July 6, 2010 (Los Angeles, California) — Patients with headache and migraine may need to have their vitamin D levels assessed, report researchers. Preliminary findings released here at the American Headache Society (AHS) 52nd Annual Scientific Meeting reveal low vitamin D levels in these patients, with levels similar to those found in patients with chronic pain.
"This potential biomarker should be studied in double-blind trials both for epidemiological and clinical reasons and for potential treatment effects," said presenter John Claude Krusz, MD, from Anodyne Headache and Pain Care in Dallas, Texas. "Vitamin D may play some yet unknown role in multiple painful and possibly headache and migraine disorders."
Researchers measured serum vitamin D levels in 900 patients and included 100 of these in the current analysis. About half of the patients had new migraine and headache (n = 55). The remaining patients had chronic pain disorders, including fibromyalgia, rheumatic, and neuropathic pain disorders (n = 45).
|Investigators report low levels similar to those found in patients with chronic pain.|
The average vitamin D level in patients with predominantly headache and migraine was 26.3 ng/mL. This compared to a mean vitamin D level of 25.2 ng/mL in chronic pain patients with no headache (P < .80).
These findings mirror those of another AHS poster presentation from 2008. In that study, Steven Wheeler, MD, from the Ryan Wheeler Headache Treatment Center in Miami, Florida, found low vitamin D levels in patients with migraine.
"Unfortunately, that study included a significant percentage of patients with coexistent pain disorders as well," Dr. Krusz told Medscape Medical News. "We tried to separate, as much as possible, headache and migraine patients from those with chronic pain syndromes in order to measure and document vitamin D in both groups individually."
In the current study, 15% of those in the headache and migraine group had other transient pain disorders in their medical history. "But not at the time their vitamin D levels were measured," Dr. Krusz said.
He acknowledges this is a small study and neither group was compared to people without these clinical conditions.
"I screen everyone," Dr. Krusz said, "and treat when the levels fall below the blue line" (see graph). "I think there are probably about 5 Nobel prizes to be won in this area. There's still so much we don't know."
|Dr. John Claude Krusz|
Treat Vitamin D Deficiency
John Cannell, MD, executive director of the Vitamin D Council in San Luis Obispo, California, echoes this view. "We propose vitamin D deficiency syndrome exists when 25-hydroxyvitamin D levels of less than 50 ng/mL are found in patients with 2 or more of the following conditions: osteoporosis, heart disease, hypertension, autoimmune diseases, certain cancers, depression, chronic fatigue, or chronic pain."
The Vitamin D Council is a nonprofit organization set up to educate the public and professionals about vitamin D deficiency. The Vitamin D Council's recommendation of 50 ng/mL is a little lower than the current investigators cutoff of 60 ng/mL.
Dr. Cannell says that deficiency is more common among people with dark skin, elderly individuals, and those who avoid the sun. He suggests that vitamin D is safe when used in physiologic doses of at least 5000 IU/day from all sources, including sunlight, diet, and supplements.
Dr. Cannell points out that vitamin D hypersensitivity can occur in patients with primary hyperparathyroidism, occult cancers — especially lymphoma — or granulomatous disease such as sarcoidosis. "In such cases," he notes, "treatment of vitamin D deficiency should be done under the care of a knowledgeable physician."
The researchers have disclosed no relevant financial relationships.
American Headache Society (AHS) 52nd Annual Scientific Meeting: Poster 51. Presented June 26, 2010.
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Cite this: Vitamin D Low in Patients With Headache and Migraine - Medscape - Jul 06, 2010.