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Headaches & Vitamins

Excerpt from:

Canadian Pharmacist's Letter
  Online Continuing Education

Natural Medicines in the Clinical   Management of Headache

Volume 12, No. 105

Riboflavin (vitamin B2) is an essential B vitamin that is now being used for migraine prevention. The idea behind riboflavin for migraine prevention is its role in mitochondrial function. It has been suggested that migraine headaches could be partly due to mitochondrial dysfunction. Mitochondria are involved in oxidative energy metabolism. Riboflavin is required as a precursor for factors needed for electron transport in mitochondria.

Clinical research is promising. Taking high dose riboflavin 400 mg/day seems to significantly reduce the frequency of migraine headache attacks.1397,1398,12387 Some evidence suggests that riboflavin might be as effective for reducing migraine headache frequency as the beta-blockers, bisoprolol (Zebeta) and metoprolol (Lopressor).1396

Riboflavin might be worth considering for some patients. But keep in mind that HIGH doses of riboflavin are needed, 400 mg/day. This is over 200 times higher than the recommended daily intake. Fortunately, toxicity isn't likely if patients have normal kidney function. Counsel patients that riboflavin is usually well-tolerated, but these high doses can cause diarrhea and polyuria.

Available commercially as 100mg tablets or compounded as Riboflavin 400mg Filler-Free capsules at Fallowfield Pharmasave.

Practice Pearl
Warn patients that high doses of riboflavin can turn their urine   fluorescent yellow and can interfere with the results on color-dependent   urine tests.

Coenzyme Q10 has gotten a lot of attention over the years for its use in patients with heart failure. Coenzyme Q10 is involved in electron transport in the mitochondria and is thought to boost energy production. It's now being studied as a potential preventive agent for migraine.

Clinical research so far suggests that coenzyme Q10 100 mg three times per day can decrease the frequency of migraines by about 30%. It also seems to reduce the number of days with headache-related nausea by about 45%.8135,11872 The number needed to treat (NNT) is three for preventing a migraine attack over three months.11872 Explain to patients that it can take several weeks to three months to notice a significant benefit.

1396 Sandor PS, Afra J, Ambrosini A, Schoenen J. Prophylactic treatment of   migraine with beta-blockers and riboflavin: differential effects on the   intensity dependence of auditory evoked cortical potentials. Headache 2000;40:30-5.
1397 Schoenen J, Lenaerts M, Bastings E. High-dose riboflavin as a   prophylactic treatment of migraine: results of an open pilot study. Cephalalgia 1994;14:328-9.
1398 Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose   riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology 1998;50:466-70.
8135 Rozen TD, Oshinsky ML, Gebeline CA, et al. Open label trial of   coenzyme Q10 as a migraine preventive. Cephalalgia 2002;22:137-41.
11872 Sandor PS, Di Clemente L, Coppola G, et al. Efficacy of coenzyme Q10   in migraine prophylaxis: A randomized controlled trial. Neurology 2005;64:713-5.
12387 Boehnke C, Reuter U, Flach U, et al. High-dose riboflavin treatment is   efficacious in migraine prophylaxis: an open study in a tertiary care centre.   Eur J Neurol 2004;11:475-7.