J Clin Neurol.  2018 Jul;14(3):366-373. 10.3988/jcn.2018.14.3.366.

Effect of Vitamin D Deficiency on the Frequency of Headaches in Migraine

• Song TJ
• Chu MK
• Sohn JH
• Ahn HY
• Lee SH
• Cho SJ

• KMID: 2415054
• DOI: http://doi.org/10.3988/jcn.2018.14.3.366

Abstract

BACKGROUND AND PURPOSE
The risk of vitamin D deficiency varies with the season. The frequency of vitamin D deficiency in migraine patients and its association with migraine are unclear.
METHODS
We retrospectively evaluated first-visit migraine patients between January 2016 and May 2017, and investigated the demographics, season, migraine subtypes, frequency, severity, and impact of migraine, psychological and sleep variables, climate factors, and vitamin D levels. The nonfasting serum 25-hydroxyvitamin D concentration was measured to determine the vitamin D level, with deficiency of vitamin D defined as a concentration of < 20 ng/mL.
RESULTS
In total, 157 patients with migraine aged 37.0±8.6 years (mean±standard deviation) were analyzed. Their serum level of vitamin D was 15.9±7.4 ng/mL. Vitamin D deficiency was present in 77.1% of the patients, and occurred more frequently in spring and winter than in summer and autumn (89.1%, 85.7%, 72.4%, and 61.7%, respectively; p=0.008). In multivariate Poisson regression analysis, monthly headache was 1.203 times (95% confidence interval=1.046-1.383, p=0.009) more frequent in patients with vitamin D deficiency than in those without deficiency after adjusting for demographics, season, migraine subtype, depression, anxiety, and sleep quality. These associations were consistently noted in subgroup analysis of episodic migraine (odds ratio=1.266, p=0.033) and chronic migraine (odds ratio=1.390, p=0.041).
CONCLUSIONS
Our study found that a larger number of monthly days with headache was related to vitamin D deficiency among migraineurs. Future studies should attempt to confirm the causal relationship between vitamin D deficiency and migraine.

Keyword

migraine; vitamin D; seasonal variation; summer; winter

MeSH Terms

Anxiety
Climate
Demography
Depression
Headache*
Humans
Migraine Disorders*
Retrospective Studies
Seasons
Vitamin D Deficiency*
Vitamin D*
Vitamins*
Vitamin D
Vitamins

Figure

• 

  Fig. 1 Flowchart outlining patient inclusion.

Reference

1. Atherton K, Berry DJ, Parsons T, Macfarlane GJ, Power C, Hypponen E. Vitamin D and chronic widespread pain in a white middle-aged British population: evidence from a cross-sectional population survey. Ann Rheum Dis. 2009; 68:817–822. PMID: 18697776.

2. Parker GB, Brotchie H, Graham RK. Vitamin D and depression. J Affect Disord. 2017; 208:56–61. PMID: 27750060.

3. Milaneschi Y, Hoogendijk W, Lips P, Heijboer AC, Schoevers R, van Hemert AM, et al. The association between low vitamin D and depressive disorders. Mol Psychiatry. 2014; 19:444–451. PMID: 23568194.

4. Littlejohns TJ, Henley WE, Lang IA, Annweiler C, Beauchet O, Chaves PH, et al. Vitamin D and the risk of dementia and Alzheimer disease. Neurology. 2014; 83:920–928. PMID: 25098535.

5. Munger KL, Hongell K, Åivo J, Soilu-Hänninen M, Surcel HM, Ascherio A. 25-hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort. Neurology. 2017; 89:1578–1583. PMID: 28904091.

6. Holick MF. The vitamin D deficiency pandemic: approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017; 18:153–165. PMID: 28516265.

7. Eyles DW, Burne TH, McGrath JJ. Vitamin D, effects on brain development, adult brain function and the links between low levels of vitamin D and neuropsychiatric disease. Front Neuroendocrinol. 2013; 34:47–64. PMID: 22796576.

8. Garcion E, Nataf S, Berod A, Darcy F, Brachet P. 1,25-dihydroxyvitamin D3 inhibits the expression of inducible nitric oxide synthase in rat central nervous system during experimental allergic encephalomyelitis. Brain Res Mol Brain Res. 1997; 45:255–267. PMID: 9149100.

9. Thys-Jacobs S. Vitamin D and calcium in menstrual migraine. Headache. 1994; 34:544–546. PMID: 8002332.

10. Buettner C, Nir RR, Bertisch SM, Bernstein C, Schain A, Mittleman MA, et al. Simvastatin and vitamin D for migraine prevention: a randomized, controlled trial. Ann Neurol. 2015; 78:970–981. PMID: 26418341.

11. Buettner C, Burstein R. Association of statin use and risk for severe headache or migraine by serum vitamin D status: a cross-sectional population-based study. Cephalalgia. 2015; 35:757–766. PMID: 25424706.

12. Wang TJ, Zhang F, Richards JB, Kestenbaum B, van Meurs JB, Berry D, et al. Common genetic determinants of vitamin D insufficiency: a genome-wide association study. Lancet. 2010; 376:180–188. PMID: 20541252.

13. Sato K, Hayashino Y, Yamazaki S, Takegami M, Ono R, Otani K, et al. Headache prevalence and long working hours: the role of physical inactivity. Public Health. 2012; 126:587–593. PMID: 22721815.

14. Varkey E, Hagen K, Zwart JA, Linde M. Physical activity and headache: results from the Nord-Trondelag Health Study (HUNT). Cephalalgia. 2008; 28:1292–1297. PMID: 18771495.

15. Prakash S, Mehta NC, Dabhi AS, Lakhani O, Khilari M, Shah ND. The prevalence of headache may be related with the latitude: a possible role of Vitamin D insufficiency? J Headache Pain. 2010; 11:301–307. PMID: 20464624.

16. Zandifar A, Masjedi SS, Banihashemi M, Asgari F, Manouchehri N, Ebrahimi H, et al. Vitamin D status in migraine patients: a case-control study. Biomed Res Int. 2014; 2014:514782. PMID: 24524078.

17. Mottaghi T, Khorvash F, Askari G, Maracy MR, Ghiasvand R, Maghsoudi Z, et al. The relationship between serum levels of vitamin D and migraine. J Res Med Sci. 2013; 18(Suppl 1):S66–S70. PMID: 23961291.

18. Lippi G, Cervellin G, Mattiuzzi C. No evidence for an association of vitamin D deficiency and migraine: a systematic review of the literature. Biomed Res Int. 2014; 2014:827635. PMID: 24900990.

19. Kjaergaard M, Eggen AE, Mathiesen EB, Jorde R. Association between headache and serum 25-hydroxyvitamin D: the Tromsø Study: Tromsø 6. Headache. 2012; 52:1499–1505. PMID: 22973803.

20. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38:1–211. No authors listed. PMID: 29368949.

21. Chu MK, Im HJ, Ju YS, Yu KH, Ma HI, Lee BC. [Validity and reliability assessment of Korean Headache Impact Test-6 (HIT-6)]. J Korean Neurol Assoc. 2009; 27:1–6.

22. Seo JG, Park SP. Validation of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with migraine. J Headache Pain. 2015; 16:65. PMID: 26174509.

23. Seo JG, Park SP. Validation of the Generalized Anxiety Disorder-7 (GAD-7) and GAD-2 in patients with migraine. J Headache Pain. 2015; 16:97. PMID: 26596588.

24. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28:193–213. PMID: 2748771.

25. Centers for Disease Control and Prevention (US). CDC Vitamin DStandardization-Certification Program (VDSCP)-total 25 hydroxy vitaminD certified procedures [Internet]. Atlanta (GA): Centers for Disease Control and Prevention;2017. cited 2017 Dec 8. Available from: https://www.cdc.gov/labstandards/pdf/hs/CDC_Certified_Vitamin_D_Procedures.pdf.

26. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96:1911–1930. PMID: 21646368.

27. Wheeler SD. Vitamin D deficiency in chronic migraine. Headache. 2008; 48(S1):S52–S53.

28. Khorvash F, Mottaghi T, Askari G, Maracy MR, Ghiasvand R, Maghsoudi Z, et al. The association between serum vitamin D levels with general and abdominal obesity among patients with migraine. Int J Prev Med. 2013; 4(Suppl 2):S313–S317. PMID: 23776744.

29. Jeong H, Hong S, Heo Y, Chun H, Kim D, Park J, et al. Vitamin D status and associated occupational factors in Korean wage workers: data from the 5th Korea National Health and Nutrition Examination Survey (KNHANES 2010–2012). Ann Occup Environ Med. 2014; 26:28. PMID: 25852939.

30. Prakash S, Rathore C, Makwana P, Dave A, Joshi H, Parekh H. Deficiency in patients with chronic tension-type headache: a case-control study. Headache. 2017; 57:1096–1108. PMID: 28470754.

31. Deng X, Song Y, Manson JE, Signorello LB, Zhang SM, Shrubsole MJ, et al. Magnesium, vitamin D status and mortality: results from US National Health and Nutrition Examination Survey (NHANES) 2001 to 2006 and NHANES III. BMC Med. 2013; 11:187. PMID: 23981518.

32. Assarzadegan F, Asgarzadeh S, Hatamabadi HR, Shahrami A, Tabatabaey A, Asgarzadeh M. Serum concentration of magnesium as an independent risk factor in migraine attacks: a matched case-control study and review of the literature. Int Clin Psychopharmacol. 2016; 31:287–292. PMID: 27140442.

33. Makrani AH, Afshari M, Ghajar M, Forooghi Z, Moosazadeh M. Vitamin D and fibromyalgia: a meta-analysis. Korean J Pain. 2017; 30:250–257. PMID: 29123619.