Gout Linked to a Significantly Higher Likelihood of Migraines

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In a cohort of Korean patients, a gout diagnosis was shown to be significantly linked to migraines when compared with controls, highlighting the complex relationship between chronic disorders, according to a study published in Journal of Clinical Medicine.¹

Migraines affect approximately 1 in 10 individuals, making it the second most prevalent disabling neurological disorder, and is more likely to affect women, people living in urban locations, and people aged 25 — 64 years. The condition is categorized as either with or without aura, with aura defined as visual, sensory, and other central nervous system symptoms prior to headache onset. Additionally, previous research has demonstrated migraines can develop as a complication of autoimmune disorders or inflammatory arthritis.²

“In light of the well-understood etiopathogenesis of gout, with hyperuricemia as a primary intermediary step, attention has been drawn to the repeated observations of a potential link between serum uric acid levels and migraine occurrence,” wrote a group of Korean investigators. “For instance, a cross-sectional cohort study revealed an exponential relationship between serum urate levels and migraine occurrence when serum urate exceeded 7.8 mg/dL. A positive relationship exists between variations in serum uric acid levels during migraine attacks and the intensity of pain.”

A 16-year longitudinal study was performed using the Korean National Health Insurance Service-Health Screening Cohort (KNHIS-HSC) database to evaluate the relationship between migraines and gout, particularly among different subtypes. The KNHIS was developed in 1999 and is comprised of approximately 97% of the Korean population.

A total of 23,137 patients with gout and 92,548 age-, sex-, income-, and residence-matched controls were analyzed. Age was categorized in 5-year intervals, residence was categorized as rural or urban, and participants were further categorized based on smoking status, body mass index, and alcohol intake. Controls were randomly selected in sequential order to minimize potential selection bias. Hazard ratios to determine the likelihood of migraines were assessed using Cox proportional hazards models.

Although both groups demonstrated comparable demographic characteristics, patients with gout reported a higher prevalence of obesity (73.70% vs 62.74%, respectively).

Within the follow-up period, 1000 patients with gout and 3214 controls reported migraines, with incidence rates of 5.86 and 4.67 per 1000 person-years, respectively.

Subgroup analyses revealed a link between gout and migraines, which remained significant across a variety of subgroups, such as sex, income, smoking status, alcohol consumption, and residence. After adjusting for health-related variables, weight categories, and demographics, patients with gout had a 1.26-fold higher likelihood of experiencing migraines when compared with those without gout. This was particularly prevalent in the migraines without aura subtype, although the association was not significant for migraines with aura (.30 vs .29 per 1000 person-years, respectively).

Investigators noted limitations such as the observational and retrospective study design, which did not allow for the evaluation of the causal relationship between gout and migraines. Further, they were unable to determine potential underlying mechanisms that could help to better understand the connection between the conditions. Additionally, generalizability may have been hindered as the study exclusively recruited Korean subjects aged >40 years. Data such as dietary factors, genetics, and family history were not included in the analyses. Lastly, the results of the study could have potentially been subject to recall bias.

“These results are vital in the management and education of patients with gout and decision-making by healthcare practitioners,” investigators concluded. “Furthermore, there is a need to conduct studies to evaluate the mechanisms underlying the increased likelihood of occurrence of migraines.”

References

1. ^{Kang HS, Kim JH, Kim JH, et al. Gout and Migraines: Exploring the Complex Link in a 16-Year Longitudinal Study of the Korean Population. J Clin Med. 2023;13(1):138. Published 2023 Dec 26. doi:10.3390/jcm13010138}
2. ^{Peroutka, S.J.; Price, S.C.; Jones, K.W. The Comorbid Association of Migraine with Osteoarthritis and Hypertension: Complement C3F and Berkson’s Bias. Cephalalgia 1997, 17, 23–26.}