Migraines and Hypothyroidism: Pathophysiology and Clinical Implications

Pathophysiological Mechanisms

Thyroid hormone receptors are widely expressed throughout the brain, including areas of the limbic system involved in pain processing, and hypothyroidism may affect migraine through alterations in cross-communication between central thyroid, noradrenergic, and serotonergic systems that regulate pain perception 1

Patients with overt hypothyroidism commonly experience symptoms that overlap with those seen in migraine patients, including fatigue and cognitive difficulties, which are associated with hypothyroidism 2
Patients with hypothyroidism may also experience irritability and mood changes, which can be related to migraine symptoms 3

The American Academy of Neurology and other guideline societies may recommend thyroid function testing in patients presenting with new or worsening migraine patterns, especially those with other symptoms suggestive of thyroid dysfunction 3
Regular monitoring of thyroid function and headache patterns is recommended for patients with confirmed subclinical hypothyroidism and migraine, to ensure optimal replacement and improvement in migraine symptoms 3
Monitoring of calcium levels is also important in hypothyroid patients with migraine, as hypocalcemia can exacerbate headache symptoms 3