Case reports of successful vitamin D treatment of tension headaches

Posted on: March 16, 2016   by  John Cannell, MD

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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.

Prakash S, Makwana P, Rathore C. Vitamin D deficiency mimicking chronic tension-type headache in children. BMJ Case Rep. 2016 Feb 2;2016. pii: bcr2015213833. doi: 10.1136/bcr-2015-213833.

The same authors have reported case series about this before.

Prakash S, Shah ND. Chronic tension-type headache with vitamin D deficiency: casual or causal association? Headache. 2009 Sep;49(8):1214-22. doi: 10.1111/j.1526-4610.2009.01483.x. Epub 2009 Jul 8.

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.

Baseline values:

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.

Prevalence of osteomalacia

Prevalence of osteomalacia on bone biopsy

Some patients diagnosed with fibromyalgia actually have osteomalacia.

Osteomalacia or fibromyalgia?

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.

1 Response to Case reports of successful vitamin D treatment of tension headaches

  1. hlahore@gmail.com says

    Vitamin D treats various types of headaches, including Migraine and Cluster. http://vitamindwiki.com/tiki-index.php?page_id=3437. Increased levels of Magnesium and Zinc also reduce headaches

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