BOSTON—Obesity joins the list of risk factors for episodic migraine, along with age, sex, and race, according to a new study presented at the 2013 International Headache Congress.
B. Lee Peterlin, DO, Associate Professor of Neurology at Johns Hopkins University School of Medicine in Baltimore, and colleagues conducted a cross-sectional study of 3,862 black and white adult participants interviewed in the National Comorbidity Survey Replicated. Episodic migraine diagnostic criteria were based on the International Classification of Headache Disorders. BMI was classified as underweight (less than 18.5 kg/m2), normal (18.5 to 24.9 kg/m2), overweight (25 to 29.9 kg/m2), and obese (greater than 30 kg/m2). Odds ratios (OR) and 95% confidence intervals (CI) for migraine were estimated using logistic regression and adjusted for demographics and health characteristics. Models were also stratified by age (younger than or older than 50), race (white or black), and sex (male or female).
The mean BMI was greater in those with episodic migraine (27.8), compared with controls (27.1). The unadjusted prevalence estimates of obesity were 32.2% among those with episodic migraine and 26.0% among controls. In all participants, the adjusted odds of episodic migraine were 81% greater in obese as compared with normal weighted individuals (OR 1.81). In addition, stratified analyses demonstrated that the odds of episodic migraine were greater in obese as compared with normal weighted individuals who were: younger than 50 (OR 1.86), white (OR 2.06), or female (OR 1.95), and were not increased in those older than 50 (OR 1.15) or men (OR 1.43). Due to the small number of black participants with episodic migraine, no conclusion could be drawn regarding the odds of episodic migraine in obese black participants alone. Similar findings were demonstrated in lower frequency episodic migraine subgroups.
“There has been controversy about whether obesity is associated with an increased risk of migraine in general or if this risk was limited to just chronic or high frequency migraine sufferers,” said Dr. Peterlin. “This study demonstrates that the risk of migraine in those with obesity extends to episodic migraineurs, even those with low frequencies. Specifically, in those with obesity, the odds of episodic migraine in general were increased by 81%, while the odds of lower frequency episodic migraine increased by 83% to 89%. Further, we found that the risk of episodic migraine in those with obesity was greatest in those under 50 years of age, white individuals, and women.”
Post-Traumatic Stress in Veterans May Mediate the Relationship Between Psychologically Traumatic Events and Headache
The relationship of headache to traumatic events that occurred during military service may be different than the relationship of headache to other traumatic experiences, according to new research.
In light of the fact that veterans of military service in Iraq and Afghanistan have high rates of headache, trauma, and post-traumatic stress, researchers sought to determine whether the relationship between trauma and headache is independent of post-traumatic stress or if this relationship occurs primarily in the context of post-traumatic stress. Elizabeth K. Seng, PhD, of the VA Connecticut Healthcare System in West Haven, and colleagues examined cross-sectional survey data from the Women Veterans Cohort Study. Participants were recruited through mailings sent to 8,465 veterans of military service in Iraq and Afghanistan now living in New England, Indiana, and Illinois, and through flyers in Connecticut and Indiana. A total of 693 veterans completed the baseline survey from July 2008 to December 2011. Of those, 551 veterans (228 males) responded to the study inclusion item, “During the past 12 months, have you taken prescription medication for headaches,” which is nonspecific to headache type and identifies clinically significant headache. Measures included PTSD symptoms (Post-traumatic Stress Disorder Checklist, Military Version) and trauma (Traumatic Life Events Questionnaire, Combat Exposure Scale, and military sexual trauma [sexual harassment and rape]).
Among the 139 veterans who reported taking prescription headache medication in the prior year, a higher number of lifetime traumas was associated with higher odds of taking prescription medication. A greater number of childhood and adulthood interpersonal traumas were both associated with higher odds of taking prescription headache medication. Post-traumatic stress symptoms mediated both of these associations.
“We saw that neither combat trauma nor rape was associated with taking a prescription headache medication,” said Dr. Seng. “We found that military sexual harassment was associated with decreased odds of taking prescription headache medication.”
The authors reported preliminary evidence suggesting that post-traumatic stress symptoms may play an important role in the relationship between psychologically traumatic events and headache and that the relationship between traumatic events occurring during military service and headache may differ from the relationship between other traumatic events and headache.