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Comparison Between the Efficacy of Ginger and
Sumatriptan in the Ablative Treatment of the
Common Migraine
Mehdi Maghbooli,*Farhad Golipour, Alireza Moghimi Esfandabadi and Mehran Yousefi
Zanjan University Of Medical Sciences, VALI-e-ASR Hospital, Neurology Department, Zanjan, Iran
Frequency and torment caused by migraines direct patients toward a variety of remedies. Few studies to date
have proposed ginger derivates for migraine relief. This study aims to evaluate the efficacy of ginger in the
ablation of common migraine attack in comparison to sumatriptan therapy. In this double-blinded randomized
clinical trial, 100 patients who had acute migraine without aura were randomly allocated to receive either ginger
powder or sumatriptan. Time of headache onset, its severity, time interval from headache beginning to taking
drug and patient self-estimation about response for five subsequent migraine attacks were recorded by patients.
Patients
,
satisfaction from treatment efficacy and their willingness to continue it was also evaluated after 1 month
following intervention. Two hours after using either drug, mean headaches severity decreased significantly.
Efficacy of ginger powder and sumatriptan was similar. Clinical adverse effects of ginger powder were less than
sumatriptan. Patients’satisfaction and willingness to continue did not differ. The effectiveness of ginger powder
in the treatment of common migraine attacks is statistically comparable to sumatriptan. Ginger also poses a
better side effect profile than sumatriptan. Copyright © 2013 John Wiley & Sons, Ltd.
Keywords: common migraine; ginger; sumatriptan.
Supporting information may be found in the online version of this article.
INTRODUCTION
Migraine, a periodic chronic neurologic disorder, is one
of the most common causes of pain syndromes with a
prevalence rate of 12%. This disorder imposes exorbi-
tant expenditures and creates disadvantages on personal
function. These can vary from minimally disturbed
activities of daily living to complete, although temporary,
incapacitation requiring total rest. Unfortunately, the
wait-and-see approach often prolongs the symptoms
constituting the disease, while also decreasing the effec-
tiveness of the treatment.
Despite continuous improvements in the field of
migraine treatment, which has provided further opportuni-
ties to select more specific and effective remedies, many
patients prefer to relieve headaches by nonchemical
(herbal) means or readily available over-the-counter
(OTC) products. A part of this trend is a result of fears
associated with adverse drug reactions and apprehensions
of dependency. Patients often experience a loss of satisfac-
tion from their usual medications which contributes to
their unmet needs. Even the general chronic relapsing
nature of migraine disease poses frustrations for sufferers
that lead them to seek out alternative remedies.
Ginger is a native plant of southeastern Asia that has
been widely cultivated in Jamaica, China, India, Nigeria,
Sierra Leone, Haiti and Australia. These thick rhizomes,
in dehydrated form, contain 40–60% carbohydrate, 10%
protein, 10% fat, 5% fiber, 6% minerals, 10% water,
1–4% essential oil, 5–8% resin and mucilage (Langner
et al., 1998; Shri, 2003; Mascolo et al., 1989; Mustafa
et al., 1993, Awang, 1992).
Ginger products have long been used in the manage-
ment of motion sickness, dyspepsia, articular pain, local
pains and vertigo (Grant and Lutz, 2000; Yarnell, 2002;
Holtmann et al., 1989; Riebenfeld and Borzone, 1999;
Micklefield et al., 1999; Grøntved and Hentzer, 1986;
Altman and Marcussen, 2001).
One of the most favorable aspects of ginger is that there
are no serious or even frequent side effects reported with
its use. Anecdotal reports even indicate a therapeutic role
for ginger in vomiting, flatulence and memory problems
(Ernst and Pittler, 2000; Yamahara et al., 1989). Pharma-
cologic studies have revealed its effectiveness in the
reduction of blood sugar, normalizing of blood pressure,
strengthening of the overall cardiovascular system, inhib-
itory effects on prostaglandins and platelet aggregation,
as well as lipid lowering properties and hyposecretion of
gastric acid (Bordia et al., 1997; Tjendraputra et al.,
2001; Guh et al., 1995).
In a study performed by Cady et al., Gelstat (an OTC
drug which contains ginger extract) alleviated migraine
headache completely in 48%, and partially in 34% of
patients within 2 h of taking the drug (Cady et al., 2005).
Aurora et al., performed a double-blinded placebo-
controlled study demonstrating that the Gelstat-treated
group also had a significantly higher pain relief rate 2 h
following proper drug use, at 65% versus 36%, p = 0.038
(Aurora et al., 2006).
In a case report review, a 42year old woman with classic
migraine achieved headache subsidence within a 30 min
period of taking a 500–600 mg water-soluble ginger
powder upon onset of visual aura. Patients, who continued
* Correspondence to: Maghbooli Mehdi, Zanjan University of Medical
Sciences, Vali-e-Asr University Hospital, Neurology ward, Zanjan, Iran.
E-mail: m.maghbooli@zums.ac.ir
PHYTOTHERAPY RESEARCH
Phytother. Res. 28: 412–415 (2014)
Published online 9 May 2013 in Wiley Online Library
(wileyonlinelibrary.com) DOI: 10.1002/ptr.4996
Copyright © 2013 John Wiley & Sons, Ltd.
Received 09 September 2010
Revised 09 March 2013
Accepted 17 March 2013
consumption of ginger powder, every 4 h for a total of
four days, reported both diminished headache severity
and frequency (Mustafa and Srivastava, 1990).
Given the high frequency, the variability in treatment
options, along with the diverse inclinations and satisfaction
of the sufferer population, the purpose of this study is to
determine the therapeutic effects of ginger powder on
the attacks of migraine without aura and compare it with
standard sumatriptan treatment.
METHODS AND MATERIALS
This is a double-blinded randomized controlled clinical
trial comparing the efficacy of ginger to sumatriptan in
the treatment of the common migraine. One hundred
study participants who are sufferers of common migraine
were enrolled after admission to the Neurology Clinic of
Zanjan Vali-e-Asr Hospital. Participants were assigned
to two coequal groups by way of simple, random
nonprobability sampling; one group was blindly given
ginger powder, while the other was given sumatriptan.
Inclusion criteria used (International Headache Soci-
ety Classification ICHD-II, Migraine, nd): (i) Confirmed
diagnosis of migraine without aura by a neurologist,
based on IHS criteria (ICHD-II), (ii) Aged ≥18 years,
(iii) Education level high school diploma or higher,
(iv) Headache frequency between 2 and 10 days/month.
Exclusion criteria were: (i) History of biliary calculus or
peptic ulcer disease, (ii) Allergic reaction, (iii) Hemorrhagic
diathesis or using anticoagulants, (iv) History of ischemic
heart disease or Prinzmetal’s angina, (v) Pregnancy or
lactation, (vi) Headache after head trauma.
After completion of an introductory questionnaire,
one sealed box containing five capsulets (sumatriptan
or ginger powder) was randomly delivered to each
subject. Subjects were instructed to take only one
capsulet upon headache onset. Each ginger capsulet
contained 250 mg powder of ginger rhizome, while each
Imegraz capsulet contained 50 mg of sumatriptan.
All patients were committed to keeping up with their
previous maintenance therapeutic regimens, and, with
each attack they were required to fill out a questionnaire
revealing: time of headache onset, headache severity
(rated on a visual analog scale), timing of drug taking,
response self-assessments following 30, 60, 90,120 min
and 24 h. Subjects also included any clinical adverse
drug reactions within the questionnaire. This study was
conducted for the duration of one month, at which point
patients evaluated their overall satisfaction with regards
to treatment efficacy as well as their willingness to con-
tinue their respective treatments. All statistical analysis
was performed by using SPSS for windows (version 16)
software. Means of quantitative variables were com-
pared by using student T-test between the two groups.
In the case of categorical variables, Chi-square test was
applied. Headache severity in the study groups, before
and after intervention, was assessed with a paired sam-
ples T-test analysis. All P-values were two-tailed and a
P-value <0.05 was considered significant.
RESULTS
One hundred patients with common migraine were
selected to take either sumatriptan or ginger (groups
equally proportioned).
The mean age of patients was 35.1 6.2 years old in
the sumatriptan group and 33.9 8.3 years old in the
ginger group. Females comprised 68% (34 patients)
sumatriptan subjects versus 74% (37patients) ginger.
Average duration of migraine diagnosis was 7.3 4.5
years in sumatriptan and 7.2 4.6 years in ginger group.
Average number of headache attacks in sumatriptan
and ginger-treated groups were 5.8 3.1 and 4.9 2.7
attack/month, respectively. This frequency was 4.6 0.9
attack/month during trial period in both groups.
Average time interval from headache onset to drug
intake was 24 15 min (median: 21 min) for sumatriptan
and 20 11 min (median: 20 min) for ginger patients.
Figure 1 represents changes of mean headache severity
in subsequent time intervals following consumption of
either drug.
Before taking the medication, 22% of the sumatriptan
group and 20% of the ginger group had severe headaches
(VAS ≥8); mean values were 56% versus 48% for moder-
ate severity (5 ≤VA S ≤7) in the two groups, respectively
(P = 0.527).
Frequency distribution of mean headache severity at
2 h after drug use demonstrated similar effectiveness
for sumatriptan and ginger groups (P = 0.116) (Table 1).
Comparing mean headache severity before and 2 h after
treatment revealed a 4.7 unit reduction (according to
VAS) in the sumatriptan group (P <0.0001) and a 4.6
unit reduction in the ginger group (P <0.0001).
In this study, 70% of sumatriptan-treated and 64% of
ginger-treated patients showed favorable relief (≥90%
decrease in headache severity) at 2 h following drug
Figure 1. Changes in mean headache severity after taking sumatriptan and Ginger during subsequent time intervals. This figure is available in
colour online at wileyonlinelibrary.com/journal/ptr.
413MIGRAINE ABLATION BY GINGER VERSUS SUMATRIPTAN
Copyright © 2013 John Wiley & Sons, Ltd. Phytother. Res. 28: 412–415 (2014)
use. Frequency of favorable relief according to gender,
age group, duration of migraine history and maintenance
regimen was compared between the sumatriptan and
ginger groups and summarized in Table 2. These findings
indicated that both the sumatriptan and ginger signifi-
cantly impressed on pain relief and no significant differ-
ences were demonstrated in the headache subsidence
between the sumatriptan- and ginger-treated groups.
Subjective side effectsarose from sumatriptan including
dizziness, a sedative effect, vertigo and heartburn.
The only reported clinical adverse effect of ginger was
dyspepsia. Prevalence rate of clinical complaints was
20% for sumatriptan in contrast with only 4% for ginger
(P = 0.028). 86% of subjects reported high or superior
satisfaction from the sumatriptan-treated group as com-
pared to 88% in ginger group (P = 0.736). Eighty-eight
percent of sumatriptan users and 72% of ginger recipients
were inclined to continue their randomly assigned drug
for the abortion of migraine attacks (P=0.139).
DISCUSSION
The current study reveals that both sumatriptan and
ginger powder decrease mean severity of common
migraine attacks in within 2 h of use. A comparison of
efficacy in headache alleviation and patients
’
content-
ment does not show any significant difference amongst
the two drugs. However, subjective side effects due to
ginger powder were significantly less than sumatriptan.
Despite availability of multiple drugs specifically for
the abortion of migraine attacks (such as ergots and
triptans), as well as advances in pharmacologic and
alternative therapies, problems including poor satisfac-
tion of drug efficacy as well as varied side effects persist.
Challenges also include the chronic and recurrent
nature of the disease; these can cause patients to
constantly reevaluate their treatment needs, a delay or
interruption in self management, and a tendency to take
OTC and herbal medications.
Anecdotally, oral ginger has been used for migraine
headache, nausea and vomiting (Kemper, 1999). The es-
sential oil of ginger has also been used topically as an an-
algesic (Srivastava and Mustafa, 1989). For migraine,
500 mg ginger taken at onset, repeated every 4 h up to
1.5–2 g per day, for 3–4 days has been recommended
(Mustafa and Srivastava, 1990).
Researchers at the city of London Migraine Clinic
found that feverfew also eliminated about two-thirds
of migraines in a selected group of headache patients,
which is similar to the effectiveness of most migraine
drugs. While some people experience a pronounced
effect, others may have none at all (Hylands et al.,
1985; Murphy et al., 1988).
The amount that has been shown to prevent migraine
attacks in research studies ranges from 50 to 114 mg per
day. Though most practitioners use capsules containing
250 mg of a standardized potency feverfew.
Mustafa et al. reported a 42-year-old woman, with a
16 years history of migraines, experienced enormous
relief after supplementing her diet with 1.5–2 g of dried
ginger daily.
Table 1. Frequency of mean headache severity before each drug use and 2 h after its intake
Headache severity
Drug Free Mild
b
Moderate
c
Severe
d
Sum
Sumatriptan Before 0 22 (11) 56 (28) 22 (11) 100 (50)
After 44 (22)
a
48 (24) 8 (4) 0 100 (50)
Ginger powder Before 0 32 (16) 48 (24) 20 (10) 100 (50)
After 44 (22) 56 (28) 0 0 100 (50)
Sum Before 0 27 (27) 52 (52) 21 (21) 100 (100)
After 44 (44) 52 (52) 4 (4) 0 100 (100)
a
Digits outside and inside the brackets indicate percent and number of patients.
b
Headache severity as 1 ≤VAS ≤4.
c
Headache severity as 5 ≤VAS ≤7.
d
Headache severity as 8 ≤VAS.
P = 0.116.
Table 2. Frequency of ≥90% reduction in headache severity after 2 h following each drug use compared based on some features of subjects
Drug
Variable Sumatriptan Ginger powder PV
Sex Male 68.8 (11)
a
69.2 (9) 0.978
Female 70.6 (24) 62.2 (23) 0.453
Age group <35 72 (18) 61.3 (19) 0.400
≥35 68 (17) 68.4 (13) 0.976
Duration of migraine history <5 73.3 (11) 62.5 (10) 0.519
≥5 68.6 (24) 64.7 (22) 0.733
Maintenance therapy With 78.1 (25) 78.6 (22) 0.967
Without 55.6 (10) 45.5 (10) 0.525
a
Digits outside and inside the brackets indicate percent and number of patients.
414 M. MAGHBOOLI ET AL.
Copyright © 2013 John Wiley & Sons, Ltd. Phytother. Res. 28: 412–415 (2014)
In double-blinded placebo-controlled study of Aurora
et al., Gelstat (ginger extract) relieved migraine headache
more significantly than placebo within 2 h of taking the
drug. There was no meaningful difference in relief rate
of headache by Gelstat and placebo (19% versus 7%
respectively).
In the present study, ginger powder reduced mean
headache severity up to 4.6 units in relation to before
taking drug.
Cady et al. performed an open-label study enrolling
30 patients that were treated in the mild pain phase with
Gelstat Migraine (a combination of ginger and fever-
few).Two hours after treatment, 48% were pain-free
with 34% reporting a headache of only mild severity.
Twenty-nine percent reported a recurrence within 24 h.
Side effects were minimal, and 59% of subjects were
satisfied. 41% preferred Gelstat Migraine or felt it was
equal to their pre-study medication. In our study, 2h
after ginger intake, 44% of subjects became pain free
with 56% reporting a headache of only mild severity.
Clinical adverse reactions occurred in 4% of ginger
group, and 88% of patients rated headache relief as
great or excellent, and 72% preferred this drug for
long-term therapy.
The present investigation demonstrated an overall
44% palliation in all headache attacks 2 h following
treatment with sumatriptan or ginger powder. In
conjunction with evidence from other studies, it is antici-
pated that increasing the total amount of ginger intake
per attack can greatly enhance migraine relief rate.
CONCLUSION
Consequently, ginger products are a favorable choice
for treatment of acute migraine without aura when com-
pared with sumatriptan. Therefore, it is recommended
for migrainous patients who are uneasy or poorly
responsive to other medications or in general simply
tend to use herbal remedies. It is suggested a more
extensive placebo-controlled study which can measure
the effectiveness of various doses of ginger-based
medications with differing types and severities of migraine
is examined.
Acknowledgements
We would like to thank all patients for participating in this study. We
are also very grateful to pharmacy companies Goldaru and Razak
for providing Zintoma and Imegraz. Thanks are also extended to
Mrs. Manizhe Asemani, Head nurse of Vali-e-Asr neuroclinic,
for her assistance in sample collection and patient follow-up.
This study was supported by a grant from Zanjan University of
Medical Sciences.
Conflict of Interest
The authors have declared that there is no conflict of interest.
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Copyright © 2013 John Wiley & Sons, Ltd. Phytother. Res. 28: 412–415 (2014)
