The relationship between serum levels of vitamin D and migraine
Journal of Research in Medical Sciences, Supplement 1 March 2013
Tayebeh Mottaghi 1, Fariborz Khorvash 2, Gholamreza Askari 3 Askari@ mui.ac.ir, Mohammad Reza Maracy 4, Reza Ghiasvand 1,3, Zahra Maghsoudi 1, Bijan Iraj 5
1Food Security Research Center, Isfahan University of Medical Sciences, 2Neurology Research Center, School of Medicine, Isfahan University of Medical Sciences, 3Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, "Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, 5Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Background: Migraine is common worldwide. In recent years, vitamin D deficiency has been determined as a global health problem. A few studies have shown inverse relationship between serum vitamin D levels and headache. Thus, in this study, we assessed relationship between serum vitamin D levels with migraine.
Materials and Methods: The present study was a cross-sectional. Seventy-six migraine patients aged 10-61 years were included. The multiple linear regression was used to show association between serum 25-0H-D3 and migraine. Adjustments were performed for age, sex, waist circumference, body mass index (BMI), number of chronic diseases, and education level.
Results: The positive weak relationship was observed between serum vitamin D and headache diary result (P = 0.042, r = 0.19). But, no significant relationship was observed between serum vitamin D and migraine severity (P = 0.741).
Conclusion: High levels of serum 25-OH-D3 was related to higher headache diary result. After adjustment for confounding variables, this significant association remained. No significant relationship was shown between serum vitamin D and migraine severity.
Key words: Migraine, relationship, vitamin D
INTRODUCTION
Headache is common during childhood and adolescence.111 Migraine and tension-type headache are most common primary headache disorders, that affects 80% of people worldwide.[2] Migraine is a neurological disorder[31 that is debilitating, progressive and chronic.[[41 Mechanism of migraine pain in the brain is due to release of pain-producing inflammatory substances around the nerves and blood vessels in the head.[[5] Main characteristic of the migraine attacks is headache[61 that may take several hours to 2-3 days[[51 and is often severe,[[61 pulsating, and one-sided.[[51 Other related symptoms include nausea, sometimes vomiting, intolerance to light and sound,[[51 neck pain, and muscle tension.[[71 Migraine is related to almost 2-fold greater risk of ischemic attacks.™ In addition, migraine in adults are associated with seasonal allergies, asthma, epilepsy, continuous nightmares, atopic disorders, stroke, cardiovascular disorders, sleep problems, motion sickness, epistaxis and among women of reproductive age are related to preeclampsia and uterine bleeding. [[11 The most common causes of migraine is hunger or not eating enough, which is important especially in young people.[[61 Migraine is the 19th cause of disability in the world[[91 and involves in 10-20% of the population during their lifetime.[[101 Recent data indicate that one in every four American adults, suffer from frequent or severe headache including migraine.[[11 Women are approximately three times more likely to get migraine disease as compared with men.[[61 Migraine prevalence in Turkey is 16.4% (8.5% in men and 24.6% in women);[[111 in European adults it is 14.7%,[[121 England (7.6% in men and 18.3% in women),[[131 Germany 13.4%;[[21 in Africa it is 3-7%;[[51 and in Asia (3% in men and 10% in women).[[51
Moreover, migraine is one of the most common headaches in Iran.[[141 Headache prevalence is 63.4% among Ilam students, that is, 8.1% students have migraine,[[151 7.3% among Ardabil students,[[161 8.85% in Rasht among high school students,[[171 and 1.7% in Shiraz among students aged 6-13 years.[[181
In recent years, vitamin D deficiency has been known as a global public health problem.[[191 A total of 30-80% children and adults have vitamin D deficiency around the world.[[201 In Iran, the prevalence of vitamin D deficiency is 75.1% among women and 72.1% among men.[[211 In Isfahan, prevalence of mild, moderate, and severe vitamin D deficiency are 19.6%, 23.9%, and 26.9% respectively, which is more common among women and children.[[221 The prevalence of vitamin D deficiency is higher in winter and autumn than in summer and spring.[[221
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Wheeler and O'Brien showed that patients with migraine have low vitamin D levels.[[31,321 Wheeler, reported that 14.8% of patients with chronic migraine had serum levels of vitamin D less than or equal to 20 ng/ml and 25.9% of patients had serum vitamin D levels between 20 and 30 ng/ml.[[311 In Greece, prevalence and frequency of headaches was more in northern areas and regions with average low temperature than in southern regions.[[331 Serum vitamin D levels is higher among individuals who live at lower latitudes and is an important factors for low prevalence of headache.[[191 Data have shown an increasing frequency of headache attacks during the fall and winter and minimum attacks in summer,[[191 which is probably due to low levels of vitamin D in the fall and winter and indicates possibility role of vitamin D in causing headache.[[191
In a cross-sectional study including 11,614 participants in the sixth survey of Troms0 study, significant relationship was not observed between serum levels of vitamin D and migraine, but association between nonmigraine headache and vitamin D levels was only significant in nonsmokers group and adjustments were performed for age, BMI, sex, in D and migraine season, chronic diseases, education level, physical activity, and alcohol consumption. 41
Accurate role of vitamin D deficiency in headache is unknown.[[191 The main mechanisms in causing headache include possible sensitization of second and third neurons due to continuous stimulation of sensory receptors of periosteal coverage (because of bone swelling) and also, central sensitization (because of bone swelling). Other possible mechanisms of headache in patients with vitamin D deficiency are low serum levels of Magnesium.[[231 Abnormal metabolism of Magnesium is involved in the pathogenesis of tension-type headache.[[231 Magnesium deficiency in the brain, blood, erythrocyte, monocyte, and platelet have been found among patients with tension-type headaches and other types of headache. About 40-50% of patients with tension-type headache have low serum levels of Magnesium.[[231 In different studies, patients with tension-type headache have responded to treatment with Magnesium.[[231 Vitamin D deficiency may lead to tension-type headache using decreased absorption of Magnesium, because, intestinal absorption of Magnesium through food is dependent on vitamin D.[[231 Another mechanisms include the presence of vitamin D receptors, 1-hydroxylase (the enzyme responsible for the formation of the vitamin D active form) and vitamin D binding protein in the brain, particularly hypothalamus.[[191
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