The effects of vitamin supplementation and MTHFR (C677T) genotype on homocysteine-lowering and migraine disability.
BACKGROUND
Migraine is a prevalent and debilitating disease that may, in part, arise because of disruption in neurovascular endothelia caused by elevated homocysteine. This study examined the homocysteine-lowering effects of vitamin supplementation on migraine disability, frequency and severity and whether MTHFRC677T genotype influenced treatment response.


METHODS
This was a randomized, double-blind placebo, controlled trial of 6 months of daily vitamin supplementation (i.e. 2 mg of folic acid, 25 mg vitamin B6, and 400 microg of vitamin B12) in 52 patients diagnosed with migraine with aura.


RESULTS
Vitamin supplementation reduced homocysteine by 39% (approximately 4 mumol/l) compared with baseline, a reduction that was greater then placebo (P=0.001). Vitamin supplementation also reduced the prevalence of migraine disability from 60% at baseline to 30% after 6 months (P=0.01), whereas no reduction was observed for the placebo group (P>0.1). Headache frequency and pain severity were also reduced (P<0.05), whereas there was no reduction in the placebo group (P>0.1). In this patient group the treatment effect on both homocysteine levels and migraine disability was associated with MTHFRC677T genotype whereby carriers of the C allele experienced a greater response compared with TT genotypes (P<0.05).


CONCLUSIONS
This study provides some early evidence that lowering homocysteine through vitamin supplementation reduces migraine disability in a subgroup of patients. Larger trials are now warranted to establish whether vitamin therapy is a safe, inexpensive and effective prophylactic option for treatment of migraine and whether efficacy is dependant on MTHFRC677T genotype.
Lea
Rod
R
Genomics Research Centre, School of Health Science, Griffith University, Gold Coast, Australia.
Colson
Natalie
N
Quinlan
Sharon
S
Macmillan
John
J
Griffiths
Lyn
L
D004311:Double-Blind Method; D005260:Female; D005838:Genotype; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics*; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics; D014805:Vitamin B 12 / Q000008:administration & dosage* / Q000627:therapeutic use; D025101:Vitamin B 6 / Q000008:administration & dosage* / Q000627:therapeutic use
D006710:Homocysteine; D025101:Vitamin B 6; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D014805:Vitamin B 12