By Marcello Cherchi, MD PhD
For patients
Riboflavin (vitamin B2) can be taken as a pill. It may make migraines happen less often.
For clinicians
Overview
Riboflavin (vitamin B2) is a mitochondrial enzyme. It is generally well tolerated and there is no clear evidence of toxicity. It has been studied as a migraine prophylactic, with mixed results.
Introduction
Riboflavin (vitamin B2) is a water-soluble vitamin that plays a role in mitochondrial energy metabolism (Yamanaka et al. 2021).
Adverse effects, cautions and contraindications
There is no clear evidence of riboflavin toxicity.
Relevance in otoneurology
Riboflavin has been studied in migraine prophylaxis. The use of riboflavin for migraine was proposed as early as 1946 by Dr. Clifford B. Smith (Smith 1946), and numerous studies have accumulated since then.
A meta-analysis of the use of riboflavin for migraine prophylaxis concluded that, “Riboflavin is well tolerated, inexpensive and has demonstrated efficacy in the reduction of adult patient’s migraine headache frequency. Additional data are needed, however, to resolve questions involving pharmacokinetic issues and pharmacogenomic implications of therapy” (Thompson and Saluja 2017). In contrast, a subsequent systematic review and meta-analysis concluded that, “Vitamin B2 400 mg/day for three months supplementation had significant effect on days, duration, frequency, and pain score of migraine attacks” (Chen et al. 2022).
Riboflavin is usually taken at a dose of 400 mg once per day. If riboflavin is effective, this tends to become apparent around 12 weeks (Schoenen et al. 1998).
Other notes
Riboflavin is available over-the-counter. It is safe to take during pregnancy and nursing.
References
Chen YS, Lee HF, Tsai CH, Hsu YY, Fang CJ, Chen CJ, Hung YH, Hu FW (2022) Effect of Vitamin B2 supplementation on migraine prophylaxis: a systematic review and meta-analysis. Nutr Neurosci 25: 1801-1812. doi: 10.1080/1028415X.2021.1904542
Schoenen J, Jacquy J, Lenaerts M (1998) Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology 50: 466-70.
Smith CB (1946) The role of riboflavin in migraine. Can Med Assoc J 54: 589-91.
Thompson DF, Saluja HS (2017) Prophylaxis of migraine headaches with riboflavin: A systematic review. J Clin Pharm Ther 42: 394-403. doi: 10.1111/jcpt.12548
Yamanaka G, Suzuki S, Morishita N, Takeshita M, Kanou K, Takamatsu T, Morichi S, Ishida Y, Watanabe Y, Go S, Oana S, Kawashima H (2021) Experimental and Clinical Evidence of the Effectiveness of Riboflavin on Migraines. Nutrients 13. doi: 10.3390/nu13082612
