Assessing the Synergistic effect of Vitamin supplementation and Migraine preventative management in children and adolescents with chronic migraine- retrospective cohort analysis
Peyton Crest1, Marley Lemons2, Lauren Olivia McComb3, Brianna Freeman4, Jenny Schmidt3, Tracee Ridley-Pryor4, Ankita Ghosh3
1Rhodes College, 2Lebonheur Children's Hospital, 3Neurology, University of Tennessee Health Science Center, 4Neurology, Lebonheur Children's Hospital
Objective:
To determine the synergistic effect of nutraceuticals and migraine preventatives for chronic migraine in children and adolescents.
Background:
Studies have shown evidence for mitochondrial energy depletion in migraine headaches1,2. Riboflavin and coenzyme q10 play a vital role in mitochondrial energy production and neuroprotective effects of vitamin D helps in migraine prevention.
Design/Methods:
This is a retrospective cohort analysis from an established electronic database (RedCap) from our tertiary care headache program. Participants were diagnosed with headache disorders based on international classification of headache disorders. As part of the initial visits, patients with chronic migraine were assessed for vitamin deficiencies and levels were quantified with standard reference ranges. Patients with vitamin deficiencies (25-OH vitamin D<30 ng/ml, vitamin B2<10nmol/L and coenzyme q10<0.7 microg/ml) were prescribed vitamin supplementation.
Results:
Out of 234 patients, 148 were diagnosed with chronic migraine. Mean age of patients at the time of diagnosis was 11.5±3.6 (range: 3-18). Out of 148, 103 received the vitamin labs and 78 were prescribed nutraceuticals based on the lab results. The mean total vitamin D level was 19.9±9.4 ng/ml, vitamin b2 level was 14.07±18.62 nmol/L and coenzyme q10 level was 0.9±2.09 microg/ml. Subset of patients; 39/78 returned for timely follow up (mean follow up duration 90 days). The average headache duration in this patient group improved from 15.03±21.19 to 5.3±9.3 hours (p<0.006), PedMIDAS disability score improved from 40.3±43.3 to 13.02±15.5 (p<0.001), headache frequency improved from 15.5±9.3 days to 8.7±7.7 days (p<0.001).
Conclusions:
Deficiency of vitamin D, vitamin B2 and Coq10 may be common in pediatric and adolescent migraine. Determination of deficiency and consequent supplementation along with preventative management may result in clinical improvement. Further analysis in a bigger sample will be required to confirm this observation.