Neurology Today: Food Insecurity and Migraine Are Linked in Young Adults How to Address This Association With Patients
By Olga Rukovets
Young adults who lack reliable access to affordable, nutritious food— considered food insecure—had a significantly higher chance of being diagnosed with migraine, according to a research letter published online in the June 24 edition of JAMA Neurology, though the direction of this risk could not be determined.
Using cross-sectional, national data, the researchers found that “one quarter of food-insecure young adults experienced migraine,” Jason Nagata, MD, MSc, assistant professor at the University of California San Francisco Benioff Children's Hospitals, told Neurology Today.
“Few studies have examined the association between food insecurity and neurologic outcomes. To our knowledge, prior research on food insecurity and migraine is limited to 1 cross-sectional study representative of the Canadian population 12 years or older, which found a positive association,” Dr. Nagata and colleagues wrote. “We confirm this finding in a nationally representative sample of young adults from the United States.”
Food insecurity was identified in 11 percent of the young adults in the study. Migraine was more frequently present in food-insecure young adults—23.9 percent vs 13.6 percent; p<.001—and young adults who were food insecure also had a greater odds ratio (OR) of migraine in both unadjusted (OR, 2.00; 95% CI, 1.68-2.38; p<.001) and adjusted (OR, 1.58; 95% CI, 1.30-1.95; p<.001) models.
Although this study included a large, nationally representative sample, due to its cross-sectional nature, the direction of causality could not be confirmed, Dr. Nagata noted. “Food insecurity can lead to psychological stress and poor diets including missed meals and frequent hunger, which can trigger migraine,” he added.
Jennifer Bickel, MD, FAAN, chief of the headache section and associate professor of pediatrics at Children's Mercy Kansas City/University of Missouri-Kansas City School of Medicine, said: “While association does not equal causation, it makes physiological sense that a poor diet could increase migraine frequency.”
She suggested that adding two questions, adapted from a Pediatrics paper by Hager et al., when taking a patient's history “could prove incredibly helpful in better understanding the needs of the young adult: 1. Within the past 12 months, we worried whether our food would run out before we got money to buy more (Yes or No). 2. Within the past 12 months, the food we bought just didn't last and we didn't have money to get more (Yes or No).” An affirmative response to either one of these statements should encourage follow-up questions.
In her own clinical practice, in those situations where there are concerns, Dr. Bickel added, they are “fortunate enough to have a dedicated headache social worker who can assist in situations of family financial struggles.” Children's Mercy also offers free summer lunches to all kids to help address the food insecurity problems that intensify when school is out of session and kids don't have access to free school lunches.
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