Objective:

This systematic review aims to assess the current evidence supporting the effectiveness of ALA in migraine prophylaxis

Background:

While oxidative stress is implicated in migraine pathophysiology, the efficacy of antioxidant-based prophylactic therapies remains unclear. Alpha-lipoic acid (ALA) possesses neuroprotective and anti-inflammatory properties, making it a potential candidate for migraine prevention.

Design/Methods:

A comprehensive search was conducted on major databases up to April 2024 to identify relevant randomized controlled trials (RCTs). The quality of the studies was assessed using the Cochrane risk of bias tool (ROB2).

Results:

A total of five RCTs, involving 255 patients were included. The results indicated a significant improvement in migraine mean monthly frequency (MMF) in both ALA as monotherapy and ALA in combination with other treatments groups. The mean difference (MD) for MMF was -1.43 (95% CI: [-2.48, -0.39]; p = 0.007) and -2.32 (95% CI: [-3.18, -1.46]; p = 0.001), respectively. ALA was also effective in reducing migraine mean monthly duration (MMD) (MD = -5.2, 95% CI: [-9.43, -0.98]; p = 0.02). Additionally, ALA led to significantly higher risk of achieving 50% reduction in migraine frequency compared to control group (relative risk = 2.00; 95% CI: [1.34, 3.00]; p = 0.0008). No serious adverse events were reported in any of the included studies.

Conclusions:

Our findings suggest that ALA is a safe intervention with potential benefits in reducing the frequency of migraines. However, further studies are necessary to strengthen the evidence base and enhance our understanding of its mechanism of action.