Wednesday, December 6, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)
Physician Assistant - 0.25 AAPA hour(s) of Category I credit
IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit
This activity is intended for neurologists, family medicine/primary care clinicians, internists, nurses, pharmacists, physician assistants, and other members of the health care team for patients with migraine.
The goal of this activity is for learners to be better able to describe the relationship between dietary zinc intake and migraine, based on a cross-sectional study of US National Health and Nutrition Examination Survey data from 1999 to 2004.
Upon completion of this activity, participants will:
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activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.
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CME / ABIM MOC / CE Released: 3/10/2023
Valid for credit through: 3/10/2024, 11:59 PM EST
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Worldwide prevalence of migraine is approximately 1 billion. The 2016 Global Burden of Disease study showed that it is the second most common cause and the most common neurological cause of disability.
Neuroinflammatory and oxidative stress have been implicated in the pathogenesis of migraine. Zinc, an anti-inflammatory and antioxidant trace element, is a cofactor for antioxidant enzymes that plays a key role in neuronal signaling.
People with higher dietary zinc intake have a nearly one third lower risk for migraine than those who get little zinc in their diets, according to results from a cross-sectional study of more than 11,000 American adults.
For their research, published online in Headache, Huanxian Liu, MD, and colleagues at Chinese PLA General Hospital in Beijing, analyzed publicly available data from the US National Health and Nutrition Examination Survey to determine whether people self-reporting migraine or severe headache saw lower zinc intake compared with people without migraine.[1] The data used in the analysis were collected between 1999 and 2004 and contained information on foods and drinks consumed by participants in a 24-hour period, along with additional health information.
The investigators divided their study’s 11,088 participants (mean age, 46.5 years; 50% female) into quintiles based on dietary zinc consumption, as inferred from foods eaten. They also considered zinc supplementation, for which data were available for 4324 participants, of whom 2607 reported use of supplements containing zinc.
Some 20% of the cohort (n = 2236) reported migraine or severe headache within the previous 3 months. Pregnant women were excluded from analysis, and the investigators adjusted for a range of covariates, including age, sex, ethnicity, education level, body mass, smoking, diabetes, cardiovascular disease, and nutritional factors.
Dr Liu and colleagues reported an inverse association between dietary zinc consumption and migraine, with the highest-consuming quintile of the cohort (15.8 mg or more zinc per day) seeing the lowest risk for migraine (odds ratio [OR], 0.70; 95% CI, 0.52-0.94; P=.029) compared with the low-consuming quintile (5.9 mg or less daily). Among people getting high levels of zinc (19.3-32.5 mg daily) through supplements, risk for migraine was lower still, to between an OR of 0.62 (95% CI: 0.46-0.83; P=.019) and an OR of 0.67 (95% CI, 0.49-0.91; P=.045).
Although the investigators acknowledged limitations of the study, including its cross-sectional design and use of a broad question to discern prevalence of migraine, the findings suggest that “zinc is an important nutrient that influences migraine,” they wrote, citing evidence for its antioxidant and anti-inflammatory properties.
Commenting on the research findings, Deborah I. Friedman, MD, MPH, a headache specialist in Dallas, said that Dr Liu and colleagues’ findings added to a growing information base about nutritional factors and migraine. For example, “low magnesium levels are common in people with migraine, and magnesium supplementation is a recommended preventive treatment for migraine.”
Dr Friedman cited a recent study showing that vitamin B12 and magnesium supplementation in women, combined with high-intensity interval training, “silenced” the inflammation signaling pathway, helped migraine pain, and decreased levels of calcitonin gene-related peptide.[2] A 2022 randomized trial found that alpha lipoic acid supplementation reduced migraine severity, frequency, and disability in women with episodic migraine.[3]
Vitamin D levels are also lower in people with migraine compared with controls, Dr Friedman noted, and a randomized trial of 2,000 IU of vitamin D3 daily saw reduced monthly headache days, attack duration, severe headaches, and analgesic use compared with placebo.[4,5] Other nutrients implicated in migraine include coenzyme Q10, calcium, folic acid, vitamin B6, and vitamin B1.
“What should a patient with migraine do with all of this information? First, eat a healthy and balanced diet,” Dr Friedman said. “Sources of dietary zinc include red meat, nuts, legumes, poultry, shellfish (especially oysters), whole grains, some cereals, and even dark chocolate. The recommended daily dosage of zinc is 9.5 mg in men and 7 mg in women. Most people get enough zinc in their diet; vegetarians, vegans, pregnant or breastfeeding women, and adults over age 65 may need to take supplemental zinc.”
Dr Liu and colleagues’ work was supported by China’s National Natural Science Foundation. The investigators reported no financial conflicts of interest. Dr Friedman has received financial support from Alder, Allergan, Amgen, Biohaven, Eli Lilly, Merck, Teva, and other pharmaceutical manufacturers.
Headache. 2023;63(1):127-135.
