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Is there a link between migraine and type 2 diabetes?

By Jane Lewis
A large prospective study has reported an inverse association between type 2 diabetes and migraine in women, finding that women with active migraine have about a 30% lower risk of developing type 2 diabetes.

‘This somewhat surprising finding comes without any direct information on what might be the link between migraine and reduced diabetes risk,’ commented Professor Jonathan Shaw, Council member of the Australian Diabetes Society, and Deputy Director, Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne.

‘Dietary choices made by women with migraine, perhaps related to avoiding migraine triggers, or the possibility that mild hyperglycaemia may reduce the occurrence of migraines are among several possible explanations for this association,’ he said.

The research, based on data from 74,247 women participating in the French E3N cohort study (initiated in 1990 on a cohort of women born between 1925 and 1950), found that during 10-years’ follow up, women who reported active migraine had a statistically significant lower risk of incident type 2 diabetes (multivariable-adjusted hazard ratio, 0.70), compared with women with no migraine history.

The study, published in JAMA Neurology, also found a linear decrease in the prevalence of active migraine before diabetes diagnosis (22% to 11% over a 24-year period, after adjustment for potential type 2 diabetes risk factors), and a stagnation in prevalence after diagnosis (about 11% for a period of 22 years).

The authors of an accompanying editorial said these findings were in line with observations from clinical practice, and ‘headache practitioners have long discussed the rarity of patients with type 2 diabetes in headache clinics’.

Although the reason for the observed association was uncertain, the editorialists suggested that insulin resistance and hyperglycaemia could result in damage to the sensory neurons that produced the calcitonin gene-related peptide, known to be involved in the pathophysiology of migraine.

The study authors suggested that ‘tracking the evolution and especially the decrease of migraine frequency in individuals with migraine at high risk of diabetes, such as individuals with obesity, irrespective of age could be the sign of ... emerging increased blood glucose levels, prediabetes, or type 2 diabetes.’

‘The potential beneficial role of both hyperglycemia and hyperinsulinism on migraine occurrence needs to be further explored’, they concluded.
JAMA Neurol 2018; doi:10.1001/jamaneurol.2018.3960.
JAMA Neurol 2018; doi:10.1001/jamaneurol.2018.E1-E2.