Frequency of migraine in patients with allergic rhinitis

Abstract

Objectives: Allergic rhinitis (AR) is an IgE mediated disease which is released by activation of mast cells and basophils, and often leads to sinus headache. Histamine which is the key mediator in the pathogenesis of AR, also plays an important role in the pathogenesis of migraine with nitric oxide (NO). Aim of our study was to investigate the frequency of migraine in patients with AR. Methodology: Headache assessment and neurological examination was performed on patients diagnosed as AR in the outpatient ear nose and throat clinic with age-matched controls. Participants with headache were classified according to the International Headache Society criteria, and migraine frequency was investigated in the patients with AR and control groups. Results: Migraine headache was detected in 50% of the patients with AR. Among these, 95% were migraine without aura, and 5% were migraine with aura. Migraine frequency in the control group was 18.75% in the control group, and all was migraine without aura. Migraine frequency in the patients with AR was four times higher when compared with the control group. Conclusion: While a histamine and IgE associated common mechanism is responsible in the pathogenesis of AR and migraine, not only sinus headache but also migraine headache should be kept in mind. Headache assessment of the patients with AR, and in case of headache existence, referral of these patients to neurology outpatient clinics for differential diagnosis and, to maintain appropriate therapy should not be forgotten.

Allergic rhinitis and associated risk of migraine among children: a nationwide population‐based cohort study

“…reported migraine in 34% of AR patients and in 4% of non‐AR controls. Similarly, Ozturk et al . and Saberi et al .…”

“…However, these were hospital‐based and cross‐sectional studies with limited numbers of patients, where no causal relationship was confirmed. In addition, these studies essentially focused on adult patients, and the exact incidence rate and relative risks of migraine in children with AR is not clear. Our results suggest that children with AR are more likely to develop migraine regardless of sex, age, and urbanization of living area.…”

“…Previous studies reported a high prevalence of migraine in patients with AR. However, those studies, with a limited number of patients, were cross‐sectional studies and mainly focused on adults . The exact incidence and subsequent risk of migraine in children with AR remains unknown.…”

Allergic Rhinitis and Chronic Daily Headaches: Is There a Link?

“…Allergic rhinitis is defined as a chronic inflammatory disease of the upper airway caused by an IgE-mediated inflammatory response of the nasal mucous membranes after exposure to inhaled allergens. It is characterized by the symptoms of rhinorrhea (anterior or posterior nasal drainage), nasal congestion, sneezing, and nasal itching (Table 1 ) [ 29 •], and it often leads to sinus headache [ 36 ]. Allergic rhinitis may be classified according to the temporal pattern of exposure to the allergen: for example, seasonal allergic rhinitis, in which the inflammatory response is related to seasonal aeroallergens (e.g., tree, grass, weed pollens), and perennial allergic rhinitis, in which the response is related to year-round environmental aeroallergens (e.g., dust mites, mold, pet danders, or certain occupational allergens).…”

“…Certainly, it is well established that allergens can activate trigeminal nociceptors by releasing inflammatory chemicals from dural mast cells, triggering a migraine attack [ 73 – 75 ]. Evidence also exists that histamine may induce migraine attacks by increasing the level of nitric oxide (NO) [ 36 ], which is believed to promote migraine attacks through its vasodilator effects via H1 and H2 receptors; this is another inflammatory mediator found in both allergic rhinitis and migraine [ 57 , 76 , 77 ]. Inflammation plays an important role in the complex pathogenesis of migraine as well as of allergic rhinitis [ 58 , 78 ].…”