A combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study

DOI: https://doi.org/10.1186/s12906-017-1933-7

Abstract-Summary Adult patients suffering from migraine according to the criteria of the International Headache Society were enrolled by general practitioners (≥2 migraine attacks dur- ing previous month; exclusion of chronic migraine and medication overuse) and after a one-month baseline phase, supplemented with one tablet of 100 mg feverfew, 100 mg coenzyme Q10 and 112.5 mg magnesium per day for 3 months.

Supplementation significantly reduced the number of days with migraine headache during third month of supplementation compared to baseline phase (1.3 days ±1.5 versus 4.9 days ±2.6, p  <  0.0001; n = 68 intention to treat; primary criterion).

The decrease was progressive over the period of supplementation and significant from first month (1st month: −2.5 days ±3.1, p < 0.0001; 2nd month: −3 days ±2.8, p < 0.0001).

The proportion of patients with a reduction of at least 50% in the number of days with migraine headache was 75% (51/68) after 3 months, with a progressive increase over the period of supplementation (63.2% [43/68] after 1 month and 70.6% [48/68] after 2 months).

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The proportion of patients with anxiety and depressive symptoms (Hospital Anxiety and Depression Scale) decreased between baseline phase and third month of supplementation from 61.9% (39/63 patients with information available) to 35% (21/60) for depression and from 52.4% (33/63) to 30% (18/60) for anxiety.

Results suggest that the proprietary supplement containing feverfew, coenzyme Q10 and magnesium assessed could be beneficial and safe for the prevention of migraine in adult patients and merits further study.

Extended: We conducted an observational study to assess a 3-month supplemen- tation with a proprietary supplement containing feverfew, coenzyme Q10 and mag- nesium (Antemig®) in adults diagnosed with migraine according to the criteria of the International Headache Society; the number of days with migraine headache per month was the primary outcome.

Background In a double blind, randomised, placebo-controlled clinical trial performed in adult patients with migraine [328], treatment with coenzyme Q10 (100 mg per os three times a day for 3 months) significantly decreased the frequency of migraine attacks. In a randomised placebo-controlled study, supplementation with magnesium (600 mg per os daily for 3 months) significantly reduced the frequency of migraine attacks in adult patients [329].

The American Academy of Neurology (AAN) and American Headache Society (AHS) guideline for migraine prevention in adults gave feverfew and magnesium a Level B recommendation (probably effective and should be considered for preven- tion) [32] and the EFNS guideline a Level C (probable efficacy) [272].

We conducted an observational study to assess a 3-month supplementation with a proprietary supplement containing feverfew, coenzyme Q10 and magnesium (Antemig®) in adults diagnosed with migraine according to the criteria of the International Headache Society; the number of days with migraine headache per month was the primary outcome.

Methods Patients who were taking a prophylactic treatment for more than 3  months were allowed to participate in the study because it was considered that after three months, prophylactic treatment was installed and therefore would not have any impact on the effect of supplementation tested.

From V1 till the end of the study, all patients kept an electronic diary in which they reported migraine characteristics (number of days with migraine headache, intensity, associated symptoms and concomitant medications).

On the second visit (V2; Day 30  ±  10), eligibility of patients was verified: patients with less than 2 or more than 15 migraine attacks during baseline phase and patients unwilling to be supplemented with the combination were excluded from the study.

Reduction of at least 50% in the number of days with migraine headache, associ- ated symptoms, quality of life (QVM), anxiety/depression (HADS), safety and compliance were the secondary evaluation criteria.

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Results During the third month of supplementation, patients declared 1.3 days ±1.5 with migraine headache compared to 4.9 days ±2.6 during baseline phase (−3.5 days ±2.9; p < 0.0001).

During the third month of supplementation, a significant decrease in the number of patients with sensitivity to light (−55%, p < 0.05) and noise (−37.5%, p < 0.05) was observed.

A significant decrease in the mean of both the HADS-Anxiety and HADS- Depression scores was observed after three months of supplementation (6.2 ± 3.3 [p < 0.0001] and 6.2 ± 3.6 [p = 0.0003], respectively).

Using a HADS cut-off value of 8, prevalence of anxiety and depressive symp- toms before supplementation was 61.9% (39/63 patients with information available) and 52.4% (33/63), respectively.

Discussion The results of this observational study suggest that the proprietary supplement con- taining feverfew, coenzyme Q10 and magnesium could be of interest for migraine prophylaxis.

Such a fast onset was previously reported in the randomised, double-blind, mul- ticentre, placebo-controlled study of Diener et al. [330] with a monopreparation of feverfew (MIG-99, 6.25 mg three times a day); in this study, decrease in the fre- quency of migraine attacks was significant from the fifth week of treatment.

The combination of feverfew, coenzyme Q10 and magnesium was well tolerated;

only four adverse events of mild severity were reported in four patients.

In a recent randomised double blind placebo-controlled clinical trial per- formed in 130 patients with a combination of 400 mg riboflavin, 600 mg magne- sium and 150 mg coenzyme Q10 [327], the mean number of days with migraine headache per month declined by approximately 2 days after 3 months of treat- ment; although not statistically significant, this reduction was considered as clini- cally relevant.

Conclusions This observational study conducted in primary care suggests that the proprietary supplement containing feverfew, coenzyme Q10 and magnesium (Antemig®), at the dose of one tablet per day for up to 3  months, could be effective and well tolerated for the prophylaxis of migraine in adults and deserves further research; the results will have to be confirmed in a randomised placebo- controlled clini- cal trial.

Supplementation with this formulation could be particularly useful in the thera- peutic armamentarium to meet the needs of patients suffering from migraine; using it in conjunction with conventional treatments as part of a multidisciplinary treat- ment plan is likely to result in optimum responses.

Acknowledgement A machine generated summary based on the work of Guilbot, Angèle; Bangratz, Marie; Ait Abdellah, Samira; Lucas, Christian. 2017  in BMC Complementary Medicine and Therapies.

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Clinical success of greater occipital nerve blockade in improving sleep quality of chronic migraineurs: a prospective observational study