Intake of Riboflavin (Vitamin B2) and the Occurrence of Migraine: An Analysis of the National Health and Nutrition Examination Survey (NHANES) 2001 to 2004 Database

Abstract

Background: Migraine is a common neurological disorder that causes moderate to severe headache attacks accompanied by other disabling symptoms. Previous clinical studies have found a daily single dose of 400 mg riboflavin to be effective as migraine prophylaxis for adult migraineurs. However, the dose and the administering pattern of riboflavin supplementation in previous studies were not supported by solid justification. Additionally, the average riboflavin consumption of migraine patients in the United States is not revealed in any previous literature to our knowledge. Objective: This study aimed to evaluate the average daily dietary, supplement, and total (diet + supplement) riboflavin consumption of adult migraine sufferers. Moreover, this study investigated the relationship between dietary, supplement, and total (diet + supplement) riboflavin consumption and the occurrence of migraine. Methods: This observational cross-sectional study analyzed adult participants aged from 20-50 years old using NHANES 2001-2002 and 2003-2004 datasets. After excluding disqualified individuals who were pregnant, breastfeeding, menopausal, diabetic, diagnosed with thyroid disease, having missing data, taking tricyclic medication, having unrealistic dietary intake, and having unrealistic dietary intake, a total of 3,634 participants were included, containing 884 probable migraineurs and 2,750 controls. Migraine status was determined based on the self-reported NHANES miscellaneous pain questionnaire. Dietary and supplement riboflavin intake was determined based on the 24- hour recall NHANES dietary interview and supplement section questionnaire. Riboflavin intake was divided into quartiles. Odds ratios and 95% confidence intervals were calculated using logistic regression model, adjusted for sex, BMI, and alcohol consumption. P value was computed using Wald test, adjusted or sex, BMI, and alcohol consumption. All statistical test and summary statistics were survey-weighted. The significance level was set at 0.05. Results: The mean dietary riboflavin consumption of adult migraineurs was significantly lower than the control. (2.14 mg/day vs. 2.36 mg/day, p=0.0005). In contrast, supplement riboflavin consumption (9.37 mg/day vs. 7.19 mg/day, p=0.625) and total riboflavin consumption (4.25 mg/day vs. 4.28 mg/day, p=0.958) of the migraine group and the control group were not statistically different. Among adult migraine suffers, dietary riboflavin intake was associated with the occurrence of migraine (poverall =0.0013), with the riboflavin intake level ranging from 2.07-2.87 mg/day showing the greatest reduction in migraine occurrence (ORQ3 =0.732 [0.558-0.962]) compared to the lowest riboflavin intake quartile (0-1.45 mg/day). The relationship remained true between the total riboflavin consumption, which further included supplement intake, and migraine odds (ORQ3 =0.630 [0.463-0.859], poverall =0.032). When considering supplement riboflavin intake alone, no relationship was observed between supplement riboflavin intake and the odds of migraine (poverall =0.1988). Conclusion: The average dietary riboflavin intake of adult migraine patients (2.14 mg/day) meets the Recommended Dietary Allowance but is lower than the control. The mean riboflavin intake from supplement source only is 9.37 mg/day. The mean total riboflavin consumption of adult migraineurs, including both dietary and supplemental intakes, is 4.25 mg/day. Dietary riboflavin intake is associated with a 27% lower occurrence of migraine when the consumed amount is between 2.07 mg/day to 2.87 mg/day as compared to 0 mg/day to1.45 mg/day. Total riboflavin consumption amount between 2.45 mg/day to 3.60 mg/day corresponds to 37% reduction in migraine odds as compared to 0 mg/day to 1.58 mg/day.