By Marcello Cherchi, MD PhD
For patients
Vitamin D is made by your body, and also comes in your diet. Taking too much vitamin D may give you high levels of calcium and kidney stones. Some researchers think that low vitamin D makes you more likely to have migraines or benign paroxysmal positional vertigo. Some researchers suggest that taking extra vitamin D makes these diseases less likely.
For clinicians
Overview
Vitamin D comes in several forms, including cholecalciferol (endogenously synthesized in humans given sufficient exposure to sunlight) and ergocalciferol (acquired in the diet). Vitamin D plays a role in numerous metabolic processes. Toxic levels of vitamin D may increase the risk of hypercalcemia and kidney stones. In the field of otoneurology, some studies report an association between vitamin D deficiency and an increased risk of migraine and benign paroxysmal positional vertigo, and some literature advocates vitamin D supplementation as prophylaxis against these conditions.
Introduction
Vitamin D was first described by Adolf Otto Reinhold Windaus (1876 – 1959), whose work on sterols was awarded the Nobel Prize for Chemistry in 1928 (https://www.nobelprize.org/prizes/chemistry/1928/windaus/facts/).
Vitamin D is a fat-soluble vitamin that occurs in several forms. It can be synthesized in the human body as cholecalciferol (vitamin D3), and can be ingested from plants and certain fatty fish as ergocalciferol (vitamin D2) (Bikle 2014).
Given sufficient exposure to sunlight, humans can endogenously synthesize cholecalciferol. This process requires chemical steps carried out in several organs (skin, kidney, liver) (Borel et al. 2015).
Vitamin D is required for many metabolic processes. The commonly cited ones include bone metabolism and other aspects of calcium homeostasis. Research also suggests that vitamin D plays significant roles in immune function, cardiovascular function, neuromuscular function, neural transmission, neurodegenerative processes, malignancy and others.
Pharmacology
A range of factors can affect absorption and bioavailability of dietary vitamin D (Borel et al. 2015). Cholecalciferol has a half-life of about 15 days (Jones 2008).
Adverse effects, cautions and contraindications
Vitamin D supplementation is low risk but not zero risk. The main reported risks of vitamin D supplementation pertain to hypercalcemia and kidney stones.
Vitamin D supplementation should be used with caution in patients with a history of disorders of calcium metabolism, such as hypercalcemia (Rizzoli 2021).
Increasing one’s level of vitamin D (even without supplementing additional calcium) may increase serum calcium concentrations, which at least in theory can increase the risk of developing kidney stones (Letavernier and Daudon 2018), though it is unclear whether this increased risk is clinically meaningful; one might think that vitamin D supplementation should perhaps be avoided in persons who already have a history of kidney stone formation, but this does not seem to be borne out by the evidence (Ganji et al. 2019).
A patient considering supplementing vitamin D intake (with or without calcium supplementation) should first consult their primary care physician.
Relevance in otoneurology
Some (Celikbilek et al. 2014; Ghorbani et al. 2019; Hussein et al. 2019; Kilic and Kilic 2019; Patel et al. 2019; Song et al. 2018; Togha et al. 2018), but not all (Lippi et al. 2014; Mottaghi et al. 2013; Zandifar et al. 2014) literature, has observed an inverse correlation between vitamin D levels and migraine activity. Some studies (Buettner et al. 2015; Cayir et al. 2014; Gazerani et al. 2019; Ghorbani et al. 2020; Ghorbani et al. 2019; Kilic and Kilic 2019; Mottaghi et al. 2015) report that taking vitamin D supplementation improves migraine frequency. Vitamin D supplementation as a prophylactic treatment for migraine has been studied in both pediatric (Kilic and Kilic 2019) and adult populations (Gazerani et al. 2019). Recommended doses of vitamin D supplementation vary from 1000 to 4000 international units (I.U.) per day; one study explored 50,000 I.U. per week (Mottaghi et al. 2015) (amounting to about 7000 mg per day). The time to onset of efficacy remains unclear; observation periods varied from 10 weeks (Mottaghi et al. 2015) to 24 weeks (Gazerani et al. 2019).
Vitamin D deficiency (Chen et al. 2020) may increase the risk of benign paroxysmal positional vertigo (BPPV). Such observations led to the question of whether supplementation of vitamin D might reduce the risk of BPPV. There is emerging evidence that, after a first episode of BPPV, taking vitamin D and perhaps calcium may reduce the likelihood of recurrence of BPPV (Jeong et al. 2020b). For instance, a randomized controlled trial (Jeong et al. 2020a) reported that supplementation with vitamin D 400 I.U. and calcium carbonate 500 mg twice per day reduces the annual recurrence rate of BPPV.
References
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