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Review
. 2025 Jan 24;29(1):33.
doi: 10.1007/s11916-025-01358-3.

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

Stewart J Tepper  1   2 , Katharine Tepper  3
Affiliations
Review

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

Stewart J Tepper et al. Curr Pain Headache Rep. .

Abstract

Nutraceuticals are not regulated by the US Food and Drug Administration, so a careful literature review is essential to make clinical decisions. 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.

Keywords: Butterbur; Coenzyme Q10; Feverfew; Magnesium; Melatonin; Migraine; Vitamin B2.

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Conflict of interest statement

Declarations. Disclosures: Stewart Tepper has the following disclosures: Nutrceutical companies: none Advisory role: Aeon, Abbvie, Alphasights, Amgen, Aruene, Atheneum, Axsome Therapeutics, Becker Pharmaceutical Consulting, ClearView Healthcare Partners, ClickTherapeutics, CoolTech, CRG, Decision Resources, Defined Health, DRG, Eli Lilly, ExpertConnect, FCB Health, Fenix, GLG, Guidepoint Global, Health Advances, Health Science Communications, HMP Communications, Impel, Initiatior Pharma, InteractiveForums, Keyquest, Ki Health Partners, Krog and Partners, Lundbeck, M3 Global Research, Magnolia Innovation, MJH Holdings, Miravo Healthcare, Neurofront Therapeutics, Neurolief, Novartis, P Value Communications, Pain Insights, Inc, Palion Medical, Pfizer, Pulmatrix, Putnam Associates, Rehaler, SAI MedPartners, Satsuma, Slingshot Insights, Spherix Global Insights, Strategy Inc, Synapse Medical Communication, System Analytic, Taylor and Francis, Tegus, Teva, Theranica, Trinity Partners, Unity HA, Vial, XOC. Honoraria lecture fees, continuing medical education: American Academy of Neurology, American Headache Society, Annenberg Center for Health Sciences, Catamount Medical Education, Diamond Headache Clinic, Forefront Collaborative, Haymarket Medical Education, HMP Global, Medical Education Speakers Network, Medical Learning Institute Peerview, Miller Medical Education, National Association for Continuing Education, North American Center for CME, The Ohio State University, Physicians’ Education Resource, PlatformQ Education, Primed, Vindico Medical Education, WebMD/Medscape. Honoraria lecture fees, other: AbbVie, Eli Lilly, Pfizer, Teva. Research funding: Aeon, Abbvie, Eli Lilly, Lundbeck, Neurolief, Pfizer, Suven. Travel: AbbVie, American Headache Society, Diamond Headache Clinic, Eli Lilly, Pfizer. Stock, stock options, patents, royalties, manuscript fees, subsidies, endowments: none. Competing interests: Katharine Tepper has no financial or non-financial disclosures or competing interests to declare.

References

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