Nutraceuticals in migraine
Migraine is one of the most common neurologic conditions, yet many people with migraines have difficulty getting care to reduce or prevent chronic headache. 4.9 million people in Australia suffer from migraine, with 71% migraine sufferers are women and 86% are of working age.
Migraine is a debilitating brain disorder with serious social and financial consequences for the individual and the society. It may be induced by a wide spectrum of triggers, including intake or withdrawal of specific food, physical exercise, weather changes, and others. However, it is not clear why some people develop migraine in response to such triggers while others do not. Migraine medications usually aim to reduce the frequency and intensity of headache attacks and few of the medications act as preventive medication.
There’s an increasing studies reported the brain energy deficit-mitochondria-oxidative stress may play a role in migraine pathogenesis. Mitochondria can be central for this axis, as they are the main energy producers in the brain and mitochondrial electron chain (ETC), essential for ATP synthesis and produce reactive oxygen species (ROS) even in their normal functioning. These ROS can be overproduced by impaired mitochondria, contributing to oxidative stress.
The general strategy to prevent migraine attack is to ‘avoid triggers’, that is to avoid or escape migraine-supporting conditions. Besides that, diet with nutrients to restore impaired mitochondrial functions may help to be effective in migraine prevention. Based on results of various studies, nutrition approaches are safer and more cost-effective than pharmacological approaches in the required treatments of this disorder. Several dietary factors such as magnesium, combination of Coenzyme Q10 (CoQ10) and L-carnitine have been reported to be helpful in the treatment of migraine.
Magnesium plays many roles in the human body, including contributing intracellular energy storage and expenditure, acts as a cofactor in many enzymes and regulation of ion channels. Magnesium deficiency can increase the sensitivity of migraine neuro-inflammation, calcium channel as well as endogenous hormone regulation. Magnesium also has an important role in regulating receptors involved in pain transmission inside nervous system and controlling brain blood flow, as well as preventing calcium entry into cells. Studies have shown that serum level of magnesium in migraine patients is lower than healthy subjects. By consuming magnesium, researchers have found that the frequency of migraine attacks in patients is reduced, as well as its severity and symptoms.
Among the nutritional factors affecting migraine, recently CoQ10 and L-Carnitine have received particular attention. CoQ10 is beneficial for migraine treatment by two active mechanisms. CoQ10 is a vital factor in the electron transport chain of mitochondria, which improves energy metabolism and oxygen utilization in the brain and muscles. Its antioxidant properties have also been confirmed by different studies. On the other hand, L-Carnitine is an essential substrate that aids the transporting of fatty acids across the mitochondrial membrane and metabolism of fatty acid in mitochondria. Any dysfunction in fatty acid oxidation in brain mitochondria may cause accumulation of toxins. Both CoQ10 and L-Carnitine have been shown to be effective in treatment of mitochondrial disorders as well as migraine outcomes. A recent study has shown that concurrent CoQ10 and L-Carnitine supplementation favourably affects migraine symptoms.
The bottom line
With the complex pathogenesis of migraine and the possible side effects of various drugs used for migraine treatment, considering a nutraceutical agent for migraine prevention might be a good alternative. Magnesium, CoQ10 and L-Carnitine reduce the frequency and severity of migraine attacks via positive effects on mitochondrial function, reducing inflammatory factors and improving antioxidant status.
C. Sun-Edelstein, A. Mauskop, Role of magnesium in the pathogenesis and treatment of migraine, Expert Rev. Neurother. 9 (3) (2009) 369–379.
Hajihashemi P, Askari G, Khorvash F, Reza Maracy M, Nourian M. The effects of concurrent Coenzyme Q10, L-carnitine supplementation in migraine prophylaxis: A randomized, placebo-controlled, double-blind trial. Cephalalgia. 2019 Apr;39(5):648-654. doi: 10.1177/0333102418821661. Epub 2019 Jan 6. PMID: 30612463.
D'Onofrio F, Raimo S, Spitaleri D, Casucci G, Bussone G. Usefulness of nutraceuticals in migraine prophylaxis. Neurol Sci. 2017 May;38(Suppl 1):117-120. doi: 10.1007/s10072-017-2901-1. PMID: 28527067.