High rates of (treated) hypothyroidism among chronic migraine patients consulting a specialized headache clinic: are we missing something?

DOI: https://doi.org/10.1007/s10072- 021- 05424- 7

Abstract-Summary Roughly three percent of episodic migraine patients evolve into the most burden- some chronic form of this condition every year.

2.5 Hormones

415

We aimed to re-assess the association between hypothyroidism and chronic migraine controlling for factors such as hormone replacement treatment status and bodyweight.

We retrospectively analyzed the medical records of episodic and chronic migraine patients who consecutively consulted our headache clinic in order to determine the prevalence of adequately treated hypothyroidism in each group. Data from 111 migraine patients was included for analysis. Treated hypothyroidism was significantly more prevalent in chronic migraine

patients (29.55%) compared to episodic migraine patients (8.96%).

This association was independent of the patients’ body mass index or other

variables.

Alterations of neuronal metabolism, deficient calcitonin release, or focal inflam- mation causing local hormonal deactivation might explain why hypothyroidism, in spite of is associated with migraine chronification.

levothyroxine replacement

therapy,

Introduction According to the amount and features of headache days experienced by patients every month, migraine can be sub-categorized into an episodic (EM) and chronic forms (CM).

The presence of comorbid obesity (which is common to both hypothyroidism and chronic migraine [14, 86, 165, 179, 181, 265, 361, 363–738]) was not taken into accountin that study and, furthermore, treatment status (i.e., treated, untreated, titra- tion) was also not considered.

The effects of hormone replacement therapy and the possible influence of body- weight on this hypothyroidism-related chronic migraine risk augmentation merit to be better elucidated.

Because of that, and based on our clinical observations, we aimed to retrospec- tively analyze the prevalence of adequately treated hypothyroidism among episodic and chronic migraine patients visiting our specialized headache clinic taking into account possible interference of patients’ bodyweight and other demographic variables.

Materials and Methods Demographic, anthropometric, and clinical variables were then compared between episodic and chronic migraine patients.

A multivariate regression analysis model including sex, age, BMI and hypothy-

roidism as predictors of migraine diagnosis (episodic vs chronic) was built.

In our primary analysis a non-significant difference in the mean age of episodic and chronic migraine patients was observed, we conducted a post hoc case–control supplementary analysis in order to further control for this cofactor.

In this secondary analysis, an investigator blinded to hypothyroidism diagnosis (TCZ) selected age, gender, and BMI matching controls from the episodic migraine sample database to be compared with the “cases” (patients in the chronic migraine group).

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Results Complete data from 111 migraine patients (67 episodic and 44 chronic, 39 (88.6%) with current medication overuse (ICHD-III code 8.2)) fulfilling inclusion criteria were available for analysis.

Treated hypothyroidism (dose stable) was significantly more prevalent among chronic migraine patients (29.55%) than in episodic migraine patients (8.96%; χ = 7,937, p < 0.01), with an estimated odds ratio of 4.26 (95% confidence interval = 1.48 to 12.30).

From all the variables included in the model, only the presence of hypothyroid- ism reached statistical significance (p = 0.01) as a predictor of migraine diagnosis (i.e., chronic or episodic).

Discussion Our results corroborate the contribution of hypothyroidism to migraine chronifica- tion previously described [739] and, in addition, demonstrate that this risk factor persists in spite of adequate thyroid hormone replacement therapy.

Our findings show that this association is independent of the patients’ body weight and, considering that most chronic migraine patients in our study also ful- filled the current criteria for medication overuse headache, suggest that this compli- cation can also be related to hypothyroidism, which was not fully clear before [739]. A study including 8788 patients followed during 20 years found that individuals with possible migraine had a 41% increased risk for developing hypothyroid- ism [740].

In spite of these limitations, our study provides valuable information that helps to clarify the role of hypothyroidism as a risk factor for migraine chronification which, although previously associated with burdensome migraine forms in the past, receives perhaps too little attention nowadays [122, 741].

Acknowledgement A machine generated summary based on the work of Filipchuk, Marcelo; Gassmann, Jesica; Castro Zamparella, Tatiana; Tibaldo, Maria Cecilia; Carpinella, Mariela; Sesto Tagliavini, Pablo; Scarnato, Pablo; Goicochea, Maria Teresa; Bruera, Osvaldo; Conci Magris, Diego Martin; Lisicki, Marco. 2021  in Neurological Sciences.

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Chapter 3 Diagnosis

Introduction The undeniable clarity of the migraine diagnostic process must be chained to a deep understanding of the classification and the skills useful for unravelling the inter- twining of comorbidities or co-occurrences. Even the process of using the often redundant neuroimaging, useful only to support the suspicion of a secondary head- ache, has its own worth of reading in the course of a multi-faceted pathology. The risky shadow of acute drug overuse, that factually complicates the natural process of evolution into a chronicity phase, can and should also be read as attitude of a subset of migraineurs towards addiction.

Machine-Generated Summaries 1. Diagnosis

Machine generated keywords: moh, child, medication, brain, overuse, cerebral, functional, medicationoveruse, medicationoveruse headache, tth, moh patient, aura, matter, score, volume.

3.1

Classification

Machine generated keywords: ichd, machine, classifier, algorithm, ichd beta, child, beta, class, typical, european, interview, expert, headache clinic, cranial, referral.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 P. Martelletti (ed.), Migraine in Medicine, https://doi.org/10.1007/978-3-030-97359-9_3

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European headache federation consensus on the definition of resistant and refractory migraine