Living with migraines can be incredibly challenging. The throbbing pain, sensitivity to light and sound, and nausea can make even the simplest daily tasks feel impossible. If you’ve been struggling with migraine headaches, you might be looking for additional options beyond conventional treatments. One herbal remedy that’s showing promise is St John’s wort (Hypericum perforatum).

As a medical herbalist, I’ve seen how traditional plant medicines can support people with various health challenges from wound healing to hot flashes. While St John’s wort is commonly known for its use in mild to moderate depression, research suggests it may also help those suffering from migraines. This traditional herb has been used for centuries for various health concerns, and its potential benefits for migraine sufferers have been studied as well.

St John’s wort isn’t just any ordinary plant. It contains several active compounds that affect our brain chemistry in ways that might help both mood disorders such as mild-moderate depression and pain conditions like migraines.

When you take St John’s wort, it influences important brain chemicals including serotonin, dopamine, and noradrenaline. These neurotransmitters play key roles in how we experience pain. The herb works by:

• Inhibiting the reuptake of these neurotransmitters, making more of them available in the brain
• Affecting other neurotransmitter systems like adenosine, GABA, and glutamate
• Blocking protein kinase C (PKC) pathways, which are involved in pain hypersensitivity 

These actions may help reduce both the frequency and intensity of migraine attacks. It’s a bit like turning down the volume on pain signals in your brain.

Scientists have been investigating whether St John’s wort might help people with migraines, with some encouraging findings.

A study by Ghazavi and colleagues (2012) found that when St John’s wort was combined with sodium valproate (a common migraine prevention medication), patients experienced:

• A significant reduction in migraine intensity compared to those taking sodium valproate alone
• A noticeable decrease in how often migraine attacks occurred
• These benefits without significant additional side effects

The study used 300 mg of St John’s wort three times daily alongside the conventional medication.

While these results are promising, it’s important to remember that more extensive clinical trials are needed to fully understand how effective St John’s wort might be for migraine relief.

St John’s wort might offer additional benefits that could be helpful for migraine sufferers:

• Mood improvement: Since migraines can often come with feelings of depression or anxiety, the mood-balancing effects of St John’s wort might help address these related symptoms.
• Anti-inflammatory properties: Some components of St John’s wort have anti-inflammatory effects, which might help reduce inflammation involved in migraine attacks.
• Sleep support: The herb may help with sleep issues, which is important since poor sleep can be both a trigger and consequence of migraines.

This combination of effects might make St John’s wort particularly interesting as a complementary approach for people living with migraines.

Despite its potential benefits, St John’s wort isn’t right for everyone. There are several important safety considerations to keep in mind:

Drug Interactions

One of the most significant concerns with St John’s wort is how it interacts with other medications. The herb affects liver enzymes that process many drugs, potentially making them less effective or increasing side effects.

You should be especially cautious if you’re taking any prescription medication, including:

• Antidepressants: Combining St John’s wort with SSRIs, MAOIs, or tricyclic antidepressants can lead to harmful levels of serotonin, causing serotonin syndrome.
• Hormonal contraceptives: St John’s wort can reduce the effectiveness of birth control pills, patches, and implants, potentially leading to unplanned pregnancy.
• Blood thinners: The herb can decrease the effectiveness of medications like warfarin, increasing the risk of blood clots.
• Other migraine medications: It may interact with triptans and other migraine treatments.

Who Should Avoid St John’s Wort

St John’s wort isn’t suitable for:

• Pregnant or breastfeeding women
• People planning surgery (stop at least two weeks before)
• Those with bipolar disorder, as it may trigger manic episodes
• People with certain conditions like schizophrenia or Alzheimer’s disease

Possible Side Effects

Even when used appropriately, St John’s wort can cause side effects such as:

• Digestive issues like nausea, diarrhoea, or stomach discomfort
• Dizziness, restlessness, or anxiety
• Sleep problems
• Increased sensitivity to sunlight
• Dry mouth
• Headaches

Most of these side effects are mild, but they’re important to be aware of before trying the herb.

If you’re considering St John’s wort for migraine relief, here are some practical tips:

Seeking Professional Guidance

Rather than self-prescribing St John’s wort for migraines, it’s best to consult with a qualified medical herbalist who can:

• Assess your individual health needs and medical history
• Consider potential interactions with any medications you’re taking
• Recommend an appropriate preparation and dosage specific to your situation
• Monitor your response and adjust your treatment plan as needed

A medical herbalist understands both the traditional uses and modern research around herbs like St John’s wort and can provide personalised guidance.

Duration of Use

Many herbal traditions have long histories of using St John’s wort safely over extended periods. While formal studies often focus on shorter timeframes (typically up to 12 weeks), this reflects research limitations rather than specific safety concerns.

When working with a medical herbalist, they can:

• Provide guidance on appropriate duration of use based on your individual needs
• Monitor your response over time
• Adjust the treatment approach as your condition evolves
• Draw on traditional knowledge that spans generations of use

This personalised approach allows for appropriate long-term support when needed.

When comparing St John’s wort treatment to conventional migraine treatments like triptans, there are some important differences to consider:

• Speed of relief: Triptans typically work quickly, often within 2 hours. St John’s wort may take longer to show effects and may be better as prevention
• Evidence base: Triptans have extensive clinical data supporting their use, while St John’s wort’s effectiveness for migraines needs more research.
• Side effect profile: Each has different potential side effects, with St John’s wort generally having milder side effects but more drug interactions.
• Availability: Triptans require a prescription, while St John’s wort is available over the counter as a supplement.

For some people, St John’s wort might work best as a complementary approach alongside prescription drugs for migraines rather than as a replacement.

If you’re struggling with migraines and interested in exploring St John’s wort, here’s what I recommend as a medical herbalist:

Seek out a qualified medical herbalist who can provide personalised guidance tailored to your unique situation.

Share your full health history with your herbalist, including any medications you’re taking and other treatments you’ve tried.

Work collaboratively with both your healthcare provider and herbalist, especially if you’re taking prescription migraine medications.

Keep a detailed migraine diary to help track your response to herbal treatment.

Be patient – herbal approaches often work gradually to help restore balance.

Stay informed about research as it continues to develop.

While it may be more commonly thought of for affective disorders, using St John’s wort for migraine relief shows real promise, particularly when used alongside certain conventional treatments.

However, it’s crucial to approach St John’s wort with a level of caution. But you need to be careful with St John’s wort. Its benefits must be balanced against risks, especially alongside other medicines. Don’t try it on your own – talk to a qualified medical herbalist who can give you personal advice for safe, effective use.

As a medical herbalist, I believe traditional plant medicines like St John’s wort can be very helpful. When properly matched to the person, herbs can really help manage ongoing conditions like migraines.

You might also be interested in my post about Probiotics and Migraine Prevention.