C677T Methylenetetrahydrofolate Reductase Homozygosis and Vitamin Supplement in Migraineur Children

Purpose: Methylenetetrahydrofolate reductase (MTHFR) variant C677T has been associated with an increased genetic risk in migraine susceptibility. Individuals with the homozygous genotype show higher levels of plasma homocysteine (Hcy) [1,2,3].

Methods: Open-label study evaluating clinical trial was performed on 148 children migraineurs among 236 children suffering from headache, admitted to the Headache Regional Centre in l’Aquila (Italy)-Neuropsychiatric clinic, recruited and observed sequentially during the years 2015-2017. 31 patients (16,6% of all the sample) MTHFR homozygous were selected and underwent clinical evaluation of migraine characteristics (frequency, severity of pain and use of acute treatment) at baseline and after a 12 month-period of daily supplement of vitamins B9(2 mg), B6(25 mg), B12(400 mcg). In 20 patients with hyper Hcy (>95° percentile for age) the second collection of blood sample was obtained for Hcy assessment. Diagnosis of headache according to ICHD-III criteria. Statistical analysis is made by Wilcoxon test.

Results: 20 children suffer from Migraine without aura (MwoA) and 11 from Migraine with aura (MA). 86% of children aged >10 years had significantly higher Hcy values compared with controls (p<0.0001). 21 patients (70%), 14 F and 7 M (13 MwoA and 8 MA), have Hcy values > 95°percentile. In all the sample the vitamin supplementation was effective in producing significant reduction in Hcy levels (p=0.0001) and a significant improvement of migraine disability of frequency (p<0.0001), severity of pain (p<0.0003) and use of acute treatment (p<0.0001).

Conclusions: The study results are encouraging and emphasize the importance of a comprehensive therapy in paediatric migraines.