Migraine Headache and Coenzyme Q10

Andrew D. Hershey, MD, PhD
Assoc. Professor of Pediatrics and Neurology
University of Cincinnati
Director, Headache Center
Associate Director, Neurology Research
Children’s Hospital Medical Center
3333 Burnet Ave
Cincinnati, OH 45229
(513) 636-4222 / (513) 636-1888 (FAX)

“Coenzyme Q10 Deficiency and Response to Supplementation

 In Pediatric and Adolescent Migraine,”

Headache, 2007; 47(1): 73-80. 45025 (5/2007)

Kirk Hamilton:          Can you please share with us your educational background and current position?

Andrew D. Hershey:             I earned my MD, PhD from Washington University. I am currently Director, Cincinnati Children’s Headache Center and Associate Professor of Pediatrics and Neurology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, College of Medicine.

KH:    What got you interested in studying the role of coenzyme Q10 (CoQ10) and migraine headaches? What is the hypothesized biochemical connection?

ADH: One hypothesis is that there is a mitochondrial basis of migraine and that CoQ10 can be measured. A study by Rozen on the efficacy of supplementation in adult migraine patients inspired our research.

KH:    What is the relationship between CoQ10 serum levels and migraine headaches?

ADH: Approximately 30% of patients with frequent migraines are low in CoQ10.

KH:    Can you please define what is a low level of CoQ10?

ADH: This was based on laboratory established standards. There are some variations between laboratories, but in general anything below 0.5 to 0.7 micrograms/ml would be low for total CoQ10. The reference range for the laboratory that we used was 0.5 to 1.5 micrograms/ml as normal, thus below 0.5 was considered low, although even patients on the low end of normal may have some benefit.

KH:    Where did you come up with the dose regimen of 1-3 mg/kg per day and why did you use a liquid gel capsule formulation? Was the CoQ10 given in a single dose or divided dose? With meals or away from meals?

ADH: The dose of 1-3 mg/kg was chosen based on a cardiac study. Liquid gels were chosen for bioavailability. The CoQ10 was given in a single dose.

KH:    Can you tell us about your study and the basic results?

ADH:  This study involved 1,550 subjects (aged 3-22 years; mean age: 13.3 years) with frequent headaches. CoQ10 deficiency was found to be quite common in this group of subjects, and supplementation with CoQ10 among those deficient was found to be effective in reducing the frequency of headaches and improving plasma levels of CoQ10. The subjects were patients at a multidisciplinary tertiary headache clinic who experienced frequent headaches and who had a diagnosis of migraine (with or without aura), chronic migraine, or probable migraine . Plasma levels of coenzyme Q10 were measured in patients. Approximately 74.6% of patients were found to have low levels of CoQ10, out of which 32. 9% had levels below the reference range (range: 0.21 to 1.77 microg/mL). These patients were recommended to supplement with coenzyme Q10 at a dose of 1-3 mg/kg per day (liquid gel capsule formulation). Of these patients, 250 were examined at follow-up at an average of 97 days later. Supplementation was found to improve plasma levels of coenzyme Q10 to an average of 1.20 microg/mL. Moreover, the frequency of headaches significantly decreased – from 19.2 days per month to 12.5 days per month, headache disability improved from 47.4 to 22.8 (as assessed with PedMIDAS), and 46. 3% of patients experienced a 50% reduction in headache frequency. The bottom line was the high prevalence of low CoQ10 in frequent migraine suffers.

KH:    Were there any side effects with the CoQ10 therapy? How was the patient compliance?

ADH: No side effects were reported by patients except for the size of capsule. Patient compliance was not measured as this was a retrospective study.

KH:    How can you tell which migraine sufferer may be a responder to CoQ10 therapy? Are serum levels good correlates of susceptibility to migraines?

ADH: Serum levels documented improvement with increasing CoQ10 levels. A blinded study is underway to assess efficacy.

KH:    Do you now have a better understanding of the biochemistry of CoQ10 and how it might reduce the incidence of migraine headaches?

ADH: The mitochondrial basis of migraine may be the etiology, but inflammation and oxidative stress may also be possible causes of migraine.