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Migraine may lower risk for type 2 diabetes in women
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Women with active migraine were at lower risk for type 2 diabetes, according to findings recently published in JAMA Neurology.
“Because migraine has also been associated with factors associated with insulin resistance and type 2 diabetes, an association between migraine and diabetes has been hypothesized. However, to our knowledge, data are scarce,” Guy Fagherazzi, PhD, Center for Research in Epidemiology and Population Health at the Institut National de la Santé et de la Recherche Médicale in France, and colleagues wrote.
Researchers reviewed questionnaires from 76,403 women (mean age, 61 years) without type 2 diabetes that were part of a previously existing cohort in France.
They found 2,372 incident type 2 diabetes cases during 10 years of follow-up. There was a lower risk for type 2 diabetes in women with active migraine vs. women with no migraine history (multivariable-adjusted HR = 0.7; 95% CI, 0.58-0.85). Researchers also found after adjustment for potential type 2 diabetes risk factors, there was a linear decrease in active migraine prevalence from 22% (95% CI, 16-27) to 11% (95% CI, 10-12) during the 24 years before diabetes diagnosis.
Fagherazzi and colleagues discussed possible reasons for the association.
“It has been proposed that a trigger for migraine could be nutritional, hormonal or metabolic in some individuals. An association between polymorphisms in the insulin receptor gene and migraine has been shown. An elevation in free fatty acid plasma concentration and ketone bodies has also been reported before a migraine attack. Therefore, fasting could promote the development of migraine, mostly by favoring hypoglycemia and increased ketone bodies production. Hypoglycemia has long been known to be a precipitating factor in migraine onset,” they wrote.
In a related editorial, Amy A. Gelfand, MD, MAS, of the Child and Adolescent Headache Program at the Benioff Children’s Hospital, University of California, San Francisco, and Elizabeth Loder, MD, MPH, department of neurology at Brigham and Women’s Hospital, Harvard Medical School offered other potential explanations for the association.
"One plausible biological explanation involves calcitonin gene-related peptide, which is involved in energy metabolism in animal models. Calcitonin gene-related peptide is also clearly involved in the pathophysiology of migraine. It is possible that the development of insulin resistance and hyperglycemia result in damage to sensory neurons that produce this peptide,” they wrote.
Fagherazzi and colleagues added that based on their findings, the “potential beneficial role” of hyperinsulinism and hyperglycemia on migraine occurrence should be further researched. – by Janel Miller
Disclosures: Gelfand reports consulting for Biohaven, Eli Lilly, Impax, and Zosano; receiving research funding Amgen and eNeura; receiving personal compensation for medical-legal consulting; and receiving honoraria from JAMA Neurology and UpToDate. Gelfand’s spouse reports receiving consulting fees from Genentech; receiving research support from Genentech, MedDay and Quest Diagnostics; and receiving personal compensation for medical-legal consulting.