Thyroid Headache

About 30% of hypothyroid cases will have had a new onset headache at the time of diagnosis.

In a few rare cases, it may be the only feature of thyroid disease.

However, most people with underactive thyroid and headache will have the other features of thyroid underactivity:

• Intolerance of cold temperature
• Lethargy
• Eyebrow thinning
• Menstrual irregularity
• Goitre (swollen thyroid gland)

It is non-pulsatile but may have some very mild migrainous features e.g. nausea, mild photophobia.

It is usually successfully treated with simple analgesics (like Paracetamol or Aspirin) and goes away completely when the thyroid hormone replacement is started.

I've only ever seen one case with headache as a dominant feature.

This is probably due to the fact that GPs will commonly test for thyroid disease and most cases are treated long before a neurologist is needed.

However, primary care doctors should be aware that thyroid disease can present with new onset headache, and have low threshold for thyroid testing if a new headache occurs.

It is common practice, in primary care, to run a series of basic blood tests (Urea and Electrolytes, Liver FUnction Tests, Calcium and Phosphate, Full Blood Count, Vitamin B21 and Folate, Thyroid Function, and ESR) for people with new-onset headache and any sort of lethargy or "systemic upset".

Some people with thyroid disease will also have common headache disorders such as migraine.

These migraines may require treatment in its own right after thyroid replacement has been established.

References