Can allergic rhinitis cause migraines?

Relationship Between Allergic Rhinitis and Migraine

Yes, allergic rhinitis can cause migraines in susceptible individuals, with recent research showing that patients with allergic rhinitis have up to a 69% prevalence of migraine headaches compared to approximately 19% in the general population. 1

Pathophysiological Connection

The connection between allergic rhinitis and migraine involves several shared inflammatory pathways:

1. Common Inflammatory Mediators: Both conditions involve the release of inflammatory mediators such as:

   • Histamine
   • Nitric oxide (NO)
   • Calcitonin gene-related peptide (CGRP) 2, 1

2. Neurogenic Inflammation: The inflammatory response triggered by allergens in allergic rhinitis can activate trigeminal nerve pathways that are also involved in migraine pathogenesis 3

Epidemiological Evidence

Recent research provides strong evidence for this connection:

• A 2024 study found that 69.1% of patients with allergic rhinitis experienced migraines 1
• A 2013 study showed that migraine frequency in allergic rhinitis patients was four times higher than in control groups 2
• Severity of allergic rhinitis correlates significantly with both the presence of migraine (p=0.034) and the type of migraine (p=0.004) 1

Risk Factors and Associations

Several factors influence the allergic rhinitis-migraine relationship:

• Age: Stronger association in younger patients (under 45 years) 4
• Sex: Significant association between female sex and migraine in allergic rhinitis patients (p=0.006) 1
• Socioeconomic status: Significant association (p=0.034) 1
• Degree of allergic sensitization: In younger patients, higher degrees of atopy are associated with increased migraine frequency 4

Diagnostic Considerations

It's important to note that misdiagnosis is common:

• Up to 90% of self-diagnosed "sinus headaches" are actually migraines 3
• Many patients with allergic rhinitis and headache fulfill diagnostic criteria for chronic migraine but are treated only for rhinosinusitis 3

Therapeutic Implications

The connection between these conditions has important treatment implications:

• Treating allergic rhinitis may improve migraines: Studies show that allergen-specific sublingual immunotherapy for allergic rhinitis can reduce both interictal serum C-reactive protein levels and migraine symptoms 5
• Immunotherapy effects: In patients under 45 years, immunotherapy for allergic rhinitis is associated with decreased migraine frequency and disability (RRs of 0.48 [95% CI; 0.28,0.83] and 0.55 [95% CI; 0.35,0.87]) 4

Clinical Approach

When evaluating patients with allergic rhinitis and headaches:

1. Screen for migraine: All patients with allergic rhinitis should be screened for migraine symptoms 1
2. Consider comorbidity: Recognize that both conditions may coexist and require separate treatment approaches
3. Evaluate allergic component: In patients with migraines, assess for possible allergic rhinitis, especially when headaches have seasonal patterns

Pitfalls to Avoid

• Misdiagnosis: Don't assume all headaches in allergic rhinitis patients are "sinus headaches"
• Incomplete treatment: Failing to address both conditions can lead to suboptimal outcomes
• Age considerations: The relationship between allergic rhinitis and migraine varies with age, with stronger associations in younger patients 4

The evidence strongly supports that allergic rhinitis can trigger or exacerbate migraines in susceptible individuals through shared inflammatory pathways, and treating the allergic component may provide significant relief from migraine symptoms.