Serum vitamin levels key to proper assessment, management of pediatric chronic migraine

Key takeaways:

• A retrospective chart review analyzed more than 3,400 pediatric migraine patient visits for vitamin deficiency.
• Older age was associated with more vitamin deficiencies and worsening disability.

SAN DIEGO — Obtaining serum vitamin levels in children with migraine should be part of symptom management, particularly for older adolescents, according to a speaker at the American Headache Society Annual Scientific Meeting.

“The work I’ve been doing at the children’s hospital this year (has been examining) vitamin deficiencies and their impacts on headache outcomes,” Paul Gong, MD, a headache medicine fellow at Cincinnati Children’s Hospital Medical Center (CCHC), said in his presentation.

Gong and colleagues sought to examine this potential causal relationship in a cohort of pediatric patients seen at CCHC between January 1998 and June 2023.

Their retrospective chart review yielded 3,430 new patient visits (75% girls) within those parameters who had serum vitamin D, riboflavin, folate and/or coenzyme Q10 drawn at the time of their visit.

Based on the draws, vitamin deficiency was determined by low-level value cutoffs for each (vitamin D less than 30 ng/ml; riboflavin less than 10 nmol/L; folates less than 20 ng/ml; coenzyme Q10 less than 0.7 mcg/mL) and patients were subsequently placed into one of five groups based on the number of deficiencies from zero to five.

The primary outcome was the determination of differences between each deficient group in terms of headache frequency per month and disability as measured by the Pediatric Migraine Disability Assessment (PedMIDAS) score.

Among the five groups, 184 (5.4%) recorded no deficiencies, 830 (24.2%) had one deficiency, 1,234 (36%) registered two deficiencies. 898 (26%) were found to have three deficiencies and the remaining 284 (8.3%) logged four deficiencies.

No statistically significant differences were observed in headache frequency per month or PedMIDAS score in comparing groups with multiple vitamin deficiencies.

The researchers additionally found that no single vitamin deficiency or combination of such was associated with a statistically meaningful difference in either the age of the participant, headache frequency per month or PedMIDAS score.

However, based on serum levels of vitamins taken from a patient’s initial visit, multiple vitamin deficiencies were associated with worsening disability as measured by PedMIDAS compared with those who had only one vitamin deficiency.

Additionally, Gong and colleagues observed dual trends of older age associated with more vitamin deficiencies as well as worse headache frequency per month.

“We also have follow-up data for a lot of these patients, so the next steps would be for us to look at their response to supplementation,” Gong said.