COMMENTARY

How Are Rosacea and Migraines Connected?

A Link to One Type in Particular Has Been Established

Graeme M. Lipper, MD

Disclosures

May 17, 2017

Prevalence and Risk of Migraine in Patients With Rosacea: A Population-Based Cohort Study

Egeberg A, Ashina M, Gaist D, Gislason GH, Thyssen JP
J Am Acad Dermatol. 2017;76:454-458.

Rosacea is an inflammatory skin disease characterized by centrofacial erythema and flushing; telangiectatic mats; papules, pustules, and cysts; and rhinophyma. The National Rosacea Society Expert Committee delineates four subtypes of rosacea—erythematotelangectatic, papulopustular, phymatous, and ocular—although these patterns often overlap in clinical practice.[1] Rosacea affects all ethnicities, but light-skinned people of European descent are most prone, with one Swedish study showing a prevalence of 10%.[2]

Rosacea has a complex pathophysiology and is associated with hyperreactivity of innate cutaneous immunity, triggered by environmental, dietary, hormonal, and lifestyle factors.[3] Recent studies have shed light on autoimmune diseases linked to rosacea; these include type 1 diabetes, celiac disease, rheumatoid arthritis, multiple sclerosis, dementia, and Parkinson disease.[4]

Patients with rosacea often experience flushing and paroxysmal burning of the face and chest—a phenotype termed "neurogenic rosacea."[5] Intriguingly, patients with neurogenic rosacea also may have a higher prevalence of migraines (recurrent headaches and nausea, triggered by light or sound).[6]

To explore this proposed association, Egeberg and colleagues evaluated the prevalence of new-onset migraine in a large cohort of Danish adults aged 18 years or older with rosacea (n = 49,475; 68% female) vs a control reference population (n = 4,312,213; 50.6% female).

Egeberg and colleagues' statistical analysis—which controlled for confounding variables, including socioeconomic status, smoking, and alcohol consumption—showed the following statistically significant associations:

  1. Baseline prevalence of migraine was higher in the rosacea group (12.1%) vs the reference population (7.3%), with an adjusted hazard ratio (HR) of 1.31.

  2. Ocular rosacea showed the strongest correlation with migraine (HR, 1.69). In other words, patients with ocular rosacea were 69% more likely than rosacea-free controls to have migraine headaches.

  3. There was no association between phymatous rosacea and migraine.

  4. Rosacea correlated more strongly with migraine in women and older individuals (aged 50 years or older).

Discussion

A decade ago, rosacea was thought to be an infectious condition of the pilosebaceous units, triggered by either bacterial (Propionibacterium acnes), yeast (Pityrosporum ovale), or mite (Demodex) overgrowth. Over the past 5 years, the focus has shifted to causative roles of a hyperactive innate cutaneous immunity and vasomotor instability.

In this context, Egeberg and colleagues found a higher prevalence of and risk for new-onset migraines in a large cohort of Danish adults with rosacea—especially women, those older than 50 years, and those with ocular rosacea.

This association, though intriguing, does not establish any cause-and-effect relationship. Furthermore, the researchers acknowledge that their Danish study population (predominantly white) cannot be generalized to other ethnicities.

Nevertheless, clinicians should consider screening patients with rosacea for migraine symptoms, and vice versa. Future studies should also explore whether rosacea and migraine triggers overlap, because this may shed light on the pathophysiology of both common conditions.

Abstract

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