Is it my allergies?

by Deena Kuruvilla, MD

Many patients ask me whether there is an association between migraine and their allergies. Other patients ask me whether there is an association between migraine and asthma. In the April edition of Headache, Dr. Aupiais and her colleagues in France and Italy shed some light on the association between atopic diseases, anti-allergy therapies and their effects on migraine occurrence in pediatric patients.

Atopic diseases span a large number of subclassified disorders, including asthma, allergic rhinitis, allergic conjunctivitis, atopic dermatitis (eczema) and food allergies. Asthma is a chronic disorder that affects 8% of the United States population. Previously, two large population studies have shown that patients with asthma are 1.5 times more likely to develop migraines than non-asthmatic patients. Inflammation has been thought to be an underlying, unifying mechanism between bronchial hyperreactivity and migraine without aura. Another commonality between migraine and asthma is the increased risk of also having anxiety and depression as a comorbid condition.

Both epidemiological and clinic based studies have shown a relationship between migraine and allergic rhinitis and eczema. Patients frequently question whether allergy symptoms are causing sinus headaches and if there is a component of sinusitis. While we know that a runny nose and tearing eyes can be present in migraine it can be difficult to tease out if there is a component of allergic rhinitis. Allergic rhinitis is an IgE mediated inflammatory reaction that usually consists of one of the following: congestion, runny nose, sneezing or itching. Pain within the sinus region, which is supplied by branches of the trigeminal nerve (ophthalmic, maxillary and mandibular) is seen in migraine. The presence of migrainous features such as photophobia, phonophobia, nausea, vomiting and worsening on exertion should always make one suspicious for a migraine diagnosis instead of sinus headache. In a study of 2,991 patients, with a history of “sinus” headache, 88% were found to truly have migraine headaches. The authors encourage clinicians to consider a migraine diagnosis in patients with sinus like symptoms without fevers or purulent discharge.

Back to our study, a personal history of any atopic disease was found in 57.6% of children with migraine and in 67.2% of children without migraine. This is the first study to show that there is an increased risk of migraine in children with persistent asthma and a decreased risk of migraine in children treated with long term corticosteroid or antihistamine treatments.

Article: https://onlinelibrary.wiley.com/doi/10.1111/head.13032/full