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Riboflavin in cyclic vomiting syndrome: efficacy in three children

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Abstract

Cyclic vomiting syndrome is an episodic disorder considered to be a migraine variant. Riboflavin is efficient in the prophylactic treatment of migraines in adults. We describe the effectiveness and tolerance of riboflavin treatment in three children with cyclic vomiting syndrome. All of them fulfilled the diagnosis criteria for cyclic vomiting syndrome. They received prophylactic monotherapy with riboflavin for at least 12 months. Excellent response and tolerability was observed.

Conclusion: Based on clinical observation in three cases, riboflavin may be an effective and safe prophylactic treatment for children with cyclic vomiting syndrome.

What is Known:

• CVS is one of the “childhood periodic syndromes” classified as a migraine subtype by the International Headache Society.

• Riboflavin is currently used as a prophylactic treatment in patients with migraine.

What is New:

• Riboflavin may be an effective and safe prophylactic treatment for children with CVS.

• Increasing doses of riboflavin and long periods of prophylaxis may be needed in some children..

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Abbreviations

CVS:

Cyclic vomiting syndrome

mtDNA:

Mitochondrial DNA

CNS:

Central nervous system

31P-MRS:

Phosphorus magnetic resonance spectroscopy

References

  1. Barbiroli B, Montagna P, Cortelli P, Funicello R, Iotti S, Monari L et al (1992) Abnormal brain and muscle energy metabolism shown by 31P magnetic resonance spectroscopy in patients affected by migraine with aura. Neurology 42:1209–1214

    Article  PubMed  CAS  Google Scholar 

  2. Boehnke C, Reuter U, Flach U, Schuh-Hofer S, Einhaupl KM, Arnold G (2004) High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol 11:475477. doi:10.1111/j.1468-1331.2004.00813

    Article  Google Scholar 

  3. Boles RG (2011) High degree of efficacy in the treatment of cyclic vomiting syndrome with combined co-enzyme Q10, L-carnitine and amitriptyline, a case series. BMC Neurol 11:102. doi:10.1186/1471-2377-11-102

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Boles RG, Adams K, Li BU (2005) Maternal inheritance in cyclic vomiting syndrome. Am J Med Genet A 133A:71–77. doi:10.1002/ajmg.a.30524

    Article  PubMed  Google Scholar 

  5. Boles RG, Lovett-Barr MR, Preston A, Li BU, Adams K (2010) Treatment of cyclic vomiting syndrome with co-enzyme Q10 and amitriptyline, a retrospective study. BMC Neurol 10:10. doi:10.1186/1471-2377-10-10

    Article  PubMed  PubMed Central  Google Scholar 

  6. Boles RG, Williams JC (1999) Mitochondrial disease and cyclic vomiting syndrome. Dig Dis Sci 44:103S–107S

    PubMed  CAS  Google Scholar 

  7. Bruijn J, Duivenvoorden H, Passchier J, Locher H, Dijkstra N, Arts WF (2010) Medium-dose riboflavin as a prophylactic agent in children with migraine: a preliminary placebo-controlled, randomised, double-blind, cross-over trial. Cephalalgia 30:1426–1434. doi:10.1177/03331024103651060333102410365106

    Article  PubMed  Google Scholar 

  8. Colombo B, Saraceno L, Comi G (2014) Riboflavin and migraine: the bridge over troubled mitochondria. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 35(Suppl 1):141–144. doi:10.1007/s10072-014-1755-z

    Article  Google Scholar 

  9. Condo M, Posar A, Arbizzani A, Parmeggiani A (2009) Riboflavin prophylaxis in pediatric and adolescent migraine. J Headache Pain 10:361–365. doi:10.1007/s10194-009-0142-2

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cuvellier JC, Lepine A (2010) Childhood periodic syndromes. Pediatr neurol 42:1–11. doi:10.1016/j.pediatrneurol.2009.07.001S0887-8994(09)00344-0

    Article  PubMed  Google Scholar 

  11. Di Lorenzo C, Pierelli F, Coppola G, Grieco GS, Rengo C, Ciccolella M et al (2009) Mitochondrial DNA haplogroups influence the therapeutic response to riboflavin in migraineurs. Neurology 72:1588–1594. doi:10.1212/WNL.0b013e3181a4126972/18/1588

    Article  PubMed  Google Scholar 

  12. Gaul C, Diener HC, Danesch U (2015) Improvement of migraine symptoms with a proprietary supplement containing riboflavin, magnesium and Q10: a randomized, placebo-controlled, double-blind, multicenter trial. J Headache Pain 16:516. doi:10.1186/s10194-015-0516-6

    Article  PubMed  Google Scholar 

  13. Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E (2012) 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 78:1346–1353. doi:10.1212/WNL.0b013e3182535d0c78/17/1346

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  14. Li BU, Lefevre F, Chelimsky GG, Boles RG, Nelson SP, Lewis DW et al (2008) North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr 47:379–393. doi:10.1097/MPG.0b013e318173ed3900005176-200809000-00022

    Article  PubMed  CAS  Google Scholar 

  15. Li BU, Misiewicz L (2003) Cyclic vomiting syndrome: a brain-gut disorder. Gastroenterol Clin North Am 32:997–1019

    Article  PubMed  CAS  Google Scholar 

  16. MacLennan SC, Wade FM, Forrest KM, Ratanayake PD, Fagan E, Antony J (2008) High-dose riboflavin for migraine prophylaxis in children: a double-blind, randomized, placebo-controlled trial. J Child Neurol 23:1300–1304. doi:10.1177/088307380831805323/11/1300

    Article  PubMed  Google Scholar 

  17. Maizels M, Blumenfeld A, Burchette R (2004) A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: a randomized trial. Headache 44:885–890. doi:10.1111/j.1526-4610.2004.04170

    Article  PubMed  Google Scholar 

  18. Markley HG (2012) Coenzyme Q10 and riboflavin: the mitochondrial connection. Headache 52(Suppl 2):81–87. doi:10.1111/j.1526-4610.2012.02233.x

    Article  PubMed  Google Scholar 

  19. Marriage B, Clandinin MT, Glerum DM (2003) Nutritional cofactor treatment in mitochondrial disorders. J Am Diet Assoc 103:1029–1038. doi:10.1053/jada.2003.50196S0002822303004760

    Article  PubMed  Google Scholar 

  20. O’Brien HL, Hershey AD (2010) Vitamins and paediatric migraine: riboflavin as a preventative medication. Cephalalgia 30:1417–1418. doi:10.1177/03331024103783580333102410378358

    Article  PubMed  Google Scholar 

  21. Penn AM, Lee JW, Thuillier P, Wagner M, Maclure KM, Menard MR et al (1992) MELAS syndrome with mitochondrial tRNA(Leu)(UUR) mutation: correlation of clinical state, nerve conduction, and muscle 31P magnetic resonance spectroscopy during treatment with nicotinamide and riboflavin. Neurology 42:2147–2152

    Article  PubMed  CAS  Google Scholar 

  22. Pringsheim T, Davenport W, Mackie G, Worthington I, Aube M, Christie SN, Gladstone J, Becker WJ (2012) Canadian Headache Society guideline for migraine prophylaxis. The Canadian journal of neurological sciences Le journal canadien des sciences neurologiques 39:S1–59, doi:B8311210P2528QT4

    PubMed  Google Scholar 

  23. Schoenen J, Jacquy J, Lenaerts M (1998) Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology 50:466–470

    Article  PubMed  CAS  Google Scholar 

  24. Scholte HR, Busch HF, Bakker HD, Bogaard JM, Luyt-Houwen IE, Kuyt LP (1995) Riboflavin-responsive complex I deficiency. Biochim Biophys Acta 1271:75–83

    Article  PubMed  Google Scholar 

  25. Sparaco M, Feleppa M, Lipton RB, Rapoport AM, Bigal ME (2006) Mitochondrial dysfunction and migraine: evidence and hypotheses. Cephalalgia 26:361–372. doi:10.1111/j.1468-2982.2005.01059.x

    Article  PubMed  CAS  Google Scholar 

  26. Taylor FR (2011) Nutraceuticals and headache: the biological basis. Headache 51:484–501. doi:10.1111/j.1526-4610.2011.01847.x

    Article  PubMed  Google Scholar 

  27. The International Classification of Headache Disorders: 2nd edition (2004). Cephalalgia 24 Suppl 1:9–160

  28. Van Calcar SC, Harding CO, Wolff JA (2002) L-carnitine administration reduces number of episodes in cyclic vomiting syndrome. Clin Pediatr (Phila) 41:171–174

    Article  Google Scholar 

  29. Wang Q, Ito M, Adams K, Li BU, Klopstock T, Maslim A et al (2004) Mitochondrial DNA control region sequence variation in migraine headache and cyclic vomiting syndrome. Am J Med Genet A 131:50–58. doi:10.1002/ajmg.a.30323

    Article  PubMed  Google Scholar 

  30. Zaki EA, Freilinger T, Klopstock T, Baldwin EE, Heisner KR, Adams K et al (2009) Two common mitochondrial DNA polymorphisms are highly associated with migraine headache and cyclic vomiting syndrome. Cephalalgia 29:719–728. doi:10.1111/j.1468-2982.2008.01793.xCHA1793

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We would like to thank Dr. Charles-Antoine Haenggeli for his careful revision of the manuscript before its initial submission.

Compliance with ethical standards

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. For this type of study, formal consent is not required.

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None.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Authors’ contributions

Anastasia Martinez-Esteve Melnikova contributed to the acquisition, analysis, and interpretation of data; carried out the literature search; conceptualized and designed the study; drafted and critically reviewed the manuscript; and approved the final manuscript as submitted. Dr Schäppi contributed to the acquisition, analysis, and interpretation of data, and to the conceptualization and design of the study; critically reviewed the manuscript and approved the final manuscript as submitted. Christian Korff contributed to the coordination and supervision of data collection at the three sites of acquisition, to the analysis and interpretation of data, to the conceptualization and design the study, and to the review and revision of the manuscript and approved the final manuscript as submitted.

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Authors and Affiliations

  1. Pediatric Neurology, Child and Adolescent Department, Geneva University Hospitals, Geneva, Switzerland

    Anastasia Martinez-Esteve Melnikova & Christian Korff

  2. Pediatric Gastroenterology, Grangettes Clinic, Geneva, Switzerland

    Michela G. Schäppi

Authors
  1. Anastasia Martinez-Esteve Melnikova
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  2. Michela G. Schäppi
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  3. Christian Korff
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Corresponding author

Correspondence to Anastasia Martinez-Esteve Melnikova.

Additional information

Revisions received: 04 June 2015 / 09 July 2015

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Martinez-Esteve Melnikova, A., Schäppi, M.G. & Korff, C. Riboflavin in cyclic vomiting syndrome: efficacy in three children. Eur J Pediatr 175, 131–135 (2016). https://doi.org/10.1007/s00431-015-2597-2

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  • DOI: https://doi.org/10.1007/s00431-015-2597-2

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