Could ginger extract be a therapeutic drug for migraine?
Academic editor: James H. Zothantluanga
Sciences of Phytochemistry 2(1): 75-81 (2023); https://doi.org/10.58920/sciphy02010075
This article is licensed under the Creative Commons Attribution (CC BY) 4.0 International License.
14 Apr 2023
30 Apr 2023
12 May 2023
12 May 2023
Abstract: Migraine is a common neurological disorder that may be accompanied by vascular disturbances, Migraine is one of the most causes of disability worldwide. Zingiber officinale is a medicinal herb that has an analgesic effect on many disorders such as headaches, migraine, muscle tension, stomach spasm, and dysmenorrhea. Also, ginger has many pharmacological actions used to treat and prevent various common symptoms and diseases. This review aims to evaluate the potential of ginger to treat or prevent migraine episodes. Especially nowadays, Patients prefer herbal and complementary medicine to avoid the hard side effects of chemical drugs. The author searched several databases including PubMed, Science Direct, Wiley Online, and Scopus through February 2023 for recent articles with good quality evaluating the potential of ginger to treat migraine patients. The author made investigations and Interpretations depending on the results of the authors' experiments in previous articles included in my review. It is suggested that the bioactive compounds in ginger have the potential to treat and prevent acute migraine episodes effectively and safely. The author recommends encouraging the manufacturing of different pharmaceutical dosage forms of ginger extract to be used worldwide in a safe way and to render a higher absorption rate, and pharmacological response.
Keywords: GingerHeadacheketoprofenMigrainesumatriptanZingiber officinale
1.
Introduction
Migraine is considered a neurological
disorder. It may be accompanied by visual, gastrointestinal, and/or
premenstrual disturbances (1). It is a significant
contributor to disability and lowers people's quality of life globally (2-6). According
to estimates, migraines cause 45 million years of impairment to be lived
globally, with a prevalence of 8 to 18% (7-14). Prophylaxis and effective
treatment can decrease migraine attacks’ severity and frequency (15). There are several
classes of drugs commonly used for migraine treatment, such as beta-blockers,
calcium channel blockers, tricyclic antidepressants, selective serotonin
reuptake inhibitors, anti-epileptic drugs, triptans,
ergot alkaloids, and non-steroidal anti-inflammatory drugs that may cause various
side effects and are prescribed with caution for a limited duration (16). Due to their unhappiness with traditional therapy and associated
adverse effects, many patients prefer nonchemical (herbal) or easily accessible
over-the-counter (OTC) medications to treat their headaches (17,18). Southeast
Asia is home to the popular medicinal plant ginger. Dehydrated zingiber
rhizomes include 40–60% carbohydrates, 10% protein, 10% fat, 5% fibre, 6%
minerals, 10% water, 1% essential oil, and 5%–8% resin and mucilage (19-21). The
volatile and non-volatile compounds found in ginger rhizomes are numerous. The
ginger's flavour comes from volatile compounds, which make up a small portion
of the ginger rhizome. The primary bioactive compounds are non-volatile, which
include shogaols and gingerols. These bioactive compounds can be found in
ginger extracts (22). Ginger has analgesic and anti-inflammatory effects so
that it could relieve pain (23, 24).
2. Ginger Effects on migraine patients
Administration of 400 mg of ginger
extract greatly reduced pain in acute migraine patients (25). In a previous
study performed by Cady et al. (2005) Gelstat (an OTC drug that contains ginger
extract) improved migraine headaches within 2 hours of administration of the
drug (26). In a previous case report, a 42-year-old woman with a 16-year
history of migraine achieved headache relief within 30 minutes of
administration of a 500–600 mg water-soluble ginger powder till the onset of
visual aura. Patients, who continued consumption of ginger powder, every 4
hours for four days, reported both diminished headache severity and frequency (21).
A randomized,
double-blind, placebo-controlled trial (n = 100) comparing the efficacy of
ginger and sumatriptan in treating migraine without aura found the 2 agents
equally effective. Patients who took sumatriptan (50 mg) or ginger (250 mg
ginger rhizome powder) within two hours of taking it reported at least a 90%
reduction in headache intensity (27). In a randomized
controlled trial, patients taking a sublingual product containing feverfew
(another medicinal herb) and ginger at the earliest recognition of migraine
twice daily were free of pain at two hours compared to patients taking a
placebo (P = .02) (28). Patients who reported migraine episodes and
administered 400 mg of ginger extract divided into two capsules (containing 20
mg (5%) of active gingerols), and an intravenous drug of 100 mg ketoprofen
resulted in a pain decrease and the functional capacity was improved (29).
Administration of 500 mg of ginger powder three times a day for 2 days before
the onset of the menstrual period and continued for the first three days of the
menstrual period was reported to be effective to decrease the severity of
dysmenorrhea-related pain (30). Chen & Cai. (2021) have confirmed the
effect of ginger to reduce migraine-induced nausea and vomiting. Ginger showed
antiemetic properties and improved nausea and vomiting induced by chemotherapy,
post-operative, or during pregnancy (30-34). Ginger has a lot of
pharmacological actions that greatly contribute to the improvement of migraine
symptoms.
3. Methodology for review
The author searched a lot of databases
including PubMed, Wiley Online, Scopus, and Science Direct through February
2023 for articles with good quality evaluating the potential of ginger in the
treatment of migraine patients with the following keywords: “migraine”, and
“ginger” or “Zingiber” (Figure 1). The reference lists of papers were also
hand-searched, and the author has performed the process above repeatedly to
include additional better studies. He made investigations and Interpretations
depending on the results of the authors' experiments in previous articles
included in my review. Finally, He has used Microsoft
Office Excel software to design the following charts that classify the number and
type of included articles each year. It is noted that there are few clinical
trials and randomized controlled studies evaluating the potential of ginger for
treating migraine, however,
we can see a kind of evolution of research in this field compared to the past (Figure
1, 2).
4.
Effect of ginger extract on
Biomarkers
The release of inflammatory mediators such as prostaglandins, cytokines, and bradykinin due to the release of neuropeptides that activate trigeminal nerve fibers activate nociceptive pathways during migraine attacks (35,36). Drugs used in pain treatment usually act by altering the transduction and/or modulation of nociception (37). Symptoms associated with migraine attacks can be activated by nociceptive signals, therefore, the blocking of nociceptive pathways may improve these symptoms (38). The analgesic action of ginger is due to its active components; gingerols and shogaols that inhibit arachidonic acid metabolism via decreasing the expression of cyclooxygenase-2 enzyme (COX-2), leading to inhibition of prostaglandin biosynthesis like the non-steroidal anti-inflammatory drugs (39,40). Ginger blocks lipoxygenase (LOX), another enzyme in the arachidonic acid pathway (41). The concomitant inhibition of COX and LOX may increase anti-inflammatory action and reduce its side effects (42).
Figure 1 Types of collected articles only evaluate the potential of
ginger to treat migraine.
Figure 2 The included
studies' distribution only evaluates ginger's potential to treat migraine each
year.
Furthermore, shogaols
modulate neuroinflammatory pathways via the downregulation of inflammatory
spots on existing microglial cells that regulate brain development, maintenance
of neuronal networks, and injury repair and serve as brain macrophages as they
are responsible for the elimination of microbes, dead cells, redundant
synapses, protein aggregates, and other particulate and soluble antigens that
may endanger the CNS (43). While gingerols may act as agonists of the
capsaicin-activated vanilloid receptors that evoke capsaicin-like intracellular
Ca2+ transients and ion currents (44). All these various mechanisms of ginger
render more benefits to improve migraine (Figure 3).
Figure 3 Ginger extract
role in the treatment of migraine episodes.
5.
Conclusions
Considering the above,
powdered, or fresh ginger has the potential to treat acute migraine patients, but
with some limitations (45). Using ginger as an
add-on therapy to NSAIDs renders more benefits not only for treatment but also
for prophylaxis (29). It is
suggested that 250 mg of ginger rhizome powder is clinically effective and safe to treat migraine headaches (27). In patients administering ginger, some side effects were
observed such as heartburn, headaches, and vertigo, especially if taken in
large doses (46, 47). The author pays attention that ginger should not be used
as a replacement for prescribed medication without consulting a healthcare
professional.
Funding
Not applicable.
Acknowledgment
There is a lot I need to thank God for, every day. But I think I am
blessed because I have a very loving, understanding and supporting family. The
author is grateful to his mother, Mona, his father, Abd El-Moniem, his brothers,
Mohamed, Mahmoud, and Omar, his sister, Menna, and his best friends. The author
expresses his gratitude to all his professors and teachers.
Conflict of Interest
The author declares that there are some
limitations as the appropriate dose, and pharmaceutical dosage form of ginger
for treating migraine needs to be established through well-designed clinical
trials on a large scale for relatively long follow-up periods to determine the
optimal dosage, duration of treatment, and potential side effects of ginger in
treating migraine.
Data Availability
The data would be provided upon request.
Authors contribution
Conceptualization : Ahmed Abd
El-Moniem
Investigation : Ahmed
Abd El-Moniem
Supervision : Ahmed
Abd El-Moniem
Administration : Ahmed
Abd El-Moniem
Writing and Editing : Ahmed Abd
El-Moniem
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