The frequency and related factors of primary headaches in patients with Hashimoto thyroiditis
Rabia Gökçen Gözübatik Çelik1
, Derya Uludüz Ulu2, Esra Hatipoğlu3, Yalçın Hacıoğlu4, Bengi Gül Alparslan Türk2, Mehmet Ali Sungur5, Baki Göksan2, Sabahattin Saip2, Aksel Siva2
1Department of Neurology, University of Health Sciences, Bakırköy Training and Research Hospital for Psychiatry and Neurological Disorders, İstanbul, Türkiye
2Department of Neurology, Istanbul University, Cerrahpasa Faculty of Medicine, İstanbul, Türkiye
3Department of Internal Medicine, Istanbul Çam Sakura City Hospital, İstanbul, Türkiye
4Department of Family Medicine, Istanbul Training and Research Hospital, İstanbul, Türkiye
5Department of Biostatistics and Medical Informatics, Düzce University Faculty of Medicine, Düzce, Türkiye
Keywords: Autoimmunity, comorbidity, hashimoto thyroiditis, primary headaches, thyroid stimulating hormone.
Abstract
Objectives: The purpose of this study was to evaluate the incidence of primary headache and potential biomarkers in patients diagnosed with Hashimoto thyroiditis.
Methods: Patients with Hashimoto thyroiditis referred to the outpatient endocrinology clinic were included in the study. The demographic data, thyroid function test results, and autoantibody titers were recorded. The headache’s clinical characteristics were also determined. The same researcher used the visual analog scale for headache severity rating in all patients.
Results: 155 patients with Hashimoto thyroiditis were included the study. There were 95 (61.3%) cases diagnosed with headache consisting of 20 (21.1%) migraine cases, 17 (17.9%) tension type headaches (TTHs), and 20 (21.1%) new daily persistent headaches (NDPHs). 38 of 155 (24.5%) had hypothyroidism related headaches (HRHs). There was no statistically significant relationship between the headache type and a high blood antibody level anti thyroid peroxidase antibody (p=0.135), while a positive correlation was found with thyroid stimulating hormone (TSH) (p<0.001). Hashimoto patients with migraine (n=14, 70.0%) were found to have higher blood antibody levels, while these ratios were found as 86.8% (n=33) in HRH-patients, 76.5% (n=13) in TTH-patients, and 60.0% (n=12) in NDPH-patients. 86 of 155 (55.5%) patients reported new onset headaches after a Hashimoto’s thyroiditis diagnosis, and the headaches persisted without hormone therapy in 48 (84.2%) of these patients. These patients diagnosed with primary headache and this was interpreted as demonstrating comorbidity between Hashimoto’s disease and primary headaches.
Conclusion: Detection of only the relationship between TSH level and headache suggested that different mechanisms play a role in the pathophysiology. In the diagnosis of primary headache, it is important to look into secondary reasons.