Journal Article

Serum vitamin D levels in chronic versus episodic migraine: A cross-sectional three-arm study of associations with migraine chronicity and musculoskeletal tenderness

Sujal Mahendrabhai Patel, Sanjay Prakash, Varoon Vadodaria, Manju Yadav

2026

Overview

Background Migraine chronification is associated with increased disability and central sensitization, yet potentially modifiable metabolic contributors remain incompletely understood. Vitamin D deficiency has been implicated in neuroinflammatory and neuromuscular pathways relevant to migraine, but its relationship with migraine chronicity and objective musculoskeletal tenderness has not been systematically evaluated. Methods In this cross-sectional, three-arm observational study, 50 patients with chronic migraine (CM), 50 with episodic migraine (EM), and 50 age- and sex-matched healthy controls were enrolled. Serum 25-hydroxyvitamin D levels were measured, and deficiency was defined as <30 ng/mL. Muscle and bone tenderness were assessed using a standardized 4-point scale. Group comparisons were performed using ANOVA with post-hoc testing. Multivariable logistic and modified Poisson regression models estimated adjusted odds ratios (aOR) and relative risks (aRR). Trend analysis across chronicity (control → EM → CM) and Pearson correlations were conducted. Results Vitamin D levels declined progressively across chronicity (CM 18.7 ± 11.1; EM 26.3 ± 11.6; controls 35.7 ± 12.7 ng/mL; p < 0.001). Deficiency was present in 78% of CM, 60% of EM, and 46% of controls. CM was independently associated with deficiency (aOR 3.57; aRR 1.54). A significant linear trend was observed (β = −7.41 ng/mL per step; p < 0.001). Muscle and bone tenderness were significantly higher in CM. Vitamin D levels inversely correlated with muscle tenderness ( r = −0.41, p < 0.001). Conclusions Vitamin D deficiency is associated with CM and increased musculoskeletal tenderness. Given the cross-sectional design, causality cannot be inferred, and reverse causation remains a plausible explanation. It warrants further longitudinal and interventional investigation .

• Publisher: SAGE Publishing