Migraines are complicated — and when patients are dealing with recurring symptoms, it’s no surprise many turn to natural medicines. From butterbur and CoQ10 to caffeine, these options are easy to find and frequently discussed, but the evidence and safety can vary widely depending on how they’re used.
In this episode, NatMed editors Jeff Langford, PharmD, BCPS, BCCP; Andrea Stafford, PharmD; and Kelly Daniels break down the evidence behind common natural medicines for migraines and discuss how clinicians can help patients match the right option to the right goal… prevention versus acute treatment, while setting realistic expectations at the point of care.
Questions we answer in this episode:
- What should clinicians know about butterbur, including effectiveness, PA‑free labeling, product quality, and safety concerns?
- How long does coenzyme Q10 typically take to show benefit, and how should patients be counseled before starting it?
- When can caffeine play a helpful role in migraine treatment — and when might it backfire?
Throughout the episode, we discuss how dose, timing, and total intake can shape whether natural medicines work as expected — and why those details matter just as much as the ingredient itself. We also share practical counseling approaches pharmacists can use to keep conversations focused and useful when patients ask what’s worth trying for migraines, without defaulting to a one‑size‑fits‑all answer.
🏷️ Get 10% off a new or upgraded subscription with code natmed1026b at checkout.
NatMed / TRC Healthcare Editor Hosts:
- Jeff Langford PharmD, BCPS, BCCP (Managing Clinical Editor)
- Andrea Stafford, PharmD (Assistant Editor)
- Kelly Daniels, BA (News Editor & Associate Content Manager)
CE Information:
This podcast is sourced from the NatMed April 2026 Newsletter. To claim CE credit, subscribers should read the newsletter and click “Take the CE Quiz” link to take the quiz.
Clinical resources, part of a subscription to NatMed:
- 🌱 NatMed Pro
- 💊 TRC Healthcare
- Newsletter
- Infographic
- Monograph: Butterbur
- Monograph: Coenzyme Q10
- Monograph: Caffeine
- Effectiveness by Condition Tool: Migraine Headache
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Email us: [email protected]
The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Natural Medicines: Evidence in Practice is a production of TRC Healthcare.
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Transcript:
Introduction
Kelly Daniels
Migraines are complicated. And if you’ve ever had one, you know you can just be absolutely desperate for relief. Is caffeine your friend, or is it the thing that just completely backfires? Butterburst sounds promising, but is it safe? And if you’re trying CoQ10, how long does it take to actually work?
Andrea Stafford
If you’ve heard those questions from patients, or just simply found yourself wondering the same things, you are in the right place.
Jeff Langford
Welcome back to Natural Medicines Evidence in Practice. I’m Jeff Langford, pharmacist and managing editor at NatMed, here with my teammates and co-hosts Kelly Daniels and Andrea Stafford.
Kelly Daniels
Hi, Jeff.
Andrea Stafford
Hi, Jeff.
Jeff Langford
All right. Well, on this show, we’re going to cut through noise and trends to bring practical evidence-based guidance on this topic.
Andrea Stafford
And today’s episode is all about migraines. And we will be breaking down three natural medicines that frequently come up in practice butterburr, coenzyme Q10, and caffeine. We’ll cover what the evidence actually says, safety concerns, and how to counsel patients who are asking about them or maybe already taking them.
Kelly Daniels
Quick note: CE credit is available for our podcast through our monthly NetMed newsletter. Check the show notes for details.
Jeff Langford
Okay, Kelly. Well, help us get started here and just set the foundation for why are we talking about migraines and why are natural medicines just such a big part of that conversation inherently?
Kelly Daniels
Well, I mean, migraines affect one in 10 people. That’s a lot of people. So for many people, they’re not occasional. You know, they’re recurring, they’re disruptive, and they’re just honestly exhausting. So patients are looking for any solution. I agree.
Andrea Stafford
Someone who suffers with migraines, this can affect kind of daily life. And just kind of for that additional clarity, migraines are more than just a bad headache. They can last hours to days and are commonly accompanied by nausea, vomiting, sensitivity to light, or aura, the type of symptoms that can disrupt your week and, like I said, impact your quality of life.
Kelly Daniels
Right. And when something just keeps interrupting your work life, your family life, your sleep, like I said, you’ll just be willing to try anything.
Jeff Langford
And patients may be coming to us looking for something different for different reasons. It may be in some cases they want to avoid another prescription medication. They may be frustrated with side effects that they’ve experienced from past treatments, or maybe they’re just really worn down after years of trial and error with different therapies.
Andrea Stafford
You’re right, Jeff. Maybe patients want to avoid kind of adding another prescription medication, but it’s not always about replacing a prescription. Maybe they just want something to complement it, something over the counter or a familiar ingredient that can be appealing because it gives them kind of a sense of control that they can go into a store and pick something off the shelf.
Kelly Daniels
Right. And that’s when we start hearing about these natural products butterburr, CoQ10, caffeine, and many others.
Andrea Stafford
And this is kind of where things can get a little complicated. We need to determine what the end goal is. Are we stopping a migraine that’s happening right now, or are we trying to reduce how often they’re having them?
Jeff Langford
Yeah, and that distinction, Andrea, it really matters because some natural medicines do have evidence specifically for prevention, others for treatment, just like with traditional therapies. And if patients are using them without knowing what to expect in terms of that outcome or benefit, that can really lead to frustration if things aren’t working out like they may expect.
Andrea Stafford
Yes. And without that guidance, patients may reach for the wrong product, use the wrong dose, or give up too soon. And in some cases, they might use something that actually carries a real risk.
Kelly Daniels
Right. So grabbing that double espresso after already having the large cold brew may not end up working out well.
Jeff Langford
Right. And to that end, Kelly, we’re going to try to help sort out everything around this conversation. What’s actually worth discussing with patients? What are the key safety considerations with some of these options? And really at the end of the day, how can we equip everyone to have clearer and more confident conversations about managing migraines using natural therapies? So let’s dive in and sort all of this out.
Kelly Daniels
Great. So let’s start with Butterbur. This one comes up a lot. If you’ve ever searched for natural remedies online, you’ll definitely see Butterbur on that list. It’s also super popular on social media right now. A lot of people really swear by it. But there are definitely some nuances to this one, right, Jeff, when it comes to product quality, safety. And it’s also best for prevention, but not necessarily treating an active migraine.
Jeff Langford
Exactly. So let’s start maybe just kind of putting a quick recap on the evidence for butterburr for migraine prevention. We do have some clinical research in adults suggest that using a specific butterburr extract, we’re going to talk more about that in a minute, can reduce migraine frequency by roughly 50%. It also may reduce the intensity or duration of any breakthrough headaches that people have. So reducing how often they have a headache and if they still have one, making it less intense and lasting for a shorter amount of time. It’s been studied in adults at a dose of 75 milligrams once or twice a day for roughly four months. And this product was also studied in kids ages six to 17 using age-specific doses.
Andrea Stafford
Jeff, that sounds like a very meaningful reduction.
Jeff Langford
Yep. And not all products are the same, Andrea. Yeah. I mentioned a moment ago that this was using a specific butterbur extract. And the products in these studies were standardized to the active butterburr constituents. And that’s 15% of petasin and isopetasin.
Kelly Daniels
And that’s probably not something patients really have on their radar. They’re thinking, oh, I’m taking this herb, this natural product. They’re not thinking about active constituents or even looking for that on a product.
Jeff Langford
Absolutely.
Andrea Stafford
And this is where safety kind of plays a role and is important. The Butterbur plant also contains pyrrolizidine alkaloids or PAs. The concern is that CYP3A4, a key liver enzyme, metabolizes PAs into toxic byproducts that can cause hepatotoxicity. And so because of these serious adverse effects, it’s important that patients prioritize looking for products that are certified and labeled as PA-free.
Jeff Langford
Yeah, Andrea, and I really would emphasize that point as not being optional. We do want, if we’re having a conversation about Butterbur as a supplement for migraine prevention, we do want to emphasize finding one of these PA-free products that doesn’t entirely exclude the chance of liver injury. And it’s still been reported in certain instances, even with a PA-free product. So we still want to have that conversation about possible liver injury and signs and symptoms to monitor for, like persistent abdominal pain, a change in urine or stool color, or jaundicing, certainly any yellowing of the skin or eyes would be attention getting and would encourage patients to report that right away. But do look for the PA-free label. And I will tell you, as we were prepping for this, I looked at some products, and that’s not always easy to find. A few products have it very clearly on the label, and sometimes it’s kind of hidden in very tiny print on the back. So definitely help patients go over those labels and find a product with that information on it.
Kelly Daniels
So this really isn’t, you know, look a butter product up on Amazon and grab it. You need to make sure you know what you’re looking for. I think this is also a good time to point out quality certifications because I know for myself, before I entered the NatMed world, I didn’t realize, you know, the FDA isn’t checking that what’s in the bottle is on the product label and everything matches. No one’s actually testing these unless you choose a product that’s verified by a reputable third party like USP or NSF.
Andrea Stafford
Perfect. And I think that is just important to kind of explain to patients what they’re looking for, especially when they walk into a pharmacy, reach out to your pharmacist and kind of ask what those are and what those mean. So the bottom line with Butterbur is it may reduce migraine frequency when used for prevention, but that benefit depends on using kind of that right product at the right dose and consistently. And again, PA-free labeling is critical for safety.
Jeff Langford
Yeah. And Butterbur, I think, is just a nice example of the kinds of things we always want to think about with natural medicines. We want to really look at that effectiveness data, not just what something might do, but what do clinical studies show it has done in people? But we want to couple that with important safety considerations. And Butterbur is an example of where we have data for both that might suggest use, but also some really important safety considerations.
Coenzyme Q10 (CoQ10)
Kelly Daniels
Great. Okay, next up, let’s talk about coenzyme Q10 or co-Q10. Um, it’s super popular for patients looking for something relatively low risk, but this isn’t an immediate fix, is it, Jeff? This is something you have to kind of commit to and wait out before you see some relief.
Jeff Langford
Yeah. So, like Butterbur, this is going to be in the prevention category. It’s not a treatment option for migraine, but it can be used for prevention. And again, we do have some evidence here in clinical studies in adults, um, generally small studies, but suggesting that CoQ10 can reduce the frequency and severity of migraine headache. Study dose ranging from roughly 100 to 400 milligrams per day. Now, we talked before about Butterbur having data in kids. This is a little differentiator here with CoQ10 and kids. Overall, CoQ10 really doesn’t seem to improve the frequency, severity of duration of migraine headache in the pediatric population, but it does in adults. And at the level of kind of zooming out and thinking about what professional societies have to say about some of these therapies, American Academy of Neurology does rate CoQ10 as possibly effective for migraine prevention, specifically in the adult population.
Andrea Stafford
And just to point out again that even when CoQ10 was effective, it took three months to see that benefit.
Kelly Daniels
And that’s a really long time. If you’re battling migraines and your provider says you have to wait three months, that might not be for everyone.
Andrea Stafford
The good news is that cocu10 is generally well tolerated with no serious adverse effects being reported in studies. And even common side effects, including diarrhea, nausea, and heartburn, are uncommon, occurring in less than 1% of patients. And some things, if they, if patients are experiencing those side effects, you could split the dose above 100 milligrams throughout the day. And that can help reduce those effects, kind of making it easier for patients to stick with it long enough to potentially see those benefits. And that delayed onset is probably similar to other prophylactic therapies like Butterbur.
Jeff Langford
Yeah, so kind of to put a bottom line on this one for CoQ10, we can consider it as possibly effective for migraine prevention in adults. A typical dose of CoQ10 for migraine prevention is 100 to 400 milligrams daily in adults. As Andrea mentioned, tolerability might be improved if you divide the dose. But we, as we counsel patients about this option, we do want to emphasize it is prevention, and it may take a few months for that benefit to appear. But it is well tolerated, which may help get through that transitional period.
Andrea Stafford
So so far we’ve discussed prevention, but caffeine kind of flips the script a little.
Kelly Daniels
Can you get us started, Kelly? Yeah. I mean, sometimes it’s just I have a migraine right now. What can I do to help it? And like I mentioned earlier, sometimes caffeine or coffee or soda, whatever it is, that’s usually the answer. Even if you’re not intentionally choosing it as a treatment, you’re just thinking this might provide some relief.
Jeff Langford
Yeah, and caffeine does have evidence for treating migraine headaches. So kind of going beyond just that anecdotal experience that you’re talking about, Kelly, where we may intuitively recognize a certain beverage coupled with a treatment may improve symptoms. There are data to suggest that caffeine can be an effective treatment. And specifically, it’s FDA approved in conjunction with some traditional therapies like acetaminophen, aspirin, or sumatriptan to be used in combination with those things. Typically, to dose, a caffeine dose of 100 to 260 milligrams orally.
Andrea Stafford
And this is where kind of that dose and patient context really matter with regards to safety. We want to remind all patients not to exceed 400 milligrams daily from all sources, because going above that does raise the risk of rapid or irregular heartbeat, sleep disturbances, and it can potentially trigger migraines. There are also some nuances in the guidelines. As Jeff mentioned, the FDA approves caffeine in combination with other medications for adults. And this is supported by the American Headache Society. However, the American Academy of Neurology hasn’t really provided specific guidelines on caffeine use. So it’s not really straightforward. And that variability may cause some confusion.
Kelly Daniels
And that probably explains, you know, why some people say coffee helps my migraine, other people say it doesn’t do the trick. And some say, you know, I avoid it completely altogether because it triggers my migraines. So it’s one of those things that helps some people, but can also actually cause problems for others.
Andrea Stafford
Exactly. So bottom line with caffeine is that it can be helpful for acute migraine treatment when combined with standard medications. Again, that typical effective dose is 100 to 260 milligrams.
Jeff Langford
So, Andrea, I think as we talk through this, what really comes to my mind is that if we’re thinking about caffeine for migraine, this is probably where we really need to have a close conversation with patients and start to elicit a little bit more information, uh, diving into maybe what are their personal experiences with it in terms of it being beneficial or have they identified it as a trigger? And maybe talking, not maybe, but really talking to them about how much and how often they use caffeine products, because the caffeine content of beverages and supplements can just vary wildly. Um, if we think about just common examples, like, you know, standard cup of brewed coffee, roughly 100 to 150 milligrams of caffeine in a standard eight-ounce cup. Um, on the other hand, black tea, 40 to 70 milligrams average in an eight-ounce serving. And sodas are all over the board, but a regular cola or diet cola in a 12-ounce serving might be like 30 to 45 milligrams. So caffeine content all over the place. And if we’re thinking about the limit and and how much to use, we probably really need to talk to our patients about what they’re doing and their preferences.
Andrea Stafford
Yes. And let’s not forget about those energy drinks that are hugely popular right now and can contain around 200 milligrams of caffeine per can on average. Some are higher and some maybe lower. And that problem is where patients are drinking maybe one of those alongside their morning coffee, and they don’t even realize how quickly that caffeine is adding up and then potentially triggering migraines without knowing why. And so, like you said, Jeff, this is a great opportunity for counseling and encouraging patients to track their total daily caffeine intake and kind of look for a pattern that you were talking about.
NatMed Pro
Jeff Langford
Yeah. So the other thought I’ll tack on there too, because it is a complex topic. When patients think about caffeine and headache, the other thing that can introduce into that conversation is that stopping caffeine suddenly, especially for people that have a lot of caffeine, like you mentioned, can actually lead to withdrawal headaches. So lots of things to consider there. And caffeine is one example of how a familiar substance can be both helpful and harmful, depending on these factors like dose and frequency. If conversations like this are happening in your practice, NatMed Pro is designed to support counseling.
Andrea Stafford
It pulls together effectiveness, dosing, and safety information so you can quickly answer patient questions, whether it’s migraine prevention or acute treatment. Particularly, our effectiveness by condition tool is where you can quickly search a condition to find ratings for supplements.
Kelly Daniels
You’ll also find CE opportunities in our monthly NatMed newsletter to keep you up to date on what patients are asking about most.
Andrea Stafford
And listeners can save 10% with code NATMED1026 at checkout. Links are in the show notes. Now back to migraines.
Jeff Langford
So I want to think about what I think is probably a very common scenario. Back to what you told us at the beginning, Kelly, around the stats. If this affects one in 10 patients, we’re having conversations with people with migraines all the time. And I think a very natural conversation is where a patient is really just saying, I have migraines a couple of times a month. I want something natural. What should I use?
Kelly Daniels
Right. It’s such a common question. And it usually just comes from frustration. Nothing else is working. What can I try?
Andrea Stafford
And I think that’s where we want to ask several questions to determine what the patient’s goal is. They may be having them several times a month, but are we trying to reduce how often migraines happen? Are we trying to treat one that’s already started? Or maybe it’s both. And it’s also important to ask more purposeful questions about frequency or the character of the migraine headaches, because that may, they may already be taking prescription medications, or we may need to refer them to their healthcare provider if it’s something more serious. But kind of when thinking about the supplements we discussed today specifically, if the goal is prevention, that’s where Butterbur has some evidence for reducing migraine frequency. But again, we want PA free labeling, a standardized product, because that safety piece really matters. But also CoQ10 is another option that’s generally well tolerated.
Kelly Daniels
And if a patient’s really asking, I have a migraine this minute, what can I take right now?
Jeff Langford
And that’s where our conversation around caffeine may come in, usually in conjunction with standard medications, providing really clear guidance on the dose of caffeine timing and consideration around total intake and the patient’s individual experience with caffeine as well.
Andrea Stafford
So the answer to that, what should I try isn’t necessarily a one fits all or a one product. It’s really just kind of matching the option to the goal.
Jeff Langford
And certainly the three options we talked about today aren’t the only ones that patients may ask about in the in the natural medicines world.
Andrea Stafford
Yes. So in NatMed Pro’s effectiveness by condition tool, you can also see other natural medicines that have been studied for migraines, including fever few, melatonin, and riboflavin, and quickly see where the evidence is stronger or more limited. Notably, several of these ingredients are often found in combination with one another as well.
Kelly Daniels
Which helps keep those conversations focused without having to memorize every single option.
Andrea Stafford
So the big takeaway is when it comes to migraines and natural medicines, the most important step is kind of matching the patient’s goal to the product, prevention versus acute treatment.
Jeff Langford
And once we know that goal, the options and the counseling become much clearer.
Kelly Daniels
And that clarity is often what patients are really looking for, not just another product name.
A few more things…
Andrea Stafford
And setting those expectations upfront about safety, dosing, and timelines. This can make a big difference between something helping and something failing and helping patients feel like they’ve got a solution.
Jeff Langford
So to claim CE, follow the instructions linked in our show notes. We’ve also included links to our monographs for Butterbur, CoQ10, and caffeine, the newsletter article, and other tools we discuss so you can bring these tips straight into your practice.
Kelly Daniels
Also, in the April newsletter, we cover some other interesting and timely topics, including what works for constipation relief, protein powders, and in our most recently published May newsletter, we dive into sea moss and helping parents navigate supplement safety in kids and teens.
Andrea Stafford
So follow and subscribe to this show in your podcast app so new episodes land automatically.
Jeff Langford
Thanks for listening to Natural Medicines: Evidence in Practice. It’s evidence, not hype.
Andrea Stafford
See you next month.
Natural Medicines: Evidence in Practice
