Several medical journal studies have shown that Vitamin B2
(riboflavin) can help prevent migraine headaches.   I have tried it
(400 mg twice a day) and found that it diminishes the frequency and
intensity of my migraines considerably.  But the effect lasts only
about a month or two, even though I continue taking the vitamin. 
After that, the migraines return to pre-vitimin frequency and
intensity.

Why does the effect diminish after a month?

How can I cause the effect to continue?

Thanks.

Hi magic_mark, 

It seems that you may be experiencing what is called ?The Rebound
Effect?, possibly caused by the B2 (Riboflavin) or any other migraine
medication you are taking.  Simply put, the nerve cells become
?resistant? or ?tolerant? to the medication  that used to stop the
pain. (This is a common occurrence, and is well known among users of
known addictive drugs.) This is NOT to say you are addicted to B2, it
just may not be as effective as it once was. The brain receptors that
once took up the B2, become desensitized, and the B2 loses its
effectiveness. Some studies have shown that migraine patients may have
a breakdown in the brain?s own pain management system with a decreased
production of natural painkillers known as endorphins. According to
the University of Maryland Medicine web site ?Once a medication has
controlled the migraine, the patient should try tapering the dose
after six to 12 months, with the goal of stopping completely.?
University of Maryland
http://www.umm.edu/patiented/articles/what_general_guidelines_preventing_migraine_attacks_000097_8.htm
American Council for Headache Education
http://www.achenet.org/articles/38.php
Acu-Cell
http://www.acu-cell.com/dis-hea.html

MedicineNet?s definition of ?Rebound Effect?
http://www.medterms.com/script/main/art.asp?articlekey=5234
On rebound effect: ?If patients stop taking them, they experiences
rebound headaches, so they start taking the drugs again. Eventually
the headache simply persists and medications are no longer effective.
Medications implicated in rebound migraines include simple painkillers
(eg, aspirin, ibuprofen), barbiturates, sedatives, narcotics, and
migraine medications, particularly those that also contain caffeine.
(Heavy caffeine use can also cause this condition.), University of
California Davis
http://wellness.ucdavis.edu/wellconnected/migraine97.html

It does appear that B2 is a safe and somewhat effective preventative
treatment for migraine sufferers, and it is known to potentiate
(increase the efficacy) of beta-blockers, another commonly used type
of migraine treatment.
I found evidence of only one study on B2, however. This study ran for 
3 months only, and included only 55 patients, in Liege,Belgium. Long
term effects of taking B2 were not studied, although the data from
this study seems to be widely accepted, and B2 has few adverse
effects. This study believes that B2 increases mitochondrial energy
efficiency in brain cells, as migraine patients may have impaired
oxygen metabolism in brain cells.
?There is reasonable evidence on the benefits of vitamin B2 for
migraine sufferers. In one study, patients who took 400 mg of vitamin
B2 (riboflavin) reduced their migraine attacks by half, although the
vitamin had no effect on the severity or duration of migraines that
did occur.?
University of California Davis
http://www.ucdmc.ucdavis.edu/ucdhs/health/a-z/97migraine/doc97nonmedic.html

According to this site, the effects of B2 don?t reach maximum
efficiency for 3 months.
http://www.mercola.com/1998/archive/vitamin_b2_helps_migraines.htm
Page 54 of this American Academy of Neurology gives B2 treatment
fairly good marks, with a ?B? for quality of evidence, and ?++? for
clinical impression for effect.
http://www.aan.com/professionals/practice/pdfs/gl0090.pdf
 ?It is important to note vitamin B2 only was studied for 3 months.
There is no data to indicate if it would work long-term. ?
HT Solutions
http://www.htsolutions.com/medchest/1998/may20-98.html
?There is no typical headache sufferer and, as such, each person may
respond to different treatments. Clinical trials of medications are
the best for proving the benefit, but these need many patient
volunteers and cost lots of money. Often experts cite what works in
their practice, which may or may not have all the scientific evidence
to support it.? Dr. Lisa Mannix, speaking at Harvard medical School on
migraines.
http://www.intelihealth.com/IH/ihtIH/WSIHW000/21302/21306/351266.html?d=dmtContent


Treatment of Rebound Effect:
This Headache Treatment site has some good recommendations for
treating rebound effect. The site recommends making an appointment
with a headache or pain clinic for help. ?If patients with rebound
headache stop taking the drug(s) that are causing the syndrome, in 4-8
weeks 80% note dramatic improvement -- without doing anything else!
However, for many patients, the initial few weeks may result in a
worsening of their headache. If the culprit medication is not stopped,
additional treatments often will have very limited benefit. Studies
have shown that a prophylactic headache medication often will not have
a beneficial anti-headache effect when given to a patient that is
rebounding?  Anti-depressants may help.
http://www.headache-treatment.net/rebound.php


Dr. Morris Maizels writes, on this Doctor?s Guide site that NOT taking
pills can stop the rebound effect. ?Dr. Maizels found that up to 78
percent of patients studied, who suffered from chronic daily
headaches, experienced a marked lessening of symptoms just by cutting
out daily use of pain pills.?
http://www.pslgroup.com/dg/634de.htm

You could try tapering off the B2, since your headaches are intense
anyway, and gradually start it up again, with a lower dose. Since only
25mg. is absorbed at one time, you could reduce your dosage
accordingly. Perhaps you could try MigraHealth (information below). 
Please visit your doctor, who can prescribe one or more of several new
migraine medications currently available, especially if your headaches
are intense!


Some new nasal sprays, such as sumatriptan and dihydroergotamine
mesylate are now available, which appear effective, and have far fewer
side effects than oral or injectable forms of the same drugs.
http://www.aafp.org/afp/20000101/180.html


Additional Information:

According to this DCDoctor site, about 60% of chronic headaches may be
drug-induced. Ironic that the medicines we take to stop a headache,
can cause a headache! Numerous medicines, both prescription and over
the counter drugs can be the culprit! Common headache inducing drugs
include Tylenol, aspirin, tetracycline, anti-coagulants and heart
medications.
http://www.dcdoctor.com/pages/rightpages_healthconditions/headaches/ha_types.html
This WhyVitamins site references the Belgian study, and notes that
only 25mg. of B2 can be absorbed by the body at one time.
http://www.whyvitamins.com/articles/vitamin-b2-riboflavin-and-health.html

Some patients for whom ibuprofen (Advil, Mortin) had little effect,
have good luck with ketoprofen (brand name Orudis), available as over
the counter, and in a greater strength by prescription.

This site suggests a product, MigraHealth, containing B2, magnesium,
and feverfew for migraines. (I?m not endorsing this product, but many
migraine sites have suggested these ingredients for migraine relief)
http://migrahealth.com/faq/#q6

More on MigraHealth from a Newsday article, by Jamie Talan.
http://www.newsday.com/ny-hssupp1125,0,7469210.story?coll=ny-health-utility

Review of migraine medications, from the State of Mississippi
http://www.dom.state.ms.us/Pharmacy_Services/MigraineMedsSumJan04.pdf

Other prescription and over the counter medications for migraines:
Migraine Mentors
http://www.migrainementors.com/employees/commonmedications.asp

Migraine triggers to avoid:
Migraine Mentors
http://www.migrainementors.com/employees/can_attacks.asp

Midas Migraines will soon have a downloadable migraine headache diary:
http://www.midas-migraine.net/

This page on the Midas Migraines site has a downloadable migraine questionnaire:
http://www.midas-migraine.net/About_Midas/questionnaire5.pdf

Hope this helps your aching head! If any part of my answer is unclear,
please request an Answer Clarification, before rating. This will allow
me to assist you further, if possible.

Sincerely,
crabcakes-ga


Search Terms
Rebound effect migraines
B2 migraines

---

Request for Answer Clarification by magic_mark-ga on 07 Mar 2004 14:34 PST

Hi CrabCakes--

Thanks for all your effort.  You came up with some new information I
hadn't heard before, like the different vitamins and minerals for
"one-sided headaches."

I know about the rebound effect, and although I suppose it's possible
that's what I'm experiencing with vitamin B2, you didn't cite any
evidence that vitamin B2 can cause rebound.  Did I miss it?  Did you
find anything to suggest that vitamn B2 can cause rebound?

Thanks.

Magic_Mark

---

Clarification of Answer by crabcakes-ga on 07 Mar 2004 22:04 PST

Hello magic_mark, 

Thank you for your clarification.

No, you didn't miss anything in the answer! 

Rebound effect can occur from almost anything, from nose drops, to
migraine remedies, to dieting. There are very few studies on B2 for
headache, and I came across no hard evidence that B2 is the cause of
yours. I said you may be experiencing a rebound effect, because that's
what is appears to be. It's possible you have built up a sensitivity
to B2, but there is no way to know, or prove. Not enough studies have
been done on B2 and rebound effect, that I could find.

Hope this helps!
Regards,
crabcakes

On the one hand, my researcher worked hard and gave me a lot of
Internet references to information that came close to my question.  On
the other hand, it didn't directly answer my question.  Instead, he
gave me his opinion on the answer of the question.  He did help me.

A friend of mine suffered from really severe migraine attacks for over
30 years before he discovered he was allergic to yeast and his allergy
was the cause of the attacks.

Now, he's relatively trouble free, except that yeast crops up
unexpectedly in lots of food & drink.

Just a thought.