The effectiveness of ginger powder in the treatment of common migraine attacks is statistically comparable to sumatriptan.Comparison Between the Efficacy of Ginger and Sumatriptan in the Ablative Treatment of the Common Migraine
This is the surprising conclusion of a 2013 medical research study (Maghbooli and colleagues).
But before all migraine sufferers rush out to stock up on ginger, there remain some unanswered questions:
- Is this really true? Could a herbal remedy be as effective for an episode of acute migraine, as a tried and tested, popular, anti-migraine drug such as sumatriptan, which has transformed the lives of millions of migraine sufferers?
- Should migraine sufferers take ginger instead of sumatriptan?
It’s important to be critical of everything you read on the internet, and especially medical papers. Just because it’s been published, doesn’t mean it must be correct!
We can’t trust academic journals to tell the scientific truth!The Guardian, June 2017
Let’s take a look at the Maghbooli study a bit more closely …
What was being compared in the study?
The effect of ginger was compared to sumatriptan, in people suffering from acute episodes of migraine.
- Ginger, is the underground stem (rhizome) of a plant (Zingiber officinal) found mostly in Asia. It is commonly used as a spice in cooking, and contains more than two hundred oils which have important anti-inflammatory properties. Ginger has been used, as an alternative medicine for many generations.
- Sumatriptan is a pharmaceutical medicine. It is a 5 -hydroxytryptamine (5-HT) receptor agonist. 5-HT receptors are found in the brain, the central, and peripheral nervous system.
Sumatriptan relieves symptoms of acute migraine, by stimulating blood vessel constriction in the carotid arterial circulation, and by damping down trigeminal nerve activity.
A large amount of research substantiates the effectiveness of sumatriptan as a treatment for acute migraine. It can be taken as a tablet or a nasal spray.
Triptans – the class of drug that includes sumatriptan – are recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of acute migraine.
What did the researchers actually do?
One hundred migraine sufferers (excluding migraine with aura) were selected for the study.
They were divided into two groups at random. One group was given ginger powder and the other group sumatriptan. They were asked to use this with their next migraine attack.
Neither the study participants nor the study investigators knew what they were taking – this is called a double blind study. The results of a double blind study are considered to be more meaningful.
To assess the effect of ginger and sumatriptan on relief of migraine symptoms, the study participants measured parameters such as:
- the time of onset of the migraine
- the severity of the migraine
- the time between the onset of the headache and taking the study drug
- the degree of headache relief
- their own personal perception of their response.
They collected these measurements over five subsequent migraines, and also for one month after the study period.
What did the researchers find?
The response to treating acute migraine was similar in both the ginger and the sumatriptan groups.
- Within 2 hours of the onset of migraine, headache symptoms had decreased in both groups. The reduction in pain score was 4.7 units in the ginger group and 4.6 in the sumatriptan group, and these results were both highly statistically significant.
- Side effects were less in the ginger group.
- Patient satisfaction with treatment did not differ between the two groups.
- In addition, patients in both groups were equally willing to use either medication in future.
Why might ginger treat the symptoms of migraine?
Ginger is a herb used to treat gastrointestinal symptoms. For example, it is sometimes used to treat morning sickness in pregnancy.
Ginger contains substances called gingerols, which are known to have a variety of health benefits. These are anti-inflammatory, as well as anti-oxidant, anti-cancer, and anti-microbial effects. Ginger has been shown specifically to reduce inflammation within nervous tissue and also to help relieve pain.
For example, in a 2001 randomised double blind, placebo controlled, study of patients with knee pain from osteoarthritis, ginger was statistically significantly better than a placebo at relieving knee pain on standing, and after walking.
Other studies have been published which show ginger to be effective in treating migraine (see below).
How were the study participants selected?
All the study participants had been diagnosed with migraine by a neurologist, and satisfied the IHD (International Headache Society Classification of Disorder) criteria for their migraine diagnosis.
No information about previous use of sumatriptan, or ginger, and whether this had been successful or unsuccessful, was recorded in the paper.
What information were the patients given about the study?
There is no information in the paper about what information patients were given about the study, or how it was given. If patients were seen by different study investigators and had differing explanations about the trial, they may have had specific expectations of their treatments.
What exactly did the study participants take?
They took 250mg capsulets containing powdered ginger, or 50mg sumatriptan – from a sealed box. 50mg is the standard dose of sumatriptan, although the 100mg dose is significantly more effective than the 50mg dose.
How were the patients randomised to either take either ginger or sumatriptan?
Exactly how the patients were randomised, is not well explained.
Also, although the title says this was a double blinded study, the paper actually doesn’t state that the researchers or the participants were unaware of who was taking each product. This has to be assumed.
In addition, it is not stated that the two study boxes containing the medications were completely identical. How were they labelled?
The paper does state that the participants took capsulets containing either ginger powder or sumatriptan, but does not say that the capsulets had an identical appearance?
Any of these factors could have led to un-blinding, and then this could cause biased results.
The study participants self reported the effect on their migraine symptoms by filling in a questionnaire
When you are feeling ill with a migraine, it’s probably hard to read a questionnaire and fill in an analogue scales at regular intervals. These were self recorded symptoms of improvement, and this may not have been a reliable indicator.
What were their migraines like in the past?
In general, migraines tend to last 4 to 72 hours. However, for these study participants, there was no record in the publication of how long their previous migraine attacks had lasted.
Migraine attacks do resolve by themselves over time, without any medication. It’s hard to be sure how much improvement in migraine symptoms, was directly due to the therapeutic effects of either of the treatments.
There was no placebo group
Strangely enough, even a placebo (a dummy pill) can produce good symptom relief. For example, in one study, 30–60% of participants reported improvement in pain after taking a placebo. The power of the placebo effect should not be underestimated.
One way of addressing this is to have a placebo controlled – double blind – trial, in which participants may be given the study drug, or a placebo, but still remain unaware which product they are taking.
Because there was no placebo group in this trial, it is impossible to know if the effect of ginger or sumatriptan was better than a dummy drug. If you take a placebo, symptoms may well improve simply because: you are in a clinical trial, are being medically supervised, and believe you are taking a form of therapy likely to cause an improvement.
In fact the authors of this paper do quote a randomised placebo controlled study (Aurora S.K., 2006), in which a ginger containing product was compared to a placebo for migraine, and although migraine symptoms improved in both groups, both ginger and the placebo resulted in a similar degree of improvement.
Results were not calculated on an intention to treat basis
Although one hundred patients completed this study, there is no record of how many patients were enrolled at the start, but dropped out, or why. All studies have some patients who fail to complete the study. This means this study has not been reported from an intention to treat perspective and may have led to bias in the results.
Has other research reached similar conclusions?
The authors quote several studies in which ginger has been shown to be effective in treating migraine. These are mostly anecdotal reports from the 1980s and 1990s.
However, a small 2005 placebo controlled, double blind, randomised controlled trial of GelStat (an over the counter product containing ginger and feverfew) and placebo, concluded that migraine sufferers who took Gelstat had significantly better pain relief at 2 hours than a placebo (65% compared to 36%). Notably, there was also a large placebo response.
Is ginger recommended by any recognised authorities on migraine?
There are currently no recommendations to take ginger for acute migraine on most UK migraine websites. However there are some references to ginger, see below:
There are a wide range of different treatment options for migraine, quite apart from ginger, and sumatriptan.
So what’s the conclusion?
Although the Maghbooli study shows ginger to be as effective in relieving migraines symptoms as sumatriptan, a critique of the study, as in every research trial, leaves unanswered questions.
On the positive side
- 80% of the world’s population now use a herbal medicine to treat a healthcare need. Evidence is accumulating that some herbal products are safe and effective treatments.
- Ginger appears to be safe, and it may help relieve symptoms for some migraine sufferers.
- In low doses, ginger has very low incidence of side effects.
- Sumatriptan, a popular first line option, is not suitable for everyone.
- is not effective for everybody
- may be contraindicated
- may be associated with side effects
- is not recommended in people aged 65 and older or age 10 to 17
- effects are unknown in pregnancy
- it is not advisable to breastfeed for 12 hours after taking it.
Sumatriptan has been hailed as a wonder drug for treating migraine.
Sumatriptan started a revolution in treatments for migraine, and the triptans are a hard act to follow!”Dr Anne MacGregor of the London Migraine Clinic
Regarding ginger and migraine, sometimes a headline grabs your eye on the internet – and it seems too good to be true! Always go back and consider the subject from first principles.
It’s very difficult to prove that any medicine has truly had a positive treatment effect. It takes a large number of well conducted studies, and a significant body of evidence for the respected authorities to give treatment recommendations on any specific product.
Evidence about ginger and migraine is lacking, and these are only small studies, and a few case reports. In comparison the evidence linking sumatriptan to rapid symptom relief, is substantial.
The 2013 Maghbooli study, discussed here, provides additional information about ginger as a possible treatment for acute migraine. However, as is always the case with any medical study, it is open to criticism, and the findings may not be entirely representative.
Until more evidence is available, clinical experience with sumatriptan suggests this remains an appropriate first choice for now. But who knows – if advice may change in the future?
Migraines: The facts
- 1 in 7 people worldwide are affected by migraines
- Of those 1 in 5 are women and 1 in 15 are men
- Some people with migraines get visual disturbances – known as aura – such as seeing stars or flashing lights, or even temporary blindness
- Others feel dizzy, get pins and needles, or nausea
For more information
- Migraine Treatments – The Migraine Trust
- Alternative Treatments for Migraine – A Research Update. Neurology Advisor, 2016
- 11 Proven Health benefits of Ginger – Healthline
- Migraine: What happens in the brain when you have one? – BBC
- Video: Ginger for Migraines – Nutritionfacts.org