Vitamins for migraine

Magnesium, riboflavin,
co-enzyme Q10 and migraine
Magnesium, riboflavin and co-enzyme Q10 are sometimes suggested
as a preventative treatment for people with migraine. Here we look at
the evidence.
Magnesium
Magnesium is one of the essential
mineral elements in the human body.
An adult has about 25 grams of
magnesium in their body (mostly in the
bones). More than two thirds of our usual
daily intake of magnesium comes from
cereals and vegetables.
There has been an expanding amount
of scientific literature supporting the
theory that a deficiency of magnesium
occurs in the brains of people who have
migraine, and that this has a role to play
in the way migraine develops. It may be
the case particularly for women with
premenstrual symptoms. The lower levels
of magnesium may be increased by
taking a magnesium supplement.
The magnesium dose usually
suggested by the research literature is
600 mg daily. The published trials to
date have produced mixed results, with
favourable effects reported on
magnesium as an acute treatment for
people with migraine with aura. There
are different types of magnesium and the
formulation of the magnesium used in
the trials has varied. This of course
makes comparing the different trial
results much more difficult. The research
literature suggests however that a high
dose over a minimum period of three to
four months is needed for there to be any
preventative (prophylactic) benefit from
taking magnesium.
In recent research the only sideeffect reported for this treatment has
been diarrhoea. This however may
account for a reduced efficacy in some
of the trials as the magnesium would
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not then have been properly absorbed

into those patients systems.
The recommended dosage of 600 mg
is in the form of magnesium dicitrate. The
other forms magnesium sulphate,
magnesium hydroxide and magnesium
oxide have a more laxative effect and so
are best avoided.

Research does
suggest some
therapeutic benefit
for magnesium,
riboflavin and
co-enzyme Q10 in
the management
of migraine
Riboflavin
Riboflavin, the water-soluble vitamin B2,
improves energy metabolism in the body,
as does coenzyme Q10 (see below).
Riboflavin is also sometimes used as a
migraine preventative treatment
(prophylaxis). Researchers have proposed
that the brain cells of some people with
migraine may have a mitochondrial
dysfunction resulting in impaired oxygen
metabolism. It is further thought that
taking a riboflavin supplement has the
potential to increase the mitochondrial
energy efficiency in an individual who has
migraine. In short riboflavin would be
taken with the aim of improving the way

oxygen is metabolised in the brain.

The minimum daily requirement for an
adult is approximately 1.5 to three mgs.
It is found in green leafy vegetables,
peanuts, whole grains, milk and milk
products, eggs, liver, heart and kidney.
A randomised control study in Belgium
in 1994 compared 400 mg of riboflavin to
placebo for 55 subjects with migraine in a
trial lasting three months. 59% of the
patients receiving riboflavin reported a
50% reduction in migraine attacks
(compared with only 15% in the placebo
group). These subjects showed
statistically significant reductions both in
their migraine frequency and in the
duration of episodes.
This research has shown an effective
dose to be 400 mg per day. That amount
incidentally is over 250 times the normal
recommended daily intake for an adult.
Riboflavin has minimal side-effects
however and being water soluble is a
relatively safe option for treatment. In the
Belgian trial two people experienced
diarrhoea and polyuria (passing a lot of
urine) whilst one person in the placebo
group experienced abdominal cramps.
None of these side-effects were serious.
The researchers suggest that, because of
the low number of side-effects and its
potential efficacy and low cost, riboflavin
is a feasible option for migraine
prophylaxis. More research needs to be
conducted to compare it with established
prophylactic drugs and over a longer
time period.
It should be noted that riboflavin
supplements produce fluorescent yellow
urine. The required 400 mg dose of

riboflavin should not be amassed from

taking multivitamin supplements as there
then would be a risk of overdosing on the
other vitamins.
Coenzyme Q10
An enzyme is a catalyst that facilitates
and controls chemical reactions occurring
in the body, and a co-enzyme is a
substance that is needed for the enzymes
to work. Coenzyme Q10 (CoQ10) is made
naturally by the human body. It helps the
cells to produce energy, and it acts as an
antioxidant. As a supplement CoQ10 has
been proposed for use in many conditions
including high blood pressure, breast
cancer and Alzheimers disease.
The usual recommended dose of

CoQ10 for migraine is 100 mg three times

per day. A study in 2002 at this dosage
was compared to placebo in 42 patients
with migraine in a double blind,
randomised, placebo controlled trial. The
patients included those with and without
aura and all had had migraine for over a
year, with two to eight attacks per month.
Patients were screened to exclude overconsumption of acute anti-migraine
medication, and were currently taking no
other prophylactic medication for their
migraine. They also had no serious
organic or psychiatric disease. CoQ10
was administered in a liquid form
corresponding to 2 ml (44 drops). This
formulation is not available commercially.
Patients kept a migraine diary to record

headache severity, any accompanying

symptoms such as nausea and vomiting,
name of acute medication taken, and
duration of the headache. The study
showed the effect of CoQ10 began after
the first month and was most effective
after three months. The frequency of
migraine attacks was reduced by 50%
in the active group by month four as
compared to a reduction by 14.4% in the
placebo group. Because CoQ10 is so well
tolerated by patients it may well make an
acceptable migraine prophylaxis for
children and for women of child
bearing age.
Whilst some websites describe it as
the wonder nutrient and a miracle
vitamin, there is still only fair evidence to
support the use of CoQ10 treatment in
migraine prevention or treatment. More
well-designed studies are needed to
consolidate these findings.
The future
Nutritional supplements acting on
mitochondrial metabolism, such as
magnesium, riboflavin, and CoQ10 have
been shown to be effective, but so far only
in small, randomised, controlled trials. At
this stage, the bottom line is that peer
reviewed, published research does
suggest some therapeutic benefit for
magnesium, riboflavin and CoQ10 in the
management of migraine. However, larger
double blind randomised studies are still
needed to confirm this more conclusively.
Sources
1. Evans R W, Taylor F R. Natural or Alternative
Medications for Migraine Prevention. Headache
2006; 46:1012-1018
2. Goadsby P J. Recent advances in the diagnosis
and management of migraine. BMJ 2006;332:25-9
3. MacGregor A. Understanding Migraine and Other
Headaches. Poole: Family Doctor Publications
(BMA), 2002 updated 2006
4. Sandor P S, Di Clemente L, Coppola G, Saenger U,
Fumal A, Magis D, et al. Efficacy of coenzyme Q10
in migraine prophylaxis: a randomized controlled
trial. Neurology 2005;64:713-5.
5. Schoenen J, Lenaerts M, Bastings E. High dose
riboflavin as a prophylactic treatment of migraine:
results of an open pilot study. Cephalagia 1994;14:
328-329
6. Smith C B. The Role of Riboflavin in Migraine.
Canadian Medical Association Journal 1946; 54:
589-591
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Migraine News 11