Pyridoxine, folate and cobalamin for migraine: A systematic review

Liampas, Ioannis; Siokas, Vasileios; Aloizou, Athina‐Maria; Tsouris, Zisis; Dastamani, Metaxia; Aslanidou, Paraskevi; Brotis, Alexandros; Dardiotis, Efthimios

doi:10.1111/ane.13251

Cited by 30 publications

(18 citation statements)

References 62 publications

(180 reference statements)

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“…Our results suggest a possible role of elevated homocysteine and/or decreased folate in the pathophysiology of migraine, rationalizing, therefore, the investigation of the deployment of Hcy lowering vitamins in subjects suffering from migraine. Preliminary data from clinical trials have already yielded positive results especially in MA patients 136 . It is possible that vitamin supplementation based on the individualized vitamin deficiency profile might prove even more beneficial than already demonstrated.…”

Section: Discussionmentioning

confidence: 95%

Serum Homocysteine, Pyridoxine, Folate, and Vitamin B12 Levels in Migraine: Systematic Review and Meta‐Analysis

et al. 2020

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Background Migraine, especially migraine with aura (MA), has been linked to increased risk for ischemic cerebrovascular disease. The possible role of elevated serum homocysteine (Hcy, a cause of thrombophilia) in migraine has been demonstrated by several studies. Objective The present study aims to review and meta‐analyze data from studies investigating the difference of serum Hcy and Hcy lowering vitamins between migraine patients and healthy controls (HC), as well as between patients with MA and migraine without aura (MO). Methods Literature search involved MEDLINE, Embase, CENTRAL, Google Scholar, and trial registries. The Newcastle‐Ottawa Scale was used to evaluate the quality of the retrieved studies. Standardized mean differences (SMDs) and 95% confidence intervals (95%CIs) were calculated. Funnel‐plots were utilized for the evaluation of publication bias. Results Overall, 29 (28 case‐control and 1 cross‐sectional) studies were retrieved. Meta‐analysis was indicative of higher Hcy concentration in migraine patients vs HC overall [adults and children: 16 studies, I2 = 81%, SMD = 0.41, 95%CI = (0.20, 0.61)]. Hcy was consistently elevated in adults with migraine [adults: 12 studies, I2 = 76%, SMD = 0.35, 95%CI = (0.15, 0.54); children: 1 study, SMD = 0.37, 95%CI = (−0.05, 0.79)]. Subgroup analyses reproduced the results for both adults with MA [7 studies, I2 = 83%, SMD = 0.37, 95%CI = (0.03, 0.71)] and MO [5 studies, I2 = 84%, SMD = 0.46, 95%CI = (0.03, 0.89)]. Figures for serum folate were lower in the overall comparison of migraine patients with HC [adults and children: 11 studies, I2 = 87%, SMD = −0.36, 95%CI = (−0.68, −0.05); adults: 8 studies, I2 = 6%, SMD = −0.11, 95%CI = (−0.22, 0.01); children: 1 study, SMD = −0.71, 95%CI = (−1.14, −0.29); MA adults: 4 studies, I2 = 44%, SMD = −0.16, 95%CI = (−0.35, 0.04); MO adults: 4 studies, I2 = 47%, SMD = −0.17, 95%CI = (−0.44, 0.10)]. Serum vitamin B12 levels were not different between migraine patients and HC [adults and children: 11 studies, I2 = 88%, SMD = −0.24, 95%CI = (−0.57, 0.09); adults: 8 studies, I2 = 57%, SMD = −0.10, 95%CI = (−0.28, 0.08); children: 1 study, SMD = 0.29, 95%CI = (−0.13, 0.71); MA adults: 4 studies, I2 = 63%, SMD = −0.14, 95%CI = (−0.48, 0.20); MO adults: 4 studies, I2 = 59%, SMD = −0.15, 95%CI = (−0.45, 0.15)]. Serum Hcy was lower in MO than MA [adults and children: 10 studies, I2 = 39%, SMD = 0.30, 95%CI = (0.14, 0.46), adults: 6 studies, I2 = 29%, SMD = 0.21, 95%CI = (0.09, 0.36), children: 1 study, SMD = 0.51, 95%CI = (0.22, 0.80)]. Serum folate and vitamin B12 did not differ between MA and MO. Conclusions Our results suggest that there is a possible link between migraine, mainly MA, and elevated serum Hcy.

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Section: Discussionmentioning

confidence: 95%

Serum Homocysteine, Pyridoxine, Folate, and Vitamin B12 Levels in Migraine: Systematic Review and Meta‐Analysis

et al. 2020

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“…RCTs were appraised based on the Risk of Bias (RoB) Cochrane tool for Systematic Reviews of interventions 25,27 . Outcome measures were defined after taking into consideration the International Headache Society (IHS) guidelines for controlled trials in CH 28,29 . The following efficacy parameters were evaluated (according to the intention‐to‐treat principle): reduction in headache frequency (in attacks per week), reduction in headache duration (in min), reduction in headache severity, reduction in analgesic consumption, and subjective (according to the study participants) treatment evaluation.…”

Section: Methodsmentioning

confidence: 99%

“…25,27 Outcome measures were defined after taking into consideration the International Headache Society (IHS) guidelines for controlled trials in CH. 28,29 The following efficacy parameters were evaluated (according to the intention-to-treat principle):…”

Section: Me Thodsmentioning

confidence: 99%

Meta‐analysis of melatonin levels in cluster headache—Review of clinical implications

et al. 2020

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Cluster headache (CH) has been associated with circadian disturbances. The present systematic review examined available evidence for the utilization of melatonin (MT) in CH prophylaxis. First, case‐control studies assessing nocturnal MT or its urine‐expelled metabolite 6‐sulfatoxymelatonin (aMT6s) in CH individuals and healthy controls (HC) were reviewed and meta‐analyzed. Secondly, the results from randomized controlled trials (RCTs) and non‐randomized studies evaluating MT’s use in the prevention of CH were discussed. Literature search included MEDLINE, EMBASE, CENTRAL, PsycINFO, trial registries, Google Scholar, and OpenGrey. Bouts and remissions were assessed separately. Ten case‐control studies (adult participants) were retrieved. Seven evaluated serum MT; meta‐analysis involved only three of them (due to deficient reporting, n: bout = 31, remission = 38, HC = 31). Results were compatible with lower nocturnal serum MT levels during bouts [bout‐HC; FE‐MD = −29.89 pg/mL, 95% CI = (−46.00, −13.78), remission‐HC; FE‐MD = −2.40 pg/mL, 95% CI = (−16.57, 21.38), bout‐remission; RE‐MD = −32.10 pg/mL, 95% CI = (−56.78, −7.42)]. Nocturnal urinary melatonin was appraised in two studies, but reporting issues impeded the capitalization of the results. Nocturnal urine aMT6s was evaluated by two studies (n: bout = 29, remission = 22, HC = 20), and pooled results were indicative of lower aMT6s concentration in CH individuals during both active and inactive periods [bout‐HC; FE‐MD = −9.63 μg/nocturnal urine collection, 95% CI = (−14.40, −4.85), remission‐HC; FE‐MD = −9.12 μg/nocturnal urine collection, 95% CI = (−14.63,‐3.62), bout‐remission; FE‐MD = −0.58 μg/nocturnal urine collection, 95% CI = (−4.58, 3.42)]. Regarding CH prophylaxis, one RCT and two non‐randomized trials were retrieved, involving a total of 41 adult CH individuals (11—episodic, 31—chronic) and rendering the deduction of any conclusions precarious. Overall, available data for the role use of MT in CH are insufficient and inconclusive. Complementary studies evaluating endogenous MT concentrations and MT administration to patients with CH are warranted.

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“…A systematic literature search evaluating studies assessing the supplementation of B6 and B12 to migraine patients showed a potential beneficial effect with an attractive safety profile [ 52 ]. Dosages used in the different studies analyzed by Liampas et al have been widely variable: up to 300 mg for vitamin B6, and up to 400 mcg for vitamin B12.…”

Section: B Vitamin Supplementation and Tthmentioning

confidence: 99%

Use of Nutraceutical Ingredient Combinations in the Management of Tension-Type Headaches with or without Sleep Disorders

Curatolo

Moavero

2021

Nutrients

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Headache is the most common pain complaint in the pediatric population, with tension type headache (TTH) having a prevalence of 10–15% in children. Up to 70% of pediatric patients with chronic headache also experience sleep disruption, with a likely bidirectional relationship between headache and poor sleep. Treatment options include specific pharmacological approaches as well as non-pharmacological alternatives; nutraceuticals have the advantage of a relative lack of side effects. Exogenous melatonin has been shown to be useful and safe in improving sleep-wake cycles and quality of sleep in children, helping to regulate the circadian rhythm, with a secondary positive impact on headache. Supplementation with other nutraceutical ingredients, such as tryptophan, magnesium, and B vitamins, can have significant additional effects in children with primary headache, with or without sleep disorders. Tryptophan may reduce night awakenings and improve the efficiency of sleep. Primary headache has been related to low amounts of magnesium in serum, and integration with magnesium appears to be effective in reducing headache attacks without adverse effects. There are different observational reports and uncontrolled studies suggesting a possible synergistic effect for these nutraceuticals, but there is now a need for high-quality randomized controlled trials in order to confirm these positive preliminary findings.

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Pyridoxine, folate and cobalamin for migraine: A systematic review

Cited by 30 publications

References 62 publications

Serum Homocysteine, Pyridoxine, Folate, and Vitamin B12 Levels in Migraine: Systematic Review and Meta‐Analysis

Serum Homocysteine, Pyridoxine, Folate, and Vitamin B12 Levels in Migraine: Systematic Review and Meta‐Analysis

Meta‐analysis of melatonin levels in cluster headache—Review of clinical implications

Use of Nutraceutical Ingredient Combinations in the Management of Tension-Type Headaches with or without Sleep Disorders

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