Question & Context

Frequent headaches and migraine – what helps?

In brief

For frequent migraine and tension-type headaches, regular endurance and strength training are the best-supported levers without medication: in a randomised trial, endurance training worked about as well as the migraine drug topiramate, without its side effects. Just as important is taking painkillers on fewer than 10 to 15 days a month, because more frequent use can itself make headaches chronic. Fixed sleep times and a headache diary help you spot patterns. Among supplements, the German guideline lists magnesium, riboflavin and coenzyme Q10 as effective, with low-quality evidence; for melatonin the picture is contradictory. A sudden, explosive headache or new neurological deficits are an emergency.

What matters first

Train your endurance regularly

The German migraine guideline recommends regular aerobic endurance exercise for prevention. In a randomised trial with 91 people with migraine, attacks fell by 0.93 per month after three months of training and by 0.97 on the migraine drug topiramate, with no difference between groups. Side effects occurred only with topiramate. A meta-analysis of 19 studies with 2,776 participants found that aerobic training in migraine brought a small to moderate reduction in pain intensity and less painkiller use, with low to very low certainty of evidence.

Strengthen neck and shoulders

For tension-type headache, the German guideline recommends regular endurance and strength training as supportive prevention, especially strength training for the shoulder and neck muscles for at least 6 weeks. In the same meta-analysis, strength training reduced pain intensity in tension-type headache with a moderate effect. The authors rate the certainty of the evidence as very low; the studies had a high risk of bias and low transparency.

Count your painkiller days

Taking simple painkillers on 15 or more days a month, or triptans or combination products on 10 or more days, risks medication overuse headache after more than three months. It is treatable: in a Danish trial with 120 patients, headache days fell by 12.3 per month after a medication break combined with medical prevention, and 74.2 percent of those analysed in this group were back to episodic headaches.

Keep fixed sleep times

The German guideline counts a steady daily rhythm, known as biorhythm hygiene, among the effective measures against migraine. In a small randomised pilot study with 43 women with chronic migraine, headache frequency and intensity fell after they received instructions on fixed sleep times and better sleep habits. By the end, 48.5 percent had reverted to episodic migraine. Larger studies are lacking.

A headache diary instead of a ban list

A headache diary shows how often attacks occur, which medication you take and whether a preventive measure works; the guideline explicitly recommends one. Suspected triggers are worth a sober check: when 27 people with migraine with aura were exposed in the lab to their own reported triggers such as flickering light or strenuous exercise, only 3 had an aura attack and 3 more a migraine without aura.

When you should have this checked by a doctor

Call emergency services (112 in Europe) immediately if a headache reaches full intensity within seconds to a few minutes (thunderclap headache), if paralysis, numbness, speech or visual disturbances, confusion or reduced consciousness occur that you do not recognise as your usual aura, or if headache comes with fever and a stiff neck. See a doctor promptly about a new or clearly changed headache from age 50, especially with temple pain, jaw pain when chewing or visual disturbances, as well as headaches after a fall or blow to the head, headaches triggered by coughing, straining or a particular body position, headaches that worsen over weeks, start during pregnancy or after childbirth, or occur with cancer or a weakened immune system. A first or unusually long aura and painkillers on 10 or more days a month also belong in medical hands.

Migraine or tension-type headache: what lies behind it

The two most common types of headache feel different. Migraine comes in attacks that last 4 to 72 hours untreated, often throbbing and one-sided, with nausea and sensitivity to light and noise, and in some people preceded by an aura. Tension-type headache is usually on both sides, dull and pressing like a hat that is too tight, mild to moderate and without typical accompanying symptoms. It can last from 30 minutes to 7 days.

Migraine is considered a disorder of a highly sensitive brain involving the trigeminal nerve and messengers such as CGRP. That is why levers that keep the system stable help: a steady rhythm, training, stress reduction. The German guideline rates relaxation techniques and behavioural therapy as similarly effective to classic drug prevention. According to the guideline, medical prevention is worth considering from 3 attacks a month that impair quality of life, among other criteria.

Magnesium, riboflavin, coenzyme Q10: what the studies show

The German guideline lists magnesium, riboflavin (vitamin B2) and coenzyme Q10 as supplements with efficacy in migraine prevention but stresses that the scientific evidence is weak. For magnesium, a meta-analysis of 10 studies with 789 participants found fewer and milder attacks. The individual trials are inconsistent: in one, attack frequency fell by 41.6 percent versus 15.8 percent on placebo; in another, equal numbers responded to magnesium and placebo. The most common side effect is diarrhoea.

With riboflavin, headache days halved in 59 percent of 55 patients in one trial, compared with 15 percent on placebo. Both controlled trials come from the same research group, and the urine turns intensely yellow as a side effect. For coenzyme Q10, a network meta-analysis of 14 studies with 791 participants calculated 1.91 fewer attacks per month than placebo, while a trial in children and adolescents found no benefit. The guideline considers most other supplements and probiotics ineffective.

Melatonin and medical options

Melatonin has mixed data. In a trial with 196 participants, migraine days fell by 2.7 per month on melatonin, by 1.1 on placebo and by 2.2 on the antidepressant amitriptyline, with melatonin better tolerated. A crossover trial with 46 evaluable participants, using a prolonged-release product, found no difference from placebo. The guideline considers melatonin interesting because of its good tolerability but sees no clear proof of efficacy.

If lifestyle and supplements are not enough, there are well-studied medical options: for migraine, for example beta blockers, topiramate, amitriptyline, flunarizine or antibodies against CGRP, and for chronic tension-type headache mainly amitriptyline. Which one fits depends on other conditions and side effects and belongs in medical hands, ideally with a headache diary as the basis.

What the database says

Sorted by strength of evidence. The BK-Score rates the state of knowledge, not the substance.

Strength training 3× per week Evidence 9/10 · Well supportedStrength training is the best-supported single measure in this database. For tension-type headache, the guideline recommends strength and endurance training, especially for the shoulders and neck.
Caffeine Evidence 9/10 · Well supportedCaffeine is well studied and has two sides with headaches: it boosts painkillers during an attack but is also a possible trigger. The guideline advises people with migraine to limit it.
Magnesium Evidence 7/10 · Supported, with caveatsBiochemically very well established, with solid studies on blood pressure and sleep quality. For migraine prevention, the guideline lists magnesium as an option with weak evidence, and individual trials are inconsistent.
Coenzyme Q10 (Ubiquinol) Evidence 7/10 · Supported, with caveatsIn migraine prevention, meta-analyses show fewer attacks than with placebo. The underlying trials are small, however.
Melatonin Evidence 7/10 · Supported, with caveatsSupported by meta-analyses for time to fall asleep and jet lag. In migraine prevention, melatonin worked in one trial but not in another.
Consistent sleep times Evidence 7/10 · Supported, with caveatsRegular sleep times are linked to better health in large cohorts, though causality is not proven. For migraine, the guideline counts a steady daily rhythm among the effective preventive measures.
Zone 2 cardio 2–4× per week Evidence 6/10 · Supported, with caveatsThe migraine guideline recommends regular endurance training for prevention. That Zone 2 intensity in particular works better than more intense training is not proven.
Meditation 10 min daily Evidence 6/10 · Supported, with caveatsMeta-analyses find small to moderate effects on stress and anxiety. In migraine, according to the guideline, mindfulness approaches mainly improve disability and quality of life, not always the number of attacks.

Frequently asked questions

What helps prevent migraine without medication?

The best evidence is for regular endurance exercise, relaxation techniques and a steady daily rhythm with fixed sleep times. In one trial, endurance training worked about as well as the migraine drug topiramate. The German guideline rates psychological approaches such as relaxation and behavioural therapy as similarly effective to classic drug prevention. A headache diary shows whether things improve.

How often can you take painkillers for headaches?

The limits are simple painkillers on fewer than 15 days and triptans or combination products on fewer than 10 days a month. Exceeding this for more than three months risks medication overuse headache, in which the headaches themselves become more frequent. It is treatable, but a medication break should be medically supervised.

Does magnesium help with migraine?

A meta-analysis of 10 studies with 789 participants found fewer and milder attacks, but the individual trials partly contradict each other. The German guideline counts magnesium among the options with weaker evidence and sees it as a choice if you do not want to take an approved migraine drug. The most common side effect is diarrhoea.

What is the difference between migraine and tension-type headache?

Migraine comes in attacks of 4 to 72 hours, is often throbbing and one-sided and comes with nausea and sensitivity to light and noise, sometimes with an aura. Tension-type headache is usually on both sides, dull and pressing and mild to moderate, and physical activity does not make it worse. Both can occur side by side; a headache diary helps tell them apart.

When is a headache an emergency?

If the pain peaks suddenly within seconds to a few minutes, if paralysis, speech problems, confusion or reduced consciousness occur, or if fever and a stiff neck appear, call emergency services. Headaches after a head injury and a new or changed headache from age 50 should also be checked by a doctor promptly.

Can coffee and caffeine trigger headaches?

Caffeine has two sides. Combined with painkillers it boosts their effect during an attack, but caffeinated drinks are also described as triggers. The German guideline advises people with migraine to limit caffeine to help prevent the headaches from becoming chronic. A headache diary is the best way to see whether there is a link for you.