In a new study realized by researchers in Iran, a combination of coenzyme Q10 and L-carnitine was found to be effective for episodic migraine prevention, with 10% of constipation and stomach ache side effects.
Let’s look at some details!

What are the natural supplements recommended in Canada for migraine prevention?

Four supplements are currently recommended in the Canadian Guidelines for Migraine Prophylaxis (fancy term for prevention):

  • Magnesium citrate 300 mg twice per day. Some clinicians also recommend glycinate. The other forms (laxative magnesium) are not well absorbed and should not be used.
  • Vitamin B2 or riboflavin 400 mg per day
  • Coenzyme Q10 150 mg twice a day or 100 three times per day
  • Butterbur or petasites 75 mg twice a day. This last product has been associated with rare cases of liver toxicity and many clinicians are not prescribing it anymore.

Why would CoQ10 and L-carnitine work to prevent migraine?

The mechanisms of migraine are like a huge puzzle of interacting pieces, including serotonin and CGRP. One important piece to understand the migraine puzzle is the role of energy metabolism and oxidative stress. Our brain needs a lot of energy to function. This energy is produced by the mitochondria, the «energy shop» of the cell. Many chemical reactions take place in the mitochondria, involving hundreds of substances, enzymes and ions.

Science supports that the migraine brain has particular ways of processing energy. That is why acting on the mitochondrial mechanisms makes sense.

Coenzyme Q10 plays a role in this energy production process in the mitochondria. It is also an anti-oxydant.
L-carnitine also plays a role, transporting the fatty acids to the mitochondria.

Therefore, we can assume that by improving the energy metabolism of the brain cells, these two supplements could improve migraines. That’s the reason why it makes sense to study it.

How was the study done?

The study was done on patients with episodic migraine (baseline of 6-9 days per month).
The treatment was a combination of CoQ10 30 mg/day and L-Carnitine 500 mg/day.

Fun fact: the CoQ10 product was actually from Canada!

Half of patient received the active product, and half the placebo.
Patients took the placebo or product for 8 weeks.

Fun fact: participants reported a food intake of 1500 and 1600 kcal per day, which is what people eat when they are on a weight loss diet. We can question whether this was representative of their ordinary diet…

What were the results for improvement/effectiveness?

The study was positive. That means that the group receiving the supplements improved more than the group receiving the placebo.

  Active baseline 

Versus 8 weeks

 Gain Placebo baseline 

Versus 8 weeks

 Gain
Frequency 

Days/month

 9.5 

3.6

 5.9 less days 6.5 

5.3

 1.2 less days
Duration of attack 17 

8.5

 8.5 less hours/attack 18 

15

 3 less hours/attack

The supplements were associated with a greater decrease in migraine days per month, shorter frequency and also severity of attacks, and also a small decrease in lactate levels in the blood.

Were there side effects?  

Constipation and stomach ache were seen more in the active group (10%) than the placebo group (3%).
No other significant side effects were reported.

Is the study of good quality and reliable?

  • There were 56 patients (49 women), so this was a small study. Small studies are less conclusive than big ones with hundreds of patients.
  • Six persons did not finish the study (drop out rate). That’s reasonably good. It means the study was carefully conducted and it suggests that there were not a lot of severe side effects leading to drop out.
  • The doses of CoQ10 and L-carnitine used were quite low compared to the doses recommended for migraine (300 mg/day) and the doses used in study on inflammation (1000 mg to 4000 mg/day).
  • During the study, patients had to fill dietary and physical activity reports. This could confuse the results, as people tend to behave better when they feel observed. An improvement in diet and physical activity could have explained part of the improvement, but not the difference between active and placebo.
  • The group taking the real product started with 9.5 days per month. The placebo group started with 6.5 days per month. That’s a big difference! We can say that the potential for improvement (decrease of days) was better in the active group.
  • This study was also of short duration, and it does not tell us what happens over 6 months or a year, for example does the benefit last?

What can we conclude and where can I find those products?

This is a small positive study with placebo supporting the use of CoQ10 and L-carnitine for the prevention of migraine.

Why such low doses were used is not clear, but a significant benefit was observed anyway.

References:

The effects of concurrent Coenzyme Q10, L-carnitine supplementation in migraine prophylaxis: A randomized, placebo-controlled, double-blind trial.
Hajihashemi P, Askari G, Khorvash F, Reza Maracy M, Nourian M.
Cephalalgia. 2019 Apr;39(5):648-654.

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