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Coenzyme Q10 and migraine

Coenzyme Q10 has been like an old but embarrassing friend to Bandolier. Over the years, many readers have asked for an appreciation of the evidence relating to all the wonderful health-giving properties it supposedly has. Ever obedient, Bandolier scurries off to look for this evidence, but finds none - hence the embarrassment.

It is ironic, then, that just now there is a smidgin of evidence that Q10 may be useful in preventing frequent headaches and/or migraine. The dictionary definition of smidgin is a tiny or scarcely detectable amount, so don't hold your breath for anything exceptional.

Search

Searching was fairly simple, looking for articles with coenzyme Q10, ubiquinone, and/or headache or migraine. Any study was accepted, cohort or randomised trial, as long as it reported some indicator of frequency of migraine or headaches, principally as the number of patients with at least a 50% reduction in the number of migraine or headache attacks (number per month) or days affected per month.

Results

Three studies were found, two cohorts, and one randomised trial, all published since 2002.

Cohort studies

The first cohort [1] included 32 patients with International Headache Society-defined migraine for at least one year, and usually with two to eight migraine attacks each month. All were seen by a neurologist before study entry, and a full history and examination performed. Treatment consisted of a baseline month followed by three months of coenzyme Q10 at 150 mg daily, given once in the morning.

Among the 31 completers, 19 (61%) had at least 50% reduction in headache days per month, and 29 (93%) had at least a 25% reduction (average of last two months on treatment). The mean number of days per month with headache fell from 7.3 to 3.0. The mean number of attacks fell from 4.9 per month at baseline to 2.8 during the last two months of treatment. There was no difference in severity of headache or associated symptoms, and no adverse events reported with coenzyme Q10.

The second cohort [2] reported on a consecutive series of 1,550 paediatric and adolescent patients with migraine (ICD classification) in whom a series of coenzyme Q10 measurements were made. The reference range used for serum coenzyme Q10 was 0.5 to 1.5 mg/L; 1143 had levels below 0.7 mg/L and 510 had levels below 0.5 mg/L. Coenzyme Q10 supplementation was recommended (at 1 to 3 mg/kg/day) for those below 0.7 mg/L.

In 252 young patients who took supplements and who had follow up data, mean serum coenzyme Q10 levels rose from 0.5 to 1.2 mg/L, with a large increase in those with levels initially below 0.7 mg/L. In those taking supplements, there was at least a 50% reduction in headache frequency in 46%. The average number of headache days per month fell from 19 to 13.

Randomised trial

This trial [3] randomised 43 patients with IHS-defined migraine occurring two to eight times a month to 300 mg coenzyme Q10 daily or placebo. The trial was of good quality (properly randomised and double blind), but six patients dropped out after randomisation. A baseline month was followed by three months of treatment.

The proportion of patients with at least a 50% reduction in attack frequency was 3/21 (14%) with placebo and 10/21 (48%) with coenzyme Q10 for the last month of treatment compared with baseline. There was no difference in migraine severity, but there were fewer migraine days and days with nausea or vomiting.

Comment

As Figure 1 shows, there was a consistent improvement for major reduction in headache frequency or days of headache per month in both cohort studies and the randomised trial. Half the people involved had a major benefit in headache reduction.



Figure 1: At least 50% reduction in headache frequency (dark) or days (light)





But the evidence itself is not extensive. The total number of patients on coenzyme Q10 was about 300, and with only a single small randomised trial of good quality there is not sufficient good evidence to be sure of benefit (or adverse events, come to that).

Let's face it, if a huge trial told us there was no effect, then we might not be surprised. But no such trial is likely. While coenzyme Q10 is being tested in a number of indications, no further trials in migraine prevention appear to have been registered, so this is all we have to go on right now.

  1. TD Rozen et al. Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia 2002 22: 137-141.
  2. AD Hershey et al. Coenzyme Q10 deficiency and response to supplementation in pediatric and adolescent migraine. Headache 2007 47: 73-80.
  3. PS Sándor et al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology 2005 64: 713-715.

References:

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