Tension headaches are the bane of existence for primary care providers and neurologists. Tension headaches affect about 1.4 billion people (20.8% of the population) and are more common in women than men (23% to 18% respectively). Tension-type headache pain is often described as a constant pressure, as if the head were being squeezed in a vise. The pain is frequently present on both sides of the head at the same time. Tension-type headache pain is typically mild to moderate, but may be severe. Amitriptyline (Elavil), a drug that affects the balance of certain neurotransmitters in the brain, is the most effective preventative of tension headaches.
Now, a group out of India led by Dr. Sanjay Prakash, describe three older children whose headaches were associated with vitamin D deficiency and were much improved when vitamin D was given.
The same authors have reported case series about this before.
In fact, Dr. Prakash has made a good argument that in some patients, tension headaches are actually caused from osteomalacia of the skull.
Prakash S, Kumar M, Belani P, Susvirkar A, Ahuja S. Interrelationships between chronic tension-type headache, musculoskeletal pain, and vitamin D deficiency: Is osteomalacia responsible for both headache and musculoskeletal pain? Ann Indian Acad Neurol. 2013 Oct;16(4):650-8. doi: 10.4103/0972-2327.120487.
In the most current cases series, three girls presented with tension headaches and severe vitamin D deficiency.
|Findings:||Patient 1||Patient 2||Patient 3|
|Serum 25(OH) vitamin D||very low 4.2 ng/mL||very low 6.6 ng/mL||very low 7.8 ng/mL|
|Serum calcium||Low (7.6 mg/100 mL)||Low (7.8 mg/100 mL)||Low 7.4 mg/100 mL|
|Serum phosphorus||Low (2.6 mg/100 mL)||Low (2.5 mg/100 mL)||Low 2.4 mg/100 mL|
|Serum alkaline phosphatase||Raised (188 IU/L)||Raised (214 IU/L)||Raised 208 IU/L|
|Serum parathyroid hormone (PTH)||Raised (226 pg/mL)||Raised (136 IU/L)||Raised 216 pg/mL|
|Bone and muscle tenderness||Present||Present||Present|
All three patients were diagnosed with osteomalacia and treated with 2,000 IU/day of vitamin D3 and 500 mg/day of calcium. Osteomalacia is adult rickets and is much more common than we think.
These children should have had x-rays of the distal radius and ulna to see if they had any x-ray evidence of rickets, but that would not have changed treatment.
Some patients diagnosed with fibromyalgia actually have osteomalacia.
These 3 young people were lucky they had doctors who checked vitamin D, calcium, phosphorus, alkaline phosphatase and parathyroid hormone (PTH). Some, if not all, of these tests will be abnormal in osteomalacia.