Migraine and its strange and surprising associations

By Sasha Wolff from Grand Rapids - Can't Concentrate: 14/365, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=11343038
By Sasha Wolff from Grand Rapids – Can’t Concentrate: 14/365, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=11343038

I am casting my sight on the scourge of millions around the world-migraine. This post is a prelude to a piece I am working on titled How is migraine research soothing the pain of neurology? In doing this, I came across a few curiosities which I thought would do nicely as a separate post. Therefore, before the real stuff, here are 8 strange and surprising migraine associations.

α. Migraine and the weather

Texture: Thunder Clouds. Virginia Moerenhout on Flikr. https://www.flickr.com/photos/yndra/4784553320
Texture: Thunder Clouds. Virginia Moerenhout on Flikr. https://www.flickr.com/photos/yndra/4784553320

Some migraineurs know that their migraine attacks are related to changes in the weather. For them therefore, the science is just catching up. This piece from the American Migraine Foundation summarises some recent articles which discuss the weather alterations that may trigger migraine headaches. The fingers are pointing at low barometric pressure, high environmental temperature, strong winds, and…wait for it…> 3hours of sunshine!

β. Migraine and irritable bowel syndrome (IBS)

This is not even officially out yet, but a press release announcing the American Academy of Neurology’s April 2016 meeting whets our appetites. The findings of a study to be unveiled in Vancouver reports that migraine is probably genetically linked to irritable bowel syndrome (IBS). Not only that, the two may also share genetic markers with tension type headache (TTH). And the link is thought to be the serotonin transporter, and the serotonin receptor 2A, gene. The association of migraine and IBS will really put the cat among the pigeons; dealing with migraine alone is hard enough but combine the two and…

γ. Migraine and Parkinson’s disease (PD)

By Marvin 101 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=7533521
By Marvin 101Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=7533521

Migraine sufferers will really balk at the scary report of migraine as a risk factor for Parkinson’s disease (PD). This is the conclusion of a research work published in the journal Cephalalgia (really just a fancy word for headache). The authors followed up >40,000 people to see if those with migraine are more likely to develop PD than those without. Curious indeed! I have to confess, whatever the hazard ratios say, that I was not impressed by the difference in numbers developing PD of 148 versus 101.

δ. Migraine and radiotherapy

Varian radiation therapy machine. Dina-Roberts Wakulczyk on Flikr. https://www.flickr.com/photos/littlesister/490643515
Varian radiation therapy machine. Dina-Roberts Wakulczyk on Flikr. https://www.flickr.com/photos/littlesister/490643515

I’m not trying to be smart, but SMART syndrome is real. It is an acronym for Stroke-like migraine attacks after radiation therapy. It is easy for neurologists to miss this condition because it sets in years after the radiation treatment. There is however a clue in the MRI of people with SMART syndrome: cortical thickening and gadolinium enhancement in the area of brain treated with radiation. It’s simple really!

ε. Migraine and raised intracranial pressure

By Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center - The Eyes Have It, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=16115920
By Jonathan Trobe, M.D. – University of Michigan Kellogg Eye Center – The Eyes Have It, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=16115920

An article in Journal of Neurology reports that many people with unrelenting migraine have raised pressure in the brain (raised intracranial pressure or ICP). The article, titled association of unresponsive chronic migraine and raised intracranial pressure, showed that reducing the pressure by a spinal tap (lumbar puncture) leads to sustained remission of migraine. Neurologists diagnose raised ICP by look into the back of the eye for a sign called papilledema. This article however throws a spanner in the works because >75% of the people with migraine and raised ICP in the study did not have papilledema. What do the headache gurus have to say about this, I wonder?

ζ. Migraine and stroke

Neurologists really haven’t sorted this one out yet. We struggle to give our patients a straightforward answer to their simple question, ‘does migraine cause stroke?‘ This is because the literature on this is all smoke and mirrors, and recent papers do little to clear the air. Take this paper in a recent issue of Neurology titled Age-specific association of migraine with cryptogenic TIA and stroke. The authors could only conclude that there is probably a causal or shared risk, and this only in older people. The accompanying editorial, titled Migraine and cryptogenic stroke: the clot thickens, concludes that there may be a higher risk of stroke in migraineurs, but this is in those with other traditional stroke risk factors in the first place. A shaky association I say, but one not to be dismissed too hastily.

η. Migraine and teeth-grinding

By Mik81 - Photography of author, original description page was here., Public Domain, https://commons.wikimedia.org/w/index.php?curid=2478383
By Mik81 – Photography of author, original description page was here., Public Domain, https://commons.wikimedia.org/w/index.php?curid=2478383

I did say these are strange links. Teeth grinding or bruxism is not something neurologists would give a second thought to, but a review article in Practical Neurology says we should think again. Titled Bruxism in the Neurology Clinic, the review says bruxism is closely linked to migraine, and sleep bruxism is only associated with migraine. There is much more to bruxism and neurology; the authors suggests that bruxism may be a form of oromandibular dystonia, and it may arise from dysregulation in the basal ganglia. Quite a lot to chew! Dentists out there should be very worried-the neurologists are out to expand their territory.

θ. Migraine and hiccups

Try this Flikr. Bart on Flikr. https://www.flickr.com/photos/cayusa/3029282000
Try this Flikr. Bart on Flikr. https://www.flickr.com/photos/cayusa/3029282000

And finally a report which links migraine and hiccups. Again from Cephalalgia, this is a case series of people with migraine who report hiccups as aura of migraine. Strange and surprising indeed!

migraine aura 2 - when it's light and shimmery. Joanna Roja on Flikr. https://www.flickr.com/photos/cats_mom/2758240218
migraine aura 2 – when it’s light and shimmery. Joanna Roja on Flikr. https://www.flickr.com/photos/cats_mom/2758240218

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