Co-occurrence of migraine and atopy in children and adolescents: myth or a casual relationship?

No causal association between allergic rhinitis and migraine: a Mendelian randomization study

PURPOSE

Allergic rhinitis (AR) and migraine are among the most common public health problems worldwide. Observational studies on the correlation between AR and migraine have reported inconsistent results. This study aimed to investigate the causal relationship of AR with migraine and its subtypes, including migraine with aura (MA) and migraine without aura (MO).

METHODS

Bidirectional two-sample Mendelian randomization (MR) analysis was performed with publicly available summary-level statistics of large genome-wide association studies to estimate the possible causal effects. The inverse variance-weighted method was selected for primary analysis and was supplemented with the weighted median, weighted mode, and MR-Egger methods. The causal analysis using summary effect estimates (CAUSE) were further performed to verify the causality. Several sensitivity tests, including the leave-one-out, Cochran's Q, MR-Egger intercept, and MR-PRESSO tests, were performed to assess the robustness of the results.

RESULTS

AR did not exhibit a significant causal correlation with the elevated risk of any migraine (odd ratio (OR), 0.816; 95% confidence interval (CI), 0.511-1.302; P = 0.394), MA (OR, 0.690; 95% CI 0.298-1.593; P = 0.384), or MO (OR, 1.022; 95% CI 0.490-2.131; P = 0.954). Consistently, reverse MR analysis did not reveal causal effects of any migraine or its subtypes on AR. Almost all sensitivity analyses supported the robustness of the results.

CONCLUSIONS

This MR study did not reveal a clear causal association between AR and migraine risk. More research is warranted to reveal the complex association between AR and migraine.

Migraine, Allergy, and Histamine: Is There a Link?

The relationship between migraines and allergies is controversial. Though they are epidemiologically linked, the underlying pathophysiological connection between them remains unclear. Migraines and allergic disorders have various underlying genetic and biological causes. As per the literature, these conditions are epidemiologically linked, and some common pathophysiological pathways have been hypothesized. The histaminergic system may be the clue to understanding the correlation among these diseases. As a neurotransmitter in the central nervous system with a vasodilatory effect, histamine has a well-documented influence on the allergic response and could be involved in the pathophysiology of migraines. Histamine may influence hypothalamic activity, which may play a major role in migraines or may simply influence their severity. In both cases, antihistamine drugs could prove useful. This review examines whether the histaminergic system, particularly H3 and H4 receptors, may provide a mechanistic link between the pathophysiology of migraines and allergic disorders, two common and debilitating conditions. Identifying their connection could help identify novel therapeutic strategies.

Clinical Implications of the Association between Respiratory and Gastrointestinal Disorders in Migraine and Non-Migraine Headache Patients

Headaches, particularly migraine, are associated with gastrointestinal (GI) disorders. In addition to the gut-brain axis, the lung-brain axis is suspected to be involved in the relationship between pulmonary microbes and brain disorders. Therefore, we investigated possible associations of migraine and non-migraine headaches (nMH) with respiratory and GI disorders using the clinical data warehouse over 11 years. We compared data regarding GI and respiratory disorders, including asthma, bronchitis, and COPD, among patients with migraine, patients with nMH, and controls. In total, 22,444 patients with migraine, 117,956 patients with nMH, and 289,785 controls were identified. After adjustment for covariates and propensity score matching, the odds ratios (ORs) for asthma (1.35), gastroesophageal reflux disorder (1.55), gastritis (1.90), functional GI disorder (1.35), and irritable bowel syndrome (1.76) were significantly higher in patients with migraine than in controls (p = 0.000). The ORs for asthma (1.16) and bronchitis (1.33) were also significantly higher in patients with nMH than in controls (p = 0.0002). When the migraine group was compared with the nMH group, only the OR for GI disorders was statistically significant. Our findings suggest that migraine and nMH are associated with increased risks of GI and respiratory disorders.

Atopic Disorders and Their Risks of Migraine: A Nationwide Population-Based Cohort Study

PURPOSE

Migraine is a relatively common neurologic disorder. A possible link between atopic disorders and migraine has been suggested. This study investigated atopic disorders and their risks of migraine in the Korean population.

METHODS

From the Korean National Health Insurance Service database, patients aged ≥ 20 years who underwent health screening between January and December of 2009 were enrolled. To evaluate the risk of migraine, Cox proportional hazards regression analyses were performed.

RESULTS

In multivariable analysis, the atopic dermatitis group (adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.23-1.33), asthma group (aHR, 1.32; 95% CI, 1.30-1.34) and allergic rhinitis group (aHR, 1.45; 95% CI, 1.44-1.46) had significantly increased risks of migraine compared to their respective control groups (P < 0.001). The patients with 1 (aHR, 1.43; 95% CI, 1.42-1.44), 2 (aHR, 1.50; 95% CI, 1.47-1.53), and 3 (aHR, 1.64; 95% CI, 1.43-1.88) atopic disorders had significantly increased risks of migraine compared to the control group (P < 0.001).

CONCLUSIONS

Our results demonstrate that patients with atopic disorders may have increased risk of migraine and that the larger the number of concomitant atopic disorders, the higher the risk of migraine.

Brain to Belly: Abdominal Variants of Migraine and Functional Abdominal Pain Disorders Associated With Migraine

Migraine is one of the most frequent causes of primary headache and 9% of children suffer from migraines. Most children will continue to experience migraine attacks as adults, therefore it is imperative that we have a thorough understanding of this major health issue. This article considers the so-called abdominal variants of migraine, which are more commonly seen in children rather than adults: abdominal migraine, cyclic vomiting syndrome, and infantile colic. Other functional abdominal pain disorders such as irritable bowel syndrome and functional dyspepsia have also been linked to migraine in clinical studies. The common pathophysiological root of these diseases seems to be the gut-brain axis mechanism. Abdominal variants of migraine are considered pediatric precursors of migraine whereas the functional abdominal pain disorders related to migraine seem to share a pathophysiological root with no temporarily link as for today. In this review we aim to describe the epidemiological background, the current pathophysiological theories and the relationship of each disease to migraine. This review is the first to compile abdominal variants of migraine and functional abdominal pain disorders associated with migraine and we endeavor to elucidate the broad spectrum of migraine-related episodes in children.

Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico

Introduction:

Migraine is a polygenic multifactorial disorder with a neuronal initiation of a cascade of neurochemical processes leading to incapacitating headaches. Headaches are generally unilateral, throbbing, 4–72 h in duration, and associated with nausea, vomiting, photophobia, and sonophobia. Chronic migraine (CM) is the presence of a headache at least 15 days per month for ≥3 months and has a high global impact on health and economy, and therapeutic guidelines are lacking.

Methods:

Using the Grading of Recommendations, Assessment, Development, and Evaluations system, we conducted a search in MEDLINE and Cochrane to investigate the current evidence and generate recommendations of clinical practice on the identification of risk factors and treatment of CM in adults.

Results:

We recommend avoiding overmedication of non-steroidal anti-inflammatory drugs (NSAIDs); ergotamine; caffeine; opioids; barbiturates; and initiating individualized prophylactic treatment with topiramate eptinezumab, galcanezumab, erenumab, fremanezumab, or botulinum toxin. We highlight the necessity of managing comorbidities initially. In the acute management, we recommend NSAIDs, triptans, lasmiditan, and gepants alone or with metoclopramide if nausea or vomiting. Non-pharmacological measures include neurostimulation.

Conclusions:

We have identified the risk factors and treatments available for the management of CM based on a grading system, which facilitates selection for individualized management.

The Comorbid Relationship Between Migraine and Asthma: A Systematic Review and Meta-Analysis of Population-Based Studies

Objective: Recent studies have indicated a pathophysiologic link between migraine and asthma. This meta-analysis aimed to comprehensively estimate the risk ratio for migraine in asthma as well as that of asthma in migraine based on available evidence. Method: We systematically searched the electronic databases including PubMed, Web of Science, and SCOPUS for population-based studies that measured either the odds or the risk of asthma in subjects with migraine as well as that of migraine in subjects with asthma. The titles and abstracts were screened by two independent reviewers to identify eligible studies, and this was followed by full-text review of the included studies. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias of included literature. A meta-analysis was conducted with Review Manager 5.3 Software to calculate the odds ratio (OR) for case-control and cross-sectional studies and either relative ratio (RR) or hazard ratio (HR) for cohort studies, and the source of heterogeneity was assessed. Subgroup and sensitivity analyses were conducted, and the I2 test were used to assess the source of heterogeneity. The funnel plot, Galbraith plot, and Egger's test were used to evaluate publication bias. Results: Fifteen published studies covering a total of 1,188,780 individuals were identified. Pooled analysis indicated that migraine was associated with increased odds (OR = 1.54; 95% CI: 1.34~1.77) and risk for asthma (HR = 1.42; 95% CI: 1.26~1.60), and asthma associated with increased odds (OR = 1.45; 95% CI: 1.22~1.72) and risk for migraine (HR = 1.47; 95% CI: 1.41~1.52). Conclusion: Migraine is a potential risk indicator for asthma, and vice versa, asthma is a potential risk indicator for migraine. However, future prospective cohort studies are warranted to provide more evidence concerning the detailed association between migraine and asthma.

Are Migraine Patients at Increased Risk for Symptomatic Coronavirus Disease 2019 Due to Shared Comorbidities?

The coronavirus disease 2019 (COVID-19) pandemic has rapidly transformed the whole world and forced us to look through comorbid diseases and risk factors from a different perspective. COVID-19 shows some inherent risk factors like cardiovascular comorbidities independent from age, gender, and geographic location. One of the most peculiar features of the COVID-19 pandemic is that severe acute respiratory syndrome coronavirus 2 respiratory infections disproportionately impact patients with hypertension, diabetes, and other cardiovascular comorbidities rather than those with allergic respiratory diseases and immune-compromised conditions. Migraine is a complex neuro-vasculo-inflammatory disorder that is also packed frequently with certain medical conditions including vascular disorders, hypertension, allergic diseases such as asthma and systemic inflammatory disorders. Accordingly, 2 different questions arise during the pandemic: (1) Do share comorbidities of cardiovascular diseases and hypertension increase the risk of symptomatic COVID-19 for migraine patients? (2) Do comorbid allergic and atopic diseases, including asthma act as opposite influencers alongside with female gender? This paper focuses on the co-existence of comorbidities of COVID-19, in comparison with migraine, based on a wide clinical dataset and available reports. Discussed mechanisms include potential strategic roles of angiotensin-converting enzyme 2, angiotensin-II, and nucleotide oligomerization domain-like receptor family, pyrin domain containing 3 inflammasome, playing remarkable parts in the pathogenesis of COVID-19 and migraine. There are also some clues about the importance of endothelial and pericyte dysfunction and neuroinflammation in COVID-19 infection, related to complications and survival of the patients. The large epidemiological studies as well as basic research, focusing on migraine patients with COVID-19 will clarify these vital questions during the upcoming periods.

Association between Childhood Allergic Diseases and Headache

Allergic disorders and headache are both common in pediatric populations. Chronic allergic disorders may affect sleep leading to chronic daily headaches. Poor controlled allergies may cause neurogenic inflammation that may be a predisposing factor to migraine headaches. We hypothesized that a higher prevalence of headaches may be found in children with allergy compared with those without allergy. Patients with either multiple allergic disorders or with poorly controlled allergic symptoms may be associated with headaches, especially migraine headaches. This study aimed to examine (1) the prevalence of headache in allergic children and (2) the association between allergic diseases and headache. Patients with allergic diseases and nonallergic children as control were recruited in the pediatric outpatient clinic of Naresuan University Hospital between January 2017 and January 2018. A neurological examination was performed by a pediatric neurologist. The questionnaire consisted of the pediatric headache symptom checklist and the items for evaluation of allergy control status. The diagnosis and classification of headache were based on the International Classification of Headache Disorders-3 criteria. The results were analyzed using the Student's t-test, chi-squared tests, odds ratios, and 95% confidence interval. One hundred fifty-five subjects were enrolled in our study, of which 85 subjects (54.8%) were diagnosed with allergic diseases. The allergic group had a significantly higher prevalence of headache than the control group (37 [43.5%] vs. 19 [27.1%], p = 0.035). The allergic group also had a significantly higher prevalence of migraine and probable migraine headache than the control group (23 [27.06%] vs. 7 [10%], p = 0.007). The prevalence of headache did not increase in subjects who had more than one allergic disease. There was no association between the control of allergy and headache. The present study showed that allergic diseases were associated with increased prevalence of headache and migraine in children. However, the control of allergic symptoms and the number of allergic diseases were not associated with headache. The physicians should be aware of headache in allergic patients and give appropriate treatment. Further study would be to identify specific biomarkers for the development of better treatment in these comorbid diseases.

Bidirectional association between asthma and migraines in adults: Two longitudinal follow-up studies

The objective of this study was to evaluate the bidirectional association between asthma and migraines using control subjects matched by demographic factors. The Korean Health Insurance Review and Assessment Service - National Sample Cohort from 2002 to 2013 was used. In study I, 113,059 asthma participants were matched with 113,059 control I participants. In study II, 36,044 migraine participants were matched with 114,176 control II participants. The hazard ratios (HRs) of migraines in the asthma patients (study I) and asthma in the migraine patients (study II) were analyzed using stratified Cox proportional hazard models after adjusting for depression and the Charlson comorbidity index. In study I, 5.3% (6,017/ 113,059) of the asthma group and 3.4% (3,806/ 113,059) of the control I group had migraines (P < 0.001). The asthma group demonstrated an adjusted HR of 1.47 for migraine (95% confidence interval (CI) = 1.41–1.53, P < 0.001). In study II, 15.4% (5,548/36,044) of the migraine group and 10.6% (15,271/144,176) of the control group had asthma (P < 0.001). The migraine group showed an adjusted HR of 1.37 for asthma (95% CI = 1.33–1.41, P value < 0.001). Asthma and migraines are reciprocally associated.

A step beyond the hygiene hypothesis-immune-mediated classes determined in a population-based study

BACKGROUND

Comorbidity patterns of childhood infections, atopic diseases, and adverse childhood experiences (ACE) are related to immune system programming conditions. The aim of this study was to make a step beyond the hygiene hypothesis and to comprehensively classify these patterns with latent class analysis (LCA). A second aim was to characterize the classes by associations with immunological, clinical, and sociodemographic variables.

METHODS

LCA was applied to data from the CoLaus|PsyCoLaus study (N = 4874, age range 35-82 years) separately for men and women. It was based on survey information on chickenpox, measles, mumps, rubella, herpes simplex, pertussis, scarlet fever, hay fever, asthma, eczema, urticaria, drug allergy, interparental violence, parental maltreatment, and trauma in early childhood. Subsequently, we examined how immune-mediated classes were reflected in leukocyte counts, inflammatory markers (IL-1β, IL-6, TNF-α, hsCRP), chronic inflammatory diseases, and mental disorders, and how they differed across social classes and birth cohorts.

RESULTS

LCA results with five classes were selected for further analysis. Latent classes were similar in both sexes and were labeled according to their associations as neutral, resilient, atopic, mixed (comprising infectious and atopic diseases), and ACE class. They came across with specific differences in biomarker levels. Mental disorders typically displayed increased lifetime prevalence rates in the atopic, the mixed, and the ACE classes, and decreased rates in the resilient class. The same patterns were apparent in chronic inflammatory diseases, except that the ACE class was relevant specifically in women but not in men.

CONCLUSIONS

This is the first study to systematically determine immune-mediated classes that evolve early in life. They display characteristic associations with biomarker levels and somatic and psychiatric diseases occurring later in life. Moreover, they show different distributions across social classes and allow to better understand the mechanisms beyond the changes in the prevalence of chronic somatic and psychiatric diseases.