10 Migraine News ISSUE 93

Vitamins for migraine

Magnesium, riboflavin,co-enzyme Q10 and migraine

MagnesiumMagnesium is one of the essentialmineral elements in the human body.An adult has about 25 grams ofmagnesium in their body (mostly in thebones). More than two thirds of our usualdaily intake of magnesium comes fromcereals and vegetables.There has been an expanding amount

of scientific literature supporting thetheory that a deficiency of magnesiumoccurs in the brains of people who havemigraine, and that this has a role to playin the way migraine develops. It may bethe case particularly for women withpremenstrual symptoms. The lower levelsof magnesium may be increased bytaking a magnesium supplement.The magnesium dose usually

suggested by the research literature is600 mg daily. The published trials todate have produced mixed results, withfavourable effects reported onmagnesium as an acute treatment forpeople with migraine with aura. Thereare different types of magnesium and theformulation of the magnesium used inthe trials has varied. This of coursemakes comparing the different trialresults much more difficult. The researchliterature suggests however that a ‘highdose’ over a minimum period of three tofour months is needed for there to be anypreventative (prophylactic) benefit fromtaking magnesium.In recent research the only side-

effect reported for this treatment hasbeen diarrhoea. This however mayaccount for a reduced efficacy in someof the trials as the magnesium would

not then have been properly absorbedinto those patients’ systems.The recommended dosage of 600 mg

is in the form of magnesium dicitrate. Theother forms – magnesium sulphate,magnesium hydroxide and magnesiumoxide – have a more laxative effect and soare best avoided.

RiboflavinRiboflavin, the water-soluble vitamin B2,improves energy metabolism in the body,as does coenzyme Q10 (see below).Riboflavin is also sometimes used as amigraine preventative treatment(prophylaxis). Researchers have proposedthat the brain cells of some people withmigraine may have a mitochondrialdysfunction resulting in impaired oxygenmetabolism. It is further thought thattaking a riboflavin supplement has thepotential to increase the mitochondrialenergy efficiency in an individual who hasmigraine. In short riboflavin would betaken 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 milkproducts, eggs, liver, heart and kidney.A randomised control study in Belgium

in 1994 compared 400 mg of riboflavin toplacebo for 55 subjects with migraine in atrial lasting three months. 59% of thepatients receiving riboflavin reported a50% reduction in migraine attacks(compared with only 15% in the placebogroup). These subjects showedstatistically significant reductions both intheir migraine frequency and in theduration of episodes.This research has shown an effective

dose to be 400 mg per day. That amountincidentally is over 250 times the normalrecommended daily intake for an adult.Riboflavin has minimal side-effectshowever and being water soluble is arelatively safe option for treatment. In theBelgian trial two people experienceddiarrhoea and polyuria (passing a lot ofurine) whilst one person in the placebogroup experienced abdominal cramps.None of these side-effects were serious.The researchers suggest that, because ofthe low number of side-effects and itspotential efficacy and low cost, riboflavinis a feasible option for migraineprophylaxis. More research needs to beconducted to compare it with establishedprophylactic drugs and over a longertime period.It should be noted that riboflavin

supplements produce fluorescent yellowurine. The required 400 mg dose of

Magnesium, riboflavin and co-enzyme Q10 are sometimes suggestedas a preventative treatment for people with migraine. Here we look atthe evidence.

Research doessuggest sometherapeutic benefitfor magnesium,riboflavin andco-enzyme Q10 inthe managementof migraine

ISSUE 93 Migraine News 11

riboflavin should not be amassed fromtaking multivitamin supplements as therethen would be a risk of overdosing on theother vitamins.

Coenzyme Q10An enzyme is a catalyst that facilitatesand controls chemical reactions occurringin the body, and a co-enzyme is asubstance that is needed for the enzymesto work. Coenzyme Q10 (CoQ10) is madenaturally by the human body. It helps thecells to produce energy, and it acts as anantioxidant. As a supplement CoQ10 hasbeen proposed for use in many conditionsincluding high blood pressure, breastcancer and Alzheimer’s disease.The usual recommended dose of

CoQ10 for migraine is 100 mg three timesper day. A study in 2002 at this dosagewas compared to placebo in 42 patientswith migraine in a double blind,randomised, placebo controlled trial. Thepatients included those with and withoutaura and all had had migraine for over ayear, with two to eight attacks per month.Patients were screened to exclude over-consumption of acute anti-migrainemedication, and were currently taking noother prophylactic medication for theirmigraine. They also had no seriousorganic or psychiatric disease. CoQ10was administered in a liquid formcorresponding to 2 ml (44 drops). Thisformulation is not available commercially.Patients kept a migraine diary to record

headache severity, any accompanyingsymptoms such as nausea and vomiting,name of acute medication taken, andduration of the headache. The studyshowed the effect of CoQ10 began afterthe first month and was most effectiveafter three months. The frequency ofmigraine attacks was reduced by 50%in the active group by month four ascompared to a reduction by 14.4% in theplacebo group. Because CoQ10 is so welltolerated by patients it may well make anacceptable migraine prophylaxis forchildren and for women of childbearing age.Whilst some websites describe it as

“the wonder nutrient” and “a miraclevitamin”, there is still only fair evidence tosupport the use of CoQ10 treatment inmigraine prevention or treatment. Morewell-designed studies are needed toconsolidate these findings.

The futureNutritional supplements acting onmitochondrial metabolism, such asmagnesium, riboflavin, and CoQ10 havebeen shown to be effective, but so far onlyin small, randomised, controlled trials. Atthis stage, the bottom line is that peerreviewed, published research doessuggest some therapeutic benefit formagnesium, riboflavin and CoQ10 in themanagement of migraine. However, largerdouble blind randomised studies are stillneeded to confirm this more conclusively.

Sources

1. Evans R W, Taylor F R. “Natural” or AlternativeMedications for Migraine Prevention. Headache2006; 46:1012-1018

2. Goadsby P J. Recent advances in the diagnosisand management of migraine. BMJ 2006;332:25-9

3. MacGregor A. Understanding Migraine and OtherHeadaches. 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 Q10in migraine prophylaxis: a randomized controlledtrial. Neurology 2005;64:713-5.

5. Schoenen J, Lenaerts M, Bastings E. High doseriboflavin 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