Tag Archives for " migraine "

Coenzyme Q10

It’s been awhile since I got a post up here on the blog.  December was a whirlwind with a trip to ASHP Midyear and Disneyland, closing on our house and moving 2 days before vacation with my family. We threw our boxes in, then headed to warm weather for a week in Key Largo.  You can find pictures about our adventures on Instagram. We celebrated Christmas with my family on Christmas Day at my sister’s new home in Lexington, KY,  and later in the week with Dustin’s family in Northeast Ohio.  We celebrated New Years Eve with our local friends and church family in our new home, and visited our college friends on New Years Day in Findlay, Ohio.  We have had our New Years Day gathering tradition for over a decade now!  So far January has been stay home and work on getting our house together and of course fight off viral gunk 🙂 Back in November,  Marina Reid, who is a DO student, rotated with me and we worked on this post together. She will be Dr. Reid in the spring and someday an anesthesiologist!  I love getting to spend a few weeks with medical students sharing my passions for diabetes care and functional medicine. CoQ10 is an amazing compound with lots of potential.  Make sure to read this post to the end!

Dr. Hartzler


One of the most widely sold supplements on the market is the compound with the mysterious – sounding name, CoQ101. As it turns out, this is an abbreviation for an enzyme that is found in every cell in the human body2. Logically, an enzyme so widely prevalent was given a name ‘ubiquinone’. CoQ10 describes the chemical structure of ubiquinone molecule, that is actually similar to vitamin K in structure3. ‘Co’ is short for ‘coenzyme’, ‘Q’ is for ‘quinone’ chemical group, and ‘10’ refers to the number of isoprenyl chemical subunits in the molecule4. CoQ10 is an essential molecule that participates in the rate limiting transfer from step II to step III of the electron transport chain in mitochondrial membrane to produce ATP molecules. In basic terms this means that CoQ10 is a vital part of energy production in our cells.

You may remember from high school biology class that the mitochondria are considered the powerhouse of the cell.  Organs such as the heart, liver, and kidneys are packed with mitochondria. Unfortunately, with age5 or certain disease states,6 our bodies get depleted of this essential enzyme and those vital organs suffer the most.

The role of CoQ10 in treatment of ischemia (inadequate blood supply to the heart) and congestive heart failure has been widely supported by the research. Q-SYMBIO was a prospective, randomized, double-blind, placebo controlled multicenter study that showed that patients treated with CoQ10 supplementation had significant reduction in cardiovascular death, all-cause mortality and heart failure hospitalizations7. There are reports that also show the improvement of cardiac function in transplant patients with CoQ10 supplementation8. CoQ10 supplementation can be especially beneficial for pediatric9 and postpartum patients10 with dilated cardiomyopathies (enlarged hearts). The exact mechanism of this cardio-protective function is still to be determined. Suggested mechanisms include stabilization of mitochondrial membranes and prevention of cell death,11 and prevention of damage to the lining of the blood vessels12 which may be contributing to restoring delicate balance in heart failure patients.

Another widely accepted use for CoQ10 supplementation is the prevention of muscle pain associated with a common prescription medication class called “statins” that are used for cholesterol reduction and secondary prevention of heart attacks. Both CoQ10 and cholesterol production share a common pathway, this pathway gets inhibited by statin drugs4, so not only do statin drugs slow cholesterol production, they also deplete CoQ10.

Since CoQ10 is an essential molecule for energy production, it’s depletion may contribute to one of the most common side effects of statin medications, muscle pain, also known as myopathy. Hence, taking CoQ10 supplements while taking statins may prevent the negative side effects.14 In addition, CoQ10 has been shown to lower blood pressure in several controlled studies. One study reduced Systolic Blood Pressure (SBP, the top number) by 17 mmHG!15. 

As a potent anti-oxidant, CoQ10 has been also shown to decrease the frequency and severity of migraines16,17.  This is a really exciting area of exploration, considering how debilitating migraines can be.  There are also several other uses that are being currently investigated: fibromyalgia pain18, depression in patients with bipolar19, skin texture improvement20, and Parkinson’s disease21.

Since CoQ10 is an endogenous molecule produced by our bodies, getting too much is highly unlikely even in high doses.21 Mild side effects reported include nausea, vomiting, and diarrhea12. It has to be administered with caution in patients on warfarin or chemotherapy due to the risk of drug interactions12. Always disclose supplements to your healthcare providers so they can work with you to make the best decisions for your health! 

Based on this review of the literature, the current recommended doses are listed below.

  • 100-300 mg daily for Congestive Heart Failure (CHF)12
  • 100 mg per day for high blood pressure15 statin induced myopathy14 and migraine prevention16,17

Lastly, as always, if you are going to add any supplement to your regimen for you or a patient, make sure it’s from a high-quality source.  Here are a couple of my favorite CoQ10 products. FullScript is an amazing resource with all kinds of reputable supplement manufacturers.



  1. Bronzato S, Durante A. Dietary Supplements and Cardiovascular Diseases. Int J Prev Med. 2018;9:80. Published 2018 Sep 17. doi:10.4103/ijpvm.IJPVM_179_17
  2. Tran UC, Clarke CF. Endogenous synthesis of coenzyme Q in eukaryotes. Mitochondrion. 2007;7 Suppl(Suppl):S62-71
  3. Hemmi N. Bhagavan & Raj K. Chopra (2006) Coenzyme Q10: Absorption, tissue uptake, metabolism and pharmacokinetics, Free Radical Research, 40:5, 445-453, DOI: 10.1080/10715760600617843
  4. Mikael Turunen, Jerker Olsson, Gustav Dallner, Metabolism and function of coenzyme Q, Biochimica et Biophysica Acta (BBA) – Biomembranes, Volume 1660, Issues 1–2, 2004,Pages 171-199, ISSN 0005-2736, https://doi.org/10.1016/j.bbamem.2003.11.012. (http://www.sciencedirect.com/science/article/pii/S0005273603003717)
  5. Del Pozo-Cruz, Jesús & Rodriguez Bies, Elizabeth & Ballesteros, Manuel & Enamorado, Ignacio & Bui Thanh, Tung & Navas, Placido & Lopez-Lluch, Guillermo. (2014). Physical activity affects plasma coenzyme Q10 levels differently in young and old humans. Biogerontology. 15. 10.1007/s10522-013-9491-y.
  6. Chase M, Cocchi MN, Liu X, Andersen LW, Holmberg MJ, Donnino MW. Coenzyme Q10 in acute influenza. Influenza Other Respi Viruses. 2018;00:1-7 https://doi.org/10.1111/irv.12608
  7. Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D, et al. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC Heart Fail. 2014;2(6):641–9. https://doi.org/10.1016/j.jchf.2014.06.008.
  8. Karl Folkers, Peter Langsjoen, Per H. Langsjoen,Therapy with coenzyme Q10 of patients in heart failure who are eligible or ineligible for a transplant, Biochemical and Biophysical Research Communications, Volume 182, Issue 1, 1992, Pages 247-253,ISSN 0006-291X,https://doi.org/10.1016/S0006-291X(05)80137-8.
  9. Chen, F.-L.; Chang, P.-S.; Lin, Y.-C.; Lin, P.-T. A Pilot Clinical Study of Liquid Ubiquinol Supplementation on Cardiac Function in Pediatric Dilated Cardiomyopathy. Nutrients2018, 10, 1697
  10. https://www.drkarafitzgerald.com/2018/09/04/dr-stephen-sinatra-past-present-future-integrative-cardiology/
  11. Haas RH. The evidence basis for coenzyme Q therapy in oxidative phosphorylation disease. Mitochondrion 2007;7 Suppl:S136–45. https://doi.org/10.1016/j.mito.2007.03.008
  12. Sharma A, Fonarow GC, Butler J, Ezekowitz JA, Felker GM. Coenzyme Q10 and heart failure: a state-of-the-art review. Circ Heart Fail. 2016;9(4):e002639. https://doi.org/10.1161/ CIRCHEARTFAILURE.115.002639.
  13. https://www.lifeextension.com/magazine/2008/2/Alleviating-Congestive-Heart-Failure-With-Coenzyme-Q10/Page-01
  14. Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme Q10 on myopathic symptoms in patients treated with statins. Am J Cardiol. 2007;99:1409–1412.
  15. Yang Y-K, Wang L-P, Chen L, et al. Coenzyme Q10 treatment of cardiovascular disorders of ageing including heart failure, hypertension and endothelial dysfunction. Clinica Chimica Acta; International Journal Of Clinical Chemistry. 2015;450:83-89. doi:10.1016/j.cca.2015.08.002.
  16. Shoeibi A, Olfati N, Soltani Sabi M, Salehi M, Mali S, Akbari Oryani M. Effectiveness of coenzyme Q10 in prophylactic treatment of migraine headache: an open-label, add-on, controlled trial. Acta Neurologica Belgica. 2017;117(1):103-109. doi:10.1007/s13760-016-0697-z.
  17. Elyas Nattagh-Eshtivani et al. The role of nutrients in the pathogenesis and treatment of migraine headaches: Review, Biomedicine & Pharmacotherapy, Volume 102, 2018, Pages 317-325, ISSN 0753-3322, https://doi.org/10.1016/j.biopha.2018.03.059.
  18. Cordero MD, Santos-García R, Bermejo-Jover D, Sánchez-Domínguez B, Jaramillo-Santos MR, Bullón P. Coenzyme Q10 in salivary cells correlate with blood cells in Fibromyalgia: improvement in clinical and biochemical parameter after oral treatment. Clin. Biochem. 2012 Apr;45(6):509-11 https://doi.org/10.1016/j.clinbiochem.2012.02.001.
  19. Mehrpooya M, Yasrebifar F, Haghighi M, Mohammadi Y, Jahangard L, Elevating the Effect of Coenzyme Q10 Augmentation on Treatment of Bipolar Depression: A double-blind controlled clinical trial. Journal of Clinical Psychopharmacology 2018 Oct;38(5):460-466
  20. Knott,A.;Achterberg,V.;Mielke,H.;Sperling,G.;Dunckelman,K.;Vogelsang,A.;Kruger,A.;Schwengler,H.; Behtash, M.; Kristof, S.; et al. Topical treatment with coenzyme Q10-containing formulas improves skin’s Q10 levels and provides antioxidative effects. Biofactors 2015, 41, 383–390. https://doi.org/10.1002/biof.1239
  21. Mischley L, Lau R, Bennet R, Role of diet and Nutritional Supplements in Parkinson’s Disease Oxidative Medicine and Cellular Longevity, Volume 2017, Article ID 6405278, 9 pages https://doi.org/10.1155/2017/6405278
  22. K.Ferrante, et al, Tolerance of high-dose (3,000 mg/day) coenzyme Q10 in ALS. Neurology Dec 2005, 65 (11) 1834-1836; DOI:10.1212/01.wnl.0000187070.35365.d7.



Natural Approaches to Migraine: Part 2

As promised, I’m back with another post by Dr. Christine Lewis, PharmD. Last week we put up Part 1 which focused on the underlying cases of migraines, part 2 now focuses on the treatment to address those causes. The goal is to determine the root cause and address the root cause. The treatments mentioned below are non-pharmacological methods that migraine sufferers can try under the guidance of a healthcare professional to address the root cause (or eliminate a root cause) of their migraines. Just this week I had a patient with migraines daily that have significantly decreased by addressing yeast overgrowth. Sometimes it makes me jump up and down on the inside like a little kid when there are victories like that! Next step is looking at this particular patient’s nutritional deficiences. Hope you enjoy the rest of our discussion on migraines.

Dr. Hartzler

Is it stress? Is it diet? Is it lifestyle?

A good place to start is the elimination diet to discover if there are any food sensitivities, intolerances, or allergies. Complete the elimination diet (without cheat days) for 21-28 days and slowly re-introduce eliminated foods one at a time. A good elimination diet includes the Whole 30 Program or a diet that eliminates grains, refined sugar, dairy, soy, gluten, peanuts, processed meats, eggs, whey, butter, vegetable oil, caffeine, and alcohol. Both diets focus on whole foods with lots of vegetables, healthy sources of protein, and healthy fats. Neither diet is intended to help you lose weight but to identify and eliminate aggravating foods. Slowly reintroduce food groups one at a time and keep a food diary to track your symptoms. Remember that symptoms can present minutes to a couple of days later with food sensitivities. It is important to listen to your body and monitor for signs of intolerance such as bloating, gas, irregular bowels, allergies, headache, skin reactions, etc (1).

Other things to consider include supplementation with magnesium glycinate 200-300mg twice daily and/or vitamin b-complex (includes riboflavin, niacin, folate and vit B12). Other supplements that have been beneficial in clinical studies include CoQ10, alpha-lipoic acid, l-tryptophan, vitamin C, omega-3, vit D and calcium, feverfew, butterbur, and melatonin. Below is a chart with some common dosage forms and recommendations (2-7).

SupplementStudied DosesNotes
Butterbur50mg-75mg twice daily Look for PA (pyrrolizidine alkaloids) free
Magnesium glycinate100mg-300mg twice dailyMay use magnesium oxide but may have GI side effects
Coenzyme Q1060mg-300mg once daily
Riboflavin15mg-400mg once daily
Folic acid5mg once daily5-MTFH is the active form
Alpha-lipoic acid 100mg-600mg once daily
Feverfew6.25mg three times dailyNot recommended in pregnancy
L-tryptophan500mg two to four times dailyShould not take with anti-depressants, tramadol, triptans
Vitamin D35000 IU daily if deficient
1000-2,000 IU daily to maintain
Supplement dosage (not specific to migraine). Best to take with Vitamin K2!
Omega 31200mg-6000mg once dailyCan increase risk for bleeding when on blood thinners
Melatonin3mg once daily Take 1-3 hours before bedtime

High quality supplements can be found at my FullScript Store. If you need help selecting a product that is right for you, don’t hesitate to reach out.

It is also important to restore hormone balance by exercising regularly, obtaining adequate sleep, and eliminating caffeine, alcohol, and sugar. Also, having adequate levels of b-vitamins is important for healthy metabolism of hormones. Talk to your provider about hormone level testing if lifestyle and diet modifications are not effective to see if there are underlying imbalances or deficiencies.

During an acute migraine, the use of essential oils has been shown to be effective. Lavender oil when inhaled can provide relief and relaxation after 15 minutes from migraines (8). Peppermint oil can also be of benefit for the treatment of migraine headaches. Peppermint oil can be applied to the forehead, temples, and back of the neck. It provides a cooling sensation, relaxes the muscles, and increases blood flow to the area (9,10). Both should be diluted appropriately. Check out my free e-book when you sign up for email updates for more about essential oils. You can find high quality essential oils here.

Other effective therapies that can address root causes of migraines and have been found to decrease frequency include acupuncture, chiropractic manipulation, mind-body techniques, yoga, and reflexology (11,12). It is suggested that these modalities can decrease stress, alter bio-feedback, block pain signaling, and other mechanisms that can be effective for the treatment of recurrent migraines.

If these treatments are not effective a thorough evaluation may be needed to find other underlying cause of migraine attacks. Hopefully this gives you a helpful starting point for various ways to attack your migraines!



  1. Żukiewicz-Sobczak WA, Wróblewska P, Adamczuk P, Kopczyński P. Causes, symptoms and prevention of food allergy. Advances in Dermatology and Allergology/Postȩpy Dermatologii I Alergologii. 2013;30(2):113-116. doi:10.5114/pdia.2013.34162.
  2. Loder E, Burch R, Rizzoli P. The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache. 2012 Jun;52(6):930-45.
  3. Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346-1353. doi:10.1212/WNL.0b013e3182535d0c.
  4. Gaby, AR. Migraine. Nutritional Medicine, 2ndEdition. Concord, NH: Fritz Perlberg Publishing; April 2017.
  5. Sándor PS, Afra J. Nonpharmacologic treatment of migraine. Curr Pain Headache Rep. 2005 Jun;9(3):202-5. Review.
  6. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/butterbur. Updated September 2017. Accessed April 9, 2018.
  7. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/feverfew. Updated November 2016. Accessed April 9, 2018.
  8. Sasannejad P, Saeedi M, Shoeibi A, Gorji A, Abbasi M, Foroughipour M. Lavender essential oil in the treatment of migraine headache: a placebo-controlled clinical trial. Eur Neurol. 2012;67(5):288-91.
  9. Kligler B, Chaudhary S. Peppermint oil. Am Fam Physician. 2007 Apr 1;75(7):1027-30. Review.
  10. Göbel H, Schmidt G, Dworschak M, Stolze H, Heuss D. Essential plant oils and headache mechanisms. Phytomedicine. 1995 Oct;2(2):93-102.
  11. Chessman AW. Review: Acupuncture reduces migraine frequency more than usual care, sham acupuncture, or prophylactic drugs. Ann Intern Med. 2016 Oct 18;165(8): JC44.
  12. Millstine D, Chen CY, Bauer B. Complementary and integrative medicine in the management of headache. BMJ. 2017 May 16;357: j1805. doi: 10.1136/bmj.j1805.