Can anemia contribute to migraine headaches?

Anemia's Contribution to Migraine Headaches

Yes, anemia can contribute to migraine headaches, particularly in cases of iron deficiency anemia and certain hemoglobinopathies like sickle cell anemia. 1, 2, 3

Pathophysiological Connections

• Low hemoglobin levels are associated with recurrent headaches and migraines, as documented by the American College of Radiology 1
• Iron accumulation in the brain, especially in the peri-aqueductal grey matter, has been associated with migraine duration, suggesting a relationship between body iron storage status and migraine incidence 2
• Multiple pathophysiological mechanisms link anemia to cerebral ischemia and headaches, including:
  • Reduced erythrocyte deformability
  • Reactive thrombocytosis
  • Anemic hypoxia 4

Specific Anemia Types and Migraine Presentation

Iron Deficiency Anemia (IDA)

• Recent research demonstrates a significant association between iron deficiency anemia and chronic daily headache (p < 0.001) 5
• Severe iron deficiency anemia shows a significant association with headache severity (p = 0.021) 5
• Low ferritin levels correlate with increased Visual Analogue Scale (VAS) and Headache Impact Test-6 (HIT-6) scores, indicating more severe headache symptoms 3
• In women, there is a significant association between iron deficiency anemia and migraine incidence (p = 0.001), though this association was not observed in men 2
• Menstrual migraine specifically shows association with low hemoglobin levels 3

Sickle Cell Anemia

• Patients with sickle cell anemia commonly experience migraines as a comorbidity 1, 6
• Headaches in sickle cell anemia patients require special attention as they are more frequently associated with acute central nervous system events than in the general population 1
• The threshold for neuroimaging should be lower in children with sickle cell anemia who present with headaches due to increased risk of central nervous system complications 1

Clinical Considerations and Pitfalls

• New-onset migraine-like headache in a patient with severe anemia could be a warning sign of impending ischemic stroke 4
• When evaluating patients with migraine, it's important to distinguish from tension-type headaches, which typically present with:
  • Bilateral pain
  • Pressing or tightening (non-pulsatile) character
  • Mild to moderate severity
  • No aggravation by physical activity 7
• Missed meals can trigger headaches, which may compound with anemia-related headaches 7
• Iron supplementation might be an effective treatment or prophylaxis in patients with migraine associated with iron deficiency anemia, though more research is needed 2

Diagnostic Approach

• For patients with recurrent or persistent migraines, consider checking:
  • Complete blood count (CBC)
  • Iron studies (serum iron, ferritin, total iron-binding capacity, and transferrin saturation) 2, 5
• Pay particular attention to female patients with migraines, as they show stronger associations with iron deficiency anemia 2
• In patients with sickle cell anemia presenting with headaches, maintain a lower threshold for neuroimaging 1