Herbal Therapeutic Approaches for Migraine Management: Pharmacological Mechanisms and Evidence of Medicinal Plants with Clinical Approach

Migraine is a complex, debilitating neurological disorder characterized by recurrent episodes of intense, often unilateral headache accompanied by nausea, vomiting, and heightened sensitivity to light and sound. Despite considerable advances in conventional pharmacotherapy, a significant proportion of patients experience inadequate relief, intolerable adverse effects, or contraindications to standard treatments, prompting growing interest in herbal therapeutic alternatives. This narrative review comprehensively examines the pharmacological mechanisms, clinical evidence, and safety profiles of medicinal plants used in migraine prophylaxis and acute management. Key botanical agents investigated include Tanacetum parthenium (feverfew), Petasites hybridus (butterbur), Zingiber officinale (ginger), Mentha × piperita (peppermint), Lavandula angustifolia (lavender), and Cannabis sativa, amongst others. The principal pharmacological mechanisms operative in these plants include inhibition of serotonin release and platelet aggregation, modulation of calcitonin gene-related peptide (CGRP) signaling, cyclooxygenase-2 (COX-2) inhibition, attenuation of cortical spreading depression, and interaction with transient receptor potential (TRP) ion channels. Clinical trial evidence, whilst promising for several agents—particularly feverfew and butterbur—remains variable in methodological rigor. Safety concerns include hepatotoxicity associated with unsaturated pyrrolizidine alkaloids in butterbur and potential drug interactions with herbal preparations. This review highlights the need for standardized phytochemical preparations, robust randomized controlled trials, and regulatory oversight to translate the therapeutic promise of medicinal plants into evidence-based clinical practice for migraine management.