brintellex
ValprolBanner
Annals of Indian Academy of Neurology
  Users Online: 683 Home | About the Journal | InstructionsCurrent Issue | Back IssuesLogin      Print this page Email this page  Small font size Default font size Increase font size

Table of Contents
LETTERS TO THE EDITOR
Year : 2020  |  Volume : 23  |  Issue : 2  |  Page : 233-235
 

Vitamin D deficiency and its correlates in migraine patients


Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea

Date of Submission23-Apr-2019
Date of Acceptance28-May-2019
Date of Web Publication26-Feb-2020

Correspondence Address:
Prof. Sung-Pa Park
Department of Neurology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu - 41944
Republic of Korea
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.AIAN_229_19

Rights and Permissions

 



How to cite this article:
Seo JG, Park SP. Vitamin D deficiency and its correlates in migraine patients. Ann Indian Acad Neurol 2020;23:233-5

How to cite this URL:
Seo JG, Park SP. Vitamin D deficiency and its correlates in migraine patients. Ann Indian Acad Neurol [serial online] 2020 [cited 2020 Jul 4];23:233-5. Available from: http://www.annalsofian.org/text.asp?2020/23/2/233/263997




Sir,

Serum vitamin D levels have been associated with migraine. Seasonal variation of serum vitamin D levels depicting higher levels in summer and lower levels in autumn-winter were matched with that of migraine attacks.[1] A lower level of serum vitamin D was associated with migraine.[2] Despite a probable relationship between migraine and serum vitamin D, clinical correlates associated with vitamin D deficiency were not clearly identified in migraine patients. Therefore, we identified vitamin D deficiency and its correlates in migraine patients for suggesting the role of vitamin D supplementation in migraine therapy.

We conducted a prospective, cross-sectional study. We invited new patients with migraine who visited our headache clinic. The Institutional Review Board of Kyungpook National University Hospital approved the study (approval number KNUH 2016-03-009). All participants gave written informed consent. We collected their clinical characteristics and conducted the Migraine Disability Assessment Scale,[3] the Patient Health Questionnaire-9,[4] the Generalized Anxiety Disorder-7,[5] the Insomnia Severity Index,[6] and the Fatigue Severity Scale.[7] All eligible patients measured serum vitamin D levels by radioimmunoassay. Vitamin D deficiency is defined as a serum 25 (OH) D of less than 20 ng/ml.[8] By this value, we divided patients into two groups as having vitamin D deficiency and having no deficiency. We identified factors associated with vitamin D deficiency by using univariate and multivariate analyses.

Initially, 380 new patients were visited our clinic. Of them, 92 patients were excluded due to concurrent vitamin D intake (n = 57), probable migraine (n = 18), refusal to the study (n = 15), younger age (n = 1), and older age (n = 1). Finally, 288 patients were eligible for the study. Their mean vitamin D level is 15.8 ± 5.7 ng/ml (range: 3.4-34.9 ng/ml). Of them, 240 patients (83.3%) had vitamin D deficiency. According to the existence of vitamin D deficiency, characteristics of patients are manifested in [Table 1]. Factors associated with vitamin D deficiency by univariate analyses are denoted in [Table 2]. Younger age, chronic migraine (CM), anxiety, and fatigue were associated with vitamin D deficiency. However, BMI, the amount of sunlight exposure, the date of blood sampling, headache intensity, and disability were not associated with it. Factors associated with vitamin D deficiency by multivariate analyses are listed in [Table 3]. CM (adjusted Odds Ratio [AOR] 4.038, 95% confidence interval [CI] 1.890-8.628, P < 0.001) and younger age (AOR 1.031, 95% CI 1.006-1.058, P = 0.017) were selected.
Table 1: Characteristics of migraine patients by serum vitamin D levels

Click here to view
Table 2: Factors associated with serum vitamin D deficiency by univariate analyses

Click here to view
Table 3: Factors associated with serum vitamin D deficiency by multivariate analyses

Click here to view


We found major correlates for vitamin D deficiency were CM and younger age. The role of vitamin D deficiency on migraine chronicity has not been clearly identified. The pathogenic mechanism of migraine chronicity presumes to be associated with a neurotransmitter imbalance and upregulation of inflammatory pathways in CNS resulting in central amplification of peripheral pain signals.[9] Vitamin D has anti-inflammatory effects in the body by reducing the release of pro-inflammatory cytokines and suppressing T-cell responses.[10] So vitamin D deficiency may promote inflammatory pain mechanisms associated with CM. Another possibility is, as vitamin D deficiency was associated with emotional distress and fatigue in our patients, these symptoms is likely to work as migraine triggers and induce repetitive migraine attacks. Under these pathogenic roles of vitamin D deficiency, we presume serum vitamin D levels may be an important correlate for migraine chronicity. The lower level of vitamin D in the younger age may be explained by disproportionately greater time spent indoors and less time spent outdoors among younger compared with older individuals.[11]

Although we cannot conclude vitamin D deficiency is specific for migraine patients due to the lack of data for healthy controls, we presume migraine chronicity may accentuate vitamin D deficiency. As vitamin D supplementation is effective for decreasing frequency of migraine attacks in EM,[12] further studies should be warranted to prove the therapeutic efficacy of vitamin D supplementation on CM. In addition, the relationship between serum vitamin D levels and therapeutic response should be also identified.

Financial support and sponsorship

This research was supported by Kyungpook National University Research Fund, 2018.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
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;11:301-7.  Back to cited text no. 1
    
2.
Celikbilek A, Gocmen AY, Zararsiz G, Tanik N, Ak H, Borekci E, et al. Serum levels of vitamin D, vitamin D-binding protein and vitamin D receptor in migraine patients from central Anatolia region. Int J Clin Pract 2014;68:1272-7.  Back to cited text no. 2
    
3.
Lee HS, Chung CS, Song HJ, Park HS. The reliability and validity of the MIDAS (Migraine Disability Assessment) Questionnaire for Korean migraine sufferers. J Korean Neurol Assoc 2000;18:287-91.  Back to cited text no. 3
    
4.
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.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    
6.
Cho YW, Song ML, Morin CM. Validation of a Korean version of the insomnia severity index. J Clin Neurol 2014;10:210-5.  Back to cited text no. 6
    
7.
Chung K, Song C. Clinical usefulness of fatigue severity scale for patients with fatigue, and anxiety or depression. Korean J Psychosom Med 2001;9:164-73.  Back to cited text no. 7
    
8.
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 Endoclinol Metab 2011;96:1911-30.  Back to cited text no. 8
    
9.
Aurora SK, Brin MF. Chronic migraine: An update on physiology, imaging, and the mechanism of action of two available pharmacologic therapies. Headache 2017;57:109-25.  Back to cited text no. 9
    
10.
Hewison M. Antibacterial effects of vitamin D. Nat Rev Endocrinol 2011;7:337-45.  Back to cited text no. 10
    
11.
Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, et al. Vitamin D insufficiency in Korea--a greater threat to younger generation: The Korea national health and nutrition examination survey (KNHANES) 2008. J Clin Endocrinol Metab 2011;96:643-51.  Back to cited text no. 11
    
12.
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;78:970-81.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
Print this article  Email this article

    

 
   Search
 
  
    Similar in PUBMED
    Article in PDF (368 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Tables

 Article Access Statistics
    Viewed699    
    Printed168    
    Emailed0    
    PDF Downloaded209    
    Comments [Add]    

Recommend this journal