Migraine Headache

Migraine can be debilitating and disruptive to a person’s life. However, the symptoms are transient, and do not result in permanent physical disability. That said, migraine is associated with a 2-3 fold increase in risk of various types of stroke which can cause permanent disability. This is one of the reasons it is important to avoid self-diagnosis of migraine, and to speak to your physician about minimizing other risk factors for stroke if you suffer from migraine.

Some people experience warning signs that a migraine is coming, these warning signs start hours or a day or two before a migraine and are also known as “migraine prodrome” or an “aura”. “Prodrome” comes from the Greek term prodromos, meaning “running before”. A migraine prodrome most commonly involves neck stiffness and fatigue, and can also include sensitivity to light/sound, nausea, visual changes, food cravings, depression, and yawning.^[2][7]

In a randomized controlled trial in 245 adults with 2–6 migraine headaches per month, the intention-to-treat (ITT) analysis showed that the participants who took 75 mg of butterbur extract twice a day had a greater decrease in migraine frequency compared to the participants who took a placebo (–45% vs. –28%). However, taking a smaller dose (50 mg of butterbur extract twice a day) was not significantly better than a placebo.^[8]

The Canadian Headache Society strongly supports the use of butterbur extract for migraine prevention but warns that only properly tested products should be used. Unprocessed butterbur extract can contain pyrrolizidine alkaloids (PA), which are known to cause liver damage. It’s important to check that butterbur products are PA-free prior to use.^[4] However, not all expert organizations agree with this recommendation. The American Headache Society and the American Academy of Neurology retracted their strong recommendations of butterbur due to concerns of liver toxicity. Furthermore, in both the United Kingdom and Germany, the use of butterbur is no longer authorized due to safety concerns.^[9]

Some case studies of individual people have reported headaches or migraine occurring after aspartame ingestion.^[10][11][12] Furthermore, the Center for Disease Control (CDC) found that 67% (346/517) of people submitting a complaint about aspartame reported neurological/behavioral symptoms, including headaches, dizziness, and mood alterations after consuming aspartame-containing products.^[13] Therefore, headaches are among the complaints about aspartame, but neither the data from the CDC nor observations from isolated case studies prove that aspartame causes headaches in all people.

To explore whether there is a causal link between aspartame and headaches, some randomized controlled trials have been completed. They show that the incidence of headaches after a single dose of aspartame does not differ from that after a placebo.^[14] Meanwhile, daily administration of aspartame has increased headache frequency in some^[15][16] but not all studies.^[17] However, it is important to note that these studies include a small number of participants and the quality of their design and statistical approaches have been debated.^[18][19][20]

Consequently, the low number of case studies and complaints suggests that aspartame-associated headaches are rare in the general population, and it is currently unclear whether aspartame consumption directly causes headaches or not. Further high-quality clinical trials would help remedy that lack of clarity. In the meantime, people who are susceptible to headaches following consumption of aspartame or aspartame-containing foods can choose to avoid such products.