In-Focus: Headache and Migraine

Vitamin D Deficiency Tied to Headache

Decreased vitamin D levels appear to be linked with chronic tension-type headache (CTTH), according to results from a new study. In a case-control study, investigators evaluated 100 adult patients with CTTH and 100 matched healthy controls and found that serum 25(OH) D levels were significantly lower in CTTH patients than in the controls. Additionally, the prevalence of vitamin D deficiency (defined as less than 20 ng/mL) was greater in patients with CTTH (71 percent vs. 25 percent). CTTH patients also had a significantly high prevalence of musculoskeletal pain, muscle weakness, muscle tenderness score, and bone tenderness score in comparison to controls. The authors noted a strong positive correlation between serum vitamin D levels and total muscle tenderness score and total bone tenderness score. They concluded that intervention studies are required to find out if supplementation of vitamin D is effective in patients with CTTH.

—Headache. 2017, May 3

Ibuprofen and Lorazepam Found Effective in Acute Migraine

The combination of ibuprofen and lorazepam is effective in alleviating symptoms of acute migraine, new findings suggest. Researchers examined 90 patients with an average of two to six attacks per month and an initial diagnosis of migraine based on the International Headache Society (IHS) criteria. The first group was administered 200mg Ibuprofen capsules, the second group 400mg Ibuprofen capsules and the third group a combination of 200mg Ibuprofen capsules and 1mg Lorazepam tablets. All three treatment regimens reduced the severity of headache significantly in patients. However, the combination therapy produced the lowest mean severity of headache, according to the investigators.

— Electron Physician. 2017, Mar 25;9(3): 3912-3917

Hypothalamus Discovered to Play a Role in the Pathophysiology of Chronic Migraine

The hypothalamus plays a crucial role in the pathophysiology of migraine chronification and acute pain stage of migraineurs, according to new research. To identify pathophysiologic mechanisms of migraine chronification, researchers evaluated 18 migraineurs (EMs), 17 chronic migraineurs (CMs), and 19 healthy controls (HCs) who underwent painful ammonia stimulation of the left nostril in a 3T MRI scanner. Using brainstem-optimized protocol for high-resolution echo-planar imaging, they detected a significantly stronger activation of the anterior right hypothalamus in CMs compared to HCs. To exclude the headache as a prime mediator of the hypothalamic activations, they compared all migraineurs with headaches (EMs and CMs) to all migraineurs without headaches (EMs and CMs) and to HCs in a second analysis and found the more posterior region of the hypothalamus to be more activated bilaterally during headaches. “While the more posterior part of the hypothalamus seems to be important for the acute pain stage, the more anterior part seems to play an important role in attack generation and migraine chronification,” the authors wrote.

—Neurology. 2017, Apr 26