Low bioavailability of riboflavin and other nutrients may have implications in diagnosis and treatment of childhood migraineurs.
PHILADELPHIA—Low levels of riboflavin stores may play a role in pediatric migraine, reported Tonia M. Sabo, MD, Assistant Professor of Pediatrics and Neurology at the University of Colorado Denver, in Aurora, and colleagues at the 14th Congress of the International Headache Society.
Researchers used the Erythrocyte Glutathione Reductase (EGR) test to measure riboflavin stores in a small group of pediatric migraine patients and found more than half of the subjects were either low or deficient in the B vitamin. The EGR assay, an indicator of riboflavin stores, reflects a higher level for lower riboflavin stores. Subjects were classified as deficient in the B vitamin if their EGR values were less than 90% of the suggested upper limit (12 U/g Hb). Low levels were defined as being within 80% of the suggested range, with 10.8 U/g Hb as the cutoff.
The 17 study subjects, ages 5 to 18, were part of a larger study evaluating the nutritional relationships of certain micronutrients and migraines, and were believed to have adequate nutrition and access to nutritional resources. Yet, riboflavin stores were deficient in 47% and low in 11%.
“Despite eating a well-balanced diet, some people may have altered metabolism of select nutrients, making them more susceptible to migraine expression. It has been theorized that energy metabolism, or alteration of it, may be involved with migraine pathogenesis,” Dr. Sabo told Neurology Reviews. “Riboflavin is important in many steps of energy metabolism, and thus alteration or deficiency in this micronutrient may make one susceptible to migraine.”
The researchers noted that the prevalence of deficiency in bioavailable riboflavin stores found in this study suggests either an individual variation in a subgroup of migraine-prone patients, inadequate intake or altered metabolism of riboflavin in these patients, or a relative deficiency in the larger population.
Not Just Riboflavin
In addition to riboflavin, coenzyme Q 10 (CoQ10) is intricately involved in mitochondrial functioning and is likely to be involved in mitochondrial pathogenically related disorders, the investigators noted.
“It may be possible that if migraine patients have singly (one-hit) or in combination (two-hit) deficiency, such as riboflavin and CoQ10, there may be more prominent expression of migraine because they are needed in proper functioning of the electron transport chain and mitochondrial functioning,” said Dr. Sabo. “Nutritional correction or supplementation may thus augment the expression of migraine and may prove to be single or dual treatment options for patients suffering from migraine.”
—Rebecca K. Abma