Purpose of Review

To review carnitine’s role in migraine and headache, present a case of a patient with intractable chronic migraine refractory to medications but exquisitely responsive to mitochondrial cofactors with a particularly prompt response to L-carnitine supplementation with dose response, and suggest scenarios where L-carnitine could be considered for prophylactic treatment in migraine and intractable headache with migraine features.

Recent Findings

Multiple treatments modalities are used to treat migraine, including nutraceutical therapies. Mitochondrial supplements are often used to treat migraine, based on controlled trials. One of the nutraceutical therapies used in neurological and non-neurological conditions is L-carnitine. A few studies have examined the effect of carnitine in patients with migraine.

Summary

We present a case of a patient with chronic migraine-like headaches found to have carnitine deficiency whose headaches greatly improved with carnitine supplementation. This case suggests that secondary carnitine deficiency may cause chronic migraine. Energy deficiency states occur with migraine, and replenishment of energy substrates has demonstrated some improvement in migraine. Recent studies suggest that L-carnitine with other mitochondrial cofactors may be migraine preventives. The exact link between carnitine and migraine is unknown. Perhaps carnitine deficiency should be in the differential for refractory migraine. Supplementation with L-carnitine merits exploration as a nutraceutical treatment of chronic migraine. Our case suggests that there may be a dose-dependent response to L-carnitine.

中文翻译：

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肉碱反应性偏头痛综合征：病例报告及文献复习

审查目的

为了回顾肉碱在偏头痛和头痛中的作用，介绍一例患有顽固性慢性偏头痛的患者，该患者对药物无效，但对线粒体辅助因子反应灵敏，对补充左旋肉碱的反应特别迅速，并具有剂量反应可考虑用于偏头痛和具有偏头痛特征的顽固性头痛的预防性治疗。

最近的发现

多种治疗方式用于治疗偏头痛，包括营养疗法。根据对照试验，线粒体补充剂通常用于治疗偏头痛。用于神经系统和非神经系统疾病的营养疗法之一是左旋肉碱。一些研究检查了肉碱对偏头痛患者的影响。

概括

我们介绍了一个患有慢性偏头痛样头痛的患者，该患者被发现患有肉碱缺乏症，其头痛通过补充肉碱大大改善。该病例表明继发性肉碱缺乏可能导致慢性偏头痛。偏头痛会出现能量缺乏状态，补充能量底物已证明偏头痛有所改善。最近的研究表明，左旋肉碱与其他线粒体辅助因子可能是偏头痛的预防剂。肉碱和偏头痛之间的确切联系尚不清楚。也许肉碱缺乏症应该是难治性偏头痛的鉴别诊断。补充左旋肉碱作为慢性偏头痛的营养治疗值得探索。我们的案例表明，对左旋肉碱可能存在剂量依赖性反应。