Riboflavin (B2)
AAN Level B for migraine prevention at 400 mg/day. NNT of 2.3 in the landmark Schoenen 1998 RCT.
Why
Riboflavin at pharmacological doses prevents migraine attacks. Schoenen 1998 (Neurology) randomised 55 patients to 400 mg/day riboflavin vs placebo for 3 months: 59% of the riboflavin group versus 15% of placebo achieved ≥50% reduction in headache frequency (NNT 2.3). The 2012 AAN/AHS guideline on episodic migraine prevention assigns riboflavin a Level B recommendation (probably effective). Placed in the stress pillar because migraine is strongly stress-triggered and migraine prophylaxis sits on the recovery / nervous-system-load axis rather than nutrition.
How it works
Precursor to FAD and FMN, cofactors for mitochondrial electron transport chain complexes I and II. The leading hypothesis is correction of subtle mitochondrial dysfunction in the migraine brain.
Expected onset · Benefit usually emerges between months 2 and 3; the Schoenen RCT measured outcomes at 3 months
How to take
Dosage
400 mg/day, single oral dose (the Schoenen 1998 protocol).
Timing
Once daily with food; consistent timing aids adherence
On the label
Look for 400 mg riboflavin (vitamin B2). Lower-dose B-complex products will not deliver the trial dose.
Ideal for
Adults with episodic migraine seeking a low-side-effect prophylactic; people who prefer non-pharmaceutical migraine prevention; co-occurring fatigue or post-exertional symptoms (off-label rationale).
Safety
Evidence
Schoenen 1998 RCT (Neurology, n=55): 400 mg/day riboflavin for 3 months: 59% of treated patients vs 15% of placebo achieved ≥50% reduction in migraine days (NNT 2.3). AAN/AHS 2012 guideline rates riboflavin Level B (probably effective) for migraine prevention.
Where to get it
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