Many Children and Teens with Migraine Show Mild Vitamin Deficiencies

Summary: A study from Cincinnati Children’s Hospital Medical Center found that many children, adolescents and young adults treated for migraine have mild deficiencies in vitamin D, riboflavin (vitamin B2) and coenzyme Q10.

Source: Cincinnati Children’s Hospital Medical Center

Key point: Researchers are not yet certain whether vitamin supplementation prevents migraine attacks.

Researchers analyzing patients from the Cincinnati Children’s Headache Center report that a substantial proportion of young migraine patients have low blood levels of certain nutrients that have been linked to migraine in prior work: vitamin D, riboflavin (vitamin B2) and coenzyme Q10 (a vitamin-like substance cells use to produce energy). These mild deficiencies may be associated with migraine, but current data do not establish a clear causal or preventive role for supplementation.

The study was led by Suzanne Hagler, MD, a Headache Medicine fellow in the Division of Neurology at Cincinnati Children’s. Dr. Hagler and colleagues used a clinical database of patients seen at the Headache Center. As part of their routine practice, clinicians obtained baseline blood tests that included vitamin D, riboflavin, coenzyme Q10 and folate. Those tests were selected because previous, sometimes conflicting, studies had implicated these nutrients in migraine biology and prevention.

Among the findings, Dr. Hagler observed sex-related differences in nutrient status: females were more likely than males to have coenzyme Q10 deficiency at baseline, while males were more likely to have vitamin D deficiency. The study did not find clear evidence for widespread folate deficiency. Patients with chronic migraine (headaches occurring on more days of the month) were more likely to show coenzyme Q10 and riboflavin deficiencies compared with patients who had episodic migraine.

Many patients in the clinic received preventive migraine medications as part of their care. When blood tests showed low nutrient levels, clinicians commonly recommended vitamin supplementation in addition to other treatments. Because relatively few patients were treated with vitamins alone, the investigators were not able to determine from this study whether correcting these mild deficiencies by supplementation reduced headache frequency or prevented migraine attacks.

Dr. Hagler emphasized the need for additional research: “Further studies are required to clarify whether vitamin supplementation benefits people with migraine, and whether those who have mild deficiencies are particularly likely to improve with targeted supplementation.” The current findings support the idea that screening for common nutrient deficits may be relevant in young patients evaluated for migraine, but they do not prove that supplements will prevent or reduce migraine on their own.

Study context, limitations and implications

This observational analysis describes nutrient levels measured as part of routine clinical care at a pediatric headache center. As an observational study, it can identify associations but cannot prove cause and effect. Confounding factors such as diet, sun exposure, body mass index, medication use and other health conditions may influence nutrient levels and were not all controlled for in this report. The mixed results from prior clinical trials testing vitamin and coenzyme Q10 supplementation for migraine prevention underline the need for well-designed randomized controlled trials to determine whether treating identified deficiencies improves migraine outcomes.

For clinicians, the findings suggest awareness of possible vitamin D, riboflavin and coenzyme Q10 insufficiency in young migraine patients may be warranted. For families and patients, the results suggest that testing and follow-up with a healthcare provider can guide decisions about supplementation and overall migraine management. Any supplementation should be discussed with a physician to ensure appropriate dosing and to avoid interactions with other treatments.

Presentation details and attribution

The findings were presented by Dr. Suzanne Hagler at the 58th Annual Scientific Meeting of the American Headache Society in San Diego on June 10, 2016. The research was conducted at Cincinnati Children’s Hospital Medical Center.

Image source: Public domain illustrative image used for context.

Note: This summary reports the study’s main observations and limitations without implying that supplementation definitively prevents migraine. Further clinical trials are necessary to answer that question.