Pediatric migraine: Neurodevelopmental mechanisms, clinical phenotypes, and modern therapeutics

Table 7 Comparison of common pediatric migraine nutraceuticals

Nutraceutical	Biological rationale	Clinical evidence	Typical pediatric dosing	Key adverse effects
Magnesium	Modulates NMDA receptors; inhibits cortical spreading depression; reduces CGRP release	Modest but supportive; specifically effective for migraines with aura	5-10 mg/kg/day (elemental), often divided	Dose-dependent diarrhea; abdominal cramping
Riboflavin (vitamin B2)	Addresses mitochondrial dysfunction by enhancing electron transport chain efficiency	Some randomized trials show reduced frequency; high placebo response noted in children	200-400 mg/day (often used in doses higher than RDA)	Benign bright yellow discoloration of urine (chromaturia)
Coenzyme Q10	Acts as an antioxidant and essential cofactor in mitochondrial energy production	Shown to reduce headache frequency and severity in children with low levels	1-3 mg/kg/day (typically 100 mg daily)	Rare gastrointestinal upset or insomnia; generally extremely well-tolerated

NMDA: N-methyl-D-aspartate; CGRP: Calcitonin gene-related peptide; RDA: Recommended dietary allowance.