Forty-two patients (mean age, 38.7 years) with recurrent migraines were randomly assigned to receive, in double-blind fashion, 100 mg of coenzyme Q10 (CoQ10) 3 times a day or a placebo for 4 months. The primary outcome measure was the change in attack frequency in month 4 compared with baseline. At baseline, the mean attack frequency in both groups was 4.4 per month. The proportion of patients who had a 50%-or-greater reduction in attack frequency in month 4 was 47.6% for CoQ10 and 14.4% for placebo. The mean reduction in attack frequency was 27.1% in the CoQ10 group and 2.1% in the placebo group (p < 0.05 for the difference in the change between groups). The mean duration and severity of migraines did not differ between groups. No significant side effects were reported.

Comment: Previous studies have demonstrated that migraine patients have impaired mitochondrial function, resulting in a reduction in energy production, in brain tissue. Nutrients essential for mitochondrial energy production include magnesium, riboflavin, niacinamide, and CoQ10. Controlled trials have demonstrated that supplementing with either magnesium or riboflavin can reduce the attack rate in migraine sufferers. Niacinamide has not been studied for migraine prophylaxis. While there is a single case report in which niacin reduced the recurrence rate of migraines (Mayo Clin Proc 2003;78:770-771), the effectiveness of niacin may have been due to its vasodilatory action, which is not shared by niacinamide. An earlier uncontrolled trial showed a beneficial effect of CoQ10, and those results have now been confirmed in this double-blind trial.

Sandor PS, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology 2005;64:713-715.