By Louise M. Klebanoff, MD
Assistant Professor of Clinical Neurology, Weill Cornell Medical College
SYNOPSIS: Among participants experiencing severe headaches or migraine, those with 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. Diet modification, including B vitamins (e.g., thiamine and riboflavin), which are involved in mitochondrial metabolism, could help.
Li et al 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 program, 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 age 20 years or older, excluding participants without information on severe headache or migraine, leaving 13,439 subjects for this study. Participants self-reported headaches or migraines. Researchers used 24-hour dietary recall interviews to collect dietary thiamine and riboflavin intake.
Li et al noted 2,745 participants reported severe headaches or migraines in the past three months. The proportion of women reporting severe headaches or migraines was approximately double that of men. Additionally, subjects who reported headaches were more often non-Hispanic Black and Mexican American individuals, were younger, were more likely to have a lower education level, and recorded 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 who experienced headache (P < 0.0001). Dietary thiamine intake was inversely related to headache history (P = 0.046). This was particularly true in women and those older than age 50 years. 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 riboflavin was effective in migraine prevention. Li et al provided support for the benefits of thiamine, but they did not show an association between riboflavin intake and headache.
The study was limited by several factors. Migraine was not medically defined. Patients self-reported either severe headache or migraine; both were included as a positive migraine headache. Although many, if not most, severe headaches reach migraine criteria, using 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 is warranted. Considering the prevalence of migraine and the degree of disability associated with the condition and the higher proportion of migraine in women of childbearing years, which may limit the use of medications for migraine prevention, finding 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.
Among participants experiencing severe headaches or migraine, those with severe headaches also reported a lower intake of thiamine and riboflavin, based on 24-hour recall of food intake.
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