Thiamine deficiency in patients with chronic migraine: A case-control study

Thiamine deficiency is well recognized in several neurological disorders, and subclinical deficiency has been associated with nonspecific symptoms, including headache. However, thiamine deficiency is not currently recognized as a cause of headache in standard headache classifications. Chronic migraine (CM) is often accompanied by symptoms such as nausea, vomiting, and reduced appetite, which may influence nutritional intake and micronutrient status, including thiamine depletion. These factors raise the possibility of an interaction between migraine and thiamine status. Our objectives were to compare serum thiamine levels in patients with CM and matched healthy controls and to explore whether low thiamine levels are associated with CM and related clinical features.

In this observational case-control study conducted at a tertiary care neurology center in Vadodara, India, between May 2024 and October 2025, 100 adults with CM diagnosed according to the International Classification of Headache Disorders, 3rd edition, and 100 healthy controls were enrolled. Controls were frequency matched for age and sex. Fasting serum thiamine levels were measured using enzyme-linked immunosorbent assay. Associations between thiamine levels and CM, including dose-response relationships, were evaluated using regression models adjusted for potential confounders.

Mean serum thiamine levels were significantly lower in patients with CM than in controls (52.4 ± 22.5 vs. 83.8 ± 18.6 nmol/L, p < 0.001). Thiamine levels <30 nmol/L were independently associated with CM (adjusted odds ratio=4.9, 95% CI = 2.1-11.7, p < 0.001). In a continuous sensitivity analysis, each 10 nmol/L decrease in serum thiamine was associated with higher odds of CM (adjusted odds ratio = 5.3, 95% CI = 3.4-8.3, p < 0.001). Patients with low thiamine levels had longer disease duration (13.6 ± 6.2 vs. 10.4 ± 5.3, p < 0.010), more headache days per month (20.7 ± 5.0 vs. 18.0 ± 3.6, p < 0.020), and a higher frequency of symptoms such as fatigue (81% vs. 41%, p < 0.001), dizziness (69% vs. 40%, p < 0.001), disturbed sleep (84% vs. 41%, p < 0.001), and abdominal pain (75% vs. 41%, p 0.002).

Low serum thiamine levels are significantly associated with CM and greater disease burden. These findings support a potential relationship between thiamine status and migraine-related factors, although causality cannot be established. Further research is required to clarify whether thiamine deficiency represents a consequence of CM or contributes to migraine-related biological mechanisms.