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Ask the Pharmacist: Coenzyme Q10 for Prevention of Migraine

Q. What information is available on the use of coenzyme Q10 for migraines?

A. Coenzyme Q10 (or CoQ10) is present in almost all cells in the body and is a critical component for the conversion of energy in the body. It is believed that migraines could be related to a problem with cellular energy metabolism. The July 2004 issue of Pharmacists Letter stated that coenzyme Q10 might be a possible option for those patients who do not respond to more conventional preventive migraine therapy. A couple of studies have suggested that coenzyme Q10 may reduce migraine attacks by up to 50%. Thirty-one patients completed a study that appeared in the journal Cephalgia in 2002. A 50% reduction in the number of days with a headache was seen in 61.3% of patients. The average number of days with headache went from 7.34 days at baseline to 2.95 days after three months of therapy. The mean number of attacks per month was 4.85 at baseline compared to 2.81 at the end of the study. CoQ10 did not affect the severity of the attacks.

The average dose used is 150 mg/day. It should be taken for at least four weeks to see any effect and should be used for 12 weeks for maximum results. Side effects are minimal. They include stomach upset, loss of appetite, nausea and diarrhea. In doses above 300 mg/day, coenzyme Q10 can elevate liver enzymes. Overall, coenzyme Q10 is a preventive option worth discussing with your healthcare provider in order to determine if it is an appropriate option for you.

The British Take Miguard, Americans Use Frova

Q. I’m wondering where I could buy Miguard for migraines.

A. Miguard is the brand name in the United Kingdom for frovatriptan. Frovatriptan is available in the United States under the brand name Frova and can be obtained through a prescription from a healthcare professional. Frova has a long half-life of 26 hours. Its mean maximal blood concentration is seen approximately 2-4 hours after the first dose. It may be advantageous for those with prolonged migraines or those with slower-onset moderate to severe migraines.

Concerned About Overusing Imitrex

Q. I use Imitrex for migraines. Lately I’ve had severe migraines every day. How often should I be using the Imitrex? I have 100 mg and 50 mg tablets. I read an article that said you shouldn’t use them more than once a week. What will happen if I do?

I’m very nervous about taking them until I start vomiting and then I do what I have to, but I really don’t want to cause other problems. Nobody seems to be able to answer this.

A. Imitrex (sumatriptan) tablets can be dosed 25 mg, 50 mg or 100 mg at the onset of a migraine. This dose may be repeated after two hours if complete relief has not been attained. It is important to note that this repeat dose should only be used if some relief was experienced from the initial dose. There is a 200 mg maximum daily dose for Imitrex tablets. Most experts recommend limiting use of acute migraine therapies to two days per week to minimize side effects and prevent rebound headache.

I also recommend that you talk with your healthcare provider about treatment options that are available to reduce the severity of your nausea and vomiting. Medications such as metoclopramide, chlorpromazine or prochlorperazine may be administered 15 to 30 minutes before ingestion of acute oral medications to help with nausea and vomiting. If you are unable to keep medications down, I suggest discussing medications that can be given either by injection or nasal spray.

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