Treating Subclinical Hypothyroidism May Help Migraine

Pauline Anderson

July 05, 2017

AMSTERDAM — Patients with migraine who have subclinical hypothyroidism and receive thyroid treatment have significantly fewer and less severe headaches, new research shows.

"To the best of our knowledge, this is the first study showing that treatment of subclinical hypothyroidism was effective in reducing both the frequency and severity of migraine attacks and improved the quality of life in patients," said study investigator Antonasia Bougea, PhD, Department of Neurology, National and Kapodistrian University of Athens Medical School and Eginition Hospital, Athens, Greece.

The results suggest that patients with migraine should undergo thyroid function tests, said Dr Bougea.

The findings were presented here at the Congress of the European Academy of Neurology (EAN) 2017.

"A Matter of Debate"

The association between migraine and thyroid disease is still "a matter of debate," Dr Bougea told conference delegates. Treatment for hypothyroidism is effective in the relief of headaches, but data are "largely lacking" on treating the subclinical form of hypothyroidism, she said.

Between 0.04% and 1.3% of migraineurs have subclinical hypothyroidism.

The cross-sectional study included 45 consecutive patients with migraine without aura and with subclinical hypothyroidism, attending a single outpatient headache clinic from January 2015 to February 2016.

Subclinical hypothyroidism was defined as thyroid-stimulating hormone (TSH) greater than 4.5 mU/L and normal thyroxine (T4) levels of 4.5 to 13 µg/dL.

The mean age of study patients was 62 years; 52% were men. About a quarter (24%) had hypertension, and 15% had a family history of thyroid disease. The mean TSH was 10.6 mU/L and the mean free T4 was 8.2 µg/dL.

Researchers obtained sociodemographic information and migraine data from diaries and the eight domains of the Greek version of the Short-form General Headache Survey (SF-36).

The primary outcome was the effect of levothyroxine, 50 to 100 mg per day, on severity by using the visual analog scale score (which ranges from 1 to 10) and monthly frequency of migraine at 2 months.

The study excluded patients with other primary headaches, any chronic illness known to affect thyroid hormone levels, long-term intake of drugs known to affect thyroid status, and psychiatric comorbidity.

The analysis showed that migraine severity was significantly reduced from a mean of 6.54 to 1.23 (P = .001). In addition, the monthly migraine frequency was reduced from a mean of 14.68 to 1.86  (P < .001).

The duration of migraines was also decreased from a mean of 186 hours to 1.44 hours (P = .09).

These results "are important," said Dr Bougea. "Improvement after levothyroxine has not yet been recorded."

A comparison of domains of the SF-36 showed that the treatment also had a positive effect on quality of life, including such areas as limitations due to physical health or emotional problems.

Sustained Effect

Dr Bougea reported that at 10-month follow-up, the frequency and severity of migraine were "stable" and the "good results were maintained."

She also reported on a control group of patients with migraine and subclinical hypothyroidism who were not treated with levothyroxine.

She noted that the control group had significantly poorer headache parameters than the study group. These parameters included mean severity, mean monthly frequency, and mean duration of migraine (in hours) (all P < .001).

However, she noted that this was not a randomized controlled trial.

During a question-and-answer session, Manjit Matharu, PhD, Headache Group, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom, commented that the study "is very useful for hypothesis generation."

However, said Dr Matharu, "on its own, it's not sufficient to start treating patients because there could be a very large placebo response there."

Follow-up with a placebo-controlled study will be needed "before this can become clinical practice," he said.

Now that she and her colleagues have positive results, such a clinical trial "is our next step," said Dr Bougea.

Dr Bougea has disclosed no relevant financial relationships.

Congress of the European Academy of Neurology (EAN) 2017. Abstract O4111. Presented June 27, 2017.

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