Supplements
Supplements
Vitamins and supplements can make a huge difference to migraines. My understanding is they help the body convert food to energy, and the migraine brain has high energy requirements. The theory is this lack of available energy leads to migraines, particularly during periods of high energy demand including in busy environments, when stress is high, in work meetings and workshops, and in bright busy areas your brain works hard and needs more energy.
My supplement stack has evolved over the past couple of years. Initially my GP said "Magnesium and B2 can fix migraines for some people". From there as I learned about the metabolic origins of migraines I researched supplements myself and added them over time, with many of them recommended by Dr Turknett and Dr Gross, and others discovered with the help of AI.
Warning
Supplements may in some cases interfere with prescription medications. Anyone considering adding supplements should consult with their doctor.
Start Slowly
This may be obvious, but these supplements affect the body and brain. I've found in some cases my migraines can initially get a little worse when I first start taking a supplement before I improve. Everything below has benefits for me, but it may take a few days to a few weeks to get those benefits. For example I find creatine very helpful, for migraines and athletic performance, but I felt a bit off for a week when I started taking it, and it took a couple of weeks to feel the benefits. ALA was similar, as were ketones / BHB.
When I add a new supplement these days I add one at a time, and I avoid all migraine triggers for a few days. I also start with a low dose and work my way up. I also start by taking it after food, as food tends to reduce the speed of absorption, which reduces impact and side effects.
I started with a multivitamin, magnesium, B2, and ubiquinol, which are some of the most commonly recommended supplements and are relatively low impact as they're common in the food we eat. I added new supplements over time, and any that didn't help I stopped taking. I occasionally stop taking supplements to see what happens, weaning off them slowly as any change can affect a migraineurs brain.
I find it useful to visit my doctor to ask for a full blood panel perhaps annually, making sure it includes iron and ferritin, fasting glucose and insulin, HgA1C, hsCRP, and thyroid tests. I did this once and found I had a completely unexpected condition that needed urgent treatment. The book "Good Energy" on the resources page has a list of suggested blood tests.
Evidence
Before I took these supplements I researched them. I used a combination of peer reviewed research from the National Library of Medicine and more recently also use ChatGPT / Claude - though any information I get from an AI I check with a reliable source.
- This paper particularly supports many of the supplements recommended below. I encourage independent investigations before taking any supplement.
- This paper describes the role of ketone bodies in preventing migraines.
- This paper describes which nutrients have evidence to support migraine reduction.
There are many papers regarding vitamin deficiencies, such as this paper regarding magnesium deficiency.
Dr Gross Created Supplement
Dr Gross created a commercial supplement Brain Ritual. This has key vitamins and minerals the body needs to convert food to ATP, plus exogenous ketones to directly provide energy. It costs US$79 per month, but only ships to the US and Canada. For people outside those countries it's useful to see the ingredients, which are listed here. My supplement stack includes most of what is in Brian Ritual, plus some extras I found in my research that are useful for me to improve mitochondrial function.
Supplements
I take all of the supplements below. My core supplements are everything up to and including creatine, these gave me the most benefits, though the later supplements also helped. I made sure to address triggers and food quality at the same time as adding supplements, as no amount of supplements will overcomes strong triggers. If I was starting these again after a break I would add one every 2-3 days, that way you can see if they help and check if any cause side effects - some people can get an upset stomach if they take a large number of supplements.
The core supplements are widely recommended for migraine prevention. I've linked to what I usually buy, but it changes based on price and availability. Avoid the cheapest options and brands that sell only one or two vitamins, there's a lot of poor quality supplements around, especially on Amazon. Nutricost, BestVite, and Bulk Supplements seem to be good brands. Use Supp Co to work out reputable brands - website and app.
In some cases I buy powders rather than capsules because they can be significantly cheaper in some cases. The monthly costs for all the vitamins on this list is around NZ$180, which is significantly less than the $330 monthly Emgality injections I was previously using.
NB: the "timing" section below provides tips on the best time to take nutrients. All the quantities below are daily, though I tend to split many of them into two doses where practical so I get it gradually rather than all at once.
| Name (daily dose) | Notes |
| Core Supplements | |
| Magnesium Glycinate (400mg) | Doctors Best capsules, powder. The Glycinate form seems best for migraines. 400mg total across all supplements seems to be more effective than a lower dose, and helps sleep as well. 400 - 600mg is generally recommended, but beware it can contribute to an upset stomach. |
| CoQ10 as Ubiquinol (100mg) | Qunol seems to work well and is good value. This is the active form of CoQ10, which is used directly by the body for energy production. Its unclear if this is more bioavailable than ubiquinone as some brands claim. |
| Vitamin B2 (200-400mg) | Current brand, 100mg tabs. Also known as riboflavin. You can take one 400mg dose or three smaller doses. The body can only absorb about 30mg at a time, but larger doses act in the gut to produce butyrate which can regulate inflammation, metabolism, and immune function through the body. It can upset the tummy until you get used to it. There's limited evidence on whether 400mg provides benefits over 200mg. I currently take 400mg with lunch. |
| Omega 3 (3g) | Higher dosages seem more effective. I currently take three Sanderson 3000mg from Chemist Warehouse as it's best value at $18 for 150 caps on special, one with lunch and dinner. When I dropped from 3x daily to 2x daily it didn't make much difference. |
| Vitamin D3 (2000IU) | Link. Don't get a very high dose unless you have had a blood test that says you're deficient. Take it earlier in the day as it can disturb sleep, but it's important for migraines. After a few months get a blood test to see if you need more or less Vit D. |
| Multivitamin | I use both:
Research suggests that methylated multivitamins can be stimulating, and should be taken with lunch rather than dinner. I take all my multivitamin capsules with lunch. |
| Creatine monohydrate | Creatine supports brain energy production, which may help reduce the energy deficits associated with migraines. It also helps maintain muscle strength and performance, supports recovery, and I've found it has benefits for cognitive function. 5g of creatine monohydrate. |
| Vitamin B12 | If it's not in your multi. This is commonly recommended for migraines. |
| CoQ10 as Ubiquinone (100mg) | Another form of CoQ10. I felt benefits when I start taking this in addition to Ubiqunol, but it's meant to be less easily absorbed particularly for people over 50. The generally recommended dose is 100 - 300mg / day, but it's somewhat expensive, and it can contribute to an upset stomach. |
| Exogenous Ketones | |
| Exogenous ketones - Calcium BHB or Magnesium BHB (3g 2-3 times daily plus as required to help relieve migraine) | Ketones are an alternate energy source for the brain, as made by the liver during ketosis. I mix 1.5g Calcium BHB with 1.5g Magnesium BHB (alternate) and take it with breakfast and lunch. Available from Amazon USA / AU. I find this very effective to prevent migraines, and they can help reduce migraines as well. They don't taste great, I used to mix it either with Ribena, raro / orange vitafresh but now I just have it with water. Start at 1g after each meal and work your way up. |
| Mitochondrial Supplements | |
| Glutamine Monohydrate (5g) | Musashi from Chemist Warehouse and Cyborg Sport from Amazon AU. Takes 1-3 weeks to help migraines. |
| Alpha Lipoic Acid / ALA (600mg) | Nutricost or Best Naturals. You may feel a bit off for the first few days. This is a type of Omega3 fatty acid. Relevant article. If you get an upset stomach try R-ALA 100mg twice daily, this avoids the S-ALA form which is inactive and causes stomach irritation. |
| Acetyl L-Carnitine / ALCAR (500 - 1000mg) | Nutricost or Vitamatic from Amazon Au. Buying the Nutricost powder in a container instead of capsules is a lot cheaper. 500mg is probably plenty. I felt better increasing from 250mg to 500mg and may try 750mg. |
| Iron Bisglycinate (25mg daily) | Solgar. Likely only required for vegetarians or people who don't eat much meat. Take with Vitamin C if you want to maximise absorption, every second day is better for absorption in theory but I take it daily. Check your RDA and compare with your food sources. It's best to get a blood test and try to get your ferritin up above the midpoint of the lab reference range, maybe a bit higher. |
| Melatonin (3-5mg) | Natrol is by far the best brand I've tried, I also find the Life Extension brand effective (check for their extended release formulations). Solgar is my backup to avoid the B6 in Natrol. Melatonin's an antioxidant, there's evidence that suggests it reduces migraines. It helps you get to sleep too, but doesn't help you stay asleep. There is a correlation between melatonin use and heart disease, so beware. Pubmed article. |
| Niacinamide (500mg) | Helps increase NAD levels in the brain, which helps make more ATP / energy. Link. I felt better after increasing from 200mg to 500mg. NB: I no longer take this as Nicotinamide Riboside seems to be even more effective. |
| Nicotinamide Riboside (600mg) | I use Niacinex Nicotinamide Riboside or Tru Niagen . I found when I changed from Niacinamide I had further improvement in migraine symptoms, and it enabled me to eat a wider range of foods without developing a migraine. Don't take any other B3 / Niacinamide supplement with NR. The other forms block absorption of this one according to AI. A bit in a multi is fine. I tried β-Nicotinamide Mononucleotide (NMN) as an alternative to NR. I found it less effective than NR. I currently use NR in the morning and NMN with lunch, that works well, but I find NMN in the morning less effective than NR. I only use NMN as it's cheaper. If I skip NR and NMN at lunch I end up quite tired by dinner. Research suggests NR and NMN, which are commonly taken to reduce side effects of cancer chemotherapy, can help cancer cells resist treatment. Talk to your doctor about supplements if you have any illnesses or are undergoing any treatments particularly for serious illnesses. |
| Nutricost Taurine (1g) | I'm not sure it helps migraines, but it's meant to be good for longevity. Link. |
| NAC | I started taking NAC (N-Acetyl L-Cysteine) as it can help with chest infections, but it seems to have helped with energy, mood, and a further small reduction in migraines. I also seem to wake less at night and feel more rested and less tired the next day. |
Avoid excessive quantities of B6, which turns up in various vitamins and Melatonin. I've read that over 50mg per day is likely toxic, but over 10mg per day long term could be a problem for people who are sensitive to it.
Vitamin Scheduling / Optimising Bioavailability
Some vitamins are best absorbed on an empty stomach. Some are best absorbed with food. Some vitamins prevent others from being absorbed. The schedule below describes my current best effort to schedule for best absorbability.
With Breakfast or 7am
I rarely eat breakfast. Sometimes I have Nothing Naughty vanilla whey protein as it has no sugar, and the sweeteners thaumatin and stevia don't seem trigger migraines as much as most commercial powders containing soy and other things do. Commercial powders like Gold Standard sometimes give me a migraine, plus they taste sickly sweet since I stopping eating sugar. Protein powders sometimes bring on a migraine for me.
- 1x Nicotinamide Riboside
- 2.5g Magnesium / Calcium BHB Powder
Mid morning / 10am
- 1x Alpha Lipoic Acid 300mg, or NA-R-ALA 100mg. ALA is better absorbed on an empty stomach say 10am and 3pm, but I find it upsets my stomach. If taken with lunch it competes for absorption with magnesium and calcium in the multi, so best taken earlier.
With Lunch
- All multivitamin capsules (with food)
- 1x CoQ10 as Ubiqunol (must take with fatty or oily food)
- 1x D3 (with fatty or oily food)
- 1x Omega 3 (must take with fatty or oily food)
- 1x B2 400mg (best with food)
- 1x NMN or Nicotinamide Riboside
I take the following as powders, mixed with water in a shaker. I take this with lunch to reduce the stomach upset it can cause on an empty stomach.
- Creatine 5g
- BHB / Ketones 2.5g
- Acetyl l-carnitine 1g
- Taurine 1g
Early afternoon / 2pm
- 1x Alpha Lipoic Acid 300mg (though I'm reducing this to see what happens)
Mid Afternoon / 4pm
- Iron 25mg daily. Noting that vitamin C helps iron absorption, every second day works better in theory - source).
Dinner
- 1x B2 100mg
- 1x CoQ10 as Ubiquinone (must take with fatty or oily food)
- 1x Omega 3 - I reduced Omega3 and Magnesium as it was upsetting my stomach.
- 2x Magnesium (separated from vitamin C / iron they compete for absorption). I reduce to 1x if I'm taking magnesium BHB. When I increased from 1x to 3x my sleep improved.
Late Evening
- Melatonin 1mg + 5mg