According to the Global Burden of Disease Study 2017, headache disorders (consisting mainly of migraine), are the second leading cause of disability worldwide. Diabetes is the fourth. The World Health Organization (WHO) suggest that migraine affects at least 1 in 7 adults worldwide, with women nearly three times more likely to develop them than men. While the condition mostly affects those in the 35-45 year age group, it can also affect others, including children. Although migraine and type 2 diabetes are both common conditions, data on a link between the two are scarce. According to a recent large observational study, now, women with current migraine have a lower risk of developing type 2 diabetes. The study also found that migraine declined in the years preceding a diabetes diagnosis. They describe their findings in a paper that now features in the journal JAMA Neurology. For their investigation, they analyzed survey data on more than 70,000 women living in France who were members of a health insurance scheme and in the E3N Prospective Cohort Study.
The women had filled in health and lifestyle questionnaires every few years between 1990 and 2014. These included questions about migraines. Information on diagnosed type 2 diabetes came from the insurance scheme’s drug reimbursement database. The analysis revealed that women with active migraine had an approximate 30% decreased risk of developing type 2 diabetes compared with women with no history of migraine headaches. The investigators defined active migraine as having experienced migraine in the period since the last survey. First and corresponding author Dr. Guy Fagherazzi of the Institut National de la Santé et de la Recherche Médicale (INSERM) in France and colleagues call for further research to focus on understanding the mechanisms involved in explaining these findings. In their discussion of the results, Dr. Fagherazzi and his colleagues speculate on what might underpin the link between migraine and type 2 diabetes. One mechanism that they suggest is the activity of a peptide called calcitonin gene-related peptide (CGRP) that is common in the development of migraine and is also involved in glucose metabolism.
Specific to the CNS, CGRP is apparently involved in pain modulation, perception, and central sensitization, making it a potential target for migraine and other primary headache disorders. It has been reported that rats with experimentally induced diabetes have a decreased density of CGRP sensory nerve fibers. Indeed, new perspective in migraine therapy now might include a form of biological therapy with monoclonal antibodies against this peptide. An example of mAB against CGRp is eremumab, developed by Amgen Inc; FDA approved the medication for the preventive treatment of migraine in adults on May 17, 2018. Another antibody available is galcanezumab; the drug was approved by the FDA in September 2018, becoming the third marketed CGRP inhibitor in the United States. There have been already several clinical trials with these new moelcules. Clinical trial results of CGRP‐modulating mAbs indicate that treatment emergent adverse events that investigators considered possibly related to treatment were not significantly different among the active treatment and placebo groups.
Headache specialists Dr. Amy Gelfand of the University of California, San Francisco, and Dr. Elizabeth Loder of Brigham and Women’s Hospital, Boston, MA, suggest that the findings, along with those of other migraine studies, make them wonder “what is migraine good for”? Doctors in headache clinics have noticed for some time that few of people that they treat have type 2 diabetes. Could this be because those with type 2 diabetes are so busy managing the condition that they do not notice their headaches? Or are diabetes doctors also treating headaches and thus obviating any need for specialist headache care? Or could it be that there is something about diabetes that suppresses or reduces migraine? They conclude that the recent research does shed some light on these questions. However, as this was an observational study, it cannot say whether migraine causes reduced risk of type 2 diabetes. Neither can it say whether factors that raise or reduce risk of type 2 diabetes also reduce or raise migraines.
Therefore, the reason for the inverse association between migraine and type 2 diabetes remains uncertain. These findings are in line with observations from clinical practice.
- Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
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