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Migraine and Psoriasis

31 July 2021

What is psoriasis?

 

Psoriasis is a chronic inflammatory skin condition with a genetic basis affecting people worldwide [1]. The most common type of psoriasis is psoriasis vulgaris, which appears on the skin as red or pink plaques with white scales [2]. The incidence of psoriasis in populations varies, some studies suggesting the highest rates occurring in Norway or the US and lowest rates in Asian populations [1].

This condition may start to occur at any point in an individual’s life but the most common range for the first occurrence is between 15 and 30 years of age [1]. Psoriasis onset or flare-ups can be triggered by a range of factors, such as infections, lifestyle, and acute stress [1].

It could be suggested from this that by taking measures to reduce stress and make lifestyle choices that improve health, psoriasis flare-ups may reduce in frequency. There is a multitude of simultaneously occurring diseases otherwise known as comorbidities in relation to psoriasis, notably cardiovascular diseases, cancer, and inflammatory diseases [3].

 

How are migraines and psoriasis related?

 

Migraines and psoriasis are conditions that can severely impact the quality of life for those that experience it, with more serious cases impairing physical and psychological functioning [4]. In addition, several studies have indicated that both conditions are associated with ischemic stroke and other cardiovascular diseases [6].

Recently psoriasis has been linked in several studies with a greater risk of migraines. Egeberg et al particularly found psoriasis patients were at a significantly increased risk of new-onset migraines depending on the severity of their condition [4]. These findings are supported even when accounting for demographic variables are represented equally across conditions. For instance, a longitudinal study equally matched in age, sex, medical history, and other demographic factors between psoriasis and the control group found a higher rate of migraines in participants with psoriasis, suggesting that psoriasis increases the risk of developing migraines, especially in middle-aged men [6].

In the past, studies have given little consideration to this relationship but the recent findings indicate that this association may be much greater than previously understood. The research conducted on this topic has been corroborated by other international studies from the US to South Korea. Furthermore, an interesting finding in Capo et al.’s study was the prevalence of migraines with aura in the psoriasis group compared to the non-psoriasis group, which was suggestive of a common pathogenic mechanism implicating chronic inflammation [5].

The exact mechanism for this relationship is unclear but it has been suggested that systemic inflammation may play a role since evidence suggests psoriasis patients may have endothelial dysfunction and a mechanism of migraines involve neuropeptide action on the endothelium [6]. But currently, the process by which both diseases are linked is speculative, as there is a possibility for other lifestyle factors such as exercise playing a role.

 

What are the implications for this relationship?

 

There are many studies that show there is a significant association between psoriasis and migraines, which raises the possibility of developing related comorbidities like cardiovascular diseases [7].

It’s always important to control cardiac risk factors to prevent cardiovascular events & this may be particularly relevant to people with these conditions.

 

 

References

[1]J. Gudjonsson and J. Elder, “Psoriasis: epidemiology”, Clinics in Dermatology, vol. 25, no. 6, pp. 535-546, 2007. Available: 10.1016/j.clindermatol.2007.08.007.

[2]C. Griffiths and J. Barker, “Pathogenesis and clinical features of psoriasis”, The Lancet, vol. 370, no. 9583, pp. 263-271, 2007. Available: 10.1016/s0140-6736(07)61128-3.

[3]Y. Yang, J. Keller and H. Lin, “Medical comorbidity associated with psoriasis in adults: a population-based study”, British Journal of Dermatology, vol. 165, no. 5, pp. 1037-1043, 2011. Available: 10.1111/j.1365-2133.2011.10494.x.

[4]A. Egeberg, L. Mallbris, G. Hilmar Gislason, L. Skov and P. Riis Hansen, “Increased risk of migraine in patients with psoriasis: A Danish nationwide cohort study”, Journal of the American Academy of Dermatology, vol. 73, no. 5, pp. 829-835, 2015. Available: 10.1016/j.jaad.2015.08.039.

[5]A. Capo, G. Affaitati, M. Giamberardino and P. Amerio, “Psoriasis and migraine”, Journal of the European Academy of Dermatology and Venereology, vol. 32, no. 1, pp. 57-61, 2017. Available: 10.1111/jdv.14472.

[6]C. Min, H. Lim, J. Lim, S. Sim and H. Choi, “Increased risk of migraine in patients with psoriasis”, Medicine, vol. 98, no. 17, p. e15370, 2019. Available: 10.1097/md.0000000000015370.

[7]A. Steuer, J. Cohen, P. Wong and R. Ho, “Psoriasis and the risk of migraines in the United States”, Journal of the American Academy of Dermatology, vol. 82, no. 5, pp. 1225-1226, 2020. Available: 10.1016/j.jaad.2019.10.050.

 

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