Blackmores Institute

<h3>Coenzyme Q10</h3>Coenzyme Q10’s involvement in the electron transport chain and energy metabolism makes it an essential cofactor for supporting mitochondrial function, suspected to be part of the pathogenesis of migraine pain.1 Coenzyme Q10’s anti-inflammatory and antioxidant capacity are beneficial for migraine and headache sufferers and has been shown to offer prophylactic support.2,1 Supplementation of 150-300 mg/day of coenzyme Q10 reduced migraine frequency for 50% of participants in a trial of 3 months.2 Potential adverse effects of coenzyme Q10 for migraine treatment included cutaneous allergy which was determined not to be a clinical concern.1 <h3>Riboflavin (vitamin B2)</h3>Riboflavin is associated with a reduction in both the severity and intensity of migraine pain and the reliance on acute medication use as found in a study on paediatric migraine sufferers aged 6-18 years, where 61.9% of participants achieved 50% or greater reduction in headache frequency.3 Riboflavin’s mechanism of action for migraine treatment and prevention is via it’s support with mitochondrial function (NB for those interested in the biochemistry - riboflavin is a precursor for the flavin mononucleotide and flavin adenine dinucleotide molecules required for the oxidation-reduction reaction in the electron transport chain).3With a half-life of 1-2 hours and absorption saturation occurring at 30-50 mg, twice daily administration is recommended.3 An adult study administering 400 mg/day of riboflavin demonstrated a 56% reduction in migraines compared to placebo after 4 months of treatment.1 Be aware that minor adverse effects including diarrhoea or polyuria have been reported from the use of riboflavin.4,3 <h3>Palmitoylethanolamide (PEA)</h3>Palmitoylethanolamide is well-known for its ability to reduce pain and has been studied for its efficacy in migraine pain.2 Migraine with aura patients reported a reduction of migraine associated pain in a study while taking 1200 mg/day of PEA concomitantly with NSAIDs.2 <h3>Magnesium</h3>Many migraine sufferers have been identified as magnesium deficient.1 Magnesium supports migraine prevention through its involvement in vascular tone and neurotransmitter release and its function in calcium channel, neuroinflammation, N-methyl-D-aspartate (NMDA)-glutamate receptor, nitric oxide synthesis and serotonin receptor blockades.2,1Adverse effects of magnesium use for migraine prevention included diarrhoea and gastric irritation.1 <h3>Vitamin D</h3>Low serum vitamin D levels have been identified in migraineurs with supplementation found to reduce headache frequency, however, the mechanism of vitamin D in migraine is still unclear.2 <h3>L-arginine</h3>A known precursor to nitric oxide, a vasodilator, L-arginine may support a reduction of migraine.5 Doses of 3-8 g/day are considered safe for human use.5 <h3>Aged garlic extract (Allium sativum)</h3>Aged garlic extract inhibits the inflammation of capillaries and has a high antioxidant capacity operating as a vasodilator.5 While there are currently no studies on the use of aged garlic in humans for the treatment of migraine, this is an area to watch due to its vasodilatory capacity.5While there are several nutritional and herbal supplements that may support patients with migraine pain, it is important to monitor patients and refer as required. <img src="https://images.contentstack.io/v3/assets/blt948bd74310fc0ad0/blt6362f12729b69e67/6a14f88b58822c2dc884e408/Migraine_Table.png" alt="Migraine_Table.png" class="embedded-asset" /> References:<ol><li>Grazzi L, Toppo C, D’Amico D, Leonardi M, Martelletti P, Raggi A et al. Non-Pharmacological Approaches to Headaches: Non-Invasive Neuromodulation, Nutraceuticals, and Behavioral Approaches. International Journal of Environmental Research and Public Health. 2021;18(4):1503.</li><li>Grech O, Mollan S, Wakerley B, Fulton D, Lavery G, Sinclair A. The Role of Metabolism in Migraine Pathophysiology and Susceptibility. Life. 2021;11(5):415.</li><li>Das R, Qubty W. Retrospective Observational Study on Riboflavin Prophylaxis in Child and Adolescent Migraine. Pediatric Neurology. 2021;114:5-8.</li><li>Rajapakse T, Pringsheim T. Nutraceuticals in Migraine: A Summary of Existing Guidelines for Use. Headache: The Journal of Head and Face Pain. 2016;56(4):808-816.</li><li>Chaliha D, Vaccarezza M, Takechi R, Lam V, Visser E, Drummond P et al. A Paradoxical Vasodilatory Nutraceutical Intervention for Prevention and Attenuation of Migraine—A Hypothetical Review. Nutrients. 2020;12(8):2487.</li><li>D’Onofrio F, Raimo S, Spitaleri D, Casucci G, Bussone G. Usefulness of nutraceuticals in migraine prophylaxis. Neurological Sciences. 2017;38(S1):117-120.</li></ol>

Rounding out our series on pain we are look at the use of natural and complementary therapies for the treatment and prevention of migraine, tension-type headache, or headache pain. Headache disorders are common with 62% of adults affected by episodic tension-type headache and 2% by chronic migraine.1 Migraines severely disrupt the lives of sufferers, or migraineurs, and are estimated to affect 1 billion people worldwide – they are the leading cause of disability for neurological disorders.2 Supporting migraineurs with pain relief and prophylactic therapy is important.

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