Nonobese premenopausal women with chronic migraine have higher insulin resistance, according to a new study published in Cephalalgia.
In a cross-sectional study, glucose-stimulated insulin and glucagon-like peptide-1 (GLP-1) secretion during a 75-g oral glucose tolerance test was compared between 83 nonobese female patients with migraine who were of reproductive age (including both those with episodic and those with chronic migraine) and 36 healthy women. In addition, the researchers investigated the relationship of neuropeptide Y levels with insulin resistance and β-cell insulin secretion functions.
The researchers undertook the study because chronic migraine has a “well-documented association with increased insulin resistance and metabolic syndrome.” The associations are complex. The hypothalamus may play a role in the progression of chronic migraine through the regulation of orexigenic peptides such as neuropeptide Y. Moreover, insulin resistance may lead to increased risk for future type 2 diabetes mellitus in patients with chronic migraine, which is more likely to occur in the setting of impaired pancreatic β-cell functions and defects in GLP-1 secretion after meals.
The researchers found that plasma glucose and insulin levels during the oral glucose tolerance test were similar among the chronic migraine, episodic migraine, and control groups. However, fasting glucose levels were significantly higher in patients with migraine compared with control patients (91.8±8.2 mg/dL and 83.4±7.3 mg/dL, respectively; P <.001).
Patients with chronic migraine were found to have more insulin resistance than those with episodic migraine or control patients (P =.048). GLP-1 levels, both at fasting and 2 hours after glucose intake, were similar in in all groups, whereas neuropeptide Y levels were higher in migraineurs. In chronic migraine, neuropeptide Y was positively correlated with fasting GLP-1 levels (r=0.57; P =.04), but there was no correlation with insulin resistance (r=0.49; P =.09) or β-cell function (r=0.50; P =.07).
The researchers stated, “normal β-cell function is to compensate for the increased insulin demand during fasting and after glucose intake.”
They concluded that “increased fasting neuropeptide Y levels in migraine may be a factor leading to increased insulin resistance by specific alterations in energy intake and activation of the sympathoadrenal system.”
Siva ZO, Uluduz D, Keskin FE, et al. Determinants of glucose metabolism and the role of NPY in the progression of insulin resistance in chronic migraine [published online December 20, 2017]. Cephalalgia. doi:10.1177/0333102417748928