Migraine is a neurovascular disorder characterized by recurrent moderate to severe pulsating headaches which, if left untreated, usually last for four to 72 hours. The word “migraine” comes from the Greek “ημικρανία” (hemi-krania) which translates to “half-skull.” This makes sense, as migraines typically affect half of the head. Symptoms associated with migraines include nausea, vomiting, and sensitivity to light, sound, smell, and movement.
According to the Global Burden of Disease project, migraine is the sixth most disabling disorder in the world, and the most disabling of all neurological disorders, with a worldwide prevalence of around 15%. Moreover, it has been characterized as a predominantly female disorder with a nearly threefold higher prevalence in women compared to men. The burden imposed by migraines on sufferers’ daily life translates to a significant negative socioeconomic impact in terms of reduced quality of life, and lost work and school productivity.
A migraine attack is generally divided into four phases: (i) the prodrome or premonitory phase (which occurs hours to days before the headache), (ii) the aura phase (which immediately precedes or accompanies the headache), (iii) the headache phase, and (iv) the postdrome or “migraine hangover” phase (which follows the headache). These phases involve several signs and symptoms, can be overlapping, and are not necessarily experienced by all migraine sufferers. This complexity reflects the variable involvement of multiple neural networks and brain regions.
The causes of migraine are complex and still poorly understood, but are believed to be related to a mix of genetic and environmental factors. According to the trigeminovascular theory, depicted in Figure 1, once a migraine is “triggered,” the trigeminovascular system releases inflammatory cytokines, neuroinflammatory peptides, and calcitonin gene-related peptide, which produce vasodilation and neurogenic inflammation. The vasodilation and neurogenic inflammation sensitize the trigeminovascular sensory fibers that carry signals to the trigeminal nuclei, which are finally transmitted to the thalamus and cerebral cortex, where they are felt as pain.
Management of migraines includes pharmacological and non-pharmacological acute (aimed at aborting a migraine episode once it occurs) and prophylactic (aimed at preventing future migraine occurrence, and reducing attack duration and severity) treatments. There are some nutraceuticals among the prophylactics that are being investigated, such as coenzyme Q10 (CoQ10), magnesium, butterbur root extract, and feverfew. All four have shown promise for the treatment of migraines.
Coenzyme Q10 (CoQ10) is a molecule found in mitochondria that is both produced by the body and absorbed from foods, and which is an essential element of the mitochondrial electron transport chain. It is also an antioxidant. As the neuronal and vascular dysfunction observed in migraines has been proposed by some to be, at least partly, related to mitochondrial dysfunction, CoQ10 may be a promising agent for the prevention of migraines. However, trials investigating the effects of CoQ10 supplementation in participants with migraine have reported conflicting results. The study under review is a meta-analysis that pooled these trials together to examine the overall impact of CoQ10 supplementation on the frequency, severity, and duration of migraine attacks.
Migraine is a neurovascular disorder characterized by recurrent moderate to severe pulsating headaches, which typically affect half of the head. According to the World Health Organization, it is the sixth most disabling disorder in the world, and the most disabling of all neurological disorders. While the pathology of migraine is complex and poorly understood, mitochondrial dysfunction is thought to be, at least partly, implicated. As coenzyme Q10 (CoQ10) is an essential element of the mitochondrial electron transport chain, it has been studied as a potential preventive treatment. The study under review is a meta-analysis that aimed to assess the efficacy of CoQ10 for treating the clinical features of migraine.