Headaches & Vitamins

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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.

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.