Chronic Migraine Responding to Intravenous Thiamine: A Report of Two Cases

Abstract

Background: Migraine is a risk factor for thiamine deficiency and Wernicke's encephalopathy (WE). WE is a highly underdiagnosed condition. The misdiagnosis is associated more with early or mild WE. The interrelation between migraine and thiamine deficiency is unknown

Case reports: Here, we report two female patients with chronic migraine. During examinations, we also noted clinical signs pertinent with a diagnosis of WE. Both patients had low blood thiamine level. Intravenous thiamine supplementation led to the improvement of both WE and associated headaches.

Discussion: Nausea, vomiting, and anorexia of migraine may lead to mild to moderate thiamine deficiency and WE. Review of the literature suggests that WE in early or subclinical form will have nonspecific symptoms that may include frequent headache, nausea, vomiting, and anorexia. So, WE in the early stage may simulate migrainous features and this will further aggravate thiamine deficiency and a vicious cycle may be formed, and that will progressively increase the chronicity of headaches and other features. Breaking of this cycle by thiamine supplementation might be a promising therapy in a subset of patients with chronic migraine.

Conclusion: Thiamine deficiency due to nausea, vomiting and anorexia of migraine may further aggravate migraine like headaches in cyclical pattern.

Keywords: Wernicke's encephalopathy; chronic migraine; thiamine.