Primary headache subtypes and thyroid dysfunction: Is there any association?

Abstract

Background: Primary headaches, and particularly migraine and tension-type headache (TTH) as well as hypothyroidism are common medical conditions. To date, numerous studies have suggested a possible bidirectional relationship between migraine and hypothyroidism, although certain studies had contradictory results. Objective: To investigate whether there is any association between primary headache subtypes and thyroid disorders. Methods: A retrospective study of consecutive patients aged ≥18 years referred to the Headache Outpatient Clinic of Aeginition Hospital and diagnosed with primary headache and any thyroid disorder. Results: Out of 427 patients (males/females=76/351), 253 (59.3%) were diagnosed with migraine without aura, 53 (12.4%) with TTH, 49 (11.5%) with migraine with aura, 29 (6.8%) with medication-overuse headache, 23 (5.4%) with mixed-type headache (migraine with/without aura and TTH), nine (2.1%) with cluster headache, and 11 (2.6%) with other types of primary headaches. The prevalence of any type of thyroid disorder was 20.8% (89/427 patients). In the total sample, 27 patients (6.3%) reported hypothyroidism, 18 (4.2%) unspecified thyroidopathy, 14 (3.3%) thyroid nodules, 12 (2.8%) Hashimoto thyroiditis, 12 (2.8%) thyroidectomy, three (0.7%) thyroid goiter, and three (0.7%) hyperthyroidism. Further statistical analysis between categorical variables did not reveal any significant association between headache subtypes and thyroid dysfunction. Conclusions: No specific association was found between primary headache subtypes and specific thyroid disorder. However, a high prevalence of thyroid dysfunction in general and specifically hypothyroidism was demonstrated among patients with primary headaches, which lays the foundation for further clarification in prospective longitudinal studies.

Orofacial pain considerations in autoimmune disorders: narrative review

“…There is uncertainty on association of thyroid disorders and headaches with some studies reporting no association and other studies reporting a higher prevalence of primary headache disorders such as migraine in patients with thyroid dysfunction; primarily hypothyroidism (29)(30)(31)(32).…”

Migraine and thyroid dysfunction: Co‐occurrence, shared genes and biological mechanisms

“…Observational epidemiological studies indicate an increased cooccurrence of migraine and thyroid dysfunction [19][20][21][22][23][24][25][26][27][28][29][30]. For example, some recent studies have reported an increased chance of hypothyroidism onset in cases with migraine/headache disorders [19][20][21][22][23].…”

“…The strengths of the reviewed studies include the following: (i) the majority of the migraine studies utilized standardized diagnostic criteria using the International Classification of Headache Disorders (ICHD) [19,21,22,24,25,[27][28][29] and two studies recruited patients from headache centres [19,29], whilst the diagnoses of thyroid function and dysfunction were based on laboratory measurements [25][26][27][28][29] and a few studies recruited patients from endocrine centres [25][26][27]; (ii) large population-based studies allowed for generalization of headache prevalence in the population [20,23,28]; and (iii) Seidkhani-Nahal et al, using the Bradford Hill criteria [31] to determine causality, reported a strong association between migraine and thyroid dysfunction [30]. Limitations potentially leading to false positive and negative results include (i) the use of heterogeneous migraine diagnoses across studies, such as migraine diagnosis based on questionnaires [20], patient self-report, general physician's diagnosis and use of headache-specific medications [23], and not stating the method of migraine diagnosis [26]; (ii) thyroid diagnosis on the basis of patient self-report [19,20,24], although Le et al noted that self-reported thyroid disorders were probably correct [20]; and (iii) diagnosis of hypothyroidism (measuring the levels of T3, T4 and TSH) in Martin et al varied during the study period [23].…”

“…Martin et al [23] found that, compared to controls, cases with headaches and cases with migraine have an increased risk of developing hypothyroidism with a hazard ratio of 1.21 (95% CI 1.001–1.462) and 1.411 (95% CI 1.009–1.973), respectively. A recent study by Spanou et al [24] investigating primary headache subtypes and specific thyroid disorders amongst patients reported a non‐significant association ( p = 0.254) with a higher prevalence of thyroid dysfunction, particularly hypothyroidism amongst patients with primary headaches.…”

The relationship between migraine and Hashimoto’s thyroiditis: a single center experience

“…Although the prevalence of HT in the general population is high and still growing, there is a lack of data regarding migraine and HT connection. Hence, we found only one work that examined the presence of different types of headaches in HT patients and one regarding the prevalence of HT in migraine patients ( 14 , 15 ). Because of this, and based on our clinical observations, we aimed to retrospectively analyze the prevalence of Hashimoto’s thyroiditis among migraine sufferers visiting our specialized headache clinic considering the clinical characteristics of patients with this disease, including migraine severity.…”