In the doctor’s office, it’s a familiar combination: a patient with both asthma and migraine.
Headache specialist Roger K. Cady, MD, believes so. “I would certainly say from my clinical practice that controlling either of those will help the other,” he says. Cady, founder of the Headache Care Center in Springfield, Missouri, treats many patients, including children, who have a combination of asthma, allergies and migraine. “It’s quite common in my practice,” he says.
Dennis K. Ledford, MD, professor of medicine and pediatrics at the University of South Florida College of Medicine, agrees that better asthma control could ease migraines.
Although researchers haven’t proven for sure that asthma attacks can prompt migraines, many patients believe that they get “asthma headaches,” and Ledford offers one possible explanation: “Asthma’s stressful, and stress is one of the provocateurs of migraine.”
“But keep in mind that asthma’s very treatable,” he says. “Even though [asthma] makes you very anxious and uncomfortable when it happens, it’s important to understand that it is controllable. Once you know how to control it, you can limit that stress in your life and reduce your occurrence of migraine.”
How Are Asthma and Migraine Linked?
Scientists have found some intriguing links between asthma and migraine. For example, one large British study found that people with migraine were 1.59 times more likely to develop asthma than counterparts without migraine. Other research has shown that children with asthma were 5.5 times more likely than non-asthmatic children to have a parent with migraine.
How to explain? The British researchers offered one theory: “A shared functional abnormality of smooth muscle in blood vessels and airways offers a plausible explanation for this link.”
People with asthma or migraines or both conditions might have inherited hypersensitivities, Cady says. Those with asthma may have inherited an over-reactive respiratory system; those with migraine may have inherited an over-reactive nervous system.
There are other similarities. Asthma and migraine share many inflammatory chemicals that are released during an attack, Cady says. “There’s a host of common neurotransmitters that are shared here,” he says, including calcitonin gene-related peptide, histamines and cytokines. “Those are names for inflammatory chemicals that get activated both during asthma and during migraine,” he says.
Migraine or Sinus Headache?
Often, asthma patients believe that their headaches are sinus-related, Cady says, when in fact, the pain actually stems from migraines. “Migraine is many times the great masquerader,” he says. “You get pain around the face and eye and in the temple area. And then you get nasal congestion, kind of a clear, runny nose. It’s very easy to think, well, this is my sinuses acting up.”
But an accurate diagnosis is important because the two types of headaches need differing treatments. Although a sinus headache might require decongestants or antibiotics to treat the underlying sinusitis, migraines require drugs to prevent or stop the headaches.
Asthma patients who get headaches only on occasion may not need special attention, but those with frequent, disruptive headaches should seek expert help, Cady says.
“There’s a whole spectrum of migraine activity,” he says. “You can have people who have migraine twice a year and for them, it’s a nuisance -- probably not even a medical problem. On the other hand, you could have people that are having migraine two or three times a week and for them, it’s the center point of their life.”
Such people may benefit from seeing a neurologist or headache specialist, Cady says. “It’s really comprehensive management that they need.”
Asthma and Migraine: A Word of Caution on Medications
Patients with both asthma and migraine should be aware that drugs for one condition may worsen the other disease. For example, beta agonists to treat asthma symptoms can excite the nervous system and prompt migraine, Cady says. Conversely, beta blockers to prevent migraine can worsen asthma.
“It’s important that each doctor knows that you suffer with those conditions so that they’re sure that they try to balance the medications appropriately,” Ledford says. If medication for one disease worsens the other, “ask if there are alternatives, because many times, there are alternatives,” he says.
What else do asthma and migraine have in common? “There are common principles in the management of both,” Cady says. For example, doing some “detective work” to see what triggers an asthma or migraine attack can help the patient to avoid these things.
Lifestyle management helps, too, Cady says. “Good diet, good health, trying to do exercise, good sleep -- there are cornerstones of management for both of these. The healthier you maintain your lifestyle, the better both of these diseases are going to do.”