Vitamin B2, or Riboflavin, is an orange colored water soluble vitamin needed for proper energy metabolism (helps break down proteins, fats and carbohydrates) and a wide variety of cellular processes. Riboflavin can be found in grains, plants, meats, and dairy products (e.g. organ meats, cheese, milk, yogurt, leafy vegetables, yeast, eggs, almonds, nuts, mushrooms). Individuals may also take Vitamin B2 to help in the treatment of migraine headaches and it may also help improve iron deficiency anemia. Additionally, dry and itchy skin, acne, dermatitis, and eczema may be improved by the intake of vitamin B2. A deficiency of riboflavin can lead to cracking and reddening of the lips, inflammation of the mouth, mouth ulcers, and sore throat.
Riboflavin recommended daily allowance:
According to the University of Maryland Medical Center, riboflavin may be found included in multivitamin, B-complex vitamins and separate supplements, and is best absorbed when taken between meals. The recommended daily allowance of riboflavin also published online by the University of Maryland Medical Center is as follows: birth – 6 months: 0.3 mg, 7 – 12 months: 0.4 mg, 1 – 3 years: 0.5 mg, 4 – 8 years: 0.6 mg, 9 – 13 years: 0.9 mg, boys 14 – 18 years: 1.3 mg, girls 14 – 18 years: 1 mg, men 19 years and older: 1.3 mg, women 19 years and older: 1.1 mg, pregnant women: 1.4 mg, breastfeeding women: 1.6 mg. (8)
Riboflavin and migraines:
Research shows diet and supplements decrease the frequency of headaches. A detailed study of nutritional history and identification of food triggers led the authors to specifically recommend riboflavin as one of the preventive treatments for migraines. (4)
Riboflavin, migraine frequency, and abortive medications was evaluated by Boehnke, et al. An open label study using 400 mg per day of riboflavin in outpatients found that frequency of migraines was not only reduced in half at 3 month and 6 month reassessments, but also reduced the amount of abortive medication (7).
Riboflavin and migraine headaches in children and adolescents:
Riboflavin, also known as vitamin B2, was reported to be an effective treatment for migraine headaches in children and adolescents. In a retrospective study, 41 participants received either 200 or 400 mg/day of riboflavin orally for 3, 4, or 6 months. At the end of the study, the number and severity of migraine attacks significantly decreased during treatment. Additionally, during follow up, a reduction by at least 50% in the number of migraine headaches was reported in 68.4% of patients and in intensity in 21%. (1)
Riboflavin and efficacy for migraines in children was evaluated by MacLennan SC et al in a randomized, double-blind study. The study performed with a group of 48 children suggested that riboflavin, also known as vitamin B2, is not an effective treatment for migraine headaches. For 4 weeks, participants received either 200 mg/day of riboflavin or placebo. At the end of the study, a reduction by at least 50% in the number of migraine headaches was reported in about 44% of treatment participants and 67% in the placebo group. (2)
Riboflavin and migraines in pregnancy:
Women suffering from migraine headaches during pregnancy may benefit from riboflavin and is considered safe during pregnancy for the treatment of migraine headaches. Of note, magnesium is likely the best choice since it is the only agent with a category-A pregnancy rating, and is therefore an appropriate choice for women who are pregnant or trying to conceive. (3)
Riboflavin and anemia:
Researchers conducted a systematic review of studies looking at the relationship of vitamin supplementation on iron deficiency anemia. Riboflavin improves the body’s response to iron and may be responsible for iron deficiency anemia in some populations. Additionally it is important to note that other vitamins may benefit iron deficiency. Vitamin C improves iron absorption and vitamin A makes iron supplements more effective. (5)
Common highest riboflavin containing foods (mg):
| Spaghetti with meat sauce, frozen entrée, 1 package | 3.772 mg |
| Beef, variety meats and by-products, liver, cooked, pan-fried, 3 oz | 2.911 mg |
| Turkey, whole, giblets, cooked, simmered,1 cup | 2.237 mg |
| Shake, fast food, vanilla,16 fl oz | 2.198 mg |
| GENERAL MILLS, TOTAL Raisin Bran, 1 cup | 1.760 mg |
| KELLOGG’S ALL-BRAN COMPLETE Wheat Flakes, ¾ cup | 1.711 mg |
| Cereals ready-to-eat, KELLOGG, KELLOGG’S PRODUCT 19, 1 cup | 1.710 mg |
| Cereals ready-to-eat, GENERAL MILLS, Whole Grain TOTAL, 3/4 cup | 1.710 mg |
| Chicken, broilers or fryers, giblets, cooked, simmered , 1 cup | 1.525 mg |
| Malted drink mix, chocolate, powder, prepared with whole milk, 1 cup | 1.283 mg |
| Milk, canned, condensed, sweetened, 1 cup | 1.273 mg |
| Malted drink mix, natural, powder, prepared with whole milk, 1 cup | 1.206 mg |
| Fast foods, chili con carne, 1 cup | 1.139 mg |
| Duck, domesticated, meat only, cooked, roasted, 1/2 duck | 1.039 mg |
| Cereals ready-to-eat, GENERAL MILLS, WHEATIES, 1 cup | 0.930 mg |
| Braunschweiger (a liver sausage), pork, 2 slices | 0.865 mg |
| Malted drink mix, chocolate, with added nutrients, powder, 3 heaping tsp | 0.863 mg |
| Shake, fast food, chocolate, 16 fl oz | 0.816 mg |
| KELLOGG’S ALL-BRAN Original, 1/2 cup | 0.813 mg |
| Fast foods, submarine sandwich, with cold cuts, 1 sandwich, 6″ roll | 0.798 mg |
| Milk, canned, evaporated, with vitamin D and without vitamin added, 1 cup | 0.796 mg |
| Milk, canned, evaporated, nonfat, with added vitamin A and vitamin D, 1 cup | 0.791 mg |
| Malted drink mix, natural, with added nutrients, powder, 4-5 heaping tsp | 0.756 mg |
| KELLOGG’S COCOA KRISPIES, 3/4 cup | 0.704 mg |
| Wheat flour, white, bread, enriched, 1 cup | 0.701 mg |
| Fast foods, hotdog, with corn flour coating (corndog), 1 corn dog | 0.700 mg |
| QUAKER, QUAKER OAT LIFE, plain, 3/4 cup | 0.689 mg |
| Fast foods, cheeseburger; single, large patty; with condiments and bacon, | 0.679 mg |
| Milk shakes, thick chocolate, 10.6 fl oz | 0.666 mg |
| KELLOGG’S RAISIN BRAN, 1 cup | 0.659 mg |
| Fast foods, chimichanga, with beef, 1 chimichanga | 0.644 mg |
| Wheat flour, white, all-purpose, enriched, bleached, 1 cup | 0.618 mg |
| Fast foods, cheeseburger; single, large patty; with condiments and vegetables, | 0.615 mg |
| Milk shakes, thick vanilla, 11 fl oz | 0.610 mg |
| KELLOGG’S CRISPIX, 1 cup | 0.609 mg |
Adapted from: Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w405.pdf and http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf
Assessment and Plan: Riboflavin
- Intake of riboflavin may be enhanced by selecting foods in the diet with higher riboflavin content. The higher doses of riboflavin required for migraine prevention will not be attainable from foods and will need to be taken in an oral supplement form. It is necessary to obtain approval from the pediatric or adult primary care physician prior to taking riboflavin supplements.
- According to the University of Maryland Medical Center, riboflavin may be found included in multivitamin, B-complex vitamins and separate supplements, and is best absorbed when taken between meals. The recommended daily allowance of riboflavin also published online by the University of Maryland Medical Center as follows: birth – 6 months: 0.3 mg, 7 – 12 months: 0.4 mg, 1 – 3 years: 0.5 mg, 4 – 8 years: 0.6 mg, 9 – 13 years: 0.9 mg, boys 14 – 18 years: 1.3 mg, girls 14 – 18 years: 1 mg, men 19 years and older: 1.3 mg, women 19 years and older: 1.1 mg, pregnant women: 1.4 mg, breastfeeding women: 1.6 mg. (8)
- Studies on effectiveness of Riboflavin for migraines are mixed. A study by Condò M, et al found that 200 or 400 mg per day of riboflavin orally for 3, 4, or 6 months noted that the number and severity of migraine attacks significantly decreased (1). C. Boehnke, et al did an open label study using 400 mg per day of riboflavin in outpatients and found that frequency of migraines was not only reduced in half at 3 month and 6 month reassessments, but also reduced the amount of abortive medications used (7). However a randomized, double-blind study of 48 children by MacLennan SC, et al found that riboflavin was less effective than placebo (2). Nonetheless, riboflavin in supplement form appears to be safe, well tolerated and may be a worthwhile trial for those attempting to reduce the frequency of migraines.
- Women suffering from migraine headaches during pregnancy may benefit from riboflavin since it one of the few agents considered safe during pregnancy (3).
- Riboflavin improves the body’s response to iron and lack of this nutrient may be responsible for iron deficiency anemia in some populations (5).
References:
1.Condò M, Posar A, Arbizzani A, Parmeggiani A. Riboflavin prophylaxis in pediatric and adolescent migraine. J Headache Pain. 2009 Oct;10(5):361-5. http://www.ncbi.nlm.nih.gov/pubmed/19649688
2.MacLennan SC, Wade FM, Forrest KM, Ratanayake PD, Fagan E, Antony J. High-dose riboflavin for migraine prophylaxis in children: a double-blind, randomized, placebo-controlled trial. J Child Neurol. 2008 Nov;23(11):1300-4. http://www.ncbi.nlm.nih.gov/pubmed/18984840
3.Airola G, Allais G, Castagnoli Gabellari I, Rolando S, Mana O, Benedetto C. Non-pharmacological management of migraine during pregnancy. Neurol Sci. 2010 Jun;31 Suppl 1:S63-5. http://www.ncbi.nlm.nih.gov/pubmed/20464586
4.Sun-Edelstein C, Mauskop A., Foods and supplements in the management of migraine headaches. Clinical Journal of Pain. 2009 Jun;25(5):446-52. http://www.ncbi.nlm.nih.gov/pubmed/19454881
5.Fishman SM, Christian P, West KP. The role of vitamins in the prevention and control of anaemia. Public Health Nutr. 2000 Jun;3(2):125-50. http://www.ncbi.nlm.nih.gov/pubmed/10948381
6.Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w405.pdf and http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf
7.C. Boehnke, U. Reuter, U. Flach, S. Schuh-Hofer, K. M. Einha¨upl and G. Arnold. High-dose riboflavin treatment is efficacious in migraine prophylaxis:an open study in a tertiary care centre. European Journal of Neurology 2004, 11: 475–477. http://www.mvertigo.org/articles/high-dose.riboflavin.efficacious.migraine.04.pdf
8.Vitamin B2 (Riboflavin). University of Maryland Medical Center. Accessed September 8, 2013. http://umm.edu/health/medical/altmed/supplement/vitamin-b2-riboflavin