Background Migraines represent a substantial burden of disease in childhood, occurring in 3–10%1 of school aged children. These are associated with increased absences from school and subsequent academic sequlae. While, the pathophysiology is not yet fully understood, it has been found that sufferers of migraines show insufficiencies in mitochondrial energy processing and thus in energy metabolism in the brain.2 Riboflavin or vitamin B2 acts as a catalyst in the action of flavoenzymes and plays a vital role in the electron transport chain.2 It has therefore been postulated that supplementing this could act to improve energy production and act as prophylaxis for migraines2.
Current National Institute for Clinical Excellence (NICE) guidelines suggests Riboflavin supplement to be considered in children over 12 for migraine proplylaxis. Evidence in adult populations has been promising with a small number of studies demonstrating the reduction of migraine frequency and length. 3–7 Studies in children however are scarce with mixed result.
Objectives To review the effectiveness of Riboflavin as prophylaxis for Migraines in children under 18 years.
Methods Cases of migraines in children who were managed with Riboflavin at Worcester Royal Hospital were identified retrospectively. Patient notes were subsequently reviewed.
Results 21 children were identified with ages ranging from 9 to 17 years (median 14). There were equal numbers of males and females. 19 (90%) patients were diagnosed with Migraine and 2 (10%) with non-migranous headaches, following appropriate investigations. The most frequent associated symptom was nausea, followed by visual disturbance/photophobia at 62% (13) and 43% (9) respectively.
All patients received a 3-month course of Riboflavin 400 mg once daily, bar 1 under the age of 10 who received 200 mg once daily. 12 (57%) patients were also provided with Sumatriptan and Cyclizine for acute attacks. 8 (38%) patients had previously failed to see symptomatic improvement with other prophylactic medications. Follow up was between 4 and 28 weeks (median 13 weeks). Follow up information was not available for 2 children.
17/19 (89%) patients reported significant improvement in migraine symptoms. Of these, 7/19 (37%) patients reported complete resolution of symptoms. No adverse effects were reported.
Conclusions 200–400 mg a day of Riboflavin is shown to be an effective prophylactic medication in children with Migraines in this review, with both improvement and resolution reported.
Current available evidence in children is limited with mixed results. 2 randomised control trials (RCTs) with n=4210 and n=4811, both of which used doses of 50 mg/day-200 mg/day, failed to show a difference in treatment and placebo groups. 2 further RCTs with n=9813 and n=908, and a retrospective study without control (n= 41)9 showed clinical improvement in groups given 200–400 mg/day of Riboflavin. This mirrors the positive results seen in this review suggesting improvement in children may be dose related. Adverse effects reported included vomiting, diarrhoea and urinary frequency.
Limitations Due to retrospective element, this review does not include a control group and it not been possible to quantify improvement. The sample size is small.
Further study with randomised control trials and a larger sample size using higher doses of Riboflavin is warranted.
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