Chronic Tension-type Headache with Vitamin D Deficiency: Casual or Causal Association?

Sanjay Prakash, DM; Nilima D. Shah, MD


Headache. 2009;49(8):1214-1222. 

In This Article

Abstract and Introduction


The prevalence of tension-type headache and vitamin D deficiency are both very high in the general population. The inter-relations between the two have not been explored in the literature. We report 8 patients with chronic tension-type headache and vitamin D deficiency (osteomalacia). All the patients responded poorly to conventional therapy for tension headache. The headache and osteomalacia of each of the 8 patients responded to vitamin D and calcium supplementation. The improvement in the headache was much earlier than the improvements in the symptom complex of osteomalacia. We also speculate on the possible mechanisms for headache in the patients with vitamin D deficiency.


Tension-type headache (TTH) is the most common type of primary headache. It is a featureless headache that is characterized by nothing more than a pain in the head, and is diagnosed mainly by the absence of features described in other types of headache.[1] Because of the lack of disease specific features, several secondary headaches may mimic TTH.[1,2] However, secondary causes of headache are not well described in the literature.

Vitamin D deficiency constitutes a largely unrecognized epidemic in many populations worldwide. A total of 40–100% US and European elderly men and women may have vitamin D deficiency.[3] Vitamin D deficiency is associated with various types of disorders such as musculoskeletal disorder (rickets, osteomalacia, osteoporosis, myopathy), carcinoma (at least 17 carcinomas, such as carcinoma of the breast, prostate, colon, ovary, pancreas, etc), autoimmune disorders (diabetes mellitus, multiple sclerosis, osteoarthritis, rheumatoid arthritis, Crohn's disease, etc), cardiovascular disorders (hypertension, congestive heart failure, myocardial infarction), kidney disorders, psychiatric disorders (depression, schizophrenia), skin disorders (psoriasis), etc.[3,4]

The inter-relations of vitamin D deficiency with headache have not been explored. Here we report 8 patients in whom chronic tension-type headache (CTTH) was associated with vitamin D deficiency.


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