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.

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 Larry Charleston IV, Grand Rapids, MI: Holland et al.1 highlighted the evidence of complementary treatments for the prevention of episodic migraine. There are a few natural supplements used in the prevention of migraine or its associated symptoms that were not classified in these guidelines. A review of additional natural supplements may be worthy of examination and classification based on their respective evidence. One underpowered, randomized, controlled trial of 600 mg/day of -lipoic acid (thioctic acid) showed a strong trend for decreased monthly attack frequency (p 0.06). Within-group analysis showed significant reduction in attack frequency, headache days, and headache severity in the treatment group.2 Vitamin E effectively reduced the severity of headache pain, abortive headache medication usage, functional disability, and associated migraine symptoms (phonophobia, photophobia, and nausea) in pure menstrual migraine in a randomized, controlled trial.3 The authors recommended a dosage of 400 IU for 5 days starting 2 days prior to menses. In an open, preliminary trial, a combination of 60 mg Ginkgo Biloba Terpenes Phytosome, 11 mg coenzyme Q10, and 8.7 mg vitamin B2 (Migrasoll) was effective in reducing both aura frequency and duration in the study population.4