AD and Headache Disorders: Recent Findings

Atopic dermatitis (AD) patients may be more susceptible to migraines and headache disorders.

A study published in Frontiers in Neurology suggests that headache conditions may be associated with atopic dermatitis (AD).

According to the researchers, a person’s family history, smoking habits, and alcohol intake can all be used to predict a person’s risk of developing headaches. Several long-term inflammatory diseases, such as systemic lupus erythematosus, chronic periodontitis, and inflammatory bowel disease, are also regarded as important risk factors for headaches.

They stated that in recent years, atopic disorders have become a major worldwide public health concern; AD is one of the most prevalent chronic illnesses in early childhood and frequently signifies the beginning of the progression of atopic diseases. Although the exact relationship between AD and headache issues is still unknown, the researchers did note that growing numbers of people with AD also had headaches, which has caused healthcare professionals to become concerned.

As a result, the researchers concluded that patients who experience headaches should have AD examined more closely. As a result, their goals were to conduct a systematic assessment of the literature on the relationship between AD and the beginning of headaches and to use meta-analyses to determine the degree of that relationship.

To do this, the researchers searched the PubMed and Embase databases for pertinent papers that had been published up until December 1, 2023. The researchers extracted numerous data, such as the study’s location, design, outcomes, and quality, from studies that met the eligibility requirements. The Newcastle-Ottawa Scale, which consists of 8 questions and awards values ranging from 0 (showing a high risk of bias) to 9 (indicating a low risk of bias), was used to assess the quality of eligible research; studies with a score of Seven or above was considered high quality.

3088 suitable citations were recovered by the researchers after duplicates were eliminated. 733 items were eliminated after titles and abstracts were examined. As a result, after carefully reviewing 65 papers in full text, the researchers decided to include 10 of them in their analysis.

The ten studies that qualified were released in the years 2016 through 2023. Sample sizes varied between 4898 and 3,607,599, resulting in 12,717,747 patients aged 6 years or older. With an average quality score of 6.9, the researchers categorized 6 studies as high quality and 4 as low quality.

The combined OR for headache disorder risk in individuals with AD was 1.46 (95% CI, 1.36-1.56) across the 10 trials, according to the researchers, indicating a higher risk in this population. In a comparable vein, a strong positive correlation was found between headache disorder and the risk of AD when the researchers restricted their analysis to studies that had adjusted for at least ten factors (OR, 1.34; 95% CI, 1.22-1.45; P <.001; I2, 99.1%).

To be more precise, a higher risk was observed in individuals with mild (OR, 1.26; 95% CI, 1.18-1.34; P <.001; I2, 95.4%) or moderate to severe (OR, 1.23; 95% CI, 1.15-1.32; P <.001; I2, 94.7%) AD. These investigations evaluated the effect of AD severity on headache disorder risk. According to study location, there were significant correlations found in studies from North America (OR, 1.53; 95% CI, 1.18-1.99; P =.001; I2, 99%), Asia (OR, 1.39; 95% CI, 1.27-1.53; P <.001; I2, 92.2%), and Europe (OR, 1.4; 95% CI, 1.28-1.52; P <.001; I2, 97.1%) between headache disorder risk and patients with AD.

Additionally, data for the analysis of migraine risk for individuals with AD came from 6 trials totaling 11,090,412 people. The overall odds ratio (OR) for AD patients was reported to be 1.32 (95% CI: 1.18-1.47), suggesting a markedly elevated risk of migraine in these patients. Similarly, they found a substantial positive correlation (OR, 1.29; 95% CI, 1.12-1.47; P <.001; I2, 99.2%) between migraine and AD risk when they restricted their analysis to trials correcting for at least 10 factors.

Researchers discovered statistically significant correlations between migraine risk and AD patients in studies from Asia (OR, 1.38; 95% CI, 1.23-1.55; P <.001; I2, 95.5%) and Europe (OR, 1.09; 95% CI, 1.01-1.19; P <.001; I2, 96%) where they conducted their research. Studies from North America, on the other hand, did not demonstrate a higher risk (OR, 1.47; 95% CI, 0.91-2.4; P =.12; I2, 99.6%).

The pathophysiology of the headache disease is complex and related to numerous factors, therefore one potential influence of unknown confounders was noted by the researchers as a weakness of their study. They added that the accuracy of their conclusions can be impacted by the small number of suitable, high-caliber studies. Notwithstanding these drawbacks, the researchers offered recommendations for further study and treatment.

“Clinicians should be mindful of the increased incidence of headache disorder in patients with AD,” the authors concluded. “To examine these findings further and gain a more comprehensive understanding, future prospective cohort studies with more comprehensive data collection and consideration of potential confounders are necessary to provide additional evidence on the detailed association.”

For more information: Association of atopic dermatitis and headache disorder: a systematic review and meta-analyses, Frontiers in Neurology, https://doi.org/10.3389/fneur.2024.1383832