Introduction
Ginger has been used as a traditional herbal medicine for pain, nausea and vomiting. Ginger’s analgesic effect has been attributed to its active components inhibiting prostaglandin synthesis by decreasing the expression of cyclooxygenase.
Intervention
Consumption of ginger (500 mg ginger extract)
Indication
Acute or preventive treatment of migraine
Precautions/Adverse effects
Ginger root is generally considered safe by the U.S. Food and Drug Administration (FDA), and daily approved intake of up to 4 grams is deemed safe.[1]
Ginger is generally well tolerated. Most side effects reported were mild gastrointestinal symptoms.[2] In a trial comparing ginger with sumatriptan 50 mg, adverse effects with ginger were significantly lower.[3] According to a systematic review, up to 10% of patients taking 750-1500 mg ginger may report dyspepsia/nausea/heartburn and 2% may report worsening headache. Reported adverse events were higher on doses >1500mg which exceeds the recommended dose.[2]
There is a theoretical risk of bleeding with ginger through decreasing platelet-aggregation. Co-prescribing with warfarin is not recommended due to possibly increasing warfarin’s anticoagulant effect. Monitoring of blood glucose levels is required if oral hypoglycaemics are used due to ginger increasing the hypoglycaemic effect. [1]
Availability
Ginger is available in many forms, e.g. tablets/capsules, fresh, dried (spice), lollies, biscuits and tea.
Description
Acute treatment of migraine
Ginger may be beneficial for some individuals in the acute treatment of migraines.[3-5] It has been shown to reduce migraine pain (no pain to mild pain) at 2 hours post-treatment compared with placebo, and showed equivalent efficacy to sumatriptan.[3-5] While the average size of the effect appears to be small, some individual may experience more significant improvement. Given its affordability, availability and safety profile, ginger can be tried in individuals with a history of migraine.
Dosing: Ginger (400mg dry extract capsules) can be taken orally or sublingual as required. Dosing frequency varied – some studies used 400–500 mg bd prn while others used 500 mg taken at onset, repeated every 4 hours up to 1.5 g per day for 3 to 4 days.
Prevention of migraine
Ginger may help reduce the frequency and severity of migraine attacks when used alongside migraine preventive treatments (propanol and depakene). [6-8] Therefore, it may be tried as an add-on therapy for the prevention of migraines.
Dosing: The studies reviewed used 500 mg bd for 3 months. If no improvement is noted, cessation is recommended.
Tips and Challenges
- Half a teaspoon of freshly grated ginger is equivalent to a 500 mg dose of a standardised ginger extract.
- Advise patients to avoid consuming ginger on an empty stomach to avoid gastrointestinal side effects, and to stop taking it if they experience side effects.
- A migraine treatment that works for one patient may not work for another. Ginger can be tried as a treatment as it is accessible, safe and well tolerated.
Grading
LOW (We have low confidence in the research evidence, ie, further research is likely to have an important impact, which may change the estimates.)