The subset of patients with psoriatic arthritis had the highest odds ratio of migraine.
Patients with psoriasis face a significantly higher risk of migraine compared with patients without the disease, found data from a recent study, which showed that these individuals faced a particularly high risk of migraine with aura.
The case-control study, conducted in Iran, showed that 1 in 5 (21.2%) of the 312 patients with psoriasis had migraine, significantly higher than the 8.7% of 312 age- and gender-matched controls without psoriasis. Data from a logistic regression model showed that patients with psoriasis had an odds ratio (OR) of migraine of 2.79 (95% CI; 1.722-4.518, P < .001).
“In general, few studies have addressed the association between migraine and psoriasis. For instance, a retrospective population-based cohort study by Min et al. in South Korea showed that the hazard ratio of migraine occurrence in psoriatic patients was notably higher than in the non-psoriatic control group (HR = 1.16, p < 0.05). The results of another retrospective cohort study in Denmark revealed a significantly higher incidence rate ratio of migraine in psoriatic patients than the control group without a history of psoriasis. The results of this study corroborate the findings of these two cohort studies.”
At the time of the study, most patients had psoriasis for 2-5 years, 66.3% of which had involvement in their lower limbs, 59.9% had involvement in their upper limbs, 50.3% had involvement in their head and neck, and 41% had involvement in their trunk. The researchers found no association between migraine and the duration of psoriasis or affected areas. There were also no significant differences in headache severity (P = 0.422), frequency (P = .070), or duration (P = .247) between the 2 groups.
The increased risk of migraine in patients with psoriasis was more prominent in patients with worse disease severity, with the OR increasing from 2.06 (95% CI, 1.173-3.625; P = .012) for patients with mild disease to 3.25 for patients with moderate disease (95% CI, 1.649-6.397, P = .001) and to 4.59 for patients with severe disease (95% CI, 2.360-8.912; P < .001).
The logistic regression model showed that the subset of patients with psoriatic arthritis (PsA) had the highest OR of migraine, with the OR sharply rising to 12.9 compared with an OR of 2.4 for psoriatic patients without PsA. The finding, wrote the researchers, may have implications for the connection between migraine and psoriasis.
“Provided that psoriasis is a chronic inflammatory disease, and that chronic systemic inflammation is more prominent in cases with PsA, this finding of the present study somehow supports the role of chronic systemic inflammation as a common pathogenic mechanism between psoriasis and migraine,” explained the group. “In this regard, the results of another study revealed that most psoriatic patients clinically diagnosed with migraine were suffering from PsA.”
The researchers noted that other confounding factors that impact the relationship between psoriasis and migraine, including lifestyle, diet, and socioeconomic status were not accounted for in their study.
Sarkhani M, Mogaddam M, Fattahzadeh-Ardalani G, Fouladi N. Evaluation of the relationship between migraine and psoriasis: a case-control study. An Bras Dermatol. Published online January 19, 2023. doi:10.1016/j.abd.2022.04.009