Pharmacist Corner: The Use of Coenzyme Q10 in the Prevention of Migraines
By: Rosemarie Salo, Pharm.D.
Peer Reviewed by: Brian Solow, M.D., FAAFP
Migraine headaches are a common, chronic, debilitating neurovascular disorder. Migraine attacks may start at any age, but the incidence peaks in early to mid-adolescence. Overall, the one year prevalence of migraines is 11 percent: 6 percent for men and 15-18 percent for women in the United States and Western Europe. The frequency of attacks is 1.5 per month and each attack lasts about 24 hours. About 10 percent of patients have weekly attacks, and 20 percent have attacks lasting for 2-3 days.
Five percent of the general population has at least 18 days of migraine per year, and about 1 percent has at least 1 migraine attack per week. Most patients in the United States have not seen a physician for migraines during the previous year, nor have they been given a medical diagnosis for migraines. Most of these patients use over-the-counter medications versus prescription drugs due to side effects associated with conventional therapies.1 The side effects include, but are not limited to, dizziness, somnolence, impotence, fatigue, dry mouth, and weight gain.
Treatments can be divided into nonpharmacologic and pharmacologic therapies. Non-pharmacologic therapies include lifestyle changes such as eliminating food triggers, obtaining regular sleep and exercise, avoiding high stress situations, increasing relaxation methods, becoming educated of the disorder, and knowing of treatment options.
Pharmacological therapies that are usually prescribed for acute attacks include NSAIDS, ergot derivatives, and triptans. Patients who suffer from frequent, long endured, severe attacks should be candidates for preventative therapy. Preventative therapy is recommended when the frequency of attacks increase, or when the attacks become unresponsive to acute therapy.
Types of medications used for preventive therapy include beta-blockers, valproate, and tricyclic antidepressants. Other promising drugs include gabapentin and topiramate. On average, two thirds of patients who have been administered these types of medications have had a 50 percent reduction in the frequency of migraines.1
A mitochondrial defect is thought to play a role in the pathophysiological mechanism of migraines based on MRS4 and DNA5 analysis taken from a subset of individuals. Coenzyme Q10, also known as ubiquinone, is a naturally occurring substance and an essential element of the mitochondrial electron transport. Coenzyme Q10 may have clinical benefits for hypertension, angina, heart failure, and diabetes. Doses up to 600 mg per day have been well tolerated. If a mitochondrial impairment does in fact play a role in the pathophysiology of migraine headaches, coenzyme Q10 may be used as a medication for preventative treatment. An open label trial was conducted by Rozen et al. (2002) to assess the efficacy of coenzyme Q10 as a preventative therapy for migraine headaches. The study encompassed a total of thirty-two patients (26 women, 6 men) with a history of migraines with or without aura. Subjects included in the study experienced between two and eight attacks per month, had a 1-year history of migraines, and had not
received medications 2 months prior to the trial. During the study each subject was given a dose of 150 mg every morning of coenzyme Q10. Each subject was also given a diary to assess their attacks addressing symptoms, duration, and severity. Standard laboratory studies were conducted baseline and after 3 months of coenzyme Q10 administration. The percentage of patients who achieved at least a 50% reduction in the frequency of headache days after coenzyme Q10 administrations was the primary outcome measure.
Thirty-one out of thirty-two patients completed the study. One patient was lost to follow up. A minimum 50% reduction in the number of days with migraine headaches was seen in 61.3% of the subjects, and a minimum 25% reduction in the number of days with migraines was seen in 93.5% of the subjects. No improvement with therapy was seen in only two subjects. The average duration time for each migraine declined from 7.34 to 2.95 days after 3 months of therapy (P<0.0001). The mean frequency of attacks (mean number of migraine attacks in the last 60 days of treatment) declined from 4.85 baseline to 2.81 by the end of the study (P<0.0001). After 1 month of treatment the mean reduction of migraine frequency was 13.1% and increased to 55.3% by the end of the study. Coenzyme Q10 was equally effective in patients with or without aura. In addition, no significant adverse effects were associated with the administration of coenzyme Q10, and coenzyme Q10 was well tolerated.
Based on this study, coenzyme Q10 appears to be a promising choice for migraine prevention. Placebo-controlled trials are now warranted to determine its true efficacy in migraine prevention. Patients may choose not to use conventional types of medications due to side effects such as impotence and fatigue. Until further studies are conducted, coenzyme Q10 should be considered for patients who have failed conventional therapy without concern of significant risks.
Coenzyme Q10 is available as 300mg softgels from the McGuff Company.
1. Goadsby P, Lipton R, Ferrari M. Migraine current understanding and Treatment. N Engl J Med 2002; 346(4):257-70.
2. Rozen TD, Oshinsky ML, Gebeline Ca, et al. Open label trial of Coenzyme Q10 as a migraine preventive. Cephalalgia
3. Welch K, Ramadan N. Mitochondria ,magnesium, and migraine .J Neurological Sci 1995; 134:9-14.
4. Montagna P, Cortelli P, Barbiroli B.Magnetic resonance spectroscopy studiesin migraine. Cephalalgia 1994;14:184-93.
5. Bresolin N, Martinelli P, Barbiroli B et al. Muscle mitochondria deletion and P NMR spectroscopy alterations in migraine
patients.J Neuro Sci 1991;104:182-9.
6. Collins C, Kemper K. Co-Enzyme Q10(CoQ10 or Ubiquione). The Longwood Herbal Task Force and The Center for
Holistic Pediatric Education and Research. Peer Review performed by Brian Solow, M.D.,FAAFP, Clinical Professor of
Family Medicine, University of California, Irvine, College of Medicine