Vitamin D has been getting a lot of attention over the past few years. This is because much of the general public is low in this important nutrient. But what about those of us with primary headache disorders? Can low Vitamin D cause headaches (tension-type headaches)? We all know that migraine is more than a headache. But what evidence is there about the relationship between Vitamin D and migraine?
According to an observational study, approximately 42% of people with chronic migraine were considered deficient in Vitamin D. What’s also eye-opening was that the longer the person was chronic, the more likely they were to be low.
As a registered dietitian with migraine, I am especially interested in keeping you up on the latest published research as well as my own experience and observations. So many things have changed since I first wrote about this topic. So, it’s time for an update and refresh. In this article I will endeavor to answer your questions about Vitamin D, headache disorders, tension type headache and migraine. Most importantly, I’ll help you figure out what you can do about it.
While I am a licensed health professional, this article is for information, only. It is not medical advice nor a substitute for medical advice. It is written from the patient and patient-advocate perspective.
What Is Vitamin D?
Vitamin D, also known as the sunshine vitamin, is not really a vitamin. It’s a hormone that I’ll continue to refer to as a vitamin. It’s a critically important hormone like thyroid hormones, insulin, estrogen and testosterone.
Your body makes Vitamin D when sunlight penetrates your skin. The amount you make depends on time of year, your skin type and the amount of sun protection you wear. It’s called the sunshine hormone as the warm rays of the sun on your skin make Vitamin D.
When you take supplements or consume Vitamin D in foods, your body converts that to the active, hormone form. Vitamin D plays an important role in about 3 dozen types of tissues in your body. This important nutrient and hormone has been found to influence 200 genes. Since studies have identified 40 genes associated with migraine, perhaps there is some overlap that explains the relationship between Vitamin D and migraine.
5 questions about Vitamin D and headaches and migraine
1- Can someone have Vitamin D deficiency headaches?
Based on the available published literature, there seems to be a significant association of Vitamin D deficiency and headaches. In this study from 2017, tension type headache was strongly linked to those people who were deficient in serum Vitamin D compared to people who had normal levels. The study found 71% of those with chronic tension-type headache were deficient in Vitamin D compared with just 25% for the healthy study participants.
To answer the question- can Vitamin D deficiency actually cause headaches, more studies would need to be done. It’s possible that other factors are at play here. It sure would be helpful if there were studies showing that correcting the deficiency brought about relief for tension-type headache. Really, folks. Let’s do this!
There are also studies that show no association between a vitamin D deficiency & migraine. It’s certainly not a huge leap to lean toward the assumption that low Vitamin D can cause headaches though.
2- What is the Vitamin D and migraine link?
This is the most frequent question we get about this topic in our private Facebook group. Fortunately, published reviews of the literature on this topic are stronger than the literature for Vitamin D deficiency and headache. Vitamin D and migraine attacks are likely even more connected. In this 2020 review of the literature on Vitamin D and migraine the author discusses several possible mechanisms that suggest how lack of Vitamin D can cause headaches and migraine.
Possible mechanisms for why Vitamin D deficiency causes headache and migraine
From my own review of the literature and the 2020 review linked above, four explanations came up most frequently. As we all know, migraine is complex. Effective treatment is highly variable because of the complexity of why we have migraine in the first place. Migraine involves many genes. Each individual with this condition is metabolically unique and our lifestyles and environments vary tremendously. So, there may be more than one mechanism involved.
Neurotransmitters– Dopamine and serotonin– the roles of these 2, super-important neurotransmitters in migraine have been studied. Vitamin D may be involved in the release of these chemical messengers.
Vitamin D may also involve “the love hormone” and neurotransmitter, oxytocin. This may partly explain why Vitamin D supplementation has been shown to help depression, a common co-morbidity of migraine.
Magnesium – This vital mineral’s role is well-recognized in migraine. Vitamin D is directly involved in intestinal absorption of magnesium. Having inadequate Vitamin D may explain how being deficient in Vitamin D can cause headaches and migraine. One of our most popular articles will help you understand all you need to know about magnesium and migraine. These 2 nutrients work together for many important functions.
Inflammation and pain– Did you know Vitamin D reduces inflammation? Part of the cascade of events that leads to migraine attacks is inflammation. This might explain the connection between a Vitamin D deficiency and migraine. As per the published 2020 literature review, “Inflammation plays a key role in migraine, whereby inflammatory substances produced by mast cells, mostly in the meninges, can activate the trigeminal nerve, a main structure involved in migraine headache.” Vitamin D appears to counteract neuroinflammation according to a recently published study looking at chronic migraine, Vitamin D and pain.
Reduction of nitric oxide – Researchers have known for a while that the nitric oxide is involved in the migraine process. When an attack is in progress, nitric acid levels are high and influence the activity of spinal trigeminal neurons. Vitamin D reduces the nitric oxide and may help minimize attacks.
3- Are Vitamin D and sleep linked?
Dr. Stasha Gominak, a neurologist and sleep disorder specialist thinks so.
If you ask most headache specialists, they will emphatically tell you that sleep plays a critical role in migraine. Dr. Gominak is passionate about her work and believes that she has a big part of migraine figured out. She knows that many of us have poor sleep, sleep disorders, inadequate Vitamin B12 levels and inadequate Vitamin D levels.
Unfortunately, lousy sleep is common among those of us with migraine. If you listen to this one-hour lecture about headache and migraine from Dr. Gominak, you will come away with an amazing amount of knowledge about the relationship between sleep, headache and migraine. The video isn’t for everyone as it’s a lecture with slides given to other health professionals. But, if you are into it, you will get jazzed about fixing your sleep issues.
According to Dr. Gominak, attaining and maintaining a Vitamin D level of 60ng/mL-80 ng/mL will help restorative sleep and therefore help migraine. She says that below 60ng/mL and above 80ng/mL, sleep and migraine are likely to be worse. As a dietitian very involved in migraine-related social media I know of many people who have levels in the teens! Yikes!
Have a look at Dr. Stasha Gominak’s website to see what other practical info she has to share. In addition, we have 2 wonderful articles from Jenn Bragdon discussing quality slumber. One article is packed with tips to help people with migraine sleep. Sleeping with vestibular migraine poses it’s own unique challenges. Learn sleep hygiene tips to promote your best rest with vestibular migraine in our second article.
Sleep apnea and migraines
It would be irresponsible to not mention the link between sleep disorders, sleep apnea and migraine. It is a common explanation for why many of us awake with morning headache and/or migraine. This condition is treatable and should be addressed by a doctor as it may lead to other health issues over time. Please learn more about sleep apnea and migraine to see if this is potentially an issue for you.
4- Is there a role for Vitamin D in reducing pain?
Based on the research, it certainly seems that the Vitamin D works directly on the actual mechanism of migraine. Other studies on pain management show that Vitamin D also plays a role in controlling pain.
This is especially helpful to our community as many people with migraine also have comorbidities like fibromyalgia and/or joint pain. Vitamin D has been studied a number of other inflammatory diseases like asthma, heart disease, liver disease and multiple sclerosis too.
There are other studies that show no relationship. In my opinion, trying to correct low or “unoptimized” Vitamin D status seems reasonable, safe and inexpensive. Given the toll chronic pain can take, it may be helpful for an individual even if published studies are not unanimous.
5- Is there a relationship between BPPV and Vitamin D
BPPV (Benign paroxysmal positional vertigo) is the most common cause of vertigo. Understanding the link between Vitamin D and BPPV is likely to be very helpful for many people.
Briefly, BPPV happens when crystals that are normally housed in gelatinous matter in the utricle of the ear get dislodged and move into semicircular canals. This can disrupt the normal flow of fluid in the ear especially with certain head movements. False and confusing signals get sent to the brain causing the brain to bring on frightening spinning sensations.
There were only a small number of published studies on the Vitamin D-BPPV link. Yet each showed a clear benefit from supplementing those with deficient Vitamin D compared to those who were not supplemented. The recurrence rate for those treated with Vitamin D was significantly lower than those not treated in both studies.
In another study, supplementation of both Vitamin D and calcium showed significant improvement measured by the recurrence rate of symptoms.
In all three studies, only those who were deficient in Vitamin D were studied. It would be very interesting to see if there is improvement when people are treated with Vitamin D before they are considered deficient. Dr. Stasha Gominak would likely agree that it would be interesting to see if bringing people to the optimized range (60ng/mL-80 ng/mL) would help even more and show an even stronger Vitamin D-BPPV link. We need studies!
For more info on BPPV along with personal and practical tips of dealing with the dizziness and other vestibular symptoms we suggest reading all of Jennifer Bragdon’s articles on this site.
What Is The Recommended Daily Allowance?
When the Institute of Medicine came up with the recommended daily allowance for Vitamin D, it based the recommendation on how much they believed was safe and supportive of bone health. Their work did not include considerations for what the safe, or optimal, amount would be for supporting Vitamin D’s role for its many other important functions in the body. The recommended daily allowance for Vitamin D for an adult under 70 years old is 600 IU/day. They did not address the optimal amount.
For emphasis, I am mentioning again that the government’s recommendations were based on bone health. Not on the many other critical roles that Vitamin D plays in our bodies. In a previous paragraph I identified how vitamin D, headache and migraine are connected through neurotransmitters, magnesium status, inflammation and nitric oxide. This makes me wonder what the recommendations would be if the Institute of Medicine looked beyond bone health and into those other four factors.
Determining an optimal amount of Vitamin D intake is difficult because each individual makes different amounts. A number of factors impact an individual’s need. For example, people with dark skin have more melanin in their skin. Melanin reduces the amount of vitamin D their bodies make from the sun. Our bodies store Vitamin D in fat. Putting people who are obese at risk of storing vitamin D rather than using it in circulation. Both groups may need more Vitamin D supplementation than a person who is not obese and/or has light skin.
Testing your Vitamin D level
So what does this mean for you? First, know your vitamin D level. Ask your doctor to order a 25(OH)D blood test as this is the best measure of your vitamin D status.
Vitamin D is a fat-soluble vitamin. Unlike most other vitamins, much of our excess vitamin D is stored in fat in our bodies. This can lead to an accumulation of toxic amounts if supplementation is too high for too long. Knowing your Vitamin D level is important. Plan to get it rechecked as you work on bringing your level up. Get your doctor’s opinion so you can make an informed decision about your next steps.
There is a detail that can be confusing to many of us as some countries report levels in nanomoles per liter (nmol/L) and some use nanograms per milliliter (ng/mL). Take notice of that important detail as you are reading through the literature and doing your own homework. The Vitamin D Society is an excellent resource and provides a conversion tool to help you. The Vitamin D society has a plethora of reliable information on the many benefits of this nutrient and hormone.
What amount of Vitamin D should you take?
There is no definitive answer based on the a high degree of individual variation and seasonal exposure to the sun. As a Floridian, I can tell you that there are many people who regularly get adequate daily sun exposure. They eat good sources of Vitamin D yet are still unable to keep it from being low. Getting into the optimal range (60ng/mL-80 ng/mL) for helping sleep and migraine would be out of the question for them without significant supplementation.
“My doctor prescribed big, weekly doses.”
It’s not uncommon for people to get a prescription for 50,000 IUs of weekly Vitamin D for several weeks. This strategy quickly gives a loading dose to get the serum level of Vitamin D to a healthy range. The jury is out as to whether or not the large boluses are metabolically optimal. Studies show that the boluses are overall safe.
These bolus doses are typically dispensed by the pharmacy in Vitamin D2 form instead of Vitamin D3 form. This article discusses why Vitamin D3 is preferable and may be worth requesting.
This article from Dr. Gominak has excellent info to read and discuss with your doctor as well.
Personally, I think it’s a good idea to get a good loading dose. But, also have a plan to transition to a daily dose to maintain the levels.
Preferred types for migraine
Since some of us with migraine have significant sensitivities to the inactive ingredients in supplements like gelatin. This can make it difficult to find a head safe Vitamin D3 supplement. My personal preference is to take formulations that are from high quality manufacturers and combine Vitamin D3 with Vitamin K. Vitamin K is a co-factor for Vitamin D. Designs for Health is my favorite source as it contains both vitamins and is a small capsule. Some people should not supplement with Vitamin K. It’s important to involve your doctor in this decision. The dose of Vitamin D3 is 5000IUs. It is the only supplement that has helped get my stubborn D level into the optimal range. You can find this supplement and other favorites in the Migraine Strong Dispensary.
A very nice aspect of Vitamin D3 is that it is available in pleasant or neutral tasting liquid forms. The liquid droplets are quite concentrated allowing as much or as little as you’d like. The drops are nice as we often take so many tablets and capsules. Giving kids Vitamin D is even easier when it comes from a dropper!
It’s important to get your Vitamin D level tested. Do your own research and discuss a plan with your doctor to optimize and maintain your Vitamin D level. These strategies may help your head as well as your overall wellness. Will optimizing your Vitamin D level help your head? You won’t know until your try it and see if it helps your personal “migraine puzzle.”
This blog has been updated and refreshed.