Efficacy of pyridoxine supplementation on severity, frequency and duration of migraine attacks in migraine patients with aura

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Efficacy of pyridoxine supplementation on severity, frequency and duration of migraine attacks in migraine patients with aura
Key Take-Away: 

Pyridoxine supplementation in MA patients resulted in a decrease in headache severity, attacks duration and HDR compared with placebo intake, but did not affect the frequency of migraine attacks, significantly.

Migraine is a debilitating and chronic disorder that affects 10-20% of the general population worldwide. This disorder is characterized by severe recurrent headache, nausea, vomiting, sensitivity to light and sound, neck pain and muscle tension.  Migraine headaches are one-sided and throbbing that usually last between 4 and 72 h. 

ABSTRACT: 
Background: 

Migraine is a debilitating and chronic disorder that affects 10-20% of the general population worldwide. This disorder is characterized by severe recurrent headache, nausea, vomiting, sensitivity to light and sound, neck pain and muscle tension.  Migraine headaches are one-sided and throbbing that usually last between 4 and 72 hr.

Based on International Headache Society (IHS) criteria; there are two major classes of migraine: migraine with aura (MA) and migraine without aura. There are various drugs, which can successfully decrease migraine symptoms and frequency of migraine attacks, but these drugs usually are expensive. It is suggested that pyridoxine, folate and cobalamin supplementations can play a role in severity and frequency of migraine attacks. Pyridoxine is a kind of vitamin B that is involved in several metabolism reactions. Previous studies have shown that pyridoxine administration improve vascular functions that are link to migraine attacks.

  • Rationale behind research
  1. There are no studies that had assessed the effects of pyridoxine supplementation on migraine profiles directly. Earlier studies have mostly focused on pyridoxine, folate and cobalamin combination and also findings of these studies were inconsistent
  • Objective

       To assess the effects of pyridoxine supplementation on characteristics of migraine attacks including severity, frequency, duration and headache diary results (HDR) in patients with MA.

Methods: 

 

Study outcomes

  • Characteristics of migraine attacks including severity, frequency, duration (hour). Visual analog scale (VAS) ranking was used to measure the severity of the attacks. Number of migraine attacks in a month was considered as frequency of attacks and to calculate the HRD index, formula of frequency of attacks x duration of headache was used. Adverse events were also assessed
  • Time Points
  • Outcomes: baseline and at the end of study
Results: 

 

  • Outcomes
    • Baseline: Overall characteristics between the randomized groups were similar at the baseline.
    • Outcomes:
  • Severity of migraine attacks decreased in both pyridoxine and placebo group, significantly, but the reduction in the pyridoxine group was significantly more than placebo (-2.20 ± 1.70 compared with -1 ± 1.50; P=0.007)
  • Pyridoxine supplementation reduced frequency of migraine attacks but as compared with placebo group, this reduction was not significant (-2.30 ± 4 compared with -1.20 ± 7.80; P= 0.510
  • Intake of pyridoxine supplements led to a significant decrease in attacks duration (-8.30 ± 12.60 compared with -1.70 ± 9.60; P=0.030) and HDR (-89.70 ± 134.60 compared with -6.10  ± 155.50; P=0.040) compared with placebo groupFigure 1: Characteristics of migraine attacks at baseline and week 12 of migraine with aura (MA) patients who received either pyridoxine supplement or placebo

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Conclusion: 

Pyridoxine supplementation in patients with MA was effective on headache severity, attacks duration and HDR, but did not affect the frequency of migraine attacks. In this study, we observed that pyridoxine supplementation lead to a reduction on severity and duration of migraine attacks as well as HDR, and it has no effects on attacks frequency.

Our finding are supported by recent randomized, double-blinded placebo-controlled clinical trial by Menon et al., who done a 6 months trial of daily pyridoxine (25 mg), folic acid (2 mg) and cobalamin (400 μg) on 206 female patients diagnosed with MA. In this trial, a significant decrease was reported in headache severity and high migraine disability, after taking a 6 months vitamin supplementation compared with placebo intake while frequency of migraine attacks did not reduce significantly

Iran J Neurol. 2015 Apr 4; 14(2): 74–80
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