By Louise M. Klebanoff, MD
Assistant Professor of Clinical Neurology, Weill Cornell Medical College
SYNOPSIS: In a large population-based survey, 21.6% of participants reported having severe headaches or migraine. Those reporting severe headaches also reported a lower intake of thiamine and riboflavin, based on 24-hour recall of food intake. There also was an inverse relationship between thiamine intake and reports of severe headaches.
SOURCE: Li D, Guo Y, Xia M, et al. Dietary intake of thiamine and riboflavin in relation to severe headache or migraine: A cross-sectional survey. Headache 2022;62:1133-1142
Severe headaches and migraine are common disabling neurological disorders, more common in women, and estimated to be the fifth leading cause of disability in adults younger than age 50 years worldwide. Diet modification, including the B vitamins, such as thiamine and riboflavin, which are involved in mitochondrial metabolism, have been shown in small series and case reports to reduce migraine disability. The authors used a large nationally representative population sample to identify the prevalence of severe headaches or migraine and the association between dietary thiamine and riboflavin intake with headache history.
The authors used data from the National Health and Nutrition Examination Survey (NHANES), a two-year-cycle national program designed by the Centers for Disease Control and Prevention, to study a cross-section of adults surveyed between 1999 and 2004, the only cycles in which the absence or presence of severe headaches or migraines was addressed. They restricted the inquiry to adults aged 20 years or older, excluding participants without information on severe headache or migraine, resulting in a total of 13,439 subjects for the study. Headaches or migraines were self-diagnosed and reported. Dietary thiamine and riboflavin intake were collected by 24-hour dietary recall interviews.
Of the 13,439 subjects included in the study, 2,745 (21.6%) reported severe headaches or migraines in the past three months. The proportion of females reporting severe headaches or migraines was approximately double that of males. In addition, the subjects reporting headaches had a higher proportion of non-Hispanic Black and Mexican American individuals, were younger, were more likely to have a lower education level, and had a higher body mass index. In this population, headache history was not associated with smoking or other medical comorbidities, such as diabetes, hypertension, coronary artery disease, or stroke.
The average intakes of thiamine and riboflavin were significantly lower among adults with headache (P < 0.0001). Dietary thiamine intake was inversely related to headache history (P = 0.046). This was particularly true in the female subjects and those older than 50 years of age. There was no significant negative association between dietary riboflavin intake and headache (P = 0.367). The lack of association was seen in both genders and across all age groups.
COMMENTARY
This study supports the concept that dietary factors may play a role in the management of migraine and severe headaches. Although the underlying mechanism between dietary thiamine and riboflavin remain uncertain, several previous studies have shown that riboflavin was effective in migraine prevention, and case studies have reported benefits of thiamine on migraine prevention. This study provides support for the benefits of thiamine but was unable to show an association between riboflavin intake and headache.
The study is limited by several factors. Migraine was not medically defined; patients self-reported either severe headache or migraine, which both were included as a positive migraine headache. Although many, if not most, severe headaches reach migraine criteria, having a more definitive diagnosis with specific criteria as well as quantifying the number of headache days per month would be helpful for further study. In addition, dietary intake was determined by 24-hour recall, which can be limited by recall bias.
Further study clearly is warranted. Given the prevalence of migraine and the degree of disability associated with the condition, the higher proportion of migraine in women of childbearing years, which may limit the use of medications for migraine prevention, having additional nutraceuticals shown to reduce migraine disability would be welcomed. Future inquiries should better define migraine with specific diagnostic criteria and headache frequency. Prospective double-blind studies should be considered with specifically defined intakes of thiamine and riboflavin administered to patients who meet migraine criteria.
