Association between migraine and the risk of vascular dementia: A nationwide longitudinal study in South Korea

OBJECTIVE

We aimed to examine the potential association between migraine and vascular dementia (VaD) using a nationwide population database.

BACKGROUND

Migraine and VaD showed similar structural and functional changes in pathophysiology process and shared common risk factors, However, whether migraine prevalence increases VaD incidence remains controversial.

METHODS

This retrospective population-based cohort study used the medical records from the Korean National Health Insurance System database. Migraine (G43) was defined by using the Tenth Revision of the International Classification of Diseases code. More than two migraine diagnoses at least 3 months apart were defined as "chronic migraine". Cox proportional hazards model estimated hazard ratios (HRs) of VaD for group comparisons.

RESULTS

We included 212,836 patients with migraine and 5,863,348 individuals without migraine. During 10 years of follow-up, 3,914 (1.8%) and 60,258 (1.0%) patients with and without migraine, respectively, were newly diagnosed with VaD. After adjustment, patients with migraine showed a 1.21-fold higher risk of VaD than those without migraine (HR = 1.21; 95% confidence interval (CI): 1.17-1.25). Patients with chronic migraine showed a higher cumulative incidence of VaD than those with episodic migraine. The adjusted HR for the VaD incidence with migraine was higher in: (1) patients aged <65 years; (2) women; (3) patients without hypertension, diabetes, or atrial fibrillation; and (4) non-smokers.

CONCLUSION

Migraine is associated with an increased risk of VaD, particularly in chronic migraine patients. Incidence of VaD in the setting of migraine may have distinct pathophysiology from that of VaD with traditional cardiovascular risks.

Vascular Risk Score and Associations With Past, Current, or Future Migraine in Women: Cohort Study

BACKGROUND AND OBJECTIVES

Migraine has consistently been associated with an increased risk of cardiovascular disease (CVD) events. It remains, however, unclear to what extent cardiovascular risk profiles might be linked with migraine activity status and how these profiles relate to the development of migraine.

METHODS

We used data from a cohort study of female health professionals (Women's Health Study, n = 27,539, age ≥45 years at baseline) without a history of CVD or other major diseases and who provided a blood sample at baseline. Framingham risk scores (FRSs) estimating the 10-year risk of coronary heart disease calculated at baseline were used to create vascular risk categories. The presence or development of self-reported migraine was assessed by questionnaires. Women were classified as having no migraine, history of migraine (experienced migraine in the past but did not experience any migraine attacks in the year before enrollment), active migraine at baseline (active), or incident migraine (first report of migraine during follow-up but not at baseline). We used multinomial logistic regression models to calculate ORs for the association between FRS categories and migraine status.

RESULTS

Of the 27,539 participants, a total of 21,927 women did not report migraine, 1,500 women reported a history of migraine, 3,579 had migraine at baseline, and 533 reported migraine for the first time during follow-up. The odds of the probability of having a history of migraine at baseline (vs never migraine) was 76% higher among those with FRS ≥10% compared with FRS ≤1% after adjustment (OR = 1.76, 95% CI 1.39-2.23). In contrast, having FRS ≥10% was associated with reduced odds of having active migraine at baseline (OR = 0.64, 95% CI 0.52-0.80) and with newly reported migraine during follow-up (OR = 0.42, 95% CI 0.22-0.81) when compared with women with FRS category ≤1% and those not reporting migraine. A similar association pattern was observed for FRS categories 5%-9% and 2%-4%.

DISCUSSION

High FRS categories were only observed among women with a history of migraine but not with active migraine at baseline or incident migraine after baseline. Our results suggest that the life course of migraine should be considered when studying associations with the vascular system. Our data further suggest that a relatively healthy vascular system, as assessed by the FRS, is associated with active migraine status or developing migraine in the future.

Thrombophilic alterations, migraine, and vascular disease: results from a case-control study

BACKGROUND

The association between thrombophilic alterations, migraine, and vascular events has been broadly investigated but not been completely clarified.

METHODS

In this cross-sectional, case-control study, we included consecutive outpatients diagnosed with migraine referring to a tertiary headache center. Migraine patients were matched to headache-free control subjects. All participants were evaluated for free protein S anticoagulant, functional protein C anticoagulant, homocysteine, and antiphospholipid antibodies (aPLs). History of ischemic stroke (IS) or transient ischemic attack (TIA), coronary heart disease, and peripheral venous thrombosis was also ascertained.

RESULTS

We included 329 migraine patients and 329 control subjects (mean age 41 years, 77% women in both groups). Among migraine patients, 239 (72.6%) had migraine without aura and 90 (27.4%) had migraine with aura. Migraine patients had more frequently arterial hypertension, hypercholesterolemia, history of IS or TIA and, peripheral venous thrombosis compared to control subjects, whereas we found no differences in diabetes mellitus, BMI, and coronary heart disease between the two groups. At least one thrombophilic alteration was detected in 107 (32.5%) migraine patients and in 74 (22.5%) control subjects (OR = 1.66, 95% CI 1.17-2.35, p = 0.004). We identified an association of migraine with aPL positivity (OR = 2.6, 95% CI 1.5-4.7, p = 0.001) and with free protein S deficiency (OR = 4.7, 95% CI 1.6-14.0, p = 0.002), whereas we found no differences in protein C deficiency, APCR, and hyperhomocysteinemia between the two groups. Furthermore, aPL positivity and free protein S deficiency were more common in migraine patients with and without aura than in control subjects. We found that in migraine patients, aPL positivity was associated with both IS or TIA (OR = 5.6, 95% CI 1.5-20.4, p = 0.009) and with coronary heart disease (OR = 27.6, 95% CI 1.4-531.1, p = 0.028), whereas free protein S deficiency was associated with IS or TIA only (OR = 14.3, 95% CI 2.8-74.4, p = 0.002).

CONCLUSIONS

Our research documented a significative higher prevalence of aPL positivity and protein S deficiency in migraineurs than in controls. Data also showed an association between these alterations and some vascular thrombotic events in migraine patients. We can argue that thrombophilic disorders associated with migraine may contribute to the occurrence of vascular events.

Hypertension and Migraine: Time to Revisit the Evidence

PURPOSE OF REVIEW

It was reported that migraine was associated with increased vascular risks, and the association between high blood pressure (BP) and migraine was believed by some to be the missing link. The current review focused on the associations between migraine and hypertension and BP per se, and evidence on the directionality of the associations was also reviewed.

RECENT FINDINGS

In cross-sectional studies, the findings regarding whether migraine was associated with hypertension were inconsistent, and positive, neutral, or even inverse associations were reported. When individual BP parameters were examined separately, migraine was associated with higher diastolic BPs, and perhaps lower pulse pressures, although the associations with systolic BPs were incongruent. When studies mainly recruiting elderly patients are excluded, it appeared that studies reporting a positive association between migraine and high BPs, particularly high diastolic BPs, outnumbered those with an inverse or neutral association. In longitudinal studies, there was evidence that migraine patients were at increased risks of developing hypertension at follow-up. However, studies examining whether high BP could predict new-onset migraine yielded conflicting results. The association between migraine and hypertension is still a controversial issue, and a firm conclusion is precluded by the heterogeneities in methodologies and study populations. Migraine patients are at increased risk of developing hypertension. However, whether hypertension predicts migraine remains inconclusive. Further studies are needed to clarify the complicated association between BP and migraine.

Migraine and subclinical atherosclerosis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Introduction

The relationship between migraine and coronary heart disease (CHD) remains controversial. We aimed to investigate the association of subclinical atherosclerosis and migraine with or without aura compared to a non-migraine subgroup (reference) in a large Brazilian multicentric cohort study, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods

Migraine diagnostic was based on International Headache Society criteria, and aura symptoms were validated by a medical doctor in a sub-sample of the ELSA-Brasil, who also underwent coronary artery calcium score (CAC) and carotid intima-media thickness (C-IMT) evaluations. Subclinical atherosclerosis indexes (CAC and C-IMT) were analyzed as dependent variables and migraine (all, with aura, without aura) as an independent variable in the linear and multinomial logistic regression models adjusted for possible confounders.

Results

Of 3217 ELSA participants free from CVD at baseline, we found a migraine frequency of 11.9% (5.1% with aura and 6.8% without aura). Overall, migraineurs were mostly women, younger and had lower frequency of CV risk factors, such as hypertension, diabetes and low HDL-cholesterol, compared to non-migraineurs. The strongest inverse correlation between migraine and subclinical atherosclerosis was verified with CAC score. However, all associations lost their significance after multivariate adjustment.

Conclusions

In this cross-sectional evaluation of the ELSA study, migraine was not associated with subclinical atherosclerosis, regardless of aura symptoms.

Migraine and body mass index categories: a systematic review and meta-analysis of observational studies

BACKGROUND

Several studies have assessed the associations between migraine and underweight, pre-obesity or obesity, with conflicting results. To assess the consistency of the data on the topic, we performed a systematic review and meta-analysis of the available observational studies.

METHODS

Multiple electronic databases were systematically searched up to October 2014 for studies assessing the association between migraine and body mass index categories (underweight, pre-obesity, or obesity).

RESULTS

Out of 2,022 records, we included 15 studies. When considering the 11 studies following the World Health Organization BMI cutoffs, we found an increased risk of having migraine in underweight subjects (pooled adjusted effect estimate [PAEE] 1.21; 95% CI, 1.07-1.37; P = 0.002) and in obese women (PAEE 1.44; 95% CI, 1.05-1.97; P = 0.023) as compared with normal weight subjects; additionally, pre-obese subjects had an increased risk of having chronic migraine (PAEE 1.39; 95% CI, 1.13-1.71; P = 0.002). When considering all the 15 studies, we additionally found an increased risk of having migraine in obese as compared with normal weight subjects (PAEE 1.14; 95% CI, 1.02-1.27; P = 0.017); additionally, obese subjects had an increased risk of having chronic migraine (PAEE 1.75; 95% CI, 1.33-2.29; P < 0.001). The pooled analysis did not indicate an increased risk of having migraine in pre-obese subjects.

CONCLUSIONS

The meta-analysis of the available observational studies suggested an association between migraine and obesity likely mediated by gender and migraine frequency. Further studies taking into account gender, migraine type, frequency, activity, and duration could provide more robust evidence.

Gender aspects of the relationship between migraine and cardiovascular risk factors: A cross-sectional evaluation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Background

The relationship between cardiovascular risk factors (CVRF) and migraine is controversial and might be different in both genders. These associations were evaluated in Brazilian middle-aged men and women from the Longitudinal Study of Adult Health (ELSA-Brasil).

Methods

The cross-sectional relationship between our main outcome, which was migraine headache (definite, probable and overall), and CVRF was evaluated in the total sample and according to gender. We calculated frequencies and odds ratios (95% CI) for this relationship using binary and multinomial logistic regression analyses in crude, age-adjusted and multivariable models adjusted by potential confounders.

Results

Of 14,953 individuals who completed the data about headache and CVRF, the frequency of one-year migraine was of 29.5% (22.5% in women and 7.0% in men). In the multivariable-adjusted regression analyses, an inverse association between hypertension (OR, 0.53; 95% CI, 0.36–0.79), metabolic syndrome (OR, 0.65; 95% CI, 0.43–0.99) and definite migraine were confirmed for men, but not for women. In the opposite direction, a positive association between migraine headaches (definite, probable and overall) and dyslipidemia (overall migraine OR, 1.25; 95% CI, 1.13–1.38) was observed only for women, but not for men.

Conclusions

A gender influence on the relationship between migraine and CVRF was verified in the ELSA-Brasil.

Conventional vascular risk factors: their role in the association between migraine and cardiovascular diseases

INTRODUCTION

Migraine, in particular migraine with aura, has been found to be associated with cardiovascular disease. However, the role of conventional vascular risk factors in the association is still debated. The aim of the present review is to address the association between migraine and conventional cardiovascular risk factors as well as to address their possible role in the association between migraine and cardiovascular disease.

METHODS

Data for this review were obtained through searches in multiple sources up to May 2014 using the terms "migraine" OR "headache" in combination with all the vascular risk factors of interest.

RESULTS

Data about the possible association between migraine and high blood pressure values are heterogeneous, hindering any final conclusion. Data addressing the possible association between migraine and diabetes mellitus indicate the lack of any association or in some cases a negative association between the two conditions. The body of evidence on the role of dyslipidemia in migraineurs is relatively homogeneous and, with few exceptions, reports an association between migraine and an unfavorable lipid profile; however, the difference in lipid levels between migraineurs and non-migraineurs is small and its clinical implication unclear. Regarding obesity, a trend has been observed of increased risk of migraine with increasing obesity, especially in young patients, albeit in the midst of conflicting data. Evidence about the association between cigarette smoking and migraine mostly indicates that migraineurs are more commonly smokers than non-migraineurs. On the other hand, the majority of the available studies report less alcohol use in migraineurs than in non-migraineurs. Finally, many of the available studies suggest a more frequent family history of cardiovascular disease in migraineurs as compared to non-migraineurs. Since most of the studies that supported the association between migraine and cardiovascular disease adjusted the analyses for the presence of several vascular risk factors, they cannot entirely explain this association.

CONCLUSIONS

Based on the available reported data, it seems unlikely that the higher risk of cardiovascular disease in migraineurs is mediated by any single vascular risk factor. For this reason the role of specific interactions among risk factors with the contribution of genetic, environmental, personality and psychological factors should be appropriately investigated.

Vascular biomarkers in migraine

AIM

Migraine has been associated with stroke as well as with several non-atherosclerotic vascular conditions leading to discussions about the potential role of endothelium in the etiopathogenesis of migraine and migraine-associated stroke. We present a systematic review of the literature on vascular biomarkers in migraine, including those suggesting endothelial activation and damage.

METHODS

We conducted a systematic literature search from 1990 to 2013 using multiple research databases with the keywords "migraine," "headache," "vascular," and "biomarkers." We used selected inclusion and exclusion criteria to create a final pool of studies for this review.

RESULTS

The literature search identified a total of 639 citations of which 129 were included in our review. The final pool of clinical- and population-based studies assessed the level of various biomarkers (e.g. inflammatory, prothrombotic, endothelial activation, endothelial repair) in migraineurs of varying ages, gender, and demographic characteristics. Although for each biomarker there is at least one study suggesting an association with migraine, in many cases the quality of evidence is poor and there are conflicting studies showing no relationship. The results were, therefore, in each case inconclusive.

CONCLUSION

This systematic review indicated that in migraine populations there are a number of positive vascular biomarker studies, including some involving novel biomarkers such as endothelial microparticles and endothelial precursor cells. These lend insight into possible pathophysiological mechanisms by which migraine may be associated with stroke. More high-quality studies are needed to establish whether a true association between promising vascular biomarkers and migraine exists.

Obesity, abdominal obesity and migraine: a cross-sectional analysis of ELSA-Brasil baseline data

BACKGROUND AND AIM

Most studies assessing the association between migraine and obesity have shown conflicting results. We aimed to evaluate the association between obesity and migraine in ELSA-Brasil, a cohort study of 15,105 individuals aged 35-74 years.

METHODS

We assessed migraine using a validated questionnaire based on International Headache Society criteria and anthropometric measurements using standard techniques. Migraine was categorized as daily and non-daily. World Health Organization criteria were used to categorize overweight, obesity and abdominal obesity (AbO). We performed a cross-sectional analysis using multivariate logistic regression models to study the association between migraine and obesity (body mass index (BMI) ≥ 30 kg/m(2)), compared to controls without migraine.

RESULTS

We found an association between daily migraine and obesity (odds ratio (OR) 1.86; 95% confidence interval (95% CI): 1.12-3.09). Although the presence of AbO was not associated with migraine, interaction models showed that the association between obesity and daily migraine remained strong only in the absence of AbO diagnosis, notably in individuals aged 35-49 years.

DISCUSSION

In our large sample of individuals aged 35 years or older, obesity, but not AbO, was associated with daily migraine. AbO influenced the association between BMI and daily migraine in migraineurs aged 35-49 years.

Negative life events and migraine: a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline data

Background

Stress is a typical migraine trigger. However, the impact of negative life events on migraine activity is poorly studied. The aim of this study is to investigate the association between negative life events and migraine using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment.

Methods

ELSA-Brasil is a multicenter cohort study conducted in six Brazilian cities. Baseline assessment included validated questionnaires for headache classification and the occurrence of five pre-specified negative life events (financial hardship, hospitalization other than for childbirth, death of a close relative, robbery and end of a love relationship), focusing on a 12-month period before evaluation. We built crude and adjusted logistic regression models to study the association between the occurrences of negative life events and migraine diagnosis and activity.

Results

We included 4,409 individuals with migraine and 4,457 participants without headache (reference). After adjustment for age, sex, race, income and educational level, we found that the occurrence of a negative life event (Odds ratio = 1.31; 95% confidence interval = 1.19 – 1.45) was associated with migraine. However, after stratifying with subgroup analyses, only financial hardship (Odds ratio = 1.65; 95% confidence interval = 1.47 – 1.87) and hospitalization (Odds ratio = 1.47; 95% confidence interval = 1.25 – 1.72) were independently associated with migraine. Further adjustment for a current major depression episode and report of religious activity did not significantly change the results. Considering migraine frequency as (a) less than once per month, (b) once per month to once per week, or (c) more than once per week, financial hardship and hospitalization remained significantly associated with migraine in all episode frequency strata, with higher odds ratios for higher frequencies in adjusted models. We also observed a significant association between the death of a close relative and the highest migraine frequency stratum (Odds ratio = 1.38; 95% confidence interval = 1.09 – 1.75) in full-adjusted model.

Conclusions

The occurrence of financial hardship and hospitalization had a direct and independent association with migraine diagnosis and frequency. The death of a close relative was also independently associated with the highest migraine frequency stratum.

Migraine headaches and mood/anxiety disorders in the ELSA Brazil

OBJECTIVE

To describe the relationship between mood/anxiety disorders and migraine headaches emphasizing the frequency of episodes based in a cross-sectional analysis in the Brazilian Longitudinal Study of Adult Health.

BACKGROUND

It has been suggested that frequency of migraine headaches can be directly associated with the presence of psychiatric disorders.

METHODS

Migraine headaches (International Headache Society criteria) was classified as <1×/month, 1×/month-1×/week, 2-6×/week, and daily. Psychiatric disorders using the Clinical Interview Schedule - Revised were classified in 6 categories: common mental (CMD), major depressive (MDD), generalized anxiety (GAD), panic, obsessive-compulsive (OCD), and mixed anxiety and depressive (MADD) disorders. We performed multivariate logistic models adjusted for age, race, education, marital status, income, and use of selective serotonin reuptake inhibitors.

RESULTS

In our sample, 1261 presented definite migraine and 10,531 without migraine headaches (reference). Our main result was an increase in the strength of association between migraine and MDD as frequency of migraine increased for all sample: odds ratio of 2.14 (95% confidence interval [CI] 1.33-3.43) for <1 episode of migraine/month to 6.94 (95% CI 4.20-11.49) for daily headaches for all sample. Significant associations with migraine were also found for GAD, OCD, MADD, and CMD for total sample: MDD, GAD, OCD, MADD, and CMD for women, and MADD and CMD for men. Among men with daily migraine complaint, we found a significant association between migraine and OCD after correction for multiple comparisons (odds ratio 29.86 [95% CI 4.66-191.43]). Analyzing probable and definite migraine cases together, we replicated the findings in a lower magnitude.

CONCLUSIONS

The increase in migraine frequency was associated with progressively higher frequencies of having mood/anxiety disorders in all samples suggesting for some psychiatric disorders a likely dose-response effect especially for women.

Insulin resistance in migraineurs: results from a case-control study

OBJECTIVES

Several studies have suggested an association between migraine and insulin resistance (IR) without adequately addressing the issue according to migraine type. We assessed IR in subjects with migraine with aura (MwA) and migraine without aura (MwoA) to estimate the consistency of the possible association.

METHODS

In a case-control study we included case subjects with MwA and MwoA, who were consecutively selected from those referred to our Regional Headache Center from September 2011 to February 2013, and age-matched control subjects selected using general practitioners' databases. IR was calculated by means of the homeostatic model assessment of IR (HOMA-IR), β-cell function (HOMA-B), and the quantitative insulin sensitivity check index (QUICKI) measuring glucose and insulin values in a blood sample collected in the morning after overnight fasting. Data regarding anthropometric measures, comorbidity risk factors, and migraine characteristics were also recorded.

RESULTS

We recruited 50 case subjects with MwA (38 women) and 50 with MwoA (40 women) and 50 control subjects (40 women). Proportions of arterial hypertension, cigarette smoking, hypercholesterolemia, use of oral contraceptives, and mean values of the body mass index (BMI) were similar in the three groups. We found significantly different glucose values among and within groups considering case subjects with MwA and MwoA and control subjects (4.9 ± 0.6 vs 4.7 ± 0.5 vs 4.6 ± 0.5 mmol/l; P  = 0.018) in the absence of any difference in insulin (53.1 ± 24.0 vs 56.7 ± 34.4 vs 53.8 ± 24.4 pmol/l; P  = 0.811), HOMA-IR (1.6 ± 0.8 vs 1.7 ± 1.0 vs 1.6 ± 0.7; P  = 0.765), HOMA-B (121.4 ± 71.1 vs 149.2 ± 93.8 vs 162.8 ± 109.7; P  = 0.107), and QUICKI (0.36 ± 0.03 vs 0.37 ± 0.03 vs 0.37 ± 0.03; P  = 0.877) values. The logistic regression model showed increased odds of MwA in subjects exposed to the highest tertile of glucose values. This association was confirmed in the adjusted model, in which case subjects with MwA were compared with those with MwoA but not with control subjects.

CONCLUSIONS

In contrast to what has been shown by the majority of the available studies, the results of our study do not support the association of migraine with IR. As our study was not population-based and several patients had low disease activity, these findings need further confirmation.

Cardiovascular disease risk in women with migraine

Background

Studies suggest a higher prevalence of unfavourable cardiovascular risk factors amongst migraineurs, but results have been conflicting. The aim of this study was to investigate traditional and newly recognized risk factors as well as other surrogate markers of cardiovascular risk in obese and normal weight women with migraine.

Methods

Fifty-nine adult female probands participated in this case–control study. The sample was divided into normal weight and obese migraineurs and age- and body mass index-matched control groups. The following cardiovascular risk factors were analyzed: serum levels of lipids, fasting glucose, and insulin; insulin resistance; blood pressure; smoking (categorized as current, past or never); Framingham 10-year risk of general cardiovascular disease score; C-reactive protein; family history of cardiovascular disease; physical activity; sleep disturbances; depression; and bioelectrical impedance phase angle. The means of continuous variables were compared using Student’s t-test for independent samples or the Mann–Whitney U-test (for 2 groups) and ANOVA or the Kruskal-Wallis test (for 4 groups) depending on the distribution of data.

Results

All migraineurs were sedentary irrespective of nutritional status. Migraineurs had higher depression scores and shorter sleep duration, and obese migraineurs, in particular, had worse sleep quality scores. Insulin resistance and insulinaemia were associated with obesity, and obese migraineurs had lower HDL-c than normal weight controls and migraineurs. Also, the Framingham risk score was higher in obese migraineurs.

Conclusion

These findings suggest that female migraineurs experience marked inactivity, depression, and some sleep disturbance, that higher insulin resistance and insulinaemia are related to obesity, and that obesity and migraine probably exert overlapping effects on HDL-c levels and Framingham 10-year cardiovascular risk.

Migraine is not associated with enhanced atherosclerosis

AIM

Migraine, in particular with aura, has been associated with an increased risk for ischemic stroke and coronary heart disease. The underlying mechanism is unknown. In a cross-sectional case control study we investigated whether an enhanced risk of atherosclerosis in migraineurs explains this increased cardiovascular risk.

METHODS

Subjects were participants from the population-based Erasmus Rucphen Family study. Atherosclerosis was assessed in 360 migraineurs (209 without aura and 151 with aura) and 617 subjects without migraine or severe headache. Atherosclerosis was quantified by intima media thickness, pulse wave velocity and ankle-brachial index.

RESULTS

Migraineurs, especially with aura, were found more likely to smoke, have diabetes or a modestly decreased HDL-cholesterol. No differences were found for the atherosclerosis parameters.

CONCLUSION

In this large population-based study, migraineurs have no increased risk of atherosclerosis. Therefore, enhanced atherosclerosis is an unlikely explanation for the increased cardiovascular risk seen in migraineurs.

Migraine, weight gain and the risk of becoming overweight and obese: a prospective cohort study

BACKGROUND

Some cross-sectional studies have suggested an association between migraine and increased body weight. However, prospective data on the association are lacking.

METHODS

We conducted a prospective cohort study among 19,162 participants in the Women's Health Study who had a body mass index (BMI) of 18.5- <25 kg/m(2) at baseline. Migraine was self-reported by standardized questionnaires. Main outcome measures were incident overweight (BMI ≥ 25 kg/m(2)), incident obesity (BMI ≥ 30 kg/m(2)) and mean weight change. Age- and multivariable-adjusted hazard ratios (HRs) were calculated for the association between migraine and incident overweight and obesity. Differences in weight change were evaluated by analysis of covariance (ANCOVA).

RESULTS

A total of 3,483 (18.2%) women reported any migraine history. After 12.9 years of follow-up, 7916 incident overweight and 730 incident obesity cases occurred. Migraineurs had multivariable-adjusted HRs (95% confidence interval) of 1.11 (1.05-1.17) for becoming overweight and 1.00 (0.83-1.19) for becoming obese. These associations remained stable after censoring for chronic diseases and were similar according to migraine aura status. Multivariable-adjusted mean weight change from baseline to the end of study was +4.7 kg for migraineurs and +4.4 kg for women without migraine (p = 0.02).

CONCLUSION

Results of this large prospective study of middle-aged women do not indicate a consistent association between migraine and incident overweight, obesity or relevant weight gain.

Migraine and risk of incident diabetes in women: a prospective study

BACKGROUND

Previous cross-sectional studies evaluating the relationship between diabetes prevalence and migraine status have found conflicting results. We examined the relationship between migraine and incident type 2 diabetes (T2D) in a cohort of adult women.

METHODS

Prospective cohort study conducted among participants in the Women's Health Study who provided information on migraine and did not have diabetes at baseline. Our four exposure groups were migraine with aura, migraine without aura, past history of migraine and no history of migraine. Cox proportional hazards models were used to determine the hazard ratio for incident T2D.

RESULTS

Among the 38,620 women included in this study, 5062 (13.1%) women had migraine, of whom 2014 (39.8%) reported migraine with aura, and 2087 (5.4%) women had a past history of migraine. During a mean of 14.6 years of follow-up, there were 3032 cases of incident T2D. After adjustment for confounders, the hazard ratio (95% confidence interval) for developing diabetes was 1.06 (0.91-1.24) for women with migraine with aura, 1.01 (0.89-1.16) for women with migraine without aura, and 1.13 (0.98-1.30) for women with a past history of migraine compared with women with no history of migraine.

CONCLUSION

Results of this prospective study in women do not support an association between migraine and incident T2D.