Vitamin D, Chronic Migraine, and Extracranial Pain: Is There a Link? Data From an Observational Study.

Valentina Rebecchi,Lucia Princiotta Cariddi,Daniela Gallo,Maria Laura Tanda,Elisa Candeloro,Federico Carimati,Alessandro Clemenzi,Paola Banfi,Maurizio Versino,Payam Tabaee Damavandi,Marco Mauri,Marco Gallazzi,Eliana Piantanida

doi:10.3389/fneur.2021.651750

Valentina Rebecchi, Lucia Princiotta Cariddi + Show 11 more

Open Access

https://doi.org/10.3389/fneur.2021.651750

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Abstract

Several studies focused on the role of vitamin D (vitD) in pain chronification. This study focused on vitD level and pain chronification and extension in headache disorders. Eighty patients with primary headache underwent neurological examination, laboratory exams, including serum calcifediol 25(OH)D, and headache features assessment along with three questionnaires investigating depression, anxiety, and allodynia. The 86.8% of the population had migraine (48% episodic and 52% chronic). The 44.1% of patients had extracranial pain, and 47.6% suffered from allodynia. A vitD deficit, namely a serum 25(OH)D level <20 ng/ml, was detectable in 46.1% of the patients, and it occurred more frequently (p = 0.009) in patients suffering from chronic migraine (CM)–medication overuse migraine (MOH) (62.9%) than in episodic migraine (EM, 25.7%) or tension-type headache (TTH, 11.4%). The occurrence of extracranial pain and allodynia was higher in the CM-MOH than in the EM and in the TTH groups but was not related to the co-occurrence of vitD deficiency (Fisher's exact test p = 0.11 and p = 0.32, respectively). Our findings show that 25(OH)D deficit is also related to chronic headache, probably because of vitD anti-inflammatory and tolerogenic properties, reinforcing the idea of a neuroinflammatory mechanism underpinning migraine chronification.

Highlights

Migraine and tension-type headache (TTH) are common disorders, affecting up to 22 and 78% of the population, respectively [1, 2]
Since chronic migraine (CM) was complicated by medication overuse (MOH) in 91% of the cases, the CM and medication overuse headache (MOH) groups were lumped together in the CM-MOH group
The mean age of the CM-MOH group (51.8 years; standard deviation, 11) was slightly but significantly (F = 4.87, p = 0.01) larger than those of the episodic migraineurs (EM) (43.1, 15.4) and of the TTH (40.1, 14.1) groups, and this was reflected by the higher occurrence of menopause in the CM-MOH than in the two other diagnostic groups

Summary

Introduction

Migraine and tension-type headache (TTH) are common disorders, affecting up to 22 and 78% of the population, respectively [1, 2]. Migraine and TTH are generally episodic and regress taking symptomatic treatments, they may become chronic and necessitate prophylaxis. CM may favor the development of a wide spectrum of comorbidities, such as psychiatric and sleep disorders, metabolic alterations, along with other forms of pain and medication overuse headache (MOH), diffuse and persistent pain [matching the Chronic Migraine and Vitamin D. American College of Rheumatology criteria for fibromyalgia (FMS)], chronic fatigue pain, and myofascial and musculoskeletal pain [1]. More than 70% of patients with FMS complain of headache [4,5,6]. The role and the contribution of inflammation and central sensitization have been considered [7]

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