Evidence Level
Strong
Riboflavin has strong evidence for migraine prophylaxis. The landmark RCT by Schoenen et al. (1998) demonstrated that 400 mg riboflavin daily reduced migraine attack frequency by 50% compared to placebo, with a responder rate of 59% vs 15%. This finding has been replicated and riboflavin is now recommended by the American Academy of Neurology and the Canadian Headache Society as a Level B evidence migraine preventive. A 2017 review by Thompson and Saluja confirmed its efficacy and noted its excellent safety profile compared to pharmaceutical prophylactics. The mechanism is thought to involve improved mitochondrial energy metabolism in neurons.