Thyroid dysfunction and migraine across racial and age groups: A multinational cohort study.
Level 3 - non-randomized controlled study
Retrospective cohort study utilizing multinational electronic health record data with propensity-balanced controls.
PubMed 42458900 · doi:10.1111/head.70173
What was done
Two parallel retrospective cohort analyses were conducted using the TriNetX Global Collaborative Network (records from 2004 to 2024 across 21 countries). Adults aged 18–100 years with hypothyroidism or hyperthyroidism (defined by ≥3 clinical encounters within 20 years) were compared with matched controls without thyroid disease. Patients with psychiatric disorders, sleep disorders, epilepsy/recurrent seizures, or known migraine-related genetic mutations were excluded. Cohorts were balanced on demographics, hypertension, and (for hyperthyroidism) beta-blocker use. The primary outcome was a diagnosis of migraine within 5 years of the index date, stratified by race and age.
What was found
A total of 33,327,750 individuals were included in the hypothyroidism analysis and 28,182,377 in the hyperthyroidism analysis. Hypothyroidism was associated with elevated odds of migraine across all races: African American/Black (OR 2.04; 95% CI 1.91–2.17), White (OR 1.93; 95% CI 1.89–1.96), and Asian (OR 1.83; 95% CI 1.69–1.98). Hyperthyroidism was also associated with increased odds of migraine: White (OR 1.64; 95% CI 1.59–1.70), African American/Black (OR 1.28; 95% CI 1.14–1.44), and Asian (OR 1.18; 95% CI 1.07–1.29). Odds were elevated across all age groups and generally increased with age.
Why it matters
This multinational study shows that both underactive and overactive thyroid conditions are independently associated with higher migraine risk across diverse demographic groups. It establishes thyroid dysfunction as an important comorbid condition to consider in migraine management.
Limits
The retrospective observational design relies entirely on diagnostic coding from electronic health records, leaving room for misclassification and unmeasured confounding. The abstract does not provide laboratory hormone measurements (such as TSH or free T4), information on headache severity/frequency, or lifestyle factors, and the exclusion of patients with common comorbidities (e.g., mood and sleep disorders) may limit generalizability.
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