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ARTICLES: C. Di Lorenzo, F. Pierelli, G. Coppola, G. S. Grieco, C. Rengo, M. Ciccolella, D. Magis, M. Bolla, C. Casali, F. M. Santorelli, and J. Schoenen Mitochondrial DNA haplogroups influence the therapeutic response to riboflavin in migraineurs Neurology 2009; 72: 1588-1594 [Abstract] [Full text] [PDF]

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Mitochondrial DNA haplogroups influence the therapeutic response to riboflavin in migraineurs

Steven R. Brenner, None   (22 July 2009)

Reply from the author

Cherubino Di Lorenzo   (22 July 2009)

Mitochondrial DNA haplogroups influence the therapeutic response to riboflavin in migraineurs 22 July 2009
Steven R. Brenner, Dept. Neurology at St. Lous VA Med Center and Dept. Neurology and Psychiatry at St. Louis University 1438 S. Grand Blvd., St. Louis, MO 63104, None Send Correspondence to journal: Re: Mitochondrial DNA haplogroups influence the therapeutic response to riboflavin in migraineurs SBren20979{at}aol.com Steven R. Brenner, et al.	I read the article by Di Lorenzo et al. who described the effect of riboflavin on migraine in patients with mitochrondrial genetic abnormalities. [1] Treatments with riboflavin [1] coenzyme Q10 [2] and thioctic acid [3]—metabolic enhancers acting through mitochondria—may be beneficial in migraine prophylaxis. Migraine is increasingly perceived as a chronic, progressive, debilitating brain disease rather than an episodic pain disorder. [4] The positive response to riboflavin in patients with a distinctive DNA haplogroup may indicate correction of an underlying metabolic abnormality that could potentially lead to a chronic disabling state. In addition to pain relief and recurrence reduction, migraine treatment should include preventing the progression to chronic migraine, which is poorly responsive to therapy. Developing an understanding of the basic pathophysiology of the disease such as determination of mitochrondrial metabolism contributing to migraine may lead to this type of preventative measure. Those having this metabolic abnormality may need life-long treatment to prevent migraine progression. References 1. DiLorenzo C, Pierelli F, Coppola G, Grieco G, Rengo C. Mitochondrial DNA haplogroups influence the therapeutic response to riboflavin in migraineurs. Neurology 2009;72:1588-1594. 2. Sandor PS, DiClemente L, Coppola G, et al. Efficiency of Coenzyme Q10 in migraine prophylaxis: A randomized controlled trial. Neurology 2005;64:713-715. 3. Magis D, Ambrosini A, Sandor P, Jacquy J, Laloux P, Schoenen J. A randomized double blind placebo controlled trial of thioctic acid in migraine prophylaxis. Headache 2007;47:52-77. 4. Cady RK. The future of migraine, beyond just another pill. Mayo Clinic Proceedings. 2009;84:397-399. Disclosure: The author reports no disclosures.
Reply from the author 22 July 2009
Cherubino Di Lorenzo, University Centre for Adaptive Disorders and Headache (UCADH), University of Rome via Franco Faggiana, 34–04100 Latina, Italy Send Correspondence to journal: Re: Reply from the author cherub{at}inwind.it Cherubino Di Lorenzo	I thank Brenner for his comments on our article. However, pending further research on metabolic enhancers and other preventive anti-migraine treatments, it is not possible to comment on his assertions. The reduction of nonspecific white matter lesions (WML), typical in the migraineur brain, might be considered as another possible outcome for high-dose riboflavin prolonged treatment. WML have to be distinguished by mitochondrial encephalopathy with lactic acidosis, stroke-like episodes (MELAS), or other forms of leukoencephalopathy and vasculitis. [5] WLM could have a mitochondrial pathogenesis, and a treatment with metabolic enhancers could be effective to reduce them, confirming the theory regarding their pathogenesis. Our experience shows that long-term treatment with high-dose riboflavin has been safe. We have treated patients for both mitochondriopathy and migraine without major complications. These observations are consistent with Brenner’s suggestion regarding lifelong treatment to prevent chronic migraine. Reference 5. Porter A, Gladstone JP, Dodick DW. Migraine and white matter hyperintensities. Curr Pain Headache Rep. 2005;9:289-293. Disclosure: The author reports no disclosures.