Coenzyme Q10 Has a New Role
“Spark plug” molecule boosts brain energy,
which may be deficient in migraine victims
A patient in a doctor’s office complains, “When I lift my arm this way, my shoulder hurts.” The doctor says, “Well, then, don’t do that.” Today that same wise advice still constitutes one of the main approaches to an affliction that has plagued mankind (womankind especially) for thousands of years: migraine. For those who suffer from this beastly condition, certain things can act as triggers, so to prevent attacks, they must be avoided as much as possible. Often, though, it’s not possible.
The most notorious culprit is physical or emotional stress. Sometimes, paradoxically, it’s the relief from a major bout of stress that brings on migraines (these are called “holiday headaches”). Other common triggers include weather changes and annoying visual effects, such as glare, flashing lights, and repetitive geometric patterns. Menstruation, oral contraceptives, and sexual activity are also implicated, as are fatigue and hunger. And in about 20% of migraine victims, certain foods are at fault, notably chocolate, cheese (especially aged cheese), alcohol (especially red wine), citrus fruits, wheat, eggs, coffee, tea, cola, milk, beef, corn, yeast, pickled fish, and cured meats.
With No Cure . . . Prevent!
Individual sensitivities vary greatly, and what triggers a migraine in some migraineurs (as migraine sufferers are known) may be perfectly OK for other migraineurs. But it’s a sad day when a list such as the one above includes chocolate, cheese, and wine—the three basic food groups! No one should have to endure deprivation of these gifts from the gods. And so we look for preventive measures that go beyond the mere avoidance of triggers.
Prevention, of course, is always preferable to therapy. There is some evidence that aerobic exercise, if done regularly, may help prevent migraines (as, indeed, it helps prevent almost all chronic diseases). Yoga, transcendental meditation, and hypnosis may also be helpful, as well as conditioning techniques such as biofeedback. And prevention can be achieved, with varying degrees of success, through a remarkably diverse array of prescription drugs, such as alpha2 agonists, beta-blockers, calcium channel blockers, antidepressants, anticonvulsants, NSAIDs, serotonergic agents, and even botulinum toxin (Botox)—a list that bespeaks the neurological complexity of migraines. Such drugs can help, but they cannot cure—there is no cure.
Does Low Brain Energy Play a Role?
There are, however, some supplements that can also help with migraine, the most successful of which hitherto have been riboflavin (vitamin B2), magnesium, and the herb feverfew (Tanacetum parthenium). Relatively new to this particular arena is coenzyme Q10, a natural compound already well known for its extremely important role in human physiology (see “Coenzyme Q10 Sparks the Life Within You” in the May 2005 issue). It acts as the body’s “spark plugs,” in a sense, by serving as a vital cofactor to certain enzymes responsible for the production of ATP (adenosine triphosphate), life’s master energy molecule.
This process occurs in our cells’ mitochondria. Based on MRI studies and DNA analysis of migraineurs, there has been growing interest in recent years in the role that impaired mitochondrial function in the brain might play in the origin of migraine, at least in some cases. Thus it seemed reasonable to try coenzyme Q10 (CoQ10 for short), the most extensively studied agent for the treatment of mitochondrial disorders, as a potential preventive agent.
Coenzyme Q10 Reduces Incidence of Migraine
In 2002, researchers at Thomas Jefferson University in Philadelphia tested CoQ10 on 32 migraine patients, using 150 mg/day for 3 months in an open-label trial (no placebo control). By the end of 3 months, 61% of the patients had achieved a greater than 50% reduction in days with migraine headache. This was an encouraging result, but proof must be found in the pudding—a randomized, double-blind, placebo-controlled trial.
Just such a trial was carried out recently by researchers in Switzerland and Belgium with 42 migraine patients, average age 39, of whom 34 (81%) were women. The patients had been having 4.4 attacks per month, on average. For 3 months they received 300 mg/day of CoQ10 (100 mg thrice daily) or placebo. The results of this study tended to confirm the earlier results (so the proof was in the pudding). By the end of 3 months, 48% of the patients taking CoQ10 had achieved a greater than 50% reduction in the number of migraine attacks, vs. 14% in the control group. Furthermore, CoQ10treatment resulted in significant reductions in the number of days with headache and the number of days with nausea or vomiting.
It’s noteworthy that in both these studies, CoQ10 was very well tolerated by the patients, with virtually no significant side effects; this accords with prior experience in many other studies with CoQ10.
Score Another Victory for CoQ10
Despite some opinion to the contrary, much can be done to alleviate the suffering of migraine victims by relieving the frequency, intensity, and duration of their attacks, thus improving the quality of their lives. Drugs are undeniably beneficial, and they’re getting better all the time, but most of them carry such an array of adverse side effects that safe and effective nutritional supplements seem all the more desirable by comparison. Thus it’s gratifying to know that one of the most important of these natural agents, coenzyme Q10, has added a new notch to its belt by helping to prevent migraines.
- Rapoport AM, Bigal ME. Preventive migraine therapy: what is new. Neurol Sci2004;25:S177-85.
- Rozen TD, Oshinsky ML, Gebeline CA, Bradley KC, Young WB, Shechter AL, Silberstein SD. Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia 2002;22:137-41.
- Sándor PS, Di Clemente L, Coppola G, Saenger U, Fumal A, Magis D, Seidel L, Agosti RM, Schoenen J. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology 2005;64:713-5.
What Is Migraine, Anyway?
Not counting exotic headaches of different kinds (some of which are symptoms of serious problems, such as stroke, meningitis, glaucoma, or a brain tumor), there are three basic, and distinctly different, kinds of headaches, with numerous variations on the themes. Despite the pain, all are harmless (with rare exceptions).
Tension headaches hit everyone from time to time—they’re as common as dirt. Sure, they hurt, but they’re tolerable except in unusual cases, and they usually succumb to treatment with simple analgesics or muscle relaxants.
Cluster headaches occur mainly in men (who make up about 80% of their victims) and are mercifully rare, affecting less than 1% of the population. The pain, which is typically centered around one eye, can strike with explosive intensity and is so excruciating that the afflicted sometimes injure themselves in their desperate attempts to find relief. The attacks usually last from half an hour to 2 hours. The name reflects the fact that these headaches tend to come in clusters of one to three attacks daily for 4 to 8 weeks, followed by periods of remission that average 1 year.
Migraine headaches affect about 10–11% of the population (about 15% of women and 6% of men). Most victims are relatively young, as the attacks tend to taper off with age. These severe, throbbing headaches usually occur about once or twice a month and can last anywhere from about 4 hours to 3 days. Although not as painful as cluster headaches, migraines are monsters compared with tension headaches and are often accompanied by other symptoms, such as nausea, vomiting, blurry vision, and hypersensitivity to light, sound, and motion. (Never make light of someone’s migraine—and try to be quiet!)
Migraines usually occur on one side of the head (the word comes from the Greek hemikrania, meaning half a skull), although they can be bilateral. A common misconception is that they’re always preceded by the infamous “aura,” which usually consists of visual hallucinations, such as flashing, shimmering, or zigzagging lights. In reality, the aura (which lasts about half an hour before the headache itself kicks in) occurs in only about 25% of migraineurs. These cases are called classic migraine; the non-aura cases are called common migraine. Whether classic or common, the attacks are often horrendous.
The earliest known references to migraine are in Sumerian writings from about 3000 B.C. Among the famous victims of this malady were Julius Caesar, Thomas Jefferson, Charles Darwin, Edgar Allan Poe, Frédéric Chopin, Charles Dickens, Leo Tolstoy, Lewis Carroll, Peter Ilich Tchaikovsky, Sigmund Freud, George Bernard Shaw, and Virginia Woolf. Ordinary folks get migraines too, of course, but it has been claimed (probably incorrectly) that migraines occur with greater frequency in high achievers who set demanding standards for themselves.
Heredity plays a strong role in migraine, which runs in families. The cause of this disorder is still largely a mystery, however. It was long thought that the pain was caused by certain dysfunctions in the cranial vasculature (blood vessels). Vascular mechanisms have faded in apparent importance, however, compared with neurological mechanisms having to do with abnormalities of various neurotransmitters. Especially significant, it seems, is that many of the drugs used to treat migraine regulate serotonin activity and that migraine seems to be physiologically linked with depression, which is in large part a disorder of serotonin function.
Much attention has therefore been focused on serotonin, for which there are at least 15 different types of receptors in the brain. Certain drugs affect some of these receptors but not others. Consequently, it’s now possible to treat migraine with receptor-specific drugs designed to target the ones on the trigeminal nerve, which mediates sensation from the head and face. Meanwhile, however, research on other fronts continues apace, including investigations of the possibility that migraine also results from deficiencies in brain energy metabolism, for which supplemental coenzyme Q10 can be helpful.
We’ve Come a Long Way
You may never have tried rubbing raw onions or goat’s blood on your head to cure a migraine. Those are just two of the more benign remedies that have been recommended at one time or another in mankind’s colorful and smelly past—and they’re kid stuff. Believe it or not, in the eleventh century, doctors in Europe and Asia took to grinding up mummies (which were still plentiful in those days) to make powders from which to concoct teas and poultices. These delightful substances were used to cure (OK, treat) a variety of ailments, such as migraine, nausea, epilepsy, paralysis, coughs, bruises, and fractures. They were also used as antidotes for poisoning (one wonders how many survived the antidote!).
French doctors, however, knew better than to grind the mummies up. They insisted that more effective remedies could be made by boiling the mummies and using the oil that rose to the top of the brew. (Can’t you see the ad slogan for the English franchise? “Upset tummy? Try our Yummy Mummy Oil!”)
Let’s be grateful for the intervening ten centuries of scientific progress, shall we? Not that progress has entirely eliminated the ancient practice of trepanning, however. That’s the technique of drilling holes in the skull to allow evil spirits to escape. This remedy (which at least has a certain logic going for it) has been practiced in many different cultures, including Europe as late as the mid-seventeenth century. It was often prescribed for patients suffering from fractured skulls, convulsions, epilepsy, insanity, and, yes, migraines.
Trepanning (doctors favor the more elegant term trephining) is among the most ancient forms of surgery known, according to paleoanthropologists, who have found evidence of it in Neolithic peoples. Even today its still sometimes used for alleviating excessive pressure in the skull. So when someone is accused of having holes in his head, it may actually be true!