Hypocalcemia and Vitamin D Deficiency amongst Migraine Patients: A Nationwide Retrospective Study.

Background and Objectives: Inadequate vitamin D and calcium intake have been linked to many health issues including chronic headaches. Some studies suggested an association between low vitamin D levels and increase the risk of frequent headaches in middle-aged and older men; however, no single study reported the role of these deficiencies in migraine patients. We aimed to investigate the association of hypocalcemia and vitamin D deficiency with migraine hospitalizations. Materials and Methods: A population-based retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) (years 2003-2014) in migraine hospitalizations was performed. The prevalence, demographic characteristics and All Patient Refined Diagnosis Related Groups severity/disability association were compared in patients with hypocalcemia and vitamin D deficiency to those without deficiencies, using ICD-9-CM codes. Weighted analyses using Chi-Square, paired Student's t-test, and Cochran-Armitage trend test were performed. Survey logistic regression was performed to find an association between deficiencies and migraine hospitalizations and deficiency induced disability amongst migraineurs. Results: Between years 2003 and 2014, of the total 446,446 migraine hospitalizations, 1226 (0.27%) and 2582 (0.58%) presented with hypocalcemia and vitamin D deficiency, respectively. In multivariable analysis, hypocalcemia [Odds Ratio (OR): 6.19; Confidence Interval (CI): 4.40-8.70; p < 0.0001] and vitamin D deficiency (OR: 3.12; CI: 2.38-4.08; p < 0.0001) were associated with markedly elevated odds of major/extreme loss of function. There was higher prevalence (3.0% vs. 1.5% vs. 1.6%; p < 0.0001) and higher odds of migraine among vitamin D deficiency (OR: 1.97; CI: 1.89-2.05; p < 0.0001) patients in comparison to patients with hypocalcemia (OR: 1.11; CI: 1.03-1.20; p = 0.0061) and no-deficiency, respectively. Conclusions: In this study, we demonstrated a significant association between hypocalcemia and vitamin D deficiency with migraine attacks and deficiency induced loss of function among migraineurs. Early preventive measures may reduce the disability in migraineurs.

A Comprehensive Assessment of Vascular and Nonvascular Risk Factors Associated with Migraine.

INTRODUCTION:  Migraine is a chronic disabling neurological disease, with an estimated expense of $15-20 million/year. Several studies with a small number of patients have studied risk factors for migraine such as cardiovascular disorders, stroke, smoking, demographic, and genetic factors but this is the first comprehensive study for evaluation of vascular and nonvascular risk factors. It is important to evaluate all the risk factors that help to prevent the healthcare burden related to migraine.  Methodology: We performed a retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) (years 2013-2014) in adult (>18-years old) hospitalizations in the United States. Migraine patients were identified using ICD-9-CM code to determine the demographic characteristics, vascular, and nonvascular risk factors. Univariate analysis was performed using the chi-square test and a multivariate survey logistic regression analysis was performed to identify the prevalence of the risk factors and evaluate the odds of prevalence of risk factors amongst migraine patients compared to nonmigraine patients, respectively. RESULTS:  On weighted analysis, after removing missing data of age, gender and race, from years 2013 to 2014, of the total 983,065 (1.74%) migraine patients were identified. We found that younger (median age 48-years vs. 60-years), female (82.1% vs. 58.5%; p<0.0001), white population (76.8% vs. 70.5%; p<0.0001), and privately insured (41.1% vs. 27.4%; p<0.0001) patients were more likely to have migraine than others. Cerebral atherosclerosis, diabetes mellitus, ischemic heart disease, atrial fibrillation, and alcohol abuse were not significantly associated with migraine. Migraineurs had higher odds of having hypertension [odds ratio (OR): 1.44; 95% confidence interval (CI): 1.43-1.46; 44.49% vs. 52.84%], recent transient ischemic attack (TIA) (OR: 3.13; 95%CI: 3.02-3.25; 1.74% vs. 0.67%), ischemic stroke (OR: 1.40; 95%CI: 1.35-1.45; 2.06% vs. 1.97%), hemorrhagic stroke (OR: 1.11; 95%CI: 1.04-1.19; 0.49% vs. 0.46%), obesity (OR: 1.46; 95%CI: 1.44-1.48; 19.20% vs. 13.56%), hypercholesterolemia (OR: 1.33; 95%CI: 1.30-1.36; 5.75% vs. 5.54%), substance abuse (OR: 1.51; 95%CI: 1.48-1.54; 7.88% vs. 4.88%), past or current consumption of tobacco (OR: 1.40; 95%CI: 1.38-1.41; 31.02% vs. 27.39%), AIDS (OR: 1.13; 95%CI: 1.04-1.24; 0.33% vs. 0.41%), hypocalcemia (OR: 1.09; 95%CI: 1.03-1.14; 0.77% vs. 0.89%), and vitamin D deficiency (OR: 1.93; 95%CI: 1.88-1.99; 2.47% vs. 1.37%) than patients without migraine. Female patients were at a higher risk of migraine (OR: 3.02; 95%CI: 2.98-3.05) than male. CONCLUSION:  In this study, we have identified significant risk factors for migraine hospitalizations. Early identification of these risk factors may improve the risk stratification in migraine patients.