L. Rapisarda, M. Mazza, Federico Tosto
Jun 1, 2018
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Influential Citations
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Quality indicators
Journal
Neurological Sciences
Abstract
It is well recognized that vitamin D deficiency is involved in a number of neurological disorders. In the last years, several studies gave evidence of the relationship between chronic pain and vitamin D deficiency. Recently, a few studies investigated on the association between vitamin D deficiency and migraine [1]. However, if the serum vitamin D levels correlate with severity of migraine remains uncertain. The aim of this study was to investigate if the severity of vitamin D deficiency correlates with the frequency of headaches in migraine patients. In this prospective study, we enrolled 171 consecutive headache sufferers who attended the Institute of Neurology in Catanzaro from 2014 to 2017. We selected those patients with a primary headache (migraine or tension-type headache) diagnosed according to IHS diagnostic criteria, excluding subjects with trigeminal autonomic cephalalgias, patients already receiving a vitamin D supplement. Therefore, we excluded 37 patients as they did not respect our inclusion criteria or dropped out. We included 134 headache sufferers (22 men, 112 women; mean age: 41.4 ± 12.8 years) and 38 healthy controls (16 men, 22 women; mean age 47.6 ± 13.6 years). Each patient underwent a careful neurological evaluation. The frequency of headache was measured using a monthly headache diary recorded for 3 months by the headache sufferers; pain and disability were assessed with a 0–10 visual analogue scale (VAS) and Migraine Disability Assessment (MIDAS) questionnaire; allodynia was estimated through the validated 12-item allodynia symptom check lists (ASC-12) administered during an headache attack; depression and anxiety were assessed with Beck Depression Inventory-II (BDI-II) and Hamilton Anxiety Rating Scale (HARS). It has also been evaluated the presence ofmedical overuse. All participants underwent a venous blood sampling for 25-hydroxyvitamin D. It has been considered sufficient for 25-hydroxyvitamin D levels higher than 30 ng/ ml; insufficient for 25-hydroxyvitamin D values between 20 and 30 ng/ml; and deficient for 25-hydroxyvitamin D levels lower than 20 ng/ml. According to headachemonthly frequency, we grouped our patients into two groups: group 1 included 100 patients (16 males, 84 females; mean age 41.4 ± 13.5 years) with chronic migraine (patients with more than 15 headache days monthly); group 2 included 34 patients (6 males, 28 females; mean age 39.8 ± 11.9 years) with episodic migraine (patients with less than 15 headache days monthly). Statistical analysis was performed using the Statistical Package for Social Science software (SPSS, v20.0, Chicago, IL, USA) for Macintosh. First, we demonstrated that headache sufferers had a severe vitamin D deficiency compared to the healthy subjects, mainly in group 1. Indeed, there was a significant difference among groups: serum 25-hydroxyvitamin D mean values were 12.7 ± 5.1 in the first group, 17.2 ± 4.0 in the second group, and 23.0 ± 6.4 in the healthy control group (p < 0.001). Nevertheless, a moderate insufficiency was revealed even in the control group, which is consistent with epidemiological data that give evidence that vitamin D insufficiency is not an unusual finding at our latitude. Moreover, comparing the two groups of headache sufferers, chronic migraneurs had a higher percentage of medication overuse (61 and 15% respectively, p < 0.001) and higher disability (MIDAS score: 36.5 ± 17.2 and 9.6 ± 7 respectively, p < 0.001). No statistically relevant differences were reported among the other clinical parameters. Then it has been evaluated if headache frequency might be directly related to serum 25-hydroxyvitamin D levels. Our data gave evidence that there is a linear negative relationship * Francesco Bono f.bono@unicz.it