For patients, a migraine is a particularly disorienting and unpredictable experience. They aren’t likely to know the severity or duration of a migraine, or the different ways it may affect their body, until it happens. A migraine can leave them unable to perform everyday tasks, left to cope with a stabbing pain and no set timetable for recovery. As such, they’re likely to look for any way they can to mitigate the risk of developing one.
There are some risk factors for migraines that patients may know about, and may also not have as much control over as they desire, such as hormonal changes or exposure to bright or flashing lights.¹ However, there are a wide variety of factors that have the potential to increase migraine risk and severity. If they aren’t aware of some of these factors, they could unknowingly put themselves at risk for severe migraines and even morbidity. What are some of the notable risk factors worth explaining to them?
According to a 2021 study in The Journal of Headache and Pain, obesity is often associated with migraine risk, as well as idiopathic intracranial hypertension.² In examining a potential link between obesity and migraines, the researchers found that truncal adiposity (abdominal body weight detrimental to one’s health) is linked to an increased risk of migraine severity, frequency, disability, and morbidity. The researchers suggested that obesity could also increase intracranial pressure in a patient.
As a modifiable risk factor, decreasing obesity may reduce migraine risk and severity. In addition, the American Migraine Foundation estimates that a lack of exercise is responsible for as much as a 21% increase in migraine risk in adults and a 50% increase in adolescents.³ Even if it does not result in weight loss, exercise and a more active lifestyle may help address migraine risk.
Glucose may play a complex role in migraine development. A 2022 study in Genes examined glucose-related traits (defined as fasting glucose, fasting insulin, and type 2 diabetes) and its role in migraine development. The researchers identified what they considered to be strong evidence of a biological association between the two.⁴ They found that fluctuations in blood glucose and impaired glucose metabolism have associations with migraine comorbidity, and that there are possible genetic connections between migraines and type 2 diabetes. Patients with glucose-related conditions and migraines should take particular care to manage their condition to the best of their ability.
A 2022 study published in Frontiers in Neurology looked at the epidemiology, risk factors, and comorbid conditions associated with migraines.⁵ One risk factor the researchers examined was substance use, including alcohol consumption and smoking. Drinking alcohol in particular can increase migraine development substantially.
Another possible reason substance use could be a risk factor for migraines is its association with other comorbid conditions like post-traumatic stress disorder. On its own, substance use was not seen as one of the stronger risk factors, but instead one that could be indicative of other comorbidities that increase migraine risk.
Mental health disorders may also play a role in both the likelihood of substance use and migraine risk. For example, the researchers noted that substance use is often comorbid with bipolar disorder, as are migraines.
Anxiety can be a significant risk factor, especially in the form of generalized anxiety disorder or panic disorder. Per the researchers, patients with migraines are at an advanced risk of these anxiety disorders; those with migraines may be as much as three times more likely to experience anxiety than those who don’t have them.
In addition, anxiety can cause patients to have other mental health conditions that increase the risk of migraines, such as phobias, stress, fatigue, and depression.
The researchers also noted that certain autoimmune and rheumatic disorders can put patients at a heightened risk for migraine development, including rheumatoid arthritis and psoriasis.
Regarding psoriasis, it is suggested that neurogenic inflammation, which can trigger psoriasis, is also associated with migraine headache pain. Patients with autoimmune diseases who are at heightened risk of migraines should try to avoid dietary and lifestyle choices that may increase inflammation, as it puts them at risk for both a psoriasis flare and a more painful migraine.
While many of these risk factors are only so modifiable, patients with migraines still have some agency in curtailing them. Understanding how different factors increase their risk of developing migraines and increasing their severity allows them to make better decisions in their attempt to mitigate discomfort.
This article originally appeared on Clinical Advisor
1. Migraine. National Institute of Neurological Disorders and Stroke.Updated January 20, 2023. Accessed March 29, 2023. https://www.ninds.nih.gov/health-information/disorders/migraine.
2. Westgate CSJ, Israelsen IME, Jensen RH, Eftekhari S. Understanding the link between obesity and headache- with focus on migraine and idiopathic intracranial hypertension. J Headache Pain. 2021;22(1):123. doi:10.1186/s10194-021-01337-0
3. The link between obesity and migraine. American Migraine Foundation. Updated November 4, 2021. Accessed April 4, 2023. https://americanmigrainefoundation.org/resource-library/migraine-obesity/.
4. Islam MR, Nyholt DR. Glucose-related traits and risk of migraine-A potential mechanism and treatment consideration. Genes (Basel). 2022;13(5):730. doi:10.3390/genes13050730.
5. Amiri P, Kazeminasab S, Nejadghaderi SA, et al. Migraine: a review on its history, global epidemiology, risk factors, and comorbidities. Front. Neurol. 2022;12. doi:10.3389/fneur.2021.800605