NYMC Faculty Publications

Nutraceuticals and Headache 2024: Riboflavin, Coenzyme Q10, Feverfew, Magnesium, Melatonin, and Butterbur

Author Type(s)

Faculty

DOI

10.1007/s11916-025-01358-3

Journal Title

Current Pain and Headache Reports

Document Type

Article

Publication Date

12-1-2025

Department

Health Sciences Library

Keywords

Butterbur, Coenzyme Q10, Feverfew, Magnesium, Melatonin, Migraine, Vitamin B2

Disciplines

Medicine and Health Sciences

Abstract

Purpose of Review: Nutraceuticals are not regulated by the US Food and Drug Administration, so a careful literature review is essential to make clinical decisions. Summary: Riboflavin or vitamin B2 can be recommended for migraine prevention in adults, but pediatric use is not proven. Adverse events are minimal. Coenzyme Q10 has Level C evidence for migraine prevention and low adverse events. Feverfew may be effective for migraine prevention, but the absence of clear safety studies, the differences in doses and characteristics of dried leaf preparations, and the myriad of feverfew cellular effects suggest caution in recommendation for use. Magnesium is recommended for migraine prevention and intravenous acute use, with the potential for generally mild gastrointestinal tolerability adverse events. Melatonin has very low certainty for evidence of efficacy, and is weakly recommended in those with sleep problems. However, purity of US sold melatonin is very poor. Butterbur or petasites preparations have strong evidence for efficacy and concern for hepatotoxicity. Please see the US National Center for Complementary and Integrative Health/NIH online site https://www.nccih.nih.gov/health/butterbur for up-to-date recommendations on whether to use this nutraceutical.

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