Evaluation of the relationship between the frequency of attacks and vitamin levels in patients admitted to the emergency department with migraine headache

Abstract

Introduction: Migraine is a common multifactorial, neurovascular primary headache disorder that develops due to the increased excitability of the central nervous system (CNS) and causes limitations in the quality of life of individuals. In this study, it was aimed to evaluate the relationship between the frequency of attacks and vitamin levels of patients who had migraine attacks and presented to the emergency department with a migraine attack. Method: The study is a retrospective cross-sectional study. 54 patients who were diagnosed with migraine headache according to the International Headache classification between January 1, 2019, and January 1, 2020, in the Emergency Medicine clinic of Yozgat Bozok University (Group 1). There was no history of systemic diseases such as diabetes mellitus, hypertension, heart disease, or goiter. The control group consisted of individuals who were examined for a general medical examination during the same period, whose migraine history was not in their anamnesis and history, and who did not receive vitamin supplements (Group 2). Mann-Whitney U test was used in statistical evaluations according to the status of the statistically nonparametric variables and the correlated variables were categorical (nominal or ordinal) and numerical independent group. Spearman rank correlation method was used in nonparametric data for correlations between data. The results were evaluated for a significance level of p <0.05. Results: A total of 51.4% (n = 54) migraine patients (Group 1) and 48.6% (n = 51) healthy control group (Group 2) were included in the study. Of group 1 patients, 85.7% (n = 46) were female and 14.3% (n = 8) were male. Vitamin B12, Folate and Vitamin D levels were significantly lower in Group 2 (<0.05). While there was a moderate negative correlation with vitamin D level, there was a weak negative correlation with vitamin B12 and Folate parameters (<0.05). Vitamin D level was found to be significantly lower in migraine patients with aura in the migraine patient group (<0.05). Conclusion: Especially vitamin D, vitamin B12, and folate levels have an important place among the causes of migraine headaches. Besides, we think that low Vitamin D level is important in migraine-type with aura. Therefore, prospective studies are needed, especially on vitamin D and migraine subgroups.

Keywords

• vitamin D,vitamin B12
• Migraine
• emergency department

References

1. 1. Graham JR, Wolff HG. Mechanism of migraine headache and action of ergotamine tartrate. Arch Neurol Psychiatry. 1938;39(4):737-63.
2. 2.Chen ZY, Chen XY, Liu MQ, et al. Altered functional connectivity of amygdala underlying the neuromechanism of migraine pathogenesis. J Headache Pain 2017;18:1-8.
3. 3. Charles A. The evolution of a migraine attack – a review of recent evidence. Headache 2013;53:413-19.
4. 4.Vetvik KG, MacGregor EA. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol 2017;16:76-87.
5. 5. Uggetti C, Squarza S, Longaretti F, et al. Migraine with aura and white matter lesions: an MRI study. Neurol Sci 2017;38:11-13.
6. 6. Adams J, Barbery G, Lui CW. Complementary and alternative medicine use for headache and migraine: a critical review of the literature. Headache 2013;53:459-73.
7. 7. Prakash S, Kumar M, Belani P, et al. Interrelationships between chronic tension-type headache, musculoskeletal pain, and vitamin D deficiency: is osteomalacia responsible for both headache and musculoskeletal pain? Ann Indian Acad Neurol 2013;16:650-8.
8. 8. Thomsen LL, Iversen HK, Brinck TA et al (1993) Arterial supersensitivity to nitric oxide (nitroglycerin) in migraine sufferers. Cephalalgia 13(6):395–399.

9. 9. Gazerani P, Fuglsang R, Pedersen JG, Sørensen J, Kjeldsen JL, Yassin H, Nedergaard BS. A randomized, double-blinded, placebo-controlled, parallel trial of vitamin D3 supplementation in adult patients with migraine. Curr Med Res Opin. 2019 Apr;35(4):715-723. doi: 10.1080/03007995.2018.1519503.
10. 10. Wheeler S. Vitamin D Deficiency in Chronic Migraine: S33. Headache. 2008;48.
11. 11. Şarkı TJ, Chu MK, Sohn JH, Ahn HY, Lee SH, Cho SJ. D Vitamini Eksikliğinin Migrende Baş Ağrısı Sıklığına Etkisi. J Clin Neurol . 2018; 14 (3): 366-373. doi: 10.3988 / jcn.2018.14.3.366.
12. 12. Song TJ, Chu MK, Sohn JH, Ahn HY, Lee SH, Cho SJ. Effect of Vitamin D Deficiency on the Frequency of Headaches in Migraine. J Clin Neurol. 2018;14(3):366-373. doi:10.3988/jcn.2018.14.3.366.
13. 13. Motaghi M, Haghjooy Javanmard S, Haghdoost F, Tajadini M, Saadatnia M, Rafiee L, et al. Relationship between vitamin D receptor gene polymorphisms and migraine without aura in an Iranian population. BioMed research international. 2013;2013: 351942
14. 14. Aydin H, Bucak IH, Geyik M. Vitamin B12 and folic acid levels in pediatric migraine patients. Acta Neurol Belg. 2020 Sep 21. doi: 10.1007/s13760-020-01491-3. Epub ahead of print. PMID: 32955709.
15. 15. Kaiser EA, Russo AF. CGRP and migraine: could PACAP play a role too? Neuropeptides. 2013;47(6):451-61. doi: 10.1016/j.npep.2013.10.010.