High-Dose Biotin Supplementation Exacerbates Chronic Migraine: A Case Report.

Chronic migraine is a complex neurological disorder that has a significant burden on patient's lives and socioeconomic outcomes, and it is difficult to manage when patients present with comorbid medication overuse headache. This research describes a case of chronic migraine persisting for 20 years, worsening following high-dose biotin supplementation. A female patient with long-standing and well-controlled classic migraine developed a two-month history of daily severe headaches. The patient experienced a significant exacerbation of headaches after initiating biotin 10,000 mcg once daily. The patient developed daily migraines unresponsive to triptans, significantly affecting her quality of life and increasing multiple emergency visits. This may be due to alteration of mitochondrial energy metabolism, which disrupts the synthesis of neurotransmitters, including serotonin pathways and increased oxidative stress and ultimately results in migraine exacerbation. Discontinuation of biotin led to improvement and return to baseline with rare and mild attacks. High-dose biotin may act as a previously unrecognized trigger for migraine exacerbation. Future studies are required to explore the exact mechanisms of high-dose biotin in triggering migraine exacerbation.