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Metabolism and headache

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I N V I T E D S P E A K E R P R E S E N T A T I O N

Open Access

Metabolism and headache

Innocenzo Rainero

From Abstracts from the 1st Joint ANIRCEF-SISC Congress

Rome, Italy. 29-31 October 2015

Background

In the past decade, several studies have shown a significant association between migraine and several features of the metabolic syndrome (MetS), including insulin resistance, systemic hypertension, and obesity. In addition, headache is a highly prevalent symptom in several metabolic disor-ders. The purpose of this review was to discuss recent findings regarding the relationship between headache, migraine, and metabolic disorders.

Methods

A computerized search of the PubMed and Cochrane Library databases was performed to identify English-language articles published between January 1, 2000, and June 30, 2015. Search terms included migraine, headache, diabetes, hypertension, obesity, and metabolic syndrome. Out of 241 articles screened, 41 were selected for review.

Results and discussion

MetS is characterized by a cluster of metabolic abnormal-ities including insulin resistance, hypertension, dyslipide-mia, obesity, and a proinflammatory state. Over the last two decades, different definitions and diagnostic criteria for MetS have been proposed, like the EGIR, the NCEP ATP III and the AACE criteria. Migraine, as defined by the International Headache Society (ICHD-3 beta), is a chronic neurovascular disease characterized by recurrent, disabling headache attacks. MetS and migraine are highly prevalent medical conditions, affecting 15-20% of the population. Both conditions are associated with increased risk for atherosclerotic cardiovascular disease.

The two conditions often coexist, but the pathophysiolo-gical mechanisms of this comorbidity are still under inves-tigation. Several studies have clearly shown that insulin sensitivity is impaired in migraine, even in young, non-obese, non-diabetic, normotensive patients. Association

between polymorphism of the insulin receptor gene and migraine provided inconclusive results. Prevalence and characteristics of headache in patients with diabetes have been scarcely investigated. Elevated blood pressure is a fre-quent clinical feature of MetS. Few studies investigated blood pressure (systolic or diastolic) abnormalities in migraine. Recently, a large demographic study found a positive association between migraine and systolic hyper-tension. The relationship between obesity, migraine and headache is still controversial. Weight gain is not asso-ciated with migraine prevalence but may be assoasso-ciated with increased headache frequency. Intriguingly, several studies suggested that neuropeptides involved in the regu-lations of appetite, like adiponectin, leptin, orexin-A and B, may be involved in migraine pathogenesis. In conclu-sion, additional research is needed to better investigate the common biological mechanisms underlying metabolic syn-drome and migraine and to define the best clinical prac-tices in patients who present with both diseases. Increased physical activity, weight loss, and management of cardio-vascular risk factors may be of relevance for prevention and treatment of both conditions.

Published: 28 September 2015

doi:10.1186/1129-2377-16-S1-A33

Cite this article as: Rainero: Metabolism and headache. The Journal of Headache and Pain 2015 16(Suppl 1):A33.

Correspondence: innocenzo.rainero@unito.it

Headache Center, Department of Neuroscience, University of Turin, Turin, Italy

Rainero The Journal of Headache and Pain 2015, 16(Suppl 1):A33 http://www.thejournalofheadacheandpain.com/content/16/S1/A33

© 2015 Rainero This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http:// creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/ zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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