HYPOTHYROIDISM AND HASHIMOTO'S THYROIDITIS AS MIGRAINE COMORBIDITIES: EPIDEMIOLOGY, MECHANISMS, AND THERAPEUTIC IMPLICATIONS - A NARRATIVE REVIEW

Aleksandra Kędzierska; Karolina Chudecka; Michał Chylewski; Katarzyna Józwa; Jakub Lamorski; Urszula Przewoźna; Gabriela Stępień; Izabela Szubert; Julia Suchecka; Wiktor Nesterak

doi:10.31435/ijitss.3(51).2026.6040

Authors

Aleksandra Kędzierska Independent Public Provincial Integrated Hospital in Szczecin, Szczecin, Poland https://orcid.org/0009-0008-7050-4139
Karolina Chudecka Independent Public Provincial Integrated Hospital in Szczecin, Szczecin, Poland https://orcid.org/0009-0004-0262-5036
Michał Chylewski University Clinical Hospital No. 1 PMU in Szczecin, Szczecin, Poland https://orcid.org/0009-0007-4789-1903
Katarzyna Józwa Independent Public Provincial Integrated Hospital in Szczecin, Szczecin, Poland https://orcid.org/0009-0003-5615-2388
Jakub Lamorski Independent Public Provincial Integrated Hospital in Szczecin, Szczecin, Poland https://orcid.org/0009-0004-5456-7413
Urszula Przewoźna University Clinical Hospital No.2 PMU in Szczecin, Szczecin, Poland https://orcid.org/0009-0003-2186-6604
Gabriela Stępień University Clinical Hospital No.2 PMU in Szczecin, Szczecin, Poland https://orcid.org/0009-0006-4505-5162
Izabela Szubert Independent Public Provincial Integrated Hospital in Szczecin, Szczecin, Poland https://orcid.org/0009-0006-7162-6651
Julia Suchecka Independent Public Provincial Integrated Hospital in Szczecin, Szczecin, Poland https://orcid.org/0009-0001-9975-355X
Wiktor Nesterak Pomeranian Medical University, Szczecin, Poland https://orcid.org/0009-0009-5322-903X

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6040

Keywords:

Migraine; Hypothyroidism; Hashimoto's Thyroiditis; Subclinical Hypothyroidism; Levothyroxine; Narrative Review

Abstract

Background: Both migraine and hypothyroidism are prevalent chronic conditions, predominantly affecting women. A growing body of evidence suggests a bidirectional comorbid relationship between these two conditions, yet the magnitude and directionality of this association remain insufficiently characterized.

Objective: To review published evidence on the association between hypothyroidism (including subclinical hypothyroidism and Hashimoto's thyroiditis) and migraine or headache outcomes in humans, and to evaluate the therapeutic implications of thyroid hormone replacement.

Methods: A systematic search of PubMed (n = 141) and Cochrane (n = 16) databases was conducted for studies published from January 1990 to 2025. After title/abstract screening and full-text eligibility assessment, 17 studies were included. Included study designs comprised cross-sectional studies, case-control studies, cohort studies, and one quasi-randomized placebo-controlled trial.

Results: The prevalence of hypothyroidism in migraine patients consistently exceeded general population estimates. Subclinical hypothyroidism was identified in a significantly higher proportion of migraine patients compared to controls. Patients with chronic migraine showed substantially higher rates of hypothyroidism than those with episodic migraine. Hashimoto's thyroiditis was associated with migraine chronification and increased migraine days per month. Levothyroxine treatment significantly reduced headache frequency, severity, and disability in patients with comorbid subclinical hypothyroidism and migraine. Genetic evidence supported shared biological pathways.

Conclusion: Hypothyroidism and Hashimoto's thyroiditis are meaningful comorbidities in migraine patients. Routine thyroid function screening is warranted in patients with refractory or progressive migraine. Levothyroxine treatment may yield clinically significant headache reduction.

References

Abdelghani, M., Ibrahim, M. N., & Saadawy, A. S. (2022). Potential association between subclinical hypothyroidism and childhood migraine. Medicina, 58(10), 1346. https://doi.org/10.3390/medicina58101346

Bigal, M. E., Sheftell, F. D., Rapoport, A. M., Tepper, S. J., & Lipton, R. B. (2002). Chronic daily headache: Identification of factors associated with induction and transformation. Headache, 42(6), 575–581. https://doi.org/10.1046/j.1526-4610.2002.02143.x

Dev, P., Favas, T. T., Jaiswal, R., Cyriac, M., Mishra, V. N., & Pathak, A. (2023). The effect of low dose thyroid replacement therapy in patients with episodic migraine and subclinical hypothyroidism: A quasi-randomized placebo-controlled trial. Cephalalgia, 43, 1–7. https://doi.org/10.1177/03331024231182684

Ekici, B., & Cebeci, A. N. (2015). The debate on the link between subclinical hypothyroidism and childhood migraine: Is initial endocrinological evaluation necessary for children with migraine? Acta Neurologica Belgica, 115, 123–127.

Fernandez-Garza, L. E., & Marfil, A. (2022). Comorbidity between hypothyroidism and headache disorders in a Mexican population. Revista de Neurología, 75(1), 13–16. https://doi.org/10.33588/rn.7501.2022054

Filipchuk, M., Gassmann, J., Castro Zamparella, T., Tibaldo, M. C., Carpinella, M., Sesto Tagliavini, P., Scarnato, P., Goicochea, M. T., Bruera, O., Conci Magris, D. M., & Lisicki, M. (2022). High rates of treated hypothyroidism among chronic migraine patients consulting a specialized headache clinic: Are we missing something? Neurological Sciences, 43, 1249–1254. https://doi.org/10.1007/s10072-021-05424-7

Garmendia Madariaga, A., Santos Palacios, S., Guillén-Grima, F., & Galofré, J. C. (2014). The incidence and prevalence of thyroid dysfunction in Europe: A meta-analysis. Journal of Clinical Endocrinology & Metabolism, 99(3), 923–931. https://doi.org/10.1210/jc.2013-2409

Gözübatik Çelik, R. G., Uluduz Ulu, D., Hatipoğlu, E., Hacıoğlu, Y., Alpaslan Türk, B. G., Sungur, M. A., Göksan, B., Saip, S., & Siva, A. (2022). The frequency and related factors of primary headaches in patients with Hashimoto thyroiditis. Turkish Journal of Medical Sciences, 52(5), 292–298. https://doi.org/10.55730/1300-0144.5309

Hagen, K., Bjøro, T., Zwart, J. A., Vatten, L., Stovner, L. J., & Bovim, G. (2001). Low headache prevalence among women with high TSH values. European Journal of Neurology, 8(6), 693–699. https://doi.org/10.1046/j.1468-1331.2001.00310.x

Li, R., Han, J., Shao, G., Liu, C., Li, S., Wang, M., & Yang, D. (2024). Causality between multiple autoimmune disorders and migraine and its subtypes: A two-sample Mendelian randomization study. Frontiers in Neurology, 15, 1420201. https://doi.org/10.3389/fneur.2024.1420201

Lima Carvalho, M. F., Silva de Medeiros, J., & Valença, M. M. (2017). Headache in recent onset hypothyroidism: Prevalence, characteristics and outcome after treatment with levothyroxine. Cephalalgia, 37(10), 938–946. https://doi.org/10.1177/0333102416658714

Martin, A. T., Pinney, S. M., Xie, C., Herrick, R. L., Bai, Y., Buckholz, J., & Martin, V. T. (2017). Headache disorders may be a risk factor for the development of new onset hypothyroidism. Headache, 57(1), 21–30. https://doi.org/10.1111/head.12943

Mirouliaei, M., Fallah, R., Partovee, M., & Ordooei, M. (2012). Efficacy of levothyroxine in migraine headaches in children with subclinical hypothyroidism. Iranian Journal of Child Neurology, 6(4), 23–26.

Moreau, T., Manceau, E., Giroud-Baleydier, F., Dumas, R., & Giroud, M. (1998). Headache in hypothyroidism: Prevalence and outcome under thyroid hormone therapy. Cephalalgia, 18(10), 687–689. https://doi.org/10.1046/j.1468-2982.1998.1810687.x

Nowaczewska, M., Straburzyński, M., Meder, G., & Waliszewska-Prosół, M. (2024). The relationship between migraine and Hashimoto's thyroiditis: A single center experience. Frontiers in Neurology, 15, 1370530. https://doi.org/10.3389/fneur.2024.1370530

Rubino, E., Rainero, I., Garino, F., Vicentini, C., Govone, F., Vacca, A., Gai, A., Gentile, S., Govone, G., Ragazzoni, F., Pinessi, L., Giordana, M. T., & Limone, P. (2019). Subclinical hypothyroidism is associated with migraine: A case-control study. Cephalalgia, 39(1), 15–20. https://doi.org/10.1177/0333102418769917

Spanou, I., Christidi, F., Liakakis, G., Rizonaki, K., Bougea, A., Anagnostou, E., & Kararizou, E. (2020). Primary headache subtypes and thyroid dysfunction: Is there any association? Arquivos de Neuro-Psiquiatria, 78(11), 695–699. https://doi.org/10.1590/0004-282X20200070

Tasnim, S., Wilson, S. G., Walsh, J. P., & Nyholt, D. R. (2023). Shared genetics and causal relationships between migraine and thyroid function traits. Cephalalgia, 43(2), 1–15. https://doi.org/10.1177/03331024221139253

Tietjen, G. E., Herial, N. A., Hardgrove, J., Utley, C., & White, L. (2007). Migraine comorbidity constellations. Headache, 47(6), 857–865. https://doi.org/10.1111/j.1526-4610.2007.00814.x

Togha, M., Karimitafti, M. J., Ghorbani, Z., Farham, F., Naderi-Behdani, F., Nasergivehchi, S., Vahabi, Z., Ariyanfar, S., & Jafari, E. (2022). Characteristics and comorbidities of headache in patients over 50 years of age: A cross-sectional study. BMC Geriatrics, 22, 313. https://doi.org/10.1186/s12877-022-03027-1