Prophylactic effect of riboflavin on pediatric migraine: a randomized, double-blind, placebo-controlled trial
Keywords:
Migraine; Children; Riboflavin; ProphylaxisAbstract
Background and aim: Riboflavin may have an acceptable effect on migraine among children. This study was carried out to determine the prophylactic effect of riboflavin on migraine in children. Methods: This randomized clinical trial study was performed at Shahid Beheshti Hospital in Kashan, Iran from December 2012 to February 2015. Ninety children with migraine were allocated randomly into 3 groups (placebo, low-dose and high-dose riboflavin). The outcomes (frequency, intensity and duration of headaches) were measured at baseline and 12 weeks of medication in each group, and the decrease of them were compared. SPSS software version 16 was used for analysis of the data. Descriptive statistics, Chi-square, Fisher’s exact and t-test were used for statistical analyses. Results: There was a significant decrease of migraine frequency (p=0.000) and mean duration (p=0.000) in the high-dose group compared with the placebo group. No significant reduction of frequency and mean duration of attacks were reported in the low-dose group compared to the placebo group (p=0.49 and p=0.69 respectively). There was no significant reduction of migraine intensity in the low-dose and high-dose groups compared to the placebo group (p=0.71 and p=0.74 respectively). Conclusion: High-dose riboflavin is a safe, well tolerated, cost-effective method of prophylaxis for children with migraine. Trial registration: The trial was registered at the Iranian Clinical Trial Registry with number IRCT2013020412361N1. Funding: The study was supported by the Deputy of Research, Kashan University of Medical Sciences (grant number 91073).
References
Condo M, Posar A, Arbizzani A, Parmeggiani A. Riboflavin prophylaxis in pediatric and adolescent
migraine. J Headache Pain. 2009; 10(5): 361-5. doi: 10.1007/s10194-009-0142-2. PMID: 19649688,
PMCID: PMC3452096.
Ashrafi MR, Salehi S, Malamiri RA, Heidari M, Hosseini SA, Samiei M, et al. Efficacy and safety of
cinnarizine in the prophylaxis of migraine in children: a double-blind placebo-controlled randomized trial.
Pediatr Neurol. 2014; 51(4): 503-8. doi: 10.1016/j.pediatrneurol.2014.05.031. PMID: 25023977.
Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S. Practice parameter: pharmacological
treatment of migraine headache in children and adolescents: report of the American Academy of Neurology
Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology.
; 63(12): 2215-24. doi: 10.1212/01.WNL.0000147332.41993.90. PMID: 15623677.
Gaul C, Eismann R, Schmidt T, May A, Leinisch E, Wieser T, et al. Use of complementary and alternative
medicine in patients suffering from primary headache disorders. Cephalalgia. 2009; 29(10): 1069-78. doi:
1111/j.1468-2982.2009.01841.x. PMID: 19366356.
Jacobs H, Gladstein J. Pediatric headache: a clinical review. Headache. 2012; 52(2): 333-9. doi:
1111/j.1526-4610.2011.02086.x. PMID: 22288433.
Loring DW, Williamson DJ, Meador KJ, Wiegand F, Hulihan J. Topiramate dose effects on cognition: a
randomized double-blind study. Neurology. 2011; 76(2): 131-7. doi: 10.1212/WNL.0b013e318206ca02.
PMID: 21148119, PMCID: PMC3271389.
Sommer BR, Mitchell EL, Wroolie TE. Topiramate: Effects on cognition in patients with epilepsy,
migraine headache and obesity. Ther Adv Neurol Disord. 2013; 6(4): 211-27. doi:
1177/1756285613481257. PMID: 23858325, PMCID: PMC3707352.
Toldo I, De Carlo D, Bolzonella B, Sartori S, Battistella PA. The pharmacological treatment of migraine in
children and adolescents: an overview. Expert Rev Neurother. 2012; 12(9): 1133-42. doi:
1586/ern.12.104. PMID: 23039392.
Panetta J, Smith LJ, Boneh A. Effect of high-dose vitamins, coenzyme Q and high-fat diet in paediatric
patients with mitochondrial diseases. J Inherit Metab Dis. 2004; 27(4): 487-98. doi:
1023/B:BOLI.0000037354.66587.38. PMID: 15303006.
Schetzek S, Heinen F, Kruse S, Borggraefe I, Bonfert M, Gaul C, et al. Headache in children: update on
complementary treatments. Neuropediatrics. 2013; 44(1): 25-33. doi: 10.1055/s-0032-1333435. PMID:
Sherwood M, Goldman RD. Effectiveness of riboflavin in pediatric migraine prevention. Can Fam
Physician. 2014; 60(3): 244-6. PMID: 24627379, PMCID: PMC3952759.
Sparaco M, Feleppa M, Lipton RB, Rapoport AM, Bigal ME. Mitochondrial dysfunction and migraine:
evidence and hypotheses. Cephalalgia. 2006; 26(4): 361-72. doi: 10.1111/j.1468-2982.2005.01059.x.
PMID: 16556237.
Bruijn J, Duivenvoorden H, Passchier J, Locher H, Dijkstra N, Arts WF. Medium-dose riboflavin as a
prophylactic agent in children with migraine: a preliminary placebo-controlled, randomised, double-blind,
cross-over trial. Cephalalgia. 2010; 30(12): 1426-34. doi: 10.1177/0333102410365106. PMID: 20974610.
Boehnke C, Reuter U, Flach U, Schuh-Hofer S, Einhaupl KM, Arnold G. High-dose riboflavin treatment is
efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol. 2004; 11(7): 475- 7. doi: 10.1111/j.1468-1331.2004.00813.x. PMID: 15257686.
Maizels M, Blumenfeld A, Burchette R. A combination of riboflavin, magnesium, and feverfew for
migraine prophylaxis: a randomized trial. Headache. 2004; 44(9): 885-90. doi: 10.1111/j.1526- 4610.2004.04170.x. PMID: 15447697.
Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A
randomized controlled trial. Neurology. 1998; 50(2): 466-70. doi: 10.1212/WNL.50.2.466. PMID:
MacLennan SC, Wade FM, Forrest KM, Ratanayake PD, Fagan E, Antony J. High-dose riboflavin for
migraine prophylaxis in children: a double-blind, randomized, placebo-controlled trial. J Child Neurol.
; 23(11): 1300-4. doi: 10.1177/0883073808318053. PMID: 18984840.
Headache Classification Subcommittee of the International Headache Society. The International
Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004; 24 Suppl 1: 9-160. PMID: 14979299.
Rothner AD, Linder SL, Wasiewski WW, O'Neill KM. Chronic nonprogressive headaches in children and
adolescents. Semin Pediatr Neurol. 2001; 8(1): 34-9. PMID: 11332864.
O'Brien HL, Hershey AD. Vitamins and paediatric migraine: Riboflavin as a preventative medication.
Cephalalgia. 2010; 30(12): 1417-8. doi: 10.1177/0333102410378358. PMID: 20663856.
Di Lorenzo C, Pierelli F, Coppola G, Grieco GS, Rengo C, Ciccolella M, et al. Mitochondrial DNA
haplogroups influence the therapeutic response to riboflavin in migraineurs. Neurology. 2009; 72(18):
-94. doi: 10.1212/WNL.0b013e3181a41269. PMID: 19414726.
Zempleni J, Galloway JR, McCormick DB. Pharmacokinetics of orally and intravenously administered
riboflavin in healthy humans. Am J Clin Nutr. 1996; 63(1): 54-66. PMID: 8604671.
Miano S, Parisi P, Pelliccia A, Luchetti A, Paolino MC, Villa MP. Melatonin to prevent migraine or
tension-type headache in children. Neurol Sci. 2008; 29(4): 285-7. doi: 10.1007/s10072-008-0983-5.
PMID: 18810607.
Pakalnis A, Kring D, Meier L. Levetiracetam prophylaxis in pediatric migraine--an open-label study.
Headache. 2007; 47(3): 427-30. PMID: 17371359.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.