The influence of allergic rhinoconjunctivitis on migraine disability in children

Abstract

Migraine is a common condition in the pediatric population and causes a significant impact on the quality of life. Atopic disorders are some of the migraine comorbidities. Objective We hypothesized that allergic rhinitis could aggravate migraine in the pediatric population. Methods This cross-sectional study consecutively evaluated 90 pediatric outpatients (46 children 6–12 years of age; 44 adolescents up to 18 years of age) who sought medical assistance because of migraine at a general neurology clinic in Passo Fundo, RS, Brazil. They, and their parents, were given three questionnaires, to evaluate the diagnosis of current allergic rhinitis, allergic rhinoconjunctivitis and seasonal allergic rhinitis, as well as the disability caused by headache (ISAAC - International Study of Asthma and Allergies in Childhood; CARATkids - Control of Allergic Rhinitis and Asthma Test for Children; PedMIDAS - Pediatric Migraine Disability Assessment). The study was approved by the local ethics committee. Results According to the ISAAC questionnaire, children with current allergic rhinoconjunctivitis in the last year showed higher scores on the PedMIDAS than those patients without atopy (median and interquartile range 26 [10–58] vs. 5 [1–13], p = 0.008). A significant positive correlation of CARATkids scores with PedMIDAS scores was found (p = 0.007, rho = 0.39). After including other putative predictors of migraine disability (age, body mass index, time since onset of migraine) in a multiple regression analysis, only the scores on the CARATkids remained a significant independent variable correlated with PedMIDAS scores (p = 0.001; R = 0.55; R2 = 0.30). Conclusions Current allergic rhinoconjunctivitis is related to enhanced disability caused by headache in childhood migraine.

Association between Childhood Allergic Diseases and Headache

“…The results of our study are in agreement with those of previous studies in adults and children [6][7][8][9][10][11][12] in that the prevalence of headache was higher in the allergic group than the nonallergic group. Our allergic group consisted of various types of allergy including allergic rhinitis, asthma, atopic dermatitis, and atopic conjunctivitis.…”

“…7 Two pediatric studies have demonstrated that allergies are the risk factor for headache in school children (OR of 1.5), 9 and allergic rhinoconjunctivitis enhances migraine disability. 10 To date, the association of allergy and headache is not well understood. Genetic, environment, and systemic inflammatory response may contribute to headache in chronic allergic disease.…”

Atopic Disorders and Their Risks of Migraine: A Nationwide Population-Based Cohort Study

“… 12 13 23 24 25 However, most of the previous studies have limitations in that they are case reports, questionnaire studies, or single-institution studies, and that they included a limited number of study participants. 11 12 26 Recently, population-based studies have been performed to overcome these limitations whereas most of them have still targeted children and adolescents or have examined the correlation between migraine and atopic disorders other than AD. 15 27 Previous studies have evaluated the risk of migraine in children with atopic disorders, and the increased risk of migraines has been explained by several stimuli in the brain development process caused by allergic diseases.…”

“…Nasal congestion, discharge and sneezing in AR require sensitive trigeminal transmission which is associated with migraine, and the inflammatory response that occurs in AR are suggested to be involved in migraine aggravation and development through activation of immune responses. 11 …”

“… 8 9 10 Most of the previous studies were case series, and there was a limitation in that they were held in a hospital-based setting with a limited number of study participants. 11 12 13 Recently, large-scale and population-based studies have been published; however, most of them were limited to children or targeted only asthma or AR. 14 15 16 …”