Riboflavin (vitamin B2) is supported by scientific evidence for the prevention of migraine, particularly migraine with aura. Several randomized controlled trials (RCTs) and meta-analyses have investigated riboflavin’s efficacy in reducing migraine frequency and severity. The primary rationale for its use lies in its role as a precursor to flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN), essential coenzymes in mitochondrial energy production. Some studies suggest that migraine sufferers may have impaired mitochondrial function, and riboflavin supplementation can help improve mitochondrial energy metabolism in neurons.

Key research includes a 1998 RCT by Schoenen et al., where 400 mg/day riboflavin significantly reduced migraine attack frequency compared to placebo. Subsequent systematic reviews and meta-analyses (e.g., Thompson & Saluja, 2017; Yamanaka et al., 2020) have found that riboflavin is effective and well-tolerated for migraine prophylaxis, particularly in adults. Evidence in children and adolescents is less consistent, with some studies showing benefit and others not.

Current guidelines from several headache societies list riboflavin as a possible preventive therapy for migraine, based on moderate-quality evidence. However, it is generally not effective for acute migraine attacks, and its preventive effect may take several weeks to become apparent. Overall, the evidence is not as robust as for some pharmaceutical agents, but the favorable safety profile supports its use as an adjunct or alternative therapy.