Riboflavin for Migraine Prevention
Evidence for Riboflavin in Migraine Prevention
- The American College of Physicians and the U.S. Headache Consortium acknowledge riboflavin as having fair evidence for modest efficacy in migraine prevention, though more trials are needed due to methodological limitations in existing studies 1, 2
Indications for Preventive Migraine Therapy
- Preventive therapy should be considered when patients experience two or more migraine attacks per month with disability lasting 3 or more days per month 1
- Preventive therapy should be considered when patients have a contraindication to or failure of acute treatments 1
- Preventive therapy should be considered when patients use abortive medications more than twice per week 1
- Preventive therapy should be considered when patients have uncommon migraine conditions, such as hemiplegic migraine, migraine with prolonged aura, or migrainous infarction 1
First-Line Preventive Treatments with Stronger Evidence
- The American College of Cardiology is not mentioned, however, the American College of Physicians recommends beta-blockers, such as propranolol (80-240 mg/day) and timolol (20-30 mg/day), for migraine prevention due to consistent evidence supporting efficacy 1, 3
- Beta-blockers with intrinsic sympathomimetic activity are ineffective for migraine prevention 3
- The American College of Physicians recommends amitriptyline (30-150 mg/day) as the only antidepressant with consistent evidence for efficacy in migraine prevention 1, 4
- Amitriptyline may be superior for patients with mixed migraine and tension-type headache 1
- Divalproex sodium and sodium valproate have good evidence for efficacy in migraine prevention 4
Practical Considerations for Riboflavin Use
- An adequate trial of riboflavin requires 2-3 months as clinical benefits may not become apparent immediately 1
- Continuous assessment of efficacy and side effects is recommended when using riboflavin for migraine prevention 3