Psoriasis severity appears to have an association with higher migraine development risk, according to a recent meta-analysis, with substantial bidirectional associations noted between both conditions.¹

An important role in the neurogenic inflammatory response is played by several proinflammatory mediators including tumor necrosis factor (TNF), and this response is connected to both psoriasis’ pathogenesis and migraines.²

Consequently, research into a potentially causal relationship between both conditions was authored by Ching-Chi Chi, MD, MMS, DPhil, from the Department of Dermatology at the Chang Gung Memorial Hospital in Taiwan.

“Although an increasing number of studies have evaluated the association between psoriasis and migraine, the results remain debatable; hence, the causal relationship between these conditions should be determined,” Chi and colleagues wrote. “Therefore, in this study, we performed a systematic review and meta-analysis to assess the association between psoriasis and migraine.”

Background and Findings

To conduct their meta-analysis, the investigators first performed a thorough search of the Embase, MEDLINE, and Cochrane Central Register of Controlled Trials databases, performing it from the inception of each database up until May of 2022.

The research team’s database search was designed to include all of the relevant studies related to both psoriasis and migraine, and as a result it included various synonyms and related terms for these conditions.

The researchers set out to collect their data from observational studies that evaluated the connection between migraines and psoriasis, establishing 2 criteria for eligible studies: the cases needed to be either case-control, cross-sectional, or cohort studies, and the cases had to provide information on the prevalence, risk, or odds of either condition in relation to the other.

The team’s search included research studies that assessed the prevalence, odds, or risk of migraines in those with psoriasis compared to those without, as well as studies with data on the prevalence, odds, or risk of psoriasis in patients with migraine compared to without.

To investigate the potential link between both conditions, the investigators used a random-effects model. The analysis was done to assess the risk estimates that quantify the association between the conditions.

They also used a sensitivity analysis by exclusively including studies that had adjusted risk estimates, and a subgroup analysis was also done based on the severity of psoriasis.

Overall, the investigators examined data from 9 different studies involving more than 6 million participants and they found a strong association between psoriasis and migraines. Their meta-analysis’ results showed that those with psoriasis are at a significantly increased risk for prevalent migraine.

They also found that participants with migraine are also more likely to experience psoriasis, adding their subgroup analysis of the cohort studies revealed a progressively higher risk of incident migraine among participants with mild or severe psoriasis.

“Greater severity of psoriasis appears to be associated with a higher risk of developing migraine," they wrote. "Clinicians should evaluate symptoms of migraine in patients with psoriasis and provide proper treatments."

References

1. ^{Huang IH, Hung WK, Chi CC. Bidirectional associations between psoriasis and migraine: A systematic review and meta-analysis. J Dtsch Dermatol Ges. 2023 Apr 17. doi: 10.1111/ddg.14994. Epub ahead of print. PMID: 37066816.}
2. ^{Bos JD, De Rie MA. The pathogenesis of psoriasis: immunological facts and speculations. Immunol Today. 1999;20:40-46.}