Feverfew, Petadolex, and magnesium oxide, have all held up in double-blind studies as migraine preventatives.  Petadolex has been the most effective.

1. Petadolex: Commonly used in Europe, this herb has been successful in several well-designed blinded studies.  The usual dose is two per day.  Earlier concerns about carcinogenisis with this family of herbs have decreased with Petadolex.  It is prudent to stop it every three months or so.  Available at 1-888-301-1084.  Petdolex is a very effective preventive.  Patients occasionally experience GI upset or a bad taste.  Usually well tolerated.

2. Magnesium Oxide: It has been shown that magnesium levels are low in the brain of migraine patients.  400 or 500 mg per day is used as a preventive; mild GI side effects may limit use.  250 mg tablets are found in most pharmacies.  Only mildly effective.

3. Feverfew: Feverfew has been demonstrated to be mildly effective in some patients for prevention of migraine headache.  Feverfew can cause a mild increased tendency toward bleeding, and should be discontinued two weeks prior to surgery.  Feverfew should not be used during pregnancy and patients are occasionally allergic to it.  The problem with many herbal supplements is quality control, and certain farms consistently have better quality than others.  The parthenolide content (the active ingredient) varies widely from farm to farm.  The usual dose is two capsules each morning.  Eclectic Institute (a blue and white bottle, widely available in health food stores and Whole Foods) freeze dries their herbs, and the product is highly consistent and reliable.

4. Long Chain Fatty Acids (Omega-3 fatty acids): These may play a role in headache prevention, as well as (possibly) useful for anxiety, HTN, arthritis, high lipids, depression and heart disease.  We usually recommend fish oil or Flaxseed oil, 1000 mg., two or four per day (in studies on depression, eight per day have been utilized).  Fish oil capsules may be more effective than Flaxseed oil.  Oily, fatty fishes 9Salmon, Tuna) contain more than other fishes.  Look for the brands with the highest amounts (EPA/DHA) listed on the back.

5. Coenzyme Q-10: COQ-10 is relatively safe, and has started to be investigated as a headache preventive.  Doses for headache are not known.  COQ-10 may have some positive effects on the heart as well.  We usually recommend 150 to 300 mg daily.

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