Can low vitamin D levels cause headaches?

Vitamin D Deficiency and Headaches

Low vitamin D levels may contribute to headaches, particularly migraines, with evidence showing a higher prevalence of vitamin D deficiency among headache sufferers, though the relationship is not definitively established. 1, 2, 3

Relationship Between Vitamin D and Headaches

Current evidence suggests a potential link between vitamin D deficiency and headaches, particularly migraines:

• Multiple studies have found that individuals with headaches, especially migraines, have lower serum vitamin D levels compared to healthy controls 3, 4
• A 2025 population-based analysis found that participants in the highest quartile of serum vitamin D levels had a 16% lower prevalence of migraine than those in the lowest quartile 3
• For each 5 ng/mL increase in serum vitamin D, there was a 22% decrease in the odds of migraine in one study 4

However, the evidence is not entirely consistent:

• Some research has found no reliable scientific support for an association between vitamin D status and migraine 5
• The U.S. Preventive Services Task Force notes that the effect of vitamin D levels on various health outcomes, including headaches, is difficult to evaluate 6

Mechanism and Clinical Implications

The potential mechanisms linking vitamin D deficiency to headaches include:

• Anti-inflammatory and antioxidant properties of vitamin D that may affect headache pathophysiology 1, 2
• Vitamin D's role in pain modulation and neurotransmitter function

Clinical Considerations:

• Vitamin D deficiency is defined as serum 25-hydroxyvitamin D (25-OHD) levels < 20 ng/mL (50 nmol/L) 7
• Risk factors for vitamin D deficiency include:
  • Limited UVB exposure
  • Inadequate dietary vitamin D intake
  • Darker skin pigmentation
  • Advanced age
  • Obesity
  • Malabsorption conditions 7

Recommendations for Clinical Practice

For patients with recurrent headaches, especially migraines:

1. Consider testing vitamin D levels, particularly in patients with risk factors for deficiency 7

2. For patients with confirmed vitamin D deficiency and headaches:

   • Initial high-dose vitamin D3 (cholecalciferol) at 50,000 IU weekly for 8-12 weeks
   • Followed by maintenance therapy of 1500-4000 IU daily 7
   • Monitor 25(OH)D levels after 3-6 months of therapy to assess response 7

3. Monitor for improvement in headache parameters:

   • Frequency of headache attacks
   • Severity of headaches
   • Duration of episodes

Important Caveats

• While vitamin D supplementation may help reduce headache frequency in deficient individuals, it should not replace standard headache treatments
• The strongest connection has been reported between serum vitamin D levels and migraine rather than other headache types 1
• Vitamin D toxicity is rare but possible at very high levels >500 nmol/L (>200 ng/mL) 7
• The relationship between vitamin D and headaches may vary across different populations and headache subtypes

Clinical Pearls

• Vitamin D deficiency is common, with prevalence rates of 21.7% in white persons, 70.6% in African Americans, and 44.2% in Hispanics 6, 7
• When supplementing vitamin D, ensure adequate calcium intake (1,000-1,200 mg daily) 7
• Consider recommending increased consumption of vitamin D-rich foods (fatty fish, fortified dairy) and safe, limited sun exposure when possible 7