migraine prevention called amitriptyline. After three months, melatonin performed just as well in reducing headache frequency, and it had fewer side effects.

There was also a meta-analysis suggesting that melatonin reduced headache frequency, duration, severity, and painkiller use compared with placebo. The migraine medicine performed better than melatonin on some of those other measures, but melatonin performed better than placebo. Melatonin was at least as effective at reducing headache frequency. That's worth mentioning if you're struggling with migraines.

Prioritizing sleep regularity is very important. Going to bed and waking up at the same time each day supports consistently good sleep. The sleep-hygiene practices we've discussed many times are also important.

Another major factor in migraines is stress. Under high stress, the trigeminal nerve network, one of the main pathways involved in migraines, becomes more reactive. It releases calcitonin gene-related peptide, which drives migraine pain and inflammation. Studies have shown that behavioral interventions such as relaxation training, biofeedback, and cognitive behavioral therapy can reduce migraine frequency by 35 to 50 percent. In my opinion, those effects are comparable to pharmaceutical preventives. Simple daily breathwork, mindfulness, meditation, or other stress-reducing practices may also affect migraine frequency.

Something people often overlook relates to the earlier question from James about excess weight and the risks of cancer, cardiovascular disease, and diabetes. Obesity also increases the risk of frequent migraines by as much as sixfold. It's not the only cause, and people may have other underlying causes, but obesity increases the likelihood of frequent attacks. Clinical studies have shown that weight loss reduces both the frequency and intensity of migraine attacks. This is probably linked to reduced systemic inflammation and the hormonal changes that accompany weight loss, which also play roles in migraines.

Another underappreciated factor is hydration. It's important to drink enough water. I sometimes get headaches when I'm dehydrated, although I don't get migraines. In one randomized controlled trial, participants drank about 1.5 liters more water each day for 12 weeks. That group had fewer headache hours and lower headache intensity than the control group. It's a simple intervention that seems to matter. Generally, adults should aim for about two to three liters of water per day.

This is also related to caffeine, and caffeine is one of those double-edged swords. Caffeine blocks adenosine receptors in the brain. Adenosine normally builds up throughout the day and promotes the widening of blood vessels. It causes fatigue and promotes sleepiness. Interestingly, during a migraine attack, adenosine levels spike. By blocking adenosine, caffeine constricts blood vessels and reduces that vascular component of migraine pain.

There's evidence that a small amount of caffeine at migraine onset can abort or blunt the attack. A small amount is about 100 milligrams, or the amount in a very strong cup of tea or a small cup of coffee, taken as soon as the migraine begins.

For most people, you don't want to take too much caffeine either. Staying under 200 milligrams a day and keeping it regular is important. If you're taking caffeine and then abruptly withdraw, that can also trigger migraines and headaches.

Then there's physical activity. Exercise is one of the most effective tools we have for preventing migraines. That may seem counterintuitive because exercise can trigger a headache in some people if they go too hard or too fast. Overall, the evidence shows that regular endurance and strength training significantly reduce the frequency of migraine attacks.

In one randomized controlled trial, patients with frequent migraines were divided into three groups. One group did aerobic cycling three times a week for about 40 minutes. Another group took the prescription migraine-prevention drug topiramate. The third group did relaxation therapy. After three months, all three groups had roughly the same reduction in migraine frequency. That's remarkable because it suggests that a consistent exercise routine can help without requiring prescription pharmaceuticals that often have undesirable side effects.

More recently, a 2022 meta-analysis of 21 trials with more than 1,000 participants found that strength training was the most effective form of exercise for reducing migraine days. That was followed by high-intensity aerobic exercise and then moderate-intensity exercise. All three forms were beneficial. Strength training reduced migraine frequency by about 3.5 days per month, while aerobic training reduced it by about two to three days per month. The results are fairly close, and consistency is important.

Let's talk about diet. Migraines have a strong metabolic and inflammatory component, so nutrition makes a difference in both prevention and severity. Skipping meals and intermittent fasting can be triggers. Intermittent fasting can have many benefits, but for people who are prone to migraines, fasting for too long can trigger a migraine, partly because the decrease in blood glucose increases excitability in the hypothalamus and brainstem and lowers the threshold for a migraine attack.

People who are prone to migraines probably want to avoid prolonged fasts. Try to eat at regular intervals and emphasize protein and fiber, which help stabilize blood sugar levels and prevent spikes and crashes.

Diet composition is also very important. Omega-3 fatty acids are anti-inflammatory, while omega-6 fatty acids are more pro-inflammatory. In one study, researchers put migraine patients on different diets to manipulate levels of omega-3 versus omega-6. The group that increased omega-3 and lowered omega-6 had fewer headache days per month compared with the control group. Even a diet that didn't restrict omega-6 and only increased omega-3 reduced migraine days compared with the control.

The most important dietary change may be increasing omega-3 intake. Fish oil supplementation has shown similar benefits in clinical studies. That probably has a lot to do with inflammatory pathways. Omega-3 fatty acids are used to make resolvins and protectins, which help resolve inflammation and pain signaling.

Pay attention to potential trigger foods. Triggers are highly variable, so keeping a food journal is a good rule of thumb for someone with frequent migraines. Alcohol, red wine, tyramine in aged cheese, processed meats, nitrates, and MSG can trigger a migraine in some people. People who are prone to migraines should avoid the chemicals and foods that trigger their attacks.

A Mediterranean-style dietary pattern has the most evidence for reducing migraine frequency. It emphasizes foods high in omega-3 while providing protein, fiber, and minerals such as magnesium.

Magnesium is also important. Considerable evidence has examined magnesium for treating and preventing migraines. Magnesium stabilizes neuronal membranes and may help prevent the brain hyperexcitability that can trigger attacks. It also modulates blood vessel tone, which plays an important role in migraines.

Magnesium is one of the most evidence-backed supplements for migraine treatment. A meta-analysis of randomized controlled studies found that oral magnesium supplementation reduced migraine frequency and intensity compared with placebo. Intravenous studies have shown that intravenous magnesium can also mitigate acute attacks.

Regarding dose, the best evidence seems to support 400 to 600 milligrams per day of oral magnesium, usually citrate or glycinate for better absorption. Taking 400 milligrams at once causes gastrointestinal distress for some people. You could take 200 milligrams three times a day for a total of 600 milligrams, or 200 milligrams twice a day for a total of 400 milligrams. Dividing it into 200-milligram doses helps prevent gastrointestinal distress.

Ginger contains bioactive compounds such as gingerols and shogaols that inhibit prostaglandins and leukotrienes, which amplify pain and inflammation. In one randomized controlled trial, people took 250 milligrams of ginger powder or 50 milligrams of sumatriptan, a prescription migraine drug. Both groups experienced almost identical reductions in pain after two hours. That's profound if ginger powder can help someone avoid pharmaceuticals whose side effects we're still figuring out.

Riboflavin, or vitamin B2, is another option. People who get migraines often show signs of inefficient ATP production in the brain. Riboflavin is a cofactor for energy-producing enzymes, so it supports mitochondrial function and output. Multiple meta-analyses have found benefits. One found that 400 milligrams of riboflavin daily for three months significantly reduced migraine frequency, duration, and pain intensity.

CoQ10 is similar to riboflavin because it also affects mitochondrial energy metabolism. A meta-analysis showed that CoQ10 supplementation at around 300 milligrams per day reduced migraine frequency by about 1.8 attacks per month. A theme is emerging: compounds that affect mitochondrial function seem to reduce migraine frequency, duration, and pain intensity.

Alpha-lipoic acid is another option. A couple of small trials, though fewer than for CoQ10 or riboflavin, show that about 600 milligrams of alpha-lipoic acid per day reduces migraine frequency compared with placebo. Alpha-lipoic acid is also important for mitochondrial health.

I take alpha-lipoic acid and CoQ10. I don't take high-dose riboflavin, although it's in my multivitamin. I generally take compounds that support mitochondrial health, and it's interesting that they may also improve migraine frequency and duration in people who are prone to attacks.

There's some evidence for acupuncture. Temperature therapy may also play a role. Cold constricts blood vessels, much like caffeine does, and that may reduce inflammatory neuropeptides as well.

If you're looking for a protocol that covers morning and evening routines, physical activity, nutrition, and supplements, start with a regular bedtime and wake time. Focus on sleep hygiene, and get outdoors within the first 30 minutes after waking. Stay hydrated. If you're prone to migraines, don't skip meals because the resulting drop in blood glucose can trigger an attack.

Be consistent with physical activity. Aim for 30 to 50 minutes of high-intensity or moderate-intensity activity three to five times per week. Add a couple of resistance-training sessions as well. This needs to be part of your weekly routine.

For nutrition, avoid ultra-processed foods and foods high in omega-6. Try to adopt a Mediterranean-style diet, increase omega-3 intake, and stay hydrated. About 100 milligrams of caffeine may help when an attack begins.

The supplement stack includes 400 to 600 milligrams of magnesium glycinate or citrate per day, 400 milligrams of riboflavin per day, and CoQ10. I like ubiquinol, which is more bioavailable, so you can probably use a lower dose. A daily CoQ10 dose of 100 to 300 milligrams depends on the form. If you're taking ubiquinone, you may need up to 300 milligrams per day. If you're taking ubiquinol, you can probably use half that dose, such as 150 milligrams per day.

Melatonin may also help at about three milligrams at bedtime, especially if your sleep is irregular. Even more important are omega-3 fatty acids. Taking at least two grams per day can help you reach an Omega-3 Index of eight percent or more.

For stress, use mindfulness, exercise, deep breathing, or other relaxation techniques. Some people find that biofeedback and acupuncture help. Those options may be worth trying for people who have not found relief.

We also talked about some things people can do during an attack: immediately take 100 milligrams of caffeine if you tolerate it, take 250 to 500 milligrams of ginger powder or sip strong ginger tea, apply a cold pack, and make sure you're hydrated. Ginger powder seemed to work as well as a pharmaceutical drug. All these things can help during an acute attack...