Impact of nutritional deficiencies on migraines

Nutritional deficiencies may play a role in the development and/or perpetuation of migraines in children, according to a new study, but further research is needed to determine if supplementation would help.

Suzanne E Hagler, MD, headache medicine fellow at Cincinnati Children’s Hospital in Ohio, presented data from a new study linking vitamin deficiencies to migraines at the recent American Headache Society meeting in San Diego, California. The full study has not yet been published.

Hagler says she and her team believe that there is a role for nutrients such as Coenzyme Q10 (CoQ10), riboflavin, folate, and vitamin D in both the pathophysiology and treatment of migraines, although they don’t know yet to what degree.

“In practice, physicians should stress the importance of a healthy, balanced diet specifically including green vegetables, meat, and dairy,” Hagler says. “Physicians can also consider checking levels of some or all of these vitamins, or starting patients on supplements, [however] more research is needed to help guide clinical practice.”

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The objective of the study was to evaluate baseline nutritional data prior to the start of therapies or supplementation to determine if patients with chronic migraines are more prone to certain deficiencies than patients who suffer from episodic migraines.

The retrospective study was conducted using the medical records of 7800 children seen at Cincinnati Children's Hospital Medical Center’s headache center over an 18-year period.

Overall, researchers found that migraine patients were more often deficient in CoQ10, riboflavin, and vitamin D than the general population. Females were more often deficient in CoQ10 and riboflavin, whereas males were more deficient in vitamin D.

In her new study, Hagler highlights several vitamins and antioxidants, detailing the possible pathophysiologic role and therapeutic benefit each may have related to migraines.

Coenzyme Q10 is an essential co-factor in the electron transport chain and for mitochondrial function, and has antioxidant/anti-inflammatory properties. In her study, Hagler notes that 51.3% of children who suffer from migraines had CoQ10 levels at or below the reference range of 0.500 to 1.500 mcg/mL. The average CoQ10 was 0.58 mcg/mL, and 83% of the children studied were at or below 0.7 mcg/mL—the level at which supplementation is suggested.

Females were more likely to be deficient than males, with 52.2% of females compared with 49.6% of males at or below 5 mcg/mL, according to the report. Additionally, chronic migraine sufferers experienced low CoQ10 more than episodic sufferers, with 52.5% of chronic patients at or below 0.5 mcg/mL CoQ10 compared with 50.1% of episodic patients. Hagler says her data suggest that CoQ10 supplementation may lead to headache improvement.

NEXT: Folate and riboflavin

Folate levels were also found to be low in the study population. A water-soluble B vitamin needed for the synthesis of nucleic acids, folate is important for homocysteine homeostasis, notes Hagler. In her study, the average folate level was 22.01 ng/mL, and 6.3% of patients were at or below the reference range of 8.7 ng/mL or more. Almost 59% were at or below 20 ng/mL—the level at which supplementation is recommended. There were no differences between male and female patients, or among patients with chronic versus episodic migraines.

There is an inverse relationship between dietary folate consumption and migraines, and elevated homocysteine levels have been found in migraine patients, Hagler notes. Other research has suggested that lowering homocysteine through folic acid supplements could reduce migraine occurrence. More research is needed to fully determine whether migraine patients are deficient in folate, according to the data, and how the findings can be translated into clinical practice.

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Riboflavin was another B vitamin included in the study. Hagler notes that although there are no published studies assessing serum riboflavin levels in migraine patients, her study found that 15.5% of the study population had riboflavin levels at or below the 6.2 to 39 nmol/L reference range, with 41.7% below the level at which supplementation is recommended (10 nmol/L). Hagler also found that 16.8% of females were below the reference range and 43.5% were candidates for supplementation compared with 12.9% and 38% of males, respectively. Likewise, 17.1% of chronic migraine patients had riboflavin levels below reference ranges and 43.8% were candidates for supplementation compared with 13.6% and 38.9% of episodic migraine patients, respectively.

Vitamin D was also included in the study and has been associated with a host of chronic illnesses. Although there is no link between vitamin D deficiency and migraines, Hagler says there has been discussion on whether higher levels of vitamin D are needed in general.

In the study population, 31.23% were below the reference range of 20 to 60 ng/mL for vitamin D, and 90.87% were at or below the 40 ng/mL at which supplementation is recommended. Unlike in the cases of the other vitamins studied, males were more likely than females to be deficient in vitamin D, with 92.7% of males and 90.1% of females at or below the level for supplementation, according to Hagler’s data.

Hagler says previous studies have hinted that riboflavin and CoQ10 may aid in migraine prevention, and that folate may help migraine patients who experience auras, but there have been conflicting results across the earlier research. She says few of the earlier studies have evaluated baseline data on serum vitamin levels before treatments began.

Even though data might support the theory that vitamin deficiencies can perpetuate migraines, researchers say the relationship between nutritional deficiencies and migraines is poorly understood, and more research is needed to determine whether migraine patients with mild vitamin deficiencies would benefit from taking supplements.