Patients With Migraine at Increased Risk for Traumatic Brain Injury

Migraine is a potential risk factor for the development of traumatic brain injury (TBI) and is associated with a 78% increased risk for TBI compared with individuals without migraine, according to study results published in BMJ Open.

As TBI is a major cause of long-term disability in young adults and can negatively affect quality of life, a better understanding of its risk factors may assist in minimizing the risk for TBI-related morbidities and mortality. Previous studies have reported that TBI is a risk factor for migraine, but it is not clear if migraine increases the risk for TBI. The goal of the study was to explore the association between TBI and migraine and establish the potential risk for developing TBI in patients with migraine.

The retrospective population-based cohort study included data from Taiwan’s National Health Insurance Research Database. The migraine cohort included 7267 patients aged ≥18 years (74% female) diagnosed with migraine between 1996 and 2010 and 29,068 age- and gender-matched non-migraineur controls.

During a median observation of 2.8 years, 272 patients with migraine (3.74%) had TBI compared to 797 patients without migraine (2.74%) during a median observation time of 5.3 years (P <.001). After adjusting for age, gender, income, urbanization, and related comorbidities, researchers found the overall risk for TBI was 1.78 times greater in the migraine group compared with the non-migraine group (5.35 vs 1.86 per 1000 person-years, respectively).

The migraine group had a significantly higher TBI risk in both genders (adjusted hazard ratio [aHR], 1.94; 95% CI, 1.60-2.36 in women; aHR, 1.48; 95% CI, 1.13-1.95 in men). The incidence rate of TBI increased with age, but migraine was consistently associated with a higher incidence of TBI in all age groups.

Additional risk factors for TBI in patients with migraine included alcohol-attributed disease (aHR, 2.45; 95% CI, 1.67-3.60), mental disorders (aHR, 1.42; 95% CI, 1.11-1.81), and diabetes mellitus (aHR, 1.46; 95% CI, 1.15-1.85). Conversely, female gender and high income had protective roles against TBI in these patients.

Compared with patients without migraine, patients with migraine had a 149% increase in the risk for mild TBI, a 36% increase in the risk for moderate TBI, and a 263% increase in the risk for severe TBI, following adjustment of covariates. Of note, migraine had the strongest association with severe TBI (aHR, 3.63; 95% CI, 1.58-8.37).

The study had several limitations, including potential coding errors, missing information to determine the severity of migraine or TBI, and possible overestimation of TBI events in patients with migraine with psychiatric disorders.

“This population-based cohort study indicated that patients with migraine have significantly higher than normal risk of developing TBI. In addition, migraine mostly affects the development of severe TBI relative to other grades of TBI,” concluded the researchers.

Reference

Wang QR, Lu YY, Su YJ, et al. Migraine and traumatic brain injury: a cohort study in Taiwan [published online July 30, 2019]. BMJ Open. doi:10.1136/bmjopen-2018-027251