Someone asked me last week if a supplement blend - B2, melatonin, magnesium, CoQ10 - was genuinely backed by science for migraine prevention. Their doctor had recommended it. And honestly, yes. There's decent evidence there. But what struck me more was the relief in their voice when they said it. Like they'd been handed something concrete after years of vague advice about "stress" and "triggers."
Migraines aren't headaches. People use the words interchangeably, but they're not the same thing. A migraine is a neurological event - something that involves the whole brain's excitability, inflammation cascades, blood vessel changes, and a neuropeptide called calcitonin gene-related peptide (CGRP) that essentially amplifies pain signals. It's chaotic, systemic, and exhausting. And when someone tells you to "just take some paracetamol," it feels dismissive because it fundamentally misunderstands what's happening.
I think what matters most - more than any one supplement or drug - is raising what we might call the migraine threshold. That's the biological cushion between normal life and a full-blown attack. The higher that threshold, the harder it is for triggers to push you over the edge. And the good news is that threshold is modifiable. Not perfectly, not always easily, but genuinely.
Here's what actually moves the needle.
Sleep: The Foundation You Can't Skip
Sleep disruption is one of the most reliable migraine triggers we know about. Even one bad night shifts neurotransmitter balance, increases cortical excitability, and suppresses melatonin - which, it turns out, is doing more than just making you drowsy. Melatonin has anti-inflammatory effects and modulates pain pathways. There was a randomized controlled trial that compared 3 milligrams of melatonin at bedtime with 25 milligrams of amitriptyline - a prescription drug commonly used for migraine prevention. After three months, melatonin performed just as well in reducing headache frequency, with far fewer side effects.
I'm not saying melatonin is a cure-all. But it's interesting, right? It matched the drug on frequency reduction, which is often what people care about most. A meta-analysis backed this up, showing melatonin also reduced headache duration, severity, and painkiller use compared to placebo. The drug still outperformed melatonin on some other parameters, but the point stands: melatonin is doing something real.
What matters more, though, is sleep regularity. Going to bed at the same time, waking up at the same time - even on weekends. People underestimate how much the body craves that rhythm. I've seen it repeatedly: someone fixes their sleep schedule, and their migraines quiet down. Not always completely, but enough that they notice. It's like the brain finally has room to breathe.
Good sleep hygiene matters too, obviously. Dark room, cool temperature, no screens before bed. You've heard it all before. But the consistency piece is what people miss.
Stress: The Invisible Amplifier
Stress makes the trigeminal nerve network - the main pathway involved in migraines - more reactive. It primes the system to release CGRP, which drives the pain and inflammation of a migraine attack. And the data on stress reduction is surprisingly robust. Behavioral interventions - relaxation training, biofeedback, cognitive behavioral therapy - reduce migraine frequency by 35 to 50 percent in studies. That's pharmaceutical-grade prevention without the side effects.
Even simple daily breathwork or mindfulness can shift things. I'm not talking about some elaborate meditation practice. Just ten minutes of controlled breathing in the morning. Or noticing when your shoulders are up around your ears and consciously lowering them. Small consistent actions that tell the nervous system it's safe to stand down.
I don't think people realize how much chronic low-grade stress accumulates. It's not always the big dramatic things. It's the email you've been avoiding, the conversation you haven't had, the background hum of worry that never quite resolves. That all adds up. And the brain, in its hypervigilant state, becomes more sensitive to everything - including migraine triggers.
The Real Work
What I've noticed over the years is that people want a single fix. A pill, a supplement, a diet. And I understand that. Migraines are exhausting and disruptive, and the idea of doing five or six things simultaneously feels overwhelming.
But the truth is, the interventions that work best are cumulative. Sleep regularity plus stress management plus hydration plus exercise - that's what raises the threshold high enough that you start noticing real change. It's not dramatic. It's not instant. But it's durable.
