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Written by Kathleen Doheny with Gloria Simms, MD, and B. Lee Peterlin, DO
Chronic migraine is a real disorder and fairly common. In fact, the Migraine Research Foundation calls it ''an extraordinarily prevalent neurological disease, affecting 39 million Americans but arises three times more often in younger women (ages 18 to 44 years) than in men.1
If these statistics aren’t enough to bring on a headache, then prepare yourself for findings from a report published in the journal, Cephalalgia, which adds further evidence that having an endocrine-related condition is likely to increase your risk of migraine headaches.2
Endocrine Disorders May Worsen Migraines, or Vice Versa
The data uncovered by this researcher team suggests that migraine headaches seem to occur more often in individuals who also have other conditions like thyroid disease, insulin resistance, obesity, and high blood pressure.3
Don’t despair; the research sheds light on what might be driving these connections and offers a good understanding as to the steps to take to reduce your risk of having these intense headaches as well as improve your overall health and quality of life.2,3
And the good news is that by having these clearer insights into the interrelationship of migraine with numerous possible coexisting health conditions, you’re more likely to gain better treatment, particularly more effective migraine reduction or relief,2 say the researchers at the University of Torino, Italy, who reviewed the literature on comorbidities between migraine and different metabolic and endocrine disorders.
How Are Migraines and Endocrine Conditions Related?
Rainero and his colleagues combed the literature to identify any studies that addressed patients with chronic migraine to compare those were also receiving care for metabolic and endocrine system disorders as compared to those with no endocrine-related conditions.2
The link with insulin sensitivity seems very clear,2 they say. In medical-ese, they report: "All the clinical studies that used the oral glucose tolerance test to examine insulin sensitivity found that, after glucose load, there is in migraine patients a significant increase of both plasmatic [in the blood] insulin and glucose concentrations in comparison with controls."
Once type 2 diabetes (T2D) develops, interestingly, any association with migraines seems to disappear whereas individuals who have type 1 diabetes seem to be protected against having migraine headaches.2
For anyone with low thyroid function, or hypothyroidism, the link with migraine seems to be a bidirectional relationship, meaning either can increase the risk of the other condition. 2
Both obesity and high blood pressure seem to increase the risk of episodic and chronic migraine,2 they say. Metabolic syndrome—represents the presence of a cluster of medical factors, such as high blood sugar, high blood pressure, and excess abdominal fat—which appears strongly associated with migraine with aura.
When Endocrine Conditions Coexist with Migraines
To give you a better appreciation of your migraine risk and ways to lessen symptoms more effectively given any metabolic or endocrine-related conditions you may have, here is some further details regarding the links that may impact your health and disease management.2,3
Hypothyroidism: Research on the thyroid-migraine link date back to 1998 but researchers recently returned to examine this potential relationship. Now, studies suggest that having migraines means you may be more likely to face low thyroid function and vice versa.2
Insulin resistance: Insulin resistance—or, what your doctor may term a sign of prediabetes, is a state in which your blood glucose levels are high but not high enough to be considered diabetes. Anyone diagnosed with insulin sensitivity may have an increased risk of both episodic and chronic migraine.4-6
One study shows that those experiencing the worst insulin resistance faces more than a 5 times higher risk of migraine compared with those with a lower insulin sensitivty.7
While findings from all the studies were not in full agreed, when looked at all together, there seems to be convincing evidence to suggest that individuals with migraine headaches also experience poorer insulin response,2 the authors say.
That makes sense since insulin receptors are distributed abundantly throughout the brain
Diabetes: While insulin resistance appears to push up the risk of having migraines, this relationship seems to subside once the conditions evolve to develop into type 2 diabetes. Conversely, in individuals who have type 1 diabetes, there seems to be a protective effect since there is much less occurrence of migraine.1 The experts are unable to explain these contradictory findings.2
Body Weight: Obesity and migraine seem like common conspirators based on data gathered from a review of 12 studies that found the risk of migraine increased by 27% in anyone with obesity. 8 Underweight isn't any better for anyone looking to less migraines since those who fall below the healthy weight range have a 13% higher risk of having migraines compared to people who are considered at a healthy weight.8
High Blood Pressure: The jury is out on any relationship between blood pressure and migraines,2 according to the investigators. However, if proven, the link may be explained by environmental factors, shared biological factors, or a common genetic vulnerability.
Metabolic Syndrome: Is migraine a risk factor for developing metabolic syndrome, which also boosts your risk of heart disease, stroke, and type 2 diabetes? Alas, it appears that the answer is that possibly, yes, given that several studies find a strong relationship.3,9
In fact, one study found that a rise in chronic migraines occurred in women who also were diagnosed as having metabolic syndrome but when these same patients were diagnosed as having medication overuse headache, the risk increased further. That suggests using too much pain medicine can boost the risk that these individuals are more prone to developing metabolic disease.9
Should You Be Worried You’ll Develop Migraines?
While numerous studies support a link between chronic migraine and various metabolic and endocrine disorders, there is still a ways to go before anyone will be ready to declare that having an endocrine-related condition means that you may develop migraine headaches, too. The mechanisms driving these conditions remain largely under study,2 the researchers say.
Yet, much of the ongoing research points in the direction of supporting the role of insulin regulation in modulating brain functions such as metabolism and clear thinking skills (cognitive function).3
EndocrineWeb spoke with two headache specialists to review the new report and offer some advice for anyone under care for an endocrine disorder.
The associations between migraine and other health issues do not come as a surprise to Gloria Simms, MD, a neurologist and headache specialist at Valley Baptist Medical Center and attending physician at the University of Texas at Rio Grande Valley. Yet, this latest review definitely strengthens the evidence that insulin resistance is a factor in the onset of migraine, Dr. Simms says.
While we know that migraine has many factors that are likely to play into its development, "we don't fully understand it," she says.
What should patients expect? Dr. Simms says anyone who has experienced migraine or intense headaches should ask your primary care physician about checking you for insulin resistance. If your doctor tells you that you have nothing to worry about, she suggests asking your health provider to monitor you and treat as needed as it might just improve your migraines.
This new information may also lessen the stigma of migraine, which Dr. Simms says remains a huge issue. Too often, patients avoid getting care for fear that others may think a headache, even a migraine, is not a major medical concern.
"Having migraine is not normal," she says. "It is a real medical condition that can be extremely debilitating." And, the condition is driven by many factors, as this review and others suggest, including genetics.
"It is true we cannot cure migraine, but I can make your quality of life much better," Dr. Simms tells her patients.
Another expert, B. Lee Peterlin, DO, director of the Headache Clinic at Penn Medicine Lancaster General Health, in Pennsylvania, says that the link between insulin resistance and migraine has been out there a long time. It makes sense, she says, especially since headache doctors know that fasting is typically a migraine trigger.
The research supports the pattern where anyone experiencing migraine headaches doesn’t do well with big changes such as skipping a meal, which causes fluctuates in blood glucose levels, and weight changes that veer too far out of the person’s usual body weight zone.
If you have migraine, Dr. Peterlin says, you need to stop considering it an isolated disorder as addressing symptoms may require addressing other health issues such as changes in thyroid function, insulin levels, or body weight.
Action Steps to Help You Manage Migraine Risk
Based on the research overview,2 what can you do if you are having migraines? Dr. Simms and Dr. Peterlin suggest:
Stepping up your attention to your medical care by seeing your healthcare provider at least once a year, and more often if your symptoms are not well controlled.
Talk to your doctor about ruling out any of these associated endocrine-related conditions, and whether treating any irregularities more aggressively may help reduce the number and frequency of your migraines.
Take seriously any suggestions you doctor raises regarding diet, exercise, blood pressure control, and keeping your blood sugar at a steady level. You might even ask for a referral to a dietitian or certified diabetes specialist who can help you identify specific steps you can take to improve your health.
While not new or news to you, the researchers reinforce the importance of increasing your physical activity, achieving weight loss as needed, and reducing any cardiovascular risk factors such as high blood pressure as advisable for many reasons, including helping to prevent and lessen migraine symptoms.4
1. Migraine Research Foundation: Migraine Facts. Available at: migraineresearchfoundation..... Accessed August 7, 2019.
2. Rainero I, Govone F, Gai A, et al. Is Migraine Primarily a Metaboloendocrine Disorder? Curr Pain Headache Rep. 2018;22(4):36.
3. Streel S, Donneau AF, Dardenne N, Hoge A, Albert A, Schoenen J, et al. Screening for the metabolic syndrome in subjects with migraine. Cephalalgia. 2017;37:1180–1188.
4. Bernecker C, Pailer S, Kieslinger P, et al. GLP-2 and leptin are associated with hyperinsulinemia in non-obese female migraineurs. Cephalagia. 2010;30:1366–1374.
5. Fava A, Pirritano D, Consoli D, et al. Chronic migraine in women is associated withinsulin resistance: a cross-sectional study. Eur J Neurol. 2014;21:267–272.
6. Wang X, Li X, Diao Y, Meng S, Xing Y, Zhou H, et al. Are glucose and insulin metabolism and diabetes associated with migraine? A community-based, case-control study. J Oral Facial Pain Headache. 2017;31:240–250.
7. Gruber HJ, Bernecker C, Pailer S, et al. Hyperinsulinemia in migraineurs is associated with nitric oxide stress. Cephalalgia. 2010;30:593–598.
8. Gelaye B, Sacco S, Brown WJ, et al. Body composition status and the risk of migraine: a meta-analysis. Neurol. 2017;88:1795–1804.
9. He Z, Dong L, Zhang Y, Kong Q, Tan G, Zhou J. Metabolic syndrome in female migraine patients is associated with medication overuse headache: a clinic-based study in China. Eur J Neurol. 2015;22:1228–1234.
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