Progression to Chronic Migraine Impacted by Asthma

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Along with migraine, many of us have comorbid diseases and conditions. That means that we can have two or more of them at the same time, but none of them causes the others. A new study has concluded that pre-existing asthma may be a strong predictor of future chronic migraine (CM) in individuals experiencing episodic migraine attacks (EM).

The Study:

Study Background:

"Migraine and asthma are comorbid chronic disorders with episodic attacks thought to involve inflammatory and neurological mechanisms. Herein, we assess the influence of asthma on the clinical course of EM."1

Study Objective:

"To test the hypothesis that in persons with episodic migraine (EM), asthma is a risk factor for the onset of chronic migraine (CM)."1

Study Methods:

  • Study data for analysis was drawn from the American Migraine Prevalence and Prevention (AMPP) study.
  • To be eligible for this study, AMPP Study participants had to meet criteria for EM in 2008, complete the validated six-item asthma questionnaire from the European Community Respiratory Health Survey (ECRHS) in 2008, and provide follow-up data in 2009.
  • Based on the 2008 surveys, participants were divided into two groups - one with episodic migraine and coexisting asthma, and one with episodic migraine without asthma.
  • There 4446 individuals eligible for this study who had EM in 2008, 17 percent of whom had asthma and were placed in the first group.
  • Chronic migraine was the primary outcome measure and was defined as those with 15 or more migraine or headache days per month on the 2009 AMPP Study survey.

Study Results:

  • In 2009, new onset chronic migraine developed in 2.9 percent (131/4446) of the group who had episodic migraine in 2008, including:
    • 5.4 percent (40/746) of the asthma subgroup and
    • 2.5 percent (91/3700) of the non-asthma subgroup.
    • Increases in the development of chronic migraine increased with greater severity of asthma symptoms.

Study Conclusions:

"Persons with episodic migraine who have comorbid asthma have a twofold increased risk of developing chronic migraine one year later. Those with the greatest risk were in the highest category of asthma symptom severity, suggesting that “severe asthma” in particular may pose the greatest risk of transformation to chronic migraine. Potential mechanisms to explain this association are unknown, but could include mast cell degranulation, parasympathetic hyperactivity, enhanced neuropeptide release, and shared environmental or genetic factors. These represent interesting preliminary findings that merit further study to determine the specific mechanisms underlying this association."1

Comments from Study Researchers:

Vincent Martin, M.D., lead author of the study, professor of medicine in
the University of Cincinnati's division of general internal medicine, and co-director of the Headache and Facial Pain Program at the UC Neuroscience Institute, said:

"If you have asthma along with episodic or occasional migraine, then your headaches are more likely to evolve into a more disabling form known as chronic migraine. The strength of the relationship is robust - asthma was a stronger predictor of chronic migraine than depression, which other studies have found to be one of the most potent conditions associated with the future development of chronic migraine."3

Richard Lipton, M.D., director of Montefiore Headache Center and vice chair of
neurology, and the Edwin S. Lowe Chair in Neurology, Albert Einstein College of Medicine, and founder of the American Migraine Prevalence and Prevention Study, commented:

"Migraine and asthma are disorders that involve inflammation and activation of smooth muscle either in blood vessels of in the airways."2

Summary and Implications for Patients:

The study showed a strong correlation between asthma and progressing from episodic migraine to chronic migraine. Additionally, it showed that the risk is greater as the number and severity of asthma symptoms increase. The biggest implication for patients is that patients with episodic migraine and asthma need to be especially aware of the risk and work with their doctors to optimize their asthma care and treatment.


Resources:

1 Martin, Vincent T., MD; Fanning, Kristina M., PhD; Serrano, Daniel, PhD; Buse, Dawn, PhD; Reed, Michael L., PhD; Lipton, Richard B., MD. "Asthma Is a Risk Factor for New Onset Chronic Migraine: Results from the American Migraine Prevalence and Prevention Study." Headache. Early View. First published online November 19, 2015.

2 Feller, Stephen. "Asthma can make occasional migraines a chronic condition." United Press International (UPI.com). November 30, 2015.

3 Press Release. "Beware Asthma Sufferers: Migraines May Worsen." Cincinnati. Montefiore Medical Center. November 30, 2015.

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