Ginger may be an effective home remedy to help alleviate some of the most common and bothersome symptoms of acute migraine in patients who do not want to use or don’t have access to prescription medications, new data suggest.
Conducted by investigators at the National Institute of Mental Health and Neurosciences, Bangalore, India, the review showed ginger root can relieve migraine-related pain, nausea, and vomiting. However, the evidence does not support ginger’s use as a first-line therapy for acute migraine or for migraine prevention.
At this point, study author Chittaranjan Andrade, MD, professor of clinical psychopharmacology and neurotoxicology, told Medscape Medical News the evidence base is still “too small” to support formal clinical recommendations. However, he added, ginger can be considered as a viable “home-remedy option” for acute migraine.
The review was published online December 2 in The Journal of Clinical Psychiatry.
Used for centuries in traditional medicine, much of the preclinical and clinical research has examined the potential of raw ginger, ginger extracts, and ginger constituents to prevent and treat a wide range of medical conditions. These include nausea and vomiting associated with pregnancy, chemotherapy, postoperative states, motion sickness, and other diseases and disorders, said Andrade.
Ginger has “long been recommended as an effective home remedy for the acute treatment of migraine, relieving both headache and the associated nausea,” Andrade notes.
One recommended recipe is stirring half a teaspoon of ground ginger into a glass of water and to drinking the “ginger juice,” while another is to drink hot tea made from a teaspoon of freshly ground ginger.
“Patients with a number of common ailments, including migraine, are sometimes caught without medicines; or they may have poor access to medicines,” Andrade said. “I came across a reference to the use of ginger for migraine in a book on home remedies and I thought that if the research literature supports the use of ginger for migraine episodes, such patients could benefit.”
Large Treatment Gap
The review and meta-analysis included three randomized controlled trials with 227 patients looking at ginger vs placebo for the treatment.
One of the studies investigated the therapeutic efficacy of a specific proprietary formulation of ginger, combined with feverfew, while two trials were independent of industry.
Of these two, one examined the benefit of add-on dry ginger extract (400 mg; 5% active gingerols) in 50 patients who were also taking ketoprofen to treat migraine episodes, while the other examined the 3-month efficacy of daily dry ginger extract for migraine prophylaxis in 107 patients.
The two studies that examined the therapeutic efficacy of ginger vs placebo showed ginger reduced mean pain scores at 2 hours (mean difference, -1.27 [95% CI, -1.46 to 1,07]) and also increased the proportion of patients who were pain-free at 2 hours (RR, 1.79 [1.04 – 3.09]). In addition, compared to placebo, ginger halved the risk of migraine-related nausea and vomiting in all of the studies and was not associated with an increased risk of adverse events.
One RCT investigated prophylactic efficacy and found it to be more effective than placebo in bringing a ≥ 50% reduction in the frequency of monthly migraine episodes (in 42% vs 39% of patients, respectively), but the difference was not deemed statistically significant. In addition, there were no significant differences between the groups in days of pain, severe pain, days requiring use of analgesics, number of migraine episodes, and maximum duration of migraine episodes.
Andrade noted that ginger has many chemical constituents, including phenolic compounds, terpenes, polysaccharides, lipids, and organic acids of which 6-shogaol, 6-gingerol, and 10-dehydrogingerdione “may be important.”
It also has antioxidant and anti-inflammatory effects, lowering prostaglandins, and reducing several serum lipid and glycemic measures. Additionally, it has “putative” vasculoprotective effects, he added.
“Ginger has a large number of chemical constituents and we do not know which of these, separately or in combination, will help relieve migraine,” he said. “We won’t know the answer unless clinical trials are conducted with the individual constituents rather than with ginger extract.” He compared this to the study of omega-3 fatty acids rather than fish and nuts for various neuropsychiatric or cardiovascular indications.
Nevertheless, given the high global prevalence of migraine and the “large treatment gap [of migraine] in primary care,” it could be common for many affected patients to experience episodes of migraine headache “without recourse to recommended pharmacologic relief,” he noted. “In such cases, the availability of a simple home remedy, such as ginger, could be helpful.”
“Good Additional Tool”
Commenting on the study for Medscape Medical News, Jessica Ailani, MD, director, MedStar Georgetown Headache Center and professor of clinical neurology, MedStar Georgetown University Hospital, Washington, DC, said that for “people with migraine who are seeking treatment with minimal side effects that they can obtain without counsel of a healthcare provider, ginger is a good additional tool to have.”
Ailani, who is also the vice co-chair of strategic planning in the MedStar Department of Neurology and was not involved with the study, said that clinicians can “consider suggesting ginger to patients with migraine that have associated nausea who are interested in nonpharmacologic ways to treat symptoms.”
Since there are “many other effective ways to treat migraine,” she advises “conversing with the patient about speed of onset of efficacy, along with tolerability, and return of migraine symptoms as important factors to evaluate when choosing and staying with a treatment.”
Also commenting on the study for Medscape Medical News, Nada Hindiyeh, MD, clinical associate professor, Department of Neurology, Stanford University, California, called it a “nice summary of the objective research available for the use of ginger in acute and preventive treatment of migraine.”
Although there is insufficient literature evaluating ginger alone in migraine treatment, so “no definitive conclusions can be drawn,” since it appears to be safe and “somewhat helpful for migraine-associated nausea and vomiting and possibly in frequency of migraine reduction, it remains a considerable alternative for those seeking nonprescription options,” said Hindiyeh, who was not involved with the study.
Andrade publishes an e-newsletter supported by Sun Pharmaceuticals, with payments made to charities. He receives reimbursement for travel expenses incurred delivering lectures and workshops by institutions or pharmaceutical companies and has received nominal compensation in the form of academic support toward slide presentations or purchase of materials when he has provided advice to pharmaceutical companies. He has received payments for developing educational materials for scientific initiatives and programs, such as for Behavioral and Neurosciences Foundation of India, PsyBase India, Texas Tech University USA, Nordic Association for Convulsive Therapy, and American Society of Clinical Psychopharmacology. During the past 24 months, Ailani reports honoraria for independent consulting from Amgen, AbbVie, Biohaven, BioDelivery Scientific International, Eli Lilly and Company, Lundbeck, Teva, Impel, Satsuma, Theranica, Axsome, Neso, GlaxoSmithKline, Aeon, Medscape, Neurolief; ownership of stocks in CtrlM; honoraria for promotional speaking from Allergan/Abbvie, Amgen, Biohaven, Eli Lilly and Company, Lundbeck, and Teva; and clinical trial grants to her institution from the American Migraine Foundation, Allergan, Biohaven, Eli Lilly and Company, Satsuma, and Zosano. Hindiyeh discloses no relevant financial relationships.
J Clin Psychiatry. Published online December 2, 2021. Full text
Content Source: https://www.medscape.com/viewarticle/964887?src=rss