Skip to main content
Log in

Some phytomedicines show promise for the management of migraine, but further clinical evidence is needed before they can be strongly recommended

  • Disease Management
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

Phytomedicines may provide new options for migraine prophylaxis and treatment based on their historical use and pharmacological properties. However, as clinical data are limited, no phytomedicine can currently be strongly recommended to manage migraine. Feverfew and butterbur may be effective in preventing migraine, but the efficacy of butterbur has been overshadowed by reports of severe petasites hepatotoxicity. Although further research is needed, chamomile, coriander, peppermint and ginkgo have shown encouraging results in explorative clinical studies, and the active components of cannabis and St John’s wort have shown promise in preclinical studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain. 2013;154(Suppl 1):S44–53.

    Article  CAS  PubMed  Google Scholar 

  2. Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. J Neurosci. 2015;35:6619–29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Headache Classification Committee of the International Headache Society. The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38:1–211.

  4. Goadsby PJ, Holland PR, Martins-Oliveira M, et al. Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev. 2017;97:553–622.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rajapakse T, Davenport WJ. Phytomedicines in the treatment of migraine. CNS Drugs. 2019;33(5):399–415.

    Article  CAS  PubMed  Google Scholar 

  6. Levy D, Burstein R, Kainz V, et al. Mast cell degranulation activates a pain pathway underlying migraine headache. Pain. 2007;130:166–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. De Weerdt CJ, Bootsma HP, Hendriks H. Herbal medicines in migraine prevention randomized double-blind placebo-controlled crossover trial of a feverfew preparation. Phytomedicine. 1996;3(3):225–30.

    Article  PubMed  Google Scholar 

  8. Pfaffenrath V, Diener HC, Fischer M, et al. The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis: a double-blind, multicentre, randomized placebo-controlled dose-response study. Cephalalgia. 2002;22(7):523–32.

    Article  CAS  PubMed  Google Scholar 

  9. Diener HC, Pfaffenrath V, Schnitker J, et al. Efficacy and safety of 6.25 mg t.i.d. feverfew CO2-extract (MIG-99) in migraine prevention—a randomized, double-blind, multicentre, placebo-controlled study. Cephalalgia. 2005;25:1031–41.

    Article  CAS  PubMed  Google Scholar 

  10. Murphy JJ, Heptinstall S, Mitchell JR. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet. 1988;2:189–92.

    Article  CAS  PubMed  Google Scholar 

  11. Palevitch D, Earon G, Carasso R. Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: a double-blind placebo-controlled study. Phytother Res. 1997;11:508–11.

    Article  Google Scholar 

  12. Holland S, Silberstein SD, Freitag F, et al. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1346–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Pringsheim T, Davenport WJ, Mackie G, et al. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2013;40(5 Suppl 3):S1–80.

    PubMed  Google Scholar 

  14. Evers S, Afra J, Frese A, et al. EFNS guideline on the drug treatment of migraine–revised report of an EFNS task force. Eur J Neurol. 2009;16(9):968–81.

    Article  CAS  PubMed  Google Scholar 

  15. McGuffin M. American Herbal Products Association’s botanical safety handbook. Boca Raton: CRC Press; 1997.

    Google Scholar 

  16. Shimoda H, Tanaka J, Yamada E, et al. Anti type I allergic property of Japanese butterbur extract and its mast cell degranulation inhibitory ingredients. J Agric Food Chem. 2006;54:2915–20.

    Article  CAS  PubMed  Google Scholar 

  17. Lipton RB, Göbel H, Einhäupl KM, et al. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology. 2004;63:2240–4.

    Article  CAS  PubMed  Google Scholar 

  18. 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;51:89–97.

    Article  CAS  PubMed  Google Scholar 

  19. Tepper SJ. Evidence-based basics on neutraceutical herbs, minerals, vitamins and supplements in migraine management. https://americanheadachesociety.org/wp-content/uploads/2018/06/Tepper-Nutraceuticals.docx. Accessed Jun 2019.

  20. Diener HC, Freitag FG, Danesch U. Safety profile of a special butterbur extract from Petasites hybridus in migraine prevention with emphasis on the liver. Cephalalgia Rep. 2018;1:1–8. https://doi.org/10.1177/2515816318759304.

    Article  Google Scholar 

  21. Pittler MH, Ernst E. Feverfew for preventing migraine. Cochrane Database Syst Rev. 2004;CD002286.

  22. Wider B, Pittler MH, Ernst E. Feverfew for preventing migraine. Cochrane Database Syst Rev. 2015;4:CD002286.

    PubMed  Google Scholar 

  23. Delavar Kasmaei H, Ghorbanifar Z, Zayeri F, et al. Effects of Coriandrum sativum syrup on migraine: a randomized, triple-blind, placebo-controlled trial. Iran Red Crescent Med J. 2016;8(1):e20759.

    Google Scholar 

  24. Kamali M, Seifadini R, Kamali H, et al. Efficacy of combination of Viola odorata, Rosa damascena and Coriandrum sativum in prevention of migraine attacks: a randomized, double blind, placebo-controlled clinical trial. Electron Physician. 2018;10:6430–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kasper S, Caraci F, Forti B, et al. Efficacy and tolerability of hypericum extract for the treatment of mild to moderate depression. Eur Neuropsychopharmacol. 2010;20(11):747–65.

    Article  CAS  PubMed  Google Scholar 

  26. Borhani Haghighi A, Motazedian S, Rezaii R, 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;64:451–6.

    Article  CAS  PubMed  Google Scholar 

  27. Niazi M, Hashempur MH, Taghizadeh M, et al. Efficacy of topical Rose (Rosa damascena Mill) oil for migraine headache: a randomized double-blinded placebo-controlled cross-over trial. Complement Ther Med. 2017;34:35–41.

    Article  PubMed  Google Scholar 

  28. Fan P. Cannabinoid agonists inhibit the activation of 5-HT3 receptors in rat nodose ganglion neurons. J Neurophysiol. 1995;73:907–10.

    Article  CAS  PubMed  Google Scholar 

  29. Baron EP. Comprehensive review of medicinal marijuana, cannabinoids, and therapeutic implications in medicine and headache: what a long strange trip it’s been. Headache. 2015;55:885–916.

    Article  PubMed  Google Scholar 

  30. Williamson EM, Evans FJ. Cannabinoids in clinical practice. Drugs. 2000;60:1303–14.

    Article  CAS  PubMed  Google Scholar 

  31. Aggarwal SK. Cannabinergic pain medicine: a concise clinical primer and survey of randomized-controlled trial results. Clin J Pain. 2013;29:162–71.

    Article  PubMed  Google Scholar 

  32. Zargaran A, Borhani-Haghighi A, Salehi-Marzijarani M, et al. Evaluation of the effect of topical chamomile (Matricaria chamomilla L.) oleogel as pain relief in migraine without aura: a randomized, double-blind, placebocontrolled, crossover study. Neurol Sci. 2018;39(8):1345–53.

    Article  PubMed  Google Scholar 

  33. Galeotti N, Ghelardini C. St. John’s wort reversal of meningeal nociception: a natural therapeutic perspective for migraine pain. Phytomedicine. 2013;20:930–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Consortia

Ethics declarations

Conflict of interest

The article was adapted from CNS Drugs 2019; 33(5):399–415 [5] by employees of Adis International Ltd./Springer Nature, who are responsible for the article content and declare no conflicts of interest.

Funding

The preparation of this review was not supported by any external funding.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adis Medical Writers. Some phytomedicines show promise for the management of migraine, but further clinical evidence is needed before they can be strongly recommended. Drugs Ther Perspect 35, 413–417 (2019). https://doi.org/10.1007/s40267-019-00657-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-019-00657-1

Navigation