Background and Objective:
Migraine is a globally prevalent neurological disorder, ranking as the eighth most disabling disease worldwide. Although several medications exist for migraine prevention, many carry undesirable side effects. In this context, Coenzyme Q10 (CoQ10)—a mitochondrial antioxidant—has emerged as a potential prophylactic agent with a favorable safety profile. This study aimed to evaluate the efficacy of CoQ10 (100 mg/day) as an add-on treatment in reducing the frequency, severity, and duration of migraine headaches in adults.
Study Design and Methods:
This open-label, parallel, add-on, matched-controlled clinical trial was conducted between September 2014 and September 2015 at Ghaem Hospital, the main neurological referral center in Mashhad, Iran.
Participants:
- 80 adult patients diagnosed with migraine according to International Headache Society criteria.
- Inclusion required ≥1 migraine attack/week or ≥4/month, or less frequent but severe/debilitating episodes.
- Exclusion criteria included diabetes, hypertension, thyroid disease, asthma, prior use of CoQ10 in the last 6 months, or use of migraine-worsening drugs.
Interventions:
- CoQ10 Group (n=36): Received 100 mg/day of CoQ10 in addition to standard prophylactic drugs.
- Control Group (n=37): Continued on standard preventive therapy only.
- Both groups were matched for baseline characteristics and prophylactic medications (mainly tricyclic antidepressants and sodium valproate).
Duration:
- Total: 4 months (1 month pre-intervention + 3 months intervention).
- Assessment at baseline and monthly intervals.
Outcome Measures:
- Primary Outcome: ≥50% reduction in monthly migraine frequency.
- Secondary Outcomes: Attack severity (VAS), duration, days with headache, work absenteeism, and accompanying symptoms (nausea, vomiting, photophobia, phonophobia).
Results:
Baseline Characteristics (Table 1):
- No significant differences in demographics or migraine characteristics.
- Mean age: ~33 years (p=0.9)
- Gender: Mostly female (89.5% in CoQ10 vs. 81.6% in control; p=0.051)
- Severity (VAS): 8.5 ± 1.1 in CoQ10 vs. 8.1 ± 0.1 in control (p=0.2)
- Monthly attacks: 7.8 (CoQ10) vs. 6.5 (Control); p=0.5
Efficacy Outcomes (Table 2):
Outcome
CoQ10 (3rd Month)
Control (3rd Month)
p-value
Attacks/month
1.0
3.1
p < 0.001
Attacks/week
0.1
0.5
p < 0.001
Attack duration (hours)
4.8
16.4
p < 0.001
Days with headache/month
1.4
8.3
p < 0.001
Work absenteeism (days/month)
0.6
2.7
p < 0.001
Severity (VAS)
1.3
5.7
p < 0.001
Symptom Relief:
- Nausea: Reduced to 2.8% in CoQ10 vs. 24.3% in control (p=0.014)
- Photophobia: Reduced to 0% in CoQ10 vs. 13.2% in control (p=0.054)
- Phonophobia: Reduced to 2.8% in CoQ10 vs. 18.9% in control (p=0.056)
- Vomiting: No significant change (p=0.45)
Primary Outcome Achievement:
- ≥50% reduction in monthly attack frequency observed in:
- CoQ10 Group: 29 patients (≈80%)
- Control Group: 6 patients (≈16%)
- Absolute Risk Reduction (ARR): 64.34% (95% CI: 46.78–81.90%)
- Number Needed to Treat (NNT): 1.6
- Worst-case NNT: 1.7 (95% CI: 1.3–2.5)
Adverse Events:
- No side effects reported in the CoQ10 group.
Discussion:
This trial demonstrated that adding 100 mg/day of CoQ10 to conventional prophylactic therapy led to a statistically and clinically significant reduction in:
- Frequency and severity of migraine attacks
- Duration of individual episodes
- Associated symptoms like nausea and photophobia
- Number of days patients missed work due to migraine
These effects were observed consistently across all measured parameters with p-values < 0.001, confirming the robustness of the results.
Mechanism of Action:
The benefits of CoQ10 are likely due to its role in mitochondrial energy production and its antioxidant properties. Since mitochondrial dysfunction is implicated in migraine pathogenesis, CoQ10 might restore normal energy metabolism in neurons and reduce neuronal hyperexcitability.
Comparative Perspective:
This study aligns with earlier research, including smaller trials and pediatric studies, showing CoQ10’s efficacy. Notably, this trial included a well-matched adult cohort and showed a remarkably low NNT of 1.6, outperforming several other supplements or non-pharmacologic interventions.
Limitations:
- Open-label design: Potential for placebo effect.
- Add-on study: May confound results with baseline treatments.
- Self-reported outcomes: Risk of recall bias.
- Non-randomized allocation: Despite matching, randomization would have strengthened internal validity.
Conclusion:
This controlled, match-designed study supports the use of CoQ10 as a safe and effective add-on therapy for migraine prophylaxis. With significant improvements in attack frequency, duration, severity, and associated symptoms—and no observed adverse effects—CoQ10 represents a promising alternative or adjunct for patients seeking tolerable long-term preventive treatment. Further randomized, double-blind trials are encouraged to confirm these findings and guide clinical implementation.
For full details, refer to the original article: https://pubmed.ncbi.nlm.nih.gov/27670440/
