The prevalence of coenzyme Q10 (CoQIO) deficiency and effectiveness of CoQIO supplements in treatment of migraine were assessed in a study at the Cincinnati Children’s Hospital, OH. Total CoQIO serum levels measured in 1550 migraine patients, age 13.3 +/- 3.5 years (range 3-22 years), was 0.60 +/- 0.20 mcg/mL (range 0.21-1.77 mcg/mL; 33% were below the reference range of 0.5-1.5 mcg/mL Patients with low CoQIO levels (below 0.7 mcg/mL) received supplements of 1 to 3 mg/kg per day of CoQIO in liquid gel capsule form. In 250 patients seen at follow-up (mean, 97 days), CoQIO levels had increased to 1.20 +/- 0.59 mcg/mL (P<0.0001), and headache frequency improved from 19.2 +/- 9,8 days per month to 12.5 +/- 10.8 days per month (P<0.001). A 50% reduction in headache frequency was obtained in 46.3% patients. Headache disability measured by the PedMIDAS score improved from 47.4 to 22.8 (P<0.001), and headache disability grade improved from 2.6 (moderate) to 1.9 (mild) (P<0.001). 
COMMENT. CoQIO deficiency may be common in pediatric and adolescent migraine, and supplementation may result in decreased headache frequency and disability. CoQIO is included among several alternative (“natural”) therapies with suggested potential effectiveness in migraine prevention. These include riboflavin, feverfew, and magnesium. A randomized controlled trial of CoQIO (3x110 mg/day) compared to placebo in 42 migraine patients found CoQIO superior for lessening attack-frequency, headache-days and days with nausea, after 3 months treatment. 
Modi S and Lowder DM, of ECU Brody School of Medicine, NC, reviewed published trials of medications for migraine prophylaxis  and found sufficient evidence to recommend propanolol, timolol, amitryptyline, divalproex, sodium valproate, and topiramate as first-line migraine prevention agents. Evidence to support the use of coenzyme Q10, riboflavin, and magnesium in migraine prophylaxis is limited, and data and opinions on feverfew are mixed. The above study should prompt further investigation and trials of CoQIO in migraine pediatric patients, over longer periods. CoQIO and high-dose vitamin therapies in children with mitochondrial disease are found possibly effective in the short term, but ineffective in the longer term.