How do you prevent and treat migraines?
For a mild attack, start with ibuprofen or paracetamol; for severe attacks, choose a triptan as early as possible in the attack.
For a mild to moderate attack, ibuprofen and paracetamol are a good first choice. They work and are inexpensive, but they fall short for severe attacks. Combining ibuprofen with a triptan (a medicine developed specifically for migraine) works better than either medicine on its own.
Triptans are the most well-supported option for a moderate to severe attack. Between 42 and 76% of users experience relief within two hours; 18 to 50% become completely pain-free. The earlier you take them at the start of an attack, the better they work.
Newer medicines, such as rimegepant and lasmiditan, work better than doing nothing but are less effective than most triptans. Their advantage is that they do not narrow blood vessels, which makes them an option when triptans are medically inadvisable, for example in people with heart or vascular disease. Lasmiditan does cause the most side effects, such as dizziness and drowsiness.
Opioids are not recommended as a standard treatment. The evidence that they help is weak, and the risk of dependence and headache caused by overusing medication is real.
For people who have four or more attacks per month, or attacks that are severely disabling, preventive treatment is strongly recommended. The best-supported options are valproate, topiramate, and the beta-blockers propranolol, metoprolol, and timolol. Despite this clear evidence, fewer than 13% of people who would benefit from prevention are actually using these medicines.
Without medication, relaxation training, biofeedback, and cognitive behavioural therapy are well-supported preventive options with no side effects. Magnesium and riboflavin (vitamin B2) are probably somewhat effective. Butterbur also shows signs of benefit, but only use a certified product that has had the liver-damaging substances removed.
Based on multiple bodies of combined studies, including a large network comparison of many studies at once. The strongest claims (triptans, preventive medication, NSAIDs) are well supported. Data on newer medicines and nerve stimulation are based on reviews with moderate evidence.
Is berberine safe to use if you are taking medication?
Berberine can influence the blood levels of certain medications, although the clinical significance is unclear in most cases. If you are taking medication, discuss this with your doctor or pharmacist before using berberine.
What are the side effects of metformin?
Metformin causes gastrointestinal complaints such as diarrhoea, nausea and vomiting in a substantial proportion of users. Discuss with your doctor whether the dose can be built up gradually, or consider an alternative if the complaints persist.
How much berberine do you need per day?
For blood sugar regulation in type 2 diabetes, 500 mg three times daily (1500 mg per day) for at least 8 to 12 weeks is the best-supported schedule; for cholesterol, 500 mg twice daily is the starting point. If you have a condition or use medication, always discuss this with your doctor.
How healthy is meditation, and what does it actually do for you?
Meditation has a moderate but well-demonstrated effect on depression, anxiety and pain, and can safely be combined with other treatments. For other health claims the evidence is still too thin to rely on.
Does metformin help you live longer in good health?
For people with diabetes, metformin has a reasonably well-supported health benefit, but as an anti-ageing agent for healthy people it remains unproven. Wait for the results of that large ongoing study before drawing conclusions.
What does ibogaine do and what is it used for?
Research shows that ibogaine reduces drug craving and withdrawal symptoms. The heart risks are serious and well documented, so always discuss it with a doctor first.