Asthma and Migraine – a Link?

Leukotrienes play a major role in asthma, which is a chronic inflammatory disease. Inflammatory mediators instigate the contraction of airway smooth muscle and cause inflammation and damage to the lining of the airways. Inflammation is also present in migraine where there is both dilation and constriction of blood vessels. Inflammation then may be the common link between asthma and migraines. Both are episodic and both can be chronic. With migraines, individuals who have episodes may progress to having chronic migraines which are defined as having 15 or more headaches a month.

The prevalence of migraine in the USA is 4% before puberty. With women, it increases to 25%and decreases with menopause. About 11.7% (35 million) Americans suffer from migraines with more women (17.1%) than men (5.6%) being affected.1

The word ‘migraine’, originally from the Greek, means ‘half-skull’, since migraines tend to affect one side of the head. A complex condition, it has a wide variety of symptoms with headache as the main characteristic. The pain from the headache tends to be severe. Other symptoms include sensitivity to light, sounds and odours; disturbed vision; temperature change; nausea; vomiting; sweating and diarrhea. Prodromal signs may also include difficulty with speech and hearing, memory changes, feelings of fear and confusion and in a few cases fainting and partial paralysis.

As with asthma, migraine symptoms can vary from one individual to the next. The World Health Organization defines the types of migraines as either with or without an aura. Auras relate to neurological symptoms that include visual disturbances such as blind or coloured spots, flashing lights before the eyes, tunnel vision, zig-zag lines and temporary blindness; as well as symptoms such as numbness or tingling, dizziness, weakness, and vertigo (a feeling of spinning).

Among migraine sufferers, the majority (70–90%) do not have auras. Attacks may occur anywhere from once a year to several times a week. This frequency is similar to those persons who have migraines with auras.

Migraine has four distinct stages, each of which can vary in duration and severity. It is these stages that distinguish a migraine from a headache. The Premonitory stage lasts from 1 to 24 hours and is noted for physical and mental changes that include fatigue, mood swings, thirst, a stiff neck and a craving for sweet foods. Then comes the Aura stage (5 minutes to 1 hour) that is marked by visual disturbances and sensory symptoms. This is followed by the Main Attack stage (4 to 72 hours) with head pain often described as one-sided and throbbing or pulsing. Finally there is the Recovery stage where there may be either a sudden or a slow resolution.

There are a number of similarities in the prevention of migraines and asthma. Both

  • are more common in women than men
  • are a leading cause of ER visits
  • have warning signs
  • have triggers that include temperature changes, strong smells, certain odours, perfumes, smoke (tobacco or biofuels), hormones, certain foods, stress, excitement
  • have allergic triggers
  • can have exercise as a trigger
  •  have co-morbidites that include obesity and atopy
  • treatments include three crucial steps

    -    avoidance of triggers
    -    control of symptoms, and
    -    taking medication

Certain foods can trigger migraine, including foods that contain

  • tyramine – aged cheese, red wine, chicken livers, smoked fish, figs, some beans
  • nitrates – bacon, salami, hot dogs
  • MSG (monosodium glutamate)
  • fermented or pickled components .

Some of the other foods that may trigger migraines include chocolate, peanut butter, nuts, avocado, banana, citrus, onions and dairy products. Other possible triggers include jet lag, alcohol, dehydration, fatigue, fasting, tension headaches, changes in sleep patterns, irregular sleep, medications such as sleeping tablets, contraceptives and hormone replacement therapy.

Link between Migraines and Asthma or its Co-morbidities

Studies of individuals with migraines have noted a link with asthma. Individuals who had migraines were at an increased risk (RR 1.3) of developing asthma2 and that individuals with chronic migraines had a higher risk of asthma (RR1.77).3 Both migraine and non-migraine headaches were related to asthma, hay fever and chronic bronchitis.4 Özge and colleagues5 noted that atopic disorders such as seasonal rhinitis and asthma were closely correlated with chronic tension-type headaches and migraines with auras. They suggested that patients with migraine should be checked for atopic disorders.

Researchers6 have also noted a link between body mass and migraines. 7601 adults who participated in the National Health and Nutrition Survey of 1999-2002 were evaluated for BMI and migraines. After adjusting for a number of confounders, the researchers found that prevalence of migraine was related to BMI in a non-linear way such that the highest prevalence was found in individuals with a BMI of <18.5 at 34% or a BMI >30 at 25.9%. Individuals with a BMI between 18.5 and <25 had a prevalence of 18.9% while those with a BMI between 25 and 30 had a prevalence of 20.7%. The researchers concluded that BMI is associated with migraines. BMI also affects asthma.

Adolescents with migraines had an OR of 2.22 for asthma and OR of 1.66 for seasonal allergies in a study7 that examined co-morbidities in a representative sample of US adolescents. A separate study8of data from over 3000 pregnant women found that those who had migraines had a 1.38 increased odds of developing asthma when compared with women who did not have migraines. The combination of migraines and asthma also increased the risk for preeclampsia and pregnancy-induced hypertension.

Wang et al9 listed the comorbidites of migraine, many of which are common to asthma, including psychiatric disorders (depression, anxiety, panic disorder, suicide), obesity, cardiovascular disorders and asthma among others. Cole and colleagues found a high prevalence (40%-80%) of migraine and depression in individuals with irritable bowel syndrome; as such, it should be considered a co-morbidity of migraine.10

Asthma as a Risk Factor

While both asthma and migraines are based on inflammatory conditions, the question arises as to whether asthma is a risk factor for migraines. Statistically, while 7.5% of the U.S. population suffers from asthma, 11.6% have migraines. The connection then is most likely.

Karlstad and colleagues11 looked at the incidence of nine chronic diseases in patients with asthma. They found that 59% of the individuals with asthma had at least one of nine chronic diseases when compared with just 18% of the general population, with a majority having more than one chronic ailment. The nine chronic diseases were: attention deficit/hyperactivity disorder, autoimmune disorder, allergy, diabetes, epilepsy, mental illness, cardiovascular disease, migraine and gastroesophageal reflux disease (GERD). Allergies and GERD were most common in patients with asthma.

A recent study by Martin and colleagues12 at the University of Cincinnati tested the hypothesis of asthma as a risk factor for a change from episodic to chronic migraine by reviewing 2008-2009 data from the American Migraine Prevalence and Prevention (AMPP) study. They found that having asthma increased the risk of new onset chronic migraine a year later among individuals who had episodic migraines. See Table 1. 4446 individuals with migraine in 2008 reported an increase of 2.9% (131 individuals) in new chronic migraines in 2009. The presence of asthma doubled the risk (OR 2.1) while individuals with asthma who had the greatest number of respiratory symptoms – indicating increased severity of asthma – had the highest risk (OR. 3.3).

In conclusion, the asthma educator thus has a further question to put to the patient with asthma: does he or she suffer from headaches/migraine? This is an area that has hitherto been neglected despite the connection both with asthma and reduced quality of life. Currently it is unknown if control of the asthma will influence the severity of migraines, but it is essential that the asthma itself be well controlled if only to improve both morbidity and mortality.

 

References

  1. Lipton RB, Bigal ME, et al; AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007 Jan 30;68(5):343-9.
  2. Becker C, Brobert GP et al. The risk of newly diagnosed asthma in migraineurs with or without previous triptan prescriptions. Headache. 2008;48(4):606-10. doi: 10.1111/j.1526-4610.2007.01030.x.
  3. Chen YC, Tang CH et al. Comorbidity profiles of chronic migraine sufferers in a national database in Taiwan. J Headache Pain. 2012 Jun;13(4):311-9. doi: 10.1007/s10194-012-0447-4.
  4. Aamodt A. H., Stovner L. J., Langhammer A., Hagen K., Zwart J. A. (2007). Is headache related to asthma, hay fever, and chronic bronchitis? The Head-HUNT Study. Headache 47, 204–21210.1111/j.1526-4610.2006.00597.x
  5. Özge A, Öksüz N et al. Atopic disorders are more common in childhood migraine and correlated headache phenotype. Pediatr Int. 2014 Dec;56(6):868-72. doi: 10.1111/ped.12381.
  6. Ford ES, Li C, et al. Body mass index and headaches: findings from a national sample of US adults. Cephalalgia. 2008 Dec;28(12):1270-6. doi: 10.1111/j.1468-2982.2008.01671.x. Abstract.
  7. Lateef TM, Cui L, et al. Physical comorbidity of migraine and other headaches in US adolescents. J Pediatr. 2012 Aug;161(2):308-13.e1. doi: 10.1016/j.jpeds.2012.01.040.
  8. Czerwinski S, Gollero J, et al.  Migraine-asthma comorbidity and risk of hypertensive disorders of pregnancy. J Pregnancy. 2012;2012:858097. doi: 10.1155/2012/858097.
  9. Wang SJ, Chen PK, Fuh JL. Comorbidities of migraine. Front Neurol. 2010 Aug 23;1:16. doi: 10.3389/fneur.2010.00016. eCollection 2010
  10. Cole JA, Rothman KJ, et al. Migraine, fibromyalgia, and depression among people with IBS: a prevalence study. BMC Gastroenterol. 2006 Sep 28;6:26. Abstract
  11. Karlstad Ø, Nafstad P et al, Comorbidities in an asthma population 8-29 years old: a study from the Norwegian Prescription Database. Pharmacoepidemiol Drug Saf. 2012 Oct;21(10):1045-52. doi: 10.1002/pds.2233.
  12. Martin VT, Fanning KM, et al. Asthma is a risk factor for new onset chronic migraine: results from the American migraine prevalence and prevention study. Headache: The Journal of Head and Face Pain. doi: 10.1111/head.12731.