Migraine and tension headache comorbidity with hypothyroidism in Egypt

DOI: https://doi.org/10.1186/s41983- 020- 00208- w

Abstract-Summary Subclinical and overt hypothyroidism were significantly higher in patients with migraine and TTH (P = 0.001) than control subjects.

Patients with migraine and TTH showed significantly more abnormal thyroid

gland morphology than healthy control (p = 0.027).

Patients having migraine and TTH more prone to develop hypothyroidism when

compared with control group.

Patients with chronic TTH are susceptible to develop hypothyroidism (either subclinical or overt) when compared with patients having frequent or infre- quent TTH.

Extended: Subclinical and overt hypothyroidism were significantly higher in our

patients more than control (p = 0.001).

Patients with migraine headache were diagnosed according to the International

Classification of Headache Disorders (ICHD)-III beta criteria [435].

Patients with migraine or TTH had 3.73 times higher odds to exhibit hypothy-

roidism (BLR = 1.316, 95% CI = 1.82-7.64, p = 0.001).

Introduction Migraine and tension type headache (TTH) disorders are among the top six most prevalent disorders and the third cause of disability worldwide in individuals under the age of 50 with a major impact on activities of daily living and quality of life [436, 437].

Tension-type headache (TTH) is defined as a mild to moderate band-like pres-

sure headache associated with some somatic and emotional symptoms.

Hypothyroidism represents one of non-neurological comorbidities of migraine. Many studies defined a bidirectional relationship between migraine, TH, and

hypothyroidism including underlying pathophysiological aspects.

The purpose of this study was to investigate the potential association between

hypothyroidism in patients with migraine and tension headache.

Subjects and Methods Patients with migraine headache were diagnosed according to the International Classification of Headache Disorders (ICHD)-III beta criteria [435].

Patients with tension type headache was diagnosed according to the International

Classification of Headache Disorders (ICHD)-III beta criteria [86].

Completely normal laboratory tests (complete blood count, creatinine, liver function tests) Exclusion criteria included patients that were beyond the range of 18-55 years, showed abnormal neurological examination, and or had chronic illness known to affect thyroid dysfunction (chronic kidney disease, psychiatric disorders) were excluded from the study.

2.3 Comorbidities

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To compare quantitative data for two groups, independent-samples t test was used for normally distributed data in both groups with no significant outliers other- wise the alternative non-parametric test (Mann-Whitney U test) was used.

To compare quantitative data for >two groups, one-way ANOVA test was used for normally distributed data in all groups with no significant outliers otherwise the alternative non-parametric test (Kruskal-Wallis H test) was used.

Results Subclinical and overt hypothyroidism were significantly higher in our patients more than control (p = 0.001).

Binary logistic regression (BLR) analysis was run to assess the influence of hav- ing migraine or TTH versus no headache on the likelihood that participants will exhibit hypothyroidism (subclinical or overt).

Logistic regression analysis was also run to assess the influence of having chronic tension headache vs other types (frequent and infrequent) on the likelihood that participants will exhibit hypothyroidism (subclinical or overt).

Migraine patients were significantly younger than tension type headache patients

(p = 0.001). Using

intragroup comparative statistics, hypothyroidism

is significantly expressed in chronic TTH more than TTH with infrequent or even frequent attacks (p = 0.009).

Discussion The female preponderance in our study was consistent with Khan and his colleagues which found higher prevalence of both migraine and TTH in patients with hypothy- roidism [438].

We have found in our study of 212 patients (migraine and tension headache) that there was significantly higher proportion with subclinical (23.3%) and overt hypo- thyroidism (6%), as compared to the control subjects of 9% and 1%.

The subclinical and overt hypothyroidism prevalence in our patients with migraine and tension headache were also higher than that reported in the general population.

Regarding sub analysis of migraine patients, there were no significant differ- ences between migraine with aura, migraine without aura, or chronic migraine as regards thyroid function or morphology (p = 0.137 and p = 0.468 respectively) and this is consistent with a recent Russian study who reported negative results regard- ing comorbidities of migraine and hypothyroidism with abnormal levels of TSH in only 5% of their migraine patients.

Conclusion The limited number of patients and control (small sample size) beside we did not recruit other cases of primary headache disorder may be a limitation of our study.

Study the response of patients suffering from migraine or tension headache using conventional measures and having hypothyroidism when controlling thyroid function.

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2 Mechanisms

Sufficient number of patients with migraine, tension headache and control sub-

jects for detection the accurate relationship.

Study the relationship between other types of primary headache disorders and

hypothyroidism.

Study if there is relationship between primary headache disorders and thyroid

dysfunction whether hypo or hyperthyroidism.

Acknowledgement A machine generated summary based on the work of Abou Elmaaty, Ali A.; Flifel, Mohamed E.; Belal, Tamer; Zarad, Carmen A. 2020  in The Egyptian Journal of Neurology, Psychiatry and Neurosurgery.

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