100 MIgraine Drugs, A to Z: metformin
Metformin (Glucophage, Glumetza) is a drug for the treatment of diabetes and you will not find any scientific articles if you google “metformin and migraine”. However, I’ve been prescribing metformin to some of my migraine patients with some success. In the absence of controlled trials to prove its efficacy, one can argue that those patients who improved are experiencing the placebo effect. However, there are two possible ways by which metformin can help prevent migraines.
Obesity does not predispose one to migraines, but in those who do suffer from migraines increased weight is associated with an increased frequency and severity of migraine attacks. Since metformin is proven to help reduce weight, this could be one of the mechanisms by which it improves migraines. Weight loss due to metformin has been shown to be sustainable for up to 10 years.
The second possible mechanism is metformin’s direct effect on inflammation, which is one of the major mechanisms involved in migraines.
I usually prescribe metformin to patients who are overweight and I prefer metformin to the most popular migraine preventive drug, topiramate (Topamax). Topiramate can cause difficulty with memory, kidney stones, osteoporosis, acute glaucoma and other serious side effects, while metformin only occasionally causes nausea. If nausea does occur, changing to a slow release form of metformin (metformin ER) usually helps. Metformin can also cause a drop in vitamin B12 level, so it is worth prescribing a vitamin B12 supplement along with metformin. Metformin should not be prescribed to patients with impaired kidney function, so a baseline blood test is necessary.
Another group of patients I prescribe metformin to are those who are not obese, but report having migraines due to low blood sugar – either when they are hungry or after eating carbohydrate-rich foods, which can lead to a drop in blood glucose (so called reactive hypoglycemia). They often report feeling less hungry and not needing to eat frequently to avoid migraines. Metformin works by regulating the release of glucose from the liver to maintain a steady level of glucose in the blood. This is why this drug does not cause a drop in blood glucose level like other diabetes medications and can be taken by non-diabetics.
The starting dose of metformin is 500 mg a day and if necessary, it can be increased to 1,000 and up to 2,000 mg a day.
Metformin has another unproven potential benefit – it may make you live longer. For now, it’s been shown to be the case only in mice, fruit flies and worms.
Very well written article, thank you for sharing keep writing.
I’ve had migraines for 45 years; now age 61. As I’ve gotten older they’ve gotten worse. I’ve tried every prescription product with no success, except Maxalt does help and for my last resort (before the emergency room) I use injectable sumatriptan. I’ve tried every prophylactic; all with limited or no success until now when I tried metformin. It has been life-changing. My migraines have reduced about 75% and their intensity is also reduced about 75%. I have gone from as many as 25 migraines a month and 50-60 doses of Maxalt a month to about 8 doses of Maxalt a month for 8 migraines. Every single one has been cured quickly by 1 maxalt. I have slowly increased the metformin to 2000 mg a day. Side effects are diarrhea each time I increase the dose but after about 3 days things return to normal. My weight is unchanged since I was 16 years old; I am 6’2″ and 209 lbs. I do not have diabetes or any issues with high blood sugar. In fact, I have had trouble with reactive hypoglycemia my entire life. I believe the metformin is leveling my blood sugar. Most, but not all of my migraines begin in the middle of the night when blood sugar is at its’ low. I post here to urge anyone who believes they may have hypoglycemia to give metformin a try. It is cheap, effective, and the side effects are manageable. FWIW, I continue my very restrictive diet of no alcohol, no chocolate, no dairy, no msg, no food preservatives, no fermented foods, and no dark green leafy vegetables. I walk 7500 steps a day. So, give it a try.
I’m posting some of my observations from my own experiences, in case they are of use to others. Please excuse the personal nature of some of the details!
My migraines reduced dramatically for me when I noted the link between digestion and sinuses. Most of my migraines had become facial and linked to the sinuses.
Just before or during opening of the bowels, clear liquid would run from the nose/sinuses, quite profusely at times. Therefore regular opening of the bowel (through good diet and only one daily (morning) cup of strong coffee) led to clear sinuses and therefore absence of migraine.
I then recognised the link to (pre-)menstrual migraine. At this period the digestive system seems to go into a kind of stasis or slowing down. There is however a tendency to carry on eating. This leads to a cycle of eating when already full and so the signals to the brain to indicate that the stomach has moved from empty to full do not come into operation. There is therefore no signal to ‘stop eating’. As a result the eating continues, leading to overeating and what many call ‘pre-menstrual binge-ing’. This slows down digestion even more. The bowels do not open as the system becomes slowed and perhaps blocked. Therefore the sinuses are not triggered to drain through a bowel movement and migraine ensues.
If we really listen to the body at this time, we find that the slowing of the digestive process means we do not really become hungry. I would recommend waiting for that real feeling of hunger in the solar plexus. It leads to recognition that there is in fact little hunger and LESS need for food when premenstrual, possibly even to the point of a short period of fasting. This means that the digestive system continues to operate, albeit at a slower pace. There is still some opening of the bowels, the sinuses drain and so there is no menstrual migraine.
I just wanted to share this with you. I was a person experiencing one or two migraines every month and regularly needing time off work. When I focused on the things written above I became migraine-free, with only very occasional ones linked to having a bad cold.