Overview 

Migraine is a neurological condition marked by frequent and intense headaches, often accompanied by nausea, vomiting, and sensitivity to light and sound. It affects many people globally, disrupting daily life and causing severe pain and considerable discomfort. While there are treatments available to relieve migraine symptoms during an attack, there's also a growing interest in finding ways to prevent these episodes from happening in the first place. This is where nutritional supplements come into play. Three specific ones: riboflavin (known as vitamin B2), magnesium, and coenzyme Q10, are being looked at closely for their potential to help prevent migraines.

Migraine prevention

Various factors, such as stress, hormonal changes, deficiency of certain vitamins, some foods, or environmental stimuli can trigger Migraine. These triggers can set off a cascade of events in the brain which leads to the characteristic symptoms of throbbing head pain, sensitivity to light and sound, and nausea. Preventive measures are important in managing migraines as they aim to reduce attacks' frequency, duration, and severity. This can include lifestyle changes, stress management techniques, and identifying and avoiding triggers. Certain vitamins, minerals, and herbal supplements may help prevent migraine attacks. In this article, we will delve into what science has found regarding the effectiveness and safety of some of these nutritional supplements in preventing migraines.

Riboflavin (vitamin B2)

Riboflavin, known as Vitamin B2, is a nutrient involved in cellular energy production. It contributes to converting food into energy and is necessary for properly functioning various metabolic processes. Riboflavin is found naturally in many foods including meat, eggs, dairy, green veggies, and nuts. It’s also found in daily multivitamin supplements.

Riboflavin in migraine prevention 

People with migraines may have an impairment in the metabolic processes. Research highlights three significant hallmarks of migraine: 

• elevated oxidative stress
• neuroinflammation
• mitochondrial dysfunction

Riboflavin takes part in many metabolic processes and can reduce oxidative stress, mitochondrial dysfunction, and neuroinflammation, making it a strong candidate for migraine prevention.¹

Recent studies indicated its potential to reduce the pain experienced during migraine attacks and the frequency of the attacks.²

• A 2021 study demonstrated that taking 400 mg/day of Vitamin B2 for three months reduced migraine attacks' duration, frequency, and severity³
• In a trial in 55 adults with migraine, riboflavin at a dose of 400 mg/day reduced the frequency of migraine attacks by 2 months compared with a placebo and also reduced the number of headache days⁴
• A study of 41 children and adolescents found that taking riboflavin at a dose of 200 or 400 mg/day for 3 to 6 months reduced the frequency and severity of migraines. The effects also continued after treatment ended⁵ 
• The American Academy of Neurology and the American Headache Society recommended taking riboflavin to prevent migraine headaches⁶ 
• The Canadian Headache Society also recommends riboflavin for migraine prevention⁷
• According to the National Headache Management System for Adults 2019 by the British Association for the Study of Headaches, 400mg per day of riboflavin may reduce migraine frequency and severity

Dosage, safety, and side effects

The recommended dose of riboflavin for migraine prevention is 400 mg per day.⁸ This dose is much larger than the dose of riboflavin found in a daily multivitamin. Also, be aware that you shouldn’t take more than 400 mg because this won’t do you more good and can be harmful. 

Riboflavin is safe and has no serious side effects at doses of up to 400 mg.^5,9

Some common side effects include yellow or orange urine and nausea. A few people may be allergic to Riboflavin. Get immediate medical help if you notice allergic symptoms like itching, rash, swelling, dizziness, or trouble breathing. 

If you have any medical condition or are pregnant, you must ask your healthcare provider before taking riboflavin. Additionally, riboflavin may interact with some medications like tetracycline antibiotics so tell your healthcare provider if you’re taking any medicine, or if you’re drinking alcohol as well. 

Magnesium

Magnesium is a mineral that assists many enzymes to carry out various reactions in the body. It also acts as an electrical conductor that pitches in muscle contracts and regulates heartbeats. Magnesium is important for controlling blood sugar and blood pressure and maintaining nerve and muscle function. It is naturally found in many foods including whole grains, legumes, nuts, bananas, avocados, and leafy greens. It is also found in daily supplements, antacids, and laxatives.

Magnesium in migraine prevention

Low magnesium levels are linked to headaches and many studies showed that people with migraines tend to have lower magnesium levels. This is why magnesium may play an important role in preventing migraines.^10,11,12 

• A 2021 study found that taking 500 mg/day of magnesium oxide supplement for 8 weeks significantly prevented migraine without serious side effects¹³ 
• A review of 21 studies indicated that taking magnesium orally helps prevent migraine as it reduces the frequency and intensity of migraine attacks while taking it intravenously helps with the treatment as it can reduce the acute attacks¹⁴ 
• Several studies have shown that magnesium may be particularly effective in preventing menstrual migraines, as magnesium deficiency is associated with this type of migraine in women^15,16,¹⁷
• The American Migraine Foundation recommends taking 400–600 mg/day of magnesium oxide supplement for migraine prevention¹⁸ 
• According to the National Headache Management System for Adults 2019 by the British Association for the Study of Headaches, magnesium is a migraine prevention option with a starting dose of 400 mg and a maximum dose of 600mg

Dosage, safety, and side effects

The recommended dose of magnesium to prevent migraine headaches is 400 - 600 mg per day.¹⁸ 

Even though it’s considered safe in the recommended doses, magnesium can rarely cause adverse side effects including¹⁹ 

• dizziness 
• nausea
• diarrhoea
• stomach cramps 
• muscle paralysis
• troubled breathing

Overdose can cause adverse effects such as:

• blurred vision 
• trouble breathing 
• trouble heart beating

If you experience any unusual symptoms, immediately check with your healthcare provider. People with kidney issues and bowel conditions tend to develop high blood magnesium levels, called hypermagnesemia.²⁰ Additionally, Magnesium interacts with some medications like tetracycline antibiotics and others.

Therefore, you MUST ask your healthcare provider before taking magnesium supplements. 

Coenzyme Q10

Coenzyme Q10 (CoQ10) is an antioxidant produced naturally in the body. It plays a significant role in cells’ growth and maintenance. CoQ10 is found in foods like nuts, meat, and fish. As we age, it is important to take it as a supplement as its amounts in food can’t increase its levels in the body.

Coenzyme Q10 in migraine prevention

As an antioxidant, Coenzyme Q10 (CoQ10) can protect against the oxidative stress associated with migraine, especially episodic migraine. It can also help those with metabolic issues like diabetes or metabolic syndrome who are more likely to get migraine headaches.²¹ Taking CoQ10 supplements might help keep things balanced and possibly prevent migraine. 

• A study showed that taking coenzyme Q10 might help prevent migraine headaches. They gave 32 patients with a history of migraines either coenzyme Q10 or a placebo pill every day for three months. Most patients who took coenzyme Q10 had fewer migraine days - more than half had over a 50% reduction. Before the study, patients had about 7 migraine days a month, but after three months of treatment, this went down to about 3 days. The number of migraine attacks also dropped significantly. There were no side effects from taking coenzyme Q10²² 
• A 2021 review of 6 studies on a total of 371 people aged 18 to 50 found that taking a CoQ10 supplement reduced the frequency and duration of migraine attacks but was not able to reduce the severity of the attack²³ 
• A 2018 review of five studies on 346 people including 120 children and 226 adults indicated that CoQ10 effectively reduced the number of migraine days per month and the duration of the migraine. However, it mentioned that more research is needed to support this²⁴ 
• A large study conducted on 1550 migraine patients found that deficiency of CoQ10 is common in pediatric and adolescent migraine²⁵ 
• The American Headache Society of Migraine considers CoQ10 as a nutraceutical option for migraine prevention²⁶
• The Canadian Headache Society recommends CoQ10 for migraine prevention as it is well tolerated⁷
• According to the National Headache Management System for Adults 2019 by the British Association for the Study of Headaches, taking 150mg/day of CoQ10 supplement may help prevent migraine headaches

Dosage, safety, and side effects

Different doses were used in the studies. The American Headache Society recommends a dose of 300 mg per day of CoQ10 for Migraine prevention. On the other hand, the British Association for the Study of Headaches recommends a dose of 150mg/day. 

The effectiveness of CoQ10 supplements may depend on the form of CoQ10 you take. There are two forms of CoQ10 in supplements: ubiquinol and ubiquinone. According to some studies, the ubiquinol form is better absorbed than the ubiquinone. 

CoQ10 supplements are safe and well tolerated when taken as recommended. 

Some possible side effects include: 

• Digestive issues such as upper abdominal pain (upper stomach), loss of appetite, nausea and vomiting, and diarrhoea
• Headaches and dizziness
• Insomnia
• Fatigue
• Skin itching or rashes
• Irritability or agitation

CoQ10 supplements can interact with some anticoagulants as they might make warfarin less effective. This could increase the risk of a blood clot. Moreover, CoQ10 supplements are not safe during pregnancy or for individuals with certain health conditions. Always ask your healthcare provider before taking them. 

Summary 

Migraine may be prevented through specific nutritional supplements. Riboflavin (vitamin B2), magnesium, and coenzyme Q10 have shown promise in preventing migraine attacks. These supplements work by addressing factors like oxidative stress, neuroinflammation, and mitochondrial dysfunction. Although more evidence is needed to confirm their effectiveness, several studies have shown that these supplements are well tolerated and produce positive results in reducing the severity, frequency, and duration of migraine attacks. It is important to consult a healthcare provider before taking any supplement.